Fentanyl - inflated problem or real threat? Episode 57

Monika Rachtan
Hi, Monika Rachtan. I'd like to welcome you to another episode of 'First Patient'. The internet is flooded with images of people standing in the street and supposedly turning into zombies after taking fentanyl. Is this problem really that important in Poland? This is what I will be discussing today with Artur Malczewski. Hi, good morning.

Artur Malczewski
Good morning, and welcome to you.

Monika Rachtan
Artur is an expert who deals with addictions. Tell me please, do people actually take fentanyl en masse in Poland?

Artur Malczewski
The whole fentanyl problem started with the United States, and we will tell you about the United States in a moment. We see some signals that something is happening in Poland with fentanyl. For now, these are just signals. This does not change the fact that this could change dramatically. In a week, in a fortnight. For now, according to the GIS, we are talking about a few deaths and twenty-something poisonings.

Monika Rachtan
So not hundreds and thousands, as reported in some media?

Artur Malczewski
According to the data we collect every year, in cooperation with the IMCD, an agency of the European Commission, two years ago in Poland there were 290 deaths from drugs, all of them, from different substances. In our country, in fact, stimulants predominate mainly. Nearly half of people are treated with amphetamines or meth. We can talk about them too, because there are very many synthetic cathinones on the market. But actually, let's also look at our neighbours. In Germany, the Czech Republic or Slovakia there is no opioid problem, no fentanyl problem. It's different in the Baltic States, where, yes, in Lithuania the problem is carfentanyl, fentanyl derivatives. And in Latvia and Estonia it's a problem with nitazenes, which are strong opioids from the group of synthetic ones. So this situation is very, very diverse. With fentanyl and its derivatives there is a problem, because a very small dose can already have a psychoactive and lethal effect. One tenth of a gram of carfentanyl is ten thousand street doses. Generally, carfentanyl and various types of fentanyl derivatives come from China.

Artur Malczewski
This has been part of the tension between the Trump administration, and now Biden, and Xi Jinping of China, because it's also no secret that they are going into Mexico as fentanyl or precursors across that border into the States, or directly into the United States.

Monika Rachtan
This problem in the United States is indeed very significant. These people can be seen on the streets there. From what I remember 100,000 deaths a year from just fentanyl. But let us return to our backyard. Let us go back to Poland. We have several deaths documented in Poland. In fact, for the most part, we are unable to determine what the people whose films are shown on the internet have ingested. So should this discussion be cooled down a bit, or is it worth talking about and worth preparing for something that might come? Well, because, as you said, we don't know where we will be in a week, in a fortnight.

Artur Malczewski
Discussion is certainly needed, but it is best to talk without emotion about the current situation and about the steps we can take to face the problem. Because we have different signals about the situation in Poland. Last year there was a very big security of another potent opioid nitazene, which is taking its deadly toll in Latvia and Estonia.

Monika Rachtan
Nitazene security, well that's what it is, as if you could explain to our viewers.

Artur Malczewski
That is, the police detained a person who had more than 12,000 nitazene tablets, that was methonitazene, also a very strong opioid and may even be stronger than fentanyl. It is used in Latvia and Estonia. Estonia in general is quite an interesting country, because it had a very big problem with fentanyl, carfentanil until a few years ago. It had the highest death rates in Europe. There were more than 100 deaths there. That, with a population of a million and a bit, gave the highest rates. They, thanks to the fact that they cut off this fentanyl market and introduced naloxone programmes, or handouts, antidotes for opioid poisoning. In terms of after training, parents now even police officers are on naloxone.

Monika Rachtan
In Poland too?

Artur Malczewski
No, I am talking about Estonia. They, thanks to this programme, in Poland there are only attempts to start such a programme, which would be a very nice idea for opioid overdose problems, and they succeeded in reducing this number of deaths. But nitazene came along which is just as dangerous, even maybe more dangerous. And again they went back to this trend of over a hundred deaths. A colleague of mine from Estonia even wrote such a scientific article a few years ago. What can the United States learn from Estonia, because they went from a hundred deaths there to 10 or 20. With this action of theirs against the fentanyl market and the introduction of naloxone programmes, they have now gone back to that earlier one.

Monika Rachtan
But wait, wait, I will come back to nitazen, because 12 000 tablets were found in Poland. Do we know what market they were supposed to go to? Because yet someone had to be there, someone was in charge, someone owned this illegal factory, so what, what are the police saying.

