Awareness of the Harm of New Psychoactive Substances (NPS) Among Youth Using NPS in Tashkent (Uzbekistan)

People diagnosed with substance use disorder (SUD) might represent a high-risk subpopulation for New Psychoactive Drugs (NPS) consumption, and hair analysis offers a unique perspective to assess drug prevalence in this population. The present study aims to assess the prevalence of NPS and their co-consumption with traditional drugs of abuse (DoA) in individuals diagnosed with SUD. Hair samples from patients under care at the addiction treatment service of Bologna, Italy, for a diagnosed SUD, were collected during 2023 and analyzed by ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS/MS), using a previously validated method. Among the 88 patients included, 95.5% tested positive for at least one substance, of which 88.1% for traditional DoA only, and 11.9% for NPS in addition to DoA. Among the positive samples, patients were found positive for more than two drugs in 67.9% of cases. The combination of DoA and NPS was more frequent in the younger age group (<21-30 years old, compared to 31-70, p = 0.025). Ketamine was detected in 8.0% of all samples, with mean hair levels 49.68 pg/mg (ranging 8.55-81.90 pg/mg) and was frequently accompanied by cocaine (85.7% of cases). Fentanyl was detected in 3.4% of all samples, while, among NPS, buphedrone was the only one detected. Our retrospective study highlights that the consumption of NPS is relatively low compared to other vulnerable or high-risk populations. However, the prevalence of polydrug consumption and the high rate of ketamine-cocaine combination warrant careful monitoring even in this population.

Background Although there is a growing body of literature surrounding new psychoactive substances (NPS), and reasons for general use have been described, there is little understanding as to why certain NPS spread through user populations and become popular. This research used Rogers’ 1962 diffusion of innovations theory (DOI) to help better understand the NPS market and how it is shaped and characterised. Objective The aim of this research was to explore the diffusion of NPS in the UK and why different NPS diffuse and others fail to do so, to identify appropriate public health interventions to reduce harm. Methodology A mixed methods approach was undertaken, which comprised four studies. The first study involved a critical analysis of the appropriateness of Rogers’ DOI to explain the diffusion of NPS. This study was followed by two sets of interviews. The first interview study was conducted with NPS online retailers based in the UK. The second interview study involved interviews with NPS professionals including law enforcement professionals, drug policy organisations and NPS early warning system representatives from the UK, wider Europe, America and Australasia. These findings were analysed using thematic analysis. The final study was an online questionnaire and choice-based conjoint analysis with UK pre-existing recreational drug users aged between 18 and 35. These findings were analysed using Latent Class Analysis. Results The DOI was found to be applicable for the diffusion of an NPS product. However, the theory should be used in application to different individual NPS; NPS should not be classed as a homogenous group of substances and NPS users should not be classed as a homogenous group either. It was found that the theory should be updated in relation to NPS to include the influence of the internet. The key reason for the diffusion of an NPS was found to be the psychopharmacological effects of a product. However, there should also be an acknowledgment of the importance of friendship networks, and increasingly online forums. Even if a product had the desired psychopharmacological effects, if these are not communicated then it is unlikely to diffuse at a fast rate. Conversely, unless a product had the psychopharmacological effects desired by an individual, despite positive feedback from friends and online forums, it would be unlikely to diffuse. The emergence of NPS did not have a transformative effect for all drug-using groups; instead, it affected different user groups in different contexts. Similarly, it is likely that the introduction of the UK Psychoactive Substances Act will not have a transformative effect on the use of NPS by all drug-using groups. Nevertheless, the changes in health and social harms associated with individuals accessing NPS through the underground market or choosing to use traditional illegal drugs should be recognised. Finally, the need to conduct research with a range of stakeholders, to gain a greater understanding of motivations for drug use to assist with future public health interventions, was an important finding of the thesis.

