 the use of methamphetamine in Europe in the in the bigger proportion the only thing we can say it would start breaking very bad for all of us because if you look at the situation in the United States or the situation in Australia New Zealand or southeastern Asia the damages that are associated for health and for the people using drugs the damages that are associated to the use of methamphetamine can be huge and certainly this is something we need to anticipate not so much talking in terms of threats or expanding the concept or the notion of threat which is not only a threat for the society or for all countries in the EU but the threat for the health of people who would be using those substances so the importance of adapting or approach for prevention the need to adapt our approach of treatment and the offer of treatment is depending also for better and more precise knowledge of what is changing and this is why here we have first we have Norman Holler that I would like to thank for for his participation with the author of a very important book about some historical foundations of consumption and production and consumption of pervitin we have the Czech Republic with Pavla and Victor and they're the use of pervitin is also quite historical for many years and when the Czech Republic was preparing to join the EU well basically the main problem as far as drugs were concerned in Czech Republic 25 or 30 years ago was the injection of pervitin rather than opioids so and I think Pavla will share with us I think pervitin is still a problem in the Czech Republic and then we Desta and Gabriela we we have the opportunity to open a window and to have to shed light on something that may look limited in its importance but is fast-changing and I remember a discussion with the Joan Villalby who's the delegado del gobierno para el plan nacional sobre drogas we were together in the conference on addictions last year and he was explaining to the participants that in the beginning some years ago in Catalonia when there was a need the appearance of of use of methamphetamine and the colleagues will tell us more about this this was more focused on people doing chem sex but apparently and this is why we need to further adapt our monitoring system it appears that for the moment the consumption of methamphetamine is most probably expanding beyond the the the limit of the group of people practicing chem sex so there is a potential for further spreading and and before to call for measures to be taken or for responses to be adapted certainly there is a call for better understanding the reasons the causes but also how people consume why and how and and as it is and you know that the the the narrative we present for the drug situation in Europe is everywhere everything and everyone meaning drugs are everywhere in Europe not in the sale proportion but there was never so much and so many drugs available in Europe the second is well illustrated by the topic of today which is everything can be used as a drug so be the the the cause of an addictive behavior and we have here an emerging phenomenon that may still look anecdotical if we refer it to the 450 millions of inhabitants in the EU but where there is a problem and for people who have the problem they have it 100% so this is why it deserves our attention and finally it means and again we will learn from our colleagues from Catalonia what is the situation there we see that this everyone can be can have or be the witness of someone having a problem of addiction is because it's not only about opioids and heroin and there are much more substances involved today we have different groups of people that we don't know for some of them that that are consuming methamphetamine and therefore it's this webinar today it's playing a bit the role of a kind of early warning not only for decision-maker or makers or to ask for security measures but also again a warning for us that building on the lessons learned from 30 years of drug policy in Europe we need to adopt our understanding of what drugs are today if we want first to avoid to miss some emerging problems and if we want to be able to adapt the responses to be still helpful because the ultimate goal of our work is beyond just drug policy support is to be helpful for people who are using drugs and their families where it and for the society and the communities where it is needed so thank you very much and and with this introduction I'm happy to give the floor to the chair of the webinar today Victor it is yeah thank you thank you thank you very much hello to everyone also from my side I am in department of addictology the oldest addiction treatment center in in Czech Republic I don't need to remind you that the pervitin methamphetamine is very important topic for Czech Republic because it is in the center of drug problem for for many years Alex is covered almost everything only important aspect of our today's snapshot into the methamphetamine so we'll have three presentations and four speakers so first it's Norman Holler writer journalist who will introduce the history of pervitin methamphetamine in Germany so we will have the insight into the past public hominova will continue with the also a bit of past of methamphetamine in in Czech Republic and present situation and the last one will be the snapshot into the situation Catalonia as Alexis already mentioned so we will have Gabriella Barbalia and Esther Aranda who will inform us about the recent development of methamphetamine issue phenomenon in in Barcelona in Catalonia so I think we can start so the first question is true Norman what are the origins of methamphetamine in Europe what is the history of pervitin in Europe in Germany and in Europe in the broader perspective maybe so please Norman thank you I was first in touch with the phenomenon of methamphetamine in around 2010 when I spoke to a friend of mine and asked him what should I write my next book about and he said you should write about the drug abuse during the so-called third right when the Nazis were ruling over Germany and big parts of Europe and I said what drug abuse are you talking about because I had always thought that the Nazis were very anti drug regime so I decided to I actually asked him how do you know that the Nazis took so many drugs and he told me that a friend of his is an antique was an antique dealer in Berlin and he had bought an old cabinet from an old East Berlin apartment and found original pervitin packages in that old cabinet so they must have been 60 to 70 years old and my friend who is a DJ was adventurous enough to actually try them and he said that they had a very strong drug effect on him and this this story was strange enough for me to actually start serious research and one of the first so because then I thought this on the one hand this was a legal product in in Germany at the time on the other hand crystal meth is this illegal drug so how does how do the how does this work together what's the what's the connection so this is this was the starting question of this book which in English is called blitzed in German it's called der totale Rausch and which was published in 2015 and then later in different translations so what I've I became very interested in this contradiction between my grandfather telling me under Hitler there were no drugs and suddenly this pervitin package which obviously contained a very strong drug and the first research that I started actually showed that indeed the Nazi regime was one of the first regimes in Europe who had a very strict anti drug policy they did not invent new anti drug laws but they took the old opium laws from the Weimar Republic in Germany but enforced them in a way that in which they have not had not been enforced before so suddenly in 1933 the government said we will be an and we will be a drug free society and these laws were strictly enforced drug users were were were criminalized and the early concentration camps in Germany and Nazi Germany already had some drug users as inmates so there was a complete policy shift between the Weimar