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Official websites use. Share sensitive information only on official, secure websites. Recreational drug use in the nightlife setting carries the risk of many negative consequences, such as violence, injuries, aberrant driving and sexual risk-taking. The aim of this study is to investigate recreational drug use and user characteristics among people visiting licensed premises, for example, nightclubs and bars, by using self-reports and biological markers. Staff of licensed premises will be asked to report drug use observations. Further, by using qualitative data, we will examine the motives, consequences and culture associated with recreational drug use. An additional aim is to compare self-reported drug use with oral fluid test OFT results in order to validate the different measurement methods in this context. On consent, patrons will be asked to anonymously complete a questionnaire, a breath alcohol concentration test and an OFT. Survey data will be analysed by univariate and multivariate statistical methods and the oral fluids will be analysed for a large number of drugs using biochemical methods. Data collection will be repeated on a biannual basis until at least , allowing for examination of trends in recreational drug use. Results will be disseminated in research journals, conferences and the media. Keywords: Nightlife, Blood Alcohol Level, Recreational drug use, Club drugs, licensed premises, oral fluid drug testing. A rich supply of data from a high-risk group in a high-risk setting, including biological measures, self-reports and in-depth qualitative data. Recreational drug use in the nightlife setting is potentially a public health problem that requires targeted interventions. Short-term consequences include increased risk of violence, injuries, aberrant driving and risky sexual behaviour. Alcohol reduces prefrontal cortical activity, which may in turn increase the propensity to experiment with recreational drugs. Licensed premises eg, nightclubs, bars are common environments for young adults to be introduced to recreational drugs and to initiate use under the influence of alcohol. Young adults with a strong propensity to use drugs are likely to actively seek out the nightlife setting. Furthermore, previous surveys have tended to only include self-reported data, which are potentially skewed towards socially desirable responses. Also, the fact that response rates to surveys have been decreasing could challenge the ecological validity of results. Recent advances in the field of drug testing allow for an unobtrusive and efficient collection of oral fluid tests OFT to examine the presence of a range of drugs. This method has significant advantages over self-reporting, where both over-reporting and under-reporting are common. OFT can detect drugs such as cocaine, amphetamines, cannabis and the new psychoactive substances NPS. Some NPS are not yet prohibited by law in several countries. There are relatively few studies which have combined OFT and self-reports of recreational drug use. Some of these studies suggested considerable under-reporting on questionnaires when compared to OFT results. There are also few studies including licensed premises staff. The present study will advance previous studies by investigating recreational drug use in a large pool of different licensed premises, including people participating in the nightlife setting and staff enrolled in Responsible Beverage Service RBS Training. Thus, we will approach the phenomenon by using multiple sources of data, that is, self-reporting, biological and qualitative data, coupled with multiple measurement waves time series. The main aim of our study is to examine recreational drug use and the characteristics of users in the Oslo nightlife setting. We also aim to investigate motives, consequences and the culture surrounding recreational drug use in this setting. An additional aim is to compare self-reported drug use with OFT results in order to test the validity of different methods for measuring recreational drug use in this context. The findings are expected to yield information that will be used to establish adequate community-based interventions in the nightlife setting. During the study, we will obtain four types of data: 1 cross-sectional survey data from patrons outside licensed premises, 2 cross-sectional biological data from patrons outside licensed premises, 3 cross-sectional survey data from staff at licensed premises, and 4 data from individual qualitative in-depth interviews see also figure 1. Data collection 1—3 will be repeated biannually until Cross-sectional data will be collected from a sample of patrons close to the entrance of strategically selected licensed premises. A modified portal survey methodology will be used, where data will be collected once for each participant, instead of twice on entering and exiting licensed premises as was done in previous work. To establish a sample that covers the broad spectrum of the nightlife setting in downtown Oslo, we will obtain a complete list of licensed premises from the municipality administration. The list will be reviewed by an expert group of relevant authorities. Premises that clearly do not match the inclusion criteria will be excluded. Similar approaches have been used to select licensed premises for studies in Europe, 17 19 the USA 20 and Australia. A total of 20 research assistants will conduct the data collection. They will receive training in recruitment and on the study procedures. The assistants will be divided into four groups five people in each group and the data collection will be conducted from to on Fridays and Saturdays. Data collection stations are going to be placed close to the entrance of the selected licensed premises and an imaginary line will mark out a selection zone. As patrons cross the line, a research assistant will approach them and invite them to participate. They will offer patrons an informed consent statement, verbally and in writing. When the person