The new drug phenomenon

Target and suspect screening of (new) psychoactive substances in South Korean wastewater by LC-HRMS

We believe that analysing pooled urine samples for recreational drugs used at mass events can provide useful information about trends in drug use. An opportunity arose with the Ultra Europe music festival, which is attended by more than 150,000 people from over 150 countries every year. We analysed 30 pooled urine samples collected from portable chemical toilets located at or close to the Ultra Europe music festival venue in Split, Croatia in 2016–2018 to detect the presence of classic and new psychoactive substances (NPS). Four urine samples collected in 2016 were from a toilet without added chemicals (otherwise used to kill the smell) while the remaining samples were collected from toilets with added chemicals. Samples were qualitatively analysed with gas chromatography-mass spectrometry (GC/MS) using the full-scan mode. Data were compared with the Wiley mass spectral library of designer drugs and our in-house library containing about 1000 compounds and metabolites. We identified forty-six different substances and metabolites, 26 of which were classic substances/metabolites, mostly from the stimulants group, while 20 were NPS. In the NPS group, most of them were phenethylamines and cathinones. The variety of substances was the highest on the first day of the festival regardless of the year, but 2018 showed a significant drop compared to the previous two years. The results of our study revealed a stable trend of classic drug consumption, while NPS trend changed from one year to another.

New psychoactive substances (NPS) on cryptomarket fora: An exploratory study of characteristics of forum activity between NPS buyers and vendors

ABSTRACTBackground: Novel psychoactive substance (NPS) use has emerged as a new trend in the recreational drug market with increasing prevalence and availability rates. Little evidence has focussed on psychologically based cognitive/motivational processes that may increase the likelihood of continuing NPS use leading to habitual behavior patterns/dependence. One such process, highlighted in studies examining a plethora of addictive behaviors, concerns users’ preferential attention (attentional bias) to concern-related stimuli. Methods: The current study assessed whether current NPS users compared to never NPS users showed differential attentional processing of (i) NPS-related words, (ii) NPS positive expectancy words, and (iii) NPS negative expectancy words in a modified Stroop task. Results: For NPS users, only negative expectancies captured increased attention—the semantic nature of the word interfered with the secondary task of color-naming the ink within the Stroop task. In addition, the magnitude of this attentional bias was significantly different from zero (the point of no registered interference). Finally, we found no association between attentional biases for all word types and severity of problems associated with NPS use in NPS users. Conclusions: Among nonproblematic NPS users, expectancy-based cognitions may be characterized by highly accessible negative NPS expectancies that are salient for attentional capture and preoccupation.

Background: There has been an increase in the availability of novel psychoactive substances (NPS) over the last decade. The 2013 US Monitoring the Future study suggested that the perceived risk of NPS use in US students was greater than for classical recreational drugs. This survey was undertaken to determine the perceived risk of NPS in adolescents in UK education.Methods: Questionnaire survey of 917 students (15–18 years) collected the details of whether: (i) they had heard of NPS; (ii) they had taken an NPS; and (iii) their perceived risk of NPS use.Results: Five-hundred and fifty-four (57.9%) had heard of NPS and 75 (8.2%) had previously used an NPS. The mean ± standard deviation perceived risk of using an NPS was 7.32 ± 2.07 (95% CI 7.18–7.46), where 1 is “completely safe” and 10 is “not safe at all”; those who had previously used an NPS had a lower perceived risk [6.11 ± 2.17 (95% CI 5.60–6.62)] compared to those who had not previously used an NPS [7.46 ± 2.00 (95% CI 7.31–7.61) (p < 0.0001)].Discussion: Further work is needed to determine whether the lower perceived risk relates to having previously used NPS or whether those who perceive them as low risk are more likely to use NPS. It is important to determine whether this perceived risk is same across all NPS to inform the development of harm minimisation educational strategies.

