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BACKGROUND: New drugs, of which the risks are still unknown, are attractive to various groups of people. The identification of local trends is crucial in order to prevent these trends from diffusing beyond a tipping point and becoming problematic at the macro level as well. Local authorities need to know the risks of new trends in the local situation, and how to respond to them. AIMS: In response to this need, the European Local PASS project was set up. The main aims of the project were to: develop standardised local guidelines for identification, risk assessment, and interventions; share knowledge on, discuss, and review best practice approaches to responding to emerging drugs, and raise social and political awareness of the consumption of new drugs. DESIGN, MEASUREMENTS, AND SAMPLE: Nine international partners from five European countries helped to collect data by means of a literature review, key informant interviews (five or six informants from each country), focus groups (one representative per partner), and an online survey (470 respondents from the five countries together). RESULTS: Some of the main findings are that it is crucial to know the target group of a newly emerging drug, the information provided on this drug needs to be tailored to the target group, and good communication and collaboration between all stakeholders is essential. CONCLUSIONS: All the findings have been processed into the Local PASS Toolkit, which is a set of guidelines, flowcharts, and tools that can be used for the early identification of, and an early response to, newly emerging trends in drug use and abuse in local settings. Its explicit goals are to inform local drug policy making, to contribute to a transparent decision-making process, and to provide relevant and evidence-based input into the implementation or design of appropriate responses to emerging drug trends. [ABSTRACT FROM AUTHOR]

BACKGROUND: After the closure of smart shops (also referred to as "Amsterdam shops") in the Czech Republic in 2011, new synthetic drugs (NSDs) spread within specific groups of drug users in the country, problem drug users (PDUs) being one of them. AIMS: The aim of this analysis is to assess: (a) the prevalence of NSD use among PDUs in regions where these substances are present; (b) the characteristics of the population affected by NSD use and the motivations for this use; (c) the differences between the capital city and other regions, and (d) the main risks related to NSD use. This article also discusses the possibilities of harm reduction within this population. METHODS: Structured questionnaires and semi-structured interviews in five regions affected by NSD use were deployed. This study demonstrates differences between the years 2013 and 2014 using the chi2 test and qualitative data analysis. SAMPLE: 466 respondents filled in the questionnaire (72.2% male, Ø age 32.9 years), 271 in 2013 and 195 in 2014; 71% in Prague. 87 semi-structured interviews were conducted (64 in 2013 and 23 in 2014). FINDINGS: About half of the respondents had used NSDs in the past 12 months (52.4% in 2013 and 52.0% in 2014). In both years, over half of the respondents in Prague used NSDs; outside Prague the prevalence of NSD use decreased to 23.7% in 2014. Those who had used NSDs in the past 12 months showed higher levels of risky drug use. CONCLUSIONS: NSDs became well established among the group of PDUs, usually as one of many substances used. Information exchange between PDUs and the EWS should be a priority for public health-oriented policies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Given the lack of information about new psychoactive substances (NPS), their effects and risks, analysis of online discussion forums is a useful method to obtain this data. AIMS: Monitoring of Czech online discussions about NPS aimed to describe and categorise their content and identify trends in the use and purchase of NPS. DESIGN AND MEASUREMENTS: The content of two Czech discussion forums for users of NPS with 1916 posts was analysed quantitatively and qualitatively. The forums were monitored on a monthly basis from January 2013 to December 2014. RESULTS: The forums contain a wide range of knowledge about NPS and their purchase which is based on users' own experience, supplemented by information from other sources. A substantial decrease in the number of discussants (-20%) and posts (-49%) was observed in 2014. In that year, the share of the posts dedicated to so-called "commercial products/ collectors' items" decreased (from 20% to 0.3% of all the posts), while the share of posts discussing so-called "research chemicals" increased (from 36% to 45%). Qualitative analysis suggests that this may be due to a reduced supply of commercial products on the market and the discouraging properties of such products, such as their unknown and changing content and unpredictable effects. As indicated by the posts, the most popular Czech web-based shops wound up their activities in 2013. Consequently, the members of the forums started to purchase more frequently from foreign online shops that they had previously avoided. To some extent, the outcomes of the analysis correspond with the relevant information on NPS use available from other sources. CONCLUSIONS: Discussion forums play a crucial role as a source of information about NPS and are a self-help tool for reducing the potential risks for their users. When made part of a comprehensive monitoring approach, analysis of forum's content can yield information for a wide array of experts. [ABSTRACT FROM AUTHOR]

