Use Of New Psychoactive Substances Research Articles

New psychoactive substances in Taiwan: The current situation and initiative for rational scheduling.

Use of New Psychoactive Substances (NPS) has posed a global threat to public health and the security of the population. As of December 2019, the NPS items identified in total have outnumbered by three to one the controlled substances listed in the 1961 and 1971 UN Drug Conventions. However, most of these NPS have not been scheduled by the United Nations because of their easy modification on the chemical structures to shun control. Currently, the scheduling and control of NPS is mostly at the national level and a rational scheduling of NPS by objective assessments is essential but often lacking. To rationally schedule NPS, the NPS misuse situation was firstly estimated with the Taiwanese Substance Misuse Monitoring and Reporting Systems (SMMRS) from 2006 through 2019. Then, the assessment of drug-related harms with an expert Delphi procedure for drug scheduling was performed. The epidemiological analysis revealed that among 37 substances commonly misused in Taiwan, heroin posed the highest risk, followed by (meth)amphetamine and ketamine. Of note, misuse of NPS, such as ketamine, synthetic cannabinoids (JWHs, AM-2201, XJR-11), synthetic cathinones (MDPV, bk-MDMA, 4 –MMCetc.), phenethylamines (PMMA, FMA, 2C–B, 2C-E etc.), piperazines (BZP, TFMPP) and tryptamines (5-MeO-DIPT) has been on the rise. Though perceived drug-related harms differed among experts with different professional backgrounds, the differences were not significant. Four dimensions of drug-related harms– addiction, misuse, social harm and physical harm– integrated from Nutt’s model and scheduling criteria of Taiwan’s Statute for the Prevention and Control of Illicit Drugs (SPCID), were further divided into 11 indicators and applied to assess harms of the 37 substances. Among the 11 indicators that corresponded to the four dimensions, 7 had significant prediction capabilities. Additionally, prevalence of misuse nationally was an important predictor of harm assessment. These indicators of harm assessment of drug misuse can help develop a proper scheduling system for the management of controlled/illicit drugs. In conclusions, drug scheduling is the first step toward proper management of drug use problems. Facing the threats of NPS, it is imperative to implement a rational and effective scheduling system for appropriate management. This study provides a mechanism to scrutinize, and improve, the current evaluation process for NPS scheduling.

New psychoactive substances in several European populations assessed by wastewater-based epidemiology

Wastewater-based epidemiology (WBE) can be a useful tool to face some of the existing challenges in monitoring the use of new psychoactive substances (NPS), as it can provide objective and updated information. This Europe-wide study aimed to verify the suitability of WBE for investigating the use of NPS. Selected NPS were monitored in urban wastewater by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). The main classical illicit drugs were monitored in the same samples to compare their levels with those of NPS. Raw composite wastewater samples were collected in 2016 and 2017 in 14 European countries (22 cities) following best practice sampling protocols. Methcathinone was most frequent (>65% of the cities), followed by mephedrone (>25% of the cities), and only mephedrone, methcathinone and methylone were found in both years. This study depicts the use of NPS in Europe, confirming that it is much lower than the use of classical drugs. WBE proved able to assess the qualitative and quantitative spatial and temporal profiles of NPS use. The results show the changeable nature of the NPS market and the importance of large WBE monitoring campaigns for selected priority NPS. WBE is valuable for complementing epidemiological studies to follow rapidly changing profiles of use of drugs.

New psychoactive substances (NPS) and serotonin syndrome onset: A systematic review

