Much of what is known about NPS in Europe comes from the EU Early Warning System. This system is the cornerstone of Europe’s response to new substances, and allows the Member States to directly report data to the EMCDDA and Europol on events such as law enforcement seizures, acute poisonings and deaths. The two agencies then analyse and assess the data to detect signals of harm, allowing the agencies and the Member States to react in a timely manner in order to reduce that harm. Such measures include public health alerts, law enforcement operations and risk assessments; in some cases, control measures across the EU may be applied by the Council of the European Union (EMCDDA, 2015d).
Number of new psychoactive substances reported to the EU Early Warning System for the first time, 2005–15
Because of the highly diverse and dynamic nature of the market, many of the existing epidemiological indicators of drug use are poorly suited or configured to measure and monitor new substances. In addition, the seizure data collected on new substances which are used in this report should be regarded as minimum estimates because of the lack of standardised reporting in this area. These data are not directly comparable to the data on established illicit drugs. Nevertheless, they provide useful information on the nature and extent of use of these substances.
The EMCDDA monitors a broad range of new psychoactive substances that have been reported through the EU Early Warning System. These include ‘synthetic cannabinoids’ (mainly synthetic cannabinoid receptor agonists), synthetic cathinones, phenethylamines, opioids, tryptamines, benzodiazepines, arylalkylamines and a range of other substances. In 2015, 100 new substances were detected for the first time, bringing the total number of new substances monitored to more than 560 — with more than 380 (70 %) of these detected in the last 5 years alone (Figure 7.2). There are now more than twice as many new substances on the market as drugs controlled under international drug control conventions.
Seizures of new psychoactive substances reported in Europe, 2005–14
Note: Data on reported to the EU Early Warning System is drawn from case reports rather than routine monitoring systems, therefore estimates represent a minimum and are not comparable to other seizure data.
The figures supplied for cannabinoid and cathinone seizure case numbers and quantity below are the figures reported for all forms of those substances seized e.g. includes powders, plant material, blotters etc. for both categories of NPS.
Seizure data from law enforcement agencies also serve to confirm the growth and importance of this drug market. In 2014, almost 50 000 seizures of new substances, amounting to almost 4 tonnes, were made across Europe — many of these substances are vastly more potent than their controlled counterparts (Figure 7.3). Synthetic cannabinoids, which are sold as replacements for cannabis, accounted for the majority of these seizures, almost 30 000, and weighing more than 1.3 tonnes. Synthetic cathinones, which are sold as replacements for stimulants, such as amphetamine, MDMA and cocaine, were the second largest group, with more than 8 000 seizures with a combined weight of more than 1 tonne. Together, synthetic cannabinoids and cathinones accounted for almost 80 % of the total number of seizures and over 60 % of the weight seized during 2014. However, the other groups, while smaller in number, also reflect important changes in the drug market. This includes the benzodiazepines and exceptionally potent narcotic analgesics — such as fentanyls — which may be sold as heroin.
The availability of new substances to European consumers through the internet as well as bricks-and-mortar shops in some countries is also high. In 2013, 651 web shops were identified on the surface net; and recent targeted snapshots and test purchasing show that new substances continue to enjoy high availability on the surface web. In addition, data from the monitoring of anonymous marketplaces on dark nets suggest that such sites may also be an important supply route, although further study is required (Abouchedid et al., 2015; EMCDDA, 2015d,e; Ho et al., 2015a,b). In addition, and apparently benefiting from the economies of scale that this expanding market brings, new substances are also increasingly sold on the illicit drug market, where they are specifically sold and sought either by name, or passed off as illicit drugs such as amphetamine, cocaine, heroin, ‘ecstasy’ or genuine medicines.
