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Early warning system

nov 2012 early warning

When a new drug starts causing trouble, who you gonna call? The police? The district health board? Your local newspaper? At the moment, there is no clear protocol for reporting new substances. Catherine McCullough outlines why New Zealand needs an early warning system for synthetic drugs.

If it bleeds, it leads.

This mantra of the media may partly explain why there are always so many drug-attributed horrors hitting the headlines. While it is true there are some grisly outcomes associated with drug use, drugs are also a convenient explanation for acts that shock society. There’s so much about drugs that is unknown or esoteric, it’s easier to get away with just making things up. As Russell Brown explained in the last edition of Matters of Substance, these sensational stories are all too often overhyped, falsely attributed or even completely unsubstantiated. While this may make for an entertaining read, it is not doing anyone any favours. In a world where a new drug is identified every week, good information is crucial to public health. We need to get our facts straight.

The latest poster child of the ‘look what drugs will do to you’ campaign is ‘bath salts’. This substance – or rather, assortment of them – is supposedly so badass, it is capable of turning people into flesh-eating zombies. Or making you skin yourself alive. Except of course in the first case, there was only cannabis in the guy’s system (and pot can stay detectable for up to a month) and the second is completely unsubstantiated. Yet the truth never seems to get in the way of a good story. True or not, if it bleeds a lot, it doesn’t just lead, it goes viral. Fiction quickly gains credibility through repetition. Faster than you can call for a fact check, these memes have spanned the globe and inserted themselves into people’s perceptions. 

It’s not just journalists contributing to the confusion. Local examples of misinformation regarding drugs include those attributed to police sources. It was a member of the police who recently suggested bath salts were to blame for the superhuman strength shown by an Auckland man who had to be tasered twice before he could be subdued. He didn’t need to test for the drugs, he just “understood” bath salts were the culprit. It was a member of the police who told a journalist samurai swords are the weapon of choice for methamphetamine users. I guess he’d conducted a survey.

When misinformation about drugs is more accessible than accurate information, we have a problem. In fact, we have a range of them. For starters, people who use drugs already face stigma so great it is a barrier to them seeking help or recovering successfully. Would you want to put your hand up and say “I’m a junkie” or a methamphetamine user? Both identities come with significant societal baggage. How do you think potential employers would feel about you if you were on methadone? Do you think you’d pass a pre-employment drug test? It is already hard enough for people. Adding a predilection for human flesh or samurai swords to the public’s perception about those using certain substances only adds to this stigma in the worst possible way. The promotion of such sensational stereotypes is not only baseless but is actively harmful.

The second issue is that, contrary to some of these stereotypes, people who use drugs are not stupid. They know if what they’re reading rings true to their own experience or not. Someone who has used methamphetamine is going to know it didn’t make them pick up a samurai sword. Someone who has taken bath salts is going to remember it didn’t result in a self-induced skinning. The more blatantlyincorrect information is released about drugs, the more people are going to dismiss the things hey’re told. The more misinformation is provided by supposedly trustworthy sources like the police, the more people’s trust in that source is eroded. Cry wolf or utilise hyperbole too frequently when talking about drugs and when something really scary does hit the market, any warnings are going to sound like the same old alarmist BS and go unheeded.

And there are some potentially dangerous drugs out there. One of the consequences of fear mongering around less harmful drugs in the past is that the rigid structures we’ve designed to contain them have given rise to things that are far more unnerving. The scary thing about the wave of new psychoactive substances that’s hitting the market is just how little we know about their contents or consequences. These new synthetic drugs are deliberately designed to circumvent both legislation and common forms of drug testing. They are a moving target. Once one is pinned down, it’s just a quick tweak of a molecule and another is ready to take its place.

What research has shown is that even identical packages carrying identical brands often contain a different combination of substances. So even if you’re taking the same amount from the same source, you could actually be taking different drugs and/or different doses. Ultimately, you are off the map. No one really knows what will happen to you when you take them. Or how to help you if something goes wrong. While the general wisdom has been that these new synthetics will have similar effects to the drugs they are designed to replicate, scientists are figuring out that this is not always the case.

So how do we ensure the accuracy of drug information in a world of moving targets? How do we get good information about these drugs to all of the people who need it? With a new drug being identified every week and so many players in the game, these are not easy questions to answer. Lots of countries are currently struggling to figure them out. However, many of them are making more headway in this area than New Zealand. Although the yet to be implemented pre-market process for new psychoactive drugs will make us a world leader in regulating synthetic substances, it is not going to be a panacea for all of our problems. We still need to develop a better system for collecting and disseminating good information to all concerned.

