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The purpose of this paper is to present some of the continued resistance and challenges faced by drug checking services (DCS) and review how the existing literature and the contributions to the special issue address them, with a view to making recommendations.

The existing literature and the contributions to the special issue are reviewed.

Drug checking cannot be equated with quality control. With the appropriate equipment and chemistry staff, DCS can provide quantitative analysis and reliable results. When the product does not match expectations, service users discard the tested substance of concern. To more easily compare the results of different studies and better evaluate drug checking, standardisation of measures is desirable. Uptake of drug checking, notably in festivals, is low and depends in part on the capacity of DCS. Drug checking has added value in monitoring drug markets and is complementary with chemical (forensic) analysis.

This paper interrogates in a relatively comprehensive way the continued resistance to drug checking in light of theoretical and empirical research to derive recommendations that are specific to drug checking and that are addressed to health professionals, researchers and also to policymakers.

This study aims to assess service user characteristics, uptake and outcomes for drug checking services offered to over 250,000 English festival-goers in summer 2018 and to compare findings with earlier years, wider festival-goers and the general population.

A total of 2,672 substances of concern were submitted by the public and tested by chemists in mobile laboratories on 24 show days at seven festivals. Results were embedded in 2,043 individually tailored brief interventions (BI) delivered by health professionals to 4,240 service users. Comparative data were collected through anonymous self-report surveys with 1,291 respondents at five of the same festivals.

Three percent of drug-using festival-goers received BI, 95% of whom had not previously accessed health services regarding their alcohol or other drug use. Drug checking service users were significantly more likely to be younger, male and past month polydrug users with a wider range of drugs consumed in the last month compared with the general festival population. For samples matching purchase intent, nearly half intended to reduce dosage, with younger and female service users significantly more likely to reduce dosage. For substances identified as other than expected, nearly two thirds disposed of them.

Festivals are potential sites to deliver innovative health interventions and to monitor their outcomes, reduce the risk of poisoning and overdose, and facilitate access to follow-up support services.

This study suggests that there is value in event-based services that provide risk reduction communications directly to young adults engaged in higher risk drug use compared with wider event and general populations.

The recent influx of interest in and the changing status of drug checking has led us to reconsider some fundamental questions about drug checking. This commentary aims to define drug checking. It proceeds in three parts: terminology, definitions and programmes that are excluded from the definition of drug checking that still have value for harm reduction.

To inform the commentary, an informal review of pertinent publications on the topic was conducted to extract relevant definitions and terminology.

Drug checking services (DCS) have five necessary features: (1) aim of reducing harm; (2) analyse samples directly from the public; (3) return results to the service user; (4) involve information exchange between service user and DCS; and (5) conduct a tailored intervention with the service user. Variable features include the populations served, setting, analysis methods, immediacy of results, nature of intervention, levels of engagement with other stakeholder groups, funding models, legal status and staff skillsets. Programmes that are not DCS but have some similarities to DCS include non-publicly accessible testing of drugs as well as testing of bodily fluids where results may inform drug alerts.

Drug checking remains a legally, politically and commercially sensitive health service. Reflecting on the history and evolution of drug checking, both as a term and as a harm reduction service, helps provide clarity in terms of what drug checking is and what it is not. This facilitates more effective framing of evaluations, in terms of what DCS aim to do and achieve.

The 3,4-methylenedioxymetamphetamine (MDMA) content in ecstasy tablets has increased enormously throughout Europe across the past decade. This study aims to determine whether this is caused by the production of “stronger” tablets (more mg MDMA per mg of tablet), or if tablets have simply been getting larger and heavier (more mg of tablet in total).

A data set of 31,716 ecstasy tablets obtained in 2012–2021 by 10 members of the Trans European Drug Information (TEDI) network was analysed.

The MDMA mass fraction in ecstasy tablets has remained virtually unchanged over the past 10 years, with increased MDMA contents being attributed almost exclusively to increased tablet weight. These trends seem to be uniform across Europe, despite varying sampling and analytical techniques being used by the TEDI participants. The study also shows that while tablet weight correlates perfectly with MDMA content on a yearly basis, wide variations in the MDMA mass fraction make such relations irrelevant for determining the MDMA content of individual tablets.

These results provide new opportunities for harm reduction, given that size is a tangible and apparently accurate characteristic to emphasise that one tablet does not simply equate to one dose. This is particularly useful for harm reduction services without the resources for in-house quantification of large numbers of ecstasy tablets, although the results of this study also show that chemical analysis remains crucial for accurate personalised harm reduction.

The findings are both new and pertinent, providing a novel insight into the market dynamics of ecstasy tablet production at a transnational level.

