New Psychoactive Substances Users Research Articles

3-Methoxy-Phencyclidine Induced Psychotic Disorder: A Literature Review and an 18F-FDG PET/CT Case Report.

New Psychoactive Substances (NPS) are modifying the drug scenario worldwide and have become a public health concern because of their toxicological profiles and their harmful physical/psychological effects. 3-Methoxy-Phencyclidine (3-MeO-PCP), a non-competitive antagonist of glutamate N-methyl-D-aspartate (NMDA) receptors, belongs to the phencyclidine-like subfamily of arylcyclohexylamines and has gained attention for its toxic, sometimes fatal, effects. Despite several cases of intoxication and death reported in the literature, little is known about substance-induced psychotic disorders (SIP) and potential cognitive impairment following 3-MeO-PCP intake. This literature review aimed to summarize available evidence about 3-MeO-PCP mechanisms of action and physical and psychotropic effects and to spread preliminary findings about persistent psychotic symptoms and impaired cognitive functioning. Additionally, the case of an SIP is reported in a 29-year-old man with small oral intakes of 3-MeO-PCP over two weeks until a high dose ingestion. Psychometric and neuropsychological assessment and brain [18F]-fluorodeoxyglucose positron emission tomography integrated with computed tomography were used to support clinical description. Identifying and addressing the characteristic clinical features and neural substrates of NPS-induced psychoses might help clinicians with a more precise differentiation from other psychotic disorders. Although further studies are required, phenotyping the cognitive profile of NPS users might provide targets for tailored therapeutic approaches.

Clinical characteristics in new psychoactive substance users: A single center study.

New psychoactive substances (NPS) are emerging illegal substances or synthetic drugs that pose public health threats worldwide. This study was aimed at reporting the clinical characteristics of NPS and classical illicit substances used by patients who presented to the emergency room. We conducted a retrospective cohort study on patients with suspected illicit substance use who visited the emergency department (ED) with the suspicion of illicit substance use. We divided the patients into 4 groups based on the NPS testing results: NPS positive, NPS negative, NPS combined with classical illicit drugs (INPS), and subjects with negative testing results. The majority of patients in all groups were male. The NPS users were significantly younger than those with negative results on toxic testing (26.4 vs 37.5, P = .005 < 0.05). The heart rate of NPS users was significantly faster than that of the group with negative results of toxic testing (111.1 vs 93.5 beats per minute, P = .046). The heartbeats of INPS group were also significantly faster than those with a negative result in toxicology screen (119.6 vs 93.5 beats per minute, P = .024). Those who used classical illicit drugs combined with NPS had significantly higher palpitation than those with negative results of toxic testing (27.3% vs 3.1%, P = .017). Patients who were highly suspicious of NPS use were younger, had tachycardia, felt palpitations, and had fair oxygen saturation compared to patients who were negative for urine toxicity screening.

Understanding synthetic drug analogues among the homeless population from the perspectives of the public: thematic analysis of Twitter data

ABSTRACT Objectives The last few years have seen the rapid emergence of synthetic drug derivatives known as new psychoactive substances (NPS) among the homeless population. Previous research has focused on understanding the issues from homeless or stakeholder perspectives but not the public’s. The purpose of this research is to understand the perspectives of the public and service providers regarding NPS use among the homeless population using thematic analysis of Twitter data. Method Tweets from Twitter were extracted and imported into NVivo 12 for thematic analysis. Tweets were included if they were written and related to NPS among the homeless. Excluded tweets were those related to interventional studies or with personalized information. Results The findings showed that two NPS were discussed on Twitter being novel synthetic opioids (NSOs) and synthetic cannabinoid receptor agonists (SCRAs). Thematic analysis of Twitter discussions revealed that individuals held a negative attitude toward the government and the services provided to the homeless NPS users, for both NSOs and SCRAs. Conclusion In summary, NSOs were more frequently discussed on the Twitter platform than SCRAs. NSOs were consumed by homeless population in the United States and Canada, and SCRA by the homeless in the United Kingdom.

Qualitative Confirmation of 94 New Psychoactive Substances and Metabolites in Urine Using Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry.

