Use and availability of new and emerging psychoactive substances in Australia: Findings from Drug Trends 2018 Rachel Sutherland NDARC Symposium, 8th October 2018 National Drug and Alcohol Research Centre, UNSW, Sydney

What are new and emerging psychoactive substances? Designer drugs, research chemicals, synthetic drugs, analogues, legal highs. Substances not controlled by international legislation, but which may pose a public health threat. Psychoactive drugs that are relatively new to recreational markets.

Number of new NPS reported each year in Europe, 2005-2017 Currently monitors over 670 NPS Growth has generated considerable concern amongst policy makers and generated significant media interest Source: European Monitoring Centre for Drugs and Drug Addiction (2018)

Number of NPS reported by country, December 2017 Source: United Nations Office on Drugs and Crime

Number of weight of analysed seizures that contain NPS, 2007/08-2016/17# (Australia) NPS seizures by type, 2016-17 There were 968 detections of NPS at the Australian border this reporting period. The number of NPS seizures at the Australian border selected for further analysis. Cathinone-type substances account for the greatest proportion of the number of seizures within this subset, amphetamine-type substances continue to account for the greatest proportion of the weight of analysed seizures. Consistent with previous years Source: ACIC, Illicit Drug Data Report 2016-17

NPS use in Australian general population National Drug Strategy Household Survey Conducted every 3 years; 2013 survey first to include data on NPS Lifetime NDSHS doesn’t provide details regarding which NPS people are using Most people who use NPS also use other illicit drugs Hence Drug Trends (EDRS/IDRS) is a good tool for monitoring NPS in more detail *p<0.05

Typology of illicit drug consumers in Australia Six types of Australian illicit drug consumers: Cannabis consumers (46%) Pharmaceutical consumers (21%) Ecstasy and cocaine consumers (19%) Amphetamine and cannabis consumers (7%) Polysubstance consumers (6%) Inhalant consumers (2%)

Which types of consumers use NPS? Six types of Australian illicit drug consumers: Cannabis consumers (46%) Pharmaceutical consumers (21%) Ecstasy and cocaine consumers (19%) Amphetamine and cannabis consumers (7%) Polysubstance consumers (6%) Inhalant consumers (2%)

Which types of consumers use NPS?

Self-reported NPS use

Past six month use of ‘any’ NPS, 2010-2018 IDRS/EDRS Interviews Annual interviews with people who inject drugs (IDRS) and who use stimulants (EDRS) Approximately 100 participants recruited from every capital city of Australia (per project) Maybe on the slide or in the text you can emphasise that we have one of the most comprehensive assessments of specific NPS in monitoring work, asking them about a range and constantly updating the list based on info from data source and people in Aus and internationally Note: EDRS – people who use psychostimulants; IDRS – people who inject drugs

Past six month use of DMT#, 2010-2018 Powerful, visual psychedelic which produces short-acting effects when smoked. Median frequency (2018): 2 days DMT is a powerful hallucinogen found in the seeds, bark, leaves or stem of various plants around the world, including some acacia species native to Australia. It is consumed by many individuals as ayahuasca which is mainly used for spiritual purposes. Alternatively, it can be synthesised into a crystalline form which is typically vaporised or smoked. #among EDRS participants

Past six month use of hallucinogen NPS#, 2010-2018 2C-x: psychedelic phenethylamines NBOMe: derivatives of 2C-x family, but more potent. First appeared 2010 Median frequency (2018) 2C-B: 2 days NBOMe: 2 days #among EDRS participants

Past six month use of stimulant NPS#, 2010-2018 Median frequency (2018) Mephedrone: 3 days Methylone: 2.5 days In 2010, mephedrone was banned in both the UK and Australia. #among EDRS participants

Past six month use of synthetic cannabis, 2011-2018 In 2011, Western Australia was the first government to ban individual synthetic cannabinoids. Most Australian jurisdictions followed suit shortly thereafter, and in July 2011 it became a federal offence to possess eight specific cannabinoid agonists. In 2012, the Therapeutic Goods Administration introduced a blanket ban on any type of synthetic cannabinoid that produces the same pharmacological effect as cannabis. Note: EDRS – people who use psychostimulants; IDRS – people who inject drugs

Online purchasing

Online drug purchasing#, 2014-2018 Among those who purchased substances online in the past year (2018), 100% purchased from dark web marketplaces and 12% from surface web marketplaces #among EDRS participants ##among those who had purchased substances online in the past year

Obtained drugs from third party who purchased them from dark net marketplaces# Among those who purchased substances online in the past year (2018), 100% purchased from dark web marketplaces and 12% from surface web marketplaces Additional 71% reported that they had obtained drugs through a third party who had purchased drugs online. #among EDRS participants

Substances purchased online in past year#, 2014-2018 ‘Traditional’ illicit drugs (e.g. ecstasy, cannabis, LSD) remain the main drugs purchased online In 2018, one-quarter of those who had purchased substances online in the past year reported purchasing NPS #among EDRS participants who had purchased substances online in the past year

NPS purchased online in past year# 2018 Not surprisingly, this corresponds with the most commonly used NPS amongst EDRS participants #among EDRS participants who had purchased substances online in the past year

How else do we monitor the NPS market in Australia?

