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A harm reduction educational strategy towards Ecstasy PDF Print E-mail
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Articles - Dance/party drugs & clubbing
Written by Erik Fromberg   
INTRODUCTION

The use of XTC (methylenedioxymethamphetamine, MDMA or Ecstasy) has been increasing in the Netherlands since 1985. First supplies came from the USA, but production of the drug in the Netherlands is presumed to have started in 1987. In general, the first producers sold their product only to friends and relations, so the nature of these relationships more or less guaranteed the quality of their product. The producer—consumer chain was short, the production local.

In 1988, XTC was brought under the Dutch Narcotic Law on list 1, alongside heroin, cocaine, etc. As a result, many small producers stopped their production. However, at the same time the popularity of XTC increased logarithmically. This discrepancy between supply and demand resulted in the provision of more dangerous 'impostors', such as LSD and MDA, but particularly amphetamine.

The increasing popularity of this 'new' drug and the widespread presence of impostor-drugs necessitated an educational strategy to reduce harm as well as prevent use.

GOALS AND METHODS

It is self-evident that the essence of our advice can be formulated as the reduction of the harmful effects of drug use, which is in accordance with the central purpose of the Dutch drug policy. Harm reduction is a preventive goal. When we, albeit reluctantly, acknowledge that the primary aim of the narcotic laws is prevention, we also have to acknowledge that these laws have failed completely — drugs are and will be used, notwithstanding laws. Since XTC has been placed under the narcotic law, the demand for it has increased enormously. One might state that the law has resulted in a reduction of the availability of the drug. However, this is not the whole story. The demand is met with the supply of more dangerous drugs. The crux of the problem lies in the fact that narcotic laws take away the responsibility for individual behaviour from the individual and place it in the hands of the government. The availability of all sorts of illegal drugs makes clear that govemments are not able to bear this responsibility.

In our educational strategy we emphasize the individual's responsibility, in a way which can best be compared with 'safe use' AIDS campaigns. This implies that we neither want to moralize nor assume a missionary point of view. The starting point is the supposition that everybody is capable of acting responsibly with regard to themselves, as long as no impediments exist, such as a lack of information, etc. The existence of a small number of innately irresponsible people has never been an argument to prohibit car driving or other potentially dangerous activities.

In the Dutch drug policy the spreading of factual information has always been an important part of our prevention strategies. In contrast to some other countries, where information on drugs and their effects is often considered propaganda and punished as such, people in Holland can freely discuss and write about drugs. No one who acknowledges that drugs as such are neither good nor bad, and that drugs legally considered as entailing 'unacceptable' risks can (in certain circumstances) even have more positive than negative effects, has ever been prosecuted because of alleged drug propaganda. In the Dutch drug policy the relativity of 'unacceptable' is taken into account.

As a result, the Dutch public is relatively well informed about drugs compared with the public abroad. Thus, a second aspect of our educational strategy is that we make use of and rely on the already existing knowledge of the user.

However, information as such is not sufficient. Education is not the same as information. Education implies that the information is being placed in a normative frarne of reference. Occasionally establishing norms is confused with moralizing. In such cases it is stated that the use of a drug is bad, with an implicit argumentation on ethical considerations. It has to be stated emphatically that ethical considerations have their own value, but are subjective.

In short, the goal of our education is harm reduction, by giving factual information offered in a normative frame, without moralizing, taking into account the responsibility of individuals and their existing knowledge on drugs.

THE TARGET GROUP

The target group for our educational intervention are those who use XTC, because there exists a lack of information among them. Furthermore, we also expect to reach those who are considering whether or not to use XTC. This expectation is based on considerations regarding:

1 the properties of XTC;
2 the structure of the market;
3 the local character of the market.

The properties of XTC

The most important property is that XTC is characterized as a 'drug for social occasions'. Next in importance is that XTC has a low 'entry threshold'. This threshold is determined by pharmacological and sociological factors. The pharmacological factors are:

—    the soft action, when compared with 'real' hallucinogens like LSD;
—    the 'practical' duration of action, not as short as cocaine, not as long as LSD;
—    the dnig is relatively easy to combine with other drugs;
—    the drug is easily dosed, also with regard to its differential effects; — the user can function socially;
—    the drug does not cause physical dependence.

