1. Changing patterns of new and emerging psychoactive substances in Australia
Rachel Sutherland, Monica Barratt, Lucinda Burns and Raimondo Bruno
The Drug Trends program is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund

2. 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.

3. Number of new NPS reported each year
Source: EMCDDA, EMCDDA - Europol 2016 Annual Report on the implementation of Council Decision 20054/387/JHA.
628 NPS 2016

4. 15 January 2015
17 August 2016
23 August 2016
Growth has generated considerable concern amongst policy makers and generated significant media interest

5. NPS use in Australian general population
National Drug Strategy Household Survey
Conducted every 3 years; 2013 survey first to include data on NPS
Is Australia really being ‘flooded’ by NPS?
-1.2% (230,000); 0.4% (80,000)
However, NDSHS doesn’t allow us delve into greater detail regarding which NPS people are using etc

6. Most people who use NPS also use illicit drugs, hence Drug Trends good tool for monitoring NPS in more detail
Source: 2013 National Drug Strategy Household Survey

7. Monitoring NPS through Drug Trends
IDRS (1999)
Illicit Drug Reporting System
1. Interviews with people who inject drugs
2. Interviews with Key experts
3. Indicator data
NIDIP (2002)
National Illicit Drugs Indicator Project
Analysis data from other sources eg.
* Overdose
* Seizures
* Treatment
EDRS (2003)
Ecstasy and Related Drugs Reporting System
1. Interview with regular psychostimulant users
2. Interviews with key experts
DNeT (2012)
Drugs and New Technologies
Investigates:
* Drug marketplaces online; and
* New technologies
Drug Trends is an Australian Health Department funded project based at NDARC which has 4 components. (1) the IDRS which surveys people who inject drugs, key experts and indicator data; (2) the EDRS which interviews regular psychostimulant users, KE and indicator data; (3) the NIDIP which analysis data from other sources and lastly (4) DNeT which monitors drug market places online.
EDRS emerged from recognition that there was a gap in knowledge of other drug use – ecstasy GHB etc

8. Which NPS are being monitored? (EDRS)
PHENETHYLAMINES
(2C-x, Benzo Fury, PMMA, DOI, NBOMe, 4-FA)
PIPERAZINES
(BZP)
TRYPTAMINES
(DMT, 5-Meo-DMT, 4-AcO-DMT)
PLANTS & EXTRACTS
(LSA, Mescaline, Salvia Divinorum, Datura, Ayahuasca)
SYNTHETIC CATHINONES
(Mephedrone, Methylone, 4-MEC, Alpha-PVP, MDPV, Other substituted cathinone)
AMINOINDANES
(MDAI, 5-IAI)
SYNTHETIC CANNABINOIDS
(K2/Spice, Kronic, Other)
ARYLCYCLOHEXYLAMINES
(Methoxetamine)
United Nations Office on Drugs and Crime, 2013, The Challenge of New Psychoactive Substances
Not feasible to ask participants about their use of 600-odd substances, so limited to some of most common NPS with ‘other’ open-text option to capture the less known, upcoming NPS>
From 2010 onwards have asked participants about their use of ~30 individual NPS, which can be categorised into 8 NPS classes.
Todays presentation will focus on those in the left hand column.
Phenethylamines: psychoactive and stimulants effects
Tryptamines: hallucinogenic
Synthetic cathinones: similar to phenethylamines, but lower potency.
Synthetic cannabinoids: functionally similar to THC
If interested, refer to UNODC document for more details on these NPS classes.

9. Past six month use of ‘any’ NPS, 2010-2017 (n=5,703)** ** * *
Note: based on full sample: 2010: n=693; 2011: n=574; 2012: n=574; 2013: n=685; 2014: n= n=796
**p<0.01; *p<0.05

10. NPS Classes: What’s increasing?
***
*** **
In 2017, phenethylamines and tryptamines two most commonly used NPS classes.
Although overall increase, phenethylamines has remained stable/declined in past few years.
***p<0.001; **p<0.01

11. NPS Classes: What’s decreasing?
***
***
***
In 2017, phenethylamines and tryptamines two most commonly used NPS classes.
Although overall increase, phenethylamines has remained stable/declined in past few years.
***p<0.001

12. NPS Classes: Other patterns
Synthetic opioids, 2017 (n=3)
In 2012, sig increase in synthetic cannabinoids to 17%. Sig decrease in 2014, back down to 7%.
Aminoindanes and MXE uncommon.
Frequency of all NPS remains pretty low.
Legislative changes TGA blanket ban on synthetic cannabinoid

13. What might be driving these changes?
Legislative changes
Consumer preference
Matthews et al., I like the old stuff better than the new stuff? Subjective experiences of new psychoactive substances. International Journal of Drug Policy, 40, 44-49
Sutherland et al., Motivations for new psychoactive substance use among regular psychostimulant users in Australia, International Journal of Drug Policy, 43, 23-32
Cairns et al., The impact of Australian legislative changes on synthetic cannabinoid exposures reported to the NSW Poisons Information Centre, International Journal of Drug Policy, 43, 74-82

14. Degree of overlap between use of classes (2010-2017)
Note: Does not include synthetic cannabinoids.
Repeat participants excluded
Note: only first time participants included; n=3593
It’s actually not as substantial as you might think!
Most people use NPS that have similar properties to other illicit substances they are using (e.g. weekly ecstasy users more like to report use of phenethylamine NPS, LSD consumers more likely to report tryptamine type NPS etc.
Those using a single NPS class didn’t differ much from other illicit drug consumers in terms of risk behaviours. Rather ‘poly-NPS consumers’ are the ones most likely to engage in risk behaviours and they should be the target of any harm reduction campaigns.