The use of several new psychoactive substances (NPS) has become very popular and is posing global health risks. Chemically and pharmacologically diverse molecules are constantly emerging and are presenting with a wide range of clinical implications. Serotonin toxicity, and specifically Serotonin Syndrome (SS), might develop as a result of an over-activation of the serotoninergic system caused by several mechanisms resulting in a classic triad of altered mental status, neuromuscular effects, and autonomic hyperactivity.In the present systematic review, we have investigated and summarized the available evidence related to the association between SS and NPS intake.Three retrospective studies, two case series and five case reports were included in this systematic review; several NPS were found to be implicated in SS occurrence These include psychedelic phenethylamines, e.g. 2, 5-dimethoxy-4-iodophenethylamine (2C-I); 2-(4-Iodo-2,5-dimethoxyphenyl)- N-I[(2-methyoxyphenyl)methyl]ethanamine (25I-NBOMe); and 5-(2-aminopropyl)indole (5-IT); and synthetic cathinones, e.g. mephedrone; 3,4-methylenedioxypyrovalerone (MDPV); methylone; butylone; NRG3; alpha-methyltryptamine (AMT); methoxphenidine (MXP); and the antidepressant bupropion. Bupropion was here misused at high dosages and/or in combination with other licit/illicit serotonergic drugs. Whilst most substances were ingested orally, nasal insufflation (with both 5-IT and 2C-I) and sublingual administration of blotter paper (with 25I-NBOMe) were reported as well. Interestingly, the psychiatric history was negative for most subjects, apart from two cases.Clinicians should be aware of NPS potential risks and the severe consequences of their recreational use, including SS. Also, due to their undetectability in routine and common drug screenings, the diagnostic challenges posed by NPS should not be underestimated during the treatment of such patients.

International snapshot of new psychoactive substance use: Case study of eight countries over the 2019/2020 new year period

There is considerable concern around the use of new psychoactive substances (NPS), but still little is known about how much they are really consumed. Analysis by forensics laboratories of seized drugs and post-mortem samples as well as hospital emergency rooms are the first line of identifying both ‘new’ NPS and those that are most dangerous to the community. However, NPS are not necessarily all seized by law enforcement agencies and only substances that contribute to fatalities or serious afflictions are recorded in post-mortem and emergency room samples. To gain a better insight into which NPS are most prevalent within a community, complementary data sources are required. In this work, influent wastewater was analysed from 14 sites in eight countries for a variety of NPS. All samples were collected over the 2019/2020 New Year period, a time which is characterized by celebrations and parties and therefore a time when more NPS may be consumed. Samples were extracted in the country of origin following a validated protocol and shipped to Australia for final analysis using two different mass spectrometric strategies. In total, more than 200 were monitored of which 16 substances were found, with geographical differences seen. This case study is the most comprehensive wastewater analysis study ever carried out for the identification of NPS and provides a starting point for future, ongoing monitoring of these substances.

Can NMR spectroscopy discriminate between NPS amphetamines and cathinones? An evaluation by in silico studies and chemometrics

The use of new psychoactive substances (NPS) has become a problem that affects many countries. Because new chemical structures appear frequently and reliable reference data do not always exist, identifying these compounds is an operational problem. Theoretical chemistry associated with statistical methods has scarcely been used to tackle such problems and can provide an unvaluable aid. In this study, we have employed quantum chemistry tools to simulate NMR spectra and to evaluate, as a paradigm, the main differences between amphetamines and cathinones. We have generated and examined the 1H and 13C chemical shifts of 21 homologous amphetamine and cathinone structures. In our computational approach, we used a test set and a proof set to generate the shifted factors on the basis of experimental observations. We employed three different DFTs (B3LYP, M062X, and PBE0) with a TZVP basis set and different solvents (water, ethanol, chloroform, and gas-phase). To evaluate the data, we applied statistical approaches, which allowed us to assess the methods and to distinguish between the studied NPS. This study provided reliable information that helps to explain how NMR evaluation differs in assessing these molecules and promoting their discrimination in forensic analysis.

New psychoactive substances in Eurasia: a qualitative study of people who use drugs and harm reduction services in six countries

BackgroundThis study examines the use of new psychoactive substances (NPS) and the harm reduction response in six Eurasian countries: Belarus, Moldova, Serbia, Kazakhstan, Kyrgyzstan, and Georgia. The aim is to identify current patterns of NPS use and related harms in each country through recording the perspectives and lived experience of people who use drugs and people who provide harm reduction services in order to inform the harm reduction response.MethodologyThe study involved desk-based research and semi-structured interviews/focus groups with 124 people who use drugs and 55 health and harm reduction service providers across the six countries.ResultsPeople who use drugs in all countries were aware of NPS, primarily synthetic cathinones and synthetic cannabinoids. NPS users generally reflected two groups: those with no prior history of illicit drug use (typically younger people) and those who used NPS on an occasional or regular basis due to the lack of availability of their preferred drug (primarily opiates). In many cases, these respondents reported they would not use NPS if traditional opiates were available. Common factors for choosing NPS included cost and accessibility. Respondents in most countries described NPS markets that use the DarkNet and social media for communication, secretive methods of payment and hidden collection points. A recurring theme was the role of punitive drug policies in driving NPS use and related harms. Respondents in all countries agreed that current harm reduction services were important but needed to be enhanced and expanded in the context of NPS.ConclusionsThe study identified patterns and drivers of NPS use, risk behaviours and drug-related harms. It identified gaps in the current harm reduction response, particularly the needs of non-injectors and overdose response, as well as the harmful effects of punitive drug policies. These findings may inform and improve current harm reduction services to meet the needs of people who use NPS.

