József Rácz

Voice of the Psychonauts: Coping, Life Purpose, and Spirituality in Psychedelic Drug Users

Abstract Psychoactive drug use shows great diversity, but due to a disproportionate focus on problematic drug use, predominant nonproblematic drug use remains an understudied phenomenon. Historic and anecdotal evidence shows that natural sources of “psychedelic” drugs (e.g., mescaline and psilocybin) have been used in religious and spiritual settings for centuries, as well as for psychological self-enhancement purposes. Our study assessed a total of 667 psychedelic drug users, other drug users, and drug nonusers by online questionnaires. Coping, life purpose, and spirituality were measured with the Psychological Immune Competence Inventory, the Purpose in Life test, and the Intrinsic Spirituality Scale, respectively. Results indicate that the use of psychedelic drugs with a purpose to enhance self-knowledge is less associated with problems, and correlates positively with coping and spirituality. Albeit the meaning of “spirituality” may be ambiguous, it seems that a spiritually-inclined attitude in drug use may act as a protective factor against drug-related problems. The autognostic use of psychedelic drugs may be thus hypothesized as a “training situation” that promotes self-enhancement by rehearsing personal coping strategies and by gaining self-knowledge. However, to assess the actual efficiency and the speculated long-term benefits of these deliberately provoked exceptional experiences, further qualitative investigations are needed.

Online drug user-led harm reduction in Hungary: a review of "Daath".

Harm reduction has been increasingly finding its way into public drug policies and healthcare practices worldwide, with successful intervention measures justifiably focussing on the highest-risk groups, such as injecting drug users. However, there are also other types of drug users in need for harm reduction, even though they pose less, low, or no public health risk. Occasionally, drug users may autonomously organise themselves into groups to provide advocacy, harm reduction, and peer-help services, sometimes online. The http://www.daath.hu website has been operated since 2001 by the “Hungarian Psychedelic Community”, an unorganised drug user group with a special interest in hallucinogenic and related substances. As of today, the website serves about 1200 visitors daily, and the online community comprises of more than 8000 registered members. The Daath community is driven by a strong commitment to the policy of harm reduction in the form of various peer-help activities that aim to expand harm reduction without promoting drug use. Our review comprehensively summarises Daath’s user-led harm reduction services and activities from the last ten years, firstly outlining the history and growth phases of Daath, along with its self-set guidelines and policies. Online services (such as a discussion board, and an Ecstasy pill database) and offline activities (such as Ecstasy pill field testing, and a documentary film about psychedelics) are described. In order to extend its harm reduction services and activities in the future, Daath has several social, commercial, and legislative challenges to face. Starting with a need to realign its focus, outlooks for the upcoming operation of Daath are pondered. Future trends in harm reduction, such as separating harm-decreasing from benefit-increasing, are also discussed. We aim to share these innovative harm reduction measures and good practices in order to be critically assessed, and – if found useful – adapted and applied elsewhere.

Transition to injecting 3,4-methylene-dioxy-pyrovalerone (MDPV) among needle exchange program participants in Hungary

In 2011, anecdotal data indicated that 3,4-methylene-dioxy-pyrovalerone (MDPV) might become popular among needle exchange program (NEP) clients in Hungary as a possible substitute for formerly used substances such as amphetamines and heroin. The aim of the study reported here was to examine how the emergence of MDPV influenced the choice of the injecting substance among NEP clients. A total of 183 injecting drug users (IDUs) participating in the largest NEP in Budapest agreed to participate in the study and report on their drug use habits. During 2011, remarkable changes occurred in the structure of the primary injected substances. Amphetamine was cited as the primary injected substance by 45.9% of the respondents and MDPV by 48.1%. Close to half of the former amphetamine injectors had switched to MDPV (64 persons, 45.1%) as had 10 (41.7%) of the former heroin injectors and 11 (78.6%) of those using other substances (cocaine and mephedrone). The appearance of MDPV on the illegal drug market had a substantial effect on the drug use patterns of the IDU population. Further research should be conducted to explain the changes, that might include the purity, price and availability of amphetamine and heroin.

New cases of HIV among people who inject drugs in Hungary: False alarm or early warning?

