Perceived availability of drugs, exposure, access to drugs

product being studied are collected from as many different users. This is consequently the main focus of the SINTES scheme: obtaining details on the composition of a given product on a national basis for a given year.

• The monitoring component comes under the health alert system. Any professional working with drug users may ask the OFDT for authorisation to collect an illegal product as long as this product has generated undesirable and unusual effects amongst users, or if it is new in some way. The annual number of samples collected is generally between 60 and 100. The contributions made by this approach are the identification of newly circulating molecules and occasional information on the composition of certain molecules at a given moment and in a given location.

• Since 2010, the SINTES system has benefitted from the addition of Internet monitoring for new psychoactive substances in order to help identify the emergence of new products and new circulation modalities.

All pharmacologically active substances are identified provided that they are included in the laboratory database. However, only the main psychoactive substance in a product undergoes content analyses, unless requested otherwise.

Heroin

In France, heroin is available in two chemical forms: the "white" hydrochloride form and the

"brown" freebase form. The white form accounts for a very small share of the market. It only circulates through highly specific channels, such as in certain sections of the Asian immigrant community (the Chinese community in particular) and among Greater Paris-based users, who by their very nature are not particularly visible. In contrast, the freebase form dominates the market.

After a period of decline following the introduction of substitution treatments in France in the second half of the 1990s, observers of drug markets as well as drug trafficking and drug-use law enforcement services noted that brown heroin has again become more available since 2006.

This has been taking place in a context in which the price has stabilised at a fairly low level of about €40 compared to the early 2000s, when the price reached €60 or even €70. This increase in availability occurs in low-threshold structures amongst the most marginalised users, as well as in specialised treatment centres and certain alternative and underground festive milieus with close ties to the electronic music scene (Cadet-Taïrou et al. 2010b). The latter group tends to use heroin by snorting or even inhaling it (“chasing the dragon”), thereby minimising heroin’s dramatic image.

In 2011, this trend was confirmed by the majority of the TREND sites, and for OCRTIS, "The availability of heroin is increasing all over France.” (DCPJ (Direction centrale de la police judiciaire) et al. 2012). In French regions, the presence of heroin is determined by proximity to the developing Afghan heroin storage and distribution markets of the Netherlands, Belgium and Switzerland. Subsequently, it is in the northeastern and Rhône-Alpes regions of France that heroin is the most widely available. Furthermore, SINTES, conducted a survey in 2011 amongst users on the composition of heroin, and confirmed the high availability of the product at TREND sites, since 71% of the consumers met stated that they had no difficulty in procuring it.

Cocaine

In 2011, according to a study published by the OFDT, cocaine sales in France were approximately €900 M, representing a domestic consumption of about 15 tonnes (Ben Lakhdar 2012).

The availability of cocaine in France has been continuously expanding since the late 1990s. This development is steady and does not seem to be exhibiting any declines or stagnation. Indeed, the demand for cocaine hydrochloride is extremely dynamic in widely varying sectors of the French population, ranging from the very well off to the most marginalised clients of low threshold services (Cadet-Taïrou et al. 2010a).

In 2011, the availability measured by TREND remained just as high, both in urban and festive environments. According to the OCRTIS, cocaine is widely available in the main urban centres of Metropolitan Lille, Paris, Lyon and Marseille.

In contrast, the availability of crack cocaine (sold in its crack form and in very small quantities to a primarily very unstable clientele) remains characteristic of north-eastern portions of Greater Paris, the Antilles and French Guyana. The micro-markets that sporadically crop up in provincial cities are very short-lived.

Crack and freebase: what is the difference in France?

Both of these correspond to forms of cocaine hydrochloride that are converted to “freebase” form by dissolving the hydrochloride form in water and adding an alkaline reagent. The use of bicarbonate produces “crack” and that of ammonia produces “freebase”, although the active substance remains the same. However, given how these methods arrived in France, it is mainly the context of use that determines the use of "crack" or "freebase": while crack is sold already prepared in the form of a rock, freebase is often prepared by users themselves after purchasing hydrochloride in powder form.

Crack, for which the only significant markets remain north-eastern Paris and the Antilles-Guyana French region, is mainly sold to an extremely unstable population, while freebase is primarily used (but used to a lesser extent) by the cocaine-using population. Therefore, freebase users often consider themselves in surveys to be cocaine users rather than crack users. However, this theory has been disproven recently on several levels: on the one hand the use of cocaine that is freebased after purchase and the use of crack, in Paris in particular, can overlap since some freebase users source on the crack market; on the other hand, there is no “official” definition of crack and freebase, and users employ these terms interchangeably. Subsequently, certain Parisian users talk about crack when they use a crack pipe and freebase when they use a homemade tool (aluminium foil on glass, for example) (Pousset 2012).

