GDS Key Finding 2019

May 16 2019

GDS2019 KEY FINDINGS REPORT

Prepared by the GDS Core Research Team

Professor Adam Winstock, Dr Monica Barratt, Dr Larissa Maier and Associate Professor Jason Ferris & Members of the GDS Academic Research Network (see citation) Suggested citation: Winstock AR, Barratt MJ, Maier LJ, Aldridge A, Zhuparris A, Davies E, Hughes C, Johnson M, Kowalski M & Ferris JA (2019). Global Drug Survey (GDS) 2019 Key Findings Report.

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

GLOBAL DRUG SURVEY IS AN INDEPENDENT SELF-FUNDED RESEARCH ORGANISATION We conduct our work free from oversight or interference from any government, research funding agency or corporate group. We take no funding from the alcohol or tobacco industries.

Global Drug Survey is compromised of academics from diverse disciplines, clinicians and harm reduction experts. We have published over 50 peer reviewed papers based on GDS data.

We rely on the hard work of people* all over the world and our media partners who share our commitment to helping people use drugs more safely regardless of the legal status of the drug, through the sharing of data and promotion of honest conversations about drug use.

We produce free harm reduction resources and videos (GDS YouTube Chanel) to share what we learn.

If you would like to support our work through offering time, resources or financial donation we would be very grateful. For further information please e-mail adam@globaldrugsurvey.com *you know who you are – thank you!!

GLOBAL DRUG SURVEY 2019

MISSION

Data from 123,814 people from over 35 countries was used in the preparation of this report.

We aim to make drug use safer regardless of the legal status of the drugs by promoting honest conversation and sharing information in a credible and meaningful way.

GDS is an independent research organisation that conducts university ethics approved, anonymous, encrypted web surveys in collaboration with global media partners who act as hubs to promote our survey and share our findings.

GDS draws on a diverse network of experts from the fields of medicine, toxicology, public health, psychology, chemistry, policy, criminology, sociology, harm reduction, and addiction.

We research key issues of relevance and importance to both people who use drugs and those who craft public health and drug policy.

Over 50 academic papers and over 150 conference presentations have been generated using GDS data.

Our last 5 surveys, run at the end of 2014-2018, have each received over 100,000 responses. To date >700,000 people have taken part in our annual surveys.

Over the last 7 years GDS has successfully supported the widespread dissemination of essential information both to people who use drugs - through our media partners, and to the medical profession through academic publications, presentations at international conferences, expert advisory meetings and the online resources www.drugsmeter.com and www.drinksmeter.com, www.saferuselimits.co, www.onetoomany.co and the Global Drug Survey Highway Code.

GDS2019 was translated into 19 languages, with active partners in over 30 countries.

GDS2020 launches in November 2019 and we hope to expand our reach and be available in over 20 languages. If you would like your country or organisation to be part of GDS2020 please contact us at info@globaldrugsurvey.com.

We are especially keen to expand into Africa, SE Asia and the Middle East.

GDS METHODS & ACADEMIC CREDIBILITY • GDS uses encrypted anonymous online surveys to get to the truth about the use of drugs around the world.

We are self-funded and free to explore positive aspects of drug use in addition to drug related harms. Our work aims to support the crafting of effective public policy that optimise the health and well-being of people who use drugs and the wider community.

• Participation is voluntary. Our survey is not a general population survey and should not be used to determine the prevalence of drug use within a population.

• Recent work by GDS suggests that the age and sex distribution of those who volunteer to be surveyed is not vastly different between these non-probability and probability methods such as general household surveys.

• Our work is increasingly recognised as a legitimate complementary data source to better understand drug use and its impact on health around the world.

• GDS is comprised of the Core Research Team and international partnerships with researchers and harm reduction organisations in over 30 countries.

“Probability based surveys tell you about the size of the drug use problem in your country GDS tells you what to do about it.”

Professor Adam Winstock Founder & CEO Global Drug Survey

MORE ON GDS METHODS Our recruitment strategy is an example of non-purposive sampling. We acknowledge that this has significant limitations, most notably with respect to response bias. It is more likely that individuals will respond to surveys if they see topics or items that are of interest to them, and thus by definition will differ from those who do not participate.

Don’t look to GDS for national estimates. GDS is designed to answer comparison questions that are not dependent on probability samples. The GDS sample is thus most effectively used to compare population segments, young, old, males, females, gay, straight, clubbers, thin people, obese people, vegetarians, those with a current psychiatric diagnosis, students, etc. Given that GDS recruits younger, more involved drug using populations we are able to spot emerging drug trends before they enter into the general population. GDS complements existing drug use information and provides essential, current data on the patterns of use, harms, health and well-being experienced by the drug users in your country.

THE FOUNDER AND CEO OF GDS IS PROFESSOR ADAM R WINSTOCK MD

Adam is a Consultant Addiction Psychiatrist and academic researcher based in London. The views presented here are entirely his own and have no relationship to those of his current employers or affiliate academic organizations. No government, regulatory authority, corporate organization or corporate entity has influenced the design/content of the survey/report.

LIMITATIONS GDS is not a nationally representative sample, but it does represent one of the largest studies of drug use ever conducted. The findings can inform policy, health service development and, most importantly, provide people who use drugs with practical advise on how to keep healthy and minimize the harms associated with the use of psychoactive substances. Findings are preliminary and subject to change on further analyses.

Throughout this report we provide some country comparisons on some key areas that may be of interest to readers of our publications. Because the samples we have obtained from different countries vary considerably in the size, their representativeness, the precise demographics and other characteristics of respondents such as involvement in clubbing and drug use, these comparisons have to be treated with caution.

The results do not necessarily represent the wider drug using community. Saying that, if you ask a 100 people in a country how much a drug costs or a group of 50,000 people who had used cannabis last year how often they sought emergency treatment you can’t dismiss the findings as irrelevant. For countries with small numbers the findings need to be treated with more caution. For a full review and critique of or methods please see Barratt M, Ferris JA, Zadhow R, Palamar J, Maier LJ, & Winstock AR. Moving on from representativeness: testing the utility of the Global Drug Survey. Substance Abuse: Research and Treatment; 11: Epub.

Further detailed country reports are available on request for a fee.

WHAT GDS CAN DO FOR YOU • GDS is an efficient approach to gain content rich data that explores diverse health outcomes associated with the use of alcohol and other drugs across the population of your country.

• GDS helps you understand quantitative dynamics of personal decision-making about drug use, detects regional differences in patterns of drug use and related harm, and informs novel interventions.

• Provides data on new drug trends and crucial public health and policy issues.

WHAT GDS WON’T DO FOR YOU •

Don’t look to GDS for national estimates, GDS is designed to answer comparison questions that are not dependent on probability samples.

•

Be aware that GDS recruits young, mostly welleducated people who are more involved in substance use than the general population.

•

The GDS database is huge but its non-probability sample means analyses are suited to highlight group differences among people who use drugs.

“We conclude that opt-in web surveys of hard-to-reach populations are an efficient way of gaining in-depth understanding of stigmatised behaviours and are appropriate, as long as they are not used to estimate drug use prevalence of the general population” Barratt et al. 2017

SHARING OUR FINDINGS WITH PEOPLE EVERYWHERE To ensure our findings are accessible and useful to people who use drugs we offer a range of free harm reduction resources such as: • The GDS Highway Code www.globaldrugsurvey.com/brand/the-highway-code/ • The Safer Use Limits www.saferuselimits.co/ • Digital health apps to deliver brief screening and intervention: www.drinksmeter.com and www.onetoomany.co • Harm reduction and drug education videos available on our YouTube channel www.youtube.com/user/GlobalDrugSurvey When reporting the results in print, online and on TV we ask all our media partners to place links to these free resources where suitable.

KEY RESULTS IN THIS SECTION

þ GDS2019 participation rate by country (n/%) þ Gender: male vs. female (1% identified as transgender/non-binary; their data was not considered for the analyses in the present report*) þ Age: mean age by country and global age distribution (%) þ Clubbing: frequency in the last 12 months (%) þ Ethnicity & employment (%) þ Use of legal & illegal drugs in the last 12 months by country (%) þ Injection drug use ever and in the last 12 months by country (%) *We are currently analyzing data from the last 3 years of the GDS to explore drug use patterns among people who do not identify as male or female. We don’t think the numbers from a single year give a robust enough picture so we decided to share the findings separately later on and will only include those on sexual assault.

2,491 2,437 2,184 1,960 1,629

Austria Hungary Finland Canada Netherlands

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Serbia 293

South Africa 294

Lithuania 318

Poland 335

Argentina 402

Chile 451

Czech Republic 468

Slovenia 482

Portugal 500

Belgium 536

Scotland 566

Sweden 675

Spain 717

Greece 744

Mexico 831

Romania 847

867

2,762

Slovakia

India

3,185

France

871

3,363

Ireland

Norway

3,666

Switzerland

950

4,105

Italy

Colombia

4,306

5,670

Brazil

England

7,738

9,998

Denmark

0K

7,864

10K

Australia

New Zealand

11,248

20K

United States

35,030

40K

Germany

No of Respondents

GDS2019 PARTICIPATION RATE BY COUNTRY (n)

30K

N > 120,000

2.3% 2.1% 2.0% 1.8% 1.6% 1.3% 0.8% 0.7% 0.7% 0.7% 0.7%

Slovakia Austria Hungary Finland Canada Netherlands Colombia Norway India Romania Mexico

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Serbia 0.2%

South Africa 0.2%

Lithuania 0.3%

Poland 0.3%

Argentina 0.3%

Chile 0.4%

Czech Republic 0.4%

Slovenia 0.4%

Portugal 0.4%

Belgium 0.4%

Scotland 0.5%

Sweden 0.6%

Spain 0.6%

Greece 0.6%

2.6%

France

3.0%

Switzerland 2.8%

3.4%

Italy

Ireland

3.6%

4.7%

Brazil

England

6.4%

Denmark

8.3% 6.5%

0

Australia

New Zealand

9.3%

10

United States

29.0%

30

Germany

% of Respondents

GDS2019 PARTICIPATION RATE BY COUNTRY (%)

20

N > 120,000

40.7

31.3 31.0 30.9 30.8 30.5 30.1 29.6 29.5 29.4 28.9 28.8 28.6 28.5 27.5 27.3 26.8 26.7 26.7 26.5 25.5 25.3 25.2 25.1 24.8 24.0 23.7 23.3 23.3 22.8 22.7 22.5 22.4 21.0

Chile Portugal Germany Norway United States Hungary Belgium Switzerland Global Spain Canada Finland Brazil India Austria Argentina Scotland Mexico Sweden Czech Republic Netherlands Greece England Slovakia Colombia Italy Australia Serbia Lithuania Romania Denmark Poland Slovenia

0

31.9

10

France

20

32.3

30

South Africa

35.7

40

Ireland

New Zealand

Years

GDS2019 MEAN AGE OF PARTICIPANTS BY COUNTRY 50

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

GDS2019 GENDER & AGE DISTRIBUTION OF PARTICIPANTS AND CLUBBING 100%

100%

90%

90%

80%

80%

41.5% 70%

% of Respondents

% of Respondents

70%

60%

50%

60%

56.8%

Var1Fact 4+ tim

50%

22.8%

<4 tim 40%

no clu

40%

Global 30%

30%

58.5%

24.5%

20%

20%

10%

10%

59.7%

17.5% 18.7%

Var1Factors 4+ times per year

0%

0%

Global

22.8% <4 times per year <25

25-34

35+

no clubbing

Global

Gender (%)

59.7%

Age distribution (%) 17.5%

Clubbing (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

GDS2019 ETHNICITY & EMPLOYMENT STATUS OF PARTICIPANTS Ethnicity (%)

Employment (%)

100

100% 90

90%

86.9%

80%

70

70%

% of Respondents

80

% of Respondents

60

50

40

66.0%

60%

50%

40%

30

30%

20

20%

26.6%

7.5%

10%

10 6.2% 2.5%

White

Mixed

Other - (please specify)

0%

1.4%

1.3%

1.0%

0.5%

0.2%

0.0%

Aboriginal / Maori

South East Asian (including Chines..

Asian (Pakistani, Indian, Bangladeshi)

Hispanic / Latino

Black African / Black Caribbean

Native American

0

paid employment

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

unemployed: not looking

unemployed: looking

20

0

9.4% 8.2% 7.2% 6.2% 6.1% 5.7% 5.5% 5.3% 4.8% 4.5% 4.1% 4.0% 3.7% 3.7% 3.6% 3.3% 3.0%

methamphetamine dmt truffles salviadivinorum ghbgbl methylphenidate kratom 1plsd crack heroin dexamphetamine viagra opium mephedrone zdrug kava ayahuasca

10.9%

2cb

9.7%

12.3%

caffeinetablets

syntheticcannabis

14.5%

17.7%

poppers tramadol

18.8%

tobaccosnus

23.5%

nitrous

20.3%

25.7%

benzodiazepines

ketamine

28.2%

33.6%

lsd prescopioids

34.2%

magicmushrooms

39.8%

electroniccigarettes

35.8%

42.5%

tobaccoshisha

amphetamine

43.1%

cocaine

mdma

77.4%

40

cannabisthc 49.2%

60

78.1%

80

tobacco

98.3%

100

alcohol

% of Respondents

GDS2019 LIFETIME USE OF DRUGS

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

0%

29.1%

cocaine

4.7% 4.2% 4.0% 3.4% 3.3% 3.1% 2.8%

caffeinetablets dmt methamphetamine kratom truffles 1plsd methylphenidate

Global Drug Survey GDS2019 © Not to be reproduced without authors permission ayahuasca 1.1%

kava 1.1%

salviadivinorum 1.3%

modafinil 1.3%

heroin 1.4%

syntheticcannabis 1.5%

crack 1.6%

pregabalin 1.6%

zdrug 2.1%

ghbgbl 2.4%

80%

viagra 2.4%

86.3%

100%

dexamphetamine 2.5%

5.5%

2cb

11.9%

nitrous

6.8%

12.8%

ketamine

tramadol

14.8%

magicmushrooms

7.5%

16.1%

benzodiazepines

poppers

16.4%

prescopioids

9.5%

17.5%

lsd

tobaccosnus

18.9%

tobaccoshisha

22.1%

30.6%

electroniccigarettes

amphetamine

33.0%

mdma

61.6%

20%

tobacco

40%

63.8%

60%

cannabisthc

alcohol

% of Respondents

GDS2019 DRUGS USED IN THE LAST 12-MONTHS Among GDS2019 participants, the use of THCcontaining cannabis in the last 12 months was more prevalent than tobacco.

Of the 20 drugs used most prominently: à 4 were tobacco/nicotine based products à 6 were psychedelic/dissociative drugs à 4 were stimulant drugs à 3 were prescription CNS depressants

GDS2019 DRUGS USED IN THE LAST 12-MONTHS: EXCLUDING ALCOHOL, TOBACCO/NICOTINE & CAFFEINE CONTAINING PRODUCTS 63.8%

60%

40%

33.0% 29.1%

30%

22.1% 20% 17.5%

16.4% 16.1% 14.8% 12.8%

11.9%

10%

7.5% 6.8% 5.5% 4.2% 4.0% 3.4% 3.3% 3.1% 2.8% 2.5% 2.4% 2.4% 2.1% 1.6% 1.6% 1.5% 1.4% 1.3% 1.3% 1.1% 1.1%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

ayahuasca

kava

salviadivinorum

modafinil

heroin

syntheticcannabis

crack

pregabalin

zdrug

ghbgbl

viagra

dexamphetamine

methylphenidate

1plsd

truffles

kratom

methamphetamine

dmt

2cb

tramadol

poppers

nitrous

ketamine

magicmushrooms

benzodiazepines

prescopioids

lsd

amphetamine

cocaine

mdma

0%

cannabisthc

% of Respondents

50%

G LO B A L G D S S A M P L E S E E K I N G E M E R G E N C Y M E D I C A L T R E AT M E N T

FOR THE 13 MOST COMMON DRUGS USED IN THE LAST 12 MONTHS >100,000 PARTICIPANTS FOR ALCOHOL; FEWER FOR OTHER SUBSTANCES (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND

• Emergency medical treatment (EMT) seeking can be taken as a proxy measure for the acute harms experienced following the use of alcohol and other drugs.

• Emergency medical attendance and admission represent significant economic burden upon acute medical services.

• While the press often highlights attendance at A+E departments as a frequent occurrence among those who drink and take other drugs, there is little data on the actual prevalence of such treatment seeking among people in the general population.

• This year we asked people who reported having used the 13 most common psychoactive substances in the last year whether they had sought EMT following the use of these drugs.

• This is the first time that we also included EMT seeking following the use of heroin.

EMERGENCY MEDICAL TREATMENT (EMT) SEEKING IN THE LAST 12 MONTHS BY DRUG 13.6% 10% 3.2%

3.2%

2.9%

2.7%

1.7%

1.2%

1.1%

1.0%

0.4%

10% 3.7%

5%

3.2%

2.2%

3.2%

1.9%

1.7%

1.2%

1.1%

0.7%

1.1%

0.9%

0.3%

1.0%

1.0%

1.2%

0.6%

0.5%

0.4%

10.8%

2.3%

1.6%

nps

syntheticcannabis

ghbgbl

4000

3000

1500

2500

alcohol

methamphetamine

heroin

0%

100,000

0.7%

23,500

20,000

15,000

13,000

15,000

magicmushrooms

3.6%

cannabis

3.1%

amphetamine

2.8%

cocaine

10%

Approx: N for each drug 1500

The ranking of 13 drugs looked at in GDS2019 were as follows 1.

2.

16.4%

mdma

% of Respondents

0.7%

15%

0% 20%

Male

0.8%

ketamine

Female

% of Respondents

0% 20%

0.9%

lsd

All

% of Respondents

20%

64,000

11,000

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Heroin Novel Drugs + Methamphetamine 3. SCRAs (Synthetic Cannabis) 4. GHB/GBL 5. Alcohol 6. MDMA 7. Cocaine 8. Amphetamine 9. LSD 10. Ketamine 11. Cannabis 12. Magic Mushrooms

HOSPITAL ADMISSION AMONG PEOPLE WITH EMT IN THE LAST 12 MONTHS BY DRUG 100

88.9%

90

80

70

60

60.7%

59.3%

59.4%

56.0% 53.1% 50.9%

50 42.9% 40

28.6%

30

20

10

Magic Mushrooms

Synthetic Cannabis

Amphetamine

Methamphetamine

Heroin

MDMA

Cannabis

LSD

Cocaine

0

Alcohol

% of Respondents

65.1%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Note very small numbers for GHB, Heroin, NPS and Synthetic cannabis (SCRAs)

• Think about if you really want to take it. If you don’t feel comfortable or well in yourself or just unsure, then leave it till another day.

• If you’re drug naïve – you have no tolerance and won’t know what to expect so always take a very small dose.

• The biggest risk is taking a lot of an unknown drug before you know how long it takes to come on, peak and to start coming down – so easy does it. Test drive it before you take a ‘full dose’ • Wait for at least 90-120 minutes before redosing.

GDS ADVICE FIRST TIME USE OF A NEW DRUG

• Don’t have anything else in your system, includes alcohol and prescribed medication.

• Choose your time – don’t be coming down or experimenting on the back of a bender.

• Avoid taking other drugs or drinking alcohol after dosing.

• Don’t be on your own. Be with people who you trust who can take care of you if you don’t feel well.

• Plan ahead before you’re too off your head. Know where you’ll stay that night and how you will get home.

• Make sure others know what you have taken and that at least one of them is not intoxicated.

• If you feel unwell tell someone you know and seek help.

• Be in a safe and familiar place.

• Don’t drive, bath or play with knives.

• Accept many drugs won’t be very good, effective or nice.

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

• We have data on hundreds of thousands of people who use drugs from all over the world and a network of highly skilled researchers who are experts in their field. From in depth questions on patterns of use, harms, motivations and cost to source of purchase, policing, harm reduction strategies and much more.

• We have data on virtually every drug you can think of (almost). We are always interested in collaborating with academics and other groups especially those involved in public policy, health promotion and harm reduction. We are able to provide bespoke data based reports to help you craft optimal policy and harm reduction strategies in your country.

• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network

G LO B A L G D S S A M P L E ALCOHOL

98.2% OF THE GDS2019 PARTICIPANTS REPORTED THE USE OF ALCOHOL IN THEIR LIFETIME 87.8% OF THE GDS2019 PARTICIPANTS REPORTED THE USE OF ALCOHOL IN THE LAST 12 MONTHS >100,000 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND • GDS2019 has continued to map global drinking patterns using the Alcohol Use Disorders Identification Test (AUDIT), a World Health Organisation questionnaire to ascertain a score for harmful drinking levels and dependence.

• All AUDIT scores of 8 or higher indicate hazardous and harmful alcohol use. AUDIT scores ranging from 8-15 represent risky use causing some problems whereas scores of 16 and above represent harmful use causing lots of problems. AUDIT scores of 20 or above warrant further diagnostic evaluation for alcohol dependence.

The higher the score, the larger not only the problems but also the need for treatment.

• Each year, about 1 in 3 GDS participants expresses a desire to drink less alcohol in the next 12 months. Digital health applications, media and lifestyle blogs help to raise awareness of the health harms associated with excessive drinking. The results of the GDS are, for example, also used to inform the online and smart phone app Drinks Meter www.drinksmeter.com • This year, we explored how often people got drunk and on what proportion of these occasions did the person regret vs. really enjoyed the experience.

KEY RESULTS IN THIS SECTION Drinking harms and adverse experiences þ Average AUDIT score category for each country – total & by gender & by age (16-24 and 25+) þ Rates of feelings of regret or guilt at least monthly because of their drinking – total & by gender & by age (16-24 and 25+) Who wants to drink less, who wants help and who sought emergency medical treatment? þ The % of last year drinkers who would like to drink less in the next 12 months þ The % of last year drinkers who would like help to reduce drinking þ The % of last year drinkers who sought emergency medical treatment – total & by gender & by age

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission 14.5% 14.5%

Australia Brazil

Switzerland Austria

4.5%

6.5% 5.9%

Italy

Germany

7.3% 6.9%

Netherlands

8.0% 7.3%

Belgium

Norway

Hungary

9.1% 8.4%

Czech Republic

9.6% 9.4%

Slovakia

Sweden Denmark

10.0% 9.8%

Portugal

10.0%

Global Finland

11.4% 11.2%

France

13.0%

14.5%

Argentina

Spain

15.1% 14.7%

New Zealand

16.9% 16.8%

USA Balkans

19.0%

0%

18.6%

10%

Canada

20%

United Kingdom

30%

Republic of Ireland

70%

20.8%

80%

19.2%

50% 41.6%

30.4%

30.9%

32.9%

32.9%

33.5%

34.3%

35.2%

35.9%

37.0%

37.8%

38.5%

39.1%

39.3%

39.4%

39.5%

40.3%

40.4%

40.8%

41.1%

41.5%

42.1%

42.5%

42.5%

44.4%

44.8%

44.9%

47.4%

90%

Chile

% of Respondents

Would like help to drink less

22.4%

0%

Mexico

Denmark

Switzerland

Portugal

20%

India

Overall 37% of all participants who recently drank alcohol want to drink less next year.