Numerous methods and techniques have been published for the identification of new psychoactive substances (NPS) and their metabolites in urine. However, there lacks a holistic approach to analyze different groups of NPS and their metabolites with decision points for reporting their use. In this study, data-dependent acquisition workflow using liquid chromatography--quadrupole time-of-flight mass spectrometry was developed and validated for the identification of a total of 94 NPS and metabolites in urine using the established decision points. The limit of identification for all analytes was determined at 25% below their respective decision points. The method was demonstrated to be accurate and precise at their respective decision points with extraction recoveries and ion suppression/enhancement ranging from 51.0% to 103.5% and -81.6% to 159.1%, respectively. There was no observed carryover up to 200 ng/mL for all analytes and no interferences from urine matrixes, internal standards and other common drugs of abuse. The extracted drug analytes were stable at 4 and 15°C for up to 3 days. The validated method was successfully evaluated and applied in the testing of urine samples from NPS users. In conclusion, this validated method can analyze a wide range of NPS and their metabolites with the use of decision points for consistency in reporting.

Taking the cat-and-mouse game to the next level: different perspectives on the introduction of the German New Psychoactive Substances Act

BackgroundTo counteract the spread of new psychoactive substances (NPS) and to prevent the emergence of novel substances, specifically designed as a response to the legal control of individual substances, a new law was introduced in Germany in 2016: the New Psychoactive Substances Act (NpSG). The NpSG combines a generic approach with the waiver of criminal liability for the acquisition and possession of NPS for personal use, which is a novelty in German narcotics law. The present study aimed at exploring the impact of the introduction of the NpSG from three different perspectives—NPS users, staff of addiction care facilities, and members of law enforcement authorities—to better understand the dynamics surrounding such a change in legislation and to contribute to the body of international experience in dealing with NPS.MethodsSemi-structured narrative interviews were conducted with a total of 193 representatives of the three different groups affected by the law. These interviews included questions on perceived changes associated with the introduction of the NpSG as well as questions on opinions regarding legal and criminal policy issues. The analysis was carried out using qualitative content analysis according to Mayring.ResultsMost interviewees welcomed the non-criminalisation approach of the NpSG but also noticed that, in practice, not much has changed for users. Nevertheless, the changes in legislation have had an impact on the market. For example, novel substances have emerged circumventing the new legislation. According to users, this has led some to reduce NPS use and others to adopt more hazardous consumption patterns. Overall, most respondents did not expect the introduction of the NpSG to bring any significant changes.ConclusionsAlthough the idea of non-criminalisation inherent to the NpSG is appreciated and the generic approach has been well implemented in the law, thus covering a wide range of substances, the introduction of the law—perhaps for that very reason—has also had unintended and negative consequences, taking the cat-and-mouse game to the next level. To end the game, or at least to defuse the game situation, a combination of different strategies will be necessary, with legislation always playing a key role.

New Psychoactive Substances and Violence within a UK Prison Setting

Background and aims: New Psychoactive Substances (NPS) have affected prison populations, threatening the safety of prisoners and staff. We investigated the prevalence of substance use within a prison in the United Kingdom, focusing on NPS and its links with violence and impulsivity. Method: Cross-sectional questionnaire of 158 male category C prisoners with a mean age of 34.82 years (SD = 8.78). During their current sentence, 23% reported NPS use (NPS), 11% “traditional substances” (TD), 23% both, and 43% no substance use (ND). Lifetime use was reported as 62% NPS, 20% TD, and 18% ND. Findings: More participants used NPS exclusively than participants using TD exclusively, although the definition of NPS is problematic. The odds of violence against other prisoners, staff, and property were higher for NPS users and they were more likely to be impulsive compared to other groups. However, there was no significant interaction between NPS use and impulsivity in participation in violent acts. Conclusion: NPS use is a complex term and is prevalent in the prison, impacting on levels of violence and influenced by impulsivity. The findings emphasize the need for tailored treatment and prevention initiatives for NPS users.

Motives for using new psychoactive substances in three groups of Polish users: nightlife, marginalised and active on the In.

The aim of this article is to present the motives for using new psychoactive substances (NPS) among users in Poland and to evaluate the relationships between motives and consumption of different types of NPS. The fieldwork was conducted in four locations: in Warsaw, Krakow, Poznan, and Tricity. The study involved a total of 596 users of new psychoactive substances. Among them were: nightlife users, using NPS recreationally (N = 172), socially marginalised users (N = 86) and users active on the internet (N = 338). The technique used in the study was a self-filled questionnaire. As assessed by all respondents, enhancement of mood was the most frequently indicated motive for using NPS. Among nightlife users, the NPS were most often used for the purpose of having more fun at parties. Among the marginalised users, the most common motive for using the new psychoactive substances was the desire to get intoxicated, which is a motive belonging to the group of motives related to enhancement. In the group of people active on the Internet, the most common motives for using these substances were those related to expansion. Identifying motives for using new psychoactive substances may contribute to reducing the use of NPS. The recreational and marginalised users have different motives for using substances. The same conclusion applies to the use of the individual NPS. The motives of using them vary. Thus, preventive, educational and therapeutic programs should be judiciously adapted to the needs of the users as well as to the kind of substances they use.

