New psychoactive substances in Belgium 2005-2011 documents/Reports... · Table 12. Overview of...

Scientific Institute of Public Health Substance Use and Related Disorders research program Belgian Monitoring Centre for Drugs and Drug Addiction Juliette Wytsmanstreet 14 1050 Brussels | Belgium

New psychoactive substances in Belgium (2005-2011)

An analysis of the registration data of the Belgian Early Warning System for Drugs

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Public Health and Surveillance | February 2012 | Brussels, Belgium Rue J. Wytsmanstraat 14 | 1010 Brussels Internal reference No.: PHS-Report 2012-19 Deposit No. or ISSN: D/2012/2505/40 Trudy Van der Linden Scientific Researcher Jerome Antoine Scientific Researcher Peter Blanckaert Belgian Early Warning System on Drugs, Coordinator Johan C.H. van Bussel* Belgian Monitoring Centre for Drugs and Drug Addiction, Coordinator

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Please refer to: Van der Linden G, Antoine J, Blanckaert P, van Bussel JCH (2012) New psychoactive substances in Belgium (2005-2011): An analysis of the registration data of the Belgian Early Warning System for Drugs, Brussels: WIV-ISP, available at: http://bewsd.wiv-isp.be/ (update: 07/08/2012 11:23:00).

About the BMCDDA’s mission In its role as the primary information hub between Belgium and the EMCDDA, it is the

BMCDDA’s mission to support the development, implementation and assessment of an

integrated and evidence-based drugs policy by providing national and international

policymakers and professionals with the analyses and interpretation they need of factual,

objective, reliable and comparable information on drugs and drug addiction (read the full

mission statement of the BMCDDA here: http://bmcdda.wiv-isp.be).

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Summary This report describes the appearance of new psychoactive substances (substances not

included on the 1971 United Nations list of psychotropic substances) in Belgium for the time

period 2005-2011, and is based on the database of the Belgian Early Warning System on

Drugs (BEWSD) and the new substances database from the European Monitoring Centre for

Drugs and Drug Addiction (EDND, EMCDDA).

The appearance of new psychoactive substances in Belgium and the EU member states is

described. From January 1st, 2005 until December, 31st 2011, the BEWSD reported the

presence of 42 new psychoactive substances to the EMCDDA and Europol. Most reported

compounds were synthetic cathinones, synthetic cannabinoids, phenethylamines,

piperazines and Indolalkylamines.

Also, an analysis of the speed of the reporting of the BEWSD, compared to the other EU

member states, was performed. This analysis demonstrated that Belgium, compared to the

other EU member states, reports a relatively large number of new psychoactive compounds.

The time interval between the first notification of a new substance by a member state to the

EMCDDA, and the first notification by Belgium, is also decreasing year after year.

To conclude, some recommendations are made to improve the performance of the BEWSD

in the future.

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Acknowledgements

The authors of this report wish to thank the following partners:

The regional partners of BEWSD: Vereniging voor Alcohol- en Andere

Drugproblemen (VAD), Observatoire Socio-Epidémiologique alcool-drogues en Communauté

Française (Eurotox), Overlegplatform Geestelijke Gezondheidszorg Gebied Brussel-

Hoofdstad (PFCSM-OPGG), Sozial-Psychologisches Zentrum VoG (SPZ).

the clinical and toxicological laboratories that reported to BEWSD: Centre Hospitalier

Universitaire de Liège (prof. C. Charlier), Hôpital Saint-Joseph Liège (mr. A. Renaux),

Chemiphar NV Brugge (dr. J. Cordonnier), UZ Gasthuisberg (dr. K. Desmet), Universiteit

Gent (prof. W. Lambert), UZ Brussel (dr. V. Maes), UZ Antwerpen (pharm. M. Martin), AZ

Groeninge Kortrijk (dr. F. Martens), ZNA Antwerpen (prof. H. Neels), Universiteit Antwerpen

(dr. K. Maudens), Katholieke Universiteit Leuven (prof. J. Tytgat), National Institute for

Criminalistics and Criminology (mr. F. Van Durme), UZ Gent (prof. A. Verstraete),

ddepartment of Medicines (Scientific Institute of Public Health, dr. J. De Beer), Hôpital CHR

Citadelle Liège (mr. T. Gougnard), Centre Hospitalier Universitaire Ambroise Paré Mons (dr.

M. Brasseur).

the EWS colleagues of EMCDDA: Ana Gallegos, Anabela Almeida, Roumen Sedefov

(Supply Reduction and New Trends Unit, European Monitoring Centre for Drugs and Drug

Addiction, Lissabon, Portugal).

the members of the ad hoc working group Legal Highs:

Andries Jean-Baptiste (Advocaat-generaal te Luik, College van Procureursgeneraal),

Borrenbergen Karel (Cel drugs, FOD VVVL / secretariaat ACD), Clarysse Francis (Advocaat-

generaal te Gent), De Beer Jacques (WIV, Food, medicines and consumer safety), De Boeck

Gert (FOD Justitie, NICC), De Buck Philippe (FAGG, Speciaal Gereglementeerde

Substanties en Kadaster), De Gryse Pascale (FOD VVVL, DG Dier, Plant en Voeding, Dienst

Voedingsupplementen en Cosmetica), De Ruyver Brice (Coördinator Algemene Cel

Drugsbeleid), Denonne Charles (FOD, Dienst Internationale Betrekkingen), Doms Kurt (Cel

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drugs, FOD VVVL / secretariaat ACD), Failla Jessica (FOD Justitie, DG Wetgeving en

fundamentele rechten en vrijheden, dienst bijzondere inbreuken en procedures), Garlement

Pascal (Federale Gerechtelijke Politie, Centrale dienst drugs), Gillard Claude (FOD Justitie,

DG Wetgeving en fundamentele rechten en vrijheden, dienst bijzondere inbreuken en

procedures), Gustin Deborah (Beleidscel Minister Onkelinx), Hippe Steven (FAGG,

Juridische Dienst), Mergan Dirk (FAGG, Cel precursoren), Pelc Isidore (Voorzitter Cel

Gezondheidsbeleid Drugs), Piette Véronique (WIV, Food, medicines and consumer safety),

Sivri Salih (FOD Justitie, Dienst voor Strafrechtelijk Beleid), Van Cauwenberge Roy (FAGG,

Speciale Onderzoekseenheid), Van der Elst Josiane (FAGG, Directeur-generaal DG

Inspectie), Van Durme Filip (FOD Justitie, NICC), Vandenbosch Bernard (FAGG, Dienst

Verdovende Middelen), Vanderleyden Stijn (FOD Financiën, Administratie der douane en

accijnzen)

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Disclaimer For this report, data obtained from the database of the Belgian Early Warning System on

Drugs (http://bewsd.wiv-isp.be) as well as data obtained from the European Database on

New Drugs (EMCDDA, http://ednd.emcdda.europa.eu) were used.

The statements, views, opinions, results and conclusions presented in this report are those

of the authors and the BMCDDA in particular, and are not endorsed by, nor do they

necessarily reflect, the opinions of European authorities, in particular the European

Monitoring Centre for Drugs and Drug Addiction or its national partners, the national Early

Warning Systems on Drugs.

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Table of Contents

List of abbreviations .................................................................................................................9

List of tables ...........................................................................................................................11

List of figures ..........................................................................................................................12

1. Background ........................................................................................................................14

2. Methodology.......................................................................................................................16

3. Results ...............................................................................................................................20

3.1. Number and type of new psychoactive substances in Belgium...................................20

3.2. Time interval between first reporting in EU and first reporting in Belgium ..................27

3.3. Sequence of reporting in EU Member States, Norway and candidate countries ........30

3.4. Monitoring of the presence of new psychoactive substances on the Internet ............40

4. Risk & Harm assessment ...................................................................................................40

4.1. Risk assessment according to the EMCDDA .............................................................40

4.2. Harm assessment .......................................................................................................41

5. Conclusion..........................................................................................................................49

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List of abbreviations BEWSD Belgian Early Warning System for Drugs BMCDDA Belgian Monitoring Centre for Drugs and Drug Addiction DOA Drugs of Abuse EDND European information system and Database on New Drugs EEG Europese Economische Gemeenschap EMCDDA European Monitoring Center for Drugs and Drug Addiction EUROTOX L’Observatoire socio-épidémiologique alcool-drogues en

Communauté Française NICC National Institute for Criminalistics and Criminology VAD Vereniging voor Alcohol- en andere Drugproblemen 2C-T-4 2,5-dimethoxy-4-isopropylthiofenethylamine 3-(4-hydroxymethylbenzoyl)-1-pentylindole