Half of all people who drank alcohol in India, Finland and Ireland wanted to drink less. Danish participants were least inclined to cut down.

Italy

50.1% 49.8%

80%

Columbia

*Note India is a very big country and we only had 850 people from there, so the representativeness of the Indian sample, will be very restricted.

Germany

Austria

Sweden

Balkans

Argentina

Global

Netherlands

Australia

Belgium

Brazil

40%

Hungary

France

USA

Chile

Columbia

Spain

Czech Republic

United Kingdom

New Zealand

Norway

Canada

Slovakia

Mexico

Republic of Ireland

53.3%

60%

Finland

India

Would like to drink less

% of Respondents

20% Only countries with n > 250 people who recently drank alcohol were included in these graphs

22.4%

9.6%

6.5%

10.0%

6.9%

4.5%

5.9%

9.8%

16.8%

14.5%

11.2%

7.3%

14.5%

8.0%

14.5%

7.3%

11.4%

16.9%

20.8%

19.2%

13.0%

9.1%

14.7%

15.1%

8.4%

19.0%

9.4%

18.6%

10.0%

DESIRE TO DRINK LESS & INTENTION TO SEEK HELP IN THE NEXT 12 MONTHS

41.6%

% of Responden

Would like help to drink less 60%

40%

0% 100%

100%

Overall only about 1 in 10 people who wanted to drink less wanted help to do so.

The lowest interest in seeking help was seen among the GDS2019 participants in Switzerland, Austria and Germany.

60%

40%

Male

1.8%

India

1.6% 1.4%

Slovakia New Zealand

Global Drug Survey GDS2019 © Not to be reproduced without authors permission 1.1% 1.0% 0.6% 0.7%

Switzerland Netherlands Spain Czech Republic

1.5%

0.9%

Germany

1.8%

2.3%

2.5%

2.1%

2.3%

2.3%

1.9%

2.6%

2.3%

2.0%

1.9%

0.9%

1.4%

1.7%

0.9%

2.8%

1.4%

1.2%

1.6%

0.5%

0.5%

0.4%

0.0%

3.5%

3.5%

3.5%

2.3%

0.7%

0.0%

0% 10%

Belgium

0.6%

Chile

1.5% 0.7%

Italy

Austria

Argentina 0.0%

1.6%

1.1%

France Denmark

1.6% 1.5%

Global Hungary

2.8%

1.6%

Finland

Portugal

1.8% 1.5%

USA Republic of Ireland

1.8% 1.7%

Colombia

2.3%

Mexico

Canada

2.6%

Balkans

2.0%

2.2%

Norway

Sweden

2.1%

Brazil

3.7%

0%

United Kingdom

5%

4.7%

5%

3.6%

% of Respondents

0.5%

0.5%

0.9%

0.9%

1.0%

0.9%

0.9%

1.0%

1.3%

1.0%

1.4%

1.5%

1.6%

1.5%

1.7%

1.7%

1.9%

2.0%

1.8%

1.7%

2.0%

1.9%

2.2%

2.2%

2.2%

2.5%

2.5%

2.7%

3.7%

4.1%

5%

Australia

Female

% of Respondents

All

% of Respondents

EMERGENCY MEDICAL TREATMENT DUE TO ALCOHOL USE BY COUNTRY & GENDER Only countries with n > 250 people who recently drank alcohol were included in these graphs 10%

0% 10%

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THE PLEASURE & THE PAIN OF GETTING DRUNK Getting drunk (and we did not define the term ‘drunk’ in the survey) is generally considered an unwise thing to do.

Whether it’s increasing the risk of accidents, arguments, fights and hangovers, or adding to the risk of developing longer term health harms as a result of excessive consumption, drinking lots on a day and getting intoxicated (drunk), is something no country’s drinking guidelines allow for, not even once a year.

Given that most countries recommend not drinking than more than about 40gm of alcohol (half a bottle of wine or 2 pints of beer) on any one day to minimise the risks of acute harm, and most people report needing at least twice this (often much more) to get ‘happily drunk’, we know that guidelines offer little of relevance once you’re drunk.

So getting drunk is bad for your health. But people drink to excess despite the harms. Why? Because it’s fun. But is it always fun? How often do people really enjoy getting drunk? How often does it lead to regret? Who gets drunk the most times? Who regrets it the least?

GDS2019 asked 3 simple questions: 1.

2.

3.

On approximately how many days did you get drunk last year?

On how many of those days did you regret getting drunk?

On how many of those days did you really enjoy getting drunk?

Please note that some percentages on the following slides do not add up to 100%. We excluded people who told us they regretted or enjoyed getting drunk more times than the actual number of times they said they got drunk. However, for some people, the number of times they regretted and enjoyed did not add up to the number of times that they said they got drunk. Perhaps they neither particularly regretted or enjoyed some occasions, and enjoyed some at the time, but regretted them afterwards.

MEAN NUMBER OF TIMES DRUNK IN THE LAST 12 MONTHS BY COUNTRY Only countries with n > 250 people who recently drank alcohol were included in this graph 55 51.1 50.3 50 47.9

47.4

45 41.7

41.0

40.7

40 38.2 36.8 34.9

34.7 33.6

33.0 32.2

31.9

31.9

31.7

31.5 30.0 29.2

30

29.0

28.6

28.1 27.3 24.9

25

23.6 22.0

21.5 20.2

20 16.4 15

10

5

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Chile

Portugal

Germany

Colombia

Argentina

Hungary

Brazil

Switzerland

Netherlands

Norway

Austria

Italy

Balkans

Slovakia

Sweden

Spain

France

Global

New Zealand

Belgium

Finland

Czech Republic

Mexico

Republic of Ireland

India

Denmark

Australia

Canada

USA

0

United Kingdom

Mean No of Times Drunk

35

Male

20.0% 20.0% 23.1% 20.3% 21.1% 19.3% 19.3% 18.3% 17.8% 18.3% 18.7% 16.3% 19.7% 16.5% 19.4% 16.8% 15.4% 15.0% 15.8% 15.3% 16.1% 15.0% 16.0% 12.6%

Global Chile Slovakia Colombia Netherlands Balkans Brazil Italy Finland Spain France Mexico United Kingdom India Argentina New Zealand Sweden Canada USA Czech Republic Australia Portugal Denmark

17.1%

Belgium

Republic of Ireland

19.5%

Norway

22.3%

23.6%

Switzerland

Hungary

23.8%

0%

Austria

50%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission 17.5%

16.5%

19.8%

19.3%

20.8%

21.0%

24.0%

23.0%

21.3%

18.9%

22.5%

18.8%

23.7%

21.5%

23.8%

24.5%

24.7%

24.8%

24.7%

23.1%

24.6%

21.1%

25.6%

26.2%

26.0%

32.8%

32.0%

33.1%

33.3%

32.4%

50%

25.7%

% of Respondents

14.7%

16.0%

17.0%

16.9%

17.1%

17.7%

16.7%

18.0%

19.4%

19.3%

18.5%

19.4%

18.3%

19.8%

19.5%

20.0%

21.0%

21.1%

21.5%

21.9%

21.6%

22.8%

21.8%

21.6%

23.2%

22.1%

22.5%

26.2%

27.3%

27.7%

50%

Germany

Female

% of Respondents

All

% of Respondents

% OF OCCASIONS THAT PEOPLE REGRETTED GETTING DRUNK BY COUNTRY & GENDER Only countries with n > 250 people who recently drank alcohol were included in these graphs 100%

0% 100%

0% 100%

% OF OCCASIONS IN THE LAST 12 MONTHS ON WHICH PEOPLE GOT DRUNK THAT THEY REALLY ENJOYED v REGRETTED IT: BY GENDER & AGE (GLOBAL SAMPLE) 100%

80%

Enjoy

Percentage

70.5%

71.9%

74.2%

75.3%

60%

Women over the age of 25 years old reported highest rates of regret following getting drunk.

40%

20%

Young men reported the lowest rates.

0% 100%

Regret

Percentage

80%

60%

40% 29.1% 22.2%

22.3% 17.3%

20%

0% Female 25 +

Female <25

Male 25 +

Male <25

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

ENJOYMENT VS. REGRET OF BEING DRUNK IN THE LAST 12 MONTHS BY AUDIT* CATEGORY 100%

Regret %

% of Respondents

80%

60%

40%

34.5% 26.3%

20%

18.7%

21.5%

People with more risky alcohol use patterns report regretting getting drunk almost twice as often as people who drink at low risk.

0% 100%

80%

74.1%

74.3%

72.0%

Enjoy %

% of Respondents

68.3% 60%

40%

20%

0% Low risk

Increasing risk

Higher risk

Possible dependence

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

LOW RISK DRINKING = HIGHER ENJOYMENT WHEN DRUNK On average people who took part in GDS2019 and reported recent alcohol use got drunk a mean of 33 times in the previous 12 months. The highest average rates were reported by the UK (51 times) and USA (50) whilst the lowest number was reported by Portugal (20) and Chile (16 times).

English-speaking countries top the GDS countries for getting drunk, with respondents from the UK, Australia, the USA and Canada getting drunk about once a week.

Globally just over one in three participants reported having never regretted getting drunk in the last 12 months. Although there were marked country differences, one difference transcended nations – that of women consistently reporting higher rates of regret than men across virtually every single country we assessed (Chile and India were the exceptions). For example while 12% of the whole sample reported regretting getting drunk at least half the times they got drunk, for women over 25 years the figure was 20%. Women in German speaking countries reported the highest rates of regret (over 30% of the times they got drunk). The same trend was seen for men from these countries as well and is consistent with previous work done by GDS (Davies et al 2017) which identified social humiliation as being a major motivator for drinking less in these countries.

Changing the cultural narrative concerning intoxication and promoting moderation seems to be good for a nation’s health. The EU may see the UK leaving the EU as positive in terms of reducing the contagion of ‘le binge’ which may have been one of the UK’s less popular exports.

From a public health and policy perspective our findings throw up one major challenge. People overwhelmingly like getting drunk, with people saying they really enjoyed getting drunk on over 70% of occasions. Most would have had much fun drinking a bit less. It’s a hard call to make especially knowing how happy this might make the alcohol industry, but it might be time to look at providing guidelines offering advice on how to get drunk safely and offering some lower risk limits on the frequency of this risky activity and to highlight that for most people they would get as much pleasure when they choose to get drunk if they drank a bit less (especially if as a group you all decide to drink a bit less on night out). We might at least engage people who at present may see guidelines as irrelevant especially after that fourth drink.

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

• We have data on hundreds of thousands of people who use drugs from all over the world and a network of highly skilled researchers who are experts in their field. From in depth questions on patterns of use, harms, motivations and cost to source of purchase, policing, harm reduction strategies and much more.

• We have data on virtually every drug you can think of (almost). We are always interested in collaborating with academics and other groups especially those involved in public policy, health promotion and harm reduction. We are able to provide bespoke data based reports to help you craft optimal policy and harm reduction strategies in your country.

• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network

G LO B A L G D S S A M P L E CANNABIS

77.4% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED THC-CONTAINING CANNABIS 63.8% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED THC-CONTAINING CANNABIS IN THE LAST 12 MONTHS > 64,000 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

KEY RESULTS IN THIS SECTION

Number of days of cannabis use in the last 12 months The most common and the preferred cannabis products The rate (%) of participants who use tobacco when they smoke cannabis The amount of cannabis use on a usual day Common sources for obtaining cannabis The rate (%) of participants who reported having sought emergency medical treatment in the last 12 months as a result of cannabis use þ The rate (%) of participants who should have sought emergency medical treatment in the last 12 months as a result of cannabis use but chose not to & the reasons for not having sought help þ The rate (%) of participants who want to use less cannabis in the next 12 months þ þ þ þ þ þ

80%

NUMBER OF DAYS (RANGE) CANNABIS USED IN THE LAST 12 MONTHS BY GENDER 70% 100.0

60% 90

80

50%

70.0 70 Median no of days

All

% of Respondents

100

40%

30%

60

50 40.5

20.8%

22.2%

20.6%

40

20% 30

13.1% 10.0%

9.9%

20

10% 3.5%

10

0% 0

1

02-10

11-50

51-100

101-200

Number of days (range) used (%)

201-300

301+

All

Female

Male

Median no of days

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

CANNABIS PREPARATIONS USED IN THE LAST 12 MONTHS 100%

Category Normal weed High potency

90%

Resin / hash Edibles group Kief group

80%

Concentrates 72.7% 70%

60%

50% 43.0% 40% 33.2% 30% 21.6% 18.9%

20%

10%

Concentrates

Kief group

Edibles group

Resin / hash

High potency

0%

Normal weed

% of Respondents

65.6%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

24.7%

40.3%

78.0% 77.3% 77.0%

Spain Netherlands India

53.2%

Australia

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission 8.8%

Mexico

6.6%

8.9%

Argentina

Chile

9.9%

Colombia

12.0%

18.5%

Canada United States

19.7%

Brazil

New Zealand

South Africa

54.0%

Slovakia

60.1%

Czech Republic

55.0%

60.3%

Global

Poland

61.5%

64.1%

Finland Sweden

65.3%

Norway

74.7%

78.4%

Germany

England

78.7%

Ireland

83.6%

Slovenia

79.2%

83.8%

Hungary

Austria

84.0%

88.5%

Denmark

Lithuania

89.6%

Switzerland

85.5%

89.6%

Serbia

Belgium

90.2%

France

90.7%

0%

Greece

20%

91.1%

40%

Portugal

60%

91.4%

80%

Romania

95.0%

100%

Italy

% of Respondents

RATES OF CANNABIS USE MIXED WITH TOBACCO BY COUNTRY

Only countries with n > 100 participants who used recently were included in this graph

0.5%

0.7%

3.5

5+

5

0.5%

0.2%

4.5 0.0%

0.2%

0.8%

3

4

0.9%

2.5

2

1.9 0.0%

0.8%

0.2%

1.7

Don't know

Global Drug Survey GDS2019 © Not to be reproduced without authors permission 1.8

0.2%

0.2%

0.6%

1.6

1.5

1.4

1.3

0.9%

0.3%

3.3%

3.6%

5.2%

10%

1.2

1.1

2.8%

11.9%

12%

1

0.9

0.8

3.3%

0%

0.7

2%

3.4%

4%

0.6

5.8%

12.0%

15.9%

16%

0.5

6%

0.4

0.3

13.1%

13.0%

14%

0.2

0.1

% of Respondents

AMOUNT OF CANNABIS USED ON A USUAL DAY OF USE 18%

Less than 15% report consuming more than 1 gram per day

8%

Cannabis: use less cannabis

Cannabis: help to use less cannabis Cannabis: use less cannabis 60

40

Portugal

35.0%

Norway

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission 33.6%

Germany

Argentina

Finland

Austria

19.6%

25.4%

31.4%

37.5%

32.5% 31.0%

Spain

27.8%

18.2%

15.4%

21.2%

14.7%

15.7%

27.8%

18.7%

19.0%

29.3%

17.2%

17.6%

18.1%

7.0%

8.4%

7.9%

17.0%

17.7%

8.1%

8.3%

11.7%

18.6%

11.4%

12.7%

20.3%

14.0%

10.7%

13.0%

14.3%

14.6%

10.9%

10.5%

10.4%

5.8%

0.0%

0 100

Azerbaijan

33.2%

24.5%

United States Switzerland

24.1%

New Zealand

34.7% 34.0%

Serbia

32.0%

Slovakia

Italy

25.6%

Hungary South Africa

32.3%

24.9% Lithuania

Chile

31.6%

32.7%

Sweden

80

Global

33.8%

Poland

38.1% 33.9%

Netherlands

Belgium

34.5% 31.0%

38.5% 24.0%

80

Czech Republic

29.0%

Slovenia Canada

36.7% 35.8%

Australia

24.7%

33.8%

Ireland Mexico

33.7%

England

27.6%

41.0%

Brazil

40.7%

0

Romania

20

France

44.5%

35.6%

20

Denmark

10 51.4%

20 40

41.6%

30

Colombia

0

India

31.6% Cannabis: help to use less cannabis

% of Respondents

50

Greece

40

% of Respondents

% of Respondents 80

70

DESIRE TO USE LESS CANNABIS & HELP-SEEKING BY COUNTRY

Only countries with n > 100 participants who used recently were included in these graphs

60

100

Of those who want to use less, the (%) that help to use less

60

14.0%

Want to use less (%)

GDS LAUNCHES WORLDâ&#x20AC;&#x2DC;S FIRST SAFER USE LIMITS GUIDELINES FOR CANNABIS

Try it here now: www.saferuselimits.co

G LO B A L G D S S A M P L E C A N N A B I S H E A LT H I N F O R M AT I O N L A B E L S

> 55,000 PARTICIPANTS WHO USED CANNABIS IN THE LAST 12 MONTHS COMPLETED THIS SECTION THE REPORT PRESENTS DATA FROM COUNTRIES WITH > 250 PARTICIPANTS WHO RECENTLY USED CANNABIS

BACKGROUND • Some of GDS’s key objectives are to promote honest conversations about drug use and to encourage changes to the style and content of health based communications and drug policies. Within the context of illicit drugs, governments tend only to support health messages consistent with government policy, that is zero tolerance, simply stating ‘drugs are bad’. Often it means that the portrayal of people who use drugs is stereotyped and negative.

• That’s why a regulated market is a game changer. It allows governments to support health messages that are honest. It allows them to stop defining people by the drug they use, instead treating people as adults who are interested in their own health and well-being.

• To date, most governments’ track record regarding health labels for legal psychoactive products has been less than impressive, often due to fierce opposition from the tobacco and alcohol industries. While huge steps have been made on tobacco packaging in recent years, very few countries support mandated health warnings on alcohol labels.

• Although mentioning harms won’t be easy for some cannabis companies and committed consumers – the reality is that mandating health warnings is the only reasonable approach any country legalising cannabis can adopt. To date none apart from Canada have chosen to do so.

• GDS2019 conducted the first ever international evaluation of cannabis labels containing information about health and side effects related to the use of THC-containing cannabis.

• GDS2019 adapted 4 health messages developed by the Canadian Government and added 2 messages on side effects based on common reasons that prompted people to quit (findings from GDS2018): the effects on memory and motivation.

KEY RESULTS IN THIS SECTION þ Demographics of respondents to this section: gender, age group, and country The following three questions were evaluated for each label by gender and by country þ Was the information contained in the labels new to you þ Do you believe the information provided in the labels ? þ What is the impact of the health label? Would people think about using less or reduce certain risks?

Support for cannabis health information labels by gender and by country þ Would participants support cannabis health information labels such as these being used on legally available cannabis products?

DEVELOPMENT OF CANNABIS LABELS • We spoke to other experts and reviewed the literature

We evaluated each proposed label:

• We reviewed the current Canadian Cannabis Government Health Warnings Labels 1-4

• Did they believe it? yes/no/unsure Believability

• We reviewed past GDS data on cannabis use

• Was the information new to them? yes/no/unsure Newness of information

• We reviewed past GDS data on alcohol health information labels • We considered to balance between universal vs. targeted population labels and utilization of ‘side effects’ label in addition to ‘health information’ based on previous GDS research on motivations to cut down or stop cannabis use

• Would it make them think about using less (or using differently, e.g., not smoking/not driving stoned)? yes/no/unsure Impact on behaviour change

For permission to use our labels and country based analysis please contact adam@globaldrugsurvey.com

4. Adolescence 3. Smoke 1. Dependence 6. Memory

2. Driving

5.

Motivation

30%

0% 1%

Female Male

Gender (%) Non-bina.. Different20 and identity under

20%

21-25

20%

10%

10%

0% 0%

26-30

Age distribution (%) 31+

29%

10%

16.6% 0%

Country (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission 1.6% 1.0% 0.9% 0.8% 0.8% 0.7% 0.5% 0.5% 0.5% 0.5% 0.5%

Netherlands Columbia Norway Mexico Non-binary Sweden Belgium Chile Czech Republic Portugal Spain

2.3%

Canada

2.1%

2.4%

Finland

1.9%

2.4%

Austria

Slovakia

2.5%

Republic of Ireland

Hungary

3.1% 2.5%

France Balkans

3.7% 3.2%

Switzerland

3.7%

Brazil Italy

4.5%

20%

Denmark

28.1% 6.6%

27.8% 5.9%

27.5%

New Zealand

30%

United Kingdom

40%

13.4%

30%

6.7%

40%

Australia

50%

50%

United States

60%

25.5%

70%

60% % of Respondents

100%

Germany

70%

% of Respondents

% of Respondents

100%

80% 90%

CANNABIS LABELS – GENDER, AGE DISTRIBUTION & COUNTRY OF RESPONDENTS 90%

80%

70%

80%

70%

60%

50%

40%

BELIEVABILITY The risk of dependence is the least believed message 100%

90% 81.1% 77.9%

80%

77.2%

76.7%

75.1%

70%

% of Respondents

64.1% 60%

50%

40%

30%

20%

10%

0% cannabis 21+: believe it

Less likely to drive stoned: believe it

cannabis cannabis motivation: forgetfulness: believ.. believe it

cannabis smoke harmful: believe it

cannabis dependence: believe it

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

80%

NEWNESS OF INFORMATION

% of Respondents

70%

60%

GDS2019 participants who use cannabis appear to be better informed about health consequences than those who drink alcohol.