Ecstasy and amphetamines

To correctly understand the current ecstasy market and supply, a distinction needs to be made between the drug’s different forms, which include tablets, capsules and powder. Although the tablet is the most widespread form in France, it is true that the market is much less dynamic than it was when the techno movement began developing in the mid-1990s. After a 2009 characterised by a drop in the availability of tablets containing MDMA, it seems that this ecstasy form is once again present on the festive scene.

For several years now, the powdered MDMA form has become increasingly available in various festive settings. This form benefits from the growing appeal of cocaine hydrochloride, to which it is frequently assimilated, and from the growing popularity of "snorting". Given its relatively high price, it only attracts a specific festive scene clientele (those frequenting discotheques and nightclubs). This specificity contributes to maintaining the clandestine nature of distribution networks, of which we currently know relatively little.

However, 2011 was characterised by a sharp rise in the availability of the so-called “crystal”

form. The “crystal” form, which is not to be confused with methamphetamine, is available as translucent rocks or crystals (red, white, grey or yellow) that need to be reduced into powder form to be snorted or ingested. It was in 2006 that this new MDMA form appeared within the TREND network. This product seems to be increasingly popular among users due to its effects, which are purportedly more powerful than those of the powder form. Over a three-year period, the price of crystal MDMA dropped from €80 to €55 (Cadet-Taïrou et al. 2012).

Amphetamine (speed) supply remains dynamic and targets a specific, clearly identified segment of users who view speed as a cheap alternative to cocaine because it is available in powdered form and is snorted. This product is predominantly available in the alternative environments of the festive techno setting, but also appears to be gaining ground in nightclubs and discotheques as increasing numbers of consumers have become dissatisfied with ecstasy tablets.

In France, until now, toxicological analysis almost always showed that products considered to be

“methamphetamines” were not. This situation changed in 2010 since, after years of rumours about the arrival of methamphetamine in France, two “cases” helped to verify its presence. The first was revealed by the French police force when it dismantled a clandestine Parisian consumption site being run by people in the Chinese community. The second became evident after collecting two samples from the Toulouse TREND site (one sample was in tablet form and the other in liquid form). The toxicological analysis of these samples confirmed the presence of methamphetamine (Sudérie 2010). However, the investigation conducted following the collection of these samples demonstrated that there was no real diffusion of this product in Toulouse or elsewhere in France. Its presence remained limited to very tight circles of experienced users who most often procured the substance abroad during touristic visits (for the “Yaba” tablet form found in Toulouse, the source was Thailand, while for the liquid form, the source was Israel).

Methamphetamine use remains exceptional and characterised by sporadic supply. The meagre quantities of product seized on French soil are usually in transit on their way to other countries.

Other synthetic drugs: New psychoactive substances (NPS)

NPS represents a vast group of products that are collectively referred to as "new drugs". These are psychoactive products, whose effects are similar to those of known products, such as amphetamines, cocaine and ketamine, but whose molecular structure is different. This difference means that narcotics laws do not regulate these products. This is why the number of “new drugs” appearing is steadily rising. Each time a NPS is classified as a narcotic, a new, similar but distinct molecule is invented and launched. The one thing all these products have in common is that they are sold over the Internet.

Generally speaking, the term “new psychoactive substance” encompasses both synthetic products designed to circumvent narcotics legislation and entheogenic plants²⁰⁰. In addition to these two major categories, we also find some medications, non-essential amino acids (L-Tyrosine) and plant-based precursors (DMT) being considered as NPS. The majority of medications being considered as NPS are psycholeptics. They can be analogues of known medications, such as ethylphenidate²⁰¹ or etizolam²⁰². Psycholeptics also include medications such as dextromethorphan. Commonly known as DXM, this molecule is present in several cough medications. The Internet reveals DXM’s various methods of consumption and the different effects that can be achieved through DXM use.

Some of the terms employed when speaking of these molecules are “legal highs”, “bath salts”²⁰³,

“party pills” and “legal ecstasy”. The products may be known by a generic trademark (see Organization of the market). The best known of these trademarks is “Spice”, which is a mixture of herbs used as a vehicle for synthetic cannabinoid consumption. These products are often presented as incense, bath salts or fertilisers and bear the phrase, “not for human consumption”.

The circulation and consumption of NPS in France constitutes an emergent phenomenon. From the late 1990s to 2008, there were rumours that such substances were being distributed (OFDT 2001; Hautefeuille et al. 2002). These rumours were not substantiated until 2008, when online

200 Plants are considered entheogens when they have psychoactive properties and are used in a religious or spiritual context.

