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Significant changes in British recreational drug use were seen throughout 2009, with the emergence and rapid growth in the availability and use of substituted cathinones or ‘M‐Cats’ (most notably mephedrone and methylone), a group of psychoactive drugs not currently controlled under the Misuse of Drugs Act 1971 (HM Government, 1971), with similar effects to ecstasy, cocaine and amphetamines. The reasons for the appearance and appeal of this group of so‐called ‘legal highs’ are explored here in relation to availability, purity, legality and convenience. The authors argue that a reduction in the availability (and thus purity) of illegal drugs such as ecstasy and cocaine and resultant disillusionment among users was a key motivation for displacement to substituted cathinones, conveniently and legally purchased online. Finally, we explore policy considerations around the likely criminalisation of substituted cathinones and the challenge of providing rapid yet considered harm reduction responses to emergent drug trends in the face of a minimal scientific evidence base and eager press demonisation.

The purpose of this paper is to suggest that the emergence of substituted cathinones or M-cat drugs (notably mephedrone and methylone) and their rapid proliferation of use, amongst drug users in the UK from 2009 onwards, signals changes in the habits, preferences and lifestyle choices made by certain drug users, whilst also indicating a pronounced increase in the levels of co-morbid mental health conditions experienced by another, yet often distinct, group of users.

This latter group of users, it is suggested, tend to initiate use of psychoactive substances (including tobacco and alcohol) at a younger age. In addition, it is suggested, they often present to treatment and criminal justice services with a history of chronic childhood relational trauma, as a background against which severe patterns of drug abuse has evolved. In this light the lack of significant supplies of social capital, as a protective factor against the development of chronic drug use, is further considered in the paper that follows though a brief literature review and qualitative clinical case reports.

Novel psychoactive substances ( Newcombe, 2013) appear so seductive, for a certain group of users, because they seem to provide a temporary form of cognitive and emotional anaesthesia, enabling users to self-medicate, often against experiences of profound psychological trauma and contemporary lives that are typically experienced as boring, hopeless and pointless. The euphoric effects of psycho-stimulants such as mephedrone are particularly appealing to individuals attempting to escape a subjective sense of daily dysphoria and may on this basis lead to, rather than recreational use, more persistent patterns of drug use. However, in contradistinction to this group of users, another recreational – mainly weekend leisure – group of users continues to evidence a voracious appetite for psycho-stimulant substances.

It is suggested that this second group of users has been particularly influential in substitute displacement towards the emergence of legal highs, due to the poor quality and illegal status of street drugs such as cocaine, amphetamine sulphate and MDMA (ecstasy).

The market in licit recreational drugs is continuing to grow, both in the UK and elsewhere, and the internet has been acknowledged as a key factor in enabling this rapid expansion over the last few years. This is particularly true of the recent rise in popularity of the substance mephedrone (4‐methylmethcathinone) and related cathinones. Keeping up to date with these new drugs and emerging trends is a challenge for both professionals and users, particularly given the relative paucity of balanced and reliable information available and the potential for misinformation to be widely disseminated. This article examines the transmission of inaccurate information in relation to mephedrone and substituted cathinones, and discusses the implication of this for harm reduction and future research, by looking at the results of the European Commission funded Psychonaut Web Mapping project, which used online resources to detect emerging trends, monitor their diffusion, and develop a reasonably accurate profile of these new psychoactive compounds.

Mephedrone is a synthetic stimulant drug causing entactogenic and hallucinogenic effects. A systematic review of all existing empirical research and literature from 2009‐2012 on this new psychoactive drug was conducted. This paper aims to report on that review.

The review was conducted according to PRISMA guidelines. Electronic databases were utilised using the search terms “mephedrone” and product nomenclature; “Plant Food”, “Feeder”, “Meow Meow”, “Miaow”, “Drone”, “Meph” “Bubbles”, “Charge”, and “MCat”. The search was restricted to publications from 2009‐2012, and produced 702 results. Data were collected by one member of the research team and cross checked by another. A primary screening was carried out to exclude inaccurate search results and drugs other than mephedrone. The results were studied and duplicates removed; 598 results were discarded, with 104 deemed suitable for inclusion.

