Not particularly special: critiquing ‘NPS’ as a category of drugs

Abstract

Novel psychoactive substances (NPS) have been a dominant feature of drug discourse for many years now and, in academic, policy and public discourse, have become established as a new – and by implication, distinct – category of drugs. We argue that this understanding of NPS is fundamentally problematic. Differences within the category are obscured, as are similarities between NPS and more established categories of drugs. Focusing on NPS as something new, different or particularly special is misleading and counterproductive and can have serious consequences in terms of understanding the bigger picture in relation to illegal drugs more generally. This has led to overestimations of the size of the NPS problem, obfuscation of the common underlying causes of dependent drug use and the implementation of significant and problematic policy changes. Furthermore, a failure to see the rise in NPS as just one of a number of emerging trends in contemporary drug scenes, alongside the development of online markets or the rise in domestic drug production operations, for example, impairs our ability to understand the wider societal, cultural and theoretical underpinnings of drug use. NPS are not particularly special: treating them as such can have dangerous and far-reaching consequences.     

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

BackgroundThe 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.MethodsThis 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.ResultsFindings 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.ConclusionImmediate 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.     

Exploring the intersections between novel psychoactive substances (NPS) and other substance use in a police custody suite setting in the north east of England

Abstract

Aims: Novel psychoactive substances (NPS), a range of plant-based/synthetic substances that mimic effects of other illicit substances (e.g. cannabis), are now illegal in the United Kingdom (May 2016) to produce/supply. Negative behavioural consequences of NPS use mean that users frequently transgress the law are arrested and detained in police custody suites. Evidence shows a link between traditional substance use and offending behaviour, with significant police time spent on alcohol-related incidents. We explore the intersections between NPS and other substances with police staff and users in custody; specifically the similarities and differences in treatment, management and policing of these substances.

Methods: A qualitative study using semistructured interviews and thematic analysis. We recruited 15 police staff (4 women/11 men) and 25 NPS users (9 women/16 men).

Results: Police staff perceived NPS users to be extremely volatile in custody and reported feeling less knowledgeable about how to manage and respond to their needs compared to other substance users (e.g. alcohol, heroin). Users rarely took NPS in isolation and often compared them to other illicit substances, balancing effects versus costs.

Conclusion: NPS use has a striking effect on custody work, primarily because of unpredictable user behaviour, adding further pressure to already overstretched police staff.     

‘Parents are the best prevention’? Troubling assumptions in cannabis policy and prevention discourses in the context of legalization in Canada

BackgroundCanada has announced that it will legalize cannabis on October 17, 2018, and as a result of this impending drug law reform the need to develop prevention resources and drug education – in schools, in public health, and for parents – has emerged as a public concern and a policy priority. Set against this context, the aim of our paper is to amplify the parent perspective on preventing problematic adolescent cannabis use, but also to interrogate the idea of ‘parents as the best prevention’ that has taken hold in discussions about the potential consequences of legalization for youth.MethodsIn 2016 we undertook an exploratory, qualitative interview study in Vancouver, British Columbia (n = 16) with parents of adolescents who had used cannabis. Building on our past research developing educator-led resources to support an open dialogue about cannabis in the classroom, in this study we asked parents about the supports and resources they needed to inform their discussions about cannabis with their adolescent children, as well the challenges they faced in responding to cannabis use when they believed it had become problematic.FindingsAcross the interviews, parents mobilized discourses of risk and responsibility for preventing problematic cannabis use that appeared to reinstate individualizing accounts of substance use. Many echoed normative ideas about health, the risks of cannabis use, and ‘good’ parenting, sidestepping social inequities around drug use, and thus implicating parents and families as solely responsible for preventing adolescent drug use.ConclusionOur analysis suggests how parents have been largely disempowered and unsupported when it comes to addressing adolescent drug use in the family context. Even as they expressed their awareness that formal supports and resources to assist them were lacking, parents also assigned blame to themselves – or to other parents – for ‘failing’ to prevent problematic cannabis use.     