Copyright of Addictology / Adiktologie is the property of Sdruzeni SCAN as a publisher of journal Adiktologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Addictology / Adiktologie is the property of Sdruzeni SCAN as a publisher of journal Adiktologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Addictology / Adiktologie is the property of Sdruzeni SCAN as a publisher of journal Adiktologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: In the Czech Republic, the cannabis market has developed in three stages: (i) outdoor cultivation, non-market, and free of charge distribution (1980-1994); (ii) market in imported indoor cannabis (1995-2005), and (iii) large-scale and small-scale indoor cannabis cultivation leading to a price decrease (2005-present). AIMS: The aim of the paper is to analyse the risks cannabis users face in terms of using indoor and outdoor cannabis products acquired on the market in contrast to buying from a grower, and in terms of self-supplying with cannabis. DESIGN: Marijuana market patterns in the Czech Republic were analysed via a mixed-methods study among marijuana users, retailers, and growers (61 semistructured interviews with interviewees recruited via respondent-driven sampling and two focus groups). The interviews took 69 minutes on average, and investigated concepts from economic theory of illicit drug market. The qualitative analysis was complemented with quantitative research findings (a representative population survey with a specific set of questions on marijuana acquisitions for the users of cannabis in the last 12 months). FINDINGS: The cannabis users identified the risks of outdoor product to be its excessive consumption; indoor products involve the risk of combination with tobacco and the use of adulterants. The risks related to market acquisitions were that no information on the strain and quality is known, and the profits of the distributors are large, but when purchasing from the grower, there is no variability. When growing outdoors, there are risks of theft, while indoor growing has high fixed costs and risks of prosecution. CONCLUSIONS: The cannabis market has reduced the risks to users in the past decade; the cannabis policy in the Czech Republic still only acknowledges the self-supply of cannabis. Acquisitions through other chains with low risks should be privileged. [ABSTRACT FROM AUTHOR]

BACKGROUND: Global cannabis markets have recently been changed by domestic cannabis cultivation. The Czech Republic has a rather high prevalence of cannabis use, and cannabis cultivation and possession have not been targeted by law enforcement bodies. AIMS: The aim of the paper is to describe the development of domestic cannabis market in the Czech Republic. DESIGN: A mixed-methods study among marijuana users, retailers, and growers recruited via respondent-driven sampling was conducted (61 semi-structured interviews, 69 minutes on average; findings from a representative population survey). FINDINGS: In the Czech Republic, domestic outdoor marijuana growing was the only source of the drug when it was part of the Soviet bloc (until 1989), and it was provided for free among the users (until the early 1990s). Commercially grown indoor marijuana, imported from western countries, appeared on the open drug market in the late 1990s. Since 2000, domestic indoor growing has spread. Since around 2005, large-scale indoor growing operations have been conducted by organised Vietnameese groups, mostly for export. Both the individual and the large-scale indoor growing have had a significant impact on the cannabis market in the Czech Republic, reducing cannabis prices. However, many users still adhere to outdoor cannabis production. CONCLUSIONS: The Czech Republic has experienced an increase in self-supply and large-scale indoor cannabis growing, as have other countries. In the Czech Republic, additionally, there is a tradition of outdoor cannabis cultivation and outside-the-market supply. It is likely that a more lenient policy approach contributes to the relatively strong role of small-scale growers, in contrast to organised criminal groups, and that it contributes to lower profits being made on the illicit cannabis market. [ABSTRACT FROM AUTHOR]