Republic which ended January 30 1933 and the Nazi regime which lasted for these unfortunate 12 years so not even more interesting how to suddenly have it come into play my research showed that the Olympic Games in 1936 in Berlin were in a way a game changer for that they they are reported to have been the last doping games where there was no effective doping controls or checks in place and there were rumors at the time and I have tried to confirm these rumors but I have not been successful I there's simply no documentation on this but there were rumors at the times at least these rumors are documented that one American athlete Jesse Owens who won I think six gold medals to the big surprise of the Nazi regime which because he was he was an Afro-American so the idea that in Nazi ideology and inferior race could run faster and jump higher better than an Aryan superhuman was cost to concern and discussion and one leading developer of medicines at the time was Teodor Temmler he owned the Temmler factory in Berlin and after the Olympic Games he had a talk with his chief chemist Fritz Hauschild to develop a stronger what the rumor was that Jesse Owens was using benzodrine which was an amphetamine a legal amphetamine at the time legal in the United States and it was it was rumored that only because of benzodrine he was able to perform better so Teodor Temmler said to Hauschild this can never happen again we must have a German answer to this we must find a better amphetamine and then Hauschild the chemist actually did some research and he found out that in 1917 a Japanese chemist called Nagai had synthesized this stronger version of amphetamine which is methamphetamine in Tokyo and then Hauschild found his own way of synthesizing methamphetamine this was patented in October 31st of 1937 and then branded by the Temmler company as Pavitin and then Pavitin came onto the market in Germany in 1938 and I did some research in the in the Landesarchief here in Berlin where the all the company the companies of Berlin that were located in Berlin have there you know their files and I could see very clearly that the Temmler company had a big hit with Pavitin because the sales skyrocketed I also could see exactly how they advertised it and it was a very professional approach they were not sure in the beginning what Pavitin actually is good for the the pharmacological tests with animals showed that there was an increase an energy increase or there was more movement and the animals also became more aggressive but it was not really clear how this how this would work with humans so there was a lot of testing actually within the Temmler company the chemist Hauschild himself and his assistants they took it and they at the time were not concerned with addiction or negative side effects they were actually concerned with positive effects and they found that it's stimulating that it increases your mood and increases your sexual appetite it was it was like a great pill to take basically that's how they perceived it and but to get wider you know responses they the Temmler company launched first of all a big ad campaign there were posters everywhere in Berlin advertising this new thing that was good against depression and just gave you a little boost of extra energy and you know thinking of you know Nazi Germany seeing Nazi Germany as a modern performance driven society just like any capitalist society also today any performance enhancing drug if it really is performance enhancing which was thought of at the time that Pavitin is performance enhancing obviously is interesting because everyone is part of the of the rat race of you know competing with other individuals so Pavitin was kind of a better Coca-Cola or it was you know they wanted it to be like a pill it's like a Coca-Cola you don't you know you take it in the morning and you're more happy you're more awake you're more eager in meetings so it spread across various you know basically all sectors of society from intellectuals artists actors would take it before they go on stage it was reported of writers taking it to write the whole night but also factory workers could increase their their output at the assembly line there was a there was a point when even a chocolate came on to the market called Hildebrand Pralinen and each little chocolate had nine milligrams of pure methamphetamine in it so quite a high dosage and the slogan was Hildegard Pralinen erfreuen immer Hildegard chocolates always a delight they were specifically marketed for housewives I mean the role of women during the Nazi regime was was not a role of you know empowerment and it was not a they were not an equal stance standing with with the men kind of I mean Weimar Republic also was a patriarchal society but still women had more involvement in the society than during Nazi times when Hitler or the ideology basically said women have to go have to stay at home to take care of the children and keep the house clean so with these Hildegard chocolates that they were at least you know kept happy doing that it's kind of what the Rolling Stones in the 60s when they when they said when when they were talking about mother's little helper the pill that that you know makes your doll everyday life a little bit easier and lighter so pavitine was in fact a big hit the Temla company also sent letters to they said each important doctor in Germany I don't know if they really managed it but also big hospitals they all received this you know propaganda material from Temla saying this is a great new medicine and please write us back how it works on your patients we want to you know improve our information leaflet on your on your input so they got a lot of feedback also German universities examined pavitine and they came like I studied all these reports from these German universities they they they were quite happy about pavitine they they said it increases the mood at lowest depression it decreases the fear level for example it decreases inhibitions so it seemed like a very interesting medicine actually at the time and then just to to sum up kind of the historical that that sum up like to discuss the last chapter of the pavitine news in the Nazi regime then a professor in Berlin called Otto Ranker also heard about pavitine because it was quite known at the time and he was the physiologist of the army so his job was performance enhancement of the of the Wehrmacht of the of the army of the Wehrmacht the German army so he was he was obsessed with the an enemy that he tried to defeat at the time this was in in the late 30s but before the war against Poland started in 38 his his the enemy that he wanted to defeat was fatigue so he was looking for ways to keep soldiers awake for a longer period of time so when he read studies from universities where they had actually tested that pavitine methamphetamine keeps you awake for longer for longer hours and if you don't take it you know similar to drinking coffee but more in a more extreme way he thought that this might be an interesting substance for the German army and he worked for you know turning pavitine into a legal no I mean it was legal already but he he he wanted to turn it into a supplement that every soldier basically has the the medical officers should all carry in their medical bags and then hand out and this was a concept basically of a modern the modern soldier he saw the modern soldier as this you know machine that you know just needs to work as efficiently as possible and pavitine seemed to be seemed to be helpful here so he conducted tests in the sanitätsakademie that was the academy where medical academy of the german army where he was leading the institute for defense physiology he made three extensive tests there which are very well documented with young medical officers and he started these tests in the early evening and they lasted all night until the next afternoon and he he found that actually people on pavitine were able to not only stay awake the whole night without symptoms of fatigue but actually solve a lot of you know quest you know questions