The psychoactive aminoalkylbenzofuran derivatives, 5-APB and 6-APB, mimic the effects of 3,4-methylenedioxyamphetamine (MDA) on monoamine transmission in male rats.

The nonmedical use of new psychoactive substances (NPS) is a worldwide public health concern. The so-called "benzofury" compounds, 5-(2-aminopropyl)benzofuran (5-APB) and 6-(2-aminopropyl)benzofuran (6-APB), are NPS with stimulant-like properties in human users. These substances are known to interact with monoamine transporters and 5-HT receptors in transfected cells, but less is known about their effects in animal models. Here, we used in vitro monoamine transporter assays in rat brain synaptosomes to characterize the effects of 5-APB and 6-APB, together with their N-methyl derivatives 5-MAPB and 6-MAPB, in comparison with 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxymethamphetamine (MDMA). In vivo neurochemical and behavioral effects of 5-APB (0.3 and 1.0mg/kg, i.v.) and 6-APB (0.3 and 1.0mg/kg, i.v.) were assessed in comparison with MDA (1.0 and 3.0mg/kg, i.v.) using microdialysis sampling in the nucleus accumbens of conscious male rats. All four benzofuran derivatives were substrate-type releasers at dopamine transporters (DAT), norepinephrine transporters (NET), and serotonin transporters (SERT) with nanomolar potencies, similar to the profile of effects produced by MDA and MDMA. However, the benzofurans were at least threefold more potent than MDA and MDMA at evoking transporter-mediated release. Like MDA, both benzofurans induced dose-related elevations in extracellular dopamine and serotonin in the brain, but benzofurans were more potent than MDA. The benzofuran derivatives also induced profound behavioral activation characterized by forward locomotion which lasted for at least 2h post-injection. Overall, benzofurans are more potent than MDA in vitro and in vivo, producing sustained stimulant-like effects in rats. These data suggest that benzofuran-type compounds may have abuse liability and could pose risks for adverse effects, especially if used in conjunction with abused drugs or medications which enhance monoamine transmission in the brain.

Prevalence of Strox Smoking Among University Students in Cairo, Egypt

Background: In Egypt, the prevalence rate of New Psychoactive Substances (NPSs) use is severely underestimated. In the last 5 years, several non-scientific reports have demonstrated the presence of an emergent, cheap NPSs that has taken the name of “Strox” or “Egyptian Spice”. The objective of this study was to estimate the prevalence rate of Strox smoking among undergraduate students attending Ain Shams University (ASU), Cairo (Egypt). Methods: A cross-sectional study was conducted in five non-medical colleges of ASU, namely, Law, Commerce, Computer Science, Engineering, and Literature. Participants were recruited using a convenient sampling method and were asked about NPSs use. Data were collected using the Marijuana Smoking History Questionnaire (MSHQ) developed by Bonn-Miller and Zvolensky (2009). The questionnaire was translated and modified to reflect Egyptian slang and culture. Results: This study included 558 students, 422 (75.6%) males and 136 (24.4%) females. The results showed that 189 (33.9%) were current tobacco smokers, 51 (9.1%) were smokers of substances other than tobacco, 45 (8.1%) were cannabis smokers, 38 (6.8%) were Strox smokers, and 3 (0.5%) were Voodoo smokers. When students were asked about their reasons for smoking Strox, they cited the following motivations: to achieve a feeling of euphoria(28.9%), depression (23.7%), experimentation (23.7%), peer pressure (21.1%), and having excess money (2.6%). The results showed a clear association between tobacco and cannabis smoking and consumption of Strox. Conclusion: Although the prevalence rates of NPSs usage as observed in this study were not high, higher rates could be expected in other communities outside of the university. Community-based studies are needed to estimate the magnitude of NPSs use in Egypt and the associated risk factors.