‘I could have went down a different path’: Talking to people who used drugs problematically and service providers about Irish drug policy alternatives

BackgroundPeople who use drugs problematically are consistently left out of consultations and deliberation on drug policy. This article explores how people who formerly used drugs problematically and service providers view Ireland's current drug policy and if alternative policies could be successful in an Irish context.MethodsSemi-structured interviews were conducted with eight people who used drugs problematically and six practitioners working with people who use drugs in Cork city, Ireland. All people who used drugs problematically had at least one year of abstinence and had been criminalised because of their drug use, all but one had served at least one custodial sentence. Participants were asked their opinions on safe injecting facilities, heroin assisted treatment, decriminalisation of drugs for personal use, depenalisation of cannabis and, the relationships between economic deprivation and problematic drug use.ResultsRespondents stressed that, in Cork city, problematic drug use is closely linked with economic deprivation and social exclusion. There was a near consensus that criminalisation and penalisation do not deter consumption and produce unintended consequences. All participants supported safe injecting facilities and the decriminalisation of drugs for personal use. Participants were less certain about the utility of heroin assisted treatment and depenalisation of cannabis. Many discussions drifted away from alternatives policies towards the need for improved treatment provision.ConclusionSeveral participants were clear that none of the alternative policies discussed are silver bullets. Participates felt that, while they could reduce the harms caused by drugs and drug policies, the government's longer-term objectives should be increased treatment provision and, reduced social exclusion and economic deprivation.     

Trends, motivations and settings of recreational cocaine use by adolescents and young adults in the Netherlands

BackgroundIn recent years the use of powder cocaine among socially integrated adolescents and young adults has normalised. It is no longer an extraordinary drug to use in trendy/innovative as well as mainstreams clubs. Not much research has been done on motivations for and settings in which this cocaine use takes place.MethodsTo gain insight in normalisation and trends in cocaine use, we used quantitative data from the National Prevalence Study on Substance Use (NPS) 1997, 2001 and 2005. To gain insight in social settings and motivations (initiation and continuation), and in the combined use of cocaine with alcohol and/or other drugs, we analysed mostly qualitative data from in-depth interviews with 55 adolescents and young adults who used cocaine in the past year.ResultsThe NPS studies show a rising trend in lifetime cocaine use, a fall in incidence, and a fall in continuation rates. From the interviews we learn that cocaine has further normalised. Cocaine is – and stays – attractive because of the ritual of snorting (the route of administration). Initiation is often planned. Effects play a role in the continuation of use, not in initiation. Motivations for use are divided into three categories: physical, mental and social. Cocaine is used in nightlife and home settings, together with friends, and it is often combined with alcohol (on the same occasion), because of feeling mentally clear and being able to drink more.ConclusionAbout 5% of adolescents have used cocaine at least once in their lives. They feel it can be used in every setting, since it leaves a user in control. While acknowledging the negative side effects, young users try to regulate their cocaine use in order to regulate these effects. Although high frequent use is an exception in our sample, we cannot foretell how many might develop a pattern of problematic use.     

Exploring influences on methamphetamine use among Black gay,bisexual and other men who have sex with men in Atlanta: A focus group study

BackgroundMethamphetamine use is a contributor to HIV risk and poor health outcomes among gay, bisexual and other men who have sex with men (GBMSM). There is a paucity of research examining methamphetamine use and its social context specifically among Black GBMSM. We therefore sought to: (1) describe trends in methamphetamine use among Black GBMSM in Atlanta, Georgia, and (2) examine the risk environment (micro-, meso‑ and macro-level factors operating in the political, social, physical, economic, and healthcare environments) that might elevate risk for methamphetamine use in this population.MethodsWe conducted a qualitative study consisting of eight focus groups with 54 key informants between December 2019 and March 2020. Participants represented community-based and healthcare organizations that work closely with Black GBMSM. Our thematic analysis included an iterative, team coding approach combining deductive and inductive elements.ResultsParticipants unanimously agreed that methamphetamine use was increasingly prevalent among Black GBMSM in Atlanta, with many describing a historical arc in which methamphetamine use – previously associated with predominantly white, affluent GBMSM – was now common among younger, lower socioeconomic status Black GBMSM. At the micro-level, participants described contributors to increasing methamphetamine use including use as a sex drug, and the interrelated burdens of stress and mental illness, housing instability, geographic mobility and poverty. At the meso‑level, participants described virtual and physical sex scenes including use of geosocial networking apps that facilitated the spread of methamphetamine use in the Black GBMSM community. At the macro-level, participants described how policies prioritizing other concerns (e.g., HIV, opioids) seemed to limit resources available for methamphetamine prevention and treatment programming.ConclusionMulti-level environmental influences are working together to elevate risk for methamphetamine use among Black GBMSM in Atlanta, with potential to adversely impact health and well-being and undermine HIV prevention and treatment efforts.     

Drug Use,Community Action,and Public Health: Gay Men and Crystal Meth in NYC

In 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.     

Towards ‘Sensible’ drug information: critically exploring drug intersectionalities, ‘Just Say No,’ normalisation and harm reduction

Abstract

Aim: This article examines the impact of new psychoactive substances (NPS) on drug service interventions using a case study of professional practitioners in South East England. We assess how professionals seek to develop an innovative approach towards providing ‘sensible drug information.’