(4-Hydroxymethylphenyl)(1-pentyl-1H-indol-3-yl)methanone

3-FMA 3-fluoromethamphetamine 3-fluormethcathinone 2-methylamino-1-(3-fluorophenyl)propan-1-one 4-ethylmethcathinone (4-EMC) (RS)-2-methylamino-1-(4-ethylphenyl)propane-1-one 4-FMA 4-fluormethamphetamine 4-methylamphetamine 1-(4-methylphenyl)propan-2-amine 4-methylethcathinone 2-ethylamino-1-(4-methylphenyl)-1-propanone 5-MeO-DALT N,N-diallyl-5-methoxytryptamine AM2201 1-[(5-fluoropentyl)-1H-indol-3-yl]-(naphthalen-1-

yl)methanone BMDP 2-benzylamino-1-(3,4-methylenedioxyphenyl)propan-1-one Butylone 2-methylamino-1-(3,4-methylenedioxyphenyl)butan-1-one D2PM Diphenyl-2-pyrrolidin-2-yl-methanol Desoxy-D2PM 2-(diphenylmethyl)pyrrolidine DMAA 1,3-dimethylamylamine DMMA 3,4-Dimethoxy-N-methylamphetamine Etaqualone 3-(2-ethylphenyl)-2-methyl-quinazolin-4-one Flephedrone 2-methylamino-1-p-fluorophenyl-propan-1-one JWH-018 Naphthalen-1-yl-(1-pentylindol-3-yl)methanon JWH-019 1-hexyl-3-(1-naphthoyl)indole JWH-073 1-butyl-3-(1-naphthoyl)indol JWH-122 1-pentyl-3-(4-methyl-1-naphthoyl)indole) JWH-200 1-[2-(4-Morpholino)ethyl]-3-(1-naphthoyl)indole JWH-203 2-(2-chlorophenyl)-1-(1-pentylindol-3-yl)ethanone JWH-210 4-ethylnaphthalen-1-yl-(1-pentylindol-3-yl)methanone JWH-250 2-(2-methoxyphenyl)-1-(1-pentylindol-3-yl)ethanone mCPP 1-(3-chlorophenyl)piperazine MDAI 5,6-methylenedioxy-2-aminoindane

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MDPBP 3',4'-methylenedioxy-α-pyrrolidinobutyrophenone MDPV 1-(3,4-Methylenedioxyphenol)-2-pyrrolidinyl-pentan-1-one Mephedrone 4-methylmethcathinone Methedrone 4-methoxymethcathinone Methylone 3,4-methylenedioxymethcathinone m-fluoramphetamine 1-(3-Fluorophenyl)propan-2-amine Naphyrone naphthylpyrovalerone Pentedrone (β-ethyl-methcathinone) 2-methylamino-1-phenyl-1-pentanone Pentylone 2-Methylamino-1-(3,4-methylenedioxyphenyl)pentan-1-one p-fluoramphetamine 1-(4-Fluorophenyl)propan-2-amine RCS-4 (4-methoxyphenyl)(1-pentyl-1H-indol-3-yl)methanone Vanoxerine 1-[2-[bis(4-fluorophenyl)methoxy]ethyl]-4-(3-

phenylpropyl)piperazine α – PVP 1-phenyl-2-(1-pyrrolidinyl)-1-pentanone

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List of tables Table 1: Number of registered toxicological samples and different substances per registration

year (2002-2010)......................................................................................................18

Table 2: Number of toxicological analysis results reported to the BEWSD per number of

seizures of psychoactive substances in Belgium by the Federal Police (2006-2010)

.................................................................................................................................19

Table 3. New psychoactive substances reported to the BEWSD (2005-2011) ......................20

Table 4. Overview of the 42 new psychoactive substances reported by the BEWSD to the

EMCDDA (period 2005-2011) ..................................................................................22

Table 5. Number (n) and relative proportion (%) of new psychoactive substances reported in

Belgium per year of first reporting in Europe (2005-2011) .......................................24

Table 6. Relative proportion (%) of reported new psychoactive substances per country,

based on the total number of reported new psychoactive substances in Europe

(2008-2011)..............................................................................................................27

Table 7. Mean time interval (months) between first reporting in Europe and first reporting by

other EU countries (period 2008-2011) ....................................................................30

Table 8. Situation of Belgium and neighbouring countries Germany, France, Luxembourg

and the Netherlands in the sequence of the 13 selected new psychoactive

substances. ..............................................................................................................32

Table 9. First reporting by the BEWSD of new psychoactive substances reported to the

EMCDDA and Europol (2010) and time of availability for sale in the ccTLD for

Belgium (.be). ...........................................................................................................40

Table 10. Parameters for harm assessment when using psychoactive substances ..............41

Table 11. Overview of available information in the EDND database for the harm assessment

category “physical harm” for the new psychoactive substances reported in the period

2008-2011. ...............................................................................................................43


category “dependence” for the new psychoactive substances reported in the period

2008-2011. ...............................................................................................................45


category “social harm” for the new psychoactive substances reported in the period

2008-2011. ...............................................................................................................47

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List of figures Figure 1. Information exchange within the network of the Belgian Early Warning System for

Drugs........................................................................................................................16

Figure 2. Reporting ratio (%) of new psychoactive substances in Belgium per year of first

reporting in Europe (2005-2011) ..............................................................................25

Figure 3. Relative proportion (%) of reported new psychoactive substances per country,

based on the total number of reported new psychoactive substances in Europe

(2008-2011)..............................................................................................................26

Figure 4. Box plot of the time interval (months) between the first reporting of a new

psychoactive substance in Europe and its first reporting in Belgium (2005-2011) ...28

Figure 5. Mean time interval (months) between the first reporting of a new psychoactive

substance in Europe and its first reporting in Belgium (2005-2011).........................29

Figure 6. Mean time interval (months) between first reporting in Europe and first reporting in

other EU countries (2008-2011) ...............................................................................29

Figure 7. Mephedrone. Sequence of first reporting by EU Member States, Norway and

candidate countries (2008-2011)..............................................................................33

Figure 8. JWH-018. Sequence of first reporting by EU Member States, Norway and


Figure 9. MDPV. Sequence of first reporting by EU Member States, Norway and candidate

countries (2008-2011). .............................................................................................34

Figure 10. 4-Fluoramphetamine. Sequence of first reporting by EU Member States, Norway

and candidate countries (2008-2011).......................................................................34





Figure 13. CP47,497. Sequence of first reporting by EU Member States, Norway and


Figure 14. 4-Methylamphetamine. Sequence of first reporting by EU Member States, Norway




Figure 16. 4-Methylethcathinone. Sequence of first reporting by EU Member States, Norway




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Figure 18. α-PVP. Sequence of first reporting by EU Member States, Norway and candidate

countries (2011). ......................................................................................................38

Figure 19. AM-2201. Sequence of first reporting by EU Member States, Norway and

candidate countries (2011). ......................................................................................39

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1. Background The continuous monitoring and gathering of information on new psychoactive substances on

the market is the first step towards the risk assessment and eventual control of these

substances (EMCDDA, 2011c). In 2005 the Council of the European Union (2005/387/JHA)

therefore commissioned the European Monitoring Centre for Drugs and Drug Addiction

(EMCDDA) and Europol to develop, in cooperation with the Member States, a European

system for the rapid exchange of information on new psychoactive substances. Recently, at

the “First International Multidisciplinary Forum on New Drugs” (11-12 May, Lisbon) the

EMCDDA and Europol presented their joint report on the major developments in Europe.

According to this report, the national Early Warning Systems on Drugs (NEWSD) notified the

presence of 115 new psychoactive substances in the region of EU Member States, Norway

and candidate countries between 1 January 2005 and 31 December 2010. More than one

third (n=41, 35.65%) of these substances were reported in the registration year 2010

(EMCDDA2011). One year later (2011) another increase was observed and 49 new

psychoactive substances were notified to the EMCDDA. In their report the EMCDDA and

Europol (EMCDDA2011) warned the EU Member States about the complexity of the large

number of new unregulated synthetic compounds and the speed at which they are marketed

on the Internet as so-called ‘legal highs’ or with the label “not for human consumption”.

Following this joint EMCDDA and Europol report, the Belgian General Drugs Policy Cell

decided to set up an ad hoc working group “Legal Highs” with representatives from the

FAGG, NICC, FOD VVVL, Federal Police, FPS Justice, FPS Finance, College van

Procureurs-generaal, Drugs Health Policy Cell, WIV, FPS Home Affairs. The objectives of

this ad hoc working group were a) to analyse the phenomenon of “Legal Highs” (including the

specific risks), and b) to establish a general framework of possible actions from a supply and

demand perspective.

The Belgian Monitoring Centre for Drugs and Drug Addiction (BMCDDA) was asked

to conduct an epidemiological study into the presence, composition and use of new

psychoactive substances in Belgium, on behalf of the ad hoc working group “Legal Highs”.

The BMCDDA, which was installed within the Scientific Institute of Public Health (WIV-ISP)

as part of the obligations assumed by Belgium at the time of establishment of the EMCDDA

(Council of Europe 1993; European Parliament and Council of Europe 2006), monitors the

presence and use of psychoactive substances in Belgium on behalf of the EMCDDA.

For monitoring the use of psychoactive substances in the Belgian population, the

BMCDDA mainly relies on various recurrent large-scale studies from internal and external

partners. These studies are carried out both at the general population level

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(Gezondheidsenquête door middel van Interview, (Gisle L et al. 2010)) and within specific

populations and contexts such as school youth (VAD Leerlingenbevraging (Kinable

2009;2011), Health Behaviour in School-aged Children survey (Godin et al. 2011;Hublet et

al. 2011), Vlaams schoolonderzoeksproject naar alcohol en andere drugs), Middelengebruik

bij middelbare scholieren Brugge” (Lombaert 2010), Brussels JeugdOnderzoeksPlatform

(JOP)-Monitor (Cardoen et al. 2011), “In hogere sferen” (Van Hal et al. 2007;Rosiers et al.

2011) and the so-called party scene (VAD Partywise: (Van Havere 2004;2006;2008;Rosiers

2010); Réduction des Risques: (Casero et al. 2008)). A trend analysis into the use of new

psychoactive substances based on the aforementioned studies is not yet possible, because

they do not survey the use of new substances in a uniform and systematic manner (usually

only via the open response option “Other substances”). Moreover, it is unclear whether

young or beginning users, for example, are able to reliably distinguish cannabis from

synthetic cannabis such as spice.