25C-NBF, a new psychoactive substance, has addictive and neurotoxic potential in rodents.

The use of new psychoactive substances (NPSs) as a substitute for illegal drugs is increasing rapidly and is a serious threat to public health. 25C-NBF is a newly synthesized phenethylamine-type NPS that acts as a 5-hydroxyindoleacetic acid (5-HT) receptor agonist, but little is known about its pharmacological effects. Considering that NPSs have caused unexpected harmful effects leading to emergency and even death, scientific confirmation of the potential adverse effects of 25C-NBF is essential. In the present study, we investigated whether 25C-NBF has addictive and neurotoxic potential and causes neurochemical changes. In addictive potential assessments, high conditioned place preference (CPP) scores and stable self-administration (SA) were observed in the 25C-NBF groups (CPP [3mg kg-1]; SA [0.01, 0.03, 0.1mg kg-1]), suggesting the addictive liability of 25C-NBF. In neurotoxic potential assessments, 25C-NBF treatment (single super-high dose [1 × 15, 30, 40mg kg-1]; repeated high dose [4 × 8, 15, 30mg kg-1]) resulted in reduced motor activity (open field test), abnormal motor coordination (rota-rod test) and impaired recognition memory (novel object recognition test), suggesting that 25C-NBF is neurotoxic leading to motor impairment and memory deficits. Subsequently, immunohistochemistry showed that 25C-NBF treatment decreased tyrosine hydroxylase (TH) expression and increased ionized calcium-binding adapter molecule 1 (Iba-1) expression in the striatum. Taken together, our results clearly demonstrate the dangers of recreational use of 25C-NBF, and we suggest that people stop using 25C-NBF and other NPSs whose pharmacological effects are not precisely known.

Identification of New Psychoactive Substances in Seized material Using UHPLC-QTOF-MS and An Online Mass Spectral Database.

The unpredictable pharmacological and toxicological effects associated with the recreational use of new psychoactive substances (NPS) represent a threat to the public health. Analysts are constantly facing a challenge to identify these designer drugs. In this article, five seized samples were submitted for analysis using ultra-high-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS). To tentatively identify the NPS in the samples, the potential usage of an online mass spectral database (HighResNPS.com) was explored by searching the exact mass of the precursor ion and evaluating the fragmentation profile. This approach successfully identified a suspected candidate compound present in three of the five samples. However, conclusive identification of the remaining two was not possible, due to indistinguishable fragmentation profiles of positional isomers. Therefore, complementary analytical methodologies are of paramount importance. In light of the above, HighResNPS.com is a useful tool in presumptively identifying an NPS without a reference standard.

Use of new psychoactive substances to mimic prescription drugs: The trend in France

Among the expanding world of New Psychoactive Substances (NPS), Designer Medicines (DM) are designed to mimic psychoactive drugs and might lead to adverse events of various severity. The DM category includes designer benzodiazepines (DB), phenmetrazine, modafinil, methylphenidate analogs, and novel synthetic opioids (NSO).To investigate DM-related complications in France, all data on NPS collected in the French Addictovigilance network database through spontaneous reports (SRs) and the annual survey on deaths related to the abuse of licit and illicit psychoactive substances (DRAMES survey) between 2009 and 2017 were analyzed. From 2009–2017, about 800 cases of NPS-related abuse or somatic complications were reported to the French Addictovigilance Network, including 71 fatal cases (9%). DM use progressively increased over the years, particularly after 2013 (4% of all SRs on NPS in 2011 versus 14 % in 2017). Moreover, DM were implicated in 17 % of NPS-related deaths in France, just after cathinones (43 %) and dissociative drugs (22 %). NSO, DB and phenidate analogs were identified in 42 %, 25 % and 25 % of all DM-related death reports, respectively.DM seem to interest a new target group of users that includes mainly patients and healthy people rather than substance users. The availability on the Internet of compounds mimicking therapeutic drugs is a worrying phenomenon that could lead to their uncontrolled use.

