Research Paper
Characteristics of the use of 3-MMC and other new psychoactive drugs in Slovenia, and the perceived problems experienced by users

https://doi.org/10.1016/j.drugpo.2015.03.005Get rights and content

Highlights

  • Characteristics of the use of 3-MMC and other new psychoactive drugs in Slovenia.

  • NPS users’ risk assessment and patterns of risk use of NPS.

  • Perceived problems of NPS users and reasons for cessation.

  • Harm reduction measures in the field of synthetic cathinones.

Abstract

Background

The study presents the characteristics of the use of new psychoactive substances (NPS), the perceived problems experienced by users, and the reasons for cessation or cutting down. The research focused mainly on synthetic cathinones and the use of 3-MMC in Slovenia.

Methods

In order to research the characteristics of NPS use, we used a questionnaire which had been developed to determine the characteristics of the use of ATS and cocaine in the context of nightlife and was elaborated in our study on the use of mephedrone. The final non-representative sample included 249 users of NPS from Slovenia, who had completed an on-line survey over a period of 5 months in 2014. Part of the sampling was conducted on the ground and with the help of peer-groups. DrogArt's outreach workers and correspondents visited open public places, clubs, and discotheques to encourage users to participate in the survey.

Results

Most users of NPS in Slovenia have tried NPS from the groups of synthetic cathinones and amphetamines. Most respondents included in the sample (67.9%) have tried 3-MMC, while 43.0% have tried methylone and 37.3% have tried mephedrone (4-MMC). Users attributed greater risks to the use of new drugs and preferred the effects of traditional drugs to those of new drugs. The most frequently reported problems were depression (55.2% of users), concentration difficulties (44.0%), damage to the mucous membrane of the nose and to the throat (39.8%), feelings of fear and anxiety (39.4%), and tingling in the arms or legs (34.4%). The main reasons for cutting down or discontinuing the use of NPS were ‘fear of the health consequences’, ‘actual health consequences’, and ‘growing weary of using’. Among users of NPS, 7% have sought help, while 9.1% have considered doing so. The results also highlight differences between the NPS drug markets in Slovenia and the United Kingdom.

Conclusions

In 2014, the most frequently used NPS in Slovenia were synthetic cathinones such as 3-MMC. Users experienced various problems related to the use of NPS. However, they are familiar with recommendations on harm reduction and want additional information on the harmful effects of the use of NPS. Based on the obtained results, we can develop specific interventions in the area of harm reduction.

Introduction

In recent years, new synthetic drugs, or new psychoactive substances (NPS), have had a significant impact on the nightlife, young people, user experiences and the market for psychoactive substances in Slovenia. The resulting responses have ranged from harm prevention programs and efforts by the Ministry of Health, through the introduction of an early warning system, to an assessment of the perceived harm to the users and a ban on mephedrone. Being rejected at first by users of ‘classic’ drugs, the new drugs took some time to establish themselves on the market. However, once the effects and potency of substances such as mephedrone became widely known (and as a result of a shortage of MDMA), the drug quickly gained popularity and established its place on the market as a powerful stimulant. Mephedrone was also the first example of a new type of psychoactive substance (synthetic cathinone) coming into more widespread use. With this, the risks and dangers of frequent use of larger amounts of these substances started to become apparent (Baumann et al., 2013, Coppola and Mondola, 2012, German et al., 2014, Miotto et al., 2013, Zawilska and Wojcieszak, 2013). In the period from 2008 to 2009, mephedrone was one of the most sought-after drugs in the country, firstly as a ‘legal high’ and later on as an illicit drug. Most European countries responded by banning the trafficking and production of mephedrone (4-MMC). As expected, this did not stifle the demand for the specific stimulative effects of the new drug (McElrath and O’Neill, 2011, Winstock et al., 2010). Developers of new synthetic substances soon put a whole range of mephedrone ‘substitutes’ on the market. Among those, 3-MMC (3-methylmethcathinone), also called sladoled, or ice cream, in Slovenia, probably due to its sweet scent, was the most recent to become widely popular after the ban on the sale of mephedrone. It is similar to 4-MMC in terms of effects although less potent and intensive, according to users. In Slovenia, mephedrone was classified as a Class I drug in 2011 when the Slovenian government amended its decree on the classification of illicit drugs following the adoption by the European Council of a decision requiring EU Member States to regulate the new psychoactive substance in the previous year.