Artur Malczewski
I am not a police officer.

Monika Rachtan
But you talk to the police.

Artur Malczewski
Discussion. Yesterday I chaired a session where there were representatives from the police. There was a big conference of 200 people for experts on addiction. We talk about this topic all the time. Earlier there was a session about opioids, we exchange experiences. Last week I was in Estonia, where we talked about nitazen, about the situation in the region. Here, for the time being, we are trying to put these puzzles together, because similar tablets, I don't know if the same ones, appeared in Sweden, where a Pole was detained. For now, we do not see that these substances are targeted for our market. But it is also the case that these things are hidden, sometimes we only find out when there are cases of death, for example, that there were these fentanyl patches in Żuromin, because this situation in Żuromin, it was an extraction from painkillers patches, because fentanyl is a very strong painkiller. Oncologically used. Carfentanyl was also used as a weapon. We can also say. The Russian Federation, for example, once used carfentanyl as a war gas. There are a variety of uses for this substance and it can be both from pain patches.

Artur Malczewski
It could be substances from that group of new psychoactive substances, once called legal highs, that have just been coming into Europe, but mainly the United States, Mexico from China. Such a bit of perhaps revenge from the Chinese for the opium wars. Maybe someone who is interested in Chinese history knows about the fact that China was forced to buy opium from the British Empire. And there the rates of use increased. And now the Anglo-Saxon world has been flooded with boosters from China. Just opioids from China a few centuries later. And this drug scene really is highly complicated, because when we talk about opioids, we have all sorts of substances. We have just these synthetic substances like nitazene, like methadone, which is used in treatment, like fentanyl and different kinds of derivatives, like carfentanyls. We have natural substances like morphine, for example, and semi-synthetic ones like heroin. And what further complicates the whole situation in general is that the Taliban who have taken over Afghanistan have restricted the cultivation of medical poppies, which is the poppy from which we can ultimately get heroin. Last week a report was published by the European Monitoring Centre for Drugs and Drug Addiction, and I also presented the Polish version of the report online today. And in this report it is stated directly that there are fears in Europe about what will happen if this heroin comes from Afghanistan, which paradoxically seems like a rather good situation.

Monika Rachtan
But these people don't end their addiction, as if they don't say ok, well it's not there, then I stop taking and I'm clean. It's only at that point that they look for another substitute.

Artur Malczewski
Because it's a bit like a balloon. If you press in one place, it comes out in another place. In Estonia they managed to restrict fentanyl derivatives, then now they have the equally dangerous, or maybe more dangerous nitazene on the market. Here, they won't have this heroin on the market and perhaps opioids are just coming on. These synthetic opiates that are even more, more dangerous, that are even difficult to dose the description of such a user And I just don't know if it was carfentanyl or some other fentanyl that was dosing herself with a pin. It's just that they, they are so strong. It's known that what's on the market is not 90%, just a few percent, even less. Even though it had a high tolerance. Because with the charges it's like, if someone takes longer, they have to take more. She doses herself with a pin, but still overdoses despite a high tolerance. That's why these substances are so dangerous, because if we're talking about marijuana, you can't fatally overdose on it. And here we have a substance that you can also by smoking. It could be that someone some dried plant, fibre hemp or other just soaks a solution with fentanyl. And people will, they will think they are smoking cannabis, and they will be smoking dangerous substances.

Monika Rachtan
But looking, looking at where we are in the geopolitical situation and what is happening in the world in general, it seems to me that such fentanyl can also be a weapon in the hands of other people. Because if you're telling me that it's possible to imbibe dried and, for example, market, say, cigarettes in Poland that will contain fentanyl, then it starts to get a bit dangerous.

Artur Malczewski
We generally live in the 21st century, where we have all sorts of terrorist groups. I have not yet heard of a case of fentanyl being used as a war gas and it would be more of a suicide mission, for example, or soaking cigarettes. But the special services of the Russian Federation many years ago was more than enough. There was a situation where a Chechen commando occupied a theatre in Moscow and the special services took hostages by just lighting it on fire. It was some kind of fentanyl derivative most likely. That's what the experts say.

Monika Rachtan
So my scenario is not so science fiction.

Artur Malczewski
And they killed all these terrorists. Unfortunately there was a tragedy too, because some of the audience, some of the people in the audience died, but they used it as a gas, as a battle gas. Of course, they went in with the proper suits. Anyway, the police in Poland when they go in to secure laboratories, and these laboratories are not few at all, because two years ago there were 60 laboratories secured illegally in our country. It is properly equipped with masks, because you never know what will be there. There was one fentanyl laboratory detected in Europe last year, but I don't remember in which country, but there was one detected.