Methodology: The research methods include observations, and individual and collective ethnographic interviews with 13 professionals who work with young people across the region.

Results: The article theorises sensible because it is a key element in contemporary drug education with a harm reduction approach. Therefore, we take up this challenge and use the ideas of Gilles Deleuze, which according to Mazzei and McCoy ‘prompts the possibilities of new questions and different ways of thinking research’. We identify a series of drug intersectionalities between ‘traditional’ illegal drugs and NPS and through social class differences between young affluent and more socially disenfranchised drug users. This article assesses the delivery of ‘sensible drug information’ as part of a harm reduction approach, which may not always be supported by other agencies. In responding to these challenges we explore Deleuze’s ideas as a foundation for ‘sensible’ drug information which incorporates Matza?s theory of drift, to explain young people?s changing pattern of drug consumption.     

The highs and lows of NPS/“Legal High” use: Qualitative views from a UK online survey

Abstract

Introduction: Novel psychoactive substances (NPS) are rapidly proliferating in the United Kingdom and elsewhere. We lack detailed information on rationales for their use. Methods: Qualitative data from 431 NPS users were collected as part of a 2014 online survey on NPS (n?=?468 NPS users, 704 non-NPS users). These 431 users answered some or all of five open-ended questions on favourite NPS and NPS they would not use and rationales for these assessments. Findings: Respondents were asked to identify and describe favourite NPS. The favourite NPS identified (n?=?258 respondents) mostly had brand names (148). Favourite NPS was associated with a good buzz/feeling, euphoria, enhancing sociability and relaxation. Ease of availability, cheapness and legality of NPS were cited. Achieving a predictable, safe high was important. Adverse NPS experience, including dependency issues both personally or amongst friends was reported by a majority of the 148 who described NPS that they would definitely not take and why, most of these reported having now ceased NPS use. Negative experiences ran from the mildly unpleasant to the persistent, serious and life threatening. Conclusions: Developing new methods of reaching and working with NPS users need timely knowledge of global and local trends in NPS use and effects. These data are of some assistance in expanding such knowledge.     

Producing the ‘problem’ of new psychoactive substances (NPS) in English prisons

BackgroundThere has been a significant change in the types of substances consumed within English prison settings in the last eight years. There have been particular concerns regarding the acceleration in the use and availability of New Psychoactive Substances (NPS), mainly synthetic cannabinoids. Although NPS were identified as a ‘problem’ in prisons in 2011, government responses emerged only in 2015. As yet, there is no overarching policy document or strategy for dealing with NPS. This paper analyses the various strands of the response to NPS in prisons published from January 2015 to December 2016.MethodsDrawing on Bacchi’s ‘What’s the problem represented to be’ framework, the ways in which the NPS ‘problem’ in prisons has been represented is analysed through a number of related policy texts including press releases, new legislative and regulatory measures, government documents and training package.ResultsFrom the various measures introduced to deal with the ‘problem’, NPS use is produced primarily as a law, order and control ‘problem’ requiring regulation, penalties and control, rather than a ‘demand problem’ calling for prevention, education, treatment and harm reduction or a ‘regime problem’ demanding greater emphasis and resources for purposeful activities such as education, training and work opportunities. This problematisation of drug use in prisons has a history dating back to the 1995 prison drug strategy and has become entrenched and reproduced within policy development over time.ConclusionThe law, order, and control problematization blames the volatility of the substances and the individual prisoners who use them as key factors contributing to the current prison crisis, rather than as consequences of the wider practices, cultures, contexts, and conditions. Multiple representations of the problem of NPS in prisons are needed in order to address the regime and structural issues which lead those imprisoned to use substances.     

The users of Novel Psychoactive Substances: Online survey about their characteristics,attitudes and motivations

BackgroundThe increasing number of Novel Psychoactive Substances (NPS) constitutes a challenge for public health agencies and researchers worldwide. Scientific studies about NPS and their users are limited and there is a need to explore the general motivations for NPS use but also to examine if and how the motivations differ between substances from separate effect classes. The aim of the present study was to investigate the characteristics, including attitudes and motivations, of a self-selected sample of international NPS users.MethodsAn online survey containing questions about drug use history, attitudes, motivations for use, and WHO-5 Wellbeing Index was promoted at the drug discussion forum bluelight.org. The data was analysed using SPSS.ResultsThe sample consisted of 619 international NPS users with overall good emotional well-being despite extensive experience of both traditional and novel drugs. The main incentive for use of NPS in general was pleasure and enjoyment. However, going beyond the general approach to NPS revealed significant variations between drug groups. For example, the use of hallucinogens was substantially motivated by self-exploration and spiritual attainment and showed very low levels of addiction potential while the use of opioids and especially GABA activating substances was mainly motivated by coping and showed much higher levels of addiction potential. Synthetic cannabinoids were the least appreciated and least likely to be used again, and were mainly motivated by circumstances such as availability and legality.ConclusionUnderstanding the different motivations for NPS use in terms of drug groups could enable more effective prevention and consequently a reduction in harm.     