In Belgium, the presence and composition of new and known psychoactive substances are

monitored by the Belgian Early Warning System on Drugs (BEWSD) of the BMCDDA. For its

monitoring, the BEWSD can rely on the medical, toxicological and forensic laboratories in

Belgium which are required to notify “the results of analyses of products that have been

found to be positive for illicit drugs other than cannabis, and/or for new synthetic drugs” to the

BEWSD of the BMCDDA (Federal Public Service Public Health 2006), even when the

analysis is part of a judicial or criminal investigation (Federal Public Service Public Health

2003).

In addition to the national BEWSD, two regional focal points (L’Observatoire socio-

épidémiologique alcool-drogues en Communauté Française, EUROTOX; and the Vereniging

voor Alcohol- en andere Drugproblemen, VAD) coordinate a regional EWSD. Whereas the

BEWSD is responsible for monitoring trends in the composition of drugs seized by the police,

the regional EWSDs focus on prevention. For this, they closely work with services such as

‘De Druglijn’, a telephone helpline for people (not only users) who have questions about

drugs. The three EWSDs work together in issuing so-called ‘warnings’ whenever new or high

risk psychoactive substances are reported in Belgium.

This report describes the psychoactive substances that were identified for the first time in

Belgium in the period 2005-2011. The Belgian data are also compared with the other EU

Member States, Norway and candidate Member States. Furthermore, an analysis is made of

the time interval between the first reporting of a new psychoactive substance in the EU and

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its first reporting in Belgium. The reporting sequence of 13 new psychoactive substances is

also included. In addition to a description of the spread of the new psychoactive substances

in Belgium, a first approach to a so-called ‘harm and risk assessment’ is described. The

report is concluded with suggestions to enhance the quality, productivity and efficiency of the

monitoring of new and high risk psychoactive substances in Belgium.

Figure 1. Information exchange within the network of the Belgian Early Warning System for

Drugs

Source: BEWSD, 2011.

2. Methodology For this report the data from the database of the Belgian Early Warning System for Drugs

(BEWSD) and the European Database on New Drugs (EDND) of the EMCDDA were used.

The EDND is the European information system and database on new psychoactive

substances. The EDND contains all notifications of new psychoactive substances identified

in the EU Member States, Norway and the candidate countries. In addition, the EDND

contains the toxicological profiles of these new substances. Data from the EDND database

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used in this report are based on the reporting forms (submitted to EMCDDA by member

states) on new psychoactive substances.

The BEWSD database contains all notifications of new and high risk psychoactive

substances identified in Belgium and notified to the BEWSD. Pursuant to Article 3 of the

Royal Decree on informing the Belgian Focal Point of the European Information Network on

Drugs and Drug Addiction (29 June 2003), Belgian laboratories are required to report to the

BEWSD the results of analyses of products that have been found to be positive for illicit

drugs (other than cannabis), and/or new synthetic drugs. The BEWSD database contains

mainly the toxicological analysis results of samples obtained as part of a seizure by the

Belgian police or customs (sea ports and airports). With such seizures, a description of the

products found is included in the official report. The identification of the substance at this

level is usually based on rapid tests (reagent tests in kit form). These can provide an

indication of the nature of the substance (in the case of conventional illicit drugs) without

having to use (expensive) lab analyses. For new psychoactive substances (in powder and

tablet form), however, these rapid tests have only limited reliability.

For the registration year 2010, 10 laboratories reported the analysis results of 1847 drug

samples to the BEWSD (Table 1). The vast majority of these samples (n = 1822, 98.6%)

originated from judicial seizures; the remaining samples were collected (e.g. by Modus

Vivendi).

A substantial part of the reported judicial analyses (683 samples, 2.48% of the total number

of seizures, were analysed and reported to the BEWSD) related to cannabis products (resin,

joints, flower tops and other vegetal material) (Table 2). For cocaine and heroin combined,

802 judicial analyses were reported in 2010 (corresponding to 11.6% of the total number of

seizures for these substances). For amphetamines and ‘Ecstasy’ products, 352 results of

seizures were reported, corresponding to 9.71% of the total number of seizures for these

substances.

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Table 1: Number of registered toxicological samples and different substances per registration year (2002-2010)

Year Registered samples

Different substances

Registering laboratories

(N) (N) (N) 2002 1002 22 7 2003 2229 20 9 2004 2516 19 7 2005 1864 27 6 2006 1446 24 7 2007 2286 24 6 2008 1381 22 7 2009 2334 28 8

2010 1847 40 10 Source: BEWSD database, 2011.

Article 3 of the aforementioned Royal Decree (29 JUNE 2003) also stipulates the information

that has to be reported by the Belgian laboratories to the BEWSD. It includes the place

where the drug was found or the place where the intoxication occurred (district and type of

location); the moment of the event; the nature of the biological sample or drug sample (form,

dimension, colour, weight, logo); the composition of the product found (active ingredients,

concentration, fillers); and the age and gender of the patient in case of acute intoxication.

The completeness of the toxicological data in the BEWSD was examined for the

registration year 2010. Of the above-mentioned variables, the colour of the drug sample is

the least reported variable (17.5%). The origin of the sample (seizure or collected sample) is

the most complete variable (99.9%) in the BEWSD. The district and the date of the sample

analysis were both reported in more than 95% of cases. The product type was indicated as

unknown in only 0.27% of cases.

Form, weight, dimensions and logo are especially important for samples in tablet

form. The completeness for these parameters varies from 48.5% for the logo to 87.7% for the

weight of the sample. Also dimensions (81.5%), form (86.9%) and concentration of active

ingredients (79%) were reported to a large extent by the laboratories. The analysis of by-

products is known for only 52.8% of the relevant analyses.

Analyses for this report were performed using Microsoft Office Excel 2007® and STATA®, a

statistical software package.

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Table 2: Number of toxicological analysis results reported to the BEWSD per number of seizures of psychoactive substances in Belgium by the Federal Police (2006-2010)

2006 2007 2008 2009 2010 A B B/A A B B/A A B B/A A B B/A A B B/A (N) (N) (%) (N) (N) (%) (N) (N) (%) (N) (N) (%) (N) (N) (%)

Cannabis 23287 115 0.5 25532 697 2.7 22418 562 2.5 29212 908 3.1 27512 683 2.5

Heroin 2341 110 4.7 2850 116 4.1 2307 155 6.7 3054 150 4.9 3433 157 4.6

Cocaine 3708 477 12.9 3656 363 9.9 3345 171 5.1 4021 327 8.1 3448 350 10.2

(Meth)amphetamines 2933 213 7.3 2767 300 10.8 2646 122 4.6 2944 312 10.6 2976 186 6.3

XTC-type 2009 200 10.0 1798 292 16.2 1412 222 15.7 921 235 25.5 650 125 19.2

LSD 1 1 100.0 1 1 100.0 2 n/a 2 n/a 59 1 1.7

Total 34279 1116 3.26 36604 1769 4.83 32128 1234 3.84 40152 1934 4.82 38078 1502 3.94

A = Number of seizures by Police; B = Number of toxicological analysis results reported to the BEWSD.

Source: Belgian Federal Police; BEWSD database, 2011.

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3. Results

3.1. Number and type of new psychoactive substances in Belgium From 1 January 2005 to 31 December 2011, the BEWSD reported the presence of 42 new

psychoactive substances to the EMCDDA and Europol (Table 3). These substances are

synthetic cathinones (n=15), synthetic cannabinoids (n=11), phenethylamines (n=7),

piperazine derivatives (n=2), indolalkylamines (n=1) and a residual group (“Other”) (n=6).

Table 3. New psychoactive substances reported to the BEWSD (2005-2011)

Group Substance Synthetic cathinones Methylone, Butylone, Mephedrone, Flephedrone, 3-

fluormethcathinone, MDPV, Methedrone, Naphyrone, 4-methylethcathinone, Pentylone, MDPBP, BMDP, α – PVP, Pentedrone, 4-ethylmethcathinone

Synthetic cannabinoids JWH-018, JWH-073, JWH-250, JWH-200, RCS-4, JWH-122, JWH-210, JWH-203, JWH-019, 3-(4-hydroxymethylbenzoyl)-1-pentylindole, AM2201

Phenethylamines 2C-T-4, p-fluoramphetamine, m-fluoramphetamine, 3-fluormethamphetamine, 4-fluormethamphetamine, 4-methylamphetamine, DMMA

Piperazine derivatives mCPP, Vanoxerine

Indolalkylamines (tryptamine derivatives)

5-MeO-DALT

Other D2PM, Etaqualone, MDAI, DMAA, Desoxy-D2PM, 3-amino-1-phenyl-butane

Source: BEWSD 2012

Synthetic cathinones are related to the parent compound cathinone, one of the

psychoactive substances in khat (Catha edulis Forsk). Cathinone derivatives are the β-keto

(βk) analogues of a corresponding phenethylamine. These products are usually encountered

as highly pure white or brown amorphous or crystalline powders, occasionally encapsulated.

In the absence of ring-substitution, synthetic cathinones behave as central nervous system

stimulants, although invariably with a lower potency than the corresponding phenethylamine

analogue. Published results of scientific research into the pharmacokinetics and

pharmacodynamics of ring-substituted cathinones are limited. From observations of patients

who presented with suspected mephedrone toxicity, it appears that cathinone derivatives

show similar sympathomimetic effects to amphetamine derivatives (EMCDDA2011a).

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Synthetic cannabinoids are functionally similar to Δ9-tetrahydrocannabinol (THC),

the active ingredient of cannabis. Like THC, they bind to the same cannabinoid receptors in

the brain and other organs as the endogenous ligand anandamide. In the pure state these

substances are either solids or oils. Smoking mixtures are usually sold in metal-foil sachets,

typically containing 3g of dried plant material to which the cannabinoids have been added.