he had all these tests for them and he came to quite an interesting conclusion because after you know carefully evaluating these tests he could see that people on pavitine are able to do much more but they actually don't do it in a better way so it also lead it also led to mistakes like in mathematical calculations or especially in exercises that are more complex to solve so the more difficult a problem is to solve the more mistakes happen on pavitine while very simple tasks like very mechanical simple tasks can be done better on pavitine because you just have a longer you know you could do them for a longer period of time so he concluded this is perfect for the soldier who's not supposed to think but it's just supposed to you know do what he's told to do so with this conclusion he went to his superior the surgeon general the of the of the german army this was just before the war against poland started but in the german in the german high command they did not quite understand yet what otoranka was trying to do so and also they were busy with preparing the attack on poland which started the second world war so his proposal first didn't get through and then he studied what happened actually in the in the attack on poland he wrote to medical officers in the field asking for reports back to was pavitine used what were what were the effects of pavitine and in fact a lot of common soldiers brought pavitine with them based on privately basically bought it in pharmacies in germany and just brought it with them because they knew if i take this stuff i can work longer or fight longer so soldiers have this probably this instinct that anything they might that they think that might help them fight they're probably eager to take it so pavitine was used quite a bit in the attack on poland again ranke wrote a report about this and said if there will be new campaigns because he knew that there will be would be an attack in the west we should we the german army should have this organized and there should be you know it should not be unregulated because it is a very strong important substance so there should be a regulation for it and he wrote the so-called stimulant decree in april 1940 where he laid down rules on how much the german soldier should take in case in the in the case of of an attack in the west temla then was received the the order of 35 million dosages of pavitine just before the attack on france and when on may 10th 1940 germany attacked luxembourg belgium holland and then later in france the pockets of the medical officers were filled with pavitine and from that moment on pavitine started spreading and actually i should i should mention that pavitine was first tested even before namely when the so-called sudetenland was occupied by by the german army in march 1939 so this is how pavitine first left german territory so the first you know foreign place it actually reached was was which is now the the check republic and maybe that is connected to that might be a connection interesting to to look at on why pavitine is so known even the name pavitine like in other countries in europe you don't say pavitine you say methamphetamine but in the check republic you actually do say pavitine but basically germany then spread pavitine all over europe with their conquests and this is in rough words how pavitine originated and then how it was distributed and yeah so this is my my rough intro my not my rough this is my introduction to the topic thank you very much thank you norman for for this interesting story on the onset and the history of pavitine in germany and then one could say pavitine was forgotten for years and a group of explorers users in in in prak in chagri public rediscovered how to produce it using this japanese way probably linked to pavitine and then the history of the check pavitine check methamphetamine started in 70s so now i would like to pass the flow to pavla on the presentation for the presentation on the situation in chagri public thank you victor thank you alexis thank you norman for having this introduction to the topic it is a really great pleasure to be here with you today and to have the possibility to share the situation in our country with you so i will focus mainly on methamphetamine use in chikia but it also needs some historical background or historical information i will start with summarizing some kind of situation what happened after the world war the drug started to be available not only in germany as already norman mentioned but in other countries as well but also in united states there was a situation that the chemist steven preisler published a book in 1970s the book was called secrets of methamphetamine manufacture and this is also how the drug became more popular and more used in the united states in 1970s and i also would like to mention that the methamphetamine and pavitine as as we call it in the chikri republic was not illegal until 1970s and it only got into the international prohibition in this time what makes chikia specific about methamphetamine use this is a question that we are always asked everyone who knows the connection when you say you come from the chikri republic so this is the first question you'll ever receive so what is the situation with methamphetamine why is it so popular in your country at first i would like to say that since 1950s there was a situation in the chikri republic which was called the iron carton division between east and west europe which lasted until 1989 when this velvet revolution took place and chikia or czechoslovakia as we were in that time just became a more pre-country and more democratic but until then it was a socialist regime and in this kind of regime no drugs were imported to the country there was a really low availability of drugs that were available in other european countries opioids and so on and what the users had to do they had to rely on substances that were available in the country in that time so in the 1940s the use of benzene drink was quite popular among users in our country at the end of 1950s the historical sources mention ephedrine-based stimulant called yastil in 1960s there were signs of use of dexfenmetrazine and then since 1970s we have this reappearance of methamphetamine in the chikri republic which was ephedrine-based at first and later the production changed and now it is more pseudo ephedrine-based pervitin was not the only drug that was used in our country since 1970s so we also had some opioids but these were also some opioids that could be based on the home production and we had the brown opioid called brown which was based on codeine as already mentioned by victor the drugs were in 1970s the users or inventors they discovered this process of production of methamphetamine and since 1970s most of the pervitin production in our country was homemade production usually based on ephedrine the source of the drug was cuff drops sultan which were available in pharmacies and then later it was ephedrine which was smuggled from one chemical plant that was producing ephedrine this chemical plant is or was located in one small city just near bragg one train stop from bragg and this is how ephedrine was getting out of this plant and used for methamphetamine production what happened among the users do know how on production was shared with like among small groups of users and these small groups of users were gathered around one person that had the skills or abilities to cook pervitin and the drug was usually not sold but it was only shared within this small group so it was based on some barter exchanges someone got some chemicals for production someone else got something else someone else was able to cook it and then the drugs produced were shared within these groups and this is what the situation was until 1990s then as I said after the velvet revolution the borders opened and the drug market started to develop in a different way but still this homemade production of pervitin remained in the Czech Republic and the methamphetamine state like the number one drug among high-risk drug users in