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The purpose of this paper is to describe and summarize the recent emergence of NPS onto the drug market. To show the international and national responses, legal and guidance. To indicate some of the challenges NPS present to jurisdictions. To indicate some of the challenges NPS present to treatment agencies. To outline what is known about prevalence and effects.

A narrative account of the substances becoming known and the response made by jurisdictions.

The use and effects of NPS are slowly becoming known and exchanged between jurisdictions and treatment agencies. The user group appears to differ from the “traditional” substance users groups with which agencies are familiar. The use of the internet is a characteristic of this new market and user group.

New substances are constantly being identified. Previous treatment approaches may not be fully relevant to NPS. The new area of cognition enhancement is being gradually realized.

Treatment agencies need to develop new approaches, both to treat the effects of NPS use and to attract NPS users, who do not identify as “drug users”.

A new user group appears to be emerging. Cognition enhancement is a feature of NPS composition and use/attraction.

An attempt to summarize existing understanding of NPS use and marketing and to predict future trends and needs.

The purpose of this paper is to investigate a group of Romanian injecting substance users “migrating” from heroin to novel psychoactive substances (NPS) as a counterpublic seeking to escape the stigma of drug abjection.

The findings are drawn from interview and observational data collected mainly at drug services sites in Bucharest, Romania.

The stimulant powders sold by head shops appealed to experienced drug users because they seemed to emulate a consumerist ethos and cultivate a healthy, rational agent that popular discourses of addiction deem incompatible with drug careers. NPS and head shops were thus initially understood as a possibility of escaping “junk identities”. However, they ultimately sealed injectors as abject bodies that obstructed the collaborative goals of rehabilitation and health restoration. A sense of symbolic distance shaped by notions of moral and bodily hygiene separated heroin and NPS users, as the latter increasingly came to be seen and see themselves as flawed consumers of health and freedom.

NPS retail spaces could present valuable opportunities to insert harm-reduction resources and harness counterpublic health strategies.

Dominant definitions of substance use as unavoidable paths into self-destruction push users towards unknown compounds they can attach more fluid meanings to. This suggests that prohibitionist language still obscures rational dialogue about existing and emerging drugs.

The paper traces ATS/NPS in an Eastern European context offering an alternative vantage point to harm-focused perspectives.

There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The purpose of this paper is to undertake a scoping survey to explore the inpatient mental health workers’ perceptions of NPS use by consumers.

A cross-sectional online survey of mental health professionals is used in the study. The participants were opportunistically recruited through social media and professional networks.

A total of 98 participants (of 175 who started the survey) were included in the analysis. All reported that some patients had used NPS prior to admission. Over 90 per cent of participants reported observing at least one adverse event relating to NPS use in the previous month. The majority of participants reported that patients had used NPS during their inpatient admission. Three quarters were not clear if their workplace had a policy about NPS. Most wanted access to specific NPS information and training. The participants reported that they lacked the necessary knowledge and skills to manage NPS use in the patients they worked with.

Whilst the authors are cautious about the generalisability (due to methodological limitations), the findings provide useful insight into the perceptions of inpatient staff regarding the extent and impact of NPS use including concerns regarding the impact on mental and physical health, as well as ease of availability and a need for specific training and guidance.

Mental health professionals require access to reliable and up-to-date information on changing trends in substance use. Local policies need to include guidance on the safe clinical management of substance use and ensure that NPS information is included.

To the best of the authors’ knowledge, this is the first survey of the perceptions of mental health staff working in inpatient mental health settings regarding NPS. The findings suggest that NPS is a common phenomenon in inpatient mental health settings, and there is a need for more research on the impact of NPS on people with mental health problems.

Drug-related web forums have been argued to be an effective way to investigate the latest generation of drug users. The purpose of this paper is to explore discussions about drugs and new psychoactive substances (NPS) on an Italian psychonauts’ online community in order to gain a better understanding of the psychonauts’ profiles by scrutinising their main motives for consumption, which is mainly addressed to psychedelic drugs.

To collect data, a keywords list was used in the forum search engine. The first five most recent conversations (threads) for each of ten most frequently mentioned substances were selected. In addition, ten posts written by new forum members to introduce themselves were added to the data set, bringing the total number of threads to 60. The data were coded using Atlas.ti 7 applying a template model analysis (King, 1998).

The forum members present themselves as well-educated, informed drug users, and connoisseurs of the pharmacological properties of chemical compounds: accordingly, they claim to be aware of drug effects and possible risks. The analysis of the motives for using psychedelic drugs substantially confirms previous studies, indicating that the main reasons include spiritual needs, self-exploration and self-treatment. The shift from a recreational use towards more “committed” aims such as self-development is seen as a step forward in a drug user’s career. A generalised interest in harm reduction suggests that the psychonauts’ attitude may be a protective factor against adverse consequences of drug use. The most problematic users represented in the data are those who use drugs for self-treatment, since their discourse focusses on suffering rather than on pleasure.

Most efforts to analyse and monitor drug-related forums have focussed on “leading edge” English-language international websites. No studies have dealt with Italian forums. Furthermore the study address a misleading use of the term e-psychonauts recently introduced by some scholars whose’s studies were focussed on NPS.

The purpose of this paper is to explore polydrug use and the factors that motivate the use of multiple substances among selected young adults.