The cannabinoid receptor agonists mimic the effects of THC and anandamide by interacting

with the CB1 receptor in the brain. However, published research data on the precise

pharmacology and toxicology of the synthetic cannabinoids are scarce (EMCDDA2011a).

The phenethylamine family includes a wide range of stimulant, entactogenic and

hallucinogenic substances, which exert their effects primarily through modulation of the

monoamine neurotransmitter systems. The group of substituted phenethylamines

encompasses the substituted amphetamines, the substituted

methylenedioxyphenethylamines and a large group of alkaloids derived from

phenethylamine. This group falls into a wide variety of therapeutic classes, including

psychotropic drugs (e.g. DOM: 2,5-dimethoxy-4-methylamphetamine), central nervous

system stimulants (e.g. amphetamine), appetite depressants (e.g. phentermine), antilipemic

agents, vasoconstrictors, bronchodilators, cardiotonic agents, vasodilators, calcium channel

blockers, antidepressants, neuroprotective agents and medication for Parkinson’s patients.

Phenethylamines are encountered in capsules, tablets and powders (EMCDDA2011a).

Piperazine is used in (veterinary) medicine as an anthelminthic (drug used in the

treatment of endoparasitic worm infestations) and is an important raw material in the

pharmaceutical industry. It is used in the synthesis of many pharmaceutical substances

(including imatinib, sildenafil, olanzapine, etc.) but also for the synthesis of hallucinogens and

stimulants such as benzylpiperazine. Piperazine derivatives are also used for certain

polyesters. Piperazines can be further subdivided into two classes, the benzylpiperazines

and the phenylpiperazines. Because of their stimulant effects similar to but weaker than

amphetamines, they are sold as a so-called legal alternative to Ecstasy. Piperazine

derivatives are usually found in illicit dosage forms such as either tablets or capsules, but

loose powders also be encountered. The tablets often carry logos similar to those seen on

ecstasy tablets. Solutions are encountered less frequently (EMCDDA2011a).

22

Table 4. Overview of the 42 new psychoactive substances reported by the BEWSD to

the EMCDDA (period 2005-2011)

Substance Group Country 1e reporting

in EU

Period 1st reporting in EU (a)

Period 1st reporting in Belgium (b)

b-a

mCPP Piperazine derivatives

France Feb 2005 Jul 2005 5

Methylone Cathinones Netherlands Mar 2005 Apr 2010 61 2C-T-4 Phenethylamines United Kingdom Aug 2005 2nd sem. 2007 19 5-MeO-Dalt Indolalkylamines

(tryptaminen) Finland Feb 2007 Jul 2011 53

Vanoxerine Piperazine derivatives

Belgium May 2007 May 2007 0

D2PM Others United Kingdom May 2007 Jul 2011 50 Butylone Cathinones United Kingdom Jan 2008 Nov 2009 22 Mephedrone Cathinones Finland Mar 2008 Aug 2009 17 Flephedrone Cathinones Denmark Sep 2008 Jun 2010 21 3-fluormethcathinone Cathinones United Kingdom Oct 2008 Jun 2010 20 MDPV Cathinones Finland Dec 2008 Mar 2011 27 p-fluoramphetamine Phenethylamines Denmark Dec 2008 Jan 2009 1 JWH-018 (Synthetic)

Cannabinoids Austria Dec 2008 Aug 2010 20

m-fluoramphetamine Phenethylamines Belgium Jan 2009 Jan 2009 0 JWH-073 (Synthetic)

Cannabinoids Denmark Mar 2009 Jul 2011 16

JWH-250 (Synthetic) Cannabinoids

United Kingdom Oct 2009 Jul 2011 21

Methedrone Cathinones Sweden Oct 2009 Aug 2010 10 Etaqualone Others Denmark Nov 2009 Jun 2010 7 3-fluormethamphetamine

Phenethylamines Finland Nov 2009 Dec 2010 13


Lithuania Dec 2009 Jul 2011 19

4-Methylamphetamine Phenethylamines Belgium Dec 2009 Dec 2009 0 MDAI Others Sweden Feb 2010 Jul 2011 17 4-fluormethamphetamine

Phenethylamines Norway Mar 2010 Dec 2010 9

RCS-4 (Synthetic) Cannabinoids

Hungary May 2010 Jul 2011 14

Naphyrone Cathinones Sweden Jun 2010 Jul 2011 13 DMAA Others Ireland Jun 2010 Jul 2011 13 4-methylethcathinone Cathinones United Kingdom Jul 2010 Jul 2011 13 JWH-122 (Synthetic)

Cannabinoids Latvia Jul 2010 Jul 2011 12

Pentylone Cathinones United Kingdom Sep 2010 Jul 2011 10 JWH-210 (Synthetic)

Cannabinoids Germany Sep 2010 Jul 2011 10

Pentedrone/ β-ethyl-methcathinone

Cathinones Austria Sep 2010 Dec 2011 15


Latvia Oct 2010 2nd sem .2010 1


Finland Oct 2010 Feb 2011 4

23

Table 4 (cont’d). Overview of the 42 new psychoactive substances reported by the

BEWSD to the EMCDDA (period 2005-2011)

Substance Group Country 1st

reporting in EU

Period 1st reporting in EU (a)

Period 1st reporting in Belgium (b)

b-a

3-(4-hydroxymethylbenzoyl)-1-pentylindole

(Synthetic) Cannabinoids

United Kingdom Nov. 2010 Juli 2011 8

MDPBP Cathinones United Kingdom Nov. 2010 Juli 2011 8 BMDP Cathinones United Kingdom Dec. 2010 Juli 2011 7 Desoxy-D2PM Others United Kingdom Dec. 2010 Juli 2011 7 AM2201 (Synthetic)

Cannabinoids Latvia Jan. 2011 Mei 2011 4

α - PVP Cathinones France April 2011 Juli 2011 3 DMMA Phenethylamines France April 2011 Dec. 2011 8 4-ethylmethcathinone/4-EMC

Cathinones Sweden Sept. 2011 Dec. 2011 3

3-amino-1-phenyl-butane

Others Belgium Dec. 2011 Dec. 2011 0

Source: EMCDDA: European database on new drugs, 2011; BEWSD database, 2011.

The group of Indolalkylamines (tryptamines) includes biologically active

compounds including neurotransmitters and psychedelic drugs related to tryptamine, which

have a psychotropic effect through modulation of serotonergic neurotransmission.

Tryptamine is a monoamine alkaloid found in plants, fungi, and animals. It is based around

the indole ring structure. Tryptamine was found in trace amounts in the brains of mammals

and is believed to play a role as neuromodulator or neurotransmitter. Tryptamine alkaloids

from fungi and plants are often used for their psychotropic effects. Prominent examples are

psilocybin and dimethyltryptamine (DMT). Synthetic tryptamines have also been made,

including the migraine drug sumatriptan (EMCDDA2011a).

Since 2005, 164 new psychoactive substances have been reported to the EMCDDA and

Europol, 42 (25.61%) of which have also been identified in Belgium (status 31 December

2011). An overview per year is shown in Table 4 and Figure 2. Of the 49 new substances

reported in 2011, 5 have already been identified in Belgium and reported to the BEWSD.

Sixteen (39%) of all new psychoactive substances that were reported in the EU (n=41) in the

registration year 2010 have also been identified in Belgium and reported to the BEWSD

(period 2010-2011).

24

Piperazine derivatives were reported in Belgium mainly in 2007, and phenethylamines were

reported to the BEWSD during the period 2007-2011. Cathinones and synthetic

cannabinoids have been reported more recently in Belgium, since 2009 and 2010

respectively. An overview of the 42 substances with details on their first reporting in both

Europe and Belgium is given in Table 3.

Table 5. Number (n) and relative proportion (%) of new psychoactive substances reported in Belgium per year of first reporting in Europe (2005-2011)

Year 1st reporting EU 1st reporting Be Be / EU

N N % 2005 14 3 21.43 2006 7 0 0.00 2007 16 3 18.75 2008 13 7 53.85 2009 24 8 33.33 2010 41 16 39.02 2011 49 5 10.20

Source: EMCDDA: European database on new drugs, 2011; BEWSD database, 2011. The relative proportion of substances reported in Belgium with respect to all reported

substances in the EU (hereinafter called the “reporting ratio”), varies from 0% (2006) to

53.85% (2008) (Table 5). The seizure of 18 psychoactive substances from a Brussels-based

Internet shop in 2010 (reported in July 2011) has an impact on the Belgian ratio of that same

year.

For the registration period 2008-2011, only Germany, the United Kingdom, Finland, Bulgaria,

Sweden and Hungary have a reporting ratio that is higher than that of Belgium (see Figure 2,

Table 5). Macedonia, Portugal, Slovenia and Spain did not report any new psychoactive

substances to the EMCDDA during this period.