15. How else do we monitor the NPS market in Australia?
DNeT. Analysis of darknet marketplaces to monitor trends over time
Weekly snapshots of the marketplaces, capturing: all drug listings, retailer names, country of origin

16. What’s being sold online? (July-Dec 2016)
Cannabis use and pharmaceutical drugs main drug sold – this remained relatively consistent over time.
However, NPS make up substantial minority of drug listings
Roxburgh, A., Van Buskirk, J., Burns, L., and Bruno, R. (2017). Drugs and the Internet, Issue 8, May Sydney: National Drug and Alcohol Research Centre.

17. Number of vendors selling NPS (July-Dec 2016)
Substance
Alphabay
Dream Market
Hansa
Valhalla n %^
2C-x 89 2
107 4 26 3 11
U-47700 48 41 10 7
DMT 64 1 61 18 12
MDA 27 21
Mephedrone 44
α-PVP 24 9
NBOMe 53 39 8 6
FuranylFentanyl 40 32 5
Synthetic Cannabinoids 42 38
DOx 33
Total
517 13
450 15
111 19
2C-family, DMT and NBOMe most commonly sold NPS which is consistent with main NPS used among EDRS sample.
For the first time, two novel/synthetic opioids made it into top ten NPS being sold on these marketplaces – U and FuranylFentanyl. These have been associated with a number of overdoses (both fatal and non-fatal) in US so their increasing availability is of concern. Although important to note that hardly anyone has reported using these in IDRS/EDRS.
Roxburgh, A., Van Buskirk, J., Burns, L., and Bruno, R. (2017). Drugs and the Internet, Issue 8, May Sydney: National Drug and Alcohol Research Centre.

18. Summary NPS use low among general population
Rates of use elevated among people who use illicit drugs
Remains a highly dynamic marketplace, highlighting the importance of drug monitoring systems
Appear to seek out NPS that have similar properties to the ‘traditional’ illicit drugs they are already using
Riskier patterns associated with poly NPS use
Synthetic opioids starting to appear on crypto markets, although use remains low among sentinel samples
-Dynamic nature of NPS classes highlights importance of continuing to monitor these marketplaces.
-Few risk factors associated with specific NPS classes.
-Poly NPS users, however, a riskier group of users. Bingeing, overdose, high levels of poly drug use all carry serious public health implications. Particularly concerning given increasing number of NPS being identified, the limited knowledge of the short and long-term effects of these drugs and a lack of information on how they interact with other illicit drugs.

19. Rates of unintentional consumption unknown
Other data sources suggest that rates of unintentional NPS use may be much higher:
Existing drug monitoring systems need to be complemented with other data sources (e.g. wastewater analysis, seizure data, biological testing – Salomone et al., 2017)
First pill-testing trial to occur in Australia, 25 November 2017
Mass of seized mephedrone, methylone & MDMA in this region(g)
2010
2011
2012
2013
2014
Methylone 97 9
426
100 86
Mephedrone
2007 1 4
MDMA
363
617
2315
1904
2921
Source: Thai et al., Monitoring temporal changes in use of two cathinones in a large urban catchment in Queensland, Australia
-Dynamic nature of NPS classes highlights importance of continuing to monitor these marketplaces.
-Few risk factors associated with specific NPS classes.
-Poly NPS users, however, a riskier group of users. Bingeing, overdose, high levels of poly drug use all carry serious public health implications. Particularly concerning given increasing number of NPS being identified, the limited knowledge of the short and long-term effects of these drugs and a lack of information on how they interact with other illicit drugs.
Salomone, A., Palamar, J. J., Gerace, E., Di Corcia, D., & Vincenti, M. (2017). Hair Testing for Drugs of Abuse and New Psychoactive Substances in a High-Risk Population. J Anal Toxicol, 41(5), doi: /jat/bkx020

20. Acknowledgements 2017 Drug Trends Team
National Drug and Alcohol Research Centre, University of New South Wales
(National, NSW, ACT, SA and the NT)
Dr Courtney Breen, A/Professor Lucinda Burns, Ms Kerryn Butler, Ms Antonia Karlsson, Ms Courtney O’Donnell,
Ms Amanda Roxburgh, Ms Jennifer Stafford, Ms Rachel Sutherland, Ms Julia Uporova, Mr Joe van Buskirk, and Professor Alison Ritter
Burnet Institute for Medical Research and Public Health (VIC)
Ms Amy Kirwan, Mr Arthur Truong, Dr Campbell Aitken and Professor Paul Dietze
School of Medicine, University of Tasmania (TAS)
Ms Bethany Lusk, Dr Amy Peacock, Dr Allison Matthews and A/Professor Raimondo Bruno
National Drug Research Institute (WA)
Mr James Fetherston, Ms Marina Nelson and Professor Simon Lenton
School of Public Health, The University of Queensland (QLD)
Dr Caroline Salom and Professor Rosa Alati
Northern Territory Department of Health (NT)
Mr Chris Moon, Ms Tania Davidson and Mr Warrant Que Noy
National project coordinated by NDARC. Collaboration with researchers across the country.