Methamphetamine use in the Czech Republic History of methamphetamine n1950s – Misuse of psychostimulant medicines (Psychoton) n1960s – Misuse phenmetrazine nSince 1970s – methamphetamine (pervitin) n (manufactured home-made in a „kitchen“ labs) n nPervitin was mostly made either of ephedrine coming from ephedrine company in Roztoky nearby Prague or of Solutan containing pseudoephedrine nSmall group of users/producers with division of roles in the production (glass, precursors, chemicals...) nSince 1990s – the main problem drug in the Czech Cepublic n3 Prevalence of methamphetamine use in the general population nGeneral population survey (2008) nLife time prevalence: 5% n in the age group 25-34: 9 % nLast year prevalence: 2% nLast month prevalence: 1% n nESPAD 2007 n3,5% - a decline since 1999 n nSlight increase in the use of pervitin within nightlife settings nLast month prevalence in 2003 – 14%, in 2007 – 16% n n4 Problem drug use of methamphetamine nIn the long term: total estimates of 30 000 PDU n95% injecting users n2/3 - 20 000 PDU preferring pervitin nSignificant increase in PDU estimates in 2009 to 37 400 (from n 32 500 in 2008) n nIn 2008 - 21 000 problem pervitin users nIn 2009 – 25 000 problem pervitin users nincrease by 4 000 in comparison with 2008 n nUsti nad Labem region (4 000), Prague (3 000) n n5 nNumber of problem drug users per 1,000 inhabitants aged 15-64 Problem Drug Use (PDU) Treatment nPervitin users accounted for 60% of all the treatment demands n2009: n5 209 in total, 1/3 women nthe average age: 25 years, 20% people under 19 years nsecondary drugs: 55% cannabis, 15% opiates. n nPsychiatric co morbidity: nacute toxic psychosis, anxious and depressive disorders nhigher level of irritability (attacks of anger), paranoid syndromes, unexpected mood/emotional changes, pathological jealousy, memory and concentration disorders, social phobia etc. n7 Treatment nNumber of first treatment demands according to drug used, 1997-2009 Pervitin related infections and deaths nFatal overdoses – 18 cases (19 in 2008) n(direct drug related deaths) in terms of pervitin n nHIV prevalence in IDUs very low: app. 1 pro mile n 7 new HIV positive IDUs nAt the end of 2009: 1 344 HIV positive cases, 65 out of them IUD (app. 5 %) n nHCV prevalence in IDUs: 20 - 40% nunivariate analysis: prevalence of HCV lower in pervitin than in opiate users nmultivariate analysis: after adjustment for duration of injecting and needle sharing no statistical difference n9 Services for pervitin users nNo specific interventions for pervitin users are generaly implemented in practise nowadays nHarm reduction services nlow thresholds programmes (about 95 facilities) nDistribution of gelatine capsules – per os alternative for pervitin use n (drug user put pervitin into capsule and use it by a mouth instead of injecting) n Treatment modalities ninpatient and outpatient facilities (various forms) nPsycho-pharmacotherapy for treatment of psychiatric comorbidity nSporadic methamphetamine substitution by methylphenidate (Ritalin) and/or by vigabatrin (Sabril) - lack of evaluation, just case reports nPsychotherapy is based especially on cognitive-behavioral therapy nSociotherapy, after treatment care, supportive accommodation and work nCA tests incentive therapy based on behavioral therapy nP-centrum tests psychotherapy program based on 12 steps (AA) n10 Gelatine capsules for oral use of pervitin Kapsle Drug crime nPrimary drug related criminality (generally) ndrug use is not illegal/punished npossession of drugs for personal use: up to 2g n n2 500 persons prosecuted n90% of them is charged n1 400 is sentenced (in total for all types of drugs) n nProportion of drug crimes related to production and trafficking: 80% nProportion of drug crimes related to pervitin: 50% n12 n nDrug crime Drug crime nSecondary criminality ncommitted by drug users to obtain money for buying drugs n20% of total criminality related to drug users, mostly stealing things from cars n nCriminality committed under influence of drugs n2% of all crime (7000 in total) committed under non alcoholic drugs, mostly influence of pervitin nFor comparison: 18% is committed under influence of alcohol n n14 Production and market with pervitin nowadays nEstimated consumption in 2008 n4,5 tons with 80% purity, 0,1 tons for export mainly to Germany nUntil 2004 pervitin made of ephedrine nafterwards – stopped production of ephedrine in Roztoky nephedrine replaced by pseudoephedrine only (e.g. Modafen, Neurofen Stop Grip) nIn 2009 nrestriction for sales of medicaments containing pseudoephedrine in pharmacies ndue to this measure higher level of import of medicaments containing pseudoephedrine especially from Poland nestimation: 95% of all medicines intended for pervitin production at present nIncreased illegal import of pharmaceuticals containing pseudoephedrine from abroad (Poland) Meth Lab Methamphetamine production n Seizures of laboratories, precursors and methamphetamine n n n n nSales of pharmaceuticals containing pseudoephedrine in the Czech pharmacies – decrease in 2009 n nSeizures n2007 n2008 n2009 nEphedrine (g) n1,185 n1,677 n6,023 nPseudoephedrine (g) n218 n– n– nModafen® (tablets) n3,480 n7,876 n840 nNurofen® StopGrip (tablets) n11,948 n21,785 n876 nPanadol® Plus Grip (tablets) n72 n17,021 n1,224 nParalen® Plus n– n– n1,440 nAcatar® (tablets) n– n– n3,508 nCirrus® (tablets) n– n– n6 nIbuprofen® (tablets) n– n– n80 nIbuprom® (tablets) n– n– n22,080 nSudafed® (tablets) n– n– n12,231 nCooking labs n388 n434 n342 nPervitin (g) n5,978 n3,799 n3,599 Price and purity of methamphetamine nOnly/mostly retail market level nAverage price stable: n1 000,- CZ crowns (about 40 €) per 1g n nAverage purity: n70% (in the long term) pervitin is often cut by piracetam n nSporadically wholesale market level n500 000,- CZ crowns (about 20 000 €) per 1kg n n18 IMG_5568 IMG_5562 nMedicines containing pseudoephedrine in illicit lab Summary and prospects nIn 2008 the Government Council for Drug Policy Coordination established the methamphetamine working group, an inter agency, multidisciplinary body with representatives from important state authorities, institutions, academic bodies, NGO´s etc. n n Discussed topics: nTreatment (new specific interventions: e.g. contingency management therapy, substitution) nHarm reduction (eg. gelatine capsules) nSupply reduction (measures to decrease of availability of precursors and other chemicals (e.g. red phosphorus) n20 Conclusion nMethamphetamine (pervitin) is historically the main problem drug in the Czech Republic nProduced and consumed (almost exclusively) domestically nMade of ephedrine in past and pseudoephedrine from medicines nowadays nThough sale of medicines containing pseudoephedrine has been limited and decreased since 2009, it has had practically NO IMPACT on supply, price, level of use of pervitin nImport of medicines containing pseudoephedrine from abroad as source for pervitin production nMeasures in neighbouring countries? At EU level? nRisk of increased use of other stimulants? Cocaine? New synthetic cathinones and phenetylamines? n Thanks J mravcik.viktor@vlada.cz www.drogy-info.cz www.focalpoint.cz www.emcdda.europa.eu