Online availability of NPS (≠ use) Secure and encrypted online marketplaces Facilitate the sale and discussion of illicit substances Exist on the ‘dark net’ Must know the exact address to access market Sometimes require referral

What’s being sold online? Week ending 31st August 2017 Dream Market (n=45288) Trade Route (n=10268) Zion (n=2139) Tochka (n=1213) CGMC (n=350) Berlusconi (n=226) Week ending 30th August 2018 Dream Market (n=61652) Olympus (n=7224) Wall Street (n=5298) Berlusconi (n=4791) Tochka (n=1923) Rapture (n=728) CGMC (n=391) Cannazon (n=129) Might be worth you mentioning if you can sneak it in that we hoping to make darknet data accessible as online viz updated monthly in the coming months

Phenibut NZ 28 February 2018

Number of n-ethylpentylone listings (bk-EBDP), 2017-2018 Week ending 31st August 2017 Dream Market (n=45288) Week ending 30th August 2018 Dream Market (n=61652) Note. Dashed line = values interpolated.

Number of n-ethylpentylone listings shipping to Australia (bk-EBDP), 2017-2018 N=0 (EDRS/IDRS) Note. Dashed line = values interpolated.

Phenibut listings (07-09-2017 to 06-09-2018)   84 total listings , duplicates removed Dream Market – 64 listings Zion – 14 listings Olympus – 6 listings 70 listings contain shipping information All ship to AU 43 listings ship from US (61.43%) 27 listings ship from AU (38.57%) n=5 phenibut (2018 EDRS) Seven teenagers Very few listings on dark web marketplaces. Likely due to it being easily accessible on the surface web (e.g. eBay) Highlights importance of monitoring the surface web as well Phenibut, sold under the brand names Anvifen, Fenibut, and Noofen among others, is a central nervous system depressant with anxiolytic and sedative effects which is used in the treatment of anxiety, insomnia, and for a variety of other indications

Summary NPS use low among general Australian population However, rates of use are elevated (but stable) among people who use illicit drugs (31% EDRS; 11% IDRS) DMT and 2C-x remain the most commonly used NPS amongst the EDRS sample, whilst synthetic cannabinoids are the most commonly used NPS amongst the IDRS sample Online purchasing has increased over time (14% in 2014 vs 20% in 2018), with DMT the most common NPS purchased online Note: EDRS – people who use psychostimulants; IDRS – people who inject drugs

Future research Rates of unintentional NPS use unknown Existing drug monitoring systems need to be complemented with other data sources (e.g. wastewater analysis, seizure data, biological testing) Surface web monitoring Would be good to make this broader and talk about implications/future directions - concerns around new methods of transport (i.e., impregnating paper with NPS) and new methods of use (e.g., vaping, intranasal sprays for opioids - forensic science SA are about to published on a fentanyl analogue death in SA from vaping), role of internet and technology (e.g., surface net, encrypted mobile phone applications), and Phenibut being a good example of where it is freely available on surface net rather than darknet. Importance of improving monitoring - objective information really important, particularly with greater infiltration of NPS into traditional market where sold as counterfeit or mixed in with traditional - so unwitting consumption problematic. Reinforces your point around triangulating various data sources. Issue with NPS is they often only come to attention once they've caused harm and then people start testing for them - how to be more proactive in detecting and responding?

Acknowledgements Funding: Australian Government Department of Health: for funding provided under the Drug and Alcohol Program Drug Trends Team: National Drug and Alcohol Research Centre: Amy Peacock, Daisy Gibbs, Antonia Karlsson, Anant Mathur, Rachel Sutherland, Julia Uporova, Amanda Roxburgh, Timothy Dobbins, Louisa Degenhardt, and Michael Farrell Burnet Institute: Amy Kirwan, Arthur Truong, Campbell Aitken and Paul Dietze School of Medicine, University of Tasmania: Ellie Bucher and Raimondo Bruno National Drug Research Institute (WA): James Fetherston, Jodie Griggs and Simon Lenton School of Public Health, The University of Queensland (QLD): Caroline Salom and Rosa Alati Northern Territory Department of Health (NT): Chris Moon Other Acknowledgements: IDRS and EDRS participants: for the time they give to complete the interview Data custodians: for the timely provision of data and input on analysis and interpretation Stakeholders: for engagement with and input on Drug Trends