Addictions Rounds Dance Drugs & Harm Reduction Presented by: Lisa Campbell Salazar, TRIP! Project Coordinator Central Toronto Community Health Centre Learning Objectives: 1. To share the TRIP! model of harm reduction and peer education. 2. To raise awareness about new trends in dance drug use and health impacts. 3. To present alternative approaches to treatment

1. Dance Drugs & Harm ReductionLisa Campbell Salazarlisa@tripproject.ca CAMH– October 14th 2011

2. TRIP! was founded in 1995, by partiers, for partiers!

3. Our Approach: We can never stop the use of drugs, but we CAN keep people safe Drug use is a health issue, not a legal one Non-judgmental education approach based on facts, not opinions/morals Providing information (for and by youth drug users) so that users can make their own informed choices

4. Who We Serve: The majority of youth respondents (46.2%) are under 19, with triple the rates of drug use of general youth population 44% of TRIP! respondents identified as LGBTQ (33% bi-sexual, 8.8% gay and 3% identifying as transgendered) 9% of TRIP! respondents identifying as homeless, under housed or transient 71.3% identified their use as casual/non-problematic 70% first trying drugs between ages 12-16, with the average age being 13 43% of survey respondents indicated they experience negative health effects from their drug use

5. What do we do? Bag and Booth Harm Reduction Outreach Festivals Advocacy Blogging & Social Media Creation of New Literature Multimedia Design Volunteer Trainings & Workshops Community-Based Research

6. Social Media Outreach

7. Creative Workshops 24 creative arts workshops planned in 4 categories: dance, music, visual arts, fashion to build resilience

8. Cupcakes, Cosplay and Beatz!

9. Zines

10. Why is TRIP! important? Research shows that, next to the internet, TRIP! is the most trusted source of information on drugs, sex and high-risk activities; while schools, media and family come in last!

11. Outcomes for Volunteers Better knowledge about the safer drug use (98%) Better knowledge about safer sex (80%) Access to Safer Use Kits(43%) Building a sense of community – caring for each other (78%) Referrals to other supports and services (55%) Work experience and connections to employment possibilities (35%)

12. “Alcohol, cannabis, and the medicine cabinet…” One in four Ontario teens is a binge drinker One in four Ontario teens have smoked pot in the last year 42% of Ontario students reported use of any drug other than alcohol or tobacco About 18% of Ontario students report using a prescription opioid pain reliever non-medically in the year

13. TRIP! Survey Data 2007/08

14. 2010 TRIP! Survey Drug use rates were significantly higher in TRIP! youth versus all of the results reported in the 2009 Ontario Student Drug Use and Health Survey (OSDUHS). Alcohol 98% vs. 58% Cannabis 94% vs. 25% Salvia 50% vs. 5% While between 5-7% of OSDUHS reported using hallucinogens and/or stimulants, 84% of TRIP! youth report using MDMA, 79% Magic Mushrooms, 70% Ketamine, 68% LSD and 48% reported using Crystal Meth.

16. Navigating Risky Behaviours 47% of TRIP! youth surveyed reported having unprotected sex, with 24% reporting having sex with multiple partners. 21% of youth drug users reported sharing straws with 42% saying that it depended on the situation. 9% identified as injection drug users, with 3% saying that they planned to try it in the near future

17. Emerging Challenges Rise in Ketamine Global Rise of Amphetamines Legal Highs and Research Chemicals

18. Ketamine Special K, K, kitty Price: ~$30 vial (Toronto 2011) White powder Looks similar to table salt or a fluffy powder Typically snorted Can be smoked or injected (IM or IV)

20. Common health problems and concerns associated with ketamine use such as bladder problems, ulcers, k-pains, sleep disturbance and memory problems, as well as paranoid / delusional thoughts in longer-term chronic users

21. Ketamine users were also poly-drug users: MDMA (99%), alcohol (97%), pot (95%), mushrooms (90%), coke (88%), acid (80%), oxies (80%), and 64% crystal meth

22. 80% of k users wanted to know more about mental health

24. Ketamine Risk Reduction Be careful using in public environments (e.g., nightclubs) so that you don’t “K-out”. Tell friends you are doing K and try to have a sober friend that can help if you do too much. Anaesthesia-levels of ketamine in certain settings could lead to serious accidents, such as falling from balconies or bathtub drownings. Tolerance builds quickly; take breaks from use to bring it back down. Long term chronic use can cause serious bladder damage!