Development, validation and evaluation of a quantitative method for the analysis of twenty-four new psychoactive substances in oral fluid by LC–MS/MS

The use of new psychoactive substances (NPS) has been recognized worldwide at an alarming rate. Oral fluid collection is becoming more prevalent as a matrix for evaluating drug consumption. In this study, a specific, quick and non-invasive method for detection and quantitation of twenty-four synthetic cannabinoids and cathinone derivatives, including ten not previously reported NPS in oral fluid was performed. A quantitative method was developed on a liquid chromatography coupled to a triple quadrupole mass spectrometer system operated in dynamic multiple reaction monitoring (dMRM) mode using solid phase extraction (SPE) as pre-concentration step. Analytical separation of the target drugs was reached in a total elution time of 10 min. The developed method was validated according to the ASB standard 036. Overall bias and precision of the method were within ±20% for twenty-three compounds. All drugs showed acceptable linearity with R2 values greater than 0.98, and LLOQ values of 0.25 ng/mL and 1.0 ng/mL for selected NPS. The overall bias for a performed blind verification study was 7%. Our results demonstrate the method is suitable for quantifying NPS in oral fluid through solid phase extraction and analysis using LC–MS/MS.

How to ask about the use of new psychoactive substances to increase the validity of results in self-report prevalence surveys.

New psychoactive substances (NPS) represent hundreds of novel compounds. However, the general public might not be familiar with the overarching term NPS. This can result in both under- and over-reporting of NPS use. The study analysed the last-year prevalence of NPS use in an online survey conducted across I-TREND project countries (the Czech Republic, the Netherlands and Poland). Self-reported NPS use was assessed within two types of questions-a generic and a checklist question. We analysed prevalence for each question separately, incorporated the free-text probe 'other' that followed them, and combined the two questions into a conservative and an inclusive estimate. Including free-text responses to the 'other' categories increased prevalence of NPS use (from 51% to 56% for the checklist question and 25% to 32% for the generic question). Taking an inclusive approach to estimating prevalence (i.e. indicating NPS use in either a generic list or from the checklist) yielded a higher prevalence estimate (60%, 95% confidence interval 58-62%), compared to a more conservative approach in which NPS use had to be affirmed by both questions (27%, 95% confidence interval 26-29%). Generic questions might lead to notably lower estimates of self-reported NPS use in comparison to checklists. However, creating relevant checklists is challenging and lengthy survey instruments have limitations. Further surveys might benefit from featuring a combination of the strategies used in this study-a single (generic) question involving a number of locally specific NPSs and a free-text 'other' probe.

Effect of the UK Psychoactive Substances Act 2016 on episodes of toxicity related to new psychoactive substances as reported to the National Poisons Information Service. A time series analysis

Background: There have been recent increases in use of new psychoactive substances (NPS) associated with acute health harms including hospital presentations due to toxicity and increasing numbers of deaths. In response, the UK Government enacted generic legislation on 26th May 2016 (the Psychoactive Substances Act) making it an offence to produce, possess with intent to supply, supply, import or export, or possess within a custodial setting a psychoactive substance. We studied the impact of this Act on monthly frequency of enquiries made by health professionals to the UK National Poisons Information Service (NPIS) about NPS. We also studied five commonly used ‘conventional’ drugs of misuse that had been controlled prior to January 2009.Method: Anonymised clinical enquiries to the NPIS and accesses to the poisons information database TOXBASE were reviewed retrospectively from January 2009 to December 2018 to ascertain the trends in reported toxicity for NPS, cocaine, heroin, cannabis, amphetamines and MDMA. Data were analysed using interrupted time series analysis with the date of the PSA used as an independent predictor.Results: Over the period of study there were 3,866 NPIS telephone enquiries and 79,271 TOXBASE user accesses made by UK health professionals concerning NPS. There were increases in monthly TOXBASE accesses (t = 7.408, P < 0.0001) and telephone enquiries (t = 4.74, P < 0.001) over the pre-specified period January 2009 to May 2016. Comparing the period after the PSA with that before, there were significant reductions in TOXBASE accesses (t = −3.327, P < 0.001) and telephone enquiries (t = −6.97, P < 0.001), although reductions started before May 2016. There were no significant changes for the five conventional drugs. There were significant reductions in telephone enquiries (t = −3.418, P < 0.001) and non-significant reductions in TOXBASE accesses (t = −1.713, P = 0.089) for NPS between June 2016 and December 2018. Increases in telephone enquiries for cocaine and reductions TOXBASE accesses for MDMA were also observed over that period.Conclusions: There have been significant recent reductions in NPIS enquiry activity relating to NPS; although these began before enactment of the PSA in May 2016.