Commonly known as ecstasy, MDMA has been central to the British acid house, rave and dance club scene over the last 20 years. Figures from the annual national British Crime Survey suggest that ecstasy use has declined since 2001. This apparent decline is considered here alongside the concurrent emergence of a ‘new’ form of ecstasy ‐ MDMA powder or crystal ‐ and the extent to which this can be seen as a successful rebranding of MDMA as a ‘premium’ product in the wake of user disenchantment with cheap and easily available but poor quality pills. These changes have occurred within a policy context, which in the last decade has increasingly prioritised the drugs‐crime relationship through coercive treatment of problem drug users within criminal justice‐based interventions, alongside a focus on binge drinking and alcohol‐related harm. This has resulted in a significant reduction in the information, support and treatment available to ecstasy users since the height of dance drug harm reduction service provision pioneered by the Safer Dancing model in the mid‐1990s.

In January 2006 ketamine shifted from medical regulation through the Medicines Act to a Class C drug through an amendment to the Misuse of Drugs Act. In the debate surrounding this criminalisation, interest has grown in prevalence and patterns of ketamine consumption. Such information is scarce however, particularly given that ketamine has yet to be included in the British Crime Survey or most other surveys of youth and young adult drug use. Here Karenza Moore and Fiona Measham reveal the true extent of ketamine use, who is using it and how.

Significant changes in British recreational drug use were seen throughout 2009, with the emergence and rapid growth in the availability and use of substituted cathinones or ‘M‐Cats’ (most notably mephedrone and methylone), a group of psychoactive drugs not currently controlled under the Misuse of Drugs Act 1971 (HM Government, 1971), with similar effects to ecstasy, cocaine and amphetamines. The reasons for the appearance and appeal of this group of so‐called ‘legal highs’ are explored here in relation to availability, purity, legality and convenience. The authors argue that a reduction in the availability (and thus purity) of illegal drugs such as ecstasy and cocaine and resultant disillusionment among users was a key motivation for displacement to substituted cathinones, conveniently and legally purchased online. Finally, we explore policy considerations around the likely criminalisation of substituted cathinones and the challenge of providing rapid yet considered harm reduction responses to emergent drug trends in the face of a minimal scientific evidence base and eager press demonisation.

The purpose of this paper is to provide an overview of recent changes in young people's consumption of alcohol in Britain before then charting emerging academic perspectives and some of the recent regulatory and legislative changes.

The approach takes the form of a selective narrative review of young people's alcohol consumption in the last ten years through an analysis of key British and European secondary schools surveys, alongside select qualitative studies of relevance.

There has been increased heavy drinking per session by some young people in the UK from the early 1990s, with a perceived growing public tolerance of drunkenness by many more. In recent years there is evidence that this heavy sessional consumption by youth and young adults is starting to level off. However, there are also growing numbers of occasional drinkers and abstainers, suggesting a polarisation of drinking patterns amongst young people since 2000.

Early indications that alcohol consumption has levelled off by youth, as well as young adults, since the turn of the century suggests that some of the most highly publicised excesses of 1990s alcohol‐frenzied leisure may have run their course. Possible reasons for both the 1990s increase and the 2000s levelling‐off are explored, including shifts in reporting patterns and tastes, interventions to address underage drinking and binge drinking, alongside broader legislative, socio‐economic and cultural changes in the drinks industry, the night time economy and the regulation and policing of public space.

In this fourth paper in a series on emergent drug trends in the UK (2006 ketamine, 2009 MDMA powder/crystal, 2010 mephedrone), the authors consider how the pharmacological landscape has changed since substituted cathinones (including mephedrone) were controlled in April 2010 and in particular assess the prevalence of mephedrone in the general night time economy (NTE) and its relationship to the use of established illegal drugs.

Surveys were conducted with a convenience sample of 207 adults stopped at random in four town and city centres on Friday nights in Lancashire in November 2010.

Of the adults surveyed, one in ten reported having taken mephedrone within the past year and one in 20 within the past month. Those who used mephedrone were also significantly more likely to report using ecstasy pills, cocaine and amphetamines. Regarding the next generation of “legal highs”, no clear substitute for mephedrone had emerged; instead, there was uncertainty, confusion and a degree of disinterest. In this vacuum, “Bubble” has emerged and evolved as a generic term in the north west of England to refer to any unidentified white powders which are synthetic stimulants.

Despite an emotional investment by advocates and opponents alike in mephedrone being an ecstasy‐type substitute, research now points towards more amphetamine‐type characteristics at a time when national prevalence of amphetamines is at an historic low. The emergence of unidentified white powders sold as “Bubble” in the North West of England is a graphic illustration of the unknown content, effect and risk of current (by contrast with previous) “legal highs”, and the resultant challenges for health service providers and criminal justice agencies. Bubble may be indicative of the enduring popularity but increasingly indiscriminate use of cheap stimulants.

For this cohort of NTE customers, the paper's analyses indicate that mephedrone was added to existing polydrug repertoires, rather than significantly displacing use of established illegal drugs or acting as a gateway for initiation into drug use.