Major groups of new psychoactive substances monitored by the EMCDDA
|(1) Now controlled internationally under the UN system.|
|Synthetic cannabinoids||160||JWH-018 (1), AM-2201(1), 5F-AKB48, UR-144|
|Synthetic cathinones||103||Mephedrone (1), alpha-PVP, pentedrone, 3-MMC, methylone (1)|
|Phenethylamines||86||2-PEA, 4-FMA, 4-MA, 25I-NBOMe (1), DOPR, 4-CMA|
|Benzodiazepines||15||Pyrazolam, diclazepam, nifoxipam|
|Arylcyclohexylamines||11||Methoxetamine, 3-MeO-PCP, deschloroketamine|
|Arylalkylamines||32||Bromo-dragonfly, 5-APB, 5-APDI, 5-IT, 2-EAPB|
|Piperidines and pyrrolidines||12||2-DPMP, desoxy-D2PM, HDMP- 28, ethylphenidate|
|Indolalkylamines (tryptamines)||37||AMT, DMT, 5-MeO-MiPT, DiPT, MET, AL-LAD|
|Piperazines||17||BZP (1), mCPP, 2C-B-BZP, NSI- 189, 2,3-XP, DB-MDBP|
|Opioids||18||Acetylfentanyl, ocfentanil, W-15, W-18|
|Plants and extracts||8||Kratom, kava, arecoline|
|Other||64||Etaqualone, pregabalin, DMAA, iso-ethcathinone, 5-HTP, LSZ|
Estimating the prevalence of use of NPS is often a challenge, especially in general population surveys; because of the rapidly changing nature of the substances on offer and the fact that the same brand name may be used to market completely different substances, people often do not know what they are consuming. Such surveys, if they do seek to elicit information on NPS use, often ask about the use of ‘legal highs’ and ‘research chemicals’. Some may also ask about the use of groups of products such as smoking mixtures containing synthetic cannabinoids or groups of substances, such as the synthetic cathinones.
One insight into the use of new substances in Europe is provided by the 2014 Flash Eurobarometer, a survey of just over 13 000 young adults aged 15–24 in the Member States, which asked about the use of new types of products such as ‘legal highs’ and ‘research chemicals’. It was found that 8 % of respondents had used such a substance at least once, with 3 % using them in the last year. The highest levels of use in the last year were in Ireland (9 %), Spain, France (both 8 %) and Slovenia (7 %), with the lowest reported by Malta and Cyprus (0 %). Most respondents who had used such substances in the last year either bought them from, or were given them by, a friend (68 %). Just over a quarter (27 %) bought them from a drug dealer, while 10 % purchased them from a specialised shop, such as a ‘head shop’ or ‘smart shop’, and 3 % bought them on the internet (multiple answers were possible).
In the case of some new substances that are sold directly on the illicit market, the user groups will reflect, to some degree, the existing markets for controlled drugs such as amphetamine; this is the case for 4-methylamphetamine and 4-FA. In the case of ‘legal highs’, most surveys have examined use in targeted groups, such as dance music fans, night club patrons and psychonauts. These groups tend to comprise larger numbers of ‘early adopters’ of new substances. These findings are not representative outside the survey population. However, the use of new substances in these populations can be very high and may provide early signals of the potential harms associated with a drug, as well as an indication of substances that may be attractive to other users and which could become more widespread. In addition, new substances are increasingly being used in some countries by chronic, marginalised drug users such as opioid and stimulant injectors, which are under-represented in general population surveys.
New psychoactive substances pose a range of challenges to health, as well as for law enforcement and policy. Some of these challenges are the same as those posed by controlled drugs; others are unique to the substances themselves and the market. The market rapidly adapts to, or may even pre-empt, legal and regulatory attempts to control it.
Despite the limitations to the available data, there is now strong evidence that new substances are causing a wide range of serious harms in Europe. These include an increase in the number of serious acute poisonings, including deaths, as well as harms arising from changes in the patterns of drug injection, as injecting drug users switch to new substances. This is particularly evident with stimulant drugs such as mephedrone, α-PVP, MDPV, pentedrone and ethylphenidate. These changes have been linked to drug-related infectious disease, such as HIV and hepatitis C, as well as bacterial infections (Péterfi et al., 2014; ACMD, 2015b; Giese et al., 2015; Néfau et al., 2015; Public Health England et al., 2015; Rácz et al., 2015). In some cases the harms arising from new substances have manifested as outbreaks of mass poisonings or infections, which can place substantial demands on health care systems. Over the past two years, serious harms such as those that required urgent attention led to 34 public health alerts being issued by the EMCDDA, while seven risk assessments were conducted (see box).
The EMCDDA, through its Scientific Committee, is responsible for the risk assessment of new psychoactive substances. The risk assessment takes into account all factors that, according to the 1961 United Nations Single Convention on Narcotic Drugs or the 1971 United Nations Convention on Psychotropic Substances, would warrant the placing of a substance under international control. This ensures an evidence-based assessment. Reflecting the growth in the market, over the past two years, seven new substances — 25I-NBOMe, AH-7921, methoxetamine, MDPV, 4,4′-DMAR, MT-45 and α-PVP — required risk assessment by the EMCDDA’s Scientific Committee.