Monika Rachtan
When it comes to fentanyl, the discussion is very heated. People are afraid for their children. You know, sometimes it falls into such a ground that people are able to understand it and say ok, well the scale is small, we have one town where this is happening in Poland, whereas we are safe. But there are also people who just get into this fear because of the clickbait titles they read on the internet and they get scared. So tell me, what are the symptoms when it comes to your child? What should catch my attention in the context of just fentanyl? And then we will talk about other psychoactive substances, because I think that in Poland we also have something to talk about in the context of other, different substances.

Artur Malczewski
I mean, in general, when we talk about fentanyl, I am not under the impression that it is the first choice drug. So that it's the case that when someone starts their career, let's call it that, maybe that's the best word for psychoactive substances, they start right away with opioids, it's generally the first substance, which doesn't mean that later on the person will reach for opioids. Well it will be cannabis. Or it will be amphetamines, or synthetic cathinones, other other substances. But we have to ask ourselves. Why do you think young people, why do they turn to psychoactive substances?

Monika Rachtan
You know what, I would answer that it's a lot of pressure from the public their so local. You know, everybody takes, everybody tries. So why don't you try it? It is the peers that are in a particular place though, they just cause it. And what are your conclusions?

Artur Malczewski
But okay, I'll still ask you, maybe we'll swap roles, and I'll remember like a legal psychoactive substance, alcohol what was the first one, how did that come into your life? You don't remember because it was a long time ago.

Monika Rachtan
It's not that long ago. You know, I'm not that old yet, but I think, in most cases, when we talk about young people, it's the environment after all. Because back in my day it was so fashionable to take beer foam from dad and it was like ok, no one accused parents of some kind of pathology, absolutely. Nowadays, on the other hand, parents absolutely won't do something like that in a public place, because they say they'll take my picture, send it to the police and there'll be a problem. But I think, despite everything, peers. But all right.

Artur Malczewski
Peers do, but it is in such a context of, shall we say, fun.

Artur Malczewski
To have a nice time, to loosen up a bit. It's not like we have terrible problems and we're looking for a solution to this problem and these drugs will solve these problems for us. Of course, some people do, but as we used to ask ourselves, it was just new substances, legal highs, there was this online research called iTrend 2014, 2015. What were the reasons for turning to legal highs? New psychoactive substances? You remember. That's not why we had that potent in 2015, 7,000 poisonings this year in July 2015. It was curiosity, an opportunity happened. Yes, they were like that, because there's a lot of initiation, such quite accidental initiation. Just peer pressure. Come on, have a beer, come on, smoke marijuana, Yeah. And one in five young people aged 15, 16 in our country, according to the ESPAD survey, have smoked, had contact with marijuana.

Monika Rachtan
But that doesn't mean that everyone smokes compulsively.

Artur Malczewski
Exactly. And now the question is, what is next? Because if someone has tried it. He has tried it, yes? And if it's all ok in that young person's life, in the environment, in the family, in the school, those are the protective factors. Yes? That is to say, there is something protecting him, that even if he has tried it, will he ever try it again. But the fact that he starts to reach systematically, then he starts to abuse regularly and there are problems related to taking the disorder of this substance. That's the result of something in this young person's life surrounding something that didn't work.

Monika Rachtan
And what is most often not working in these people's lives? What are the factors?

Artur Malczewski
They can be different. He can't cope with stress. For example, he is a very shy person who has trouble making friends. And these stimulants like amphetamine, meth, synthetic cathinones. He then functions very easily in such a peer group. Talkative. This is no secret. We are talking to experts here. Amphetamine helps to learn in small amounts. Someone with overweight problems can slim down with this substance. During the Second World War, pilots of the Luftwaffe and other armies used this substance for combat purposes, because you feel better afterwards. The shyness disappears momentarily and there are cases where people just function better and this person starts taking because he is losing weight, because he needs to lose weight, because he is shy and here he is the king of the party, because he is doing better in school and he is the one who solves a problem for himself. But by him solving for a moment and achieving some goal, then he sees that it can make it easier for him all the time and he gets into such regular ones. And then he can't function without that substance anymore.