25. Global Rise of Amphetamines

26. Global Rise of Amphetamines

27. Methamphetamine Crystal, Meth, Jib, Crank, Ice, Tina Price = $ 50-60 / bag (0.25 – 0.3 gram) White to off white powder; crystal shards (like glass)

28. Methamphetamine Strong stimulant; “upper” Releases dopamine, serotonin, norepinephrine (adrenalin) Can be swallowed, snorted, smoked or injected Smoking and injecting potentially more addictive Long half-life (12 hours) Physical effects: Increase in heart rate, body temperature; decreased appetite and sleep; dry mouth; loss of erection Psycho/behavioural effects: Increase in alertness, confidence, euphoria Paranoia; anxiety; decreased self control / inhibitions

29. Methamphetamine Immediate risks: Dehydration Lack of food / sleep Loss of inhibitions Paranoia / psychosis Longer-term risks: Physical/psychological dependency Weight loss Tooth decay Strains on heart Depression Loneliness Loss of friends, school, job

30. Methamphetamine Risk Reduction Plan ahead before partying; you may need a few days to recover. Limit what you buy. The longer you party, the rougher you’ll feel after. Smoking and injecting seem to be more common in people entering addiction treatment. Try to avoid sharing pipes and injection equipment. Try to eat something while you're high Protein shakes or fruit juices with healthy supplements are better than nothing. Feed your body the fuel it needs. Keep hydrated Use extra lube if having sex. Lack of sleep. Lack of food. Physically exhausted. Accept the comedown Spread out the partying… not every week. Dopamine and all those other neurotransmitters take time to be replaced.

31. Ecstasy E, X, pills, Molly Specific pills named based on colour, size, shape, stamp/logo Can come as powder in a gel cap $5-$15 a pill (Toronto 2011) Predominately swallowed Pills may be crushed in to powder and snorted Rarely hooped or smoked

32. Ecstasy MDMA and/or other chemicals Main neurotransmitter: Serotonin Though with adulterated pills others maybe effected (e.g., more dopamine if methamphetamine is in pills) Primarily stimulant effects; “upper” Though overwhelming sense of “bliss” may leave you feeling lethargic Physical effects: Increases in heart rate, body temperature and energy Jaw clenching/tightening, dilated pupils, nausea Psycho/behavioural effects: +ve: empathy, openness, peace, caring, open-hearted communication –ve: anxiety, paranoia, “bad mood”

33. Ecstasy Immediate risks: Not knowing what you get Ecstasy pills are one of the most adulterated illicit substances Dehydration; overheating; stroke Particularly when used in hot nightclubs and parties Say or do something you regret Tendency to talk openly and “feel connected” may not last the next day Rough comedown Can be hard to fall asleep You may feel sad, blue, and easily irritated for a couple of days after

34. Ecstasy Longer-term concerns: Tolerance Many longer-term users report taking more to get a similar effect (e.g., “½ a pill used to get me high, now I take 2 in a night”). Psychological Dependency If you have always taken ecstasy when going out dancing, it may be hard to not think about using when going out, even though your body isn’t physically needing it. Depression What goes up, must come down. Serotonin, one of the neurotransmitters ecstasy effects, is part of your eat/sleep patterns and mood cycles - it may be depleted after use. Anxiety & panic attacks Stimulant drugs can create a sense of urgency or paranoia in some people, especially with the more you take or the longer you stay high. May affect ability to perform complex cognitive tasks and memory in “chronic users”.

35. Ecstasy Risk Reduction It’s nearly impossible to know the purity and quality of the pill until after you take it. Kicks in, 20-60 minutes when swallowed (wait to get high!) Start with half a pill. Wait about 45 minutes after you’ve dosed before deciding to do more. Less is more. You will likely feel worse after using if: You do more at one time (e.g., 2 ½ pills vs. 1 pill) You stay high longer (e.g., 20 hrs vs. 7 hrs) Stay hydrated: YES: water; Gatorade NO: alcohol; energy drinks If dancing or having sex, take breaks and chill out for a while. Fruits (esp. bananas), protein shakes, juices, yogurt, are all good (and easier) to eat.

36. What goes up, must come down… Lack of sleep. Lack of food. Physically exhausted. Accept the comedown; chill out with friends. Depressed; irritable; cranky Need time for recovery Eat! Sleep! Spread out the partying… not every weekend. Serotonin takes a few weeks to be replaced.