Currently, entheogenic plants have been rediscovered and are being increasingly abused to experience hallucinations or altered states of consciousness.

201 An analogue of methylphenidate, the active substance in Ritalin®.

202 Belongs to the family of benzodiazepines, of which Valium® is a member.

203 Expression used only for cathinones (mephedrone, methylone, butylone, pentedrone…).

retail sites were pinpointed and toxicological analyses performed within the SINTES scheme confirmed the presence of some of the substances.

Despite a growing supply, use in France remains fairly secret. Consequently, the extent of the supply is still difficult to determine with precision. The characteristics of the supply, and particularly the supposedly scattered production and Web distribution, partially explain this difficulty. Indicators and observation protocols in this new area are being determined in France, as elsewhere.

For now, the indicators used to assess European and French supplies are the number of online retail sites and the toxicological identification of molecules. This identification is performed in France through the activities of the police and customs²⁰⁴ or via the SINTES scheme, and is performed in the European Union through the Early Warning System (EWS).

From 2008 to 2011, 44 molecules were identified through toxicological analyses as having circulated at least once on French territory²⁰⁵. Most of these molecules had already been identified in other EU countries. During the second half of 2011, the Service commun des laboratoires (SCL, or Joint Laboratories Department) analysed 170 seizures containing already-known NPS products. Of these 170 seizures, 52 were NPS recently classified as narcotics and 120 were non-classified NPS products.

However, these indicators do little to reveal the extent of the actual distribution of the products.

Although they attest to a different kind of supply, their contribution to demonstrating the true diffusion of these products is minimal. The identification of a molecule in France is not the same thing as tangible, identified distribution on the territory.

Hallucinogens

The market for hallucinogens is broken down into two segments: there are the synthetic products, like LSD, and natural products, like mushrooms or Salvia divinorum (Diviner’s sage).

For about 10 years, the LSD market in France has been extremely volatile due to the ups and downs of a supply that depends greatly on the law enforcement activities in the countries that produce this substance, such as Belgium or the Netherlands. Consequently, some years, observers within the TREND network reported virtually zero availability, while at other times LSD appeared to have been extensively present within the market. Since 2006, the supply of LSD seems to have experienced no major interruptions and the drug has been mainly available in festive settings associated with free parties and teknivals, where the drug appears to be actively sought by a fringe group of consumers comprised of young thrill seekers.

It seems that, since 2008, there has been an increasing availability of ketamine. While it appeared occasionally on the alternative festive scene, where it was mainly used by a specific extreme group of the festive population (travellers), ketamine appears to be much more available there recently. In 2010 and 2011, the alternative festive scene remained the environment of choice for ketamine use, even though the substance exists – albeit very marginally – in clubs and discotheques as well as in the urban arena. The supply of these two

204 The analysis of NPS within the scope of law enforcement appears to be only partially reflected in the figures when compared to narcotics seizures. NPS are not all legally classified as narcotics. Subsequently, in the statistics, they are classified in another category.

205 The OFDT regularly updates a summary table of the identification of these substances. It is available on the Internet at:

http://www.ofdt.fr/ofdtdev/live/donneesnat/notes.html

products does not appear to be driven by organized networks; instead, the drugs are produced by individuals on a small scale or acquired via the Internet. Although its availability is expanding, ketamine’s presence at festive events remains random for the most part. Furthermore, it is very difficult to obtain information about the nature and source of the ketamine being distributed on such festive scenes.

GBL (the precursor of GHB) can be easily obtained on the Internet and in certain automotive supply stores, even though in 2011 its sale to the public was banned (see chapter 1.2.2). Until 2007, its consumption was mainly limited to the gay festive scene. However, thereafter use spread from Paris out to other areas of France, and from sites of private use to clubs. Around 2009, use spread to clubs and discotheques mainly in the cities of southern France (Toulouse, Bordeaux, Montpellier, Aix en Provence), thereby extending beyond the gay party scene to a young club-going population. In 2011, use by the gay festive population was once again confined to the private sphere, and it seems that use in the young population once again became rather discreet.

As for herbal cannabis, demand for natural hallucinogens has risen sharply. This supply has been boosted by a strong demand for so-called organic products with high "mystical" content, such as herbs used in traditional societies for inducing shamanic trance states, like Salvia divinorum or Datura (Reynaud-Maurupt 2006). Furthermore, supply has been encouraged by the use of the Internet, allowing users to procure substances, generally from the Netherlands and the United Kingdom, without taking major risks.