the Czech Republic nowadays the production is based on pseudo ephedrine it is extracted from medicines that are usually available in in pharmacies these are medicines against flu and these are sometimes imported also from other countries but also used from from the market and pharmacies if someone is interested in some more reading about the history then I recommend one paper from prepared by Tomasz Zabronski and also we produced a chapter for a book which was focusing directly on the crystal meth it's a German book so I can recommend readings in both English and German but now we will move to the present situation what is the situation now as I said the methamphetamine still is the number one drug used among high-risk drug users there is estimate of nearly 45 000 people who use drugs in the Czech Republic just to remind you we are a country of 10 million people so that you can somehow compare it with your countries and three quarters of these drug users are pervitin users monitoring of the situation started in more detail in 2001-2002 so the first estimates of problem drug use in the Czech Republic come from this time there was about 20 000 people estimated to be high-risk drug users in that time nowadays or pervitin users nowadays we have 35 000 estimated about 90 percent of pervitin users or all high-risk drug users use drugs by injection and this is why methamphetamine is real issue because it has a huge health health related consequences but also social correlates as regards the health consequences the most severe ones include overdoses in our country we have about 10 to 20 cases of overdoses annually which are related to pervitin use and then we have about 30 to 50 other indirect deaths that are related to methamphetamine use what is quite an issue recently so it's psychiatric comorbidity which is discussed it is estimated that nearly two-thirds of clients that are in treatment so they suffer from psychiatric comorbidity as it's mentioned in the slides there are symptoms of intoxication, aggressive behavior, paranoia, psychosis so there is a real a lot of huge health consequences but we do not only monitor the situation of this high-risk substance use we look also to the situation in general population in other specific populations to somehow capture if there are some new trends new situations in some specific populations that meet some concern or that would mean that something is going on or trends are changing so what we do is monitoring in the general population as you can see that in the long term the prevalence of recent use of methamphetamine is relatively stable relatively low slightly higher among young adults but recently it seems it's slightly decreasing what we were also interested in because we in the long term we surveyed the substance like one category for pervitin and of vitamins in one category and we decided to look more closely on what is the type of the substance people are using in the country and now we have also new estimates specifically for methamphetamine use as regards using the specific populations we in the long term we survey student populations we have data from the SPOT study in the long term since 1995 we have data available on experience with the methamphetamine use in school population we also looked at the like the higher age of the students 18-year-olds to see if there are some differences or what is the situation in relation to the age of the respondents what we see we see higher prevalence of use of pervitin in some specific populations mostly in prison population and also in socially excluded localities you can see that the prevalence of use reported is much higher compared to what is reported by general population or student population and what seems quite an issue and it was already mentioned by colleagues it is this use in recreational settings and also use of pervitin in the context of chem sex these are data from the year 2016-2017 which refer to last 12 months use and last four weeks use so you can see pervitin is quite used in the context of chem sex as well what we know about methamphetamine users in treatment so we have also data available in the long term on treatment we know that in outpatient treatment and also in residential treatment methamphetamine users create about 11 percent of the the clients if we do not count alcohol so and we would look only on illicit drugs so they account for about 26 to 28 percent of patients in treatment the situation is different in low threshold services we can see the situation from the year 2006 till now and nowadays about 70 percent of the clients of low threshold centers are methamphetamine users sorry what we can say about interventions to for methamphetamine users as mentioned they are clients of all types of services they enter inpatient treatment outpatient treatment they appear in low threshold services but mostly because most of them are injecting users so the service they use the most is the needle and syringe exchange programs so within the services of low threshold centers they are offered also some specific interventions like gelatin capsules that are distributed to users to to offer them as an alternative to injecting use and all of our low threshold services offer this kind of service for the users just to help them to prevent from from injecting or help them to to change the mode of administration recently there is an off-label substitution offered with methylphenidate it is it was approved as a pilot pilot intervention there are recommendations of the society for addictive diseases of the Czech medical society but still there are there are just cases of users methamphetamine users that enter this kind of substitution there are also some short intervention programs that are based on cognitive behavioral therapy and these are spread across a few of the services view of the programs very briefly a few words about the market and crime the market situation changed in the 1990s the market started to be more open but still domestic production of pervitin prevails there is an estimate that six and a half tons of methamphetamine are consumed annually mostly within the country but some of of this amount is also exported to other countries every year as you can see some picture from that were taken by police within this mumbling of the laboratories so it's mostly really home production you can see like really kitchens that's why we call these kitchen labs and about 200 of these small kitchen labs were dismantled in in the last year most of them like half of them was really this home home producing laboratories with a small scale production but there are signs of increase in number of labs with a higher amount of pervitin being produced we have reported like 900 seizures of methamphetamine in the country with 30 kilos ceased so if you can compare the seizures with the whole production you can see that it is really small still a small part of the market and this is awful from my side I would like to once again thank you for having the chance to share this situation in the Czech Republic with you and I'm really enthusiastic to see what's going on in other European countries and to hear what's new in Spain and also I'm happy to answer questions you will have about the Czech Republic thank you yeah yes yes thank you Pavlan well you can see that also the history of pervitin in the Czech Republic is quite interesting and it's not homogeneous that there are developments in past there are also some stimulant use before methamphetamine pervitin as such the market has changed the patterns of use has changed also recently with methamphetamine going into nightlife setting so now we have a chance to to see what's going on with methamphetamine in Barcelona in Catalonia so question is is methamphetamine you seen in other countries and what's the situation in Spain and the challenges related to methamphetamine there so please colleagues you can continue Victor hello everybody good morning from Barcelona I would like to take the chance to thanks to the MCDDA especially to Marika Alexis Alessandra for