50%

40%

30%

27.8% 24.6%

20% 13.0% 9.7% 10%

9.5%

9.3%

0% cannabis dependence: new info

cannabis smoke harmful: new info

cannabis 21+: new info

cannabis Less likely to drive forgetfulness: new info stoned: new info

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

cannabis motivation: new info

90%

IMPACT ON BEHAVIOUR CHANGE 80%

% of Respondents

70%

60%

50%

49.3%

40% 30.8%

30.6%

30%

19.6% 20%

18.9%

10.9% 10%

0% Not drive stoned

cannabis motivation: cannabis use less forgetfulness: use less

cannabis smoke harmful: smoke less

cannabis 21+: use less cannabis dependence: use less

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

SUPPORT OF CANNABIS LABELS BY GENDER & AGE GROUP

30.5% 24.4%

No 50%

14.9%

16.4%

% of Respondents

Yes

61.3%

Yes

53.1% 50%

28.3%

25.4%

26.2%

13.9%

15.3%

14.9%

57.8%

59.3%

58.9%

20 and under

21 and over

All

50%

0% 100%

14.3%

0% 100%

58.9%

50%

0% 100%

% of Respondents

26.2%

% of Respondents

No

50%

Don’t know/ Would you don’t care overall be happy to see such health messages on your legally purchased

0% 100% % of Respondents

Don’t know/ Would you don’t care overall be happy to see such health messages on your legally purchased

% of Respondents

100%

% of Respondents

100%

50%

0% 0% All

Gender (%)

Female

Male

Age (%) Global Drug Survey GDS2019 © Not to be reproduced without authors permission

COMMENTARY BY ADAM WINSTOCK In my opinion it is inconceivable that any government that chose to regulate the cannabis market did not insist that all products carried health information labels and links to free harm reduction and self-assessment tools such as those developed by GDS (www.drugsmeter.com and www.saferuselimits.co). While we understand that the cannabis lobby and especially the large corporates would not wish to shout about the fact that the use of cannabis can be associated with health harms among some groups – we had hoped that policymakers would have learned from errors that had been made from their dealings with the alcohol industry and enforced some honest conversations about the drug. So hats off to Canada again!

Our findings are the first to explore the potential impact of cannabis health warning advice labels on use and raising awareness. Our sample of over 50,000 current cannabis users suggests that the overwhelming majority of consumers would be happy to see such messages displayed on cannabis products. To ensure that the cannabis industry does not follow in the steps of the alcohol industry that opposes such labels on alcohol – we support the idea that any country / State that decides to regulate cannabis should mandate rotating advice labels such as these.

The findings also suggest that as with alcohol, labels can be an effective way to educate people and potentially change behaviour. The messages highlighting the risks associated with driving stoned are important since it is unlikely that roadside drug testing alone will be sufficient to deter behaviour – what will be needed a change in acceptable norms – people don’t want to have an accident and don’t want to harm others – people who use cannabis for the most part are pretty responsible. That over 60% indicated the on driving message would make them think about not driving stoned is welcome news (we’ll have to work on the others) Our data also shows that ‘side effect’ warnings reminding people of common things that often motivate people to use less cannabis could be a useful and novel way to approach health labels in addition to fact based harm messages, with the GDS labels on memory and motivation ranking more highly than warnings on the risks of smoking, use under the age of 21y and dependence.

The bottom line is this – if you are going to profit from selling cannabis (whether you are the government or a corporate entity) treat your customers with honesty and respect. Be open and transparent about harms. Provide advice and support to help them use cannabis in ways that add to their health and well being not detract it. Being honest is not only the best drug policy but I also think it will the best way for private companies profiting from cannabis to interact with their customers and be viewed in a positive light. People who use cannabis are not daft. They want to be informed and we think they will respect producers and distributors all the more for it. Cannabis companies are in their infancy – now is the time to help them grow into responsible adult corporations and a bit of smart of government regulation (like good parenting) may help quite a bit.

Please see the blog on this topic on our website for more information and discussion.

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

• We have data on hundreds of thousands of people who use drugs from all over the world and a network of highly skilled researchers who are experts in their field. From in depth questions on patterns of use, harms, motivations and cost to source of purchase, policing, harm reduction strategies and much more.

• We have data on virtually every drug you can think of (almost). We are always interested in collaborating with academics and other groups especially those involved in public policy, health promotion and harm reduction. We are able to provide bespoke data based reports to help you craft optimal policy and harm reduction strategies in your country.

• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network

G LO B A L G D S S A M P L E MDMA

49.2% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED MDMA 33.0% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED MDMA IN THE LAST 12 MONTHS > 23,500 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND • MDMA remains one of the most popular illicit drugs in the world. The use of MDMA crystals and powder in many parts of the the world has increased in recent years and in conjunction with the appearance of high dose MDMA pills has led to changes in consumption habits and risk profile of users.

• In response to the apparent increase in the risks associated with higher potency pills and reports of novel drugs making their way into ‘ecstasy’ tablets/powders we have seen growth in the appearance of drug checking services across many countries.

• In addition to asking about the patterns of use and the purchase of MDMA, GDS2019 explored the use of drug checking services and the adoption of simple harm reduction strategies such as taking a small dose a from new batch of pills or powder to test the effect before taking a larger dose.

• GDS2019 also continued to track the rates of people seeking emergency medical treatment following the use of MDMA and the symptoms that they present with and time to recovery.

3

2

1

0

8.0

Colombia

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

3.0 3.0

United States Sweden

4.0

Norway

5.0

Slovakia

4.0

5.0

Netherlands

Mexico

5.0

Germany

4.0

5.0

Ireland

Switzerland

5.0

Hungary

4.0

5.0

Austria

Finland

5.0

Brazil

4.0

5.0

Belgium

Poland

5.0

Global

4.0

5.0

New Zealand

Italy

5.0

Czech Republic

4.0

5.0

France

Denmark

5.0

Spain

England

8.0

Slovenia

Turkey

10.0

10.0

4

Portugal

5

10.0

6

Argentina

7

10.0

8

Australia

9

10.0

10

Romania

7.0

Median Days Used In Last 12m

MEDIAN NUMBER OF DAYS OF MDMA USE IN THE LAST 12 MONTHS BY COUNTRY

Only countries with n > 100 participants who used recently were included in this graph 11

80%

NUMBER OF DAYS (RANGE) MDMA USED IN THE LAST 12 MONTHS BY GENDER 59.3%

60%

5.0

5.0

5.0

All

Female

Male

5

50% 4

40% Median No of Days

All

% of Respondents

70%

30% 24.1%

3

2

20% 13.4% 1

10% 2.4% 0.7%

0%

0.0%

0.0% 0

1

02-10

11-50

51-100

101-200

201-300

301+

Number of days (range) used (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Median no of days

MDMA PREPARATIONS USED IN THE LAST 12 MONTHS BY GENDER mdma used: caps/capsules

mdma used: pills/tablets

mdma used: powder/crystal

100% 90%

80%

68.7% 68.4% 68.8% 66.2% 65.1% 66.6%

60%

50%

40%

30%

27.4% 23.8%

22.2%

20%

10%

Male

Female

All

Male

Female

All

Male

Female

0%

All

% of Respondents

70%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Belgium

Hungary

Slovakia

Czech Republic

0.2

0.2

0.2

0.2

0.3

0.2

0.2

0.2

0.3

0.2

0.2

0.2

0.3

0.2

0.3

0.2

0.2

0.3

0.2

0.3

0.2

0.3

0.3

0.4

0.3

0.3

0.2

2.0

Spain

Finland

Poland

Lithuania

Italy

Switzerland

Austria

Germany

Romania

Norway

Mexico

Netherlands

Sweden

France

New Zealand

Portugal

United States

Brazil

Argentina

Colombia

Serbia

Global

0.5

0.4 0.3

0.2

0.3

0.0

Pills (%)

1.5 Median amount per day (grams)

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.3

1.5

Slovenia

Denmark

England

Canada

Ireland

0.5

Australia

MDMA powder: usual amount per day

1.5

1.5

2.0

Median amount per day (grams)

MDMA pills: usual amount per day

Median amount per day (grams)

MEDIAN AMOUNT OF MDMA PILLS/POWDER USED ON A DAY OF USE BY COUNTRY

Only countries with n > 100 participants who used recently were included in these graphs 2.0 1.0 1.0

0.9

1.0 0.8

0.5

0.0

Powder (%)

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

0.7

0.6

0.5

1.0 0.4

0.3 0.3

0.2

0.1

0.0 MDMA pills: usual amount per day MDMA powder: usual amount per day

Median value/day

MAIN METHOD OF MDMA ADMINISTRATION WHEN USED AS PILL VS. POWDER 100%

89.1%

MDMA: route of administration (pills)

% of Respondents

80%

60%

40%

20% 4.1% 0% 100%

1.7%

1.8%

3.0%

20.5%

21.7%

0.2%

0.1%

0.2%

0.2%

Rectal

Other

Pills (%)

MDMA: route of administration (powders)

% of Respondents

80%

60%

40% 27.0% 20%

17.2% 13.0%

0% Oral - swallow

Oral - crush and dab

Powder (%)

Oral - dissolve and drink

Oral - crush and bomb

Snort

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

1.2% 1.1%

Another source Dealers (WhatsApp)

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission Shopfronts 0.0%

Open website (not darknet) 0.1%

Dealers (other social media 0.8%

7.5% 5.5% 2.0%

0%

Darknet (someone else purchase)

Darknet (personal purchase)

Street/festival/club

9.0%

10%

Didn't pay/free

22.6% 19.4%

20%

Friends of friends

Known dealer

Friends

30.8%

% of Respondents

MOST COMMON SOURCE OF MDMA PURCHASE IN THE LAST 12 MONTHS 50%

40%

30%

6.0

12

10

8

6

4

2

0

10.0 10.0 10.0 10.0 10.0 10.0

Portugal Lithuania Ireland Global France Austria

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission 7.0

Canada

5.0 5.0 5.0

Slovenia Netherlands Belgium

Poland

7.2

8.0

Germany

Argentina

8.2

Hungary

7.2

8.3

Serbia

Czech Republic

8.6

Mexico

9.4

10.0

Slovakia

15.0

20

Brazil

10.0

10.8

Denmark Spain

10.9

12.0

Colombia

United States

12.6

13.5

Romania England

13.7

Australia

Italy

16.2

14

Sweden

16

16.6

18

Switzerland

Finland

20.0

22.8

24

Norway

25.2

26

New Zealand

MDMA: price per pill (euros)

Median price per pill (euro)

MEDIAN PRICE PER MDMA PILL IN EUROS (â&#x201A;Ź) BY COUNTRY

Only countries with n > 100 participants who used recently were included in this graph 28

22

Prices reported in different currencies were converted to Euros to clarify why some of the median values contain periods.

0

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission 42.7 41.5 40.0 40.0 40.0 40.0 40.0 39.2 37.7 37.6 36.2 35.5 35.2 31.8 30.0 30.0 30.0 29.0 28.7

Denmark Serbia Spain Lithuania Italy Global France Hungary England Brazil Czech Republic Slovenia Canada Argentina Slovakia Germany Belgium Colombia Poland

Netherlands

20.0

25.0

45.1

Romania

Portugal

46.1

50.0

Austria Mexico

50.0

58.2

Ireland

Switzerland

64.2

20

United States

40

64.7

60

Sweden

Finland

100.0

123.1 114.2

120

Norway

Australia

189.0

200

New Zealand

Median Price Per Gram (euros)

MEDIAN PRICE PER GRAM MDMA POWDER IN EUROS (â&#x201A;Ź) BY COUNTRY

Only countries with n > 100 participants who used recently were included in this graph

180

160

140

Prices reported in different currencies were e converted in Euros which is why some of the median values contain periods.

100

80

Brazil

27.3%

29.1%

29.4%

16.0%

All % of Respondents

20.2%

22.2%

23.3%

23.4%

23.9%

25.3%

25.6%

18.3%

20%

Italy

Finland

Slovakia

Norway

Australia

Portugal

Netherlands

Mexico

New Zealand

United States

Poland

30.7%

31.7%

31.8%

32.0%

33.1%

33.1%

33.6%

34.2%

35.7%

29.5%

30%

Denmark

Serbia

Canada

Lithuania

Sweden

Spain

Czech Republic

Colombia

Global

Switzerland

40.9%

41.1%

41.9%

42.4%

42.6%

42.8%

44.3%

44.9%

39.1%

40%

Slovenia

Romania

Ireland

Germany

France

Austria

Argentina

England

Belgium

47.7%

50%

Hungary

MDMA: test dose at least often

% of Respondents

100%

FREQUENCY OF USING A TEST DOSE WHEN STARTING A NEW BATCH BY COUNTRY

Only countries with n > 100 participants who used recently were included in this graph 90%

100%

80%

90%

70% 80%

60% 70%

60%

50%

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

46.0%

40%

30%

10% 22.7%

20%

0% 11.5%

10% 8.5%

Always (100%) Often (75%)

11.3%

0% Sometime Rarely s (50%) (25%) Never

1.7% 1.6% 1.5% 1.5% 1.5% 1.4% 1.3% 1.3% 1.1% 1.0% 1.0% 1.0% 1.0% 0.9% 0.8% 0.8% 0.7% 0.7% 0.7% 0.6% 0.6% 0.6% 0.6% 0.5% 0.5% 0.5%

Denmark Brazil Argentina Slovenia Spain Belgium England Austria Canada Italy Global Lithuania Mexico Colombia Finland Norway Romania France Czech Republic Netherlands United States Slovakia Germany New Zealand Switzerland

1.8%

Sweden

Ireland

2.3%

Australia

0%

2.5%

5%

Poland

% of Respondents

SEEKING EMERCENCY MEDICAL TREATMENT FOLLOWING THE USE OF MDMA BY COUNTRY Only countries with n > 100 participants who used recently were included in this graph

25%

20%

15%

10%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

G LO B A L G D S S A M P L E COCAINE

43.1% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED COCAINE 29.1% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED COCAINE IN THE LAST 12 MONTHS > 20,000 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND • Cocaine remains the most expensive commonly used drug in the world. Prices vary widely across the world from less than €10/gram in South America, to an average of €60-80/gram in parts of Europe to over €200/gram in New Zealand & Australia. In recent years, the purity of cocaine in Europe has increased, with 60-70% purity commonly seen in street level deals.

• Higher purity cocaine can lead to an increased risk of acute medical harms and possibly higher rates of dependence in the community, as well as increased treatment for mental health problems related to use. GDS2017 identified a significant increase in the percentage of people seeking emergency medical treatment following cocaine use.

• Increased purity is in part due to greater amount of cocaine entering the supply chain, consequent upon diversification and sophistication of dealing networks, including the darknet.

• At a time of increasing supply and harms not just to the end user but also by the people from producer and transit countries GDS2019 asked whether it is time for regulated market and whether people would pay more for ethically sourced (fair trade) cocaine?

• We also look at speed for delivery and update our work from last year – though we won’t be mentioning pizzas for a while.

80%

NUMBER OF DAYS (RANGE) 70% COCAINE USED IN THE LAST 12 MONTHS

All

Respondents

60%

50.1% 50%

40%

30%

The median number of days on which cocaine was used in the last year was 6

26.7%

20% 14.4% 10% 5.6% 2.5% 0% 1

02-10

11-50

51-100

101-200

0.4%

0.3%

201-300

301+

Number of days used (range) Global Drug Survey GDS2019 © Not to be reproduced without authors permission

8.0 8.0 8.0

United States France Ireland

6.0

Spain

Global Drug Survey GDS2019 © Not to be reproduced without authors permission 3.0 3.0

New Zealand

4.0

Netherlands

Finland

4.0

Norway

3.0

4.0

Germany

Sweden

4.0

5.0

Australia 4.0

5.0

Czech Republic

Slovenia

5.0

Hungary

Slovakia

5.0

Austria

6.0

6.0

Colombia

Global

6.0

Mexico

Belgium

8.0

Switzerland

10.0

0

England

1

10.0

2

Denmark

3

10.0

4

Portugal

5

10.0

6

10.0

7

Italy

7.5

8

10.0

9

Brazil

10

Canada

Scotland

All

Median No of Days

12.0

MEDIAN NUMBER OF DAYS USED COCAINE IN LAST 12 MONTHS BY COUNTRY 13

12

11

0.4

0.4 0.4

Slovakia Spain

0.3 0.3 0.3 0.3 0.3 0.3

Austria Finland Germany Hungary Netherlands Slovenia

Czech Republic

0.4

0.5

United States

New Zealand

0.5

Switzerland

0.4

0.5

Sweden

Mexico

0.5

Portugal

0.4

0.5

Norway

Italy

0.5

Ireland

0.4

0.5

Global

France

0.5

England

0.4

0.5

Denmark

Belgium

0.5

Colombia

0.0

0.5

0.1

Canada

0.2

0.5

0.3

Brazil

0.4

0.5

0.5

Australia

Scotland

cocaine powder: usual amount per day

Cocaine Powder: Median amount per day

0.6

MEDIAN AMOUNT OF COCAINE USED ON A USUAL DAY OF USE BY COUNTRY

0.6

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

MEDIAN PRICE PER GRAM COCAINE IN EUROS (â&#x201A;Ź) BY COUNTRY Only countries with n > 100 participants who used recently were included in this graph

220.5 220 205.1 200

180

Prices reported in different currencies were converted in Euros which is why some of the median values contain periods.

140

120.0 120

114.2 100.5 100.0 100.0

100

94.1 88.1

87.9 83.2

80.0

80.0

80.0

80.0

80

77.8 72.5

71.8

70.0 60.0 56.3

60

56.2 50.0

50.0

50.0

40 28.8 20

12.5 3.8

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Colombia

Brazil

Mexico

Belgium

Netherlands

Portugal

United States

Canada

Spain

France

Hungary

Czech Republic

Germany

Global

Ireland

Italy

Slovenia

Switzerland

England

Sweden

Denmark

Austria

Slovakia

Scotland

Norway

Finland

Australia

0

New Zealand

Median Price Per Gram (Euros)

160

More than 30 minutes 69.6%

COCAINE DELIVERY IN THE LAST 12 MONTHS GLOBAL SAMPLE

Almost two third of participants who had cocaine delivered to them in the last 12 months reported that it was delivered the same day.

One third of those who reported same day delivery, reported waiting no more than 30 minutes.

Cocaine: had cocaine delivered same day

No 38.3%

Yes 61.7%

30 minutes or less 30.4% Cocaine: average time for delivery More than 30 minutes 69.6%

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission Finland

New Zealand

Czech Republic

Australia

Portugal

Hungary

Austria

Germany

10.5% 11.5% 12.5%

44.7% 43.9% 43.6%

5.3% 6.5%

34.9% 34.4%

20.4%

22.0%

24.0%

27.6%

31.6%

9.3%

2.6%

7.7%

9.8%

2.9%

7.3%

37.7%

34.3%

4.6%

40.3%

12.7%

41.5%

6.6%

13.9%

42.4%

18.8%

9.5%

45.2%

42.7%

9.6%

4.9% 46.0%

49.7%

52.0%

18.2%

40.7%

40

Netherlands

Belgium

Slovakia

Global

France

Scotland

Slovenia

England

United States

Sweden

Switzerland

Norway

52.1%

31.0%

14.0%

54.0% 53.2%

16.2%

0 100

56.2%

11.4%

21.2%

69.0%

90.7%

80

Brazil

Spain

Mexico

Ireland

Colombia

59.1%

60

Denmark

60.6%

11.2%

40

Canada

80

64.6%

20

Italy

cocaine: use less cocaine

Avg. Respondents

cocaine: help to use less cocaine

Avg. Respondents

DESIRE TO USE LESS COCAINE & HELP-SEEKING BY COUNTRY

Only countries with n > 100 participants who used recently were included in these graphs 100

60

0

Of those who want to use less, the % that want help to use less

20

Want to use less (%)

G LO B A L G D S S A M P L E C O C A I N E & FA I R T R A D E M A R K E T A C C E P TA B I L I T Y

> 19,000 PARTICIPANTS WHO HAD USED COCAINE IN THE LAST 12 MONTHS COMPLETED THIS SPECIAL SECTION

BACKGROUND • People spend more per gram on cocaine than any other drug, with a global average of €80 per gram. However, the majority of the economic gains don’t ever make it to the primary country of origin, Colombia. Coca leaf production in Colombia has reached record levels and increasingly diverse supply routes and multiple organised trafficking organisations have resulted in widespread availability and increased purity across the European market. The cocaine trade in 2019 is booming. While cocaine use can lead to dependence and numerous health harms including death, the cost of the failed international drug control system and the national policies that implement it are far greater.

• Data from the last 5 years of the Global Drug Survey suggest that 75% of people use cocaine 12 or less times in the last year. These people tend to be otherwise law-abiding citizens. But because cocaine is illegal, if they choose to use, they have little choice but to indirectly support organised crime, human trafficking and an illegal market. Based on anecdotal evidence and ongoing surveys with people who use drugs, most of them would rather this was not the case.

• A regulated market could be a solution that offers benefits never reaped from the war on drugs. But it would be complex, since unlike cannabis or MDMA where production can be local to distribution, cocaine regulation would require agreements between producer countries such as Colombia and the regions of trafficking and consumption such as the Mexico, United States and Europe.

Could Trump broker that deal?

• To inform the debate and the economic argument for a regulated market, at the suggestion of our partners in Mexico and Colombia, GDS2019 asked would people you pay more for cocaine if you knew it came from a regulated (even fair trade) market? And if so, how much more would they pay? The answers are given in the next few slides.

SUPPORT FOR LEGAL COCAINE MARKET: HIGHER PRICE AND REGISTRATION

Cocaine: support legally regulated market

% of Respondents

100% 71.3%

50%

12.0%

16.7%

Cocaine: pay more from regulated market

% of Respondents

0% 100%

62.6% 50%

19.8%

17.7%

Cocaine: register in database for legal access

% of Respondents

0% 100%

50%

42.9% 30.1%

27.0%

0% Yes

No

Unsure

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

25.0% 25.0% 25.0% 25.0%

Sweden Spain Switzerland Sweden United States Switzerland United States

25.0% Norway New Zealand

25.0%

25.0% New Zealand Netherlands

Spain South Africa

25.0% Netherlands Mexico

25.0%

25.0% Mexico Lithuania

South Africa Slovenia

25.0% Lithuania Italy

25.0%

25.0% Italy Ireland

Slovenia Slovakia

25.0% Ireland India

25.0%

25.0% India Hungary

Slovakia Serbia

25.0%

Hungary Greece

25.0%

25.0%

Greece Global

Serbia Scotland

25.0%

Global Germany

25.0%

25.0%

Germany France

Scotland Romania

25.0%

France Finland

25.0%

25.0%

Finland England

Romania Portugal

25.0%

England Denmark

25.0% 30.0%

25.0%

Denmark Czech Republic

Portugal Poland

25.0%

Czech Republic Colombia

25.0%30.0%

40.0%

25.0%

Colombia Chile

Poland Norway

40.0%

25.0%

50.0%

25.0%

Canada Brazil Chile Canada

50.0%

25.0%

Brazil Belgium

50.0%

50.0%

25.0%

0% 0%

Belgium Austria

10%10%

25.0%

20%20%

Austria Australia

30%30%

25.0%

50%50%

Australia Argentina

Argentina

40%40%

Median % of Respondents

Median % of Respondents

HOW MUCH MORE WOULD PEOPLE PAY FOR FAIR TRADE COCAINE?