Relevant sociological factors are:

—    the reinforcement of feelings of togetherness;
—    the 'light' trend — XTC is being preferred above 'hard' drugs such as LSD, and more importantly amphetamine or cocaine; the old drugs are being rejected or being used more pragmatically;
—    the `varia' trend in consumption patterns of legal as well as illegal drugs;
—    the revival of the 'sixties%
—    the feeling of personal stardom: with your head in the clouds, but with your feet solid on the ground.

This low entry threshold is the main cause of the quickly growing popularity of this drug, but also causes a remarkable openness about the use of it. The properties of the drug and the form in which it is supplied also means that, at the consumer level, there are no means to check whether the product offered indeed contains the drug, something which is possible with a drug like cannabis.

THE STRUCTURE OF THE MARKET

New drugs are always introduced by a small group of people who have a relationship that had already been established. From this group, which usually belongs to the top layer of the community, the use spreads to the bottom. When this happens with an addictive drug, the relationship between users becomes more obscure as it spreads to the bottom. The spread of cocaine use is a good example.

The same process occurs with non-addictive drugs like cannabis and LSD, with the difference that the intrinsic criminal structure, which is so characteristic for the heroin and amphetamine trade, never developed, in spite of the illegality of these drugs. The differences between the cannabis market and the LSD market can be explained by the difference in entry thresholds, being low for cannabis and high for LSD. Due to the low threshold of cannabis this drug is attractive to many, while the high threshold of LSD limits its use to a small group. The cohesion within this group ensured that as soon as sufficient information on LSD was present within this group, its use gave no more problems. In this sense the self-correcting capacity of this market was and is large.

Until now, the market structure of XTC can best be compared with that of LSD and cannabis. The structure has certain characteristics:

—    a quick spread among a relatively large number of people;
—    the,self-correcting capacity of the market is, in principle, strong enough to limit possible dangers of the use of the drug;
—    there is only a weak coupling to specific group characteristics: XTC use persists, while, for example, the acid house musical trend passed its zenith and, while the use spreads to the bottom, it does not diminish in the top group.

The local character of the market

XTC is not a product that is traded by way of a worldwide network as is the case with cannabis and heroin. The production does not require a high degree of technical expertise or a large financial investment. It is a drug that can be produced relatively cheaply in a small laboratory from base materials that can be obtained legally. The entry threshold is not only low for the consumer but also for the producer. This resulted in a number of producers supplying a small local market. The chain between producer and consumer is short.

Within the local group of consumers, relations exist that go further than the use of the drug. As a result, the use is strongly determined by friendship-relations, in contrast with heroin, where commercial interests play a very important role, not only on the level of international smuggling but on the consumer level as well, trade to finance one's own use. This means, in the case of XTC, that information about the drug is spread in the buying and selling process.

Although the popularity of XTC has a number of aspects that can be compared with the emergence of cannabis and LSD in the 1960s and early 1970s, there exist remarkable differences too. The most important one is the 'pulverization of the scene'. While in the 1960s the binding forces between the scenes were stronger than the dividing forces, the reverse is now true: the youth culture is pulverized. In the 1960s the hippy subculture was characterized by a strong feeling of togetherness, the binding factor being a lifestyle, a value system, in which the use of cannabis was not only a binding factor, but a symbol of those binding values. In 1990 we see a multitude of different groups, having few mutual affinities, and which do not consider the use of XTC as a binding factor. Acid-house and jazz-pop fans, older and neo-hippies, New Age groups, motorclubs and yuppies: each group has its own goals, values and lifestyles. These groups seem to have little in common, though they do have some common characteristics:

—    musical interest;
—    outgoing personalities;
—    looking out for something special;
—    acceptance of drug use, i.e. of cannabis, and being relatively, well informed about drugs;
—    rejection of the pragmatization, the no-nonsense attitude of the 1980s, contiguous with the revival of the 1960s;
—    a rather strong collectivity within the group, not being drug-oriented;
—    strong indifference to the government and politics.

To illustrate this last point: most XTC users we talked to did not even know the drug had been brought under the narcotics law.

GOAL OF THE EDUCATIONAL INTERVENTION

The goals of the educational intervention are on three levels: primary, secondary and tertiary.

Primary prevention

—    Emphasizing the considerable chance that what one uses may not be XTC but a more dangerous drug, because what is offered as XTC is often adulterated or contains other drugs (i.e. amphetamine or LSD).
—    Giving the aspirant consumer more tools for decision-making about whether or not to use the drug.
—    Prevention of over-identification by avoiding scene-words.