bringing us all together to this interesting webinar for giving us the opportunity to show some of the work we are doing and most importantly to to learn from other experiences such as the one Pavla has explained us now I would like also to thank to all my colleagues in Barcelona for giving me their input from the front line which is very important for this webinar since methamphetamine has recently or relatively recently introduced here and so in trying to answer this question we will try to give a city perspective rather than a country perspective as as Pavla did so we will focus on Barcelona which is one of the city in Spain with a predominant harm reduction model and before I begin I would like to sound a note of caution regarding monitoring of illicit drugs in general and methamphetamine in particular so as we all know drug markets are complex and dynamic systems as Alexis a little bit explained at the beginning and despite having relatively good monitoring system here in Spain particularly in Barcelona it is very difficult to put all the pieces together and know exactly what is going on when it comes to drug markets so in order to answer this question please be aware that we are often only having bits of information of the reality we are trying to understand so however not having the big picture doesn't mean that we should not doing action intervention activities and making decisions in order to try to meet the needs of the methamphetamine drug users so in Barcelona we detected three main profiles with problematic methamphetamine use one is the use of methamphetamine of inhaled methamphetamine within the Filipino community and this this is called Shabu within this community and Shabu consumption is embedded in Filipino culture and we had so many challenges working with this population maybe we can discuss them at the end but one that I would would like to highlight was the the idea of building trust with this community and to be able to link them to drug services to harm reduction or treatment services the other profile that we have identified and and Alexis mentioned it as well and Pablo also is the chem sex user profile so for those who are not familiar with chem sex maybe I don't know in the public so chem sex is the deliberate use of psychoactive drugs to have sex between men who have sex with men usually but we detected women as well that practice chem sex and a number of recent studies have found that Tina which is the slang word for methamphetamine which is the word that chem sex users use is one of the most commonly drug used in chem sex sessions and so the challenge with chem sex users I think is the linkage to service as well but progressively they are coming to our services and I will show you later on in a next slide so finally a third more heterogeneous group which is the one we are seeing at the DCRs here is this physical methamphetamine in general generically so this group is very diverse and and we are detecting that they are a little bit younger maybe and probably there are more women we don't know yet and we are trying to figure it out as as we are receiving them in the drug consumption rooms so the next slide and I will show you some piece of data about what is happening with methamphetamine here so I will show you data on wastewater analysis this data was provided by the Institute of Environmental Assessment and Water Research then I will show you data from drug checking which was provided by energy control and then I will show you accesses to the DCR and treatment demands so this is the first slide this is a first verse I view over the consumption or the detection of methamphetamine in wastewater analysis for those who are not related with the technique is the analysis of municipal wastewater and in which drugs and metabolites are detected and with the idea of estimating the community consumption of different drugs so here you see here the last decade from 2011 to 2021 methamphetamine was detected was detected in the wastewater analysis and wastewater in Barcelona here you see that there are two moments of the time in which we sample the wastewater one is on some and another is springtime and basically what we see here is the increase in detection of methamphetamine through the years with a peak in 2019 actually during springtime if you haven't been in Barcelona in springtime you should because there are a lot of tourism a lot of people etc so I mean coincidentally the detection was higher during weekend days and then the pandemic came and the detection was downward decrease and in 2021 the detection was almost one-third of the detection in 2019 so we can say that we are in a situation that we are not sure how it will evolve so in the next slide this is a stair that is passing the slides instead of me that's why there is this lack so I'm going here you are seeing the annual percentage of MA medium purity this is the the data coming from energy control which is the entity that that's the drug technique in Spain and as you can see here the purity of the methamphetamine is high and it was it is higher than cocaine from 2018 onward the other thing that we found or energy found in the samples was that there are few adulterants detected in the samples so and most of the all the few that are detected actually are stimulants as well so it's mgda mdmd mdmma caffeine effigyne etc so it's a substance that is less adulterated than other drugs here in Barcelona that next slide it will show you what is the main root of administration and this is one of the characteristics I think that is different from one we we see in in in and says republic so the majority of the MA here in Barcelona is inhaled this is the percentage of visits to the dcr in which we see that 94 percent of MA is inhaled by both men and women and we also have the the information from the front line that chem sex users as well are inhaling Tina and they also injected it but but they are progressively more engaged in inhaling it than in injecting it so this is very different from the situation in says republic the next slide is that I will show you is the number not this one yeah this is the number of animal visits to the dcr here in Barcelona we have a model and I I haven't said that but here in Barcelona we have this Barcelona model which integrates treatment and harm reduction in the same center and in harm reduction services we offer a lot of interventions and we also also offer drug consumption rooms for injection and for inhalation so I will show you data from the inhalation space that we have in gas valoir as you can see is the completely the opposite of what Pablo have shown because heroin is the drug that produces the higher number of visits during over the years and then you can see here the downward trend after the pandemic and that's another thing that I would like to highlight that we managed not to shut down the services during lockdown and I think that was an incredible policy here in Barcelona not to shut down the harm reduction services they kept it open and so here we have that during 2022 one out of over 10 accesses were done to consume methamphetamine and almost half was for consumption for heroin consumption this is men and in the case of women we have the same data and we can see that from 2020 the upward trend of women of the line of methamphetamine consuming is up and in 2022 one out of six more or less visits to the drug consumption room were to consume inhaling methamphetamine in the case of women that's why we are trying to see if women are uptaking more the methamphetamine in relatively terms comparison with men and the next slide and I think it's the last one I will show you is the relationship between the treatment demands and the DCR visits by sex in this slide you have on your left an axis that is showing you the percentage of methamphetamine treatment demands over the total treatment demands of over the total drugs and then in your right axis you see the number of visits to the DCR in green are men and in orange are women and you can see that there is this increasing