Artur Malczewski
Someone has stress problems because there is a lot of pressure? I don't know, at school, in the family, on success, and he sees that he can relax, for example, after marijuana after another substance and he goes into this problematic use, abuse. And it turns out that he can no longer function without this substance and it takes over his life. The life of such an addict is de facto a search for the drug, being after the drug, coming down after the drug and all over again. And a lot of, for example, health damage that these people have. This is not only from the substance itself, but because of the lifestyle they lead.

Monika Rachtan
I mean, what do you have in mind?

Artur Malczewski
They don't eat, they don't take care of themselves. Yes, they lead an unhygienic lifestyle. For example, a person who takes amphetamines hardly eats at all and loses weight. Yes. It's known that this health will start to fail at some point, because we have substances that are dangerous like methadone. It's such a synthetic heroin, but it's a pure substance from the lab and it's for example a drug for people who are addicted even to fentanyl, to heroin. So every day and then once a week the person comes in, they get this drug in a liquid. That way there are no symptoms of physical hunger. This drug is chosen to satisfy the hunger and not to intoxicate. And that person can then function normally, they can get a job, they can get their life in order, their affairs in the family. Yes. And, for example, if we see that there is a problem somewhere with fentanyl, with heroin, with opiods, then maybe opening such a substitution programme will be an offer to these young people to get them out of the clutches of this illegal market, where they do not know what they are taking, where they sometimes have to commit a crime to buy the drug.

Artur Malczewski
Yes? And that could be an idea. It's just that if we see that there's a problem with fentanyl in our town, in our city, somewhere, let's think about what can be done to either open up a programme like that or get those people I don't know, get them to that programme.

Monika Rachtan
But such programmes operate in Poland, for example in a large city such as Warsaw?

Artur Malczewski
5 such programmes are.

Monika Rachtan
And this methadone is then given out for free. What does it look like?

Artur Malczewski
Under insurance, as the person is not insured, even has free of charge. There are more than three thousand patients in Poland. There should be more of these programmes, of course, but it is also the role of the local community to help launch such programmes as we in the local community where we live should meet and talk. We see the problem that young people I don't know, they are just taking this fentanyl or I don't know, smoking marijuana. What can we do as a community? Every municipality has its municipal addiction prevention programme. It has money in cork. There's 2,500 municipalities at the local government level, there's 900 million to address addiction issues.

Monika Rachtan
That is, the money is there, you just have to reach for it and you have to know about it.

Artur Malczewski
Yes, you need to know. And also you just have to think about what the main challenge is. Because maybe it's the case that these young people are not coping because the parents need support, some training, prevention programmes to strengthen their parenting skills. Maybe the school needs help? The climate of the school is also important. It's all quite a complex system that should work together. And we have municipalities where this really works very nicely. Where there are proven prevention programmes, where there is a therapeutic offer, where there is a cannabis problem there are special therapists CANDIS is the kind of project we promote in Germany, which helps people who are addicted to cannabis, because this client who smokes cannabis is a completely different client from fentanyl or opioids. And this is where this system at the local level would need to be built and tried. I know that this is sometimes difficult, but we are talking about the lives of young people, because the end result of the fact that it doesn't work is the death of these, these young people, in general, this tragic situation in Żuromin was a very interesting case, because it was a person who went abroad, who maintained abstinence there, came back, took it. And this is a very dangerous moment, because if.

Monika Rachtan
You think maybe it could have been that she didn't even know what she had taken, that you know it was just someone.

Artur Malczewski
It is difficult to define, because after a period of abstinence. It's when a person comes out of intoxication, out of detoxification or hasn't taken heroin or other opioids for a while, months, a year, it's a very difficult moment, because their tolerance drops. And how they could take half a gram of heroin before, now that half a gram after that detoxification or a period of not taking six months can kill them on the spot. And those are so dangerous. That's why everybody talks about fentanyl, opioids, because it's very easy to overdose. That's why we have these over 100,000 deaths in the United States. And just one of the recommendations was such a pact against synthetic drugs. I was at a meeting in Vienna at the UN, where Blinken flew in and talked about this, there was a coalition in Poland, and there was also a document produced in this coalition, where there is a coalition of countries all over the world to deal with this problem, because listen, you know, these are not simple matters. The United States, the world hegemon.

Monika Rachtan
It cannot cope with such a problem.

Artur Malczewski
Exactly. These are difficult things. And here in these recommendations, for example, what I'd like to say about that, there are programmes of such naloxone distribution.

Monika Rachtan
Is what naloxone?