A novel approach for the identification of New Psychoactive Substances (NPS) by means of Raman spectroscopy coupled with Principal Components Analysis (PCA) employing the largest dataset of NPS reference materials to date is reported here. Fifty three NPS were selected as a structurally diverse subset from an original dataset of 478 NPS compounds. The Raman spectral profiles were experimentally acquired for all 53 substances, evaluated using a number of pre-processing techniques, and used to generate a PCA model. The optimum model system used a relatively narrow spectral range (1300–1750 cm−1) and accounted for 37% of the variance in the dataset using the first three principal components, despite the large structural diversity inherent in the NPS subset. Nonetheless, structurally similar NPS (i.e., the synthetic cannabinoids FDU-PB-22 & NM-2201) grouped together in the PCA model based on their Raman spectral profiles, while NPS with different chemical scaffolds (i.e., the benzodiazepine flubromazolam and the cathinone α-PBT) were well delineated, occupying markedly different areas of the three-dimensional scores plot. Classification of NPS based on their Raman spectra (i.e., chemical scaffolds) using the PCA model was further investigated. NPS that were present in the initial dataset of 478 NPS but were not part of the selected 53 training set (validation set) were observed to be closely aligned to structurally similar NPS within the generated model system in all cases. Furthermore, NPS that were not present in the original dataset of 478 NPS (test set) were also shown to group as expected in the model (i.e., methamphetamine and N-ethylamphetamine). This indicates that, for the first time, a model system can be applied to potential ‘unknown’ psychoactive substances, which are new to the market and absent from existing chemical libraries, to identify key structural features to make a preliminary classification. Consequently, it is anticipated that this study will be of interest to the broad scientific audience working with large structurally diverse chemical datasets and particularly to law enforcement agencies and associated scientific analytical bodies worldwide investigating the development of novel identification methodologies for psychoactive substances.

An important role of modern forensic and clinical toxicologists is to monitor the adverse events of novel psychoactive substances (NPS). Following a prior review from 2013 to 2016, this critical literature review analyzes and evaluates published case reports for NPS from January 2017 through December 2020. The primary objective of this study is to assist in the assessment and interpretation of these cases as well as provide references for confirmation methods. Chemistry, pharmacology, adverse events and user profiles (e.g., polypharmacy) for NPS are provided including case history, clinical symptoms, autopsy findings and analytical results. Literature reviews were performed in PubMed and Google Scholar for publications using search terms such as NPS specific names, general terms (e.g., ‘designer drugs’ and ‘novel psychoactive substances’), drug classes (e.g., ‘designer stimulants’) and outcome-based terms (e.g., ‘overdose’ and ‘death’). Government and website drug surveillance databases and abstracts published by professional forensic science organizations were also searched. Toxicological data and detailed case information were extracted, tabulated, analyzed and organized by drug category. Case reports included overdose fatalities (378 cases), clinical treatment and hospitalization (771 cases) and driving under the influence of drugs (170 cases) for a total of 1,319 cases providing details of adverse events associated with NPS. Confirmed adverse events with associated toxidromes of more than 60 NPS were reported including synthetic cannabinoid, NPS stimulant, NPS hallucinogen, NPS benzodiazepine and NPS opioid cases. Fifty of these NPS were reported for the first time in January 2017 through December 2020 as compared to the previous 4 years surveyed. This study provides insight and context of case findings described in the literature and in digital government surveillance databases and websites during a recent 4-year period. This review will increase the awareness of adverse events associated with NPS use to better characterize international emerging drug threats.

The Internet has played a major role in the distribution of New Psychoactive Substances (NPS), and crypto markets are increasingly used for the anonymous sale of drugs, including NPS. This study explores the availability of individual NPS and vendors on the crypto markets and considers whether crypto markets are a reliable platform for the sale of NPS. Data was collected from 22 crypto markets that were accessed through the hidden web using the Onion Router (Tor). Data collection took place bimonthly from October 2015 to October 2016 as part of the CASSANDRA (Computer Assisted Solutions for Studying the Availability aNd DistRibution of novel psychoActive substances) project. In seven snapshots over 12 months, 808 unique vendors were found selling 256 unique NPS. The total number of individual NPS and vendors increased across the data collection period (increase of 93.6% and 71.6%, respectively). Only 24% (n = 61) of the total number of NPS and 4% (n = 31) of vendors appeared in every snapshot over the 12 months, whereas 21% (n = 54) of NPS and 45% (n = 365) of vendors only appeared once throughout the data collection. The individual NPS and vendors did not remain the same over the 12 months. However, the availability of NPS and vendors selling NPS grew. NPS consistently available on crypto markets could indicate popular substances.