The Scale of Intoxications with New Psychoactive Substances over the Period 2014-2020-Characteristics of the Trends and Impacts of the COVID-19 Pandemic on the Example of Łódź Province, Poland.

Legal highs are new psychoactive substances (NPSs) which pose a high risk for human health, and the spread of the SARS-CoV-2 pandemic has changed peoples’ behaviours, including the demand for NPS. The aim of the study was to assess both the frequency of intoxication with NPS in Łódź province over the period 2014–2020, and the impact of the COVID-19 pandemic on developing this trend. An analysis was carried out of data on intoxications in Łódź province in the years 2014–2020 reported by hospitals. The medical interventions rate (MI) per 100,000 people in the population was calculated. The frequency of intoxications was compared taking sociodemographic variables into account, and the effect of seasonal influence on intoxications was calculated using the Holt–Winter multiplicative seasonal method. In the period considered, there were 7175 acute NPS poisonings in the Łódź province and 25,495 in Poland. The averaged MI rate between 2014–2020 was 9.45 for Poland and 38.53 for the Łódź province, and the lowest value was found during the COVID pandemic in the year 2020 (respectively, 2.1 vs. 16.94). NPS users were mainly young men of 19–24 years old from a big city. Most cases were registered at weekends and in summer months. The majority of intoxications were caused by unidentified psychoactive substances of legal highs (chi2 = 513.98, p < 0.05). The actual number of NPS-related poisonings in the Łódź province in 2020 was lower than the value extrapolated from trend analysis of data between 2014–2019. NPS use in Poland decreased during the pandemic. It should be noted that a decrease in the number of drug-related incidents can have more than one reason, e.g., preventive programs, increased awareness, or changes in the law. This paper advocates that, in addition to monitoring NPS-related intoxications, there is further investigation into the social, cultural, and behavioural determinants of NPS to facilitate targeted prevention programmes and the development of new medical treatments.

Risk perception and risk aversion among people who use New Psychoactive Substances.

New Psychoactive Substances (NPS) are often considered to be harmful and less safe alternatives to traditional recreational drugs. Yet we have little knowledge of the ways in which risk aversion affects NPS risk perception and how risk judgements differ across types of NPS. In the analysis that follows, we investigate whether the perceived severity of risk is amplified or attenuated by users' experiences, risk avoidance strategies and modes of knowledge on risk. The data were derived from a Polish cross-sectional study on patterns of NPS use and associated risks. A convenience sample of 605 users of NPS (Mean age=22; range 15-49 years) completed a questionnaire. A principal component analyses and ordinal regression models were used to reveal the latent variables indicating modes of knowledge on NPS risk and risk avoidance strategies, and to determine the associations between risk aversion and perceived personal risk of NPS use. Several precautionary measures were employed by the majority of participants in the study. The perception of individual risk differed across NPS types. Principal component analysis yielded three components in both risk avoidance strategies ('avoiding mixes', 'precautionary measures', 'planning') and modes of knowledge on risk ('experience', 'technical knowledge', 'harm reduction'). However, ordinal regression models show that perceptions of risk are only partially affected by the modes of knowledge on NPS risk and by risk avoidance strategies. The results indicate that risk perception largely depends on NPS type. The perception of risk is driven by both modes of knowledge and risk avoidance strategies. However, they have different impacts on how individuals judge risk across various types of NPS. The perspective of risk perception should inform policy-makers and prevention experts to focus their efforts on honest and substantive risk communication. The present study shows that individuals tend to rely on various strategies of risk avoidance, which indicates the need to improve the substantive communication on NPS risks, with a particular focus on the types of NPS, which could help people using them make informed choices.

New psychoactives within polydrug use trajectories-evidence from a mixed-method longitudinal study.

AimsTo provide public health‐related research evidence on types and usage patterns of new psychoactive substances (NPS), developmental pathways into NPS and decision‐making factors for, and associated harms of, NPS use.DesignThree‐phase mixed‐methods design, including a latent class analysis (LCA) of the longitudinal Belfast Youth Development Study (BYDS), a narrative analysis of interviews with NPS users and a three‐step approach manual method modelling using regressions to reveal classes of substance use and their associated predictors and outcomes.SettingNorthern Ireland.ParticipantsA total of 2039 people who responded to the questions on ‘ever use’ of the drug variables included at wave 7 (aged 21 years) of the BYDS. Eighty‐four narrative interviews with NPS users.MeasurementsCategories of drug use identified by LCA. Predictors and outcomes included measures of family, partners, peers, substance use, school, delinquency and mental health.FindingsA four‐class solution provided the best fit for the data: alcohol; alcohol and tobacco; alcohol, tobacco and cannabis; and polydrug (the latter including NPS). The qualitative analysis yielded a taxonomy that distinguished how NPS operate within a wider range of drug repertoires from experimental to problematic.ConclusionsIn Northern Ireland, new psychoactive substances appear to be a feature of broader polydrug use rather than a standalone class of drug use.

Head shops and new psychoactive substances: a public health perspective.

In 2010, Ireland found itself at the eye of an international storm as a network of head shops emerged selling new psychoactive substances (NPS) and Irish youth rapidly became the heaviest users of NPS in Europe. Within months, the Irish government enacted novel legislation, which has since been copied by other countries, which effectively stopped the head shops selling NPS. Critics of this policy argued that it could cause harms to escalate. A number of separate studies indicate that a range of drug-related harms increased amongst Irish youth during the period of head shop expansion. Within months of their closure, health harms began to decline. NPS-related addiction treatment episodes reduced and admissions to both psychiatric and general hospitals related to any drug problem began to fall. Population use underwent sustained decline. Consequently, the closure of head shops can be viewed as a success in terms of public health.

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.

Awareness of users and motivational factors for using new psychoactive substances in Belgium

BackgroundFew data on motivations for using new psychoactive substances (NPS) are available. However, the cost, the legal status, and their accessibility through channels like internet contributed to the popularity of NPS. The objective of this article are first to gain a deeper understanding of the culture surrounding NPS in Belgium and second to define the awareness of the users concerning the content of the NPS they are consuming.MethodsSnowball sampling and partners in the drug demand reduction field were used as a gateway in order to reach a heterogeneous study population. In total, 45 users were recruited and in-depth interviews were conducted. The personal experiences of NPS users and their needs for support along the continuum of care were explored through an interview guideline, while subjects were given the opportunity to deposit a NPS sample for forensic analysis in a recognized laboratory.ResultsA diversity of profiles was found among NPS users but also a wide diversity in the motives to consume NPS: personal reasons such as pleasure, mind exploration, being connected to others, or out of curiosity, but also external reasons such as price, accessibility or the specific effects procured by certain NPS. The results showed as well that a majority of NPS users seem to be aware of the substances they are using.ConclusionUnderstanding the motivations of use is of importance to determine which type of NPS targeted interventions are adapted to different profiles of users.

Why do people use new psychoactive substances? Development of a new measurement tool in six European countries.

New psychoactive substances (NPS) pose a public health threat. Many studies have tried to identify the reasons of NPS use; however, none of them have so far used any standardised measures. The aim of this study was (i) to develop and cross-culturally validate the New Psychoactive Substance Use Motives Measure (NPSMM) and (ii) to compare motives of NPS use across countries and user types. Three subgroups (socially marginalised users, nightlife attendees and members of online communities) of NPS users (N = 3023) were recruited from six EU member countries. Demographics, motives and types of NPS used were assessed. NPS use motives were measured by adapting the extended six-factor version of the Marijuana Motives Measure. Exploratory and confirmatory factor analysis resulted in a similar five-factor solution across most of the countries: coping, enhancement, social, conformity and expansion motives. Marginalised users scored higher on coping and conformity motives, nightlife groups showed higher endorsement of social motive, whereas online community users showed higher scores on expansion motives. Various types of NPS were also associated with different motives. NPS use motives might be associated with both the groups of users and the specific types of NPS being consumed. Expansion (psychedelics) and enhancement (stimulants) motives seemed to be linked to the chosen NPS product type, while coping, social and conformity motives were rather associated with user groups. NPSMM was found to be a valid instrument to measure NPS motives.

Characteristics of analytically confirmed illicit substance-using patients in the Emergency Department

Although illicit substance use-induced toxicity or complication is a frequent cause of visit to the emergency department (ED), there are limited data on cases confirmed by liquid chromatography tandem-mass spectrometry (LC-MS/MS) analysis. This study aimed to describe clinical presentations of patients who visited the ED because of acute illicit substance-related complications. We performed a retrospective study between May 2017 and August 2018 on patients presenting to the ED with positive urine illicit substance analysis by LC-MS/MS. Of 203 patients with at least one illicit substance detected in their urine, 162 (79.8%) showed traditional illicit substances, and 56 (32.0%) showed new psychoactive substances (NPS). Methamphetamine was the most common illicit substance (67.9%). The most common NPS was ketamine (21.7%), followed by synthetic cathinones (14.8%). We divided patients into traditional, NPS and combined (both traditional illicit substance and NPS) groups. Polysubstance use was more common in the NPS group than in the traditional group (P<0.001). Most patients were men (78.3%), and the average age was lower in the NPS group compared to the traditional group (P<0.001). Although the chemical structures of cathinones are similar to that of amphetamine, 92.0% of the cathinone use cases without combination with methamphetamine use showed negative immunoassay results. Our study provided the acute illicit substance complications at ED by LC-MS/MS analysis in Taiwan. Our study showed that more than one-third cases studied were NPS users. Young adults and polysubstance users were more common among NPS users.