Patterns of alcohol use among men receiving treatment for heroin and/or cocaine use in England,Brazil and Spain. A cross-country analysis

Abstract

Introduction: Although alcohol is widely used concurrently with illicit drugs, the role of alcohol in recovery from and relapse to drug use is under-researched. This study investigates drinking patterns and factors associated with harmful drinking among men receiving community treatment for heroin and/or cocaine use.

Methods: Secondary analysis of 3 cross-sectional studies in England (n?=?153), Brazil (n?=?149) and Spain (n?=?131) was conducted. Sociodemographic, alcohol consumption (AUDIT), substance use, treatment characteristics, and physical health were assessed. Logistic regression determined factors associated with harmful drinking.

Results: 41% of men receiving heroin and/or cocaine treatment met criteria for harmful drinking. Of this, 28% were not receiving treatment for alcohol. Factors identified with harmful drinking among those who were not receiving treatment for alcohol use were as follows: homeless, unemployment/receiving benefits, poly drug use, history of injecting drug(s), hepatitis C seropositive, and receiving treatment for heroin use with/without treatment for cocaine use. Participants from England who met criteria for harmful drinking were more likely to report not receiving treatment for alcohol use than those from Brazil and Spain.

Discussion: Findings show that harmful drinking is common among men in treatment for drug use and remains neglected by the services.     

Drug Use and Conflict in Inner-City African-Anterican Relationships in the 2000s

Abstract

Inner-city relationships face numerous challenges including illegal drug use and its consequences. The nature of this challenge, however, has changed dramatically with a shift from the crack subculture of the 1980s and early 1990s to the subsequent marijuana/blunts subculture. This study presents data concerning 95 inner-city relationships where illegal drug use was present from people who were interviewed in 2004–2006 and reinterviewed in 2008. Hard drug use was still problematic in the 2000s even with the passing of the crack epidemic and its associated behavioral norms. Hard drug (primarily crack) users reported drug use was a problem, reported conflict over drugs, reported higher levels of conflict than others and were the most likely to have broken up with their partner. On the other hand, the experiences and subcultural norms associated with marijuana use appeared to be much less detrimental to relationship harmony. Subjects who used marijuana but not hard drugs reported much less relationship conflict. Indeed, many reported that they enjoyed using marijuana with their partner. These subcultural insights further the understanding that young adults have constructed a much more socially productive subculture regarding marijuana use than their predecessors had constructed around use of crack.     

Examination of Synthetic Cannabinoid and Cathinone Use among a Drug-Using Offender Sample, 2013–2015

Use of novel psychoactive substances (NPS) such as synthetic cannabinoids (e.g., “Spice,” “Serenity”) and cathinones (e.g., “bath salts”) has proliferated in recent years; however, there is a gap in research examining prevalence among offender samples. This study examined demographics, drug use, mental health characteristics, and criminal histories of NPS users compared to non-NPS users within an offender sample entering drug treatment. Using logistic regression analysis, combined 2013–2015 assessment data were examined (N = 8,791). NPS users offended more often (x? = 10.3), were more likely to have experienced homelessness (12.2%), and to have lived in a metro area (59.0%). NPS users reported significantly more past-year drug use, including substances not readily detected by standard urine analysis (e.g., hallucinogens, alcohol, and inhalants). Individuals with higher anxiety symptom counts (OR = 1.07; p < .001) and those who reported drinking to intoxication (OR = 1.30; p < .001) had an increased likelihood of NPS use. Older individuals (OR = 0.95; p < .001) and those who began using drugs at an older age (OR = 0.95; p < .001) were less likely to report NPS use. NPS use may be a marker of more severe using patterns in an offender sample. Future investigation should focus on NPS use as a possible method for bypassing drug testing measures.     

