Research paper
New psychoactive substances: Current health-related practices and challenges in responding to use and harms in Europe

https://doi.org/10.1016/j.drugpo.2016.10.004Get rights and content

Abstract

Background

The availability of new psychoactive substances (NPS) in Europe has rapidly increased over the last decade. Although prevalence levels of NPS use remain low in the general European population, there are serious concerns associated with more problematic forms of use and harms in particular populations and settings. It has thus become a priority to formulate and implement effective public health responses. However, considerable knowledge gaps remain on current practices as well as on the challenges and needs of European health professionals who are responding to use and harms caused by these substances. The aim of this study was to explore current health responses to NPS, and highlight key issues in order to inform planning and implementation of adequate responses.

Methods

This scoping study was based on a targeted multi-source data collection exercise focusing on the provision of health and drug interventions associated with NPS use and harms, in selected intervention settings across Europe.

Results

Findings revealed that in the absence of specific evidence, health professionals across most intervention settings rely primarily on acquired expertise with traditional drugs when addressing NPS-related harms. This study also identified a gap in the availability and access to timely and reliable information on NPS to users and health professionals. Health professionals in sexual health settings and custodial settings in contact with certain risk groups reported particular challenges in responding to NPS-related harms.

Conclusion

Immediate investments are required in expanding substance identification capabilities, competence building among professionals and dissemination of risk information among relevant stakeholders. The risks of neglecting under-served risk populations and failure to address the information needs of health professionals and users on NPS harms in a context of rapid changing drug markets in Europe may have unforeseeable consequences at societal level.

Section snippets

Background

The emergence of new psychoactive substances (NPS) over the last decade poses an important challenge to drug policy (UNODC, 2013). A new psychoactive substance is defined as ‘a new narcotic or psychotropic drug, in pure form or in preparation, that is not controlled by the United Nations drug conventions, but which may pose a public health threat comparable to that posed by substances listed in these conventions’ (Council Decision 2005/387/JHA). A range of public health issues have arisen as a

Methods

This scoping study was based on a targeted multi-source data collection exercise focusing on the provision of health and drug interventions associated with NPS use and harms, in selected intervention settings. The study comprised: 1) a non-systematic review of the European literature 2) a survey among experts in national focal points in 30 European countries, and 3) semi-structured presentations and facilitated focus groups with fifteen national experts. These were recruited from a range of

Results

The first objective of this study was to explore whether existing interventions are sufficient and adequate in addressing these harms or whether specific NPS interventions are required for particular NPS-using risk groups and delivered in different intervention settings in Europe.

Three quarters of the surveyed REITOX experts (11/17; 65%) reported that either specific NPS interventions had been developed or that there is a perceived need for such targeted NPS interventions in their country.

Discussion

Before moving to some general conclusions, it is important to recognise that the approach used in this study has a number of limitations. The targeted multi-source data collection approach used for this study is designed to explore new and emerging drug-related trends and developments. These will occur, by their very nature, in areas where the existing information and documentation is underdeveloped and partial. Therefore, while proving timely and valuable insights, the approach has obvious

Acknowledgments

This paper is based on work conducted by the EMCDDA and supported by funding from the European Union. The authors would like to thank the REITOX Focal Points and their staff, Harry Sumnall, Amanda Atkinson and Emma Begley from Liverpool John Moores University and the national experts who participated at the EMCDDA technical meeting in 2015 for their contributions to this study.
Conflict of interest

The authors declare no conflict of interest.

References (57)

  • L. Bolier et al.

    Alcohol and drug prevention in nightlife settings: A review of experimental studies

    Substance Use & Misuse

    (2011)
  • A. Bourne et al.

    The Chemsex study: Drug use in sexual settings among gay and bisexual men in Lambeth

    (2014)
  • T.M. Brunt et al.

    Drug testing in Europe: Monitoring results of the Trans European Drug Information (TEDI) project

    Drug Testing and Analysis

    (2016)
  • A. Bucheli et al.

    TEDI drug checking consultation and counselling guidelines

    (2013)
  • M. Daskalopoulou et al.

    Sexual behaviour, recreational drug use and hepatitis C co-infection in HIV-diagnosed men who have sex with men in the United Kingdom: Results from the ASTRA study

    Journal of the International AIDS Society

    (2014)
  • M.A. Dines et al.

    Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN)

    Clinical Toxicology

    (2015)
  • European Centre for Disease Prevention and Control

    Understanding the impact of smartphone applications on STI/HIV prevention among men who have sex with men in the EU/EEA

    (2015)
  • European Commission

    Flash Eurobarometer 401. Young people and drugs report

    (2014)
  • European Monitoring Centre for Drugs and Drug Addiction

    European drug report 2014: Trends and developments

    (2014)
  • European Monitoring Centre for Drugs and Drug Addiction

    Exploring methamphetamine trends in Europe. EMCDDA Papers

    (2014)
  • European Monitoring Centre for Drugs and Drug Addiction

    Injection of synthetic cathinones. EMCDDA perspectives on drugs

    (2014)
  • European Monitoring Centre for Drugs and Drug Addiction

    Drug-related infectious diseases in Europe Update from the EMCDDA expert network. EMCDDA rapid communication

    (2015)
  • European Monitoring Centre for Drugs and Drug Addiction

    European drug report 2015: Trends and developments

    (2015)
  • European Monitoring Centre for Drugs and Drug Addiction

    New psychoactive substances in Europe: Innovative legal responses

    (2015)
  • European Monitoring Centre for Drugs and Drug Addiction

    The internet and drug markets: Summary of results from an EMCDDA Trendspotter study

    (2015)
  • European Monitoring Centre for Drugs and Drug Addiction

    EMCDDA papers. Emergency department-based brief interventions for individuals with substance-related problems: A review of effectiveness

    (2016)
  • European Monitoring Centre for Drugs and Drug Addiction

    European drug report 2016: Trends and developments

    (2016)
  • European Monitoring Centre for Drugs and Drug Addiction

    The internet and drug markets. EMCDDA insights

    (2016)
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