The first step has to be to quickly and correctly identify the drugs that are hitting our shores. The New Zealand Drug Foundation gets almost daily requests for information on the legal highs that are currently available from dairies and head shops around the country. These include calls from police officers trying to figure out if the products they are coming across are illegal or not. Our answer is that we can’t be sure. Although the ESR did a comprehensive test on the range of synthetic cannabanoids that were available as of mid-last year, there seems to be little information available on what’s in our stores now. Lots of the suppliers rebranded or released new products after the temporary drug class notices were issued last year, and we have no way of knowing what is in them until they’ve been tested too. These drugs exploit a legislative loophole – they’re not medicines or food – it’s not like the ingredients are listed on the side of the packet.

There are lots of international models we can look to or hook into to help us achieve enlightenment. Although some operate at very local levels and some are transnational, they all attempt to bring together key informants to share information with each other quickly. These informants generally tend to include the police, Customs, scientists, health professionals and policy specialists. The membership relates to the unique issues (usually legislative) that each region is grappling with. For example, Western Australia has developed the Emerging Psychoactive Substances Review Group. Given that the marketing and advertising of these substances is seen as a potential mechanism for their control, its membership includes senior representatives from the Department of Commerce’s Consumer Protection department.

The most comprehensive model that we’ve come across is the one that operates under the auspices of the European Monitoring Centre for Drugs and Drug Addiction. The European Early Warning System (EWS) on new psychoactive substances is a “multidisciplinary network of 30 national early warning mechanisms which collect, appraise and rapidly disseminate information on new drugs and products which contain them.” It is implemented primarily by the EMCDAA and its partners in the member states (the Reitox network) in co-operation with Europol. The European Medicines Agency (EMA) and the European Commission also actively contribute.

This model utilises organisations from both health and law enforcement agencies. Each member state has what are called the National Focal Points (NFPs) and Europol National Units (ENU). NFPs are part of the Reitox network and have more of a public health focus. They are responsible for collecting data and reporting on drugs and drug addiction. NFPs draw on information from a variety of sources including the media, and the UK branch is supported by a forensic early warning system that actively seeks out and tests new drugs. NFPs report to the EMCDDA on new trends in the use of existing psychoactive substances and/or new consumption patterns involving combinations of psychoactive substances that pose a potential public health risk.

ENUs have much more of a law enforcement focus. They are responsible for collecting data on aspects such as the supply of new psychoactive substances, the inclusion of controlled drugs in new products and the involvement of organised crime in the manufacture or market of any drug. By their powers combined, these two agencies act as central co-ordination points for a two-way flow of information between individuals and organisations at the national level and the wider European network. They work with their local agencies (police, coroner, Customs, health providers and so on) to gain insight into emerging substances and feed this back to the EMCDDA and Europol. They also disseminate information coming in from other member states to those at their national level.

Some of the main strengths of the European model are that its purpose is clearly defined and it is well coordinated. There are explicit responsibilities for each organisation and an agreed process for operating. However, member states are still able to do their own thing with the information gathered. The benefit of this model is that it connects the wide range of people concerned with or coming into contact with these substances, allowing for the efficient dissemination of critical information. The data collected is also stored in a searchable database, ensuring that emerging knowledge about new drugs is easily accessible to those who need it.

Such a well defined and co-ordinated approach is exactly what is needed in New Zealand. Although there are many people working hard to try to identify and control these emerging psychoactive substances, quality information is all too often inaccessible to those who need it. We would really benefit from better co-ordination and communication between concerned parties. There is no reason why we couldn’t create something similar to the early warning system in New Zealand. In establishing such a system, we have the advantage of being able to learn from the mistakes and successes of other jurisdictions. Being such a small country with a single layer of government and two degrees of separation can’t hurt either. Ultimately, the first step is simply making someone responsible.

While we’re at it, we also need to think about how to develop our own model in a way that provides good information to the wider public, particularly those who use drugs. Most of the overseas models we came across focus only on information sharing at a very high level. However, the UK is using the information collected by their National Focal Point to populate the pages of their public drug education website, Frank. The efficient transfer of intelligence enabled by the EWS means that Frank is one of the most up to date and accessible sources of information on new drugs in the world. It is being utilised by young people and drug users and also allows them to share their own experiences on the site.

So what about those pesky journalists? While this has not been an explicit priority of the other models we looked at, any early warning system should include a process for the provision of information to the media. It also needs to include some protocols around reporting on drugs in a way that promotes public health. The media tend to be one of the first on the scene when new drugs are causing harm. Like it or not, that’s where most people are getting their information from. We need to ensure that this information is sound.

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