Only countries with n > 100 participants who used recently were included in this graph

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

COMMENTARY

• The profit on a gram of cocaine from production in Colombia to point of sale in the USA or the EU is over 30,000%.

• With profits being used to corrupt, intimidate and smuggle, and production having to be done under less than optimal conditions, its fair to say that the profits that could be extracted are even greater.

• Our study suggests that people who use cocaine would rather pay more to help reduce the collateral damage from the war on drugs and support the farmers and economies in producer countries.

• While the evidence that the way the world deals with drug use has for decades been wholly inadequate is overwhelming, but evidence resistance is rife. You’ve got to counter decades of rhetoric and international treaties.

And you also have to accept that drugs like cocaine are not safe and with regulation or without some people will become dependent, use too much and possibly suffer a fatal overdose.

• It’s a tough call, but on balance we think (that the cost of the failed international drug control system and the national policies that implement it are far greater. If we look to the USA and the billions of green dollars being made on the back of a legal cannabis market, it is clear that there is one argument, that even a government rooted in antidrug policy find hard to counter. Money.

• A regulated market could possibly even result in benefits for both the public purse and the health and well-being of populations –both those who use drugs and those who do not. Lower potency, lower risk cocaine products and smarter education could all be explored.

G LO B A L G D S S A M P L E P R E S C R I P T I O N O P I O I D U S E TO G E T H I G H

28.2% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED PRESCRIPTION OPIOIDS 16.4% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED PRESCRIPTION OPIOIDS IN THE LAST 12 MONTHS > 12,000 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND • As opioid overdose deaths rise in many countries and increasing focus is placed on the role of prescription opioids around the world, we thought we should see how much of an issue the use of these drugs were outside traditional dependent populations and the USA. • Use of very effective pain killers per se is not itself an indication that someone is using them inappropriately.

• Indeed previous research by GDS suggests that there are significant overlaps between populations who use these medications for legitimate medical reasons and those who may, on occasion, use them to get high.

• Of course people reporting use in the last year may not be using medication actually prescribed to them, but access to these drugs as part of the street drug pharmacy is more common where there are more opioid medications being prescribed.

•

With this module we’d like to explore whether prescription opioid medication appear to be part of the established non-dependent recreational drug market in certain countries.

•

Further, we’d like to understand whether access through doctors or friends with a prescription continues to be the dominant source for supply.

•

The disruption of drug markets and networks, consequent on darknet drug markets and the appearance of novel synthetic opioids is only just begun to exert influence beyond dependent populations.

% of Respondents 0%

16.4%

Belgium

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

2.8%

7.5%

Slovakia

India

8.4%

Italy

3.4%

8.9%

Romania

Hungary

9.0%

Mexico

4.3%

9.2%

Germany

Greece

10.0%

12.7%

Austria

Portugal

12.8%

Denmark

11.2%

12.8%

Netherlands

Spain

13.1%

Brazil

14.8%

16.5%

Global

Switzerland

16.8%

18.4%

Sweden Norway

19.4%

Ireland

21.6%

France

20.2%

22.8%

Finland

Colombia

23.4%

26.3%

Scotland Canada

26.5%

27.7%

New Zealand

England

29.2%

10%

United States

20%

30.4%

30%

Australia

12-MONTH RATES FOR PRESCRIPTION OPIOID USE BY COUNTRY

Only countries with n > 100 participants who used recently were included in this graph

50%

40%

RATES OF GETTING HIGH ON PRESCRIPTION OPIOIDS IN THE LAST 12M BY COUNTRY Only countries with n > 100 participants % all YES who used recently were included in these graphs 100% % 1-2

At least once (%)

80%

% 3+

1-2 times (%)

100%

3+ times (%)

65.7%

80%

11.6%

11.6%

Brazil

Ireland

8.6%

11.1% France

15.5%

24.9%

22.2% Australia

24.3% Switzerland

21.0%

26.3% England

Germany

28.5% Finland

13.5% New Zealand

38.8% 12.1% Ireland

15.6%

0%

Brazil

20%

16.1%

20%

France

25.4%

30.0% Australia

Denmark

32.6% Germany

26.0%

30.0% Switzerland

Global

28.4%

40%

24.6% 24.2% 23.7%

England

40%

60%

27.0%

40.4%

Finland

46.4% 45.5%

29.1%

50.9%

United States

% of Respondents

57.0% 56.3% 54.8%

60%

Half of participants who reported use of prescription opioids reported getting high at least once in the last year.

Almost a quarter reported using prescription opioids get high on 3 or more occasions in the last year; US highest.

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

New Zealand

Denmark

Global

United States

Ireland

Brazil

New Zealand

France

Switzerland

Denmark

Global

Germany

Australia

England

Finland

0% United States

% of Respondents

69.4%

RATES OF GETTING HIGH ON PRESCRIPTION OPIOIDS IN THE LAST 12M BY GENDER Only countries with n > 100 participants who used recently were included in these graphs % 1-2

% 3+

% all YES

% 1-2

100%

% all YES

100%

80%

80%

More than half of men and one third of women who reported use of prescription opioids said they got high on these drugs at least once last year.

60%

40%

29.2%

58.2%

37.9%

29.0%

% of Respondents

% of Respondents

% 3+

60%

58.2%

37.9%

40% 29.2%

20.4%

29.0%

20.4%

17.6%

20%

Men reported more frequent use to get high when compared to women.

17.6%

20%

0%

0% Female

Male

Female

Male

Female

Male

At least once (%)

Female

Male

1-2x (%)

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Female

Male

3+ (%)

Female

Male

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

• We have data on hundreds of thousands of people who use drugs from all over the world and a network of highly skilled researchers who are experts in their field. From in depth questions on patterns of use, harms, motivations and cost to source of purchase, policing, harm reduction strategies and much more.

• We have data on virtually every drug you can think of (almost). We are always interested in collaborating with academics and other groups especially those involved in public policy, health promotion and harm reduction. We are able to provide bespoke data based reports to help you craft optimal policy and harm reduction strategies in your country.

• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network

G LO B A L G D S S A M P L E LSD

33.6% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED LSD 17.5% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED LSD IN THE LAST 12 MONTHS > 13,000 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND â&#x20AC;˘ LSD and other psychedelics have enjoyed something of a renaissance. From the chatter and promise of microdosing (taking very small doses of LSD or magic mushrooms to increase performance and creativity) to an increasing number of clinical trials indicating the significant therapeutic potential of once demonized drugs such as MDMA, ketamine, LSD and psilocybin. GDS has been exploring psychedelics in depth, collaborating with international experts since GDS2017. This year GDS2019 has sought build on this work and investigate in depth one of the areas that been a focus of much media attention. â&#x20AC;˘ This section will focus on the current patterns of use of LSD.

100%

NUMBER OF DAYS (RANGE) LSD USED IN THE LAST 12 MONTHS 90%

80%

70%

The median number of days on which LSD was used in the last year was 3

All

% of Respondents

60.1% 60%

50%

40%

30% 24.2% 20% 13.8% 10%

0% 1

02-10

11-50

1.3%

0.5%

0.0%

0.1%

51-100

101-200

201-300

301+

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

45%

MOST COMMON SOURCE FOR PURCHASE OF LSD IN THE LAST 12 MONTHS 40%

The data only reflects people who had bought LSD from a source last year. It is worth noting that at festivals and other gatherings with a culture of gifting, LSD (and other drugs) may also be received for free.

35% 33.6%

% of Respondents

30%

25%

20% 17.5% 16.1% 15%

10.1% 10% 8.9%

4.6%

5%

4.2%

1.6%

1.5% 0.9%

0.9%

Dealers (WhatsApp)

Dealers (other social media

0% Friends

Known dealer

Friends of friends

Darknet (personal purchase)

Didn't pay/free

Street/festival/club

Darknet (someone else purchase)

Another source

Open website (not darknet)

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

12.4

11.8

11.5

10.8

Argentina

Canada

Netherlands

15

United States

13.4

16.5 Colombia

Hungary

16.9 Global

14.1

17.2 Mexico

Czech Republic

17.9 France

14.2

18.1 Austria

England

18.5 Switzerland

14.5

19.0 Brazil

Ireland

19.1 Slovakia

14.9

19.2

20

Denmark

25

20.4

22.9

25.9

26.3

30

Germany

35

10

5

Italy

Sweden

Australia

Finland

Norway

0

New Zealand

LSD: Median Price Per Tab (Euros)

The price of LSD appears to have increased over the last 12 months.

In GDS2018, the mean price for one dose of LSD was at €8.10. While we acknowledge that median and mean price are different indicators the increase is visible in several countries among both values.

33.1

40

38.0

MEDIAN PRICE PER LSD TAB IN EUROS (€) BY COUNTRY

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

G LO B A L G D S S A M P L E MAGIC MUSHROOMS

34.2% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED MAGIC MUSHROOMS 14.8% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED MAGIC MUSHROOMS IN THE LAST 12 MONTHS > 11,000 PARTICIPANTS COMPLETED THIS SECTION (ELIGIBLE IF USED IN THE LAST 12 MONTHS)

BACKGROUND • Since GDS2017 magic mushrooms have been the drug least likely to result in people seeking emergency medical treatment. Even accepting that most people who use mushrooms only do so infrequently, our work confirms that these powerful drugs carry a rather low risk of acute harm and are not a cause of dependence.

• This year we report on the typical patterns of use and highlight that these drugs are used infrequently by people in line with the idea that people need to leave enough time between trip to integrate the experience.

•

The rates of seeking EMT for magic mushrooms have creeped up from 0.2% in GDS2017 to 0.4% in GDS2019. People still need to make sure they follow key harm reduction strategies, ensuring first they don’t consume poisonous mushrooms and that care and consideration is given to dose, set and setting if they decide to use.

•

Advice drawn from GDS2018 on the first time use of LSD has significant relevance for psilocybin and is provided on this slide.

80%

NUMBER OF DAYS (RANGE) MAGIC MUSHROOMS USED IN THE LAST 12 MONTHS

All

% of Respondents

70%

60%

The median number of days on which magic mushrooms were used in the last year was 2

56.4%

50%

40% 34.5% 30%

20%

10%

7.9%

0% 1

02-10

11-50

0.8%

0.3%

0.0%

0.1%

51-100

101-200

201-300

301+

Number of days used (%) Global Drug Survey GDS2019 © Not to be reproduced without authors permission

KEEPING YOU AND YOUR MATES SAFE WHEN YOU USE PSYCHEDELICS • Check out the GDS Highway Code https://www.globaldrugsurvey.com/ brand/the-highway-code/ • Check out our excellent blog Understanding and Working with Difficult Psychedelic Experiences by Sara Gael from MAPS • And see our video on safer dosing and using with magic mushrooms on our YouTube Channel https://youtu.be/6fxdhU9HCFc

G LO B A L G D S S A M P L E A C C E P TA B I L I T Y O F P S YC H E D E L I C S I N P S YC H I AT R Y

> 84,000 PARTICIPANTS COMPLETED THE 1st PART OF THIS SECTION – ALL WERE ELIGIBLE > 20,000 PARTICIPANTS COMPLETED THE 2nd PART OF THIS SECTION – ALL WERE ELIGIBLE Special thanks to our collaborators on this section Assoc Prof Matt Johnson, Dr Rupert McShane & Dr Ben Sessa

BACKGROUND • The tools psychiatrists* have to use at present are limited in their effectiveness and acceptability. Psychiatry has long needed some new tools in its armoury.

• Through the work of psychedelic pioneering groups like MAPS and Heffter Research Institute, and respected universities like Johns Hopkins and Imperial College, psychiatrists and more importantly their patients, might soon be getting a huge boost - with research indicating the potential efficacy of psilocybin, LSD, MDMA and ketamine among others in the treatment of common psychiatric disorders such as depression and PTSD. • GDS was keen to support the work of these clinical trial groups and others around the world. After discussion with some of our psychedelic researcher colleagues, we came up with the idea of studying how acceptable different types of psychedelic therapies might be compared to traditional interventions and why they were selected.

• What we did? In this section of GDS2019 we explored the acceptability of different approaches to treating mental illness in a 2 step process. After briefly describing their experiences of drug use, mental illness and treatment, GDS participants were provided with a screening question that assessed, on a 5 point scale, the likeliness of accepting 3 different intervention types for mental illness (antidepressant like treatments, talking therapies and psychedelics (psychedelic assisted therapies PAT). Those participants who indicated they would ‘very likely’, ’likely’ or ‘maybe’ accept psychedelic based therapies were then asked to complete a further assessment that formed the second part of the study (n > 20,000). In this section, respondents were given a hypothetical scenario and required to indicate how likely it would be that they would accept 12 different treatment interventions (each of which is briefly described) and the reasons for such a choice. The options include higher and lower dose interventions with ketamine, LSD and psilocybin as well as MDMA, ceremonial versus medical ayahuasca as well as traditional psychiatric medications and talking therapies. A description of each modality that was included in the survey is provided on the next slide.

• To our knowledge this will be the largest study of the acceptability of these new therapies. *Psychiatrists are not the only professional group that provide treatment to those with mental illness : general practitioners, clinical psychologists, psychotherapists, family therapists and other groups all play an important role .

PART 1: MENTAL HEALTH SCREENING AND PAST DRUG USE HISTORY

Part 2 is only provided in a truncated form here.

Part 2 and our full commentary is available on request for â&#x201A;¬ 25

MENTAL HEALTH SCREENING & SAMPLE CHARACTERISTICS • Over 87,000 people who took part on GDS2019 answered questions about their past and current mental health and then expressed their likelihood of the accepting of 3 different broad categories of treatment (64.5% M, 34.4% F, 75.2% <21y, 24.8% 21y and older) • Overall, 57.1% of the GDS2019 sample who answered questions on their mental health then expressed their likelihood of the accepting different categories of treatment, reported ever having used at least one of the following psychedelic drugs: LSD, Magic mushrooms, MDMA, ketamine of ayahuasca • 25.8% of the GDS2019 sample reported having ever been diagnosed with a mental illness (19.8% with depression, 14.8% anxiety, 2.3% bipolar, 1.2% psychosis, 4.1% ADHD, 4.0% other) • Overall, 19.5% had ever been prescribed any medication for their mental illness • Overall, 9.6% reported currently being in receipt of any psychiatric medications, most commonly antidepressants (7.4%), mood stabilizers (2.1%) antipsychotics (1.2%), ADHD medications (1.6%) and other (1.5%) • In addition, we asked about other forms of treatments that people were currently using to treat their mental illness. 8.6% reported the use of talking therapies, 4.4% yoga and other body therapies, 14.7% self management and 5.3% not applicable –fully recovered

GDS2019 ACCEPTANCE OF APPROACHES TO MANAGE MENTAL HEALTH DISORDERS PSYCHIATRIC MEDICATIONS Medication

To estimate the acceptance of different approaches to managing common psychiatric disorders, the entire GDS sample was asked:

TALKING THERAPIES Talk

100%

90%

80%

70%

60%

% of Respondents

How likely is it you would accept the following treatment types if you were diagnosed as having a common psychiatric condition like depression or post-traumatic stress disorder (PTSD)?

PSYCHEDELIC ASSISTED THERAPIES Psychedelics

50% 42.0% 40%

30%

28.1% 25.5%

24.6%

24.0%

21.7% 20%

20.0%

19.3% 17.7%

16.8%

16.6%

15.8%

14.8%

10% 6.0%

7.2%

0% Very Likely

Likely

Maybe

Unlikely

Very Unlikely

Very Likely

Likely

Maybe

Unlikely

Very Unlikely

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Very Likely

Likely

Maybe

Unlikely

Very Unlikely

COMMENT BY ADAM WINSTOCK & MATT JOHNSON Overall, 70% of the total sample indicated it would be likely or very likely that they would accept the offer of talking (psychological) therapies such as CBT. This is significantly higher than the approximately 40% indicating they would accepted traditional psychiatric medications or psychedelics. It’s somewhat worrying for those in the psychiatric profession that one third indicated that it would be unlikely or very unlikely that they would accept psychiatric medications such as antidepressants, which are the most commonly offered and utilized form of treatment for the most common psychiatric conditions such as depression, anxiety and PTSD. Similarly it may dismay those at the forefront of psychedelic therapies that almost 40% of the global sample indicated that it would be unlikely or very unlikely that they would accept psychedelic based therapies. That many forms of psychedelic therapy described in Part 2 of this study (which specifically describes how psychedelics would augment the talking therapy process) may help ameliorate some of this apparent reluctance to accept psychedelics as medicine.

A deep understanding of factors impacting on the acceptability of different treatment options by people with medical conditions is missing in many fields of medicine.

That may come as surprising given that you are more likely to engage with acceptable treatments and this may lead to better outcomes. But the area is often overlooked in medication development and within clinical trials. Being asked what type of treatment you’d prefer by your doctor is more common in surgery than with medication.

You may be asked to express an informed preference of how to manage wear and tear on your hip (a replacement or shaving) or whether you want a mechanical or pig valve for your heart, but in most cases the patient will defer to their doctor. In the field of general medicine, most people accept their doctor’s choice of antihypertensive or diabetes medicine without question. In psychiatry I suspect it is much the same. To be honest that reflects the fairly limited range of options. While talking therapies can be very effective for some conditions, access is often restricted or time limited and if not supported by public services can be very expensive, so medications on prescription become the unsatisfactory default.

In most countries, treatment of the most common psychiatric conditions rely on one of 3 groups of medicines, namely antidepressants, antipsychotics and mood stabilizers*. The myriad varieties of each vary in their side effect profile but don’t usually offer much in the way of differences in outcome. Getting the best treatment is often based on finding the optimal dose and medication combination for each individual, often by trial and error. I am simplifying this of course. Skilled assessment and treatment by an experienced clinician can all make a difference but I think most people are managed (usually quite well) by family practitioners whose available time and experience may be more limited. Although medications and offer of talking therapies are discussed with patients I am not sure how often patient preference or acceptability is taken into account – often poor compliance or discontinuation with the offered treatment tells us more than any prior discussion. In the next few slides we will explore how a person’s history of mental illness and prior experience of psychedelic drug use can influence the acceptance of different treatment modalities.

* Sedative / anxiolytic drugs like benzodiazepines are less frequently used than they once were due to concerns over the risks of

abuse and dependence, though are still commonly used in some countries for the shorter management of anxiety and insomnia.

ACCEPTANCE OF PSYCHIATRIC MEDICATION TO MANAGE PSYCHIATRIC SYMPTOMS Acceptance of medications as a psychiatric treatment among those with and without psychedelic experience and mental illness history Diagnosis

NoDiagnosis

PsychedelicHistory

NoPsychedelicHistory

100%

This slide provides the analysis to estimate the impact of :

90%

80%

- prior diagnosis of mental illness

60%

16.9%

14.0%

26.3%

20.0% Very Likely

22.8%

20.0% Very Unlikely

16.8%

24.4%

18.5% Very Likely

20.4%

19.5% Very Unlikely

16.6%

14.7% Very Likely

21.9%

16.0% Very Unlikely

19.6% Maybe

20%

12.8%

20.1% Likely

30%

27.2%

40%

31.6%

50%

10%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Very Unlikely

Unlikely

Maybe

Likely

Unlikely

Maybe

Likely

Unlikely

Maybe

Likely

Unlikely

0%

Very Likely

…on the acceptance of psychiatric medications such as antidepressants for the treatment of common mental health disorders

% of Respondents

- prior use of psychedelic drugs

70%

ACCEPTANCE OF TALKING THERAPIES TO MANAGE PSYCHIATRIC SYMPTOMS Acceptance of talk therapy as a psychiatric treatment among those with and without psychedelic experience and mental illness history Diagnosis

NoDiagnosis

PsychedelicHistory

NoPsychedelicHistory

100%

90%

This slide provides the analysis to estimate the impact of

80%

44.3%

39.2%

40.3%

50%

27.3% 6.5%

6.6%

Unlikely

Very Unlikely

15.3%

17.9% 6.1%

7.9%

17.3% 4.9% Very Unlikely

10%

5.4%

20%

Unlikely

15.3%

30%

28.7%

29.5%

40%

24.2%

on acceptance of talking therapies such as Cognitive Behavioral Therapy (CBT) for the treatment of common mental health disorders

7.9%

60%

5.2%

- prior use of psychedelic drugs

50.1%

70%

% of Respondents

- prior diagnosis of mental illness

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Very Unlikely

Unlikely

Maybe

Likely

Very Likely

Maybe

Likely

Very Likely

Very Unlikely

Unlikely

Maybe

Likely

Very Likely

Maybe

Likely

Very Likely

0%

ACCEPTANCE OF PSYCHEDELIC-ASSISTED THERAPIES TO MANAGE PSYCHIATRIC SYMPTOMS Acceptance of psychedelics as a psychiatric treatment among those with and without psychedelic experience and mental illness history

This slide provides the analysis to estimate the impact of

Diagnosis

NoDiagnosis

PsychedelicHistory

NoPsychedelicHistory

100%

- prior diagnosis of mental illness

90%

- prior use of psychedelic drugs

80%

on acceptance of psychedelic-assisted (psycho-) therapies for the treatment of common mental health disorders

60%

21.6%

9.6%

8.1%

10%

11.6%

9.7%

19.9%

21.9%

20.2%

37.0% 24.9% 16.0%

20.7%

21.6% Very Likely

16.8%

21.2% 11.4%

20%

18.2%

16.1%

30%

Very Unlikely

40%

40.5%

50%

33.2%

Importantly, the approach of using psychedelics in psychotherapy is very complex and typically requires a guided integration of the experience prior and after administration of the substance. Distinct from psychiatric medications, it is not just the drug effect alone that influences the therapy outcome.

