The dilemma of new psychoactive substances: A growing threat

Abstract

New psychoactive substances (NPS) pose a major public threat and are a growing problem worldwide. They were designed to replace banned or controlled drugs while escaping quality control measures. Their chemical structure is constantly changed which imposes a major forensic challenge, and makes it difficult for law enforcement measures to track and ban them. Hence, they are called “legal highs” as they replicate illicit drugs whilst remaining legal.

Low cost, easy accessibility and less legal liability are the main factors that contribute to the popularity of NPS among the public. This is particularly with the lack of knowledge of the health risks and harms associated with NPS not only amongst the public, but healthcare professionals as well, which further constitutes a challenge for preventative and treatment measures.

Further medico-legal investigation, extensive laboratory and non-laboratory analyses, and advanced forensic measures are necessary to identify, schedule and control new psychoactive substances. Besides, additional efforts are required to educate the public and increase their awareness regarding NPS and their potential harms.

1. Introduction

New Psychoactive Substances (NPS) have been known in the market by terms such as “legal highs”, “bath salts” and “research chemicals” (Scherbaum et al., 2017). To promote clear terminology on this issue, UNODC decided to use the term “new psychoactive substances” which are defined as “substances of abuse, either in a pure form or a preparation that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but may pose a public health threat” (Evans-Brown and Sedefov, 2018, Shafi et al., 2020). As a result, they often escape quality control measures (Helander and Bäckberg, 2017) and constitute a major forensic challenge (Elliott et al., 2020).

2. The Dilemma of New Psychoactive Substances

NPS are a large variety of drugs, sometimes called “designer drugs” (Baumeister et al., 2015), that are designed to replicate illicit drugs whilst remaining legal (Shafi et al., 2020), hence the name "legal highs" (Scherbaum et al., 2017). The manufacturers of these drugs are aiming to replace banned or controlled drugs by constantly changing their chemical structure, which makes it difficult for law enforcement measures to track and ban them (Evans-Brown and Sedefov, 2018, Helander and Bäckberg, 2017, Scherbaum et al., 2017).

Historically, NPS were medicinal in nature (Elliott et al., 2020), however, with difficulties in regulating them, consumer demand, globalization and societal change, many NPS have developed beyond that to become illicit drugs (Evans-Brown and Sedefov, 2018, Helander and Bäckberg, 2017). NPS are a heterogeneous group of substances (Fox et al., 2018) categorized into the following five major groups based on their parent compound (Baumeister et al., 2015) or their main physiological and psychological effect:

• •Stimulant-type drugs similar to cocaine, amphetamines, ecstasy (Shafi et al., 2020) and cathinones (Feng et al., 2017).
• •Synthetic cannabinoids (Rodrigues et al., 2022).
• •Sedative-hypnotic-type drugs such as benzodiazepines.
• •Dissociative drugs similar to ketamine and phencyclidine (Wallach and Brandt, 2018).
• •Hallucinogenic drugs such as LSD and psilocybin (Elliott et al., 2020).

The most popular and known NPS are synthetic cannabinoid receptor agonists such as 5F-MDMB-PICA, MDMB-4en-PINACA, 4F-MDMB-BINACA, 5F-ADB,MDMB‐FUBINACA and ADB‐FUBINACA (Evans-Brown and Sedefov, 2018, Rodrigues et al., 2022, Vaccaro et al., 2022). They are commonly found infused in paper sheets (Rodrigues et al., 2022), Some of the NPS that are derived from hallucinogenic drugs such as LSD are 1-propanoyl-LSD, 1-butanoyl-LSD and 1-acetyl-LSD (Elliott et al., 2020). There are other traditional substances of natural origin that can be considered as NPS and evade from toxicological testing, but exert stimulating and hallucinogenic effects, such as khat, salvia, magic mushroom, kratom and mandrake (Feng et al., 2017).

There are many factors playing into the popularity of NPS amongst the general public. One of the main issues around NPS is the complete lack of knowledge about their nature, mechanism of action, metabolism, adverse health effects, abuse and toxicity potential, and their social harms (Pantano et al., 2019). They are also perceived as low risk, even when identified as an addictive illicit substance. One of the major contributors to this is that they are considered “legal”, and so are not perceived as risky or dangerous (Fox et al., 2018, Madras, 2017). They are also made available for purchase online (Elliott et al., 2020), and have entered the illegal web market (Pantano et al., 2019).