Artur Malczewski
Naloxone is the de facto antidote. If you were to overdose on opioids here in the studio right now, the first thing I would do is call an ambulance. I once had such a situation in the stairwell that I lived in Jelonki, that a young man overdosed. A needle, a syringe. Such a classic case. I immediately call an ambulance. I also say.

Monika Rachtan
He was lucky to come across you.

Artur Malczewski
Anyone would have called, but I did. I don't even know if I said, but it was obvious they were on naloxone. I said overdose, possibly opioids. I said they should have naloxone on the equipment. It's an antidote, it can be injectable, they're also for nasal. And then with me I think they injected once or twice. And it turned out that they had to take it to hospital anyway. And then I spoke to the lady from the detox in Nowowiejska Street, because I took such surveys there, because she deals with monitoring the problem, and she said that here in this area, where I live, it's a bit of a basin. That was over 10 years ago now.

Monika Rachtan
But what happened to this patient? In fact, they managed to save him.

Artur Malczewski
I think once he got to the hospital, that's how they got him on the trolley. I came out in a polemic because he was not treated very well by that staff. As I say that people are addicted to different substances, so I wanted to explain to him as a person working in this area, but I saw that I didn't know if they treated me, that I was some kind of dealer who also sold to him. I dragged him out of the flat and called him.

Monika Rachtan
And you didn't say what you do for a living.

Artur Malczewski
No, I didn't at all say that I just professionally, mainly in research, monitoring international cooperation, that I've been dealing with this subject for many years, because it wasn't really an issue. And these programmes. And these are the recommendations of this global coalition against synthetic drugs, here it was mainly about fentanyl precisely, to start such programmes. Now NGOs are working on this.

Monika Rachtan
But tell me, this drug, this naloxone I remember so well. Can I buy it for myself?

Artur Malczewski
Well, that's it. And we come to the clue. It's good that you said that, because the idea is because that's what ambulances should have and they have. It's just, you know, sometimes the ambulance goes 5 minutes, sometimes it goes an hour. Right? And the idea is in a dozen countries, for example the Balkans have it, the Germans have it, and also here there is an idea to start such programmes, I mean harm reduction programmes, which work with these non-communicative clients, with these people who take opioids, to train them, their relatives, their parents, to give them handouts. It's just that intranasal, because injections can only be done by a trained worker, a nurse, a nurse practitioner, a doctor, and intranasal anyone after proper training when that person overdoses, give them right away. Because it is the case that they often take it together. And let's imagine this tragic situation in Żuromin, as if there was a loved one there. Who would have been able to give immediately, rather than waiting half an hour, 10 minutes, 5 minutes, one, two, three doses of naloxone. As I said, the police officers even have naloxone with them. This one, the intranasal one. And these are the real ideas of how to measure up to this kind of opioid problem. That is, greater accessibility to treatment, take home naloxone, naloxone distribution programmes, that close friends, family, mum. It's known that they don't want that child to take, but they know that they might break abstinence or still take. That's how they have that naloxone or his friend has it.

Monika Rachtan
You think that we in Poland are ready for such a harm reduction programme. We have, for example, talked about cigarette smoking in Poland many times and harm reduction programmes are proposed there, they are to be launched. And I keep wondering whether our viewers watching our programme will not think, well, people, why should I give someone naloxone? My taxes should be used to buy it if someone takes drugs at their own request. It's the same with alcohol. And, you know, I'm looking at society here, at how people perceive the problems of addiction and whether such a harm reduction programme, which let's not kid ourselves, is certainly very expensive if we have such drugs. Are we as a society ready?

Artur Malczewski
Then let us ask ourselves. If we are able to have empathy and express our emotions because of this tragic situation then maybe we don't just express empathy, emotions, but let's try to do something to turn this situation around. Yes, in our culture, in the Western world, the human life of every human being is of paramount value. And it's like that too, because we live in such a comfort zone, because we have a job, we have a family, but none of us really know the day or the hour when we'll find ourselves getting into some kind of addiction. Maybe it won't be fentanyl, but I don't know, maybe it will be alcohol. Gambling addiction, it's not just for people who say I don't know.

Monika Rachtan
They are from the margins of society.