25

Figure 2. Reporting ratio (%) of new psychoactive substances in Belgium per year of first reporting in Europe (2005-2011)


26

Figure 3. Relative proportion (%) of reported new psychoactive substances per country, based on the total number of reported new psychoactive substances in Europe (2008-2011)


27

Table 6. Relative proportion (%) of reported new psychoactive substances per country, based on the total number of reported new psychoactive substances in Europe (2008-2011)

Year of reporting to EMCDDA 2008

(N =13) 2009

(N = 24) 2010

(N = 41) 2011

(N = 49) 2008-2011 (N = 127)

% % % % % Germany 61.54 45.83 36.59 34.69 40.16 United Kingdom 61.54 25.00 53.66 24.49 37.80 Finland 100 37.50 29.27 22.45 35.43 Bulgaria 76.92 25.00 46.34 8.16 30.71 Sweden 69.23 16.67 39.02 16.33 29.13 Hungary 53.85 16.67 41.46 16.33 28.35 Belgium 53.85 33.33 39.02 10.20 25.61 Norway 30.77 20.83 29.27 12.24 21.26 Italy 53.85 12.50 21.95 6.12 17.32 France 61.54 20.83 19.51 8.16 16.69 Denmark 53.85 29.17 12.20 4.08 16.54 Croatia 53.85 12.50 21.95 4.08 16.54 Austria 69.23 20.83 12.20 2.04 15.75 Czech (Rep.) 38.46 12.50 17.07 0.00 11.81 Ireland 46.15 4.17 12.20 2.04 10.24 Poland 30.77 8.33 4.88 4.08 7.87 Slovakia 38.46 12.50 4.88 0.00 7.87 Turkey 23.08 0.00 4.88 8.16 7.09 Latvia 23.08 0.00 7.32 2.04 5.51 Netherlands 23.08 8.33 0.00 4.08 5.51 Malta 23.08 0.00 4.88 0.00 3.94 Cyprus 15.38 8.33 0.00 0.00 3.15 Luxembourg 15.38 4.17 0.00 0.00 2.36 Estonia 15.38 0.00 0.00 0.00 1.57 Greece 7.69 0.00 0.00 2.04 1.57 Lithuania 7.69 4.17 0.00 0.00 1.57 Romania 7.69 0.00 0.00 0.00 0.79 Macedonia 0.00 0.00 0.00 0.00 0.00 Portugal 0.00 0.00 0.00 0.00 0.00 Slovenia 0.00 0.00 0.00 0.00 0.00 Spain 0.00 0.00 0.00 0.00 0.00


3.2. Time interval between first reporting in EU and first reporting in Belgium The time interval between the first reporting of a new psychoactive substance in Europe and

the first reporting thereof by the BEWSD to the EMCDDA is graphically represented in

Figures 4 and 5. In Figure 4, reporting years 2007, 2009 and 2011 appear twice (2007, 2009,

2011 and 2007*, 2009*, 2011*), respectively, with and without the data on the substances

which, at European level, were reported first by Belgium (time interval = 0 months). These

first data sets are not taken into account in Figure 5.

28

Figure 4. Box plot of the time interval (months) between the first reporting of a new psychoactive substance in Europe and its first reporting in Belgium (2005-2011)


The box plots in Figure 4 indicate a marked decrease in the time interval between the

moment a new substance is reported in the EU and the notification of that same substance in

Belgium. Thus, the median value between the first reporting of a new psychoactive

substance in Europe and the first reporting to the BEWSD in Belgium decreased from 28.3

months (2005) to 10.1 months (2010) and 4.5 months (2011). Also the interquartile range

(difference between the 25th and 75th percentiles) of the time intervals significantly

decreased during this period.

29

Figure 5. Mean time interval (months) between the first reporting of a new psychoactive substance in Europe and its first reporting in Belgium (2005-2011).


Within the group of EU Member States, Norway and candidate countries, ten countries

recorded a lower mean time interval than Belgium for the period 2008-2011 (see Figure 6).

The lowest mean time interval was recorded for Finland (5.25 months), and the highest for

Romania (22.00 months).

Figure 6. Mean time interval (months) between first reporting in Europe and first reporting in other EU countries (2008-2011)


30

Table 7. Mean time interval (months) between first reporting in Europe and first reporting by other EU countries (period 2008-2011)

Country Records (n)

Min. Max. Mean Median Mode

Finland 20 0 18 5.25 4 2 Denmark 12 1 12 5.42 4 2 United Kingdom 19 0 22 5.95 5 0 Netherlands 5 0 18 7.00 1 0 Sweden 30 1 29 8.97 8 10 Germany 36 0 29 9.14 6 0 Estonia 2 3 16 9.50 9.5 n/a Lithuania 1 10 10.00 10 n/a Hungary 31 0 36 10.81 9 9 Cyprus 4 9 13 11.25 11.5 13 Belgium 33 1 27 11.91 12 13 Norway 23 0 42 12.04 11 11 France 23 1 43 12.30 7 n/a Luxembourg 3 5 25 12.33 7 n/a Austria 15 0 24 12.33 13 22 Czech (Rep.) 15 2 32 12.60 12 2 Poland 8 0 29 12.63 10 n/a Slovakia 10 4 34 13.90 13 n/a Ireland 9 0 29 14.56 18 18 Bulgaria 34 2 37 15.29 13 8 Turkey 8 0 36 15.63 17 0 Croatia 21 2 39 15.81 16 9 Italy 22 1 45 16.68 13 n/a Greece 2 4 33 18.50 18.5 n/a Malta 5 4 27 19.20 23 n/a Latvia 3 10 25 19.33 23 n/a Romania 1 22 22.00 22.00 22 n/a Macedonia 0 n/a n/a n/a n/a n/a Portugal 0 n/a n/a n/a n/a n/a Slovenia 0 n/a n/a n/a n/a n/a Spain 0 n/a n/a n/a n/a n/a EU mean 3.04 26.67 12.60 11.72

Source: EMCDDA: European database on new drugs, 2011.

3.3. Sequence of reporting in EU Member States, Norway and candidate countries The sequence of the reporting of 13 new psychoactive substances by the EU Member

States, Norway and candidate countries is geographically represented in Figures 7 up to and

including 19. The substances were selected on the basis of the number of countries that

reported their presence. Four of these substances were reported for the first time to the

EMCDDA in 2008, four substances in 2009, three in 2010 and two in 2011. Four substances

belong to the group of cathinones, seven to the synthetic cannabinoids, and two to the

phenethylamines (Unstats 2011).

31

The selected synthetic cathinones were usually reported first in a Northern

European country, and also in other Northern European countries in the subsequent 6 to 9

months. 4-methylethcathinone was reported first by the United Kingdom and then in other

Western European countries. The cathinones were also reported by the BEWSD, on average

after 15 months. Neighbouring countries United Kingdom, France and Germany reported

these substances sooner to the EMCDDA, with respective mean values of 3, 10 and 12

months after the first reporting in Europe. Luxembourg and the Netherlands both reported

only one of the selected substances, respectively 25 and 16 months after the first reporting

(see Table 7).

The selected synthetic cannabinoids were reported first in a Western or Northern

European country. When they were reported first in a Western European country (United

Kingdom), Northern and Eastern European countries followed suit. When they were reported

first by a Northern European country, they were subsequently reported in other Northern

European countries, followed by Western European countries. With a mean time interval of

14.6 months, Belgium reported these substances later than its neighbouring countries (see

Table 7). In Germany, synthetic cannabinoids are reported on average one and a half

months after the first European reporting.

The selected phenethylamines were reported first by Northern European countries

and subsequently by Western European countries. Compared with the neighbouring

countries, these substances were reported sooner in Belgium, with a mean time interval of

half a month (see Table 7).

In spite of the fact that the synthetic cannabinoid AM2201 (Jan 2011) and the

cathinone α-PVP (Apr 2011) were only recently identified, their presence had already been

reported to the EMCDDA by, respectively, ten and seven other EU countries.

32

Table 8. Situation of Belgium and neighbouring countries Germany, France, Luxembourg and the Netherlands in the sequence of the 13 selected new psychoactive substances.

Cathinones Cannabinoids Phenethylamines Country n mean range n mean range n mean range

Belgium 4 15 3-27 5 14.6 4-21 2 0.5 0-1

Germany 4 12 0-23 6 1.6 0-4 2 15.5 7-12

France 4 10.25 0-33 6 14.5 5-28 2 5 3-7

Luxembourg 1 25 n/a 2 6 5-7 0 n/a n/a

Netherlands 1 16 N/a 1 0 n/a 1 1 n/a

United

Kingdom

3 3.33 0-7 5 4.4 0-11 1 2 n/a


33

Figure 7. Mephedrone. Sequence of first reporting by EU Member States,

Norway and candidate countries (2008-2011).

Figure 8. JWH-018. Sequence of first reporting by EU Member States, Norway

and candidate countries (2008-2011).

This cathinone was reported first by Finland on 7 March 2008. It was also reported by

Belgium, first in August 2009. The presence of Mephedrone was reported to the EMCDDA

by a total of 24 countries.

This synthetic cannabinoid was reported first by Austria on 19 December 2008. It was also

reported by Belgium, first in August 2010. The presence of JWH-018 was reported to the

EMCDDA by a total of 19 countries.


34

Figure 9. MDPV. Sequence of first reporting by EU Member States, Norway

and candidate countries (2008-2011).

Figure 10. 4-Fluoramphetamine. Sequence of first reporting by EU

Member States, Norway and candidate countries (2008-2011).

This cathinone was reported first by Finland on 5 December 2008. It was also reported by

Belgium, first in March 2011. The presence of MDPV was reported to the EMCDDA by a total

of 19 countries.

This phenethylamine was reported first by Denmark on 5 December 2008. It was also

reported by Belgium, first in January 2009. The presence of 4-Fluoramphetamine was

reported to the EMCDDA by a total of 16 countries.


35

Figure 11. JWH-250. Sequence of first reporting by EU Member States,




This synthetic cannabinoid was reported first by Germany on 6 October 2009. It was also

reported in Belgium, first in July 2011. The presence of JWH-250 was reported to the


This synthetic cannabinoid was reported first by Denmark on 6 March 2009. It was also

reported in Belgium, first in July 2011. The presence of JWH-073 was reported to the



36

Figure 13. CP47,497. Sequence of first reporting by EU Member States,


Figure 14. 4-Methylamphetamine. Sequence of first reporting by EU


This synthetic cannabinoid was reported first by Germany on 23 February 2009. It was not

reported in Belgium. The presence of CP47,497 was reported to the EMCDDA by a total of

10 countries.

