Päihdepäivät 2018, seminaari 7: Winstock

FINLAND 2018
How Fins Do Drugs – Key Findings from GDS2018

• I am the owner and founder of Global Drug Survey.
• Take no money from the tobacco or alcohol industries.
• Independent of any government, lobby group or research funder
• We self fund our work by creating data based reports for media
networks, public health organisation, research groups, health and
monitoring agencies and corporate groups.
Conflict of interest declaration
Global Drug Survey GDS2018 © Not to be reproduced without authors permission

On-line, anonymous confidential, encrypted, self complete survey
www.globaldrugsurvey.com

Global Drug Survey
runs the world’s
largest drug survey
> 550,000
participants since
GDS2013

Core
research
team
CRT
support
team
? CRT
funders
Multi-
country
partner
orgs
Media
partners
People
who use
drugs
Wider
research
network
Acknowledgements

Core
research
team
CRT
support
team
? CRT
funders
Multi-
country
partner
orgs
Media
partners
People
who use
drugs
Wider
research
network
Acknowledgements
Finland
Aleksi Hupli
Miina Kajos
Finnish A Clinic
Foundation

GDS aims to
make drug use safer regardless of the legal status
of the drugs by sharing information with individuals,
communities, health and policy organisations and government.

GDS2018 was translated into 19 languages
But there are many places we would love to
reach in GDS2019– SE Asia, India and Africa

Triangulation: data from multiple sources

Published >50 academic articles using GDS data in last 6 years

Honest
conversations

P R E PA R E D B Y T H E G D S C O R E R E S E A R C H T E A M
Prof. Adam R. Winstock, Dr. Monica J. Barratt, Dr. Larissa J. Maier, & Ass. Prof. Jason A. Ferris
FINNISH GDS2018 REPORT
N = > 1300

A G E R A N G E ( % )G E N D E R ( % ) A G E & G E N D E R ( % )
DEMOGRAPHICS (AGE & GENDER):
ENTIRE GDS2018 SAMPLE VS FINNISH SAMPLE

MEAN AGE OF SAMPLES BY COUN T RY

E D U C AT I O N A L S TAT U S ( % )
DE MOGRAPHICS (E DUCAT ION AL AT TAIN MEN T & IN VOLV E ME NT)
ENTIRE GDS2018 SAMPLE VS FINNISH SAMPLE
D E G R E E O R H I G H E R ( % )

1 2 MON T H DRUG US E AMON G T HE FIN N ISH GDS 2 0 18 SAMPLE
n = > 1300

1 2 MON T H DRUG US E (MIN US ALCOHOL/ CAFFE IN E / N ICOT IN E)
n = > 1300

The world of drugs has
changed for ever

Internet sales of mephedrone....

A long long time ago there was first internet transaction

Product range, quality,
convenience and vendor ratings (Barratt at al 2014)

2 0 1 8 : HAVE YOU OBTAINED DRUGS FROM DARKNET MARKETS IN THE LAST
12 MONTHS? (Countries with N>500)
Base sample: Last year use of illicit drugs, new psychoactive substances and/or prescription drugs
* Includes those who report personally purchasing drugs, arranging for others to purchase drugs or purchasing on behalf of others from darknet markets.

DARKNET MARKETS DRUG PURCHASE – 5-YEAR TRENDS (12M)
NOTE: NORDIC COUNTRIES
SHOWN HERE
Base sample: Last year use of illicit drugs, new
psychoactive substances and/or prescription drugs.
* Includes those who report personally purchasing drugs,
arranging for others to purchase drugs or purchasing on
behalf of others from darknet markets.

5 -YR T RE N DS: OBTAINED DRUGS FROM DARKNET MARKETS
la st 1 2 months (Countr ie s / years whe re N >5 0 0 )
Base sample: Last year use of illicit drugs, new psychoactive substances and/or prescription drugs
* Includes those who report personally purchasing drugs, arranging for others to purchase drugs or purchasing on behalf of others from darknet markets.
Note : major English
la ngua ge countr ie s
s hown he re

FINLAND: DRUG TYPES OBTAINED
la st 1 2 months n = >3 7 5
41% bought only one drug type from darknet markets
in last 12 months

4 -YR T RE N DS: Which dr ug ty pe s obta ine d from da r k net ma r kets
LSD MDMACANNABIS NEW DRUGS