Forensic-psychiatric relationships in the context of forensic medical examination of new psychoactive substance-related deaths.

The aim of this study was to find causal relationships between the use of new psychoactive substances (NPS), the so-called "legal highs", and the cause of death, taking into account information indicating the victim's mental disorders before death. The research material includes the results of toxicological analyses of blood samples collected during autopsies of 40 deceased persons whose cause of death was associated with the ingestion of new psychoactive substances (NPS). The blood samples were subjected to solid phase extraction (SPE), and then analyzed by liquid chromatography coupled with electrospray ionization tandem mass spectrometry(LC-ESI-MS-MS) for quantification. Information on individual cases was taken from case files provided by the prosecutor's office for research purposes. As aresult of the analyses, 24 types of NPS were detected, comprising synthetic cathinones - 15 cases, synthetic cannabinoids - 10 cases, synthetic opioids - 13 cases, other - 2 cases. In the study group there were 5 women (12.5%) and 35 men (87.5%). Suicide was demonstrated in 10 cases (25%), while the remaining 30 cases (75%) were accidental deaths, including those in which the actual motivation of drug use could not be determined. Drugs used to treat mental disorders were detected in 6 cases, while analgesics were demonstrated in 5 cases. In the majority of cases, including suicides and accidental deaths where the manner of death was unknown, NPS use and consequent death from various causes are associated with psychiatric disorders.

A Sociohistorical Overview of Harm Reduction Development in Croatia

Harm reduction is viewed as a public health aspect of drug policy in Croatia. The development of needle exchange programs and opioid substitution therapies are discussed herein by sketching the basic contours of the Croatian social and cultural context in which these activities have taken place over the past several decades. Along with the critical reflection of the approaches in which drug use in Croatia is considered in the matrix of anomie and disorganization explanations, two phases were identified in the development of harm reduction programs. The first phase marked the initial establishment of these programs in the context of strong growth in the number of heroin users in the 1990s, while the second phase allowed for the further development of these programs during the 2000s. It has been shown that, in contrast to anomie and social disorganization related approaches, the economic and political development trends of Croatian society are not clearly unambiguous in relation to the development of harm reduction programs, thus indicating that consideration of harm reduction development is more appropriate to link to the decentralization of related activities and the incorporation of these programs into intravenous drug use population's social insurance. In this way, immediate and non-patronizing access to the intravenous drug use population throughout Croatia is enabled. However, although embedded in the prohibitionist government's drug policy, the current implementation of the harm reduction programs in Croatia is still characterized by the unpredictability of official drug policy action as well as the general changes in drug use, with problems associated with the use of new psychoactive substances representing the greatest challenge.

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year.

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN) is a national network of academic emergency departments (ED), analytical toxicologists and pharmacologists that collects clinical data paired with biological samples to identify and improve treatments of medical conditions arising from use of new psychoactive substances (NPS). The aim of this study was to gather clinical data with paired drug identification from NPS users who presented to EDs within PSCAN during its first year (2016-17). Observational study involving patient records and biological samples. Seven academic emergency medical centers across the United States. ED patients (n=127) >8years of age with possible NPS use who were identified and enrolled in PSCAN by clinical providers or research personnel. Clinical signs, symptoms and treatments were abstracted from the patients' health records. Biological samples were collected from leftover urine, serum and whole blood. Biological and drug samples, when available, were tested for drugs and drug metabolites via liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). Patients in whom synthetic opioids were detected (n=9) showed higher rates of intubation (four of nine), impaired mental status (four of nine) and respiratory acidosis (five of nine) compared with the rest of the cohort (nine of 118, P-value <0.05). Patients in whom synthetic cannabinoid (SC) were found (n=27) had lower median diastolic blood pressures (70.5versus 77mmHg, P=0.046) compared with the rest of the cohort. In 64 cases of single drug ingestion, benzodiazepines were administered in 25 cases and considered effective by the treating physician in 21 (84%) cases. During its first year of operation, the Psychoactive Surveillance Consortium and Analysis Network captured clinical data on new classes of drugs paired with biological samples over a large geographical area in the United States. Synthetic cannabinoids were the most common new psychoactive drug identified. Synthetic opioids were associated with a high rate of intubation and respiratory acidosis.