Between 2009 and the first quarter of 2014, only one case of HIV (contracted outside Hungary) was detected among PWIDs in Hungary. However, more recent evidence suggests increased sharing of injecting paraphernalia among PWIDs. This is linked to the emergence of new designer drugs that require frequent injection, alongside funding cuts to the Hungarian needle exchange program (NEP) which has reduced access to sterile injecting equipment. During the past five years in Hungary, drug use has become increasingly discussed in moral as opposed to public health terms, and drug consumption has been re-criminalized. The largest NEP in Hungary was closed because of political pressure and government funding for regular HCV/HIV testing/counselling and seroprevalence studies among PWIDs has been stopped. This paper describes the detection of two new cases of HIV infection in PWIDs attending two NEPs in Budapest in May 2014. These new cases may indicate an unfolding HIV outbreak among PWIDs-similar to those reported in Greece and Romania. Yet the question remains: If no further HIV cases are detected, is this because there are no new cases or because there are no testing facilities for PWID?

A needle in the haystack – the dire straits of needle exchange in Hungary

BackgroundThe two largest needle exchange programs (NEPs) in Hungary were forced to close down in the second half of 2014 due to extreme political attacks and related lack of government funding. The closures occurred against a background of rapid expansion in Hungary of injectable new psychoactive substances, which are associated with very frequent injecting episodes and syringe sharing. The aim of our analysis was to predict how the overall Hungarian NEP syringe supply was affected by the closures.MethodsWe analyzed all registry data from all NEPs in Hungary for all years of standardized NEP data collection protocols currently in use (2008–2014) concerning 22 949 client enrollments, 9 211 new clients, 228 167 client contacts, 3 160 560 distributed syringes, and 2 077 676 collected syringes.ResultsWe found that while the combined share of the two now closed NEPs decreased over time, even in their partial year 2014 they still distributed and collected about half of all syringes, and attended to over half of all clients and client contacts in Hungary. The number of distributed syringes per PWID (WHO minimum target = 100) was 81 in 2014 in Hungary, but 39 without the two now closed NEPs.ConclusionsThere is a high probability that the combination of decreased NEP coverage and the increased injection risk of new psychoactive substances may lead in Hungary to a public health disaster similar to the HIV outbreaks in Romania and Greece. This can be avoided only by an immediate change in the attitude of the Hungarian government towards harm reduction.

Portrayal of New Psychoactive Substances in the Hungarian Online Media

We assessed the portrayal of new psychoactive substances (NPS) in online Hungarian printed media between January 1, 2014 and December 31, 2014 using content analysis. Altogether five topics were identified: 1: effects/side effects from the point of view of an outsider; 2: motivation of drug use; 3: type of NPS mentioned; 4: location of consumption or seizures; 5: tone of the article. The results suggest that much of the Hungarian online printed media is written in a sensation seeking way and mainly focuses on police seizures and on the physical (especially on the deviant and aggressive behavioral) effects of NPS usage. Articles mainly associate NPS with events among the marginalized population of the 8th district in Budapest (a low socioeconomic and drug infested area with a high population proportion of marginalized Roma minorities), or law-enforcement activities outside of Budapest. The monitoring of written online media may inform public health professionals and policy makers about emerging problems related to NPS, while such professionals may inform journalists to counterbalance the sensationalist tone of news pieces about NPS.

Assessing the experience of using synthetic cannabinoids by means of interpretative phenomenological analysis