Prevalence of new psychoactive substances in Northeast Asia from 2007 to 2015

New Zealand has recently attempted to address the underlying drivers of the escalating new psychoactive substances (NPS) ('legal highs') problem by establishing the world's first pre-market approval regulatory regime for NPS. NPS products which can be shown with clinical trial data to pose a 'low risk' of harm will be approved for legal manufacture and sale. This paper critically assesses the new regime, drawing on experience of the pharmaceutical sector and legal BZP market. A number of characteristics of the recreational use of NPS may not be well addressed by standard medical clinical trials, including binge use, polydrug use, use by vulnerable groups and high-risk modes of administration. The overt advertising and covert promotion of approved NPS products on the internet may make them fairly visible to young people. The black market for unapproved NPS may be difficult to suppress given that unapproved NPS will be physically identical to approved NPS. If the legal market for NPS encourages the use of NPS, alcohol and other drugs there may be an increase in drug-related harm. Alternatively, if the legal NPS market reduces the use of more harmful drugs, there may be a considerable public health benefit. The clinical trials required for NPS products should address the characteristics of recreational NPS use. Enforcement resources and technical solutions are required to clearly distinguish legal NPS products. The impact the new NPS regime has on other drug use is a key issue and demands further study.

The use of illicit drugs causes unquestionable societal and economic damage. To implement actions aimed at combating drug abuse, it is necessary to assess illicit drug consumption patterns. The purpose of this paper was to develop, optimize, validate and apply a procedure for determining new psychoactive substances (NPSs) and classic drugs of abuse and their main metabolites in wastewater samples by using solid phase extraction (SPE) and high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS). Moreover, detailed validation of the procedure was conducted. The developed SPE–HPLC-MS/MS procedure (within the sewage-based epidemiology strategy) allowed for the simultaneous, selective, very sensitive, accurate (recoveries ≥ 80.1%) and precise (CV ≤ 8.1%) determination of new and classic psychoactive substances in wastewater samples. This study is characterized by new scientific elements, especially in terms of the freeze-thaw and post-preparative stability of the selected psychoactive substances. This is the first time that NPSs (mephedrone and ketamine), the main metabolites of heroin (6-acetylmorphine, 6-AM) and marijuana (11-nor-9-carboxy-Δ9-tetrahydrocannabinol, THC-COOH) have been detected and monitored in Poland. This study is also the first to corroborate the data available from the EMCDDA and EUROPOL report and indicates that the retail market for cocaine is expanding in Eastern Europe.

Introduction: Novel psychoactive substances (NPS) are rapidly proliferating in the United Kingdom and elsewhere. We lack detailed information on rationales for their use. Methods: Qualitative data from 431 NPS users were collected as part of a 2014 online survey on NPS (n = 468 NPS users, 704 non-NPS users). These 431 users answered some or all of five open-ended questions on favourite NPS and NPS they would not use and rationales for these assessments. Findings: Respondents were asked to identify and describe favourite NPS. The favourite NPS identified (n = 258 respondents) mostly had brand names (148). Favourite NPS was associated with a good buzz/feeling, euphoria, enhancing sociability and relaxation. Ease of availability, cheapness and legality of NPS were cited. Achieving a predictable, safe high was important. Adverse NPS experience, including dependency issues both personally or amongst friends was reported by a majority of the 148 who described NPS that they would definitely not take and why, most of these reported having now ceased NPS use. Negative experiences ran from the mildly unpleasant to the persistent, serious and life threatening. Conclusions: Developing new methods of reaching and working with NPS users need timely knowledge of global and local trends in NPS use and effects. These data are of some assistance in expanding such knowledge.