M O S T C O MMO N S O URC E F O R P U R CH A S E O F L S D
L A S T 1 2 M O N T HS

Data from over >100,000 people was used to compile this report including >1000 from Finland
ALCOHOL GDS2018 SAMPLE
FINLAND

COUNTRY COMPARISON OF RISKY ALCOHOL USE AUDIT SCORE 16+
Only countries with n > 250 drinkers were included in these graphs

ALCOHOL LABE L HEALT H WARN IN GS COMPARE D
INFORMATION NEW TO THEM (by a ge a nd ge nde r )
>50% unaware of
reducing cancer risk
by drinking less

ALCOHOL LABE L HEALT H WARN IN GS COMPARE D
WOULD IT MAKE YOU THINK ABOUT DRINKING LESS? (by a ge a nd ge nde r)

ALCOHOL LABE L HEALT H WARN IN GS ON CALORIES
WOULD IT MAKE YOU THINK ABOUT DRINKING LESS? (M+F combine d)

ALCOHOL LABE L HEALT H WARN IN GS ON CANCER
WOULD IT MAKE YOU THINK ABOUT DRINKING LESS? (M+F combine d)

EMERGENCY MEDICAL TREATMENT SOUGHT FOLLOWING ALCOHOL USE
LAST 1 2 MON T HS ( M+F combine d)

COUN T RY COMPARIS ON : EMERGENCY MEDICAL TREATMENT SOUGHT
FOLLOWING ALCOHOL USE LAST 1 2 MON T HS (M+F combine d)

COUNTRY COMPARISON ALCOHOL USE – LAST 1 2 MON T HS
WHO WOULD LIKE TO DRINK LESS AND WHO WANTS TO SEEK HELP?

Please refer your readers to our free, anonymous and confidential online tool www.drinksmeter.com and the app D R I N K S
M E T E R , recently rated as the most highly praised digital app* to help people to reduce alcohol consumption.
More than 90% recommended the app to their friends and more than 60% said they plan to actually plan to drink less after
completion. It takes 8-10 minutes and it can change a person’s life.
DRINKS METER - GET SOME FEEDBACK ON YOUR DRINKING
GDS COULD CREATE A FINNISH VERSION
*MILLWARD ET AL 2016

Over 50,000 last year cannabis users competed the GDS2018 specialist section, of which
approximately 700 were from FINLAND
FINNISH GDS 2018 SAMPLE :
CANNABIS

W H O U S U A L L Y M I X E S C A N A B I S W I T H T O B A C C O A R O U N D T H E W O R L D ( % o f c a n n a b i s
u s e r s f r o m e a c h c o u n t r y w h o r e p o r t u s u a l l y m i x i n g t h e i r c a n n a b i s w i t h t o b a c c o )
M + F c o m b i n e d

% OF CAN N ABIS US E RS WHO HAV E
E V E R T RIE D T O S T OP
H A V E Y O U T R I E D T O S T O P U S I N G
C A N N A B I S I N T H E L A S T 1 2 M O N T H S
( % o f t h o s e w h o ’ v e e v e r t r i e d t o s t o p )
Finland Finland

SEVERITY OF DEPENDENCE SCALE – SCORING 4 OR HIGHER
Drugs compared
1 in 5 cannabis
users

Drugs Meter

Do you think governments
should produce cannabis
regulation guidelines like
they do for alcohol?
Yes 75.6%
No 10.2%
Unsure 14.2%

WWW.SAFERUSELIMITS.CO

FINNISH GDS 2018 SAMPLE :
MDMA
57.1% of FINNISH GDS2018 participants reported ever having used MDMA, with 40.2% reporting use in the last 12 months
Data from 22,000+ people from around the world who reported the use of MDMA in the last 12 months was used in the
preparation of this report., including approximately 500 who came from Finland

MEAN PRICE FOR A SINGLE GRAM OF MDMA (EUROS)
Only countries with n > 100 users were included in these graphs

MEAN PRICE FOR A SINGLE MDMA TABLET OR PILL (EUROS)

AVERAGE NUMBER OF DAYS MDMA USED LAST 1 2 MON T HS
ON A DAY OF US E BY COUN T RY

MEAN NUMBER OF MDMA PILLS USED

MEAN AMOUNT OF MDMA POWDER USED LAST 1 2 MON T HS

MDMA – EMERGENCY MEDICAL TREATMENT SEEKING

For the second year running, magic
mushrooms seem to carry the lowest
acute risk of harm of any drug.
The acute harm ranking of 13 drugs:
1. Novel Drugs
2. GHB
3. Methamphetamine
4. SCRAs
5. Amphetamine
6. Mephedrone
7. Alcohol
8. LSD
9. Cocaine
10. MDMA
11. Ketamine
12. Cannabis
13. Magic mushrooms
EMERGENCY MEDICAL TREATMENT SEEKING BY DRUG & SEX – GLOBAL