% of Respondents

70%

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Very Unlikely

Unlikely

Maybe

Likely

Very Likely

Very Unlikely

Unlikely

Maybe

Likely

Very Likely

Very Unlikely

Unlikely

Maybe

Likely

Unlikely

Maybe

Likely

Very Likely

0%

COMMENT BY ADAM WINSTOCK & MATT JOHNSON There is nothing more powerful than personal experience to influence choice.

While prior use of psychedelics did not seem to deter people from other forms of treatment, conversely the absence of prior experience with psychedelic drugs appears to makes them far less acceptable as potential therapies compared to those with prior experience, suggesting that psychedelic drugs may still be perceived negatively by many drug naïve people.

If these novel therapies are to become more widely available , re-orientation of public perception of these drugs will be required.

Among those with a prior psychiatric diagnosis, nearly 50% indicated these therapies would be very likely or likely to be accepted compared to 38% for those without a psychiatric diagnosis. And among those with a past psychiatric history was the rate of acceptance of psychedelics was almost identical to the acceptance of traditional psychiatric medications.

Understanding more about the acceptability of different treatment options is important in all areas of medicine but is an under researched and hugely important area, especially in psychiatry. The promise of new therapies such as psychedelic assisted psychotherapy offers the opportunity to revisit the concept of the ‘engaged and informed patient as an active decision maker’ in their treatment. They also offers the possibility of providing both practitioner and patient the opportunity of having a ‘shared meaning in the treatment process’, something I witnessed first hand in Navaho sweat lodge sessions in new Mexico more than a decade ago.

One thing is clear however even at this stage, decades of misinformation and ideologically driven, ‘evidence resistance’ to the potential of psychoactive drugs to ‘heal not harm’ will need to be overcome. We will need to be careful not to sway the pendulum too far and offer the promise of a panacea to all psychological ills. Experience, research and reorientation of both services and cultures take time. It is worth taking that time to ensure that potential benefits don’t get waylaid by commercial interests, unqualified practitioners exploiting the vulnerable and those with a strong interest to resist change.

In the next section we explore more closely the factors driving treatment preference among those who expressed interest in psychedelic assisted therapies using a hypothetical scenario.

PART 2: ACCEPTANCE BASED ON A HYPOTHETICAL SCENARIO

DEMOGRAPHICS SAMPLE SPECIAL SECTION • Over 20,000 people who responded ‘very likely’, ‘likely’ or ‘maybe’ to the question on accepting psychedelic-assisted therapies agreed to answer the GDS2019 special section on psychedelics in psychiatry which involved the use of a hypothetical scenario and a description of the different modalities we explored this year.

Of those who provided responses to this specialist section • 80.2% reported ever having used at least one of the following psychedelic drugs: LSD/Magic Mushrooms/MDMA/Ketamine/Ayahuasca • 43.5% reported ever having been diagnosed with a mental illness.

•

34.3% with depression, 26.4% anxiety, 4.7% bipolar, 2.2% psychosis, 8.8% ADHD, 7.4% other

•

34.9% had ever been prescribed any medication for their mental illness

•

17.9% reported currently being in receipt of any psychiatric medications, most commonly antidepressants (13.5%), mood stabilizers (4.0%) antipsychotics (2.5%), ADHD medications (3.6%) and other (3.1%)

• 15.3% reported the use of talking therapies, 8.6% yoga and other body therapies, 27.2% self management and 7.2% not applicable – fully recovered Global Drug Survey GDS2019 © Not to be reproduced without authors permission

HYPOTHETICAL SCENARIO* THAT WE USED TO ASSESS THE ACCEPTABILITY OF PSYCHEDELICS USED IN PSYCHIATRY

’We’d like you to imagine yourself as having been diagnosed with a common psychiatric condition such as depression or Post Traumatic Stress Disorder (PTSD) . Your condition is of sufficient severity that it’s impacting negatively on your mood, memory and sleep as well as your ability to work and engage in significant relationships. You go to your family doctor, who after assessment offers you a number of different treatments. She says they have similar success rates and cost the same to you, but vary in the how they are delivered, their duration and the nature of side effects. She says, ‘I’m not sure which would be best for you and she thinks there’s not much basis to decide among them’. She asks which of the following treatments you would like. The treatment option are described on the next page’. *Scenario was developed by the researchers who led this section of GDS2019: 3 Consultant

Psychiatrists and a Senior Research Clinical Psychologist. To allow comparison with the most common traditional treatment modalities we included antidepressants +/- talking therapies.

We also included mindfulness which we used as a non drug control that did however require significant personal investment, but can be offered by non clinically trained people .

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

DESCRIPTIONS PROVIDED TO PARTICIPANTS OF THE 12 DIFFERENT TREATMENT INTERVENTIONS WE ASSESSED( What it is

1

ANTIDEPRESSANTS

2

TALKING THERAPY (EG COGNITIVE BEHAVIOUAL THERAPY)

3

ANTI-D + PSYCHOLOGY

4

HIGH DOSE LSD/PSILOCYBIN

Tablet medication

A summary of treatment

Tablet usually taken once per day for at least 12 months.

Should be provided with other support

Where is treatment delivered / by whom

How often is the treatment given

Time to deliver How long before I each treatment might start feel better

At home by you Every day

few seconds

Talking to a trained therapist

Understanding more about the way you feel and learning ways A trained therapist Every 1-2 weeks 1 hour to think differently usually at an outpatient clinic or consulting room Tablet plus talking therapy Combining the two options above At home and in a clinic Tablet once day + therapy ever 1-2 One hour weeks High dose (you could not function safely on this dose outside clinic) psychedelic experience

Total duration of treatment

2-4 preparation sessions are then followed by several sessions Clinic / possibility several weeks apart with high dose of a drug like LSD or overnight stay needed Once every 2-4 weeks psilocybin. The therapist is more of an observer than active participant during the drug session(s), but in post-psychedelic session helps you integrate the experience 2-4 preparation sessions are then followed by several sessions At a clinic by specialists several weeks apart with lower dose of a drug like LSD or psilocybin. The drugs augment talking therapy during the drug sessions.

An 8 to 12-week course of weekly psychotherapy sessions.

At a clinic by specialists Most therapy sessions are 60-minute non-drug assisted sessions; with MDMA taken 2-3 times over the course, spaced several weeks apart. The drug augments talking therapy during the drug sessions.

How likely is it that you would accept this type of treatment very likely likely maybe unlikely very unlikely very likely likely maybe unlikely very unlikely

2-3 weeks

1 year +

Few weeks / months

3-6 month

Few weeks / months

1 year + medication, therapy very likely likely 3-6 months maybe unlikely very unlikely very likely likely maybe unlikely 3 months very unlikely

7-12 hours

1-2 days

Once every 2-4 weeks

7-12 hours

Few days to a few weeks 3- 6 months

Eight to Twelve weekly non-drug sessions 2-3 - MDMA -assisted sessions and an overnight stay in the clinic.

Non-drug sessions Few days to a few weeks 8 to 12 weeks. last 60 minutes.

MDMA -assisted sessions last all day.

very likely likely maybe unlikely very unlikely

very likely likely maybe unlikely very unlikely

5

LOWER DOSE LSD/PSILOCYBIN Lower dose psychedelic (A HIGHER DOSE THAN assisted therapy MICRODOSING)

6

MDMA

MDMA-Assisted therapy

7

AYAHUASCA (CLINICAL)

Clinical administration of ayahuasca one-on-one with psychotherapist(s)

1-2 preparation sessions are then followed by several sessions At a clinic by specialists Once every 3-6 months several weeks apart with high dose of ayahuasca The therapist is more of an observer than active participant during the session but in post psychedelic session helps them integrate /grow from the experience.

4-6 hours

Variable (a few hours, a few days, or up to a few weeks)

3- 6 months

9

AYAHUASCA (CEREMONIAL)

Ceremonial consumption of ayahuasca in group setting with Amazonian indigenous-style ritual (e.g., shamanic practice)

Participants prepare for several days in advance by following a In a selected Once (or perhaps more) “diet” (e.g., abstinence from sex, alcohol and certain foods) ceremonial space (e.g., and setting an intention, after which they partake in an alla yurt) night ceremony led by an individual with expertise in Amazonian indigenous folk healing practices, in which ayahuasca brew is drunk once (or perhaps twice).

6-8 hours

Variable (a few hours, a few days, or up to a few weeks)

Variable (may be just once, very likely likely or follow-up sessions may be maybe unlikely sought) very unlikely

10

KETAMINE -high dose

High dose (you could not function safely on this dose outside clinic) dissociative experience

2-6 ketamine sessions over 3 weeks. May augment existing or new therapy sessions

2 hours

A few hours to a few days 3 weeks plus variable therapy

very likely likely maybe unlikely very unlikely

11

KETAMINE lower dose

Low dose which causes mild, if any, dissociation

An initial assessment followed by 2-6 intravenous or intranasal At a clinic by specialists ketamine or esketamine sessions. The therapist is more of an observer than active participant during the drug session(s), but post-dissociative session helps you to use your improved mood to address ruminations An initial assessment followed by 2 sessions of ketamine or At a clinic by specialists intranasal esketamine per week.

Twice a week for first month then every one to two weeks

30-60 minutes

Variable – up to a month Months and years

12

Meditation/mindfulness Focusing on breathing and Requires practice and guidance from teacher or app. Benefits (probably unlikely to be useful achieving inner state of and ability to engage grows with time in isolation of other tranquillity treatments)

very likely likely maybe unlikely very unlikely very likely likely maybe unlikely very unlikely

At home or in community. Can be done on own or in groups

Optimally daily for 30 mins or more 5min – 60 min + day, but lower intensity schedules /day can be useful

Few days to a few weeks Months and years

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

very likely likely maybe unlikely very unlikely

DIFFERENCES BETWEEN DEMOGRAPHICS OF GDS2019 SAMPLE WHO ANSWERED THE SPECIALIST SECTION ON THE USE OF PSYCHEDELICS IN PSYCHIATRY VS. OTHERS

• People who agreed to answer the GDS2019 specialist section on psychedelics had significantly higher rates of lifetime use of psychedelic drugs (80% vs. 57%) than those who only completed the initial screening questions.

They also had higher rates (almost double) of both having past psychiatric history and being in receipt of current psychiatric medications than those who did not express interest in psychedelic therapies.

• This means that although the analyses of the sample who completed the specialist section has an additional bias towards both psychedelics and considering psychedelics as a therapeutic option, the results are perhaps even more important given that 43% had previously been given a psychiatric diagnosis and almost one in five were currently receiving some type of psychiatric medication. These are the very groups who will be most relevant when exploring the acceptability of novel psychiatric treatments.

• In the following slides we offer preliminary analyses of this sample.

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

90%

70%

GENDER AND AGE OF THE SAMPLE THAT RESPONDED TO THE SCENARIO (n > 20,000) 80%

% of Respondents

60% 70%

67.2%

% of Respondents

60%

50%

50%

40%

40%

30% 27.0% 30.9%

24.9%

30%

20.5% 20%

19.4%

20%

10%

8.2%

10%

5.0% 0%

0% Male

Female

Gender (%)

< 20

21-25

31-40

26-30

41-50

Age distribution (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

> 50

OVERALL ACCEPTABILITY OF DIFFERENT TREATMENT FORMS I

• In the next slide we present overall data from all respondents as to the acceptability of some of the major treatment modalities we described as potentially suitable interventions among this subsample of respondents, regardless of age, gender, experience with drug or treatment or mental illness.

• As such this data has less relevance to the wider population, given the likely inherent bias once would expect from sample of people with significantly greater experience of psychedelic drugs than the general population.

• However the findings still have value, since for many people, the use of drugs may increase the lifetime diagnosis of experiencing some types of mental illness (the nature of the association may not be causal of course). In addition research indicates that often, people who use drugs (including alcohol) do less well when treated with traditional psychiatric medication based interventions such as antidepressants, due to poorer compliance, reduced efficacy or drug – medication interactions. Alternative medication options relying on less frequent administration and working through fundamentally different mechanism may have real value in such cases.

• Further many psychologists or other providers of talking therapies are often reluctant to provide treatment to those currently using drugs, fearing that drug use will detract from or diminish but not enhance the therapeutic process. Our work looks forward to a time when medication augmented psychotherapy may become much more common.

ACCEPTANCE OF DIFFERENT TREATMENT APPROACHES TO MANAGE DEPRESSION/PTSD 110%

100%

90%

This slide shows the acceptability of the various treatment modalities we described regardless of age, gender, experience with drug or treatment of mental illness.

81.6% 80% 75.9% 72.7%

69.7% 70% 66.0%

58.4%

All

% likely/ very likely

% Likely

60%

51.3% 50%

47.3%

46.1%

46.0% 40.9%

40%

30%

20%

10%

0% Low LSD

Talk Therapy

High LSD

MDMA

Mindfulness

Clinical Ayahuasca

Low Dose Ketamine

Ceremonial Ayahuasca

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Hgh Dose Ketamine

AD + Talk

Antidepressants

OVERALL ACCEPTABILITY OF DIFFERENT TREATMENT FORMS II

• Not only were anti-depressants rated as the intervention least likely to be accepted by this subsample of respondents, the addition of talking therapies did little to diminish the antipathy towards this modality of treatment. With increasing concerns of antidepressant discontinuation syndrome (withdrawal symptoms when you stop taking them) and the fact that they only benefit 6-7 out of every 10 people prescribed them, our findings are a wake up call to both the pharmaceutical industry who have rested on huge profits from repeat prescriptions and doctors who are all too often quick to script and go (though within a 7-10 minute consultation this is often all they are able to do).

• We know that how well people do from an appropriately prescribed treatment not only relies on the quality of that treatment but how compliant people are with that very treatment. Acceptability is likely to paly a key role in the later. By their very nature traditional psychiatric medications take time to start working, rely upon dosage reviews and people taking then every day often for weeks or years. While such an approach can be very effective and acceptable to many it won’t be ideal or effective for everyone.

• The potential of medication based treatments that offer improvements after a far shorter period of time and do not require daily dosing are clearly attractive to many people. It is unlikely that any of the psychedelic treatments we describe would be offered daily and would thus avoid the risk of any withdrawal upon cessation. While psychedelic treatments may have to be repeated at intervals to maintain response, the loss of effect would not be accompanied by other complications.

• And unlike opioids or benzodiazepines psychedelics carry an almost non existent risk of dependence, though this may exist with ketamine. Non-medical use / abuse will of course be a risk but this will be low compared to many other drugs.

• One final thing of interest is the high acceptability of talking therapies among the study group. As we will see in the next section, our findings may begin to challenge existing exclusions that are often an inherent part of talking therapy screening.

It is possible in 20 years instead of drug use being seen as an exclusion to entering talking therapy that the concomitant provision of some drugs such as the psychedelics will be an inherent part of many talking therapies.

OVERALL ACCEPTABILITY OF DIFFERENT TREATMENT FORMS III

• One obvious question raised by the bias inherent in the sample is to what extent past experience with drugs and psychedelics in particular influence these first run findings?

• To answer this we have analysed the likelihood of accepting some of thee different treatment modalities by comparing the responses by whether or not people had prior experience or not with psychedelics.

• One would expect higher acceptance among those with prior experience (unless this had be negative or challenging – although these aspects of the psychedelic experience are sometimes key components of their therapeutic effect). We have already seen that psychedelic therapies appear less acceptable to those with no prior experience.

• In the next set of analyses we explore how acceptable different modalities are to psychedelic naïve groups compared to those who have previously tried them and to those with and without psychiatric history. The first slide show full response details on acceptability for antidepressants and high dose psychedelics whilst the second offers a summary of the % indicating it would likely or very likely that they would accept each of the 13 interventions we described.

100%

Likelihood of Antidepressant use by psychedelic history Psychedelic History

No Psychedelic History

HOW DOES EXPERIENCE WITH PSYCHEDELIC DRUGS IMPACT ACCEPTANCE OF ANTIDEPRESSANTS VS. HIGH DOSES OF PSYCHEDELICS TO TREAT DEPRESSION/PTSD? 100%

90%

90%

80%

Likelihood of Antidepressant use by psychedelic history

80%

Psychedelic History

No Psychedelic History

70%

100% 70%

% of Respondents

% of Respondents

Likelihood of Antidepressant use by psychedelic history 90% 60%

60%

100%

50%

80%

Psychedelic History

No Psychedelic History

52.7% 50%

90% 40%

40%

70%

80%

29.6%

30.5% 30%

27.4%

30%

25.0%

24.8%

25.6%

60% 20% 17.9%

21.3%

19.2% 20.3%

19.5%

70%

20%

16.6%

13.3%

12.4% 10.2%

10%

25.6% Accepting antidepressants (%) 23.1% 20% 17.9%

19.5%

19.2% 20.3%

4.7%

4.2%

60%

1.6%

40%

Global Drug Survey GDS2019 13.3% © Not to be reproduced without authors permission

29.6%

Very Unlikely

Unlikely

Maybe

Accepting high dosed psychedelics (%)

21.3%

30%

Likely

Very Likely

Very Unlikely

Unlikely

Maybe

50%

Likely

0%

Very Likely

Very Unlikely

29.6%

30%

Unlikely

Maybe

Likely

Very Likely

Very Unlikely

Unlikely

Maybe

40%

Likely

0%

% of Respondents

10% 50%

Very Likely

% of Respondents

23.1%

HOW DOES EXPERIENCE WITH PSYCHEDELIC DRUGS IMPACT ACCEPTANCE OF DIFFERENT TREATMENT APPROACHES TO MANAGE DEPRESSION/PTSD? 100%

No Psychedelic History

79.9% 80% 79.9%

80%

60%

62.8%

62.3%

% Likely

% Likely

No Psychedelic History

100%

62.3% 60%

62.8%

52.4%

59.7% 55.2%

46.7%

52.4%

41.6%

46.7% 41.6%

40%

40%

34.8% 34.8% 27.3%

20%

% likely/very likely

27.3%

29.3%

20%

0%

0% 100%

100%

86.2%

77.6%

86.2% 75.2%

74.9% 66.7% 77.6%

Psychedelic History

80%

75.2% 62.5%

60%

40%

20%

55.3%

% Likely

% Likely

Psychedelic History

80%

74.9% 52.2%

50.1%

66.7% 62.5% 42.7%

60%

55.3%

37.5%

52.2%

40%

0% Low LSD20% High LSD

0%

MDMA

Talk Therapy

Mindfulne..

Clinical Ayahuasca

Low Dose Ceremonial Hgh Dose Ketamine Ayahuasca Ketamine

AD + Talk

Antidepre..

Global Drug Survey GDS2019 © Not to MDMA be reproduced without authorsMindfulne.. permission Low LSD High LSD Talk

Clinical

Low Dose

Ceremonial

H

OVERALL ACCEPTABILITY OF DIFFERENT TREATMENT FORMS IV

• While past experience with psychedelics certainly made it much more likely that people would be more accepting of the full range of different psychedelic treatment modalities, it of note there was little difference between drug naïve and drug experienced grouping the acceptability of talking therapies.

• The most striking effect of past experience was seen on the limited acceptance of antidepressants by those with psychedelic experience , which was almost half that of the drug naïve group. It can be postulated that for some people, being aware of the profound nature of the psychedelic experience may diminish interest in and a belief that antidepressants could not possibly be as effective in changing the way one thinks about self and the world around you as these drugs.

• As expected, past experience of psychedelics has a massive impact on the acceptability of both the low dose and high dose LSD/psilocybin and MDMA options, with the percentage indicating they would accept these treatment as being very likely/likely being almost 50% greater than for those who had never used psychedelics. However perhaps surprisingly the acceptance of these two drugs were only marginally less acceptable than antidepressants (55%) among drug naïve groups (endorsing high dose LSD/psilocybin as very likely/likely at 52% and MDMA at 47%.

• Somewhat lower rates of acceptability were also given by psychedelic users for both low dose ketamine and ceremonial ayahuasca among those with psychedelic experience (approximately 50% indicating they would accept these treatment as being very likely/likely) compared to non users (35% low dose ketamine, 27% for ceremonial ayahuasca).

• The relatively low rates for ceremonial ayahuasca may be explained by the intense , and often profound nature of the experience that often takes place over several days and may seen by some as being less rigorously /consistently supervised. It may also be that this more spiritual type of intervention would be less acceptable to those given a formal diagnosis compared to those seeking a psychedelic experience more for curiosity than problem solving.

OVERALL ACCEPTABILITY OF DIFFERENT TREATMENT FORMS V • Receiving current psychiatric treatment was associated with a two fold greeter acceptance of antidepressants than those not currently in receipt of treatment. Overall there was little difference between the two groups when it came to the acceptability of high dose LSD/psilocybin, MDMA or ketamine. LSD/psilocybin treatment was rated as more acceptable than MDMA which in turn was rates more favorably than low dose ketamine. So having experience of antidepressants does not preclude people being open to other treatments. That 21% of people with a psychiatric history said it would be unlikely or very unlikely that would accept antidepressants is consistent with the need for other treatment options.

• Our findings suggest there is high level of acceptance of these novel therapies across the subsample, independent of past experience of traditional western medical approaches to treatment. Given that currently most of these psychedelic therapies are being offered only as second/third line options or for treatment resistant cases, our findings very much suggest that these drugs could compete with antidepressants as first line therapeutic options. The earlier a person receives effective treatment for their psychiatric illness the quicker the time to recovery.

• Choosing a preferred treatment for mental illness is not an arbitrary decision. It is likely that multiple factors will be taken into account including past treatment and personal experience of drug use. In the next few slides we offer preliminary analyses of these factors for those choosing any psychedelic therapy as their most preferred option versus those who did not select any psychedelic therapy as their most preferred modality as well as those with and without a past history of psychiatric diagnosis. The expectation is that there might be marked differences between these different groups. In the next 2 slides we offer some insights that may challenge this expectation.

FACTORS THAT INFLUENCE CHOICE OF TREATMENT OPTION • One of the most important findings from this study is the consistent high ranking of people’s desire to get the root of their mental health problems and involvement of a trained therapist regardless of the type of treatment they chose. This should reassure those in the psychiatric an allied profession that they still have an important role to play.