The first wave of mephedrone use in Slovenia was recorded by a study on the use of cocaine in the context of nightlife (Sande & Purkart, 2011). Conducted in 2010, before the substance was listed as an illicit drug, it was the first to measure the prevalence of NPS in the country. It included 607 respondents, slightly over half of whom were contacted in clubs and bars across Slovenia (the remainder were contacted via the internet). With regard to the use of mephedrone, the results were surprising, with 20.8% or respondents reporting having tried it. The level of frequent use, however, remained low, with only 3.0% reporting having used mephedrone on 40 or more occasions. At that time, the highest level of mephedrone use was recorded in the UK, where according to a MixMag study conducted in 2009 (Dick & Torrance, 2010) 41.7% of respondents reported having tried mephedrone. More recent MixMag studies have since shown a steady decline in the use of mephedrone among UK clubbers, with the 2012 and 2013 studies recording prevalence levels of 19.5 and 13.8%, respectively. The drug is now said to be one of the most unpopular in terms of ‘bad effects’ (Business As Usual, 2014).

Based on the results of studies on cocaine use and the increased use and seizures of mephedrone in the EU (Annual Report, 2010, Winstock et al., 2010), DrogArt conducted in 2011 a small-scale study on the characteristics of the use of mephedrone (Nacionalno Poročilo, 2011), as new information collected on the ground began to complement available data on the use in the context of nightlife. Outreach workers and informants working at nightlife venues reported an increase in the use of mephedrone. They also reported on problems of users related to increased and more frequent use. The principal aim of the study (‘MEPH 2011’) was to shed some light on the characteristics of mephedrone use and to determine the users’ views on its harmful effects. In addition, the study also focused on other new psychoactive substances such as methylone.

An online questionnaire addressing mephedrone users only was used, and the sampling was carried out exclusively via the Internet. The sample included 112 users, all of whom had tried mephedrone. Furthermore, 55.4% reported having tried methylone and 27.7% reported having tried 2CB/2CE. A large share of respondents (42%) reported having tried other ‘legal highs’ (MDPV, 4FA) available in Slovenia at that time. The study also focused on the reasons for discontinuing the use of mephedrone, and therefore, it was important that at least half of the sample group (53.2%) consist of respondents who had given up the drug.

The MEPH 2011 study provided important information concerning the use of mephedrone in Slovenia right before the ban. According to the results, the most important reasons for use as reported by the users were the drug's ‘positive effects’, ‘greater purity when compared to illicit drugs’ and ‘low price’, with between 40 and 80% of respondents rating them as ‘important’ or ‘very important’. At the bottom of the list of reasons were easier accessibility and legality of the substance (34%). Most respondents did not purchase the drug on the Internet (before the ban), but from a dealer or friend instead. Only 10.7% acquired mephedrone on the Internet. Reflecting the findings of other studies, friends and dealers were found to be the main source of mephedrone. That fact remained unchanged after the ban (McElrath & O’Neill, 2011). Most frequently respondents bought mephedrone from a friend (62.2%) or a dealer (27%).

Like several related studies and case reports (Dargan et al., 2010, Winstock et al., 2011, Wood and Dargan, 2013), MEPH 2011 also focused on the problems cited by users as arising from mephedrone use. The most frequently reported psychological problems were insomnia, depression and concentration difficulties, while damages to the mucous membrane of the nose and tingling of the arms and legs were the most frequently cited physical problems. Furthermore, since users reported craving and using increasing amounts of the drug (information collected on the ground), signs of addiction were examined as well. The study confirmed that ‘increasing frequency of use’ and ‘using larger amounts than planned’ were common problems (22.3 and 37.5%, respectively). Sixty-three percent of respondents had had problems discontinuing the use of mephedrone before using up their entire supply.

