Category: Mental Health and Substance Use series

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Avoiding Harm from Misrepresented Drugs

Drug checking at music festivals

by Warren Michelow

The summer music festival season is full of fun and excitement, but there can be a dark side to the exuberance—people overdosing or suffering negative effects from drugs. Too often, what someone buys as ecstasy turns out to be something else, including chemicals with a history of causing injury or death. Enter drug checking, a quick and simple method for screening drug samples. The technique uses reagents to indicate the presence of target chemicals through changes in colour. While most of these tests don’t determine dose or purity, they do help people know if they are getting what they paid for and can identify contaminants or unwanted substances.

Drug checking using both reagent-based screening and mobile laboratories has been available at European venues since the 1990s. To date, tougher drug control in North America has made it harder to provide drug checking here; nevertheless, several community groups in Canada and USA have offered drug checking at events over the years. For example, ANKORS (AIDS Network Kootenay Outreach and Support Society) in Nelson, BC has provided drug checking at the Shambhala Music Festival for over a decade1.

drug-testing-at-festival

Chloe Sage from ANKORS and Warren Michelow, a graduate student associated with CARBC, have just released “Drug checking at music festivals: A how-to guide”, funded by the BC Ministry of Health, that distills knowledge and practices learned from providing drug checking and other harm reduction services at music festivals and events since the early 2000s. The guide is intended to help people in the community and public health groups interested in providing services at events or in other community settings. It describes in practical detail how to set up and run a drug checking service, how it can fit with other health-related services at a festival, and how to do the testing in a legal way.

Drug checking services are accessed by people interested enough in using drugs to already be in possession of a substance they intend to use. Seeking out drug checking demonstrates an interest in health-oriented information about substance use and potential hazards associated with the substance they think they have. Describing the strengths and limitations of results from reagent-based screening and getting confirmation of understanding is a key part of a drug checking encounter (see “Testing Disclaimer” in the Guide for an example). The natural flow of a testing encounter offers a scaffold to engage in conversation about drug-related knowledge and strategies for responsible use and managing risk. Field experience shows that after receiving an unexpected result—especially one that suggested the presence of something known to be harmful, e.g., suspected PMMA—people choose to dispose of that substance rather than take it2.

Between 2008 and 2015, the United Nations early warning system received reports of 644 new psychoactive substances with 75 being reported in the first part of 2015 alone3. Sometimes these are sold as exotic new “legal highs”, but often they are misrepresented as more popular and better known drugs such as ecstasy or LSD. Being so new, we know little about the potential for adverse health effects from consuming these substances.

Having capacity to screen for misrepresented substances and known hazardous substances is an essential tool for preventing avoidable harm at festivals and other entertainment venues where substance use takes place. In the absence of any better alternative, rapid presence/absence screening serves a vital public health function.

Download the guide and find related resources at http://michelow.ca/drug-checking-guide/ and http://www.ankorsvolunteer.com/.

1 Warren Michelow, Cheryl Dowden. “Start Small, Take it Easy” Results from the ANKORS Harm Reduction Survey at the 2013 Shambhala Music Festival. Available at http://michelow.ca/r/smf2013rep.

2 Chloe Sage. Harm Reduction and Drug Checking: A wrap-around service for festivals. Case Study: Shambhala Music Festival /ANKORS Drug Checking Harm Reduction Service data 2015. Available at http://michelow.ca/r/smf2015dcsum.

3 United Nations Office On Drugs and Crime. World Drug Report 2016. (United Nations publication, Sales No. E.16.XI.7). Available at http://www.unodc.org/wdr2016/.

Michelow_portraitWarren Michelow is a graduate student affiliated with the Centre for Addictions Research of BC. He is currently a Ph.D. candidate in the School of Population and Public Health at UBC and his doctoral research is on simultaneous polysubstance among mainstream substance users.  He has received the Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award, the Integrated Mentor Program in Addictions Research Training Fellowship and a MITACS ACCELERATE Internship.

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Detecting and addressing mental health and substance use disorders — the earlier the better

More than half of the people who seek help for an addiction also have a mental illness. These concurrent disorders present some of the most complicated and difficult-to-treat cases for our healthcare system. The links between mental health and substance use are complex, and causality can vary or be unclear. For example, a young person might use alcohol to cope with anxiety; on the other hand, the use of alcohol and drugs may promote or worsen the presence of psychological symptoms. Regardless of the direction, one way to approach the problem is to try to understand the common factors that can underlie both.

Research suggests there are many developmental pathways through which substance-use disorders and mental illnesses arise, but let’s look at one example: a child who tends to be socially withdrawn, displays emotions such as anxiety and depression, and is fearful of new experiences. Children with these characteristics seem to be at a greater risk of developing concurrent disorders. One study has shown that children with this temperament at age three were more likely later in life to attempt suicide, meet the criteria for depression, and experience alcohol-related problems. Another study of those showing these behaviours in early childhood revealed heightened activity in brain areas sensitive to reward during adolescence, which was later tied to higher levels of substance use in young adulthood.

At first blush, the developmental path to concurrent disorders might seem unavoidable, but with increasing knowledge of risk factors comes the capacity to address the issue from a preventive approach. Often overlooked, children who are socially withdrawn and anxious can be seen as less problematic by parents and teachers than their peers with overt behavioural problems. Because of such tendencies, the essential first step towards intervention is to inform parents, childcare professionals and teachers about how to detect concerning behaviours in children.

While drug-based education aimed at preventing or delaying substance use is often implemented in schools, earlier interventions that enhance social skills are lacking. Emerging evidence suggests that such interventions can be effective in addressing problems that can lead to concurrent disorders later in life. Interventions to enhance parenting skills can be beneficial in reducing behavioural and substance use problems. School-based programs where teachers are trained to implement curricula aimed at improving cognitive, emotional and social competencies in young students are showing promising results, but need to be further examined to ensure their effectiveness. Each child is unique and the best intervention strategy will be one tailored to meet his or her specific needs.

To improve policies, programs and practices in addiction prevention, detection and treatment, the Canadian Centre on Substance Abuse (CCSA) has partnered with organizations such as the Mental Health Commission of Canada, the Canadian Executive Council on Addictions, and the Ontario Centre of Excellence for Child and Youth Mental Health to provide evidence-based information through a number of CCSA publications:

Concurrent disorders are both preventable and treatable, with earlier detection and intervention producing better long-term results. More information is available at www.ccsa.ca.

A photo of Opal McInnis

Author: Opal McInnis, M.Sc., Research and Policy Analyst, Canadian Centre on Substance Abuse; PhD Candidate, Department of Neuroscience, Carleton University.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC