Use Of New Psychoactive Substances Research Articles

Prevalence of new psychoactive substances and prescription drugs in the Belgian driving under the influence of drugs population.

Driving under the influence of drugs (DUID) is a worldwide problem. Several countries have adopted DUID legislations which prove their deterrent effect and impact on road safety. However, the use of new psychoactive substances (NPS) and prescription drugs is not known, as the applied roadside screening tests have not yet been adapted for these compounds. In this study, 558 blood samples obtained during roadside controls in Belgium (January to August 2015) after a positive Drugwipe 5S® test and 199 oral fluid (OF) samples obtained from negatively screened test pads were analyzed. The NPS positivity rate was 7% in blood, while it reached 11% in OF. NPS detected were: diphenidine, ketamine, 4-fluoroamphetamine, 2-amino-indane, methoxetamine, α-PVP, methiopropamine, a mix of 5-MAPB/5-EAPB, TH-PVP, mephedrone, methedrone, 4-methylethylcathinone, 5-MeO-DALT, 4-Acetoxy-DiPT, AB Fubinaca, FUB-JWH018, JWH020, trifluoromethylphenylpiperazine, and ethylphenidate. Moreover, 17% of blood samples (and 5% of OF) contained an analgesic drug, 10% (0.5%) a benzodiazepine/hypnotic, 5% (2%) an antidepressant, 2% (3%) an antipsychotic, 2% an antiepileptic drug, and 1% methylphenidate. The presence of NPS in the young (and predominately male) DUID population is proven. Furthermore, a high level of poly-drug use including combinations of NPS, licit, and drugs of abuse was observed. Further research concerning the development of on-site NPS detection techniques should be established. Meanwhile, the effects of combined drug use on driving ability and the physical/psychological signs after NPS use should be performed to improve the on-site DUID detection of NPS by police officers, so they can engage in blood sampling for a general unknown screening.

Home Manufacture of Drugs: An Online Investigation and a Toxicological Reality Check of Online Discussions on Drug Chemistry

ABSTRACTEmerging trends in market dynamics and the use of new psychoactive substances are both a public health concern and a complex regulatory issue. One novel area of investigation is the availability of homemade opioids, amphetamines and dissociatives, and the potential fueling of interest in clandestine home manufacture of drugs via the Internet. We illustrate here how online communal folk pharmacology of homemade drugs on drug website forums may actually inform home manufacture practices or contribute to the reduction of harms associated with this practice. Discrepancies between online information around purification and making homemade drugs safer, and the synthesis of the same substances in a proper laboratory environment, exist. Moderation and shutdown of synthesis queries and discussions online are grounded in drug websites adhering to harm-reduction principles by facilitating discussions around purification of homemade drugs only. Drug discussion forums should consider reevaluating their policies on chemistry discussions in aiming to reach people who cannot or will not refrain from cooking their own drugs with credible information that may contribute to reductions in the harms associated with this practice.

Measuring inhibition of monoamine reuptake transporters by new psychoactive substances (NPS) in real-time using a high-throughput, fluorescence-based assay

The prevalence and use of new psychoactive substances (NPS) is increasing and currently over 600 NPS exist. Many illicit drugs and NPS increase brain monoamine levels by inhibition and/or reversal of monoamine reuptake transporters (DAT, NET and SERT). This is often investigated using labor-intensive, radiometric endpoint measurements.We investigated the applicability of a novel and innovative assay that is based on a fluorescent monoamine mimicking substrate. DAT, NET or SERT-expressing human embryonic kidney (HEK293) cells were exposed to common drugs (cocaine, dl-amphetamine or MDMA), NPS (4-fluoroamphetamine, PMMA, α-PVP, 5-APB, 2C-B, 25B-NBOMe, 25I-NBOMe or methoxetamine) or the antidepressant fluoxetine.We demonstrate that this fluorescent microplate reader-based assay detects inhibition of different transporters by various drugs and discriminates between drugs. Most IC50 values were in line with previous results from radiometric assays and within estimated human brain concentrations. However, phenethylamines showed higher IC50 values on hSERT, possibly due to experimental differences.Compared to radiometric assays, this high-throughput fluorescent assay is uncomplicated, can measure at physiological conditions, requires no specific facilities and allows for kinetic measurements, enabling detection of transient effects. This assay is therefore a good alternative for radiometric assays to investigate effects of illicit drugs and NPS on monoamine reuptake transporters.

Assessing self-reported use of new psychoactive substances: The impact of gate questions

ABSTRACTBackground: New psychoactive substances (NPS) continue to emerge; however, few surveys of substance use ask about NPS use. Research is needed to determine how to most effectively query use of NPS and other uncommon drugs.Objective: To determine whether prevalence of self-reported lifetime and past-year use differs depending on whether or not queries about NPS use are preceded by “gate questions.” Gate questions utilize skip-logic, such that only a “yes” response to the use of specific drug class is followed by more extensive queries of drug use in that drug class.Methods: We surveyed 1,048 nightclub and dance festival attendees (42.6% female) entering randomly selected venues in New York City in 2016. Participants were randomized to gate vs. no gate question before each drug category. Analyses focus on eight categories classifying 145 compounds: NBOMe, 2C, DOx, “bath salts” (synthetic cathinones), other stimulants, tryptamines, dissociatives, and non-phenethylamine psychedelics. Participants, however, were asked about specific “bath salts” regardless of their response to the gate question to test reliability. We examined whether prevalence of use of each category differed by gate condition and whether gate effects were moderated by participant demographics.Results: Prevalence of use of DOx, other stimulants, and non-phenethylamine psychedelics was higher without a gate question. Gate effects for other stimulants and non-phenethylamine psychedelics were larger among white participants and those attending parties less frequently. Almost one in ten (9.3%) participants reporting no “bath salt” use via the gate question later reported use of a “bath salt” such as mephedrone, methedrone, or methylone.Conclusion: Omitting gate questions may improve accuracy of data collected via self-report.

Neuropharmacological characterization of the new psychoactive substance methoxetamine

The use of new psychoactive substances (NPS) is steadily increasing. One commonly used NPS is methoxetamine (MXE), a ketamine analogue. Several adverse effects have been reported following MXE exposure, while only limited data are available on its neuropharmacological modes of action.We investigated the effects of MXE and ketamine on several endpoints using multiple in vitro models. These included rat primary cortical cells, human SH-SY5Y cells, human induced pluripotent stem cell (hiPSC)-derived iCell® Neurons, DopaNeurons and astrocyte co-cultures, and human embryonic kidney (HEK293) cells. We investigated effects on several neurotransmitter receptors using single cell intracellular calcium [Ca2+]i imaging, effects on neuronal activity using micro-electrode array (MEA) recordings and effects on human monoamine transporters using a fluorescence-based plate reader assay.In rat primary cortical cells, 10 μM MXE increased the glutamate-evoked increase in [Ca2+]i, whereas 10 μM ketamine was without effect. MXE and ketamine did not affect voltage-gated calcium channels (VGCCs), but inhibited spontaneous neuronal activity (IC50 0.5 μM and 1.2 μM respectively). In human SH-SY5Y cells, 10 μM MXE slightly inhibited the K+- and acetylcholine-evoked increase in [Ca2+]i. In hiPSC-derived iCell®(Dopa)Neurons, only the ATP-evoked increase in [Ca2+]i was slightly reduced. Additionally, MXE inhibited spontaneous neuronal activity (IC50 between 10 and 100 μM). Finally, MXE potently inhibits uptake via monoamine transporters (DAT, NET and SERT), with IC50 values in the low micromolar range (33, 20, 2 μM respectively).Our combined in vitro data provide an urgently needed first insight into the multiple modes of action of MXE. The use of different models and different (neuronal) endpoints can be complementary in pharmacological profiling. Rapid in vitro screening methods as those presented here, could be of utmost importance for gaining a first mechanistic insight to aid the risk assessment of emerging NPS.

Characteristics and correlates of drug use and misuse among university students in Wales: a survey of seven universities

Background: Over the last ten years, there has been a worldwide expansion of research on drug use among university students. However, this trend has been less noticeable in the United Kingdom (UK). The aim of the current study is to add to the existing research base by investigating some of the characteristics and correlates of drug use among university students in the UK.Methods: Seven of the nine universities in Wales collaborated in a national survey of drug use among students during the academic year 2015–2016. The online questionnaire was identical for each university and covered a range of topics including: tobacco and e-cigarette use, traditional drug use, use of new psychoactive substances and illicit use of prescription drugs.Results: All students from seven universities in Wales were individually emailed an online questionnaire. In total 7,855 students returned the questionnaire. The most commonly used drugs, after alcohol and cigarettes, were cannabis, ecstasy, nitrous oxide and powder cocaine. There was significant variation across universities in the prevalence of drug use.Conclusions: Several prevention and treatment programmes have been implemented by universities in the United States (US) to reduce drug use among students. These include university-based education and information programmes, social norm approaches, and brief motivational interventions. Such programmes should be trialled in UK universities to test their effectiveness based on rigorous methods of evaluation.

A 6-year review of new psychoactive substances at the Centre antipoison Grand-Ouest d’Angers: Clinical and biological data

For the last 10 years, recreational use of new psychoactive substances (NPS) with hallucinogenic properties was more and more described either in a context of consumption during a rave-party or at home alone or in small group. A review of 62 cases (56 M, 6 F, 16–46 y) registered from 2011 to 2016 at the French Grand Ouest centre antipoison of Angers is presented. Some of them ( n = 15) presented a severe clinical state (poison severity score, PSS = 3) and only one was a fatal intoxication (PSS = 4). Treatment of acute intoxication was mainly based on supportive care with a quick recovery in less than 48 h. A high number of these cases were documented by plasma (pl) and/or urine analyses using LC-UV, GC-MS and LC-MS 2 . Several powders or other forms bought on the web market by the patients were also analysed. Six amphetamines derivates were detected such as methiopropamine (pl: 50 – 430 μg/L, n = 6) or 5 others (6-APB, 6-APDB, 5-EAPB, 5-MAPB, 2-FA each once). Four 2,5-dimethoxy-derivates of phenylethylamines (2Cs) or of amphetamines (DOs) were detected as 2C-P (pl: < 10–20 μg/L, n = 5), 2C-T-4 (88 μg/L) or 2C-E (only in one urine) and DOC ( n = 5, pl: < 10–18 μg/L). In 24 cases, 12 different cathinones were observed in plasma samples ( n = 8) as MDPV (pl: 10–40 μg/L, n = 4), 3-MMC (pl: 7–300 μg/L, n = 6), 4-MEC (pl: 240 – 890 μg/L, n = 3), mexedrone (pl: 100 and 180 μg/L) and methylone (3130 μg/L in a peripheral post-mortem blood). Others cathinones (4-MMC, α-PVP, 4-chloro-α-PVP, bk-2C-B, MDPP, MPHP, pentedrone) were essentially observed in urine or in powders. Two tryptamine analogs were found as AMT (pl: 440 μg/L in one plasma sample) and 5-MeO-DALT ( n = 5). The 3 ketamine-like compounds ( n = 17) detected in plasma were methoxetamine (pl: 8.6–360 μg/L, n = 12), methoxphenidine (pl: 254–590 μg/L, n = 3) and diphenidine (pl: 20 μg/L, n = 1). Five other miscelleanous drugs were found in 11 cases and 9 different synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA, AKB48, 5F-AKB48, 5FUB-AKB48, 5F-PB22, AM1220, MDMB-CHMICA, UR-144) were found in 7 different patients. For the same period, illicit amphetamines constituted 52 cases with amphetamine or ecstasy intake sometimes combined with NPS. These data were presented to show the increasing use of wide-range NPS in a French region and to provide quantitative data in clinical situations besides the large information on the post-mortem cases available in the literature.

Criminal Innovation and Illicit Global Markets: Transnational Crime in Asia

The scope and form of organized crime in Asia, has been re-vitalized by the immense demand for the recreational use of methamphetamines ('ice'), ecstasy and new psychoactive substances (NPS) by the increasingly wealthy residents of the cities of East Asia and beyond. The scale of the problem has attracted serious attention by several governments. The Peoples Republic of China (PRC), for example, in October 2015 designated alpha-PVPalpha ('flakka' - a NPS) a controlled substance and placed restrictions on the export of a-PVP and another 115 chemical substances used to make synthetic drugs but without any legitimate medical or other use. Action on the suppression of the export of precursor chemicals is essential and India another major source of ephedrine, also needs to act. President Duterte's bloody 'war on drug traffickers' in the Philippines has already cost more lives than Thaskin's controversial war on drugs in Thailand in 2003 may also ultimately serve to consolidate organized crime groups, raise the cost of protection and temporarily displace activities to less hostile locations. This paper briefly reviews the scale and scope of the problem and the main actors engaged in illicit markets in the region. It concludes with comment on the effectiveness of countermeasures.

Temporal trends in drug use in Adelaide, South Australia by wastewater analysis

Analysis of municipal wastewater for drug metabolites can reveal the scale of drug use within communities. An Australian city with a population of 1.2million inhabitants was assessed for 4 stimulants: cocaine, methamphetamine, 3.4-methylenedioxymethamphetamine (MDMA) and amphetamine; 6 opioids: codeine, morphine, heroin, fentanyl, oxycodone and methadone; 11 new psychoactive substances (NPS); benzylpiperazine (BZP), trifluoromethylphenylpiperazine (TFMPP), methcathinone, methylone, mephedrone, methylenedioxypyrovalerone (MDPV), alpha pyrrolidinopentiophenone (alpha-PVP), paramethoxyamphetamine (PMA), 25C-NBOMe, 25B-NBOMe, 25I-NBOMe; and cannabis, for up to four years between December 2011 and December 2015. Temporal trends revealed increasing usage rates of methamphetamine, cocaine, oxycodone, and fentanyl, while decreasing rates of use were observed for MDMA, BZP and methylone. Use of other opioids and cannabis was generally stable across years, while use of new psychoactive substances fluctuated without an apparent direction. Opioids and cannabis were used at a consistent level through the course of the week, while use of stimulants and some NPS increased on the weekend. Seasonal differences in use were observed for MDMA and cannabis (p$_amp_$lt;0.05) where, on average, MDMA use was approximately 90% higher in December than in other months and cannabis use was approximately 45% lower in each February. Residual month-to-month variability measures on trend-free data showed NPS use had higher variability than the stimulants and opioids. Frequent wastewater sampling and analysis over prolonged periods has yielded valuable insights into long-term drug use trends, in some instances revealed important within-year trends, and demonstrated the differing patterns of use of drugs on weekends compared to weekdays.

Neurotoxicity screening of (illicit) drugs using novel methods for analysis of microelectrode array (MEA) recordings

Annual prevalence of the use of common illicit drugs and new psychoactive substances (NPS) is high, despite the often limited knowledge on the health risks of these substances. Recently, cortical cultures grown on multi-well microelectrode arrays (mwMEAs) have been used for neurotoxicity screening of chemicals, pharmaceuticals, and toxins with a high sensitivity and specificity. However, the use of mwMEAs to investigate the effects of illicit drugs on neuronal activity is largely unexplored.We therefore first characterised the cortical cultures using immunocytochemistry and show the presence of astrocytes, glutamatergic and GABAergic neurons. Neuronal activity is concentration-dependently affected following exposure to six neurotransmitters (glutamate, GABA, serotonin, dopamine, acetylcholine and nicotine). Most neurotransmitters inhibit neuronal activity, although glutamate and acetylcholine transiently increase activity at specific concentrations. These transient effects are not detected when activity is determined during the entire 30min exposure window, potentially resulting in false-negative results. As expected, exposure to the GABAA-receptor antagonist bicuculline increases neuronal activity. Exposure to a positive allosteric modulator of the GABAA-receptor (diazepam) or to glutamate receptor antagonists (CNQX and MK-801) reduces neuronal activity. Further, we demonstrate that exposure to common drugs (3,4-methylenedioxymethamphetamine (MDMA) and amphetamine) and NPS (1-(3-chlorophenyl)piperazine (mCPP), 4-fluoroamphetamine (4-FA) and methoxetamine (MXE)) decreases neuronal activity. MXE most potently inhibits neuronal activity with an IC50 of 0.5μM, whereas 4-FA is least potent with an IC50 of 113μM.Our data demonstrate the importance of analysing neuronal activity within different time windows during exposure to prevent false-negative results. We also show that cortical cultures grown on mwMEAs can successfully be applied to investigate the effects of different (illicit) drugs on neuronal activity. Compared to investigating multiple single endpoints for neurotoxicity or neuromodulation, such as receptor activation or calcium channel function, mwMEAs can provide information on integrated aspects of drug-induced neurotoxicity more rapidly. Therefore, this approach could contribute to a faster insight in possible health risks and shorten the regulation process.

The interest in eight new psychoactive substances before and after scheduling

BackgroundIn recent years the recreational use of new psychoactive substances (NPS) has increased. NPS are considered a threat to public health and the main response to this threat is to make the selling and buying of these substances illegal. In Sweden, during the last 5 years, 62 new substances have been classified as narcotics but little is known of the effects of making a particular substance illegal. The aim of this work is to study how legal status influences the interest in NPS in Sweden. MethodsForty-five thousand posts made in a Swedish Internet discussion forum (Flashback Forum) related to eight NPS (MDPV, Methylone, 4-MEC, 4-HO-MET, MXE, 6-APB, AH-7921, and 3-MMC) were used to derive time-dependent measures of interest in these substances. Intervention analyses were used to investigate the effects of legal status on the forum interest. ResultsFor all eight substances the activity on the forum (measured as number of posts per day) showed a drastic decrease around the time of classification. The statistical analysis showed that in seven of eight cases, the drop in activity could be accounted for by the legal status of the substances. ConclusionsThe legal status of the substances was shown to have a substantial effect on the interest in the substances. The novel measure used to trace the interest in particular NPS could be a useful tool to follow trends in substance use in almost real-time.

Characteristics of the use of 3-MMC and other new psychoactive drugs in Slovenia, and the perceived problems experienced by users

BackgroundThe study presents the characteristics of the use of new psychoactive substances (NPS), the perceived problems experienced by users, and the reasons for cessation or cutting down. The research focused mainly on synthetic cathinones and the use of 3-MMC in Slovenia. MethodsIn order to research the characteristics of NPS use, we used a questionnaire which had been developed to determine the characteristics of the use of ATS and cocaine in the context of nightlife and was elaborated in our study on the use of mephedrone. The final non-representative sample included 249 users of NPS from Slovenia, who had completed an on-line survey over a period of 5 months in 2014. Part of the sampling was conducted on the ground and with the help of peer-groups. DrogArt's outreach workers and correspondents visited open public places, clubs, and discotheques to encourage users to participate in the survey. ResultsMost users of NPS in Slovenia have tried NPS from the groups of synthetic cathinones and amphetamines. Most respondents included in the sample (67.9%) have tried 3-MMC, while 43.0% have tried methylone and 37.3% have tried mephedrone (4-MMC). Users attributed greater risks to the use of new drugs and preferred the effects of traditional drugs to those of new drugs. The most frequently reported problems were depression (55.2% of users), concentration difficulties (44.0%), damage to the mucous membrane of the nose and to the throat (39.8%), feelings of fear and anxiety (39.4%), and tingling in the arms or legs (34.4%). The main reasons for cutting down or discontinuing the use of NPS were ‘fear of the health consequences’, ‘actual health consequences’, and ‘growing weary of using’. Among users of NPS, 7% have sought help, while 9.1% have considered doing so. The results also highlight differences between the NPS drug markets in Slovenia and the United Kingdom. ConclusionsIn 2014, the most frequently used NPS in Slovenia were synthetic cathinones such as 3-MMC. Users experienced various problems related to the use of NPS. However, they are familiar with recommendations on harm reduction and want additional information on the harmful effects of the use of NPS. Based on the obtained results, we can develop specific interventions in the area of harm reduction.

Sewage-based epidemiology in monitoring the use of new psychoactive substances: Validation and application of an analytical method using LC-MS/MS.

Sewage-based epidemiology (SBE) employs the analysis of sewage to detect and quantify drug use within a community. While SBE has been applied repeatedly for the estimation of classical illicit drugs, only few studies investigated new psychoactive substances (NPS). These compounds mimic effects of illicit drugs by introducing slight modifications to chemical structures of controlled illicit drugs. We describe the optimization, validation, and application of an analytical method using liquid chromatography coupled to positive electrospray tandem mass spectrometry (LC-ESI-MS/MS) for the determination of seven NPS in sewage: methoxetamine (MXE), butylone, ethylone, methylone, methiopropamine (MPA), 4-methoxymethamphetamine (PMMA), and 4-methoxyamphetamine (PMA). Sample preparation was performed using solid-phase extraction (SPE) with Oasis MCX cartridges. The LC separation was done with a HILIC (150 x 3 mm, 5 µm) column which ensured good resolution of the analytes with a total run time of 19 min. The lower limit of quantification (LLOQ) was between 0.5 and 5 ng/L for all compounds. The method was validated by evaluating the following parameters: sensitivity, selectivity, linearity, accuracy, precision, recoveries and matrix effects. The method was applied on sewage samples collected from sewage treatment plants in Belgium and Switzerland in which all investigated compounds were detected, except MPA and PMA. Furthermore, a consistent presence of MXE has been observed in most of the sewage samples at levels higher than LLOQ.

ART management in children perinatally infected with HIV from mothers who experience behavioural changes in Romania.

IntroductionDuring the recent years the rate of HIV perinatally exposed children in Romania has increased as a consequence of the expanding number of HIV-infected women. These women belong to Romania's long-terms survivors, aged between 20 and 24 years and to the group of new HIV infection cases (20–24 years), acquired through unsafe sexual contact and use of new psychoactive substance (IV).Materials and MethodsWe focused on 396 HIV perinatally exposed children born between 2008 and 2013, under surveillance in National Institute for Infectious Diseases “Prof. Dr. Matei Bals,” Bucharest. Of them, 43 acquired HIV through materno-foetal transmission. Our aim was to observe the characteristics in their evolution under antiretroviral treatment and to emphasize the causes of treatment failure. Children with perinatally acquired HIV infection were followed in a retrospective case series. We assessed maternal characteristics, HIV vertical transmission prophylaxis, timing of diagnosis, immunological and virologic status and features of the evolution under combined antiretroviral therapy (cART).ResultsThe rate of mother-to-child HIV transmission was 10.8% versus the national rate registered in 2013, namely <5%. 16% of mothers belonged to the Romanian 1990s cohort and 84% were recently infected with HIV, through unprotected sexual contact (70%) or use of new psychoactive substances (14%). 51% of mothers were diagnosed postnatally as a consequence of their reluctance to access specific health services and in 57% CD4 value was <350 cell/mm. 41% of the monitored children were diagnosed with HIV infection at birth. Their median entry CD4 value was 23% and 49% had a CD4 >25%; median entry viral load was 7 log. 16 patients (37%) had undetectable viral load after six months of treatment. In 87.5% of them the virologic suppression was achieved and maintained with one single regimen (2 NRTIs+1 NNRTI or 2 NRTIs+1 PI/r). 15 children (35%) did not achieve suppression of viral load. 19 children (44%) faced special issues related to adherence to antiretroviral treatment, due to mothers’ poor adherence to a basic set of cares destined for their children.ConclusionsPrevention programmes in Romania must be designed on the basis of the new economic context and emerging psychoactive substance use. Hence, women who use drugs should benefit from a wider access to medical and social services.

MT-45: A new, dangerous legal high

Epidemiological data confirm that the use of new psychoactive substances is on the rise around the world.1 Numerous reports have described medical emergencies associated with the consumption of unconventional drugs of misuse bought in “head” or “smart” shops or online.1 New psychoactive substances, also referred as “legal highs,” “smart drugs,” or “research chemicals,” are a large group of both plant derivatives and synthetic compounds, also in combination, purposefully designed as legal alternatives to illicit substances of abuse. The most popular and widely-spread new psychoactive substances are synthetic cannabinoids and synthetic cathinones, however, various different compounds such as amphetamine-like molecules, arylcyclohexylamines, synthetic hallucinogens, prescription drugs and hormones have been found in recreational products marketed as legal highs.1

Understanding the risks associated with the use of new psychoactive substances (NPS): High variability of active ingredients concentration, mislabelled preparations, multiple psychoactive substances in single products

New psychoactive substances (NPS), are now a large group of substances of abuse not yet completely controlled by international drug conventions, which may pose a public health threat. Anxiety, paranoia, hallucinations, seizures, hyperthermia and cardiotoxicity are some of the common adverse effects associated with these compounds. In this paper, three case reports taken from the archive of processed cases of the authors' laboratory are presented and discussed to stress the risks of possible adverse consequences for NPS users: in particular, (i) the risk deriving from the difficulty of predicting the actual consumed dose, due to variability of active ingredients concentration in consumed products, (ii) the risk deriving from the difficulty of predicting the actual active ingredients present in consumed products, as opposed to those claimed by the manufacturer, and (iii) the risk deriving from the difficulty of predicting the actual pharmacological and toxicological effects related to the simultaneous consumption of different psychoactive ingredients contained in single products, whose interactions are mostly unknown. Each of them individually provide a source of concern for possible serious health related consequences. However, they should be considered in conjunction with each others, with the worldwide availability of NPS through the web and also with the incessantly growing business derived from the manipulation and synthesis of new substances. The resulting scenario is that of a cultural challenge which demands a global approach from different fields of knowledge.

New psychoactive substances as adulterants of controlled drugs. A worrying phenomenon?

The use of new psychoactive substances (NPS) as adulterants has received little attention in the literature. In this paper, results from Energy Control's drug checking service documenting the use of NPS as adulterants of controlled drugs are presented, and some reflections about possible explanations for this new phenomenon, potential risks for users, and challenges that it poses are discussed. From 2009 to 2012, 24 NPS belonging to several chemical classes such as phenethylamines, substituted cathinones, tryptamines, and methoxetamine were identified in 173 samples believed to be MDMA, amphetamine, ketamine, cocaine, mescaline, or methamphetamine. The NPS adulterant most frequently observed was 2-(4-bromo-2,5-dimethoxyphenyl)ethanamine (2C-B) followed by 1-(4-fluorophenyl)propan-2-amine (4-FA). Sixty-nine different combinations of substances were detected: 20 involving a controlled drug combined with an NPS, and 49 involving one or more NPS that substituted the controlled drug. As these combinations could pose substantial risks to users, the need to improve knowledge about toxicity associated with these combinations, and the danger of these substances being incorporated into the products of illegal markets, are highlighted. Drug checking services and the European Union's early-warning system operated by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol can play an important role in reducing the harm associated with this phenomenon.