Data from >10,000 people who reported using MDMA, cocaine or LSD for the very time in the last 12 months was used in the
preparation of this section.
LOSING YOUR DRUG VIRGINITY

Your 1st time

LOSING YOUR DRUG VIRGINITY – EXPERIENCE
Positive experience/pleasure
(10 = most pleasurable)
Negative / unpleasant
(10= most unpleasant)
COCAINE

LSD

MDMA

Did you seek, emergency medical
treatment after using MDMA for
the time use.

HOW OLD WERE YOU WHEN YOU USED LSD FOR THE FIRST TIME?

Mean age of first use of LSD and % of users where first use was aged 16 and under only countries
with n > 100 ever users)
27,92 27,79
24,13 23,68
20,89
18,48 17,9 17,67 17,58
16,87 16,63
13,45 12,99 12,58 12,55 12,29 12,12 11,9 11,9
10,96 10,91 10,64 10,2
7,58 7,43
6,09 5,59
4,86
18,58 19,13
19,98
19,09 19,42 19,47
20,41 19,83 20,1 20,4 20,04 20,54 20,89
20,25 20,63 20,29
21,48
20,16 20,48
21,25
20,16
21,07 20,71 21,25
23,19
22,36 22,33
20,44
16 years and under (%) Mean age first use (years)

BEFORE YOUR FIRST TIME HOW CERTAIN
WERE YOU THAT YOU’D TRY LSD
(M v F)

T HIN KIN G ABOUT T HE FIRST T IME YOU
US E D LS D, WAS IT AC T UALLY PLAN N ED?
(BY GE N DE R)

% where first ever use of LSD was at home alone
(only countries with n > 100 last year users)
19,6
14,6 14,4
13,6
12,0
10,3
9,5
8,4 8,0 7,9
6,5 6,3 5,9 5,9 5,9 5,9 5,4
4,5 4,4
3,7
3,0
0,0
5,0
10,0
15,0
20,0
25,0
% first time used home alone

FIRST TIME YOU USES LSD DID YOU
PURCHASE IT | TAKE ADVICE| WHAT DID YOU KNOW ABOUT LSD?

Adam Winstock
ALREADY DOWNLOADED > 200,000 TIMES

Users of
psychedelics
are generally the
most sensible
and
respectful
consumers
Use is typically experimental,
infrequent and does not lead to
dependence
Often combined with other
drugs
Poly use increase risk of
unwanted effects and harm

Have you have ever had a difficult/negative experience while under the influence of LSD or any other
psychedelic?
• The % of ever users of LSD, psilocybin, 2C-drugs, NBOMe, smoked DMT, Ayahuasca and/or Peyote who
reported having ever had a difficult/negative experience
• The % of last 12 month users of LSD, psilocybin, 2C-drugs, NBOMe, smoked DMT, Ayahuasca and/or Peyote
who reported having had a difficult/negative experience in the last 12 months
Difficult/ negative experiences while under the influence of psychedelics (global)
15,8
7,2
12,4
7,6
5,2 6,3 6,1
31,1
27,4
21,2
8,1 7,8 7,1 6,0
0
5
10
15
20
25
30
35
NBOMe Peyote Ayahuasca LSD Psilocybin 2C-drugs Smoked DMT
% of ever users % of last 12 month users

Thinking back to the last time you had a difficult/ negative experience after taking a psychedelic, which of the
following symptoms did you present with?
What makes a psychedelic experience difficult/ challenging?
56,6
39,6
35,8
33,9 32,7 31,6 30,4
26,5
21,2 20,0 19,5
16,2 15,7 14,0 12,4
0
10
20
30
40
50
60
%

Would you describe the last time you had a
difficult or challenging experience under the
influence of a psychedelic as a ‘bad trip’?
A Bad trip or just a challenging experience? How did you cope with the
39,4 39,2
15,5
5,9
0
5
10
15
20
25
30
35
40
45
Yes No Unsure Missing
78,9
44,3
6,0 5,9 5,9 5,5 4,2 4,1
0
10
20
30
40
50
60
70
80
90
%%