Artur Malczewski
Exactly, this can happen to anyone. This is the moment when we can get lost in it. Life is an art, to live life with dignity. I'm sorry, it sounds so highfalutin, but it's the truth. And we, and every one of us, whether we were born into a so-called good home or not, whether we have a university education or a primary education, is trying to live this life and every one of us can go astray, it's no secret that the problem of drugs is also a problem of rich people, wealthy kids from good homes, and everyone should have similar access to treatment services and these ideas that are there. Because, of course, it has to be said that addiction issues like alcohol, drugs affect not just that person, but the whole family. Yes, because the young person or the older person there, it doesn't matter which one, is addicted to fentanyl, opioids. He really needs a lot of money to buy it. It comes to theft, I don`t know, there might even be prostitution, there might be violence. In our country, fortunately` this does not exist. But we also talked about it at this conference.

Artur Malczewski
It is also a question of security at the local level. After all, there are juvenile drug gangs in some countries, in South America this is undoubtedly the case or Mexico. After all, Mexico is destabilised by drug gangs, which are just alive.

Monika Rachtan
We in Poland do not have this, so we are not aware of it, and in fact we can look at it in different ways. But the point of view changes when it starts to affect us, someone close to us. Because we could also say in the context of, for example, oncology patients who smoke cigarettes that they shouldn't get this treatment. But on the other hand, if an oncological disease happened to us and someone said something like that to us, we automatically don't want to hear it anymore and we stand on the other side of the barricade. So I think that empathy is worth including and it is worth wanting to help other people.

Artur Malczewski
Because we never know what kind of disease we're going to have, what kind of disease we're going to face. Because addiction is, it's a disease, it is, and it's fair to say it's this man's fault, but maybe he many, many things didn't work, including in this young man's life. Maybe the family didn't give him support, the school he went to. This peer group around is a very complicated mechanism and we, in trying to help build this man's support system, have very many elements to manage. From a well-functioning school, where it is, where proven prevention programmes are in place, not just drug talk, which can be counterproductive and arouse the curiosity of young people, because research shows that those young people who take drugs are very knowledgeable about it. Only we all rationalise it to ourselves. After all, what knowledge do we have about the harmfulness of tobacco, and one in five people in our country maybe even more smoke cigarettes.

Monika Rachtan
This is true.

Artur Malczewski
And why do we think? We adults who smoke cigarettes, I don't smoke. And why do we think that this young person, 16, 17, 15 years old, if we tell him how harmful these drugs are, he will immediately say no, I will never, never take them. Some of them probably do, but some of them, some of them don't. Because it's a more complicated mechanism. Then you would have to think about what doesn't work. E.g. there is a high level of stress in a particular school, because there is a school for results. So it's ok, but the young people are not coping with the stress. Every school should have such a diagnosis and programme. That's when we take professionals. Programmes that teach these young people to deal with stress. Parents have parenting problems, that's when we have programmes to improve the parenting skills of those parents.

Monika Rachtan
This is the ideal world you are talking about, because the Polish school is unfunded. There is a problem, there are no educators in the school. Nobody wants to work there. I really wonder with the kind of working conditions that education in Poland offers today, with how much stress it is. Because people say, there you go to school for four hours, there you have it, but it's very hard work, it's thankless, because these children are different. And it's a perfect world for everything. A programme for everything, training, professionals for everything. It would take many years of work, many years of rebuilding the system. And we have a problem today and now, because we saw what was happening just in 2014, 2015, when legal highs came on the market and people totally didn't know how to even go about it, how to embrace it. There was no idea from any side about the problem.

Artur Malczewski
Of course, I am talking about an ideal model. Yes, and we are constantly trying to get closer to this model and we have various tools, we have a database of recommended programmes, precisely those that have been tested, which have been evaluated and the results of the evaluation have shown that they work, and we encourage local governments, where there is 900 million in the system. Of this, 600 million goes on prevention, to use these programmes, to make a diagnosis beforehand. And there are some local authorities that are coming out with this. In fact, if we would look at the results of the last surveys, they are unfortunately old. Perhaps that will now change. These are the 2019, 2021 international studies. These are positive trends, that these trends that increasing consumption of alcoholic beverages, drugs says about schoolchildren, then immediately you have to take into account that this is the better picture, because those who go to school, well, let's say, because part of the youth.

Monika Rachtan
There is contact with them.

