Novel psychoactive substances (NPS), commonly known as “legal highs,” are synthetic chemicals intended to imitate the effects of well-known illegal narcotics such as cannabis, cocaine, and MDMA. Over the last two decades, these drugs have emerged as a developing public health problem.
The term “novel” refers to the fact that these drugs are new, are not regulated under international drug regulations, and are continually altering to avoid detection. Hundreds of NPS have been identified in markets around the world, with over 800 detected between 2009 and 2019. They are cheap to manufacture and are frequently marketed as “legal” and “safe” alternatives to illicit substances, making them popular among recreational drug users. The majority of NPS, however, have never been evaluated in people, and their effects are exceedingly unpredictable.
NPS is synthesised underground in China and India before being sold online as “research chemicals” or in head shops as “herbal highs” or “bath salts.” This ostensibly lawful sale takes advantage of gaps in drug laws that restrict compounds by name rather than chemical structure. NPS makers purposefully alter the molecular structures of prohibited substances in order to develop new, uncontrolled counterparts faster than legislation can keep up.
The utter lack of quality control in NPS manufacture and dissemination adds to the risks for users. Products are rarely pure, and they frequently contain mixes of chemicals and adulterants. The ingredients and concentrations are unknown, and they differ from batch to batch. Street vendors are also used for possession and sales. These unpredictability and unregulated NPS pose a serious public health risk.
The health consequences of NPS usage can be severe, acute, and long-lasting. Tachycardia, agitation, anxiety, seizures, hallucinations, aggressiveness, and psychosis are the most commonly reported side effects. NPS has also been linked to organ damage, cascade serotonin poisoning, dependence, and mortality, particularly when combined with other illegal drugs like cocaine or MDMA. Synthetic cannabinoids have been related to a number of deaths. Users’ health hazards are exacerbated because they are uninformed of what substance(s) they are taking.
Use of novel psychoactive substances is difficult to determine due to the poor detection in standard drug testing. However, studies on targeted young adult samples show lifetime use ranging from 0.4% to 42%. Use is especially prevalent among vulnerable groups such as homeless teenagers, nightclub patrons, and men who have sex with males. The Internet has made the world more accessible.
A variety of behavioural and structural variables may be motivating use. Seeking legal alternatives, curiosity and experimentation, boredom, and perceived safety versus illicit substances are all popular causes. The tech-savvy youth is increasingly drawn to online shopping. Low pricing indicate that economics is a driving factor. Social influences, availability, and stress relief all play a part.
The expanding NPS issue necessitates strong, joint public health strategies:
To detect trends, improved NPS surveillance and user monitoring are required. Clinicians should be trained on use symptoms.
People, particularly teenagers targeted by marketing, must be made aware of the dangers of NPS. Drug combination hazards should be addressed in harm reduction education.
Advances in forensic and toxicological detection will aid in the analysis of NPS contents and will inform clinical therapy.
Legislation and law enforcement against manufacture and distribution must be strengthened, with a focus on the supply chain.
Sales on the internet must be disrupted. Allowing sales should result in sanctions for retailers and social media networks.
NPS-related issues, including as psychosis and dependence, should be addressed in drug treatment programmes.
NPS are an alarming new frontier of recreational drug usage as well as a severe and evolving public health issue. To address this increasing, ever-changing issue and protect those most vulnerable, cross-sector collaboration is required.