is part of a group, the whole group will be asked to participate. Previous research has found the refusal rate to be high when single people from a group are invited to participate. Once patrons consent to participate in the anonymous study, they will be asked to give a breath alcohol test BAC and then be asked to complete a questionnaire and provide an OFT. Research assistants will help participants to fill out the questionnaire, if requested. We will record the gender and estimated age of persons who decline to participate. The questionnaire will contain a unique serial number for each respondent and the OFT samples will be given a corresponding number. The BAC level measured by a breathalyser will be noted on each individual questionnaire. Since the results from the breathalyser will be instantly available, the participants will be informed about their BAC levels should they request it. Throughout the data collection process, the participants will be able to withdraw from the study. Norwegian municipalities arrange RBS training on a regular basis, where the majority of the participants are staff at licensed premises. Participants will complete the survey during RBS training. The survey will include sections about personal characteristics, participants' observations of drug use at their workplace, participants' drug use and their opinions on drug policy. To establish time series data, we will repeat the survey biannually until using the same methods described above. That is, we will use the same criteria for selecting licensed premises and for recruiting participants. Further, we plan to keep the structure of the questionnaire unchanged, although we may have to slightly adjust the questions if drug use changes. A similar method to recruit participants has been used elsewhere previously. They will receive a letter of confirmation, which will contain the name and contact details of the researcher. The patrons will be informed about the voluntary nature of the interviews, and that they can withdraw their consent and have their data deleted at any point in time. We will obtain written consent for the interviews to be recorded. The recorded interviews will be anonymously transcribed into text. A questionnaire will be based on variables found to be important in previous work. We will also include a dummy drug MOP in order to examine the validity of self-reporting and extent of over-reporting. The respondents will also be questioned about the age of onset for each drug. Further, the questionnaire will include variables such as the past year frequency of alcohol intoxication, the age of first alcohol intoxication experience and frequency of visits to licensed premises. In addition, the questionnaire will include a section to record the participants' BAC level yielded by the breathalyser. The device is composed of a sampling pad made of cotton on a plastic stick. The cotton pad is placed under the tongue for a few minutes to collect saliva. The cotton pad is then transferred to a plastic tube, which contains a buffer with a preservative. The sample will be analysed for a large number of drugs using liquid chromatography with tandem mass spectrometry detection. The list of drugs was based on the types of drugs found in Norway by the customs services as well as updated drug-monitoring information. The final test repertory will be derived from the drugs detected in the pilot study and the drugs from recent seizures by the Norwegian customs services. Before new data collection waves are conducted, the oral fluid screening repertory will be critically reviewed and possibly revised. The repertory will be updated with new drugs based on seizures by police and customs as well as updated expert information about new drugs detected in Norway. Patrons' BAC levels will be measured by using the Lion Alcolmeter , which is a high validity breathalyser. The survey methodology that we will use to collect data from staff at licensed premises has been developed and tested by researchers in Sweden. The survey will include four sections: demographics, respondents' own alcohol and drug use experience, respondents' attitudes towards recreational drug use and observed drug use among guests at licensed premises. Both patron and staff questionnaires will be translated to English and used for respondents without proficiency in Norwegian. A semistructured interview guide will be used to explore central themes regarding attitudes, motivations and experiences related to use of alcohol and recreational drugs, with particular focus on MDMA, ecstasy, cocaine, amphetamine and NPS. The patrons will be encouraged to speak freely, and the semistructured interview guide will ensure that two core topics are covered. The first topic will be motivation for recreational drug use. This component will focus particularly on shared norms, values and beliefs between the individual and their peers ie, cultural factors , which could be relevant to recreational drug use. The second core topic will focus on the positive and negative consequences of recreational drug use. This section includes questions related to perceived consequences of drug use on mental and somatic health, social relationships, and work and educational activities. Univariate analyses will be used to describe recreational drug use and the characteristics of users. Multivariate quantitative approaches, including regression analyses, will be undertaken to assess associations between a wide range of characteristics and drug use. We will use time series analysis to investigate trends in drug use over time. The qualitative data will be analysed using an inductive approach. Some interviews will be coded by two different researchers to ensure that the themes are coded in the same way and to strengthen the validity in the study. The survey and biological markers will be collected anonymously, and written informed consent will be obtained for the semistructured interviews only. The qualitative in-depth interviews will be conducted during the day, and so