This section completes the data and
analysis provided in other sections of the annual report with
a summary of the main questions, concerns and challenges surrounding
are synthetic drugs?
The term 'synthetic drug' strictly
refers to psychoactive substances that are manufactured
through a chemical process in which the essential
psychoactive constituents are not derived from
naturally occurring substances. The term 'synthetic
drug' began to be used synonymously with dance
or recreational drugs following the emergence
of the synthetic drug ecstasy (MDMA) and other
ring-substituted amphetamines in the recreational
dance drug scene, although non-synthetic drugs,
such as cannabis, cocaine and magic mushrooms,
are also consumed in these settings. Synthetic
drugs with long histories of illicit use include
amphetamines and lysergic acid diethylamide (LSD),
while ecstasy (MDMA) and other drugs listed in
Alexander Shulgin's Pihkal list(1)
have much shorter histories of illicit use. There
is growing global concern about the potential
manufacture of other and newer synthetic drugs
sold as an alternative to MDMA, or added to MDMA
tablets. The ease with which many 'synthetic drugs'
can be manufactured constitutes a challenge to
efforts to control supply, as laboratories can
be set up and moved with relative ease.
Some synthetic drugs, not all,
have hallucinogenic effects and may be either
stimulants or depressants of the central nervous
system (CNS), the latter being the case for GHB.
There are also synthetic opiates, such as methadone,
pethidine (MPPP, MPTP), fentanyl, 3-methyl-fentanyl,
'Designer drugs' are chemical
analogues of controlled drugs. Illegal producers
modify slightly the molecular structure of a prohibited
substance in order to obtain similar or stronger
pharmacological effects, thereby avoiding prosecution.
The EU joint action
on new synthetic drugs (see box on page 46) was
launched in June 1997 with the purpose of preventing
and/or limiting the extension of such practices.
Amphetamines are synthetic drugs.
They may be injected, as is the case in Sweden
and Finland, or taken in tablet or powder form.
Amphetamines are frequently mixed in ecstasy-like
tablets with MDMA or ecstasy analogues.
Methamphetamines are methyl derivatives
of amphetamines (mainly but not exclusively of
the unsubstituted-ring type). They include 'methedrine'
as well as 'crystal' and 'ice' which are forms
that can be smoked.
While the global picture in 2000 confirms
that the spread of synthetic drugs use in the EU has generally
stabilised, upward trends in ecstasy use are still observed
in some regions where cities or holiday resorts are more likely
to attract young European tourists owing to their location
and larger offer of youth-oriented events. More generally,
urban areas where youth cultures have been established may
continue to provide a setting for ‘recreational drugs’ to
anchor and develop.
Cross-analysis of qualitative surveys suggests
that the consumption of synthetic drugs has spread beyond
the 'techno scene' to discotheques, nightclubs and also private
settings. Other settings are also reported. For example, a
1998 study in Greece, 35 % of student ecstasy users have used
the drug at football matches.
and patterns of use
A growing behaviour trend is not so
much the consumption of one particular drug above another,
but rather a tendency to instrument different drugs in relation
to needs and situations.
Changing patterns in youth behaviour have
been highlighted in some Member States as a subject for more
Most countries underline the phenomenon
of quickly changing patterns among a broad public to
experiment and/or combine different substances to get
high and/or to balance the respective effects.
In the Netherlands, the phenomenon
of 'ecstasy-fatigue' is currently being assessed. The
reasons for this trend may be due to various factors,
for example that there is no logo proof of exact contents
or a heightened awareness (raised through the media)
of the adverse residual effects on mood and feelings.
The question as to whether cocaine plays an alternate
role as a basic stimulant with regular and known effects
is also posed. The combination of cocaine and alcohol
is reputed to be a 'good mix' among experienced users,
while the combination of ecstasy and alcohol is considered
more difficult to manage.
As far as ecstasy problem users are
concerned, some studies on addiction point out that
the addictive potential of the substance itself may
play a lesser role than the non-chemical and behavioural
addiction patterns associated with it.
All Member States, when drawing up
strategies, attach importance to differentiating between
groups of synthetic drugs users. A first and very broad
differentiation of ecstasy users can be made.
Excessive users. Even if MDMA has
a low dependence potential, a minority of users show
a compulsive pattern of use - more than once a week,
more than one pill at a time, use of multiple other
substances, intensive party activity throughout the
weekend and a lack of sleep. They are frequently part
of a network where drug use is very common.
Cautious users, with a less extensive
pattern of use.
Occasional users, with less knowledge
and awareness of possible risks.
Combined use of various substances, licit
and illicit, is a common behaviour pattern among young people
with an outgoing lifestyle (bars, discotheques, 'rave' and
techno parties, private parties). Polyuse - mixing or alternating
a large range of substances, synthetics or non-synthetics
- is the main trend, and 'self-management' of polyuse in a
changing context is a predominant pattern.