This phenethylamine was reported first by Belgium on 14 December 2009. The presence of

4-Methylamphetamine was reported to the EMCDDA by a total of 8 countries.


37



Figure 16. 4-Methylethcathinone. Sequence of first reporting by EU


This synthetic cannabinoid was reported first by Latvia on 23 July 2010. It was also reported

in Belgium, first in July in 2011. The presence of JWH-122 was reported to the EMCDDA by a

total of 14 countries.

This cathinone was reported first by the United Kingdom on 8 July 2010. It was also reported

in Belgium, first in July 2011. The presence of 4-Methylethcathinone was reported to the



38



Figure 18. α-PVP. Sequence of first reporting by EU Member States,

Norway and candidate countries (2011).

This synthetic cannabinoid was reported first by Latvia on 2 June 2010. It was not reported in

Belgium. The presence of JWH-081 was reported to the EMCDDA by a total of 10 countries.

This cathinone was reported first by France on 4 April 2011. It was also reported in

Belgium, first in July 2011. The presence of α-PVP was reported to the EMCDDA by a total

of 8 countries.


39

Figure 19. AM-2201. Sequence of first reporting by EU Member States,

Norway and candidate countries (2011).

This synthetic cannabinoid was reported first by Latvia on 12 January 2011. It was also

reported in Belgium, first in May 2011. The presence of AM-2201 was reported to the



40

3.4. Monitoring of the presence of new psychoactive substances on the Internet As part of an explorative analysis, it was checked using Google® whether the new

substances identified in Belgium (in 2010) were registered in the country code top-level

domain (ccTLD) for Belgium (“.be”) before the reporting date. The overview in Table 9 shows

that, except for Etaqualone and 3-FMA, all new psychoactive substances that were reported

for the first time in 2010 by the BEWSD to the EMCDDA had already been registered in the

ccTLD .be, and were in many cases available for sale.

Table 9. First reporting by the BEWSD of new psychoactive substances reported to the EMCDDA and Europol (2010) and time of availability for sale in the ccTLD for Belgium (.be).

Substance 1st reporting in EU

1st reporting in Belgium Google® (« site :.be »)

Methylone 03/2005, Netherlands 04/2010 4/5/2005 (hebbes.be)

Flephedrone 09/2008, Denmark 06/2010 24/11/2009 (weedwholesale.be)

3-FMC 10/2008, UK 06/2010 4/5/2005 (hebbes.be)

JWH-018 12/2008, Austria 08/2010 5/12/2009 (weedwholesale.be)

Methedrone / bk-PMMA

10/2009, Sweden 08/2010 24/11/2009 (weedwholesale.be)

Etaqualone 11/2009, Denmark 06/2010

3-FMA 11/2009, Finland 12/2010

4-FMA 03/2010, Norway 12/2010 11/4/2010 (assenede.marktgigant.be)

JWH-203 10/2010, Latvia 2nd sem. 2010 4/12/2010 (weedwholesale.be)


4. Risk and Harm assessment

4.1. Risk assessment according to the EMCDDA Following Council Decision 2005/387/JHA, guidelines were established for performing a risk

assessment when new psychoactive substances are identified (EMCDDA2009). The primary

objective of these guidelines is to provide a solid methodological and procedural base for

performing such a risk assessment. According to these guidelines, the following aspects

should be addressed: (1) health and social risks associated with the use of the psychoactive

substance; (2) production of the new psychoactive substance; (3) traffic in the new

psychoactive substance; (4) involvement of organised crime, and (5) possible effects of

control measures.

Performing a risk assessment after identification of a new psychoactive substance may be

complicated by the lack of scientific evidence. This was, for instance, the case with the risk

41

assessment of mephedrone by the EMCDDA (EMCDDA2011b), not only because of the

limited available data on this substance, but also because there were few points of

comparison with other compounds that had been previously evaluated under the ‘Council

Decision’.

4.2. Harm assessment A harm assessment is an important element of the risk assessment. According to Nutt et al.

(2007), a harm assessment can be subdivided into 9 parameters, grouped into 3 categories,

notably physical harm, dependence, and social harm (see table 4). Based on the data in the

EDND profiles, the BMCDDA examined whether information on these 9 parameters is

available for the 78 new psychoactive substances that were reported to the EMCDDA in the

registration period 2008-2010.

Table 10. Parameters for harm assessment when using psychoactive substances Category Parameter Physical harm 1 Acute harm 2 Chronic harm 3 Intravenous harm Dependence 4 Intensity of pleasure 5 Psychological dependence 6 Physical dependence Social harm 7 Intoxication 8 Other social harms 9 Healthcare costs Source: Nutt et al. (2007)

The available data in the EDND profiles are recent but limited. These profiles mainly provide

information on the parameter “physical harm” and acute physical harm in particular (for 28 of

the 127 new substances). Information relating to chronic harm and the risk of psychological

dependence was also found for six and eight substances respectively. Information on

possible social harm was found for only 3 substances.

Owing to the fact that the information in the EDND profiles is recent and limited in

scope, the evidence level of the data is also limited. Approximately half (n=23) of the

documented effects (n=50) concern information from reported cases and user reports. One

fifth (n=11) concern hypothetical information that is based on the chemical properties of the

relevant substance. Nine effects (mainly relating to physical harm) were observed in in vivo

studies in mice, whereas only four harm effects were observed as part of a clinical study.

42

Based on the available information it was not possible to generate an unambiguous profile of

possible acute harm per group of substances. However, a number of specific effects are

found to occur repeatedly for each group. Thus, for the synthetic cannabinoids the following

symptoms were reported: hypothermia, hypo- and hypertension, bradycardia, agitation and

hallucinations. Frequently occurring forms of acute harm in the group of cathinones are

tachycardia and agitation. For the tryptamines, visual impairments, nausea, respiratory

irritation and tachycardia were observed. The following symptoms were reported one or more

times for the group ‘other’: paranoia, hallucinations, convulsions, bradycardia, confusion,

dizziness and drowsiness. A detailed overview per substance and per parameter is given in

Tables 11 up to and including 13.

43

Table 11. Overview of available information in the EDND database for the harm assessment category “physical harm” for the new psychoactive substances reported in the period 2008-2011.

Harm assessment parameters (Nutt et al.)

Substance Acute physical harm (1) Chronic physical harm (2) Intravenous harm (3)

A. Synthetic cannabinoids CP 47,497 hypothermia, ataxia (IV); cf. THC (H) CRA-13 inhibits gastrointestinal motility (IV) HU-210 hypotension, bradycardia (IV) learning problems (IV) JWH-018 hallucinations, dysphoria, psychomotor

agitation, epileptic insult, anxiety (CR); hypothermia, catalepsy (IV)

cognitive disorders (CR)

JWH-073 agitation, hypertension, paranoia, delusions (CR)

JWH-122 not specified (“serious side effects”) (CR) Methandamide short-term memory damage (IV)

B. Synthetic cathinones 1-Naphyrone & Naphyrone

cf. cathinones: effect on heart and blood vessels, hyperthermia, anxiety (H)

carcinogenic (H)

Butylone acute psychosis, liver failure (CR) MDPPP cf. pyrrolidinophenone derivatives: hepato-

and neurotoxicity, psychopathology, serotonin syndrome (H)

MDPV tachycardia, agitation, difficulty in breathing, hypertension, psychosis; 17 reported deaths (CR)

Methedrone headache, epileptic insult, tachycardia, hyperthermia, agitation (CR)

Mephedrone tachycardia, breast pain, agitation/ aggression, paranoia (RA)

MPPP see MDPPP (H) PPP see MDPPP (H)

C. Indolalkylamines (tryptamines) 4-Ac-O-DMT cf. psilocin, anxiety, visual impairments,

paranoia, tachycardia (CR)

AMT nausea (CR) DMT respiratory irritation (CR) permanent difficulty focusing on daily tasks,

sleeping disorders, anxiety (CR)

Based on: CR: Case report / user report H: Hypothesis (based on chemical properties) IV: In vivo tests (e.g. on mice) CS: Clinical study RA: Risk Assessment report EMCDDA

44

Table 11 (Cont’d). Overview of available information in the EDND database for the harm assessment category “physical harm” for the new psychoactive substances reported in the period 2008-2011.


Substance Acute physical harm (1) Chronic physical harm (2) Intravenous harm (3) D. Phenethylamines 4-Fluoroamphe- tamine

cf. amphetamines; bruxism, insomnia, markedly reduced appetite (IV)

4-Methylamphetamine Sympathomimetic effects, several weeks of paralysing anxiety (CR)

E. Other 5-APB pharmacology similar to MDA/MDMA (H) Arecoline dizziness, ‘strong toxic effects’ (CR) Benzydamine hallucinations, paranoia, convulsions,

insomnia (CR) ulcers, liver and kidney damage (CR)

Camfetamine DMAA hypertension, bradycardia, confusion (CR) DXM Ethylphenidate anxiety, paranoia (H) Kava liver damage (H) Pregabalin dizziness, drowsiness, loss of coordination,

blurred vision, motor skill disorders (CS)

ODT nausea, drowsiness, dizziness, headache (CS) overdose acute liver failure (CR)

Based on: CR: Case report / user report H: Hypothesis (based on chemical properties) IV: In vivo tests (e.g. on mice) CS: Clinical study RA: Risk Assessment report EMCDDA

45

Table 12. Overview of available information in the EDND database for the harm assessment category “dependence” for the new psychoactive substances reported in the period 2008-2011.