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.

Discriminative Characteristics of Marginalised Novel Psychoactive Users: a Transnational Study

New psychoactive substances (NPS) continue to be considered as a major public health concern in many European countries. The study was implemented within the framework of a transnational project of six European countries (Germany, Hungary, Ireland, Netherlands, Poland, Portugal). Our aim here is to report on the distinct and differentiating characteristics of marginalised NPS users. Three subgroups of a total of 3023 adult NPS users (socially marginalised, night life, online community) were examined regarding their socio-demographic characteristics, substance use, and external motives towards NPS use. Poland and Hungary reported higher rates of NPS use in comparison to traditional controlled drugs. The external/contextual motives did not play a central role in the background of NPS use, the least important motives were alleged legality and non-detectability of these substances. Marginalised (defined as those accessing low threshold harm reduction services) users’ substance use patterns are different from the other two groups in terms of showing more intense and riskier drug use. The most important variables which contributed to be categorised as a marginalised NPS user were lower level education, being older, having an unfavourable labour market position and using drugs intravenously. Contextual motives did not play a decisive role in being categorised as a marginalised user when drug use pattern was controlled. These identified discriminative features of marginalised drug users should inform policy makers to develop and implement tailor-made interventions targeting this user group to successfully tackle the elevated public health concerns associated with NPS use.

Prevalence of New Psychoactive Substances (NPS) and conventional drugs of abuse (DOA) in high risk populations from Paris (France) and its suburbs: A cross sectional study by hair testing (2012–2017)

BackgroundThe aim of the present study is to describe the prevalence of NPS and conventional DOA in Paris and its suburbs over a six-year period using hair testing approach. MethodHair was sampled in patients admitted to different departments of Paris hospitals between 2012 and 2017. Two high-risk populations were mainly considered: 1) drug-dependent and 2) acutely intoxicated patients. Segmental hair analysis was performed by validated LC–MS/MS method to screen for DOA and 83 NPS. Results480 patients (280 M/200 F, 15–70 years) were included. 141 patients tested positive for NPS (99 M/42 F; median age: 33). NPS prevalence was 29%, that of amphetamines, cocaine and opioids were 32%, 38.5% and 52%, respectively. 27 NPS were identified, 4-MEC and mephedrone (number of cases n = 24 each) were the most detected cathinones. JWH-122 (n = 1) was the only detected synthetic cannabinoid while ketamine (n = 104) was present in numerous NPS users (67%). 3-fluorofentanyl (n = 1), furanylfentanyl (n = 1), N-ethylpentylone (n = 2), pentedrone (n = 2), mexedrone (n = 1), methcathinone (n = 3), 6-APDB (n = 2), TFMPP (n = 2), 2-CE (n = 1), 3,4-MD-αPHP (n = 1) and dextromethorphan (n = 27) were identified for the first time in hair. Users were found to have more than one NPS in 53% of cases, mostly in combination with conventional DOA. The number of detected NPS rose from 5 in 2012 to 42 in 2017. A broad range of hair concentrations (0.001–318 ng/mg) was found, but the low median concentrations seem to show an occasional exposure more than chronic use. ConclusionNPS screening should be assessed in routine clinical practice, especially in high-risk populations.

How and Where to Find NPS Users: a Comparison of Methods in a Cross-National Survey Among Three Groups of Current Users of New Psychoactive Substances in Europe

Use of new psychoactive substances (NPS) across Europe remains a public health challenge. The study describes potentials and limitations of methods in a transnational survey of recent marginalised, nightlife and online community NPS users in Germany, Hungary, Ireland, the Netherlands, Poland and Portugal (n = 3023). In terms of demographic profile, drug use history and type of NPS, different methods reached different segments of the NPS-using population. Last year use of different NPS varied across countries and groups. Respondents used NPS in a variety of settings, with public spaces most common in the marginalised group. The study suggests that prevalence rates can reveal a picture of the NPS market that significantly deviates from what law enforcement seizures indicate. Outreach in nightlife settings and peer education are recommended to inform users about health risks and to improve access to drug services and care.