EPA-0797 - Epidemiology of new psychoactive substances in a sample of adolescents and young adults

The rapid emergence of New Psychoactive Substances (NPSs), combined with the ability of the Internet to disseminate information quickly, represents a serious issue from both a clinical and a public health point of view. Aim of our research project is to assess the knowledge of NPSs and the extent of their diffusion amongst Italian young people. A questionnaire has been administered to a youth population (2700 subjects, 16-24 year old) randomly selected from a representative group, to evaluate their knowledge/use of a group of NPSs. Other items evaluate possible alcoholic abuse, use of other drugs, smoking habit, consumption of energy drinks/caffeinate beverages, time spent over the Internet per day. In the sample a partial knowledge of NPSs has been reported. The use of Cannabis in form of ’Spices’, ’Bath Salts’ including mephedrone, and Salvia divinorum was found in 1,4%, 2.2%, and 0.8% respectively. Relevant is the consumption of alcoholic beverages, with an important prevalence of binge drinking habits (98% of alcohol drinkers, 48,4% of total sample). The results evidence a partial, but presumably significant compared to the general population, knowledge of use of New Psychoactive Substances among selected Italian adolescents and young adults. Peculiar is the percentage of subjects with Binge Drinking habits (98%) among alcohol consumers (50,8% of total sample). We aim to widen the data with further questionnaire collection, in order to present more significant results

Headspace analysis of new psychoactive substances using a Selective Reagent Ionisation-Time of Flight-Mass Spectrometer

The rapid expansion in the number and use of new psychoactive substances presents a significant analytical challenge because highly sensitive instrumentation capable of detecting a broad range of chemical compounds in real-time with a low rate of false positives is required. A Selective Reagent Ionisation-Time of Flight-Mass Spectrometry (SRI-ToF-MS) instrument is capable of meeting all of these requirements. With its high mass resolution (up to m/Δm of 8000), the application of variations in reduced electric field strength (E/N) and use of different reagent ions, the ambiguity of a nominal (monoisotopic) m/z is reduced and hence the identification of chemicals in a complex chemical environment with a high level of confidence is enabled. In this study we report the use of a SRI-ToF-MS instrument to investigate the reactions of H3O+, O2+, NO+ and Kr+ with 10 readily available (at the time of purchase) new psychoactive substances, namely 4-fluoroamphetamine, methiopropamine, ethcathinone, 4-methylethcathinone, N-ethylbuphedrone, ethylphenidate, 5-MeO-DALT, dimethocaine, 5-(2-aminopropyl)benzofuran and nitracaine. In particular, the dependence of product ion branching ratios on the reduced electric field strength for all reagent ions was investigated and is reported here. The results reported represent a significant amount of new data which will be of use for the development of drug detection techniques suitable for real world scenarios.

Use of illicit stimulant drugs in Finland: A wastewater study in ten major cities

Estimations of drug use at the national level are generally based on various sources of information, such as drug seizures, socio-scientific studies, toxicological data and hospital records. Nevertheless, all of these approaches have limitations that cannot be overcome, even if conclusions are drawn from combined data retrieved from different sources. Drug epidemiology through wastewater analysis has the potential to provide unique perspectives, internationally comparable data, and up-to-date information on the use of both traditional illicit drugs and new psychoactive substances (NPSs). In Finland, no large-scale studies on regional illicit drug consumption, based on a wastewater approach, have been reported. In this study, 24-h influent composite samples were collected during two 1-week study periods from ten different wastewater treatment plants in May and November–December 2012. The cities included in the study represent the geographical areas throughout Finland and cover 40% of the Finnish population. The samples were analyzed with an in-house validated, ultra high-performance liquid–chromatography mass spectrometric (UHPLC–MS/MS) method for various common illicit drugs and some NPS type stimulant drugs. The results were also compared with available statistics, information on drug seizures and laboratory-confirmed toxicological data, as well as other studies available based on wastewater analysis. The data show that illicit stimulant drug use is more common in the larger cities of Southern Finland. Amphetamine was the most commonly used drug in all 10 cities during both collection periods (excluding the collection period in May in Lappeenranta). Cocaine consumption remains very low in Finland in comparison to other European countries; it was concentrated in the biggest cities in Southern Finland. This study shows interesting temporal and spatial differences in drug use in Finland, as well as the possibilities of using wastewater analytics to reveal local hotspots of NPS consumption.