upward trend in the case of men and women asking for treatment and this the data show you this and the professionals told us that the profile that are asking for help mostly are chem sex users and in the columns you see that there are a progressive increasing in the number of visits due to methamphetamine use and as I said before the profile which is accessing to our DCR are very different are very diverse and that's the profile we are trying to discover and try to set responses to meet their needs so that's why I will give the floor to Esther and she will ask explain some of the intervention and activities we are putting in place for some of the challenges we are having in managing the group who is consuming at the DCRs so Esther all yours hello thank you to MCDA for the invitation to to show and to share our experience in Barcelona with Matthews okay well we have prepared this figure that describes the chronology of actions around med use in our city as you can see no our meta story begins in 2015 when we detected the first med use in a DCR at the beginning people only use in a late route as Gabriela said they were mainly Spanish between 30 35 years old and there was a presence of women it's not typical when we detected a new drug in the consumption rooms that we had presence of women and this first med use has explained it that there were few dealers located in the neighborhood of the DCR during 2016 we designed it together with energy control the drug check organization and the monitoring strategy for for the methamphetamine illegal market in our city in the DCR we started to offer drug checking service for each each med use for each med use in 2017 in the middle which are we observed an increasing number of people who reported using med and an increasing number of med super basic consumptions so despite the increase in these indicators people from DCR reported that they knew more med users who didn't come to the service so the recruiting of this new population and the improvement of the domestic domestic pipes were the reasons that promote a specific design of med pipes this design was carried out jointly with the med users we conducted two or three focus groups and administered individual questionnaires about med use paraphernalia context of use finally used this design and we the professionals manufactured the ball pipe that was exactly the pipe what they want in 2019 I think yes we started to dispense this pipe to use in the consumption room and also we started to distribute the med pipe to use outside at home or whatever you want and okay so in 2021 after COVID no in 2019 we started the trainings these trainings were to the staff and the topics were about substance illegal market funds of use effects related harms good practices the idea was that all the staff was trained in methamphetamine methamphetamine and in 2021 after COVID we saw the med users continue to rise and increasing some related problems as in the set psychosis so after COVID restrictions we started the community building work we contact to another countries as Victor in Czech Republic or another people in Europe to know his his met experience and also make contact with same sex civil society organizations in Barcelona mental health services in the city and homelessness services trying to share information about the different contexts of med use because we were thinking that not only in ham reduction services were made use now in 20 in in 2000 about in Apollo in 2022 we have we have created different work work teams operating at different levels at the base we work with a civil society organization and the people who use med in the next level we work with another ham reduction services gender services mental health units this level really requires a lot of work of sensitivity and pedagogy and education about characteristic and specific needs of people who use med for example to establish accompaniment and support specific circuits for people who use med and present psychotic symptoms this follow-up of the episode and the possible accompaniment to such to psychiatry service is carried out in more support than the rest of the people who use substances in the DCS and the other level is with the public health agencies as Gabriela or people from government where we work aspects of monitoring med use funds this kind of things okay it's not so easy to change the the apple okay so I have I'm going to show to show the different results related with med use of the last year or 2022 in relation with the specific med training in this year we trained a total of 33 professionals from ham reduction services only social workers, nurses, outreach teams, doctors, psychologists I consider that the training of the in the psychosocial approach to psychotic episode was very special of interest because often during the intoxications of methamphetamine the event thought or anti-psychotic administration is rejected by med users for this reason we have focus on the psychosocial approach because elements as the reduction of the stimulus or trust or simple accompaniment also offers discomfort reduction and sometimes it's the only it's the only possibility to approach during this year together with the public health agencies we have planed to carry out a training course on methamphetamine oriented to all professionals of drug services in Catalonia about the community building it has been a focus the big focus during the last year and this community building has led from ham reduction services we have created a network we have shared the difference of needs between med users in our city and we have include the different intersections as LGT, IBQ, homelessness, Philippine community, gender and also civil society organizations that work on relevant aspects as same sex paraphernalia treatment the objective is to be able to cover the different spheres involved in the use of methamphetamine not only the substances or not only the typical ham reduction strategy in this community we also include the participation of med users okay next okay specific from building from community building we detected the importance of creating a specific work teams to to continue the work now we have five working teams where the central point is the use of met and operating at different levels as I said and they meet mostly at the base we have incorporated an outreach team conformed by peers from LGTBQ organization and ham reduction professionals they work at night in a traditional cruising area in Barcelona and the other level we have a working conformed by chem sex organizations and ham reduction services a second working group conformed by treatment and ham reduction services and one last group conformed by three ham reduction services DCR shelter and housing first also we have a group the the the the working group conformed by public health agencies from Barcelona and and from Catalonia and with the ham reduction services okay about the no it was the it I had explained the framework and now we are going to see the activity regarding the the analysis of substances energy control has analysis 161 methamphetamine samples in Barcelona the the percentix of medium purity has been 69 percent for cocaine the other big stimuli in our context was 52.6 percent as Gabriela showed you so in the last year since Barcelona got better market format than cocaine because the price is very similar and now in both cases you can get small doses it's not it's not necessary to buy a gram you can buy five euros so this is a special to be interested for us also it's important to show that 62 percent of my users bought the substance to a trusted dealer so we could say that there is a stable illegal market to get met in our city in the last year we have started with energy control on site analysis in the DCR using fatigue technique now people who use substances can get a quantitative result for the sample at the moment so before to access to the DCR I can check my my my tracks so probably in the next year we are going to we're going to monitor it very very very good the methamphetamine