• While past experience of psychedelics was the second most important factor cited among those selecting any psychedelic treatment modality as their preferred treatment, it is prudent to note that among those selecting no psychedelic treatment as their preferred option , personal experience of psychedelics was cited as the fifth most important factor with 22% rating it as important. We can speculate that this experience may not have been positive and reminds us that the psychedelic experience can be challenging and not to everyone’s liking. This hypothesis is consistent with 25% citing fear of brain damage (LSD and psilocybin don’t cause brain damage – the jury is less consistent for the other drugs) and almost 20% citing fear of a bad trip as a reason they did not select any psychedelic treatment modalities.

• Decades of misinformation and ideologically driven, ‘evidence resistance’ to the potential of psychoactive drugs to cure not harm will need to be overcome. Our findings suggest that a more useful, informed and honest narrative is required about these drugs and their potential to heal as well as harm. We will need to be careful not to sway the pendulum too far and offer the promise of a panacea to all psychological ills. Experience, research and reorientation of both services and cultures take time. It is worth taking the time to ensure that potential benefits don’t get waylaid by commercial interests and those with a strong interest to resist change.

CONCLUSION • Compared to traditional psychiatric medications, psychedelics compare very favorably among those with prior experience of these drugs. For drug naïve people, common popular myths offer a barrier to their acceptance. Things are changing – but both culture, policy and the medical profession will change in harmony if we are to optimize the benefits these new treatments offer in a timely fashion. Delays to legal access may end up causing more harm than good, with people tempted into unsupervised self-treatment and the appearance untrained therapists who could place vulnerable people at risk of harm.

• It is critical that research continue on psychedelic-assisted therapies, and that, if safety and efficacy continue to be shown, that they be approved for use in mainstream medicine. In this framework, society can ensure the proper safeguards against the very real risks that psychedelic based therapies entail. Within proper clinical settings we can ensure there is appropriate patient screening, preparation, monitoring, and follow up care m which will help to substantially mitigate these risks providing a risk/benefit package that compares favorably with other treatment methods common in psychiatry.

• If these novel therapies are to become more widely available, re-orientation of public perception of these drugs will be required.

Understanding more about the acceptability of different treatment options will become even more important. The promise of new therapies such as psychedelic assisted psychotherapy offers the opportunity to revisit the concept of the ‘engaged and informed patient as an active decision maker’ in their treatment. They also offer the possibility of providing both practitioner and patient the opportunity of having a ‘shared meaning in the treatment process’, Psychedelic-assisted therapies can help lift up a psychiatric profession who should welcome additional mechanisms to understand, communicate and heal.

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

• We have data on hundreds of thousands of people who use drugs from all over the world and a network of highly skilled researchers who are experts in their field. From in depth questions on patterns of use, harms, motivations and cost to source of purchase, policing, harm reduction strategies and much more.

• We have data on virtually every drug you can think of (almost). We are always interested in collaborating with academics and other groups especially those involved in public policy, health promotion and harm reduction. We are able to provide bespoke data based reports to help you craft optimal policy and harm reduction strategies in your country.

• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network

G LO B A L G D S S A M P L E VA L U E F O R M O N E Y

> 70,000 PARTICIPANTS GAVE THEIR OPINION ON HOW ALCOHOL AND OTHER DRUGS COMPARED IN TERMS OF VALUE FOR MONEY RANKED FROM 1 = VERY POOR TO 10 = EXCELLENT

BACKGROUND • Drug use peaks in the late teens and early 20s. It’s a time of change, with opportunities for independent living and decisions. Entry into higher education and careers offer new social networks, identities and freedom from parental control.

Physically you’re at your peak. It would be a great time to have lots of expendable money to spend on life’s little luxuries.

But it’s a time when most people are not that flush with cash. Money for most, needs to be spent wisely.

• It’s with this in mind that GDS2019 is revisiting the notion of value for money (VfM) for the first time in 4 years. The last time we asked this as part of GDS2016, cocaine was the worst value for money drug in world with a mean score of about 4/10 compared with the highest-ranking drug, MDMA powder, coming in at 7/10.

• There was marked country variation as you’d expect, cocaine scoring highest in Belgium and lowest in Australia.

• But 4 years on, the world of drugs and especially their purity has changed. We suspect that this has not only impacted on use, pleasure and harms but also on perceived value for money.

• In GDS2016 we only explored VfM for a few drugs – this year we are doing it for 10, including LSD, heroin and ketamine, and differentiating between alcohol bought in shops versus that bought in a bar or pub.

GDS2019 RATINGS OF VALUE FOR MONEY FOR THE 13 MOST COMMON DRUGS 10 8.4 7.5 7.2

7.1

7.1

6.9 6.4

6.3

6.1 5.8

6

5.6 4.9

4.8

Alcohol (bar)

7.2

Cocaine

7.7

8

4

2

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Synthetic cannabis

Amphetamine (powder)

Nitrous

Heroin

Methamphetamine

Alcohol (shop)

MDMA (pills)

Cannabis

MDMA (powder)

Ketamine

GHB

Mushrooms

0

LSD

Mean Value for Money

On a scale from 1 (very poor) to 10 (excellent), the psychedelic drugs LSD and magic mushrooms scored highest.

These drugs are usually used less frequently when compared to alcohol, cannabis, and stimulants.

MDMA Cocaine (powder)

MDMA (pills)

Mean Value For Money Mean Value For Money

0

6.3 6.9 6.3 7.3

Argentina 7.0 7.0 Serbia

5.7 6.5

6.6Slovakia

7.7

5

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

4.5 4.5

6.4 Finland Germany 7.6

4.2 4.1

Sweden 7.0 Australia 6.8

4.35.7

4.6

Ireland 7.3

New Zealand 5.4

4.6

Canada 7.2

6.9

7.9

7.4

7.4

7.2

7.8

7.8

4.8 7.1

7.2France

4.8

4.8 6.9

Austria 7.1

6.7Norway

4.9 7.2

7.4 7.1Global

5.0

5.1 7.4

Switzerland 7.1 United States 6.8

5.1 7.3

7.4Spain

7.7

5.1

5.2 7.3

5.2

5.26.7

England 7.5

South Africa 6.9

Scotland 7.3

Italy

5.3 7.5

Slovenia 7.7

Only countries with n > 100 participants who used recently were included in this graph

6.0

5.3 7.0

7.9 Portugal 6.8

5.3

5.4 7.4

Chile 6.5

Belgium 7.6

5.46.7

5.67.1

7.0Poland Brazil

5.66.9

India

6.4

5.9

5.6 7.6

5.7 7.4

6.4Denmark

Czech Republic 7.3

5.87.1

5.9 6.7

Greece Romania 7.2

6.1

6.0 7.1

Hungary 7.4

6.2 8.0

6.6 7.6

Lithuania 7.1

Netherlands 8.2

6.9 7.7

10

7.2Mexico

0 0

6.9 7.5

5 5

Colombia 7.4

GDS2019 RATING OF VALUE FOR MONEY FOR COCAINE BY COUNTRY 7.2

7.3

5.4

7.6

6.8

7.0

6.4

7.3

7.2

6.7

7.2

7.1

7.1

6.8

7.1

7.4

7.5

6.9

6.0

7.7

6.8

6.5

7.6

7.0

6.4

5.9

7.3

6.6

6.4

6.1

8.2 7.4

7.0

7.0

7.1

7.2

7.4

Mean Value For Money

MDMA (pills)

Mean Value For Money

0

10

5

Drug 0 10 10

G LO B A L G D S S A M P L E D E S I R E TO U S E L E S S & H E L P S E E K I N G

PARTICIPANTS WHO USED 11 COMMON DRUGS IN THE LAST 12 MONTHS WERE ASKED WHETHER THEY INTEND TO REDUCE THEIR USE IN THE NEXT 12 MONTHS AND IF SO WHETHET THEY WOULD WANT TO SEEK HELP

BACKGROUND • Every year GDS explores the positive and negative aspects of different drugs. While the percentage of the GDS sample seeking emergency medical treatment are low overall and the dependence or severely problematic use is only detected in about 10%.

• However, it is also true to say that many people who use drugs, even with no obvious or diagnoseable substance use disorder do recognise the negative impact continued use may have upon their health and well-being. The simplest way to examine the impact is by asking whether they would like to use less of a substance in the following 12 months.

• This question is then supplemented by a asking people who indicate they would like to use less in the following year whether or not they would like help to cut down or stop. This latter measure gives some idea of treatment need within the community and the public health impact of upon treatment services of a particular drug.

90%

GDS2019 DESIRE TO REDUCE SUBSTANCE USE BY DRUG (USED IN THE LAST 12 MONTHS) 80%

25.3% Ecstasy/MDMA/Molly

21.5%

26.3%

30%

GHB/GBL/1 4 butanediol

37.9% Alcohol

31.6%

38.2%

41.5% Cocaine

40%

Amphetamine (powder)

43.3%

50%

Amphetamine(paste)

47.6%

54.8%

57.2%

60%

20%

10%

Ketamine

Cannabis

Synthetic cannabinoids

Crystal methamphetamine

0%

Heroin

% of Respondents

70%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Note: small sample size for people who used GHB & heroin in the last 12 months

80%

GDS2019 PLANNED HELP-SEEKING TO REDUCE USE IN THE NEXT 12 MONTHS BY DRUG 60%

50%

40%

39.3%

30% 21.0% 20% 14.0%

12.7%

11.6%

11.1% 9.4%

10%

8.7%

7.2%

6.0%

4.4%

Ketamine

Ecstasy/MDMA/Molly

Amphetamine (powder)

GHB/GBL/1 4 butanediol

Synthetic cannabinoids

Alcohol

Amphetamine(paste)

Cocaine

Cannabis

Crystal methamphetamine

0%

Heroin

% of Respondents

70%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Note: small sample size for people who used GHB & heroin in the last 12 months

G LO B A L G D S S A M P L E N O V E L / N E W P S YC H O A C T I V E S U B S TA N C E S ( N P S )

11.4% OF THE GDS2019 PARTICIPANTS REPORTED EVER HAVING USED NPS 2.6% OF THE GDS2019 PARTICIPANTS REPORTED HAVING USED NPS IN THE LAST 12 MONTHS > 3,900 PARTICIPANTS COMPLETED THIS SECTION

BACKGROUND • GDS has been exploring the use of Novel/New Psychoactive Substances, legal highs and research chemicals for the last 7 years. The use of different NPS show marked regional variation and often reflect the availability, regulation and price of traditional drugs within a region. For example the Netherlands show one of the lowest rates of synthetic cannabinoid receptor agonist (SCRA) use in the world, reflecting easy and regulated access to natural cannabis. Conversely despite ready availability of other traditional drugs they report one of highest rates of NPS use among the GDS sample.

• NPS vary widely in their risk profile, with inconsistent composition and potency often being significant factors in the risks they pose. Highly potent hallucinogen compounds like NBOMe and potent amphetamine analogues like 4-flouroamphetamine are causing real concern across Europe and Australia where their use has been associated with deaths in recent years. GDS2017 suggests drugs with a psychedelic effect profile (including LSD analogues) are on the increase while potent novel opioid drugs like acetyl fentanyl and carfentanyl have been responsible for scores of deaths in Canada and these are ones to watch in future years.

• This year we report on cross country rates of NPS use and purchase and describe the current picture in terms of their form (pills vs. powders) and function – what drug effect do they mimic. Country specific data will be analysed at a later date.

KEY RESULTS IN THIS SECTION þ Common sources for obtaining cannabis þ Global comparison of GDS countries – NPS use in the past 12 months þ Global comparison of GDS countries – NPS purchase in the past 12 months þ Who in your country had bought NPS in the past 12 months (gender, age and clubbing) þ What preparations of NPS were most commonly used globally and in your country in the last 12 months? þ Global overview of types of drug effect NPS preparations used in the past 12 months are trying to mimic þ The % of all participants who recently used NPS and sought EMT in past 12 months

90%

12-MONTH RATES OF NPS USE BY COUNTRY 80%

Only countries with n > 100 participants who used recently were included in this graph

60%

50%

40% 32.9% 30%

20% 15.0% 12.0% 9.3% 9.0%

10%

Global mean differs from overview slide (slightly higher) because only countries with more than 100 participants who had used NPS were considered here Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Brazil

Denmark

Slovakia

Hungary

New Zealand

Switzerland

Ireland

Germany

Finland

Global

Australia

Norway

England

Sweden

Scotland

Canada

Netherlands

0%

Austria

6.7% 6.5% 5.7% 4.8% 4.3% 3.7% 3.3% 2.6% 1.9% 1.6% 1.6% 1.3% 1.2% 1.2% Poland

% of Respondents

70%

80% 80%

GENDER & AGE GROUP OF PARTICIPANTS WHO USED NPS IN THE LAST 12 MONTHS 60%

nps: used year

50%

40%

70%

% of Respondents

nps: used year

% of Respondents

Only countries with n > 100 70% participants who used recently were included in this graph

60%

50%

40% 35.1%

30%

30%

24.7% 20%

20%

15.5%

13.8%

10%

10%

0%

0%

Female

Male

Gender (%)

<25

25 +

Age group (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

FORM OF NPS USED IN THE LAST 12 MONTHS

Only countries with n > 100 participants who used recently were included in this graph Category

Answer

NPS form: Powder / crystals

yes

NPS form: Pills / tablets

yes

NPS form: Tabs

yes

NPS form: Herbal smoking mixture / incense

yes

NPS form: Liquids

yes

NPS form: Other

yes

38.2%

20.4%

21.8%

12.6%

6.8%

5.9%

0%

10%

20%

30%

40%

50%

60%

70%

% of Respondents

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

80%

90%

100%

DRUG-EFFECTS THAT THE NPS USED IN THE LAST 12 MONTHS TRY TO MIMIC Only countries with n > 100 participants who used recently were included in this graph NPS mimic: Psychedelic / hallucinogen like

yes

NPS mimic: Ecstasy/MDMA/Molly / ecstasy like

yes

NPS mimic: Stimulant like

yes

NPS mimic: Benzodiazepine like

yes

NPS mimic: Cannabis like

yes

NPS mimic: Ketamine-like or dissociative like

yes

NPS mimic: Opioid (heroin) like

yes

NPS mimic: Other drug eďŹ&#x20AC;ect

yes

61.5%

29.2%

30.8%

21.5%

18.7%

20.0%

8.5%

8.0%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

% of Respondents

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

50%

55%

60%

65%

EMERGENCY MEDICAL TREATMENT SEEKING DUE TO NPS USE BY GENDER & AGE GROUP Only countries with n > 100 participants who used recently were included in this graph 5.0

4.5

4.0 Yes

3.5 3.3%

3.2%

3.1% 3%

2.9%

3.0

2.5 % of Respondents

% of Respondents

3.1%

3.1%

2.0

1.5

1.0

2%

1%

0.5

0.0

0%

Female

Male

Gender (%)

All

<25

25 +

Age Group (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

All

G LO B A L G D S S A M P L E DRUG CHECKING

7.0% OF GDS2019 PARTICIPANTS REPORTED HAVING USED A DRUG CHECKING SERVICE OR TECHNOLOGY IN THE LAST 12 MONTHS TO DETERMINE THE CONTENT AND/OR PURITY OF CURRENTLY ILLEGAL DRUGS THAT THEY INTENDED TO USE

BACKGROUND • From state of the art technologies and pioneering services like DIMS, Saferparty.ch, CheckIt, and The Loop #to home testing colour reagent kits, drug checking technologies offer the potential to change the scope of information that people can obtain. While it’s no silver bullet because knowledge does not always lead to positive changes in behaviour and nothing can ever reduce the risk to zero, drug checking initiatives have brought together disparate groups from law enforcement, harm reduction and club and festival promotion to start having honest conversations about how to keep people and their communities safe.

• Despite 30 years of drug checking, there are complexities and many remaining questions about drug checking.

The GDS2016 mini survey showed that over two thirds of people who had used MDMA in the last year said they would probably use drug checking services if they were available.

• GDS2019 explores who uses drug checking services and which drugs are being tested.

GDS2019 USED DRUG CHECKING TECHNOLOGIES LAST 12M BY GENDER & AGE GROUP 11%

10.3% 10%

9% 8.1% 8%

8% 7.0% 7%

7.0% % of Respondents

7%

% of Respondents

6%

5%

4.9%

6%

4.8%

5%

4%

4%

3%

3%

2%

2%

1%

1%

0%

0% Female

Male

All

Gender (%)

<25

25 +

All

Age group (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

GDS2019 (SUSPECTED) DRUGS THAT GOT TESTED MOST IN THE LAST 12 MONTHS Drug tested: Ecstasy/MDMA/Molly powder/crystal

26.1%

25.6%

Drug tested: Ecstasy/MDMA/Molly pills

Drug tested: LSD / other psychedelics

21.0%

Drug tested: Cocaine (powder)

11.5%

Drug tested: Amphetamine / methamphetamine

8.5%

Drug tested: Ketamine

7.7%

Drug tested: Drug type not mentioned above

5.2%

Drug tested: New/novel synthetic drug

3.7%

Drug tested: Something I found

3.3%

Drug tested: GHB / GBL

0.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

% of Respondents

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

22%

24%

26%

28%

GDS2019 TECHNOLOGIES USED FOR DRUG CHECKING IN THE LAST 12 MONTHS 35.3%

I tested them with a colour reagent test kit

My friend tested them with a colour reagent test kit

13.3%

6.4%

Fixed site/office - laboratory equipment

My dealer/vendor tested them with a colour reagent test kit

6.7%

Service at event - laboratory equipment

6.1%

Service at event - colour reagent test

4.7%

Fixed site/office - colour reagent test

2.1%

0%

5%

10%

15%

20%

25%

% of Respondents

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

30%

35%

G LO B A L G D S S A M P L E T R U S T I N T H E P E R S O N YO U G E T YO U R D R U G S F R O M ( YO U R D E A L E R , O R YO U R F R I E N D ? )

> 14,000 PARTICIPANTS COMPLETED THIS SECTION ONLY PARTICIPANTS WHO REPORTED PURCHASING ILLEGAL DRUGS OTHER THAN CANNABIS SUCH AS COCAINE, MDMA, AMPHETAMINE, KETAMINE, OR HEROIN WERE INVITED TO COMPLETE THIS SECTION

BACKGROUND • Even with the rise of the darknet and postal services dropping drugs though your letterbox, most people still get their drugs directly from a person. This person is somebody who they have to trust enough to engage with in an illegal transaction to obtain a drug of uncertain composition in exchange for money. And, you run the risk of meeting violence, getting arrested, losing your money, or being sold something with no psychoactive effect or worsen, something potentially more dangerous than you bargained for.

• As part of GDS’s ongoing exploration of drug use behaviours, we thought we’d take drugs back to where, for most people, their session starts; getting hold of drugs.

• So this year GDS2019 investigated the relationship people have with the person they get drugs from. How many different people supplied drugs over the last 12 months. For the person who most commonly supplies them, what is the nature of that relationship? How long have they been a source? Would you describe them as a friend or a dealer? A family member? Do they deliver, or do you pick up? Is scoring drugs just a brief transaction or do you hang out and chat, have a beer, have a smoke or sex? How much do you trust them, and would you feel safe complaining without the fear of violence or threat? Does the gender of the purchaser and seller make a difference?

• Read on for the biggest exploration of the ’drug dealer’ – consumer relationship ever conducted.

KEY RESULTS IN THIS SECTION Number of purchases, number of dealers and gender of your dealer þ On how many different occasions did you buy illegal drugs from another person in the last 12 months? þ From approximately how many different people did you buy illegal drugs from in the last 12 months? þ Have you ever bought drugs from a woman Your relationship with the person you most commonly buy drugs from þ What is the gender of the person you most commonly buy drugs from? þ How many years have you known them? þ How would you describe the relationship you have with this person you most commonly get drugs from? þ Over the last 12 months are you more likely to pick up your drugs or have them delivered to you? þ What else do you do when buying drugs from this person aside from the transaction?

How much do you trust the person you most commonly get drugs from? þ To supply the drug of the quality and preparation agreed on? þ To supply the amount agreed on þ To stick to the price agreed on þ Able to talk about a problem with the drug without risking violence/abuse

90% 80% NUMBER OF DEALERS & DRUG PURCHASES IN THE LAST 12 MONTHS & GENDER 50% 50%

45%

70%

45%

37.0%

40%

35%

25% 22.6% 20%

19.0%

% of Respondents

Number of drug purchases

30%

30%

25%

60%

56.6%

50% 42.9% 40%

20%

30% 14.9%

15% 14.3%

15%

12.2% 10.6%

20%

10%

10% 7.4% 5.3%

5%

5% 1.8%

1.3%

10%

3.1%

1.3%

1.9%

No of different dealers 12m (%)

51+

40 to 50

31 to 40

21 to 30

11 to 20

6 to 10

2 to 5

0%

1.00

21 +

16 to 20

11 to 15

6 to 10

4 or 5

2 or 3

0%

1.00

% of Respondents

Number of dealers

35%

% of Respondents

Bought from a woman

40%

40.7%

No of purchases 12m (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

0% No

Yes

Ever bought from a woman (%)

RELATIONSHIP WITH THE PERSON PARTICIPANTS MOST COMMONLY BOUGHT DRUGS FROM IN THE LAST 12 MONTHS BY GENDER 30% 28.6%

Buyer

Supplier 100%

Gender of the person most commonly bought from in the last 12m (%)

25%

73.7%

60% 20%

40%

% of Respondents

Man

Respondents

80%

25.0% 20%

0% 100%

19.4% 17.3%

15% 12.5%

10.1% 10%

80%

Woman

Respondents

7.1%

57.8%

60%

5.0% 5%

39.0% 40%

0%

20%

Less than 1 year

1 to 2

3 to 4

5 to 6

7 to 8

9 to 10 > 10 years

0% Female

Male

Number of years of relationship (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

RELATIONSHIP WITH THE PERSON PARTICIPANTS MOST COMMONLY BOUGHT DRUGS FROM IN THE LAST 12 MONTHS BY GENDER 100%

90% Relationship 90%

80%

70%

70% 60% 50%

62.1% 41.1%

60%

40% 30%

23.8%

22.1%

20% 7.0%

10%

1.7%

2.7%

1.5%

% of Total

Female

% of Respondents

80%

50% 42.4% 40%

90%

37.3%

70%

30%

60% 45.7%

20.5% 20%

40%

15.1%

30%

21.1%

22.1%

10%

20%

Relationship status (%) by gender of participants

2.8%

2.6%

Flirt

1.3%

None - just get my drugs

Share an alcoholic dri..