A total of 23 male and female participants (aged 23-29 years) who use illicit drugs and prescription pharmaceuticals for non-medical purposes were recruited through snowball sampling. Qualitative interviews were conducted, and the data were analysed thematically.

The use of drug “concoctions” and cocktails was widespread among the participants. Some used what they called Codeine Diet (codeine-based cough syrup mixed with a Coca-Cola^® product or malt drink), while others took Gutter Water (a cocktail of cannabis, codeine, tramadol, vodka and juice or water). The use of Monkey Tail (a mixture of local gin, cannabis leaves, stems, roots and seeds) and petrol mixed with glue and La Casera^® (carbonated soft drink) combined with Tom-Tom^® (menthol-flavoured candy) was also revealed. Pleasure, better highs, the need to experience prolonged intoxication and the use of one drug to douse the effects of another substance motivated polysubstance use.

The findings revealed that the reasons why codeine-based cough syrups are mixed with soft drinks (Codeine Diet) include avoiding social discrimination and evading law enforcement agencies. Results suggest that these drug use practices require specifically tailored public health interventions. Social stigmatization against substance users and the use of extra-legal measures by the police should be discouraged to facilitate harm reduction.

This study represents the first qualitative research to explore polydrug use among an understudied Nigerian population.

Secure Children’s Homes are safe environments where many of the most troubled children in British society are resident. These children are from either a criminal background or referred for protection of themselves and others from harm. There is often a history of drug use and diagnoses of mental health problems before admission. The purpose of this paper is to examine one Secure Children’s Home to determine the level of drug use prior to admission compared to surveys of children not in this environment and to examine the veracity of the mental health diagnoses.

This paper is a retrospective examination of case notes for admissions from 2014 to 2015.

The study found much higher levels of drug use than in the general population at similar age and a wide diagnosis of mental health problems prior to admission.

Levels of harm from traumatic childhood events need to be recognised by referrers as maybe leading to attachment disorders and not mental health problems. More research is needed into the outcomes form Secure Children’s Homes in the long term.

The children in these homes do have as anticipated much higher levels of drug use than in the general population and high levels of mental health diagnoses which are not always borne out during their admission to the children’s home.

This is an examination of a special population of young people indicating high levels of drug use and mental health problems.

This paper aims to examine knowledge production and problem representation with regard to new psychoactive substances (NPS) in Her Majesty’s Chief Inspector of Prisons (HMCIP) annual reports.

Seven annual reports published by HMCIP for England and Wales between 2014 and 2020 have been systematically reviewed drawing on thematic analysis.

This paper demonstrates how framing in HMCIP annual reports produced a characterisation of NPS in prisons that inadvertently obstructed gender-sensitive knowledge production and problem representation. The framing formalised knowledge silences about spice in women’s prisons.

HMCIP annual reports monitor drugs in prisons and this affects how these spaces are represented to government and other stakeholders. This paper provides theoretical and practical insights into how gender-blind knowledge is produced by discussing examples of gender-blind drug representations in a specific policy context.

The purpose of this paper is to explore whether there are ways in which the preventive strategies used to tackle volatile substance abuse (VSA) can be usefully applied to today’s new psychoactive substances (NPS).

In 2010-2013, with funding from the Big Lottery, Re-Solv, in partnership with St George’s, University of London, and educari, commissioned a re-analysis of both the mortality data relating to VSA and of the legislative and preventative measures taken that may have played a part in the steady downward trend in VSA mortality since. This paper is informed by Re-Solv’s research findings and the papers resulting from it, namely, Ives (2013) and Butland et al. (2013).

Efforts to reduce the harm from NPS could benefit from a re-examination of preventive approaches to VSA, which have resulted in a downward trend in mortality over the past two decades.

There is evidence from past prevention practice which could be relevant and applied to present day concerns about drugs and substances not previously available or used.

This is the first paper to explore how learning from VSA might be applied to NPS and the “legal highs” of today.

The purpose of this paper is to provide health professionals with novel psychoactive substances (NPS) clients with up to date information relating to the background, clinical pharmacology and, when possible, clinical management for each of these categories.

The world of NPS is complex and diverse, including a range of different molecules such as: psychedelic phenethylamines; synthetic cannabinoids, cathinone derivatives; novel stimulants; synthetic opiates/opioids; tryptamine derivatives; phencyclidine-like dissociatives; piperazines; GABA-A/GABA-B receptor agonists; a range of prescribing medications; psychactive plants/herbs; and a large series of performance and image-enhancing drugs. These molecules are sought by users for their psychactive effects.

The NPS categorization and classification provided here is an attempt to identify and better understand some of these substances. Given the vast range of medical and psychopathological issues associated with the NPS described it is crucial for health professionals to be aware of the effects and toxicity of NPS. The EU-MADNESS project aims to both better understand the pharmacology of the available/forthcoming NPS and to disseminate the most current NPS-related information to practising and training health professionals.

Further studies are required to identify a range of evidence-based, NPS-focused, clinical management and treatment strategies.

The rapid pace of change in the NPS online market constitutes a major challenge to the provision of current and reliable scientific knowledge on these substances.

The present review will provide an overview of the clinical and pharmacological issues related to a few hundred NPS.