Novel psychoactive substances: types, mechanisms of action, and effects, BMJ 2017;356:i6848
https://www.bmj.com/content/356/bmj.i6848
What you need to know
- Novel psychoactive substances (NPS, “legal highs”) are compounds designed to mimic existing established recreational drugs. They can be grouped into four main categories: stimulants, cannabinoids, hallucinogens, and depressants
- Legislation regarding NPS varies internationally. In the UK it is now illegal to distribute or sell NPS, but possession is not a criminal offence
- NPS should not be regarded as safer than established recreational drugs
- The most commonly clinically encountered NPS are stimulants (such as mephedrone) and cannabinoids (such as “spice”)
- Psychiatric and rehabilitation units, prisons, and schools face particular challenges in detecting and preventing use
In 2016 the Psychoactive Substances Bill banned trading but not possession of all current and future novel psychoactive substances (NPS), sometimes incorrectly called “legal highs,” in an attempt to overcome rapid proliferation of these compounds. Over 560 substances are currently monitored by the European Monitoring Centre for Drugs and Drug Addiction, with 100 new agents identified in 2015 alone. Stimulants and synthetic cannabinoids account for the vast majority and are the types most commonly clinically encountered.1 Online purchases are increasing according to the 2016 Global Drug Survey,2 potentially in response to legislative changes, as is overall NPS use: lifetime consumption was reported by 8% of younger individuals in 2015, up from 5% in 2011, with figures relatively similar between sexes and different countries.3