Take drugs together

0%

Hang out

They’re a family member

0.3%

They’re my lover or partner

I met them through social media or an app

I’d rather not say

They’re my regular drug supplier but we are not friends

I know them socially

1.8%

Have sex

7.7%

10%

Chat (<5 mins)

50%

They’re my friend

Male

% of Respondents

80%

What else do people do when meeting the person to buy drugs, except for the transaction (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission Respondents 0.5

9.3% 13.6%8.3%

8.2%

8.1% 19.4%10.5%7.8%

17.7%

12.8%

13.9%

15.8% 19.4% 8.6% 7.8%

17.7% 13.7%

United States

Switzerland

22.6%

11.3%

13.6%

9.1%

9.1% 11.2% 13.6%

14.8%

11.2%

10.5% 8.1%

73.5%

81.7%

66.1%

77.1%

52.6%

68.0%

74.7%

73.2% 13.6%

14.8% Sweden22.6% 11.3%12.8%

Slovakia

Scotland

53.0%

18.8%

9.3% 13.9%

18.7% 8.2%

Norway 18.8% Portugal

53.2%

70.7% 21.7%

New Zealand

51.4%

50.3%

61.2%

71.5%

79.8%

80.6%

51.2% 55.1%

68.7%

48.8%

21.7%

16.6%

22.3%

0.5

8.6% 14.6% 15.8% 8.9%

11.3%

22.2% 21.1%

9.3% 18.7% 16.1%

15.0%

8.9% 18.5% 14.6%

16.6% 19.0% Mexico 6.8% 7.7% 13.7%

Italy

Ireland 22.3%

19.0%

13.4%

7.6%

9.7%

11.3%11.9% 14.4%

21.1%

22.2% Hungary

Germany

19.8%

France 9.1%

Netherlands

0.6

%

0.7

%

0.8

7.3% 16.1%

15.0%

18.5%

0.9

9.3% 16.2% Finland 8.3%

England

Denmark

Colombia

14.4%

1.0

4.1%

0.0

11.9%

19.8%

0.4

Canada

0.3

13.4%

84.1%

69.0%

0.8

Brazil 11.8%

7.6%

0.6

Austria

0.1

16.2%

0.2

9.7%

0.7

Australia

% of Respondents

GDS2019 TRUST IN THE DEALER THAT THEY DONâ&#x20AC;&#x2DC;T BECOME VIOLENT/ABUSIVE 1.0 Trust level Trust them totally

0.9 Trust them a bit

Not sure

Wouldnt trust them much

Would not trust them at all

Trust level Not sure Trust them a bit

Trust them totally

Would not trust them at all

Wouldnt trust them much

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission .1%

9.3%

8%

0%

70% 29.9%

27.0%

27.7%

55.5%

United States

33.6%

Switzerland

40.9%

Slovakia

31.7%

Scotland

Norway

32.2%

New Zealand

34.2%

53.0%

55.5%

51.1%

39.0%

28.8%

30.4%

53.8%

20.1%

39.0%

35.9%

31.5%

36.4%

24.0%

29.9%

46.9%

17.9%

29.6%

14.1%

66.3%

55.6%

54.4%

45.0%

34.1%

35.0%

28.9%

25.1%

27.7%

30.3%

37.7%

32.7%

25.6%

28.9%

35.8%

Netherlands

Mexico

Italy

Ireland

Hungary 48.0%

Germany 8.6%

France

Finland

England 34.8%

Denmark 44.8%

Colombia 38.4%

Canada 37.4%

27.5%25.6%

17.1%

19.3%

8.8%

28.0%

15.8%

16.6%

16.7%

17.5%

38.4%

40.9%

31.7%

27.7%

32.2%

35.8%

29.9%

27.0%

30.3%

25.1%

27.7%

33.6%

28.9%

34.8%

44.8%

55.5%

27.5%

31.1%

37.4%

48.0%

8.6%

70%

5.8%

10% 90%

Brazil

30%

51.3%

40%

16.6%

80% 39.6%

90%

6.7%

0%

17.1%

60%

Austria 31.1%

20% 100%

43.3%

50%

39.6% Australia

% of Respondents 80%

.5%

s

GDS2019 DELIVERY OR PICK-UP OF DRUGS BY COUNTRY 100%

Category Both just as likely Delivery

Pick Up

COMMENT BY PROF. ADAM WINSTOCK • The public perception of drug dealers and dealing is largely informed by myth, images from the movies and the use of drugs by marginalized people, who may be experiencing homelessness, where dependence drives multiple small cost purchases every day. The GDS taps into a different population whose purchases are less frequent, less frantic and often less risky.

• In our study, people described having a small number of trusted, often socially networked suppliers, often described as friends. Purchase was often accompanied by a significant level of social interaction, which in a minority of cases (2-3%) involved flirting or sex.

• Perhaps contrary to the stereotyped image of the male drug dealer, over half those responding to this section reported ever having bought drugs from a woman. In terms of their most common supplier, having a female dealer was much more common among women (39%) than for men (25%).

• In keeping with overall high levels of trust and confidence in their dealer, over half the respondents reported having known their main supplier for 3 or more years.

• While overall picking up drugs occurs more often than delivery in most regions supply appears flexible with delivery being a very common option.

• In summary, although buying drugs can be risky and there are clearly dodgy dealers out there, the overwhelming view held by our respondents of the person supplying their drugs on the ground level reflects the highest level of trust required on both sides of the transaction when dealing in an illegal commodity.

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

• We have data on hundreds of thousands of people who use drugs from all over the world and a network of highly skilled researchers who are experts in their field. From in depth questions on patterns of use, harms, motivations and cost to source of purchase, policing, harm reduction strategies and much more.

• We have data on virtually every drug you can think of (almost). We are always interested in collaborating with academics and other groups especially those involved in public policy, health promotion and harm reduction. We are able to provide bespoke data based reports to help you craft optimal policy and harm reduction strategies in your country.

• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network

G LO B A L G D S S A M P L E D A R K N E T & C R Y P TO M A R K E T S

13.4% OF GDS2019 PARTICIPANTS WHO REPORTED EVER USING ILLEGAL, NOVEL OR PRESCRIPTION DRUGS REPORTED EVER OBTAINING DRUGS THROUGH THE DARKNET 10.7% OF GDS2019 PARTICIPANTS WHO REPORTED USING ILLEGAL, NOVEL OR PRESCRIPTION DRUGS IN THE LAST 12 MONTHS REPORTED OBTAINING DRUGS THROUGH THE DARKNET IN THE LAST 12 MONTHS DATA FROM > 59,000 PARTICIPANTS WHO REPORTED EVER USING ILLEGAL, NOVEL OR PRESCRIPTION DRUGS WAS CONSIDERED THIS SECTION WAS LED BY DR MONICA BARRATT

BACKGROUND • Darknet markets or cryptomarkets have now been operating for 8 years (since the launch of Silk Road in February 2011). In the dark or hidden web, site owners, vendors and buyers are able to remain relatively anonymous as their IP addresses are masked. Purchases are made using the decentralised virtual currency Bitcoin, which can also be used relatively anonymously.

• Four years after the demise of Silk Road, there is still volatility in the cryptomarket ecosystem: exit scams, where market owners close the market unexpectedly and steal the funds, have become commonplace. Despite disruptions from law enforcement efforts and scams, the size and scale of darknet markets for drugs continues to grow. Since 2017, there has been a reduction in the number of English-language cryptomarkets (where multiple vendors are located) and an increase in single-vendor markets and non-English language markets.

• GDS conducted the first survey about users of cryptomarkets in 2012 and has remained at the forefront of survey work in this area, sampling cryptomarket users on an annual basis.

• The sample used in this report includes almost 60,000 respondents who completed the darknet market section this year, all of whom reported lifetime use of drugs (including pharmaceutical and novel substances). Most of these (almost 50,000) also reported last-12-month drug use.

KEY RESULTS IN THIS SECTION þ Demographics of respondents to this section þ Have you obtained drugs from darknet markets in the last 12 months? (includes personal purchase, arranged by others and purchased on behalf of others or with intent to supply to others) - by country; 6-yr trends þ What products /services have you ever bought on line (dark dark drug purchasers only) þ Use of Tor more broadly – global by darknet history þ In what year did you first obtain drugs from darknet markets? GDS2019 global sample þ Which information resources did you use to learn about darknet markets? 2019 global sample þ How has accessing drugs through darknet markets affected the range of (any) drugs you have consumed? – global 6-yr trends þ Which drug types have you obtained from darknet markets? – global 6-yr trends

50%

100%

GDS2019 DEMOGRAPHICS OF RESPSONDENTS TO SECTION ON DARKNET MARKETS 80%

40%

35%

64.9% % of Respondents

33% were from Germany, 10% USA, 8% New Zealand, 5.5% Australia, 5% England, 4.5% Denmark, 3.5% Brazil, 3.5% Switzerland, 3% Ireland, 2.5% Austria, 2.5% Finland, 2.5% Hungary, 2% Slovakia, 2% Canada, 1.5% Netherlands, 1% Norway, 0.7% Colombia, 0.7% Sweden, 0.7% Mexico, 0.6% Spain, 0.5% Scotland, 0.5% Czech Republic.

45%

70%

% of Respondents

Of the almost 60,000 participants who completed this section on darknet markets approximately:

90%

60%

50%

30%

25%

23.9% 21.1% 19.8%

20%

40%

17.2%

33.9% 30%

15%

20%

10%

10%

5%

0%

0%

Male

Female

9.8% 8.2%

<20

Gender (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

21-25

26-30

31-40

Age group (%)

41-50

>50

GDS2019 12-MONTH RATE OF OBTAINING DRUGS ON THE DARKNET BY COUNTRY 45.2%

50%

45%

40%

28.6%

35%

30%

4.2%

3.9%

3.7%

Denmark

Brazil

Hungary

2.4%

4.5%

5%

Slovakia

5.6%

7.7% Ireland

10.1% Netherlands

8.0%

10.7% Global

Germany

11.4% Canada

10%

9.8%

11.9%

15%

United States

14.9%

20%

14.2%

25%

New Zealand

Switzerland

Austria

Norway

Australia

England

0%

Finland

% Of Recent Drug Users Who Recently Obtained Drugs Through Darknet

Only countries with n > 500 participants were included in this graph

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

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.

6-YEAR TRENDS OF OBTAINING DRUGS ON THE DARKNET I Only countries with n > 500 participants were included in this graph 30%

28.6%

Country Australia Canada

25.3%

New Zealand

25%

United Kingdom 24.6%

United States

20%

Note: Mainly English-speaking countries shown here…

% of Respondents

18.1% 18.3% 15.0%

14.9%

15% 14.3% 11.9%

13.2% 12.4% 10%

9.1%

9.7%

9.3%

11.4%

8.2% 9.0% 8.3% 7.6% 5%

7.1% 5.3%

…up to 29%

2.8%

2.4% 2.1%

2.2%

2014

2015

2.4%

1.9%

0% 2016

2017

2018

2019

Year

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

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.

6-YEAR TRENDS OF OBTAINING DRUGS ON THE DARKNET II Only countries with n > 500 participants were included in this graph

10.1% 10%

Country Austria Germany Italy

8.9%

9%

Netherlands 8.0%

Switzerland

8% 7.4% 7.1%

Note: Central European countries shown here…

% of Respondents

7%

6.7% 6.8% 6.0%

6%

5% 5.0%

4.4%

4.2% 4% 3.9%

4.0% 3.5%

3.2%

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.

3% 2.4% 2.6% 2%

…up to 10%

6.1%

6.0%

2.9%

1.9% 2.1%

1% 1.0% 0% 2014

2015

2016

2017

2018

2019

Year

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

6-YEAR TRENDS OF OBTAINING DRUGS ON THE DARKNET III Only countries with n > 500 participants were included in this graph

Country Denmark

45.8% 45% 45.2%

Finland

41.4% Norway 40%

Sweden 35.7%

35%

33.8% 30.3%

Note: Northern European countries shown here… …up to 45%

% of Respondents

30% 27.2% 25% 24.0% 24.5%

24.0% 20%

21.2%

24.6%

21.3%

17.5% 14.9% 15%

12.9% 14.2% 13.3%

10% 9.2%

8.7%

6.4%

5%

5.1% 4.2% 0% 2014

2015

2016

2017

2018

2019

Year

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

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.

45%

IN WHAT YEAR40% DID YOU OBTAIN DRUGS FROM DARKNET MARKETS FOR THE FIRST TIME? Only countries with n > 500 participants were included in this graph

30% 27.1% 25%

19.9% 20%

18.4%

15% 10.9% 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.

10% 7.7% 5.8% 4.5% 1.8%

2.3%

2011

1.7%

2009

5%

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

2018

2017

2016

2015

2014

2013

2012

0%

2010

% of Respondents

35%

WHICH INFORMATION RESOURCES WERE USED TO LEARN ABOUT DARKNET MARKETS? Only countries with n > 500 participants were included in this graph

Which information resources did you use to learn about darknet markets (to help you log-on to the darknet markets and make your 100%

90%

80%

% of Respondents

70%

60%

57.9%

50.0% 50%

40%

36.3%

30%

20%

17.6% 13.8% 10.5%

10%

6.9%

0% Friends (in real-life)

Reddit

Deepdotweb

News articles

Friends (online)

Other

Dread

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

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-YEAR TRENDS DRUGS OBTAINED FROM DARKNET MARKETS Drug LSD

Drug 2C-B

Year 2015

30.4%

2016

37.7%

2017

37.8%

2016

44.9%

2019

14.0% 15.6% 15.2%

2018

20.0%

55.6%

2019 2015

25.4%

48.7%

2016

Cannabis

52.0%

2017

44.8%

2018

56.0%

2019

66.8%

Meth/amphetamine 2015

2015

38.3%

2017

39.5%

2016

39.5%

2018

51.6%

14.5%

2016

2019

17.0%

2017

Cocaine

14.3%

2018

28.2%

2015

54.8%

2015

14.8%

2017

25.3%

2019 Mushrooms

2015 2017

2018

MDMA

Year

13.5%

2016

16.5%

13.5%

2018 2016 2017

2019

12.8%

2018

DMT

15.2%

2019 NPS all

20.3%

14.6%

20.5%

9.2%

2017

2015

37.1%

2016

26.2%

2015

12.2%

2016

10.6%

36.0%

2018 2017 2018

2019

30.8%

2019 Pharmaceuticals

15.5%

33.0%

Ketamine

38.5%

2015

16.0%

2016

18.3%

2017

19.9%

2015

11.4%

2017

11.9%

2016

11.2%

15.0%

2018

2018

19.4%

2019

2019

26.6% 0%

20%

40%

15.5%

60%

% of Respondents

80%

100%

24.1% 0%

20%

40%

60%

% of Respondents

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

80%

100%

5-YEAR TRENDS HOW DARKNET MARKETS AFFECTED THE RANGE OF DRUGS USED How has accessing drugs through darknet markets affected the range of (any) ..

I did not I have I have I have I have consume drugs consumed a consumed a consumed a consumed the prior to different class smaller range wider range of same range of accessing them of drugs than of drugs than drugs than drugs as through previously previously previously previously darknet mark..

51.7% 48.5%

50%

44.6%

44.8% 44.7%

60%

31.8% 27.1%

31.1%

2017

2019 2015

32.1%

29.6%

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.

5.4% 4.4%

7.1%

10.9% 2019 2015

6.1% 5.8%

11.2% 8.9%

6.9% 5.0% 2018 2019

2017

5.3% 2017

10%

4.5% 4.9%

20%

12.5%

15.1%

30%

2015

2018 2019

2017

2016

2018

2015 2016

2018 2019

2017

2016

2018

2015 2016

0%

2016

% of Respondents

40%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

COMMENT ON DARKNET MARKET TRENDS Over the last 6 years, there has been a year on year increase in the percentage of GDS participants obtaining drugs on the darknet in most countries. The overall ranking of countries has remained relatively stable.

Across the global sample, the impact of accessing darknet markets on peopleâ&#x20AC;&#x2122;s drug purchase habits has remained rather stable over five years, with around 30% indicating the range of drugs they use has increased and about 5% reporting that they had never used drugs prior to accessing them via the darknet.

Overall there has been an increase in the proportion of participants reporting obtaining all drug types from darknet markets over the last 5 years, with only the rates of NPS purchase holding stable. Across all years cannabis, MDMA and LSD have been the most commonly purchased drugs on the darknet. Large increases in the numbers of people reporting the purchase of some drugs over the last 5 years are notable with the biggest increases being seen for the psychedelics DMT, Ketamine, LSD and 2-CB, with marked increases also seen for crystal methamphetamine and cocaine.

Over one quarter of participants reporting darknet market use in the last 12 months began their use in the year 2018: that is, they were new recruits to the darknet. These data confirm that darknet markets continue to attract new participants and that they are an increasingly significant player in the sale of distribution of illicit and prescription medication. Changes in product popularity reflect a general increase in the use of psychedelics in many countries.

GLOBAL GDS SAMPLE DRUGS & POLICING

Ø 50,000 PARTICIPANTS COMPLETED THIS SPECIAL SECTION Ø THANKS TO DR CAITLIN HUGHES FOR COORDINATING THIS SECTION OF GDS2019 FOR ANY QUESTIONS CONTACT PROF A. WINSTOCK a.winstock@ucl.ac.uk OR DR C. HUGHES caitlin.hughes@unsw.edu.au

BACKGROUND • Getting caught with drugs can be a very stressful event in people’s lives. Criminal records for personal possession of drugs can ruin careers and opportunities and costs the police and legal system considerable time and money for uncertain gain. Added to the problem is that laws are not equally applied, and there can be significant racial bias in terms of who is policed. But, while we know a lot about how drug laws operate across the globe – we know very little about how often people who use drugs are stopped by police and the similarities and differences in policing experiences across the globe.

• As part of GDS2017 we included the first drug policing module. This revealed that significant variation in experiences of policing of people who use drugs across the globe. For example, we found that after controlling for the prevalence of drug use people who use drugs were 4.8 times more likely to encounter police if they lived in Italy or Scotland, than if they lived in New Zealand. Patterns of policing further differed such as in use of drug detection dogs versus stop and search. Does this matter? Yes, as we know some modes of policing are more likely to encourage high risk behaviours e.g. people consuming all their drugs to avoid being caught in their possession.

• This survey revisits this module to explore policing experiences in more countries (>36). It also asks about newer methods of policing (e.g. roadside drug testing). Importantly it also asks people who use drugs what they think about the police. For example, do they trust the police?

• Why? We conjecture that experiences of being policed for drugs, may well impact attitudes to police.

KEY RESULTS IN THIS SECTION þ How many people who recently used illegal drugs have been stopped by police in relation to their drug use or other drugrelated behaviour in the last 12 months? þ Who is most likely to be stopped e.g. males versus females? þ How much do experiences of drugs policing vary across the globe? þ What do people who use drugs think about police e.g. do they trust the police & would they be willing to assist police if asked?

þ Of note we show here: þ Which countries have the highest level of drug-related police encounters þ Which countries most use drug detection dogs þ Which countries have the highest rate of police bribes for drugs þ Whether people who use drugs think police make fair and impartial decisions þ Whether attitudes to police vary across countries and according to experiences of being policed for drugs

GDS2019 DEMOGRAPHICS OF RESPSONDENTS TO SECTION ON DRUGS & POLICING A total of >52,500 respondents to GDS2019 completed the drug policing section, all of whom reported using illegal drugs in the last 12 months. All were used in the preparation of this report.