NBOMe drugs (Lawn, Winstock et al
2014)
Classical 5HT2 receptor
mediated hallucinogenic
activity
Super potent
Not active orally
Sold on blotters as LSD
Temporary banning order
2013 → Class A: 2014

64% said
dosing is
guess work
GDS2016 MINI
Micro-dosing

GDS2017 : Micro-dosing with LSD and psilocybin (n= 5600)
20,0
6,0
1,2 1,9 0,6
70,4
19,7
6,2
1,0 2,1 0,6
70,4
20,7
5,4
1,6 1,4 0,6
70,4
0
10
20
30
40
50
60
70
80
Yes, but only one /
few times out of
curiosity
Yes, every now and
then to enhance
performance / cope
with stress
Yes, every now and
then to treat a
medical / psychiatric
condition
Yes, regularly to
enhance
performance / cope
with stress
Yes, regularly to
treat a medical /
psychiatric condition
Never
Patterns of and motives for micro-dosing
All (%) Male (%) Female (%)
%

Among those who reported recent micro-dosing to
help manage a medical/ psychiatric conditions (n>500)
we asked whether they consider micro-dosing as a
replacement for prescribed medications/ psychological
therapies they had previously taken to manage these
conditions.
The self-medication was subjectively perceived as
mainly beneficial, no gender differences were found.
Micro-dosing as medicine
Substitute or supplement? Overall impact on conditions?
23,6
32,6
22,1 21,722,9
32,3
21,1
23,7
25,4
33,6
24,6
16,4
0
5
10
15
20
25
30
35
40
No Yes partially Yes fully Complementary to
existing treatments
91,4
8,1
0,4
91,6
8,1
0,3
91,0
8,3
0,8
0
10
20
30
40
50
60
70
80
90
100
Positive Unsure Negative

• 6.3% (n=350) of the respondents to the specialist section on psychedelics reported ever
having taken any psychedelic under the supervision of a shaman or a traditional healer in
the last 12 months.
• 58.4% described their guide as a traditional shaman, 27.4% as a self-taught healer, 10.5%
as ‘other’, and 3.6% as a medical health care professional.
• Overall, 58.5% reported that they were asked about their mental health including whether
they were currently in receipt of any psychiatric medication
• 6.4% were asked about their mental health but not about current medication, whilst 4.9%
were asked about current medications but not about their mental health.
• 30.2% reported they were not ask any questions about their mental health and current
prescription drug use!
• The average price paid for the experience was 380 Euros.
Ceremonial use of psychedelics – the where, the when and the cost

Ceremonial use of psychedelics – motives, overall experience, risk of
acute harms
80,3
59,1 59,1
38,3
10,0 9,4 6,8
0
10
20
30
40
50
60
70
80
90
Motives for the experience
Excellent;
63,9
Good; 28,6
Neutral;
6,1
Bad ; 0,4 Very bad; 0,9
3.0% (n=10) of those reporting ceremonial use of
psychedelics in the last 12 months reported having sought
emergency medical treatment (1.8% of males, n=4 and
5.8% of females, n=6)
The rating of the overall experience was good.
%

K E E PI NG YOU A N D YOU R MAT ES SA F E WH EN YOU U S E P SYC H ED ELI CS – A DV I C E F ROM
GD S
• Check out our excellent blog Understanding and
Working with Difficult Psychedelic Experiences by
D Sara Gael from MAPS
https://www.globaldrugsurvey.com/gds2017-
launch/understanding-and-working-with-difficult-
psychedelic-experiences/
• And see our video on safer dosing and using with
mushrooms on our YouTube Chanel
https://youtu.be/6fxdhU9HCFc
Check out the GDS Highway Code
https://www.globaldrugsurvey.com/brand/the-highway-
code/

5.7% of the GDS2018 participants reported having used a drug checking service or technology to determine the content and/or purity
of illegal or unknown psychoactive drugs. Over 4,500 people completed the specialist section exploring drug checking on which this
section of the report is based.
DRUG CHECKING
GLOBAL GDS2018 SAMPLE

Pill testing:early warning system, changing the conversation helpin
informed decisions & creating better relationships

DRUG CHECKING –WHAT DRUGS?