VÝCHODISKA: V posledních letech můžeme být svědky nárůstu výskytu nových psychoaktivních substancí (NPS) neboli také takzvaných „legal highs" a rozšíření jejich užívání v běžné populaci. Užívání takovýchto látek představuje hrozbu jak pro individuální zdraví jedince, tak veřejné zdraví populace. Práce si stanovila za hlavní cíle analyzovat, (i) jak uživatelé NSD vnímají rizika spojená s jejich užíváním a (ii) jaké strategie používají uživatelé NSD, aby předešli rizikům, která mohou být spojena s užíváním těchto látek. DATA A METODA: V rámci výzkumu byla využita kvalitativní obsahová analýza internetových diskusních fór sdružujících uživatele NPS (16 internetových diskusních fór s celkovým počtem 832 příspěvků) a kvalitativní analýza polostrukturovaných rozhovorů s 9 uživateli NSD; při analýze byla využita metoda zakotvené teorie. VÝSLEDKY: Pokud jde o vnímání rizikovosti, existuje skupina uživatelů, kteří rizikovost těchto látek vnímají jako malou, což souvisí i s tím, že „legálnost" látek považují za signál ohledně jejich nízké účinnosti. Vnímání rizikovosti se v průběhu užívání NPS mění a uživatelé se vůči dříve podceňovaným NPS chovají obezřetněji na základě vlastních zkušeností, nebo zkušeností ze svého okolí a z diskusních fór. Uživatelé NPS využívali jako nástroje snižování rizik NPS užívání menšího množství látky (obzvláště při prvním užití), volbou vhodného settingu a snahou nekom-binovat NPS s jinými psychoaktivními látkami a navzájem. Jako důležitou pro minimalizaci výskytu případných poškození vnímají uživatelé zjištění si potřebných informací o užívané látce. ZÁVĚRY: Oficiální zdroje informací nepovažují uživatelé NPS za důvěryhodné, informace podávané samotnými prodejci konkrétních látek, kteří se tak chrání před případným právním postihem, považují za nedostatečné. Nejvíce využívaným a relevantním zdrojem jsou tak internetová fóra sdružující uživatele NPS a zkušenosti přátel a známých. Tyto komunikační kanály by měly být podporovány a užívány v programech snižování rizik. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent years have witnessed an increase in the incidence of new psychoactive substances (NPSs), also referred to as "legal highs", on the market and a spread of their use in the general population. The use of such substances poses a threat to the health of individuals and the public. This paper presents the results of research, the main objective of which was to analyse (i) how users of NPSs perceive the risks associated with their use and (ii) what strategies are applied by NPS users to avoid the risks that may be associated with the use of these substances. DATA AND METHODS: The research was a qualitative content analysis of online discussion fora associating NPS users (16 fora with a total of 832 posts) and qualitative analysis of interviews with 9 NPS users; the method of grounded theory was used to make the analysis. RESULTS: Regarding the perception of risk, there is a group of users who perceive the risk of these substances as low, as a result of their "legal" status, which they take as a signal of their mild effects. The perception of risk changes in the course of using NPSs and users who previously underestimated NPSs start to behave more cautiously given their own experience or the experience of people around them and the contributors to the fora. The strategies to reduce NPS-related risk were as follows: using the NPS in small amounts (especially on the first occasion of their use), selecting an appropriate setting, and trying not to combine NPSs with other psychoactive substances and other NPSs. Having enough relevant information about a substance before using it is viewed by the users as an important risk minimisation tool. CONCLUSIONS: The official sources of information were not considered reliable by the NPS users. The information provided by the sellers of particular substances was considered insufficient. The information sources of the greatest relevance and those which were utilised the most were online discussion fora associating NPS users and the experiences of friends and acquaintances. These communication channels should be encouraged and actively used in risk reduction programmes. [ABSTRACT FROM AUTHOR]

Background and Objectives: In Lithuania, injecting heroin and other illicit opioids has dominated high-risk drug use since about 2000. More recently, patients have reported a high-risk use of amphetamines. Newly diagnosed HIV cases among people who inject drugs peaked in 2002 and 2009 and drug-related deaths have been on the increase. Yet research has reported a limited number of available harm-reduction programs. This study aimed to estimate the size of high-risk drug using populations in Lithuania and to apply these estimates in assessing the coverage of opioid substitution treatment (OST) and needle and syringe programs (NSP)., Methods: We used indirect prevalence estimation methods (HIV and Mortality Multiplier, Capture-Recapture, Truncated Poisson and the Multivariate Indicator Method) to obtain annual prevalence estimates of the population of high-risk opioid users (HROU) and of people who inject drugs (PWID) in Lithuania in 2015/2016. We computed the coverage of OST (the annual percentage of HROU in these programs) and NSP (the number of provided syringes per PWID per year), using the prevalence estimates and the data from drug services., Results: There were between 4854 and 12,444 HROU and between 8371 and 10,474 PWID in Lithuania in 2015/2016. In addition, we obtained a preliminary estimate of 4742-7000 high-risk amphetamine users. This constitutes around 2.5-6.5 HROU and 4.4-5.3 PWID per 1000 inhabitants aged 15-64. On average, 9.9-25.5% of HROUs were in OST and an average PWID in Lithuania obtained 19-29 syringes via NSPs during the study period., Conclusions: While the current prevalence of high-risk drug use in Lithuania is comparable to other European countries and for PWID, it is above the average; and the coverage of OST and NSP services in this population is markedly lower than in most countries of the European Union and warrants further investment., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and Aims: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality., Methods and Results: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries., Conclusions: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

Recently, there is a global growing concern over the new (mainly synthetic) psychoactive substances, known as legal highs, research chemicals or bath salts. They are represented by various chemical groups imitating "old" illicit drugs with stimulant, euphoric, hallucinogenic or sedative effects. In the Czech Republic, the peak of their use and supply was observed at the beginning of 2011, when new psychoactive substances were available in smart shops known locally as Amsterdam shops - in that time mainly synthetic cathinones and also synthetic cannabinoids were present. After legislative change that placed tens of new substances under the control of criminal law in April 2011, new psychoactive substances are available at Internet and their use is (after short and media driven boom in early 2011) rather limited and decreasing. Though, the use of new synthetic stimulants was recently reported locally among problem (injecting) drug users; new very potent synthetic opioids represent potential threat of further expansion in this users subgroup.