The age, gender and country of the respondents is provided below • Gender 68.2% male 30.5% female • Mean age 28.1 years (47.5% under 25 years, 31.0% aged 25—34 years, 21.5% aged 35+ years) • Country of residence (top countries only), to nearest 0.5%: Germany 26.5%, USA 11.5%, Australia 6.0%, New Zealand 5.5%, England 5.5%, Italy 4.0%, Denmark 4.0%, France 3.0%, Brazil 3.0%, Switzerland 3.0%, Ireland 2.5%, Finland 2.5%, Austria 2.5%, Canada 2.0%, Hungary 2.0%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

No of respondents reporting Total no of respondents % of respondents reporting No of respondents reporting % of respond any drug-related policing any drug-related policing any drug-related policing any drug-rel encounter in the last 12 encounter in the last 12 encounter in the last 12 encounter i months months months mo

43.8%

50%

35.5% 25.3%

23.7%

23.7%

23.4%

20.1%

18.7%

18.7%

17.9%

15.2%

POLICE ENCOUNTER RELATED TO ILLEGAL DRUG USE IN THE LAST 12M BY COUNTRY 0%

pondents

Only countries with n > 1,000 participants were included in this graph

13.0%

12.9%

11.3%

12,469

10K

5K 1,661

1,074

957

990

401

303

0K 100% 60K

40K 50%

1,807

1,549 333

203

247

297

159

161

324

20.1%

18.7%

18.7%

17.9%

15.2%

13.0%

1,046

1,241

2,870

Hungary Austria Germany

New Zealand

52,551

51.1%

50.5% 43.8% 35.5% 25.3%

23.7%

23.7%

23.4%

20K 0% 0K

3,251

13,983 12.9%

6,112 2,127

Australia Denmark

2,186

2,792

Italy

England

957

990

10K

1,714

1,279 United States

Finland

12,469 Global average

1,660

1,083

France Switzerl.. Canada

1,318

1,661

Ireland

Brazil

11.3%

5K 1,661 0K 60K

40K

1,074

1,807

1,549 401

303

333

203

247

52,551

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

297

159

161

324

GDS2019 MOST COMMON PATTERNS OF POLICING OF PEOPLE WHO USE DRUGS Only countries with n > 1,000 participants were included in this graph 16% 14.7% 14%

10% 9.2%

8% 6.3% 6%

3.6%

4%

2.9% 2%

1.6%

1.3% 0.5%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Asked to pay a bribe

Arrested

Given an on the spot fine

Stopped for a roadside drug test

Given a warning

Other

Stopped and searched by police without drug dogs

0%

Encountered police with drug detection dogs

% of Respondents

12%

GDS2019 VS. GDS2017 MOST COMMON PATTERNS OF POLICING ENCOUNTERED Only countries with n > 1,000 participants were included in this graph Encountered police with drug detection dogs

Stopped and searched by police without drug dogs

Given a warning

Arrested

Asked to pay a bribe

16 14.7% 14

% of Respondents

12

10

9.5% 9.2% 8.3%

8

6

4

3.6%

3.6%

2 1.3%

1.3% 0.4%

0.5%

2017

2019

0 2017

2019

2017

2019

2017

2019

2017

2019

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

No of respondents reporting Total No of Respondents % of respondents reporting No of respondents reporting % of r they encountered a drug they encountered a drug they encountered a drug they detection dog in the last 12 detection dog in the last 12 detection dog in the last 12 detec months months months

17.6%

14.7%

12.7%

12.4%

11.7%

11.1%

9.3%

8.3%

6.2%

3.6%

3.4%

2.9%

44

57

410

0.0%

GDS2019 ENCOUNTERS ARE MUCH MORE COMMON IN 4 COUNTRIES

l No of Respondents

Only countries

8K 7K with 6K

7,717

n > 1,000 participants were included in this graph

5K 4K 3K 2K

1,455 865

1K

871

772

1,074 167

212

150

121

97

237

103

12.7%

12.4%

11.7%

11.1%

9.3%

8.3%

6.2%

3.6%

3.4%

1,046

2,870

1,660

1,241

1,661

100.0%

60K

52,551

40K 50.0%

44.8%

40.7% 35.3%

31.2%

20K 0.0%

17.6%

3,251

0K

14.7%

13,983

6,112 2,127

8K Australia Denmark 7K

2,186

2,792

1,317

1,714

1,279

Ireland

France

Finland

1,083

2.9%

7,717

Italy

England

United States

Global

Canada Hungary

New Switzerl.. Austria Zealand

Brazil

Germany

6K

• •

5K 4K 3K

Comparison of GDS2017 and GDS2019 suggest drug detection dog encounters have increased in many countries.. ..But the countries with the highest growth are Australia, Denmark, Italy and England

2K

1,455

865 1K 60K

772

871

1,074 167

212

150

121

97

237

103

44

57

410

52,551

40K

20K

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

13,983

90%

80% GDS2019 POLICE BRIBES (OFFERS OF MONEY TO AVOID DRUG CHARGE)

Only countries with n > 1,000 participants were included in this graph

% of Respondents

70%

60%

50%

40%

30% 23.2% 20.9% 20%

8.3%

10%

0.5%

0% Mexico

Colombia

Germany

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Global average

GDS2019 DEMOGRAPHIC DIFFERENCES OF THOSE MOST LIKELY TO BE POLICED Only countries with n > 1,000 participants were included in this graph Did not encounter police

Encountered police

Did not encounter police

100%

100%

90%

90%

Encountered police

89.0%

80.4%

80%

80%

77.7%

70%

70%

60%

60%

% of Respondents

% of Respondents

75.7%

50%

67.8%

50%

40%

40%

30%

30%

32.2%

24.3% 22.4% 19.6%

20%

20%

10%

10%

0%

0%

11.0%

Female

Male

Female

Male

<25

Gender (%) Global Drug Survey GDS2019 © Not to be reproduced without authors permission

25-34

35+

<25

Age group (%)

25-34

35+

ATTENDING FESTIVALS INCREASES THE LIKLIHOOD OF ENCOUNTERING POLICE Only countries with n > 1,000 participants were included in this graph

Did not encounter police

Encountered police

100% 90% 82.9% 80% 70.7%

60%

50%

40% 29.3%

30%

20%

17.1%

10%

Festival goer

Non-festival goer

Festival goer

0% Non-festival goer

% of Respondents

70%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

DO POLICE TREAT PEOPLE WITH DIGNITY AND RESPECT? Only countries with n > 1,000 participants were included in this graph

Perceptions: Do police treat people with dignity and respect?

40% 37.7%

35%

30.8%

Half of the participants who use illegal drugs have favourable attitudes to police.

Avg. % of Respondents

30%

25%

20%

15%

14.0% 12.3%

10%

5.3% 5%

0% Frequently

Somewhat frequently

Infrequently

Never

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Dont know

DO POLICE MAKE FAIR & IMPARTIAL DECISIONS? Only countries with n > 1,000 participants were included in this graph

Perceptions: Do police make fair and impartial decisions?

40% 36.8% 35%

29.6%

30%

25%

% of Respondents

Half of the participants who use illegal drugs have favourable attitudes to police.

20% 16.3% 15% 12.7%

10%

4.6%

5%

0% Frequently

Somewhat frequently

Infrequently

Never

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Don't know

DO POLICE MAKE FAIR & IMPARTIAL DECISIONS? BY RECENT POLICING EXPERIENCE Only countries with n > 1,000 participants were included in this graph

Never

Infrequently

Somewhat frequently

Frequently

Dont know

50%

40% 37.2%

% of Respondents

30%

27.9%

20%

17.8% 13.0%

11.9%

11.7%

10% 6.0% 4.1%

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Encountered police

Did not encounter police

Encountered police

Did not encounter police

Encountered police

Did not encounter police

Encountered police

Did not encounter police

Encountered police

0%

Did not encounter police

Those recently policed for drugs have less favourable attitudes to police and are less willing to assist the police if asked.

35.6%

34.8%

DO POLICE MAKE FAIR & IMPARTIAL DECISIONS? BY RECENT POLICING & COUNTRY Only countries with n > 1,000 participants were included in this graph

Infrequently

Somewhat frequently

Never

60% 45.8%

42.4%

35.8%

40% 25.4% 20%

15.8% 8.8%

10.4%

7.2%

5.8%

2.6%

0% 60%

45.1% 40.4% 40% 29.5% 20%

31.8%

16.3%

12.7%

9.1%

12.7% 1.1%

0% 60%

1.3%

34.8%

Encountered police

20%

35.7%

Did not encounter police

43.3% 37.5%

40%

14.1% 8.8%

8.7%

7.7%

4.0%

5.5%

Encountered police

United States

Frequently

Did not encounter police

New Zealand

% of Respondents

Germany

% of Respondents

Encountered police

Did not encounter police

Encountered police

Did not encounter police

Encountered police

0%

Did not encounter police

Attitudes of people who use drugs to police are more favourable in New Zealand â&#x20AC;&#x201C; including amongst those policed and not policed for drugs. In contrast, in the United States and Germany attitudes to police are less favourable and those encountering police in relation to their drug use have even poorer views.

% of Respondents

Dont know

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

G LO B A L G D S S A M P L E S E X U A L A S S A U LT, C O N S E N T A N D I N TOX I C AT I O N

> 2,500 PARTICIPANTS COMPLETED THIS SPECIAL SECTION COVERS EXPERIENCES OF BEING TAKEN ADVANTAGE OF UNDER THE INFLUENCE OF ALCOHOL OR OTHER DRUGS THANKS TO ALEXANDRA ALDRIDGE FOR COORDINATING THIS SECTION OF GDS2019

BACKGROUND • From Hollywood to Westminster, incidents of sexual misconduct are currently receiving close media attention.

However, high-profile cases dominating headlines represent only a fraction of sexual violence, and the vast majority of sexual assault goes unreported • Alcohol and other drugs play a complicated role in how sexual violence is understood. Research has demonstrated a ‘double standard’ in public perception of intoxicated sexual assault: intoxicated perpetrators tend to be held less responsible for their actions, while intoxicated victims tend to be held more so (Finch and Munro, 2007) • GDS2019 collaborated with sex and drugs researcher Alexandra Aldridge to explore the intersections of intoxication, sexual consent and sexual assault • GDS2019 aimed to explore individuals’ experiences of being taken advantage of while under the influence of alcohol and/or other drugs at the incident level. We asked who was involved, who else was around, and where the incident happened. We asked if the incident was reported to anyone else, including the police. If it wasn’t, we asked why • We’ll use findings to help shape interventions that minimise risk and harm, and maximise help and support, ensuring that no one is held responsible for sexual assault other than the perpetrator

KEY RESULTS IN THIS SECTION % OF FULL GDS SAMPLE REPORTING BEING TAKEN ADVANTAGE OF SEXUALLY WHILE UNDER THE INFLUENCE OF ALCOHOL AND/OR OTHER DRUGS (EVER v LAST 12 MONTHS) q % reporting being taken advantage of sexually while under the influence of alcohol and/or other drugs EVER and in the LAST 12 MONTHS (by gender / by age) INFORMATION AT INCIDENT LEVEL: MOST RECENT OCCASION q Substance(s) taken q Where were you taken advantage of? (private house / nightclub / festival / pub/bar / public space) q Who else did you know nearby? (no one / 1-2 people / a few people / lots of people) q How would you best describe your relationship with perpetrator(s)? (total stranger / person part of social network but not well known / person well known / person I knew fancied me / person with whom Iâ&#x20AC;&#x2122;d had a previous sexual relationship / person with whom I was in a relationship) q Did you give consent to initiate sexual activity? (yes / no / unsure) q To what extent do you recall the events? (completely remember / some uncertainty / lots of uncertainty / remember nothing) q In what way were you taken advantage of? (kissing / sexual touching / oral sex / penetration) q Did you report to the police? (yes / no) q Reasons for not reporting to the police q Did you tell anyone else? ( friend/family member / therapist/counsellor / colleague / someone nearby at time of incident)

DEMOGRAPHICS OF PEOPLE WHO WERE TAKEN ADVANTAGE OF IN THE LAST 12M • Of the full global sample (>120,000), approximately 14% (> 11,000) reported ever being taken advantage of sexually while intoxicated. 4% (> 3,250) reported being taken advantage of in the last 12 months.

• Those reporting being taken advantage of in the last 12 months were given the option of filling out an extended section regarding their most recent experience. 75% (> 2,300) chose to do so.

• Of these 2,300, 30% lived in Germany, 11% in Australia, 11% in the USA, 10% in the UK, 7% in Denmark and 4% in New Zealand. The rest currently lived in other countries.

• Of these 2,300, 28% identified as male, 69% as female and 3% as non-binary or a different gender identity • The mean age of men was 25, for women and for non-binary people 23.

• 63% of men and 74% of women and non-binary people were under 25.

• Of these 2,300, 57% identified as heterosexual, 31% as bisexual, 7% as homosexual, 3% as other, and 2% preferred not to say

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

GDS2019 RATES OF PARTICIPANTS BEING TAKEN ADVANTAGE OF WHILE UNDER THE INFLUNCE OF ALCOHOL AND/OR OTHER DRUGS BY GENDER 29.3%

Female

% of Respondents

30

20

10

8.0%

0

N > 100,000 Male

% of Respondents

30

20

10 6.1% 2.2% 0

Other

% of Respondents

30

27.7%

20

9.6% 10

0 Yes (in the last 12 months)

Yes (more than 12 months ago)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

GDS2019 RATES OF PARTICIPANTS BEING TAKEN ADVANTAGE OF WHILE UNDER THE INFLUNCE OF ALCOHOL AND/OR OTHER DRUGS BY AGE GROUP 30%

% of Respondents

25%

Yes (in the last 12 months)

20%

15%

10% 7.5% 5%

N > 100,000

3.0% 1.2%

0% 30%

Yes (more than 12 months ago)

% of Respondents

25%

20% 17.9% 16.0% 15% 10.6% 10%

5%

0% <25

25-34

35+

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

GDS2019 RATES OF PARTICIPANTS BEING TAKEN ADVANTAGE OF WHILE UNDER THE INFLUNCE OF ALCOHOL AND/OR OTHER DRUGS BY GENDER & SEXUAL ORIENTATION Heterosexual

Homosexual

Bisexual

Other

Prefer not to say

50%

Yes (in the last 12 months)

% of Respondents

40%

30%

20% 14.4%

14.2%

11.7% 9.6% 10%

N > 100,000

6.4%

5.3% 5.3% 4.8%

6.8% 6.0%

4.9%

3.9% 1.9% 1.9%

1.7% 0% 50%

40% 32.9% 30.3% 28.0%

30% 27.7% 25.7%

25.8%

25.2%

23.1% 20%

17.1% 14.6% 10.2%

9.2%

10%

6.1%

5.3%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Other

Male

Female

Other

Male

Female

Other

Male

Female

Other

Male

Female

Other

Male

0%

Female

Yes (more than 12 months ago)

% of Respondents

35.4%

THE FOLLOWING SECTION REPORTS ON DATA COLLECTED REGARDING THE MOST RECENT INCIDENT OF BEING TAKEN ADVANTAGE OF SEXUALLY WHILE INTOXICATED IN THE LAST 12 MONTHS

100%

% of Respondents

83.0%

SUBSTANCES CONSUMED WHEN THE MOST RECENT SEXUAL ASSAULT HAPPENED 29.5%

14.2% 14.5%10.1% 0% 100% 100% 90.1% 83.0%

47.6% 37.9% 33.9%

50% 50%

29.5% 21.2% 13.1% 14.2% 14.5%10.4% 7.3% 10.1% 6.5% 4.0% 1.2% 3.4% 1.1% 0.6% 2.9% 3.0% 1.0% 2.6% 1.1% 0.6% 0.1% 0.8% 0.2% 0.6%

100%

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

Mephedrone

*illegal drugs only, no alcohol

Magic mushrooms

2c-b

Drugs only

Nitrous oxide

Ecstasy/MDMA/Molly

LSD

0.3%

Cannabis

Crystal meth

0.3%

Mephedrone

0.3%

Alcohol and drugs

1.0%

Magic mushrooms

1.7%

Alcohol only

1.8%

GHB / GBL

Poppers

Ketamine

Drugs only

Cocaine

Ecstasy/MDMA/Molly

Cannabis

Alcohol and drugs

Alcohol only

Alcohol

2.0%

0%

*

GHB / GBL

3.3% 6.6% 4.9% 4.9% 4.9% 3.3% 1.6% 1.6% 1.6%

0%

Mephedrone

10% 2.4%

LSD

16.4% 19.7%

10.1% 9.6% 3.0%

Nitrous oxide

*

Magic mushrooms

41.0%

Nitrous oxide

13.5%

31.1%

GHB / GBL

20%

49.2% 50%

LSD

Other

24.0%

Crystal meth

30%

77.0%

Cannabis

35.5%

Alcohol and drugs

40%

Alcohol only

% of Respondents

100%

Alcohol

0% 0%

50%

Crystal meth

21.2%16.4% 19.7% 13.1% 7.3% 10.4% 4.9% 4.9% 3.3% 3.3% 6.6% 4.9% 1.2% 1.6% 0.6% 2.9% 1.0% 1.1% 1.1% 1.6% 0.1% 1.6% 0.2%

Ketamine

54.9%

41.0% 31.1% 33.9%

Ketamine

60%

Alcohol

% of Respondents

70%

58.8% 49.2% 50% 50%

Poppers

Other Female

Poppers

80%

0% 0% 100% 100% 90.1% 77.0%

Cocaine

% of Respondents % of Respondents

By gender (%)

90% 87.8%

6.5% 3.0% 3.4% 2.6% 4.0% 0.6% 0.8% 0.6%

58.8%

Cocaine

All (%)

37.9%

Drugs only

Female Male

47.6%

50%

Ecstasy/MDMA/Molly

% of Respondents % of Respondents

Male

90

80%

WHERE DID THE MOST RECENT INCIDENT HAPPEN AND WHO WAS NEARBY? 70% 80

66.8%

% of Respondents

60

50

60%

50%

40% 34.3% 30%

40

26.1%

25.9%

20% 30

13.7% 10% 20 14.2%

3.1% 1.3%

0 Private Nightclub house

Public space

Bar

Location (%)

Festival

Pub

People nearby (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

A few people I knew

4.0%

Lots of friends

10.5% 10

No one

0%

1 or 2 good friends

% of Respondents

70

RELATIONSHIP WITH THE PERSON(S) INVOLVED MOST RECENTLY

How would you best describe your relationship(s) with the other person/people in Total stranger – never met them until that day

30.5%

A person I knew

21.9%

In my social network but not known well

12.4%

A person I knew fancied me

11.6%

A person I had had previous sexual relations with

11.4%

A person I was in a relationship with A work colleague

8.6% 3.6% 0%

20%

40%

% of Respondents

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

RELATIONSHIP WITH THE PERSON(S) INVOLVED MOST RECENTLY BY GENDER A person I had had previous sexual relations with

Female

10.9%

Male

12.3%

Other A person I knew

16.4%

Female

23.1%

Male

19.5%

Other A person I knew fancied me

14.8%

Female

9.1%

Male

17.8%

Other A person I was in a relationship with

13.1%

Female

8.0%

Male

9.7%

Other A work colleague

In my social network but not known well

13.1%

Female

3.6%

Male

3.7%

Other

3.3%

Female

12.9%

Male

10.9%

Other Total stranger – never met them until that day

13.1%

Female

32.4%

Male

26.1%

Other

26.2% 0%

10%

20%

30%

% of Respondents

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

40%

50%

DID YOU GIVE CONSENT TO INITIATE SEXUAL ACTIVITY & HOW MUCH CAN YOU RECALL? Gave consent to sexual activity (%) Remember nothing 3.4% Unsure 25.3%

Lots of uncertainty about what happened 13.2%

Remember everything 46.1%

No 49.0%

Yes 25.8%

Some uncertainty about what happened 37.3%

Memory about the most recent incident (%)

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

FORM OF MOST RECENT SEXUAL ASSAULT BY GENDER 90%

Female

% of Respondents

80% 70% 60% 50%

42.6%

41.5%

40% 30% 20% 10%

8.8%

7.1%

90%

Male

% of Respondents

80% 70% 60% 50%

41.8%

40%

31.5%

30% 20%

16.3% 10.4%

10%

90%

Other

% of Respondents

80% 70% 60% 50%

42.4% 37.3%

40% 30% 20%

13.6% 6.8%

10% Kissing

Oral sex

Penetration

Sexual touching

Global Drug Survey GDS2019 © Not to be reproduced without authors permission

REPORTED MOST RECENT INCIDENT TO POLICE BY GENDER & REASONS WHY NOT Why didn't you report the incident to the police?

50% 90%

96.5%

45%

Female

% of Respondents

80%

43.0%

42.9%

70% 60%

40%

50% 40%

35%

30%

31.3%

10%

3.5% 98.8%

90%

Male

% of Respondents

80% 70% 60%

% of Respondents

20%

29.4%

30%

25.7% 25%

23.4% 19.0%

20%

16.9%

50% 40%

15%

30% 20%

9.9% 10%

10%

90%

1.2% 95.0%

5%

70%

Yes

Reported to police (%)

Reasons for non-reporting (%)

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Too afraid/ashamed

Worried about reporting drug use

No

Didn't want others to ďŹ nd out

5.0%

10%

Wasn't sure what happened

20%

Person was part of friendship group

30%

Didn't want police involved

40%

Didn't think to report to police

50%

Didn't think it was a crime

0%

60%

I felt (partly) responsible

Other

% of Respondents

80%

REASONS OF NON-REPORTING TO POLICE BY GENDER

Female

% of Respondents

60% 42.9%

42.2%

40% 31.5%

29.4%

27.3%

24.6% 19.0%

20%

17.6% 9.8%

42.7%

30.1%

20.7%

20.1%

18.8% 15.3% 10.3%

50.9% 47.4% 40.4%

40%

38.6%

36.8% 28.1% 19.3% 15.8%

20%

8.8%

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Worried about reporting drug use

Too afraid/ashamed

Didn't want others to ďŹ nd out

Wasn't sure what happened

Person was part of friendship grp

Didn't want police involved

Didn't think to report to police

0%

Didn't think it was a crime

% of Respondents

28.4%

20%

0% 60%

Other

44.2%

40%

I felt (partly) responsible

Male

% of Respondents

0% 60%

REPORTING OF MOST RECENT INCIDENT TO SOMEONE OTHER THAN THE POLICE

Therapist/counseller Colleague 2.4% 6.3% Someone nearby at the time of the incident 9.5%

75% of those who did not report the most recent incident to the police did tell someone else.

Most of them informed a friend or family member about the incident

Global Drug Survey GDS2019 Š Not to be reproduced without authors permission

Friend/family member 81.8%

HIGHLIGHTS : SEXUAL ASSAULT SECTION • Reported incidents of being taken advantage of sexually while intoxicated were highest among those identifying as women (29% lifetime, 8% last 12 months) or as non-binary/a different gender identity (28% lifetime, 10% last 12 months). For men, 6% reported being taken advantage of ever, and 2% in the last 12 months • Individuals identifying as bisexual represented the largest proportion of those reporting being taken advantage of for both men (9% lifetime, 5% last 12 months) and women (35% lifetime, 14% last 12 months) • When describing their most recent incident of being taken advantage of, alcohol was the most common substance reported by respondents • 88% of respondents reporting having consumed alcohol, and 55% reporting having consumed alcohol only • The second most common substance to be consumed was cannabis (24%) • 67% of incidents occurred in private houses • 70% of perpetrators were known to the person taken advantage of in some capacity • 74% of those who were taken advantage of knew other people nearby at the time of the incident • 26% of those reporting being taken advantage of sexually reported having given their consent at the initiation of sexual activity • 97% respondents stated they did not report the incident to the police • This did not vary according to type/severity (e.g. kissing, sexual touching, penetration)

SUMMARY : SEXUAL ASSAULT SECTION • Our findings provide valuable insights into contextual factors for respondents who reported having been taken advantage of while intoxicated • Our findings contradict common ‘rape myths’: ✖ ‘Only women can be sexually assaulted’ ✖ ‘Stranger danger’ ✖ ‘Women are most likely to be sexually assaulted when outside alone after dark’ • The debunking of such rape myths has important implications for educational messages aimed at preventing intoxicated sexual violence. Such messages should not rely solely on strategies to avoid being raped. Instead, messages should promote ethical sexual behaviour in which individuals are encouraged to consider the effects of alcohol and/or other drug intoxication on their own and others feelings around sexual activity • Our findings demonstrate the importance of recognising the complexity of people’s lived experience in their understanding of intoxicated sexual assault: • 43% of respondents indicated they did not report to the police because they felt at least partly responsible for events. Similarly, previous research has found that feelings of shame and self-blame are common across victims of sexual assault (Weiss, 2010; Hlavka, 2017) • 26% of respondents reported giving consent at initiation of sexual activity – such a finding demonstrates that consent is best viewed as ongoing process throughout a sexual encounter

CAN’T FIND WHAT YOU ARE LOOKING FOR? • Want more data on your own country or substance of interest?

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• Please contact me for further details at adam@globaldrugsurvey.com Thank you, Professor Adam R Winstock on behalf of the GDS Core Research Team and academic partner network