37. Ecstasy: Pills vs. MDMA MDMA = “pure” Ecstasy. Historically found pressed into a pill form, but now commonly found in caps Pills are usually “cut” with other drugs. Never know what you are getting! Each pill is different, even if it looks the same. Duration of high: 4-6 hrs (pure MDMA), 2-10 hrs (Ecstasy pills) MDMA currently waiting approval for Canadian clinical trials for PTSD. (Jan 2011)

38. Ecstasy Pills Observations and conversations with partiers and clubbers using E, show a wide variety of experiences. Toronto, 2004: 7 of 21 Ecstasy users showed methamphetamine in hair samples. BC Centre for Excellence in HIV/AIDS and UBC Dept. of Health Care and Epidemiology, 2004: 94 pills 44 (47%) contained methamphetamine Drug analysis report on designer drugs seized in Quebec, June 2007 to July 2008 (Health Canada; RCMP).

40. Subjective experiences can vary – be careful!

42. Most recent tests from ecstasydata.org (not all Canadian results)

45. Pure Pillz Piperazine class of drugs. Combination of BZP and TFMPP. First popularized as “Social Tonics” in New Zealand and marketed as a “harm reduction” alternative to street laced ecstasy pills. Were available in Canada online and in Toronto store-fronts around 2007/2008. Did not become too popular as decent quality MDMA was widely available and Pure Pillz only crudely mimiced effects of MDMA. BZP and TFMPP often show up in lab analysis of current ecstasy pills.

46. Pure Pillz

48. Health Canada Advisory – Pure Pillz

49. Ecstasy takers in hospitalCBC News Posted: Apr 8, 2011 http://www.cbc.ca/news/canada/nova-scotia/story/2011/04/08/ns-ecstasy-halifax.html

50. Media Ajax teens hospitalized after buying drugs online Toronto Star, Published On Tue Nov 30 2010 http://www.thestar.com/news/article/898878--ajax-teens-hospitalized-after-buying-drugs-online Police warn of rise of club drug 'meow-meow' following GTA bust The Globe and Mail, February 17 2011 http://www.theglobeandmail.com/news/national/toronto/police-warn-of-rise-of-club-drug-meow-meow-following-gta-bust/article1910877/ Young people treated in Halifax hospital after taking bad ecstasy Global Maritimes: Thursday, April 7, 2011 http://www.globaltvbc.com/Young+people+treated+Halifax+hospital+after+taking+ecstasy/4578060/story.html

51. Media Ecstasy takers in hospital (Halifax) CBC News Posted: Apr 8, 2011 http://www.cbc.ca/news/canada/nova-scotia/story/2011/04/08/ns-ecstasy-halifax.html RCMP issue warning about party drug BZP (Edmonton) Global News: Tuesday, May 3, 2011 http://www.globaltvbc.com/RCMP+issue+warning+about+party+drug/4719466/story.html Teen relives trip on killer ecstasy (Calgary) Sun Media: Monday, June 6, 2011 http://www.torontosun.com/2011/06/06/teen-relives-trip-on-killer-ecstasy

53. Research Chemicals Popularized by “fringe scientist” and doctor, Alexander Shulgin. Examples 2CI, 2CB, 2CT2, 2CT7, 5-meo-DiPT, 5-meo-AMT, BZP, TFMPP, mephedrone Some are legal, many are increasingly scheduled. Have been easily obtained over the internet the last few years. Often the ones with psychedelic properties are sought. Some mimic amphetamine type substances.

54. Research Chemicals Scheduling of these substances causes ‘blow-out sales’ by manufacturers. They are often sold over the internet and marketed “bath salts” or “plant fertilizer” and labeled “not for human consumption”. Come in ‘waves’ through the dance music scene or drug user networks.

55. Research Chemicals Little is known of these substances, their long-term effects, potential contraindications with medications and other drugs. Not a very high success rate: with several of the substances, only 50% of users will get the desired high, the other 50% will have vomiting and diarrhea. Some people have suggested they should be referred to as “un-researched chemicals” or “experimental chemicals”.

58. More Challenges!

60. Peer Education

61. Free Water / Fruit

62. Gum and Earplugs

63. Medics

64. Safer Consumption Kits

65. Sexual Health

67. Club Drug Clinic

68. Safer Consumption

69. Helpful Resources www.erowid.org www.bluelight.ru www.wikipedia.org www.dancesafe.org

71. Purerave.com - tripproject

72. Facebook.com/tripproject

73. Twitter.com/tripproject

74. Email us at info@tripproject.ca