Synthetic compounds known as novel psychoactive substances (NPS), or “legal highs,” are intended to replicate the effects of well-established illicit drugs such as cocaine, cannabis, and MDMA. In the past two decades, these substances have emerged as a developing public health concern.
The term “novel” denotes the novelty of these substances, which are not subject to international drug laws and are in a constant state of evolution to elude oversight. Since 2009, hundreds of NPS have inundated global markets; in fact, more than 800 were detected in 2019. Popular among recreational drug users, they are frequently marketed as “safe” and “legal” alternatives to illegal substances, in addition to being inexpensive to manufacture. Nevertheless, the majority of NPS have not undergone human testing, rendering their effects exceedingly capricious.
Predominantly in China and India, novel psychoactive substances are synthesised in underground laboratories prior to their sale on the Internet as “research chemicals” or in head stores under the names “herbal highs” or “bath salts.” Utilising vulnerabilities in drug laws that prohibit substances based on name rather than chemical structure, this illegitimate sale occurs. By purposefully modifying the molecular structures of illicit substances, NPS producers generate new, unregulated analogues at a rate that exceeds the capacity of legislation to adapt.
Users are exposed to additional dangers due to the total absence of quality control during NPS production and distribution. Products are infrequently pure, frequently comprising adulterants and mixtures of substances. Unknown are the components and concentrations, which differ between batches. Additionally, sales and possession transpire via street merchants. These unregulated and erratic NPS pose a grave threat to public health.
The adverse effects of NPS use on health can be severe, acute, and chronic. The most frequently reported adverse effects include psychosis, agitation, anxiety, seizures, hallucinations, and aggression. Organ injury, cascade serotonin toxicity, dependence, and mortality have also been linked to NPS, particularly when combined with illicit substances such as cocaine or MDMA. Cannabinoids of synthetic origin have been linked to multiple fatalities. Users face heightened health hazards when they lack awareness regarding the substances they are consuming.
Estimating the prevalence of NPS use is challenging due to the limited detection capabilities of common drug screenings. However, research indicates that lifetime usage among the targeted young adult samples ranges from 0.4% to 42%. Particularly vulnerable populations—homeless youth, nightclub patrons, and men who have sex with males—are highly susceptible to substance abuse. Internet connectivity has made the world more accessible.
Multiple structural and behavioural factors may be influencing usage. Motivations for seeking legal alternatives include boredom, curiosity and experimentation, and the perception of safety in comparison to illicit substances. Additionally, the tech-savvy generation prefers to make purchases online. As indicated by low prices, economics is a factor. Additionally, social influences, accessibility, and tension relief are factors to consider.
Expanding NPS necessitates collaborative, comprehensive public health strategies:
User monitoring and enhanced NPS surveillance are required to track trends. It is proper to educate clinicians regarding symptoms of use.
The hazards of NPS must be communicated to the public, particularly to the youth who are the focus of marketing efforts. The dangers of substance combinations should be addressed in harm reduction education.
Forensic and toxicological detection advancements will facilitate the analysis of NPS contents and contribute to the improvement of clinical care.
Targeting the supply chain, legislation and law enforcement against manufacturing and distribution must be strengthened.
Sales on the Internet must be halted. Penalties ought to be imposed on retailers and social media platforms that facilitate sales.
Drug treatment programmes ought to be equipped to address complications associated with NPS, such as psychosis and dependence.
NPS are an alarming new frontier in the realm of recreational drug use and pose a grave and ever-changing threat to public health. Sector-wide collaboration is required to contain this expanding, ever-evolving problem and safeguard those who are most vulnerable.