okay this is Victor time is running so okay the last one okay okay okay Victor thank you well in relation with relation to the activity we have attended 607 different met users we have distributed 1528 made pipes these these pipes have been dispensed in DCR to take away and also during the outreach interventions also we had 4,115 accesses to use met in the consumption rules mostly in the inelate room and bad cocaine continues to be the most common uses of stimulants 18 persons were referred to psychiatric emergency services for psychosis mostly were women we an aspect that that had been worrying us was the low access to specific harm reduction shelter for homeless for in people who use met this working group of harm reduction services concentrate a large part of his efforts on understanding what was happening and identifying the barriers it's a very good result to have the did up did up eight met users to the shelter and now they are all remain and the last year six women who use met had an emergency emergency accesses this data also is very important because the vulnerability of homeless women victims of gender violence who use met and patient psychotic symptoms is extremely high we are running also groups with peers from people from chem sex for health education and I finish I promise our conclusions we think that we think we think that we have three different profiles with problematic meta-phetamine use in Barcelona in these profiles use is predominantly in a little bit by both men and women available meta-phetamine is a high purity and have reduction services are going to organize a multi-level response to meta-phetamine related harms but we have questions these questions are are women more vulnerable to the meta-phetamine related harms how can we provide gender sensitive services are we meeting the needs of new patterns of use because we are detected different timing different rituals and maybe we need a specific DCR and that's all thank you thank you very much and and the team from from Barcelona uh well uh how much time has left marica we don't have much time so let's focus on the questions and and yes so we have a couple of questions where well there is a good communication but we are looking at the question I mean part so have you found any question interesting or should we go and I can I select some yeah I'd like already to say to the public that we will have another webinar on meta-phetamine so don't get annoyed if we skip your questions now there is one question by Rosario Sandino why do you think prevalence figures dropped that much since 2008 and then uh sorry if you have already commented that she has lost it this is for the Spanish colleague this is for Pavla I guess no sorry yes yeah so Pavla if I may respond so it's uh there is a difference between the surveys so basically the differences are related to the methodology of the studies so we cannot just say it has dropped since 2008 but it's it's also related to the methodology what we see we try to do surveys and studies in the long run to repeat with the same methodology to see the trends and just to summarize the the prevalence is relatively stable does not change over the long term what we see from the surveys uh more is a slight increase in cocaine use in in the last years which this could be a slight also explanation for decline in pervitin use some of it may be substituted by cocaine use yeah I can add that if you look at the prevalence estimates of high risk pervitin use it's quite stable or increase is quite stable so this is based on indirect methods what else maric I see here the question you pick another and you pick another question okay I see the questions related to the off-label uh therapy with metalfinidate in in in Czech Republic so Pavla can you comment that there is a question on how the pilot is going so we should clarify that it's not like formal pilot project it's rather off-label documented off-label prescription right would you like to comment on it? I would like just to add that it was already announced that there will be a special seminar webinar related to the responses and I think everyone who will join this webinar will hear really a lot of details on on this substitution program in in the Czech Republic because I suppose there are guests invited from the Czech Republic to to describe the study and the results so I would rather leave the floor to to the speakers for the next webinar not to make spoilers and I understand you have to comment on it yeah it's not a formal project for years there is an off-label prescription of metalfinidate going on so there are case reports and case series reports some of them published also in English and if we have time we can or maybe Pavla also I mean shared in the presentation we can share some some of the findings published in in papers or in English yeah so but it is based on off-label and within the COVID context Czech Society for Addictive Diseases published the guidelines for this off-label prescription yeah. Can I pick another question it's from the last two speakers noted the interest increased trend of presentations in consumption rooms as Ireland moves towards supervising injection facility would be interesting to hear the types of intervention supports offering that context you probably commented already just one one very brief comment on that. I think Esther is going to answer this because is the approaching that you are having at the DCR I think regarding the harms isn't it or is it related with the pipe program they started we can we can merge with another question by Matt Southwell asking if you can say more about community participation approach within the community building phase so that you put together the two questions about what you offer in this community approach. Okay about the community approach really very difficult okay it's a long it's a long long way that we have to run but for us in for us with our harm reduction view we are we are opening the view and we are we are we have we have groups no to to include the all the all the intersections this is the community in the community building to to see the problem with all the with all the lines and to create the spaces to talk and and as I said it's a it's a it's a very important way to sensibility the the people it's not so easy and but I think it's it's it's a very good moment for us because we are talking with organizations that we never talked before and we are we're involving all the public health agencies that it's not so common and we are we and we are involving different kinds of harm reduction services in the city that it's not so common and I think that the the difference between the other drugs we are involving users and we are we are recruiting users in the harm reduction services of course but also with with with apps with you know in the interventions in the nightlife it's it's it's I think it's different the community building that we are doing now thank you Esther I anticipate that the chat was very interesting your questions marvellous so we will try to save everything and probably get in contact afterwards I would like to ask Alexis to say something some conclusions and he will thank on our behalf all the speakers of course thank you thank you marica can you hear me yes yes so first of all thank you victor and all the speakers this was this was very good so felicitats mortes gracias and I think it's a it's a fantastic illustration I will share with you a few highlights that for me are very important and useful but much beyond the the issue of methamphetamine it's about what could or should mean a mean a modern approach and a development of responses to drugs today building on the lessons run from from what the different speakers have shared with us first is that the fact that we we we managed to have better and more data and information about the evolution of the situation is of course important and then and you I'm sure you have appreciated with me that both Cass Ballyward or the check focal points they are they managed to to present you data about the