the participants will most likely not be under the influence of any substance when giving their written consent. Outside the licensed premises, an informed consent statement will be presented verbally and also offered in writing to all participants. Signatures will not be collected in order to maintain confidentiality. Identifying information will not be captured, and so it will not be possible for respondents to withdraw their consent after their data are collected and collated. During the process, however, the respondents will be free to retract their consent and have their response deleted. For the qualitative in-depth interviews, ethical issues will be especially important to consider, as themes may be sensitive. It will be essential to acknowledge how the participants experience the interview situation, and at the end of the interview the researcher will always ask the participant how he or she felt about the interview experience. The participants will be given the option to see a clinical psychologist, free of charge if they wish to do so. There are also situations in the data collection outside the licensed premises that potentially could raise ethical issues. Many of these issues have been raised and discussed in the application for the study to the Regional Committee for Medical and Health Research Ethics. Therefore, it will be important to train the research assistants in how to approach potential respondents and how to deal with plausible situations that can occur. Each station outside the licensed premises will have a team leader, and this person will have a specific responsibility for the security of the research team. The results from the study will be disseminated in highly regarded international peer-reviewed journals, research conferences, reports and to the mass media. Owing to the potentially adverse short-term and long-term effects of drug use in the nightlife setting, it is crucial to obtain more knowledge about recreational drug use and the characteristics of users. Earlier studies in this context have mostly relied on the survey method. This study will investigate the use of recreational drugs in the Oslo nightlife setting using a combination of self-reporting, biological markers and qualitative data. To the best of our knowledge, this is the first study that examines recreational drug use in the nightlife setting using this combination of different data collection methods, and recruiting participants from a large pool of licensed premises with different characteristics. The results may help derive community-based interventions to reduce use and harm. The study design has several strengths including triangulation between data sources and a large sample size reflecting the nightlife setting in central downtown Oslo. Our study will also help to determine the feasibility of using biological samples for future nightlife research. Use of biological samples may reveal more accurate results than self-reported data. The use of qualitative data will allow in-depth investigations of the cultural contexts where drugs are used and also provide important information about motivation and perceived consequences to be incorporated into potential interventions. Possible limitations of this study include the cross-sectional nature of data, which does not allow for conclusions about causality or temporal relations between variables. However, we will mainly use quite stable characteristics eg, demographics linked to the relevant outcomes. The fact that individuals might be intoxicated when they complete the questionnaire warrants cautious interpretation of the data. This limitation is mitigated by the inclusion of biological measures, which will yield objective data about recreational drug use. Further, given the large number of NPS appearing on the illicit market and the rapid changes in availability, it is possible that the oral fluids testing will miss some NPS being used by the participants. As mentioned earlier, the drugs that will be tested for will be determined by the results from the very broad spectrum of drugs used in the pilot test samples and also by the list of drugs being confiscated by police and customs in recent years. The likelihood of overlooking many NPS should be limited, as we would expect that a frequently used drug would be confiscated by the authorities at some point. Also, we will ask the participants to name the new psychoactive drugs they have used. The same procedure will be used in the follow-ups to ensure that the oral fluid samples are examined for the most relevant drugs. This study will be the first to provide data on recreational drug use in the Oslo nightlife setting. It will also identify characteristics among individuals who are more likely to use large amounts of a range of drugs, enabling targeted interventions. If recreational drug use turns out to be substantial, the findings may facilitate collaboration work between the health authorities and the nightlife industry to establish adequate countermeasures. A general tendency in the nightlife context in Oslo and elsewhere has been to implement measures aimed at reducing alcohol consumption, and there has been less focus on recreational drug use. For example, there have been studies involving professionally trained actors to act intoxicated, in order to study the frequency of alcohol service to seemingly intoxicated patrons. KB contributed to the design of the study. TN wrote the study protocol with substantial critical input from all co-authors. All authors read and approved the final version of the manuscript. The Norwegian institute of Public Health funds personell resources related to oral fluid analysis. As a library, NLM provides access to scientific literature. BMJ Open. Find articles by Marit Edland-Gryt. Find articles by Anne Line Bretteville-Jensen. Find articles by Kristin Buvik. Find articles by Johanna Gripenberg. Open in a new tab. Provenance and peer review: Not commissioned; externally peer reviewed. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.