Artur Malczewski
It is with them, the contact. They go to school, they are looked after, then we have these positive trends. Yes, but I'm really full of admiration for the teachers, for the principals, because as you said, it's a very difficult task. There are very high expectations of the school. The school is really supposed to teach, it has this core curriculum, and these educational issues other things are an additional thing. But now there is an idea for a new handbook on prevention. We have thousands of non-governmental organisations that deal with this subject at a local level. There really is quite a large support system in Poland, and when I talk in Europe about the fact that we have 900 million from cork, or from the sale of alcoholic beverages at a local level, people are shocked. I've been to Hungary many years ago, it's in Hungary where people are talking about how to improve the quality of these prevention measures. And in Hungary they have no money.

Monika Rachtan
And how is this money used in Poland, this 900 million zloty a year, is this budget being used at all, or is it just lying around?

Artur Malczewski
It looks like this, it is. Because you remember, you probably remember 99, there was the reform of Prime Minister Buzek, there was decentralisation, that is local governments, there were 16 voivodeships, almost two and a half thousand communes. And now that's how each commune has a programme to solve alcohol problems, counteract drug addiction, behavioural addictions. It has to prepare a programme for several years on the basis of a diagnosis to implement this programme. I am talking all the time about an ideal model, yes I am talking about an ideal model. It is known that there are various deviations. Nowadays, anyone who opens a shop with alcoholic beverages has to pay the relevant sales tax to the town hall, the municipal council. And then this money goes to implement the programme. There are competitions and local NGOs, consultation points, which forward-looking communities apply for this money and implement different kinds of programmes, different kinds of activities. In addition to that, each school has its own programme. And furthermore, our data shows that more than 1,000 municipalities in Poland are implementing these recommended programmes. This is the base that the National Centre for Counteracting Addictions runs. The Centre for the Development of Education is also on the committee there. Anyone who has their prevention programme evaluated can send it for evaluation and get such a certificate. There are a lot of nice programmes going on. There are many enthusiasts, in fact, who are dedicated to this work. This is a huge potential of Poland in general. There are a lot of people at the local level, from local governments, NGOs.

Monika Rachtan
We are a leader in Europe in such activities.

Artur Malczewski
It is that when I talk about this system, many countries envy us. It's just that we in Poland are very fond of complaining. Well, yes, nothing works out in our country. Yes, but somehow this million people from Ukraine or even more, a lot of people are left. They live quite well. I'll give you an example, when I went to school in the 1990s, even before that, I don't think there was anyone from outside Poland in the whole school. Nobody.

Monika Rachtan
At my place too.

Artur Malczewski
In my class, my son's first class. Three people from Ukraine, one from Russia and one from Syria. Out of 25 students 20% These are people from other countries who have additional Polish. And these people came here for various reasons, but, for example, they could have gone to Germany from Ukraine because life is better there, and it turns out that Poland is not the worst country to live in. In fact, the progress that has been made over these 30 years. Of course we have a lot to do. It has been colossal. And it was mainly business, NGOs, e.g. our Polish system is built on NGOs, civil society, counteracting addictions. MONAR runs centres, NGOs, they run prevention activities. And local governments distribute this money. Expenditure is in the area of drugs, mainly on these self-governments are communal Commissions for Solving Alcohol Problems, where there are representatives of the local authority, there is a policeman, a therapist. This system does not look bad. And now we have to think about it.

Monika Rachtan
How to use it well and effectively.

Artur Malczewski
Just for these problems that are coming, that we have these synthetic cathinones. Poland is a record producer I think last year, I think it was 12 tonnes left, there was 3 coma 8 tonnes of the powerful stimulant klefedrone detected in one laboratory. It was one laboratory of 20 tonnes of precursors. Poland, one might even say, is flooded with these synthetic cathinones. These are actually stimulants, something similar to amphetamine, methamphetamine. There is huge production, organised crime groups on a large scale. And here too, unfortunately, we are first in Europe.

Monika Rachtan
Do you mean to say that we have a serious drug problem in Poland?

Artur Malczewski
No, this is not the case. It is quite an interesting thing in general that if we look at this production of synthetic cathinones, we do not yet see that these usage rates have somehow increased very much. That is why we have suspicions that part of this production is going to the West and to Ukraine or to the North, to the Scandinavian countries, because Polish organised crime groups also serve the North - Sweden, Norway. And, for example, those methanitazene tablets were there in some Polish man in Sweden was arrested. So it is not only for our Polish market, there is a lot of it and we do not yet see these indicators. This number of poisonings, if we look at the poisonings last year due to new psychoactive substances, including fentanyl, there were about 300 cases, and in 2015, where we had this strongman, there were over 7,000 and then for three years 4,300. Perhaps things will start to change, so we need to monitor this situation. To be vigilant. It's worth discussing and it's even nice that such a discussion is rolling around, because it forces all of us, local governments, central institutions, ministries, to lean into this, to think together about which direction to go.