Reasons for quitting or cutting down should be taken into account when planning prevention and harm reduction measures as well as the provision of counselling and psychotherapy with regard to NPS. The main reasons for cessation or cutting down were ‘fear of the health consequences’ and ‘increasing amounts used and frequency of use’. More than 50% of respondents rated these reasons as either ‘important’ or ‘very important’. Other important reasons were ‘actual consequences of use’, ‘addiction’ and ‘growing weary of using’.

Following the MEPH 2011 study and the ban on mephedrone in the summer of 2011, this NPS was no longer available for purchase in Slovenia. Unlike in other countries, it did not reappear on the Slovenian market. One or two months before the ban, mephedrone was replaced by 4-MEC (4-methylethcathinone) as the most popular NPS (according to information provided by users). Methylone (bk-MDMA) became the most sought-after NPS after the ban. While mephedrone was replaced by two legal NPS—4MEC and methylone—immediately after the ban, by August 2012, the two were replaced by 3-MMC, which had been banned along with mephedrone. According to information provided by users, reports by outreach workers, and the number of cases registered by DrogArt's counselling and therapy centre, the new (illicit) isomer of mephedrone remained the most popular and sought-after NPS among young people and young adults in Slovenia until 2014.

Given the growing popularity of various NPS in EU states including Slovenia (European Drug Report, 2013, European Drug Report, 2014), we set out after 2011 to examine in greater detail the characteristics of NPS use among young people. In addition to that, our main objective was to come up with suitable forms of intervention within the framework of existing aid programs. The resulting study focused among others on 3-MMC since it had become evident that its use was on the rise.

Section snippets

Methods

The study on the use of NPS employed a quantitative as well as a qualitative approach. The former was used to acquire information about the characteristics of NPS use, the risks and problems related with NPS use, and the need for assistance, while the later was used to gain more detailed information concerning the characteristics of use and an insight into the legal aspects and the development of the market for NPS. This article presents only the findings yielded by the quantitative part and

Study sample

The study sample consisted of NPS users (or ex-users) who had completed the online questionnaire in the period from 28 May 2014 to 30 October 2014. We attempted to reach respondents through various websites, portals, social media sites and online forums. The majority (42.4%) were reached via Facebook, while almost a third (32.2%) volunteered by clicking directly on the survey. The majority of respondents reached via websites and portals were directed to the survey from the website //www.partyinfo.si/

Data collection

The pilot questionnaire was prepared and posted online. It had been uploaded 3 months earlier, while still in the test phase, in order to gather information. The questionnaire was completed by NPS users, and our research team later updated the list of psychoactive substances and shortened the questionnaire based on the users’ feedback and comments. Since the qualitative part of the study coincided with the preparation of the questionnaire, certain questions which had arisen during the initial

Sample characteristics

The final sample was comprised of 249 users of new psychoactive drugs, of which 51.8% were men and 48.2% were women. The age range was 15–40 years. The average age was 23, while the mode was 19 (10.4% of the sample population). The majority of respondents were still in school at the time of the study (n = 249). Tertiary-level students represented 43.8% of the sample population, while secondary-level students represented a 23.7% share. The remaining share consisted of employed (18.9%),

Discussion

Due to the prevalence and relative popularity of mephedrone and other synthetic cathinones, and the developments in the market, it is extremely important to carry our regular research in this area in order to keep up with its constant evolution. The use of synthetic cathinones is potentially a huge public health risk, and therefore, studies should focus on legislation as well as on the treatment of complications related with the use of mephedrone (Dybdal-Hargreaves, Holder, Ottoson, Sweeney, &

Acknowledgements

This study was financed by the Ministry of Health of the Republic of Slovenia. The financing did not have an impact on the results of the study.

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