Secondary prevention

—    The building of knowledge and experience among user groups.
—    Reinforcing the self-correcting capacity of user groups and the market. Even on the 'black market', standardization is possible as can be seen with LSD.

Tertiary prevention

—    Stimulation of self-help, teaching people what to do when they are confronted with problems in others.

COMMUNICATING THE INFORMATION

The problem is how to reach different groups, especially while the differences between the groups are so large that media specifically directed at these groups do not exist, in contrast to the underground press in the 1960s. So two approaches are possible:

High key: a broad campaign directed at the general public, but having the risk that such a campaign evokes interest in the drug that did not exist beforehand.

Low key: communicating by many different channels, directed to all special groups.

We handled both approaches in the following way:

Higk key: a publicity campaign around a conference on XTC in which the drug XTC was not central, but the 'market pollution', i.e. the general risk of all black market products not being what they are supposed to be, due to lack of control of the products. This is information that is relevant to all people, consumers as well as potential consumers of nearly all illegal drugs, and is supposed to have a demand reduction effect.

Low key: aimed at the different groups of (potential) users with specific information on XTC, contiguous with the high key approach. The chosen media were a leaflet, an information pack and, as an experiment, a public service telephone number.

The most important consideration was that it was necessary to give a lot of factual information since, the media-hype on XTC notwithstanding, the main facts on XTC were not available. Both our information pack and the telephone message try to give these facts and can be used as the basis for further information. We had to fulfil two requirements:

1 The heterogeneity of the target groups made it difficult to find terms addressing all groups. We had to avoid words that are specific for some of these groups. For the same reason we omitted advice on condom use.

2 The status as a hard drug. Apart from upsetting the distinction between hard drugs (List I) and soft drugs (List II) which is cherished in Holland, the fact that XTC has been scheduled as a hard drug hampers the spread of information about it. One of the most important characteristics of the user group is their acceptance of soft drug use, i.e. cannabis use, so the most obvious places to spread the information are the coffee-shops where cannabis is sold. However, these shops are tolerated as long as they are not involved in any way with the hard drug scene. This makes most coffee-shops very reluctant to distribute the XTC information as this might be considered by the police as involvement with schedule 1 drugs. In fact, all coffee-shops we approached refused to distribute the pack, in two cases with a threat of violence. To involve the shops, we requested the cooperation of the local police forces, in some cases with success.

THE EDITING OF THE INFORMATION PACK

As mentioned before, we chose a very factual approach, due to the heterogeneity of the target group. The style of the pack insert was modelled on the insert enclosed with medical drugs. With regard to the contents, we used the following items:

—    The effects of the drug, by which we hope to reduce the influence of mala fide suppliers.
—    The market pollution: one never knows what one is buying. This makes an appeal to the responsibility of the potential user and connects to the high key campaign — the risks of the use, if one has proper XTC: acute poisoning and long-term effects.
—    Combinations with other drugs. We answered the question whether specific combinations should be discussed by only mentioning them in general terms. Combinations that are used only in small circles (e.g. XTC with poppers) were not mentioned, while we considered the risk involved in drawing attention to such combinations as heavier than the lack of information. We are considering making smaller leaflets on such topics to be spread among relevant circles.
— Contra-indications.

The question whether or not to give an indication of price was answered with a clear 'no'.

THE PUBLIC SERVICE PHONE NUMBER

We prepared a tape recording with the same information for use on a public service telephone. The number was advertised in several national newspapers and in the first month over 400 people dialled the number, for which they are charged 50 cents per minute by way of their telephone account. We consider this a success and are discussing how to extend the use of this medium in the future.

FINAL REMARKS

It is clear that this information is just one part of a prevention strategy. The prosecution policy also plays an important role, since the local market structure implies a self-correcting capacity which is absent in large-scale production and supplying. Therefore, prosecution should be directed at large-scale operations and leave local production and consumption more or less unhampered. We consider a balanced dismissal policy an important matter, which mainly serves the harm reduction policy by barring adulterated drugs and limiting the use to local markets. The judicial powers as well as the police have so far followed such a subtle policy. We have since noticed a clear reduction of impostor drugs on the XTC market, and consider this a first success for our policy.

 

Our valuable member Erik Fromberg has been with us since Sunday, 19 December 2010.

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