Sexual identity and prevalence of alcohol and other drug use among Australians in the general population

BackgroundInternational research assessing differences in the prevalence of alcohol and other drug (AOD) use among Lesbian Gay Bisexual and Transgender (LGBTI) and heterosexual populations shows elevated prevalence rates of substance use among LGBTI people. To date no research has been published investigating these differences at a population level among both men and women in Australia.MethodsThe 2013 National Drug Strategy Household Survey, a multistage stratified population sample collecting data on AOD use in the Australian population over 14 years of age, was analysed for differences between gay and bisexual (GB) men and lesbian/gay and bisexual (LGB) women and their heterosexual counterparts in: (1) the prevalence of lifetime and past year tobacco and AOD use; (2) age of initiation of tobacco and AOD use; and (3) frequency of alcohol and cannabis use, and history of AOD treatment.ResultsThere were elevated rates of past year cannabis (22.4%), ecstasy (11.8%) and methamphetamine (9.7%) use among GB men compared to heterosexual men (12.4%, 2.9% and 2.5%). LGB women also reported elevated rates of past year use (tobacco – 23.7%; cannabis – 24.6%) compared to heterosexual women (10.6% and 7.1%). LGB women initiated tobacco (15.2 years) and alcohol (15.5 years) at an earlier age than heterosexual women (16.6 and 17.7 years), and were significantly more likely to report daily alcohol consumption (OR 3.2, 95% CI: 2.1, 5.1), and weekly or more frequent cannabis use (OR 1.7, 95%CI: 1.1, 3.1).ConclusionsThese findings are indicative of the need for more responsive and targeted AOD harm reduction and treatment services for LGBTI communities in Australia. Of concern is the elevated risk among LGB women for earlier initiation of substance use, and the development of problematic consumption patterns. Further research, investigating the risk and protective factors for AOD use among LGB women is warranted.     

From niche to stigma—Headshops to prison: Exploring the rise and fall of synthetic cannabinoid use among young adults

The aim of this paper will be to consider the rise and subsequent fall in NPS use at national and local level with a focus on synthetic cannabinoid products in Kent. We will examine the local practice and policy responses by Kent’s Young Persons’ Drug and Alcohol Service towards a possible change in patterns of NPS drug consumption. The county has seen an expansion in the number of Headshops and we present local media coverage on NPS, and the Trading Standards and Kent Police intervention Operation Lantern to regulate Headshops. Through quantitative and qualitative data sets on socially vulnerable young people and prison populations we explore young adults’ perception of pleasure and harm in the use of NPS. Emergent data suggests young adults are now assessing the differences between NPS and more traditional illicit drugs, with this impacting on decision-making about the substances being used. When ‘legal highs’ first appeared they were associated with a more niche middle class demographic, ‘psychonauts’ and experimental users interested in pursuing recreational drug diversity. We examine macro and micro data to suggest that populations most likely to become involved in NPS use are those with degrees of stigma linked to socially vulnerable young adults suggesting that Spice is no longer a feature of middle class recreational drug use.     

Online surveillance of novel psychoactive substances (NPS): Monitoring Reddit discussions as a predictor of increased NPS-related exposures

BackgroundNovel psychoactive substances (NPS) present continuous and growing challenges for the scientific, medical, and interventional communities as emerging substances on recreational drug markets change national and international drug landscapes. NPS account for an increasing proportion of adverse events, hospitalizations, and deaths due to increasing potency and unanticipated biological effects compared to predecessors. This study evaluated the utility of drug use forums as an early indicator or predictor of impending intoxications with potentially harmful or lethal outcomes prior to their occurrences.MethodsEight NPS were selected for evaluation to assess the relationship between online mentions of drugs and their involvement in toxic exposures or overdoses. Mentions on Reddit drug forum discussions were tallied and toxicology testing results from forensic investigations in the US were assessed. The selected NPS covered several subclasses and a predetermined time range (2013–2020). They included carfentanil, U-47700, eutylone, flualprazolam, N-ethylpentylone, 5F-MDMB-PICA, isotonitazene, and brorphine.ResultsSeven NPS (excluding 5F-MDMB-PICA) appeared in discussions on Reddit prior to their implication in poisonings or intoxications. Distinct increases and decreases in number of mentions and number of exposures were observed. For most substances (n = 5, 63%), a rise in Reddit mentions was soon followed by a corresponding rise in toxicology positivity. Peak positivity for carfentanil and flualprazolam, however, preceded peak Reddit mentions.ConclusionsThis study demonstrated the utility of social media sites, such as Reddit, as a predictor for future trends in NPS-related exposures. These results provide confirmation that activity on drug use forums in the virtual world can help predict changes in exposures associated with new or re-emerging NPS in the real world. The results warrant further evaluation as a strategy for inclusion in early warning systems.