HOW SATISFIED WERE YOU WITH THE QUALITY
OF THE INFORMATION PROVIDED ABOUT THE
COMPOSITION OF THE DRUG TESTED?
1 = NOT SATIFIED
10 = EXTREMELY SATISFIED
HOW EASY TO UNDERSTAND WAS THE
INFORMATION YOU RECEIVED ABOUT THE
COMPOSITION OF YOUR DRUG?
1 = NOT EASY
10 = EXTREMELY EASY
DRUG CHECKING – QUALITY & CLARITY OF THE INFORMATION

DRUG CHECKING – HOW WOULD YOU DESCRIBE THE INFORMATION THAT YOU RECEIVED?

GLOBAL GDS 2018 SAMPLE :
NOVEL PSYCHOACTIVE SUBSTANCES (NEW DRUGS / NPS)
16% of GDS2018 participants reported ever having used an NPS.
5% of GDS2018 participants reported having used an NPS during the last 12 months. N=75,937
The GDS2018 NPS report is based on responses from >3900 people around the world.

NPS USE BY COUN T RY
LAST 1 2 MON T HS
Only countries with n > 100 NPS users were included in these graphs

WHAT DRUG EFFECTS ARE NPS TRYING TO MIMIC MOST OFTEN?
Note: Multiple responses were allowed.

Recent spike in deaths – UK, USA and Canada

Variable dose of active substance in clandestinely manufactured pills
Source: UNODC SMART UPDATE 17

• in stimulants
• in cocaine and ‘crystal meth’
• Connecticut June’16: ‘coke’ – 12 users, 3 deaths, 4 in intensive care
• in benzodiazepines
• fake ‘Xanax’ (Alprazolam + paracetamol)
• in e-cigarette liquids
• with synthetic cannabinoids
Fentanyls found in other illicit drugs
Thanks to Dr John Ramsey for the data on this slide

• much higher potency than heroin
• 1 gram fentanyl ≈ 20 g diamorphine ≈ 50 g ‘street’ heroin
• 1 kg fentanyl from China costs ~$5,000
• equivalent to 50kg street heroin
• distribution value (as 50kg ‘heroin’) ~ $5M
• short supply chain, few ‘middle men’, so nearly all profit
• other fentanyl analogues even greater potency
• carfentanil 100x fentanyl
Big money to be made in fentanyls
Thanks to Dr John Ramsey for the data on this slide

• Profit to be made from fentanyl far greater than from heroin
• Easier to traffic
• OVERDOSE RISK accidental contamination (skin contact, inhalation) by first
responder
• Though rarely sourced as drug of choice – when poor quality heroin
adulterated – feels like good heroin – so marketable
• Those most at risk are those outside treatment and vulnerable though other
pathologies including poly drug use
• Typical harm reduction approaches such as smoking / snorting may not be
effective
• RESPONSE Supply reduction, naloxone, resuscitation training, public health
messaging , easy access to good treatment
The challenge – profit, production and psychoactivity

Practical things doctors can do – ask / ultra brief interventions
Useful harm reduction resources/journal articles
New Drugs – Clinical Practice Review British Medical Journal Winstock et al 2012
Neptune Clinical Guidance documents – UK
Global Drug Survey Resources
• Ask about drugs and alcohol within the context of routine health screening
• Remind them of confidentiality
• How much
• How often
• What’s nice, any problems
• How do you use to reduce risks of harms – any advice you can share with
me that I can share with others
• Would you like to know more about using more safely
• When should you worry – or when should I worry as a doctor
• Remember to keep an aye on your friends

• GDS2018 Finland shows alcohol and prescription drugs are the biggest challenges.
• The dark net is the fastest growing supply source of illicit drugs in Finland.
• Cannabis related harm reduction could be improved – dissociate from tobacco
• Psychedelics are popular : episodic and mainly experimental, dependence is not a clinical
concern
• People can learn from negative experiences (that’s why they can help in therapy) and bad
trips requiring medical intervention are very rare
• Some novel compounds because of potency and effect profile can pose significant risk of
harm.
• We are hoping more Finnish people and partners will join us for GDS2019 where will focus on
drugs and sex, policing, prescription medication use and self therapy.
Conclusions

Thank you
Professor Adam R Winstock
Consultant Psychiatrist and Addiction Medicine Specialist
and Founder Global Drug Survey
adam@globaldrugsurvey.com
GLOBAL DRUG SURVEY
@globaldrugsurvy
@drugsmeter
@drinksmeter
www.globaldrugsurvey.com

Päihdepäivät 2018, seminaari 7: Winstock

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