Patterns of use of new psychoactive substances and perceived benefits and negative effects: results of online survey in Georgia (country)

ABSTRACTIntroduction: The increasing use of new psychoactive substances (NPS) represents a growing public health challenge. This is the first study in Georgia that aims to explore the characteristics of NPS users, patterns of use, and perception of health risks.Methods: We conducted an online survey in which individuals who have used NPS during the past 12 months filled in a structured questionnaire that covered socio-demographics, drug use practices, and perception of effects of NPS use.Results: The final database consisted of 353 questionnaires. Cannabis-, MDMA- and LSD-type NPS were most often used substances. Majority obtained NPS from friends and used NPS in a group of friends. Majority of the respondents did not attribute any physical and mental health problems to NPS use. A range of negative effects was reported.Discussion: Respondents identified a range of negative and positive health and social effects and linked them to the consumption of a particular NPS. Results of this research are important for guiding future efforts to assess health risks associated with NPS use, and to propose harm reduction strategies to mitigate those risks.

Producing the ‘problem’ of new psychoactive substances (NPS) in English prisons

BackgroundThere has been a significant change in the types of substances consumed within English prison settings in the last eight years. There have been particular concerns regarding the acceleration in the use and availability of New Psychoactive Substances (NPS), mainly synthetic cannabinoids. Although NPS were identified as a ‘problem’ in prisons in 2011, government responses emerged only in 2015. As yet, there is no overarching policy document or strategy for dealing with NPS. This paper analyses the various strands of the response to NPS in prisons published from January 2015 to December 2016. MethodsDrawing on Bacchi’s ‘What’s the problem represented to be’ framework, the ways in which the NPS ‘problem’ in prisons has been represented is analysed through a number of related policy texts including press releases, new legislative and regulatory measures, government documents and training package. ResultsFrom the various measures introduced to deal with the ‘problem’, NPS use is produced primarily as a law, order and control ‘problem’ requiring regulation, penalties and control, rather than a ‘demand problem’ calling for prevention, education, treatment and harm reduction or a ‘regime problem’ demanding greater emphasis and resources for purposeful activities such as education, training and work opportunities. This problematisation of drug use in prisons has a history dating back to the 1995 prison drug strategy and has become entrenched and reproduced within policy development over time. ConclusionThe law, order, and control problematization blames the volatility of the substances and the individual prisoners who use them as key factors contributing to the current prison crisis, rather than as consequences of the wider practices, cultures, contexts, and conditions. Multiple representations of the problem of NPS in prisons are needed in order to address the regime and structural issues which lead those imprisoned to use substances.

Simultaneous determination of new psychoactive substances and illicit drugs in sewage: Potential of micro-liquid chromatography tandem mass spectrometry in wastewater-based epidemiology

Wastewater-based epidemiology (WBE) can give valuable light on the extent and actual use of new psychoactive substances (NPS). In this work, a fully validated methodology for the simultaneous determination of illicit drugs and NPS in wastewater by solid-phase extraction followed by UHPLC-MS/MS has been developed. The small sample volume (5 mL) required for analysis is of high interest, especially when performing large sampling campaigns involving many locations of different geographical origin, as it has been performed in the past. The method was applied to wastewater samples from different European locations and permitted the simultaneous monitoring of conventional drugs and NPS. Cocaine, amphetamine, MDMA, methamphetamine and ketamine were found in all wastewater samples, and several NPS (dipentylone, butylone, mephedrone, methedrone and methylone) were observed in some of the samples monitored. It is noteworthy that dipentylone was detected in wastewater for the very first time. Furthermore, a detailed comparison of micro liquid chromatography (μLC) and UHPLC, both coupled to tandem mass spectrometry, in terms of sensitivity and reproducibility has been made for the first time in the application field of WBE. An average increase factor of 14 (mass normalized data) was observed in sensitivity for μLC-MS/MS. The overall method performance was also compared (un-normalized data), and an average increase sensitivity factor of 4.5 was observed for μLC-MS/MS. However, large deviations in retention time (up to 0.4 min) affected the reproducibility and robustness of the μLC-MS/MS method when it was applied to wastewater analysis. Although in this work μLC-MS/MS was strongly influenced by the amount of matrix loaded in the separation device, its enhanced sensitivity and promotion of green chemistry (faster analysis time and less solvent consumption) allow to expect improved future applications, especially when analytes are present at very low concentrations.