Substance Intensity of pleasure (4) Psychological dependence (5) Physical dependence (6) A. Synthetic cannabinoids CP 47,497 CRA-13 HU-210 withdrawal symptoms (IV) JWH-018 constant craving for the drug (CR) withdrawal symptoms in hospital (CR) JWH-073 JWH-122 drug properties may lead to dependence (IV) Methandamide B. Synthetic cathinones 1-Naphyrone & Naphyrone

may lead to moderate dependence (H)

Butylone MDPPP MDPV Methedrone Mephedrone may lead to moderate dependence (RA) MPPP PPP C. Indolalkylamines (tryptamines) 4-Ac-O-DMT AMT DMT Based on: CR: Case report / user report H: Hypothesis (based on chemical properties) IV: In vivo tests (e.g. on mice) CS: Clinical study RA: Risk Assessment report EMCDDA

46

Table 12 (Cont’d). Overview of available information in the EDND database for the harm assessment category “dependence” for the new psychoactive substances reported in the period 2008-2011.


Substance Intensity of pleasure (4) Psychological dependence (5) Physicial dependence (6) D. Phenethylamines 4-Fluoroamphe- tamine

4-Methylamphetamine E. Other 5-APB Arecoline Benzydamine Camfetamine reported as cocaine-like dependence (CR) DMAA DXM chronic use may result in moderate

dependence (CR)

Ethylphenidate Kava Pregabalin low abuse potential, but possible withdrawal

symptoms (CS)

ODT low (but not zero) addiction potential (CS) Based on: CR: Case report / user report H: Hypothesis (based on chemical properties) IV: In vivo tests (e.g. on mice) CS: Clinical study RA: Risk Assessment report EMCDDA

47

Table 13. Overview of available information in the EDND database for the harm assessment category “social harm” for the new psychoactive substances reported in the period 2008-2011.


Substance Intoxication (7) Other social harms (8) Healthcare costs (9) A. Synthetic cannabinoids CP 47,497 CRA-13 HU-210 JWH-018 JWH-073 JWH-122 Methandamide B. Synthetic cathinones 1-Naphyrone & Naphyrone

Butylone MDPPP MDPV impact on traffic safety (CR) Methedrone Mephedrone short stay in emergency department,

intensive care may be required (RA) MPPP PPP C. Indolalkylamines (tryptamines) 4-Ac-O-DMT AMT DMT Based on: CR: Case report / user report H: Hypothesis (based on chemical properties) IV: In vivo tests (e.g. on mice) CS: Clinical study RA: Risk Assessment report EMCDDA

48

Table 13 (Cont’d). Overview of available information in the EDND database for the harm assessment category “social harm” for the new psychoactive substances reported in the period 2008-2011.


Substance Intoxication (7) Other social harms (8) Healthcare costs (9) D. Phenethylamines 4-Fluoroamphe- tamine

4-Methylamphetamine E. Other 5-APB Arecoline Benzydamine Camfetamine DMAA DXM loss of self control accidents (CR) Ethylphenidate Kava possible injection by ignorant heroin users

(H)

Pregabalin

ODT Based on: CR: Case report / user report H: Hypothesis (based on chemical properties) IV: In vivo tests (e.g. on mice) CS: Clinical study RA: Risk Assessment report EMCDDA

49

5. Conclusion

New psychoactive substances in Belgium This report investigated the presence of new psychoactive substances in Belgium on the

basis of the Belgian Early Warning System for Drugs (BEWSD) database and the European

Database on New Drugs (EDND). In summary, it can be stated that Belgium, in comparison

with the other EU Member States, Norway and the candidate countries, reported a relatively

large number of new substances to the EMCDDA during the period 2005-2011. The

substances identified in Belgium belong primarily to the synthetic cathinones, synthetic

cannabinoids, and phenethylamines – substance groups which were notified to the EMCDDA

mainly by the EWSDs of Western and Northern European countries. Apart from the increase

in the number of new substances, a significant decline in the mean time interval between the

first reporting of a new substance in the EU and the first reporting thereof in Belgium was

observed for the period 2005-2011. In comparison with most neighbouring countries,

however, this time interval is larger for Belgium.

For the interpretation of the above-described results, a number of factors need to be taken

into account. The data in the BEWSD database, for example, have been collected almost

exclusively as a result of police seizures. The BEWSD receives a rather limited amount of

toxicological results for the total number of seizures. It is also not clear whether the number

of results that the BEWSD receives actually corresponds with the number of toxicological

analysis assignments entrusted by the police and the public prosecutors to the Belgian

laboratories. The BEWSD also receives only a limited amount of laboratory data. Moreover,

the number of laboratories performing such toxicological analyses on behalf of the police or

the judicial authorities is not known. Finally, the number of Belgian laboratories that are

sufficiently equipped (in terms of technical and personnel resources) to conduct such

specialised analyses in a valid and reliable manner is not known either. However, the

laboratories that continuously report to the BEWSD are specialised laboratories operating

within universities (a list of participating labs can be found in the acknowledgements section),

scientific public institutions (National Institute for Criminalistics and Criminology, Scientific

Institute of Public Health) or within a large private group of multidisciplinary accredited

analysis laboratories (Chemiphar Belgium).

Based on the above considerations, this report therefore describes the minimum extent of

the new psychoactive substances present in Belgium. The presence of a relatively large

number of new synthetic psychoactive substances in Belgium could possibly be explained by

50

the facilities available and know-how acquired in Belgium in the illicit synthetic production of

primarily classical amphetamines. According to the EMCDDA and Europol (2011c), Belgium

is in fact considered to be one of the main production countries (together with the

Netherlands, Poland, Bulgaria and Turkey) for amphetamines seized in Europe.

Furthermore, the Belgian customs authorities point out that Belgium acts as an import and

export country for the raw materials of these new substances which originate from China and

India in particular (Personal communication).

The fact that most of the new substances reported to the EMCDDA by Belgium’s

neighbouring countries have also been reported by the BEWSD may be an indication of the

high degree of sensitivity of the BEWSD as a monitoring instrument. From this perspective, it

is remarkable that of the 13 most frequently reported substances in the EU (up to 31

December 2011) 11 were reported by the BEWSD and only 2 by the Dutch Drugs

Information and Monitoring System (DIMS). On the one hand, this could point to a difference

in the demand side of the market, to which the supply has adapted itself. In fact, the Dutch

policy of tolerance towards home grown cannabis may result in limited demand for e.g.

synthetic cannabinoids. On the other hand, the limited number of new substances reported

by the DIMS may be the result of the use of a different data collection method. It has also to

be noted that the used EDND data are based on the reporting forms on new psychoactive

substances submitted to the EMCDDA by the EU member states, and not the EWS progress

and final reports. Although EU Member States are expected to report every new

psychoactive substance identified through a reporting form, there are occasionally

exceptions to this procedure, and this might not be reflected in our analyses.

Another indication supporting the sensitivity of the BEWSD is the fact that the

evolution (i.e. marked increase since 2009) of the observed new psychoactive substances as

observed in Belgium runs parallel to the observations at European level.

The tracing and identification of new psychoactive substances is a complex, expensive and

time-consuming activity (EMCDDA, 2011c). In spite of the increase in the number of new

substances, the mean time interval between the first reporting of a new psychoactive

substance in the EU and the first reporting thereof in Belgium nevertheless decreased. This

time interval is, however, not an unambiguous indicator. It cannot simply be interpreted as

the time duration between the actual introduction (production or import) of the substance in

an EU Member State and the actual import thereof in Belgium, or as an indication of the

performance of the information exchange within the BEWSD. The time interval described in

51

this report is nevertheless the only (albeit rough) time indicator available today for the spread

of new psychoactive substances in the EU.

The information exchange within the BEWSD follows a logical sequence of actions

(seizure, judicial investigation, toxicological analysis, fixing of penalty) by different competent

actors (police and customs, prosecutor’s office, laboratory, court) before the information can

be registered and analysed by the BEWSD. An analysis of this process (not described in this

report) revealed a large variability in the time interval a) between the seizure of a product by

the police and the order by an investigating judge to perform a toxicological analysis of a

sample, on the one hand, and b) the time interval between the toxicological analysis of a

sample and the reporting of the results to the BEWSD, on the other hand. Because the

toxicological analysis is often part of a judicial investigation, this information is considered

confidential by a number of investigation judges, for the duration of the judicial investigation

and therefore not communicated to the BEWSD, despite the provisions in the RD 2003 on

informing the Belgian Focal Point of the European Information Network on Drugs and Drug

Addiction. As a result, substances identified as new by the BEWSD have often been present

in Belgium for more than a year before they are reported to the BEWSD. The exploration of

the Internet would seem to confirm this.

Besides, it can be noticed that this variability was also observed in other EU Member

States. Consequently, the above-described sequences of first reporting of a new substance

by EU Member States, Norway and candidate countries do not necessarily correspond with

the actual geographical spread of these substances in Europe. Furthermore, the first EU

country that reported the new substance to the EMCDDA is not necessarily the country

where the product was developed and produced. Finally, it can be noted that the use of the

Internet as a sales channel for these substances will further reduce the predictability of such

distribution routes.

This report compared the occurrence of new psychoactive substances in Belgium, as well as

the time interval between first notification in Europe and notification in Belgium, with the other

EU Member States, Norway and the candidate countries. The comparison of EWSD

indicators does, however, call for some reservation. In fact, the national EWSDs in Europe

differ from each other in many respects, such as their legal and regulatory framework; their

location within the government (health, police or judicial authorities); their coverage (local,

regional or national); and the resources allocated to these systems (EMCDDA, 2011c). The

national EWSDs also differ in their composition and capacity. Some NEWSDs have strong

networks for forensic and toxicological sciences, whereas other NEWSDs monitor samples

that were collected among users (EMCDDA, 2011c). The Dutch DIMS, for example, does not

52

use seized samples (as Belgium does), but receives its drug samples mainly directly from the

consumer within a national network of 22 test facilities (mainly in addiction care institutions).

