New psychoactive substances are drugs that are not controlled under the United Nations drug control conventions but which may pose similar threats to health. These drugs include synthetic cannabinoids, opioids, stimulants and hallucinogens. Usually they are marketed as ‘legal’ replacements for the illicit drug market; while some are also used by small groups who wish to explore them for novel experiences and effects.
The large number of new substances, their diversity and the speed at which they appear is challenging both for monitoring and developing effective and timely responses.
- EU legislation provides a 3-step approach of early warning, risk assessment and control measures that allows Europe to rapidly identify and react to public health threats caused by new substances. The EMCDDA plays a central role in this system by operating the EU Early Warning System and undertaking risk assessments to support national and EU-level responses.
- Multidisciplinary harm reduction approaches are being developed and trialled in which vulnerable groups who may not come into contact with drug services are being engaged, for example, in sexual health settings.
- Clinical guidelines for the treatment of acute intoxications associated with new psychoactive substances are being developed and published. Specific guidance on responding to the use of these substances in prisons and custodial settings is also being developed in some countries.
- Harm reduction information platforms, often coupled with drug checking, are operating in several countries and online.
- Specialist treatment for problems caused by new substances is not well developed in most countries.
Summary of the available evidence
Emerging good practice for responding to new psychoactive substances
As this is a new area the evidence base is currently limited. However, responses are being developed based on adaptations of evidence-based responses to reducing harms for established drugs and these are summarised below:
- Early warning capacity to identify, assess and communicate on the risks of particularly harmful substances is important for responding to the acute harms associated with new psychoactive substances.
- Develop support and training to empower professionals in existing services to recognise how their skills and competences can be applied to responding to problems associated with new psychoactive substances.
- Development of practice guidelines for addressing problems related to new substances is generally based on responses to other drugs, for example, drug education, professional training, and low-threshold services such as needle and syringe programmes. These responses must be adapted to the harms and needs of different groups of users of new substances.
- Build cultural competence (an understanding of how cultural issues influence patterns of drug use and associated harms) within services to enhance service engagement and uptake.
- Education, including harm reduction, specific to new substances is most appropriate for target groups and individuals who are either already using drugs, or at increased risk of doing so.
- School-based prevention activities related to new substances are best delivered as part of generic prevention programmes for which there is evidence of effectiveness.
- Multidisciplinary approaches and the linking up of different services are needed to engage vulnerable groups who may not come into contact with traditional services (e.g. men who have sex with men who practise ‘chemsex’ and homeless people).
- The development of responses to new substances needs to be evaluated in order to identify effective interventions to meet the diverse challenges they pose.
Implications for policy and practice
Core interventions in this area include:
- Early warning systems to monitor new substances on the market and the harms they cause. These need to be supported by the chemical identification of new substances by forensic and toxicology laboratory networks.
- The provision of training material on new substances for health professionals and the creation of knowledge exchange platforms for clinicians, health care and social workers at local and national level.
- Interventions addressing the use of new substances based upon responses to established drug groups, but adapted appropriately to account for the nature and patterns of use of the new substances, the different user groups and contexts of use.
- National health authorities should be encouraged to develop new psychoactive substance guidelines, including on overdose management, or translate and adapt existing ones, such as the UK-based NEPTUNE guidelines, to national needs.
- Analytical and toxicological testing and risk assessment capacities need to be enhanced and results disseminated in a timely and usable way to both risk groups and relevant professionals.
- Services need to be developed to address the specific issues of use of new psychoactive substances among some particular groups such as homeless people, prisoners and people who inject drugs.
- The effectiveness of the adapted interventions now being used for responding to new substances should be evaluated.
- The impact of different ways of communicating the risks associated with new psychoactive substances is not well understood. Therefore there is a need to develop and strengthen the evidence base with respect to risk communication.
- To improve the targeting and development of appropriate responses, better epidemiological data on the extent, motivations for use and patterns of use and how they change over time is needed as well as fundamental research (pharmacology and toxicology).