Artur Malczewski
Because sometimes you have to poke something to get that offer right, to get it right. But it's not like we have, there's a desert here, nothing happens and we sit back.

Monika Rachtan
And do you think the hype around fentanyl could be some kind of deliberate disinformation activity on the internet? Or is it someone's aim to get the word out about it in Poland just now, so that something else might be going on and it might not be fully noticed?

Artur Malczewski
I will say this, it is difficult for me to comment on this subject because I am not a security expert, but rather a public health expert. Even though I have some information about the drug market, I'm looking from that perspective. But listen, also there is this mechanism that modern websites and in general are geared towards emotions. And unfortunately that's how this market works, which has its pros and cons. The plus side is that now there is a discussion, there is a discussion going on in Poland. Better quality, worse quality, but it doesn't matter. We are discussing what to do, how to react, whether this problem exists or not. The downside is that sometimes these emotions can go a little too far and, for example, sometimes reveal the faces of those people who are under the influence. Drawing conclusions straight away, because sometimes we can draw already, we already have a huge problem because it's like this or like that, but unfortunately that's the reality we live in. Yes, the modern media is based on news and on emotion, on clickbait.

Monika Rachtan
On quick information, on titles.

Artur Malczewski
Well, after all, these titles sometimes have nothing to do with the content.

Monika Rachtan
It's true, it's true. Yes, but it also shows what kind of society we have, that the public wants fast, it scrolls all the time. It needs to be encouraged with something, so that too much of this content in general is clear. Coming back to fentanyl, I think it is worth emphasising here that this discussion is extremely important, that it should take place in Poland, that these regulations, which are now being introduced by the Ministry of Health, concerning medicines, are extremely important. But, finally, I would like to ask you about what parents should pay attention to when it comes to their children, what behaviours should worry them and when and to whom they should turn for help. For help or to a therapist, or to a specialist, or to a doctor? Where to look for that person who can extend a helping hand?

Artur Malczewski
I mean yes, we had such a campaign a long time ago. It was the National Bureau for Drug Addiction, closer together, further away from drugs.

Monika Rachtan
Good slogan.

Artur Malczewski
Yes, because that's really the quintessential thing we should start with, which is to be close with the children, to talk, to observe. When we notice some changes in behaviour, some problems, it doesn't necessarily mean that there are psychoactive substances. But it is already a signal to us that we should make some attempt to resolve the situation, to support this young person. I know that this is very difficult. I myself still have children who are not teenagers and I know a lot. And I also wonder how I will face all these problems. But if there is support, there is love, there is friendship in the family, or it doesn't always have to be the parents, but sometimes a grandparent. The local environment supports each other. That peer group has norms that we don't accept the use of psychoactive substances, then we have a good chance of coming out of it. That if someone tries it, something happens to them, they get drunk, that it's just a snippet on kcpu.gov.co.uk. That is, the National Centre for Addiction Prevention. You will find helplines, addictions, behavioural addictions.

Artur Malczewski
There is a map of support services, counselling centres, inpatient centres. Where you can report. You can call these helplines, talk to a specialist, because sometimes even a conversation like that helps a lot, to find out what you can do next, because really. Police officers last year secured about 150 different drugs, 150 different drugs, with different chemical names. Really the drug market is very, very complicated, but we shouldn't panic either, because de facto I think you have to come out of this maxim that problems are there to be solved, to be tackled and we can call somewhere, read somewhere. There really is a lot, a lot of material that you can engage with. The KCPU website also has a lot of publications aimed at parents, such guides on how to build a relationship with your child, how to talk. And here we don't have to feel helpless at all.

Monika Rachtan
That is, to actually reach out for the aids that are available. I think getting rid of such shame and such intimidation. Because addictions can affect us all. And I think that's the thought that Arthur would like to leave our audience with, that this nervous clicking of these clickbait titles about fentanyl is not a good idea to spend time on, that maybe we should look after our loved ones, our children, more closely after all. Let's talk about what's going on with them and that it's having more effect than clicking. Thank you so much for our conversation today. My guest was Artur Malczewski, an addiction specialist. It was a programme called Patient First. My name is Monika Rachtan. I invite you to subscribe to the channel and thank you for your attention.

Artur Malczewski
Thank you.