The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations

Abstract

BackgroundAlthough illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.ObjectivesTo inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.DesignA scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.ResultsA total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.LimitationsScoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.ConclusionsKey research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.Future workThe validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.Study registrationThe systematic review element of this study is registered as PROSPERO CRD42016026415.FundingThe National Institute for Health Research Public Health Research programme.

Clinical and analytical experience of the National Poison Control Centre with synthetic cannabinoids

“…The growing number of SCRAs on the global and national market, their chemical diversity, frequent changes in composition, and difficulties that come with the analysis of these substances pose a significant challenge for clinical toxicologists and forensic services. Routine analysis and screening of these substances in biological samples and seized materials mainly rely on the analytical methods such as GC/MS, HPLC/MS, and immunochemical assays (10,(16)(17)(18)(19)(20)(21)(22)(23).…”

Understanding the UK Psychoactive Substances Act

“…A variety of schemes for controlling and regulating the supply of NPS have been devised and trialled around Europe. 23 None of these appear to have been completely successful although it is important to remain mindful of international best practice. 1 It is hoped that a reexamination of the effectiveness of the PSA after it has been in place for a more substantial period of time will reveal a sustained benefit to those a risk due to use of NPS.…”

Evidence for public health on novel psychoactive substance use: a mixed-methods study

“…Using a scoping review, Mdege et al 45 identified 995 articles, the majority of which examined the healthrelated adverse effects of NPS use at the individual level. They highlighted that the expanding literature on the NPS phenomenon is primarily clustered around four key areas:…”

“…46 They conclude that the literature is characterised by being early in its stage of development and lacking in data to directly inform an evidence-informed public health response to NPSs. 45 Regarding survey data, there are 29 identified studies that assessed NPS use prevalence in the UK. The authors usefully summarised the findings of the prevalence studies in tabular form.…”

“…In contrast to the limited body of research on motivations for NPS use, there has been more focus on the harmful impact of NPS use, as revealed in the recent review by Mdege et al 45 Systematic review evidence suggests that frequent side effects of NPS include psychotic symptoms, behavioural changes (e.g. aggression) and physiological effects such as changes in blood pressure, pulse and temperature.…”