The methodology of the DIMS could possibly explain why in the Netherlands the period

between first reporting in the EU and first reporting in the Netherlands is often shorter than

the EU mean period. They do, in fact, collect samples in environments where the new

substances are introduced, meaning that the substances are traced more easily. Users

having negative experiences with e.g. an ecstasy tablet will also be more easily inclined to

have them tested if such facility is available. This is also observed in Belgium among users

who have drug samples submitted to Modus Vivendi. This approach facilitates the mapping

of the use of new psychoactive substances, and may also provide relevant information for

the harm assessment of these substances.

Future priorities for the BEWSD

Investigation into the representativeness of the BEWSD. In this report, it was observed that

the BEWSD receives toxicological data from only a limited number of laboratories. The

representativeness of this data for the analysis of both biological and non-biological samples

is therefore unknown. Because representativeness is an important epidemiological

parameter, the BMCDDA launched, in collaboration with the Quality department of medical

laboratories of the WIV-ISP, a survey into the activities of 182 laboratories that perform

routine analyses on biological samples for alcohol and drugs of abuse (DOA). The results of

this survey should enable the BEWSD to evaluate the representativeness of the acquired

toxicological analyses of biological samples on the one hand, and to facilitate participation for

non-reporting laboratories on the other hand.

The BEWSD will also investigate the representativeness of the acquired toxicological

analyses of non-biological samples, at different levels: how many seizures are forwarded by

police services to prosecutor’s offices, how many samples are forwarded to which

laboratories? Since magistrates are free in the choice of experts for performing analyses on

seized samples, a good starting point would be a retrospective into requests by prosecutor’s

offices for toxicological analyses by laboratories.

Optimisation of information exchange between the BEWSD and the competent authorities

involved. Following the conflicts of interest identified during handling of the toxicological

information, the ad hoc working group “Legal Highs” of the General Drugs Policy Cell

proposed an amendment to the law of 24 February 1921 on the trafficking of poisonous,

53

soporific, narcotic, psychotropic, disinfectant and antiseptic substances and of substances

that can be used for the illicit manufacture of narcotic and psychotropic substances. The

working group proposed that the Interministerial Conference on Drugs add the following text

to Article 1 of said law: “the King can, by decree after consultation in the Council of Ministers,

and within the powers conferred upon Him by application of this article, define under which

circumstances laboratories and experts acting in the context of a judicial or criminal

investigation are required to communicate anonymous information about the composition or

the use of the substances referred to in this law, to the authorities designated by Him,

regardless of articles 28 quinquies § 1 and 57 § 1 of Code of Criminal Procedure.” (ACD

2012, Strategische nota Legal Highs). This amendment enables the compulsory transfer of

information from laboratories to the BEWSD, which will also benefit the representativeness

and up-to-datedness of the BEWSD database.

However, the information exchange from laboratories to the BEWSD also needs to be

optimised technically. To this end, the BMCDDA is planning to transform the existing

BEWSD website into a technical platform that will enable laboratories to notify their

toxicological analysis results via a registration form (unique record) or by uploading a file

(multiple records). This should result in a more standardised information transfer to the

BMCDDA and consequently improved quality of the toxicological data. It would enable the

BMCDDA to speed up the analysis, interpretation and reporting of these toxicological data to

the competent authorities involved, which in turn would be able to respond more swiftly to the

market dynamics of the ‘legal highs’. The BMCDDA aims, in addition to the current real time

ad hoc communication following the identification of new psychoactive substances or high

risk compositions of known substances, to provide annual feedback reports at the level of the

laboratories, police zones and judicial districts involved.

Supplementary to the optimisation of the exchange of toxicological information by the

laboratories to the BEWSD, the BMCDDA advocates the optimisation of the exchange of the

corresponding police and judicial information (context, location and size of seizure, referral to

the prosecutor’s office, fixing of penalty, etc.) to the BEWSD. This is aimed at retrograde

information gathering from the competent authorities involved in the seizure of a

psychoactive substance (and its follow-up). This does, however, also require the use by all

authorities involved (police services, customs, prosecutor’s office, court, laboratories) of a

unique code (Unique Identifier) that is assigned to the substance when drawing up the

seizure file.

54

The definition, in consultation with the authorities involved, of a minimal set of

variables that can be provided by each authority to the BEWSD will enable the BMCDDA to

analyse, interpret and report these data to the competent authorities involved in a reliable,

efficient and integrated manner. The BMCDDA aims to provide annual feedback reports at

the police zone and judicial canton level.

Support of regional projects in specific populations. This report on the presence of new

psychoactive substances in Belgium is mainly based on toxicological information acquired in

a context where the police have dismantled a production site or the customs authorities

seized an international shipment at a sea port or airport. These are often transit packages

that are not meant for distribution to the Belgian population. Information regarding the

composition and purity of the substances that reach the users (the so-called ‘street drugs’) is

rare in Belgium. Hence the support of methodologically valid and reliable and judicially

applicable projects aimed at collecting, analysing and reporting data on psychoactive

substances that reach and are consumed by the actual user, which could provide a

significant supplement to the existing knowledge on the presence and composition of seized

drugs, would be welcome. Several initiatives to collect substances directly from the user

have already been developed in Belgium (by the VAD: RAPID or Risk Analysis Project for

the Identification of illicit Drugs) and also operationalised in a number of cases (by Modus

Vivendi: Modus Fiesta). Optimisation of monitoring via the Internet. For this report, a rough screening for the

presence on the Internet domain .be of new substances reported by the BEWSD, has been

performed. Given the explorative character, the BMCDDA intends to further technically

develop this methodology into a full-fledged monitoring instrument. For this, the BMCDDA

can rely on the growing expertise of the EMCDDA, which each year, for a limited period of

time, takes so-called snapshots for monitoring one or more substances or products. In 2011,

for example, two multilingual snapshots were carried out, focusing on the same substances

as in the 2010 snapshot. In the first months of 2012, a snapshot was carried out in 20 EU

languages plus Ukrainian, Russian and Norwegian (EMCDDA 2011d). Alongside the

monitoring by the EMCDDA, several EU Member States (Hungary, Italy, France, Slovakia

and Romania) conduct their own Internet snapshots in their respective languages.

Monitoring of the online market of new psychoactive substances is necessary due to

the speed with which supply is expanding (EMCDDA 2011). Although the factors behind this

increase are difficult to identify, the EMCDDA (2011) refers to growing demand and

expansion resulting from the closure of the so-called physical ‘smart shops’. However, the

55

EMCDDA stresses that online monitoring alone may not be expected to describe the actual

extent of the phenomenon on the Internet, and that it is still not quite clear to what extent

drug users prefer the Internet as the main source of access to these substances. According

to the Eurobarometer 2011 of the European Commission (The Gallup Organisation. 2011),

new psychoactive substances are obtained primarily through friends (54%), in discotheques

(36%) or in specialised shops (33%). A minority (7%) of the respondents bought these

substances on the Internet (The Gallup Organisation. 2011).

Risk and harm assessment and establishment of a Committee for the Risk Assessment of

New Drugs. As a result of the rapid developments in the market of new psychoactive

substances, health authorities often lack reliable and valid scientific knowledge on the

specific substance during the risk and harm assessment. The collection of the relevant

pharmacological, clinical and socio-demographic knowledge takes time, meaning that an

interim analysis necessarily has to be based on sources (cases, in vitro studies) which often

have less strong evidential value due to their methodology.

At present the risk assessment of new psychoactive substances is conducted mainly

within the EMCDDA. However, the BMCDDA stresses the need for a procedure and

structure that can respond to specific national developments. In doing so, the BMCDDA

advocates the installation of a Committee for the risk assessment of new psychoactive

substances within the framework that was created with the approval of the protocol of 11

March 2008 (Belgian Official Journal 07.05.2008, 24196-24202) on the international

notification by Belgium under the International Health Regulations (IHR). This committee,

modelled on the Dutch Committee for Risk Assessment of New Drugs, with experts in the

field of drugs, drug use and drug addiction, and representatives from the Ministries of Health,

Home Affairs and Justice, can assist the permanent panel of experts of the “Risk

Assessment Group” (RAG) in its tasks (evaluation of notifications; analysis of the risk to

public health; proposing of measures to limit the spread of the threat).

Support of monitoring of use. The above-described results on the basis of the BEWSD are

an indication of the presence but not of the use of these new substances in Belgium. The use

of these new substances is, however, an important variable that is included in every risk and

harm assessment. This use is usually monitored by means of large-scale surveys at the

general population level or within specific populations (school youth) and contexts (party

scene). According to the recent Eurobarometer (The Gallup Organisation. 2011) of the

European Commission, 4% of Belgian youngsters between 15 and 24 years old have used

such a new psychoactive substance once in their lives. However, because new substances

56

are often not known by name, the reliability and validity of such surveys is uncertain. The

investigation into a reliable and valid methodology for monitoring the use of these new

substances should therefore be stimulated, preferably under international coordination. For

this, the BMCDDA can rely, among other things, on the expertise that is currently being

developed under the partnership agreement between the EMCDDA and the research

consortium European School Survey Project on Alcohol and Other Drugs (ESPAD).

Conclusion This report demonstrates that a growing number of new psychoactive substances have been

identified in Belgium since 2009. Approaches to optimising the monitoring of these

substances have been described. Such optimisation is necessary to enable both the

assessment and the control of the risks associated with these substances” (EMCDDA,

2011c).

57

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