BackgroundNew psychoactive substances (NPS) have been increasingly consumed by people who use drugs in recent years, which pose a new challenge for treatment services. One of the largest groups of NPS is synthetic cannabinoids (SCs), which are intended as a replacement to cannabis. While there is an increasing body of research on the motivation and the effects associated with SC use, little is known about the subjective interpretation of SC use by the people who use drugs themselves. The aim of this study was to examine the experiences and personal interpretations of SC use of users who were heavily dependent on SC and are in treatment.MethodsA qualitative research method was applied in order to explore unknown and personal aspects of SC use. Semi-structured interviews were conducted with six participants who had problematic SC use and entered treatment. The research was conducted in Hungary in 2015. We analyzed data using interpretative phenomenological analysis (IPA).ResultsParticipants perceived SCs to be unpredictable: their initial positive experiences quickly turned negative. They also reported that SCs took over their lives both interpersonally and intrapersonally: the drug took their old friends away, and while initially it gave them new ones, in the end it not only made them asocial but the drug became their only friend, it hijacked their personalities and made them addicted.ConclusionsParticipants experienced rapid development of effects and they had difficulties interpreting or integrating these experiences. The rapid alteration of effects and experiences may explain the severe psychopathological symptoms, which may be important information for harm reduction and treatment services. Since, these experiences are mostly unknown and unpredictable for people who use SCs, a forum where they could share their experiences could have a harm reducing role. For a harm reduction point of view of SCs, which are underrepresented in literature, it is important to emphasize the impossibility of knowing the quantity, purity, or even the number of different SC compounds in a particular SC product. Our study findings suggest that despite the adverse effects, including a rapid turn of experiences to negative, rapid development of addiction and withdrawal symptoms of SCs, participants continued using the drug because this drug was mostly available and cheap. Therefore, a harm reduction approach would be to make available and legal certain drugs that have less adverse effects and could cause less serious dependence and withdrawal symptoms, with controlled production and distribution (similarly to cannabis legalization in the Netherlands).

Transition from “old” injected drugs to mephedrone in an urban micro segregate in Budapest, Hungary: a qualitative analysis

Abstract Social micro segregates are spatial, geographical organizations within the city of Budapest, Hungary. Drug transition was studied in a specific micro segregate which was characterised by social marginalization, inhabitants with low economic background and dense injecting drugs user community. The members of this community changed their drugs use from “old” drugs (heroin, amphetamines) to new, “designer” drugs when they have appeared in the country in 2010. The transition was studied with qualitative interviews, where the effect of the memebrship in the micro segregate as a special injecting risk environment was conceived. Data from life narrative interviews with 17 mephedrone users were collected. Data underline the supply driven drug transitions took place in this special geographic area and risk environment. The new, more harmful injecting drug use pattern was explained by the characteristics of the micro segregate. Results raise attention to public health consequences of drug transition and to the importance of the proper public health and urban planning policies.

Emergence of novel psychoactive substances among clients of a needle exchange programme in Budapest

In this paper the authors summarize experience of a drug service provider with the injecting use of novel psychoactive substances. Among clients of the needle exchange programme of Blue Point Drug Counselling and Outpatient Centre, the authors observed the spread of the novel substances since 2009. The extensive spread of the novel substances caused substantial change in injecting use patterns, thus in the usage of the needle exchange programme. The novel psychoactive substances appeared consecutively, so that this setting gave a unique opportunity to observe and track the emergence of these substances. The authors summarize the characteristics which are important for medical practice (risks, frequent use, severe psychopathological conditions) as well as special risks associated with these substances (substances with unknown composition and effect). They highlight the importance and role of the early warning system, monitoring the online sources of information and testing of samples containing novel psychoactive substances.

Epidemiology of hepatitis C and human immunodeficiency virus infections among injecting drug users in Hungary – what’s next?

The prevalence of hepatitis C virus infection (HCV) is currently about 35% among injecting drug users in Budapest, Hungary, and it is under 20% outside of the capital, and no verified case of human immunodeficiency virus (HIV) have been detected so far. Mathematical models describe that the co-occurrence of HIV and HCV among injecting drug users is such under an HCV prevalence of about 35% the probability of an HIV epidemic is low, but above this threshold an, HIV epidemic is to be expected. According to these models, there is a looming probability of an HIV epidemic among injecting drug users in Hungary, especially in Budapest. There are four ways to prevent or delay such an epidemic: 1. substitution treatment programs; 2. legal access to injecting equipment; 3. free and confidential HIV and HCV counseling and rapid testing; and 4. hygienic injecting environment. In order to avoid a predicted HIV epidemic, epidemiological pattern of HCV among injecting drug users in Hungary requires both a comprehensive prevention response and the systematic monitoring of the epidemiological situation. The success of the prevention programs depends on two factors: 1. wide access; and 2. regular financial support from the government.