Shifting from one product to another and
polyuse patterns are linked to a certain extent to the availability
of different substances and opportunism plays a role. Personal/in-group
strategies are often mobilised to obtain a particular substance
and group dynamics play an important role.
A distinction should be made between substances
which are believed to be more adapted to the music event itself
and other drugs (such as after-dance drugs or not-dance drugs)
or substances experimented within an initiation circle led
by experienced users with at least some empirical knowledge
about dosages and side-effects. For a limited number of synthetic
drugs, the lack of such an environment could possibly present
MDMA is still the favoured product
of the ecstasy market and appears under numerous different
logos and many different names. For example, the German Criminal
Police Laboratory in Wiesbaden which monitored tablets stamped
with a 'Mitsubishi' three diamond-triangle logo has issued
a list of more than 200 different end-products.
Overdosed MDMA tablets were detected through
seizures and toxicological analysis or through on-site pill
testing by prevention teams at music events, allowing information
on their characteristics to be rapidly disseminated to all
EU countries through the EU early warning system.
A trend that needs to be monitored closely
is the increasing number of psychotropic medicines such as
ketamine, diverted from legitimate sources.
Lower purity and availability is noted for
amphetamine (or 'speed' - amphetamine sulphate). Scandinavian
countries are still the main market for injected amphetamine
and the United Kingdom for non-injected amphetamine.
The average consumption of methamphetamines
is still very limited in the EU. However, according to Europol(29),
evidence of production (laboratories dismantled) has been
confirmed for Germany and the Netherlands. Estonia and especially
the Czech Republic have also been involved in production and
trafficking. Methamphetamine, probably produced in the Czech
Republic has progressively replaced amphetamine for consumers
in Bavaria and Saxony, two bordering German Länder. Several
seizures of this substance were reported to Europol in 1999
by the law-enforcement agencies of Finland, Sweden, Germany
and the Netherlands.
Although still present on the drug scene,
the market for LSD and other hallucinogens has stabilised
or levelled off in most EU countries.
Treatment data, as an indication of
the level of problem drug use, provides very little coverage
for synthetic drugs with the exception of injected amphetamine.
Ecstasy is scarcely ever recorded as the primary drug in demand
for treatment, the patients typically being polydrug users.
The higher level of treatment demand for amphetamines as primary
drug with respect to Sweden and Finland can be explained by
the historical pattern of injecting amphetamine sulphate in
In the Netherlands, the introduction of
a specific entry for ecstasy use in 1994 has resulted in a
complete registration in 1995 in the outpatient care system.
Figures show a declining trend in treatment demand for ecstasy
since 1997, taking into account the apparent initial increase
in the two preceding years and this may be due - at least
in part - to improved registration. Still, ecstasy makes up
no more than 1 % of all drug clients (3.1 % for amphetamines).
In 1999, the number of clients reporting ecstasy as secondary
drug was twice the number of clients with ecstasy as main
drug, a figure consistent with the fact that ecstasy users
are typically polyusers.
Although rare and poorly documented,
there are possible acute effects of ecstasy-type substances,
especially when taken with other licit or illicit drugs (such
as GHB and alcohol), when mixed with other drugs with less
potential of acute adverse effects, or when tablets are strongly
overdosed and/or taken repeatedly over a short period of time.
Clinicians emphasise the role of risk behaviour
(such as the compulsive search for a 'high' and ignorance
of composition and/or effects) rather than the toxicity of
a particular substance isolated from its context and patterns
of use. Personal health background may also be a determinant.
In most cases, poly-intoxication is the
diagnosis, it being impossible to point to one substance above
In order to understand the nature and possible
long-term risks and neuro-psychic aspects which frequently
emerge in acute intoxication cases,
the priority for clinicians is now the follow-up of non-fatal
intoxications among young users of ecstasy (mostly mixed with
Long-term use may produce adverse effects.
Reversible and/or non-reversible effects on the brain are
still under discussion. In heavy ecstasy users, there is increasing
evidence of damage to serotonergic neurons. Clinical implications
indicate cognitive deficits but research projects in this
area (under way in the United Kingdom and United States) are
still few and far between.
Since outreach and other prevention
measures have been undertaken at techno/house events and parties,
a decrease in fatal incidents has been observed compared with
the early nineties, at least in countries where emergency
cases were recorded and documented.
Apparent overdose by amphetamine or phenylpropanolamine
derivatives, where these derivatives were considered as the
main cause of death, were attributed to 50 % of fatal cases
in the Netherlands during the period 1994-97. In the remaining
cases, amphetamine derivatives were present but death was
attributed to other drugs and/or alcohol or unknown causes.
One new synthetic drug, 4-methylthioamphetamine
(4-MTA, with the street name 'flatliner') has been implicated
in a number of deaths in the EU (four deaths in the United
Kingdom, one in the Netherlands). Another 'new' synthetic
drug, GHB (gamma-hydrobuxyrate), has also been linked to some
deaths, generally in association with alcohol and/or other
drugs. These two substances have been subject to monitoring
and risk assessment in the framework of the EU joint action
on new synthetic drugs (see box below).