A qualitative study that investigated the reasons people use NPS at festivals revealed that low cost plays a major role, along with easy and high accessibility (Fox et al., 2018, Shafi et al., 2020). This poses another considerable challenge for preventative and treatment measures, and informs the high demand for monitoring and risk awareness worldwide (Breindahl et al., 2018, Feng and Li, 2020). Some of the essential tools that can be employed to conteract NPS are awareness campaigns, TV ads, and school programs to educate adolescents as well and combat the spread of NPS (Elliott et al., 2020).

Another problem with NPS is the poor knowledge among many healthcare providers and substance use disorder treatment centers of the harms related to NPS (Shafi et al., 2020). This may be attributed to the little systematic recording of NPS harms across the health system, which again can be encouraging to the public to choose NPS over traditional controlled drugs, since they are associated with much less legal liability (Madras, 2017). It also encourages NPS dealers to manufacture and sell them more as they are not deemed “illegal” (Scherbaum et al., 2017).

3. A Growing Threat

The main forensic challenge with NPS is the illegal passing or smuggling of these subsances through custom departments (Zhao, 2022) Failure of detection of NPS via traditional methods is mainly due to modifications in their chemical structure from the original parent compounds. There can be various forms and routes through which NPS can be smuggled like being mixed with candies, sweets or beverages. They are also smuggled to prisons and detention centers through various methods such as via postal services, by being deposited in paper or herbal material (Rodrigues et al., 2022, Vaccaro et al., 2022).

One of the major obstacles towards controlling and detecting NPS is the unavailability of toxicological and analytical screening tests that can identify them (Pantano et al., 2019). There is much weightage on laboratory techniques such as chromatography, and non-laboratory methods such as direct analysis in real time mass spectrometry (DART-MS), ion mobility spectrometry (IMS) (Vaccaro et al., 2022) and gas chromatography-mass spectrometry (Rodrigues et al., 2022) to advance in their detection accuracy in order to catch NPS. Hyphenated techniques can also be successful in analyzing biological samples from blood, urine, saliva and wastewater, and non-biological samples for the detection of NPS (Vaccaro et al., 2022).

The main risk with NPS is the severe and possibly fatal health consequences they can cause (Fox et al., 2018, Pantano et al., 2019). A study from Russia about NPS worldwide (Evans-Brown and Sedefov, 2018) found that products containing MDMB‐FUBINACA, which is a synthetic cannabinoid (Krishna Kumar et al., 2019), were linked to more than 600 poisonings, including 15 deaths over 2 weeks. In addition, more than 700 suspected poisonings, including 9 deaths with a possible link to ADB‐FUBINACA, which is another synthetic cannabinoid (Shafi et al., 2020), were reported in Mississippi during one month in 2015 (Evans-Brown and Sedefov, 2018). In Europe, during 2015, more than 200 people were hospitalized over a few days in Poland after smoking a product called “Mocarz” (Evans-Brown and Sedefov, 2018). They attributed these mass poisonings to the high potency of the synthetic cannabinoids, inaccurate amounts of substances used, and poor manufacturing processes leading to uneven distribution of the substance in the NPS. They also describe HIV, hepatitis C, and bacterial infection outbreaks as a result from unhealthy patterns of drug injection of NPS such as new fentanyl compounds (Evans-Brown and Sedefov, 2018).

Extensive efforts need to be directed towards accurate in-field detection techniques of NPS. Laboratory and non-laboratory methods should be further developed to detect NPS that can be found deposited in various materials or infused in paper, and also detect them from biological samples such as blood, urine and saliva (Vaccaro et al., 2022). This is important for the immediate seizure of these NPS to reduce NPS-related intoxications and deaths (Pantano et al., 2019). Offenses related to NPS ought to include all processes and activities that end into consumer use such as manufacturing, distributing, retailing and transporting (Zhao, 2022).

4. Conclusions

NPS pose a major public risk and are a growing problem worldwide. Low cost, easy accessibility and less legal liability are the main factors contributing to their popularity among the public. The lack of knowledge of the nature and possible grave harms that can result from NPS amongst the public and healthcare professionals further constitutes a challenge for preventative and treatment measures.

Additional efforts are needed to educate the public and increase their awareness regarding NPS and their potential harms. Laboratory and non-laboratory analyses, medico-legal investigations and forensic measures need to further develop to identify, schedule and control NPS.

Source of Funding

No financial support was received for this study.

Ethical approval

Not applicable.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.