trends in the recent years it looks nice but but I would like to highlight and it's the same for all the services that all of that cost money so so I think it's important to convey and that's what we do together with people from the field and from the focal points that we need to to raise the awareness of decision makers and it's again why we we disseminate as much as we can the the narrative everywhere everything everyone because the conclusion is no drugs are not only about injecting air renews no drugs are not finished and they've not disappeared but it is a very dynamic market but also it's a very dynamic and changing situation for people who are using drugs and therefore to be able to understand and to adapt the responses it requires budget both for the monitoring and for the responses so that's a first point and and the second point and again I'm I'm a bit biased biased because I I know well the situation in Czech Republic but also in Spain and more recently with my visit last year in Barcelona again I think what we said in many webinars in the last three years during and the following the the covid epidemic is that what made possible to cope with the situation that was sometimes very challenging in some countries or some regions is the fact that we need inclusive policies and I think the example of Catalonia in Barcelona is it's incredibly rich because of the level of community engagement before because the the fact that you have different organizations different actors who are trying to coordinate and communicate and I like very much for that thing also the last comment of Esther it takes time so you cannot imagine you can invent a community approach within three weeks or even within three months and and we see that in many cities in Europe in the recent years there there has been kind of a deep investment in social services in proximity services including the police of proximity and this means that when you you try to build the new responses for instance for the crack problem maybe one day we come back to this in one of our webinars even when the authorities want to take a quick decision you cannot get a quick support from the community within the next weeks you need to build this partnership and it's a never-ending story so you need to permanently invest in that work and this means that sometimes the responses that may be technically correct are rejected by the citizens so we we need to find a way to to keep and maintain the community involved we need also to upscale the responses what what we see in Barcelona for for many years we we have a fresh example in Athens with the drug consumption room because there is a space for the use of methamphetamine and I think what is important here is to illustrate that there was a question in the in the chat or the Q&A about the drug consumption rooms and so on I mean you define the services in line with the needs from the population where you open those services and there may be an evolution because when people and people who are using drugs when they come to the drug consumption room or if you meet them with street workers um then if you listen to them you can better understand what are the other problems and basically there may be as as many different styles of drug consumption rooms as needed because it depends what is the local situation and what are the local challenges so there is no obligation for drug consumption room to be only for people injecting heroin or even smoking cocaine if if one of the key problems locally is for the methamphetamine well then if we if we want to bring a response that may be useful we need to adapt this then and of course one of the things that is still we have a huge deficit in Europe it's it's the services to women who are using drugs and I remember from the and I think Esther said something about this directly or indirectly I remember from my visit to Casvaluart and in other places in Europe um it's true that there is a low percentage of women attending the services but the services because also of the other part of the male population that can be extremely aggressive is it means that those services it's not their intention but they are not always women friendly enough uh so we need to be aware and to be aware it's not enough the authorities need to be ready also to finance okay it's always a question of budget but we need more specific responses for women and in some cases uh we need to to get an offer or services that is gender differentiate and then to finish at the last point that that is well illustrated by the the huge knowledge you shared with us with the different experiences and the different moments in the history of pervitin and methamphetamine in Europe is the fact that we need we need first we need to continue to invest and to keep the result of the evolution of the 30 the last 30 years in terms of associating people who are using drugs in in understanding the problem and building designing the responses and there was also an illustration uh in the presentation by Esther and Gabriela uh but I I want to highlight that we had we made a huge progress in the last 25 years but there are some risks that in the future if you see the evolution of politics in some countries uh with some countries or some cities or regions where the far right uh may be trying to to come back to business or to policy there is a risk of more excuse exclusion and stigma for people who are using drugs uh and again women are more exposed than men uh to that problem so it's not that we have made no progress in the last 30 years but now to make and to make sure this progress is sustainable and that we can build on that there is nothing that is guaranteed or grand forever so we need really to fight and to work together on that and and this goes together with the fact that you gave us such a fantastic illustration of what is the kaleidoscope of sources of information that we need to combine together to try to have a picture that teaches not only about what was drug use four years ago or three years ago but to understand what's happening today and uh certainly drug checking is a very important tool and I can just say if I compare with 30 years ago when we created the first drug checking program in Belgium with the market test if you see all professional and scientific programs like energy control and others have become just huge and amazing again it has a cost but but it's well worth the results and it contributes to produce a unique knowledge but but we need also to make sure that we articulate with wastewater epidemiology uh with other mode of interventions because it will help all of us not only emcdda but institution NGOs actors from the field to make a better case for your work for the need for responses and also for the evaluation of the programs and I think in the last five to ten years probably that's that it is also one of the evolution I observed in the contacts I have with the member states the questions they ask us and also the actors on the field in the past when those who created the needle exchange the first needle exchange or the first drug consumption consumption room they were more activists they were fighting for something and therefore they were not always interested in data collection and and I can understand this but today the decision makers who decide to take the political responsibility to create programs they need also to justify the results and for people from the field and the NGOs they need all help to to to develop their own tools for evaluation to understand where they are working well where they can make an impact but also to learn what maybe they could do differently and again there is nothing we can learn without associating and listening to people who are using drugs so plenty of new ideas and very good examples for future webinars and for a lot of food for thought for our interventions and considering maybe differently what is our role when it is about monitoring and sharing preparedness at local national or european level and frankly you you do a fantastic job thank you very much