Responses to synthetic drugs are organised
at different levels of intervention.
Primary prevention concentrates on providing
information on synthetic drugs and is usually carried out
through public campaigns and in-school interventions.
Harm-reduction/outreach activities in recreational
settings consist of chill-out rooms, pill testing, information
leaflets and on-site desks. There are also 'auto-support'
initiatives in the techno scene which aim to include information
on synthetic drugs and associated substances in a range of
Information among users about the risks
of mixing substances (especially the risk of alcohol) and
the early detection of new risk groups among young people
is now considered crucial.
The aim of quick health reponses is to provide
targeted prevention information which allows professionals
in emergency rooms and poison units, GPs, field health workers,
etc. to detect and respond better to cases of acute intoxication.
In France, since 1998, Médecins du monde has ensured
medical stand-by assistance at raves and other 'free-parties'.
Difficulties include the lack of clinically related literature
on acute intoxication episodes, and the impossibility of referring
to the individual's medical history.
Even if they have a less problematic drug-use
profile, 'new' drug users (new or experienced users not known
by treatment services) may be provided with improved information
on how to identify signs of problem drug use and the need
for assistance. Self-perception of one's state of health,
awareness of losing control of 'self-managed' use and knowledge
about access to counselling services are possible indicators
to be combined with preventive outreach actions. However,
the lack of diversity and/or relevance of existing treatment
offer may limit the effect of such efforts.
According to Europol (Annual report
2000), the Netherlands is still the primary country for the
production and export of ecstasy: 36 production sites were
identified in 1999. During the same year, four laboratories
were dismantled in Belgium, two in Spain, and one in Germany.
One of the largest amphetamine laboratories ever found was
dismantled in Greece in February 2000. Production and export
also involve a number of the east European countries (the
Czech Republic, Poland and Bulgaria) and the Baltic States.
By way of example, 10 to 20 % of synthetic
drugs for the UK market are manufactured in the United Kingdom,
while the rest are thought to be manufactured on the continent
(predominantly the Netherlands and Belgium) and enter the
United Kingdom at Channel ports or airports.
The average wholesale price (sales per kilogram)
for tablets marketed as ecstasy ranges from EUR 4 to EUR 5
per tablet, with a minimum price of EUR 1 in Portugal and
a maximum price of EUR 13 in Denmark(30).
The average retail price ranges from EUR 4 to EUR 28 per gram,
with a minimum of price of EUR 4 in the Netherlands and a
maximum of EUR 34 in Denmark.
initiatives and challenges for policy-making
Synthetic drugs are in the political
limelight despite the limited scientific evidence available
in terms of public health risks. Their high level of use among
socially integrated groups, their role as a reference model
within youth culture and the fact that production and trafficking
are set up in Europe (for both internal and external markets)
exert strong pressure for responsible action by the EU.
Synthetic substances and their risk assessment
are progressively included in a broader view of changing patterns
and behaviours, subcultures and evolutions. This has resulted
in the following actions:
setting up efficient communication channels
between all actors involved in rapid-response systems;
setting up better communication between
scientifically based information and policy responses;
for obtaining specific information on synthetic drugs
and more generally on emerging trends in drug use through
national and local prevalence estimates, treatment demand
records, also taking into account the main orientation
of treatment services towards opiates users.
EU joint action on new synthetic drugs
During the period 1998-2000,
the EU joint action 'early-warning system' for
the rapid collection and exchange of information
on new synthetic drugs detected a number of substances
which appeared on the illegal market in the European
Union. Joint progress reports summarising the
information collected at this preliminary stage
were presented by the EMCDDA and Europol to the
Horizontal Working Party on Drugs of the Council
of the European Union. At a second stage, following
a request by the Council, four of these substances
- MBDB, 4-MTA, GHB and ketamine - have been subject
to a risk assessment by the enlarged Scientific
Committee of the EMCDDA. On the basis of its risk-assessment
report and an opinion of the European Commission,
one new synthetic drug, 4-MTA, is subject to control
measures in all EU Member States by a Council
decision of 13 September 1999.
Other new synthetic drugs, such
as PMMA, 2-CT-5 and 2-CT-7 have recently been
detected under the joint action 'early-warning
system' mechanism and are currently being monitored
jointly by the EMCDDA and Europol, in close cooperation
with the European Commission and the European
Medicines Evaluation Agency (EMEA).
As an instrument to define whether
or not a particular substance should be placed
under control at EU level, the joint
action also provides Member States and European
institutions with a regular insight into the context
of drug use in recreational settings and gives
early indications on trafficking trends in synthetic
drugs. The risk-assessment exercises bring sound
material to the attention of policy-makers for
their reflection on possible options for a balanced
approach between law enforcement and preventive