The review underscores mephedrone's popularity despite legislative controls. Drug displacement patterns from illicit to licit were observed prior to controls, with blending of mephedrone and other substitute cathinones with street drugs thereafter. User consumptive choices are grounded in availability, perceptions of legality and safety, curiosity and perceived quality of drug outcomes within poly drug taking repertoires. Clinical reports indicate that mephedrone has high abuse potential and toxicity, with several dependence symptoms. Risk assessment, detection, diagnosis and treatment of mephedrone use are difficult due to polydrug use and associated mental health disorders.

The review points to the need for further research into the pharmacology and toxicity of mephedrone in order to better equip clinicians with assessment, diagnosis and treatment strategies to reduce morbidity.

The increasingly diversified new psycho stimulant market where mephedrone is a major player poses unprecedented challenges for drug surveillance, policy, community and clinical practice.

Stricter legislative controls including internet vendor responsibility for supply of mephedrone have been suggested, along with raising public awareness on an international level through coordinated efforts.

The last review was published in 2009 by the Psychonaut Webmapping Group. This review brings together a comprehensive new set of data sources as they relate to this drug.

The purpose of this paper is to explore the various ways users of synthetic cannabinoids (SCs) managed the dangers associated with the consumption of this substance.

This paper is based on a parent study of the use and market of synthetic cathinones (also known as “bath salts”) in New York City, Houston, Galveston and New Orleans. Focus groups were conducted in all four cities with a total of 20 individuals who identified as users of SCs. Grounded theory was used to analyse focus group transcripts.

Participants were aware of drug-related risks and implemented strategies to reduce harm to health. Protective measures fell into two broad categories: marketing and consumption. They noted the instability of SC products and consumer manipulation through packaging. Harm reduction (HR) strategies included: carefully selecting SC sources; sticking to one brand; handling their own SC; managing amount of K2 consumed in one sitting; controlling the pace.

Given the small amount of data on user experience with SCs and its risk to health, it is important to learn from users themselves how they create methods to keep themselves safe. This is one of the first studies recording HR practices of SC users and can contribute to intervention programs and organisations serving substance users.

The purpose of this paper is to provide health professionals with novel psychoactive substances (NPS) clients with up to date information relating to the background, clinical pharmacology and, when possible, clinical management for each of these categories.

The world of NPS is complex and diverse, including a range of different molecules such as: psychedelic phenethylamines; synthetic cannabinoids, cathinone derivatives; novel stimulants; synthetic opiates/opioids; tryptamine derivatives; phencyclidine-like dissociatives; piperazines; GABA-A/GABA-B receptor agonists; a range of prescribing medications; psychactive plants/herbs; and a large series of performance and image-enhancing drugs. These molecules are sought by users for their psychactive effects.

The NPS categorization and classification provided here is an attempt to identify and better understand some of these substances. Given the vast range of medical and psychopathological issues associated with the NPS described it is crucial for health professionals to be aware of the effects and toxicity of NPS. The EU-MADNESS project aims to both better understand the pharmacology of the available/forthcoming NPS and to disseminate the most current NPS-related information to practising and training health professionals.

Further studies are required to identify a range of evidence-based, NPS-focused, clinical management and treatment strategies.

The rapid pace of change in the NPS online market constitutes a major challenge to the provision of current and reliable scientific knowledge on these substances.

The present review will provide an overview of the clinical and pharmacological issues related to a few hundred NPS.

In this fourth paper in a series on emergent drug trends in the UK (2006 ketamine, 2009 MDMA powder/crystal, 2010 mephedrone), the authors consider how the pharmacological landscape has changed since substituted cathinones (including mephedrone) were controlled in April 2010 and in particular assess the prevalence of mephedrone in the general night time economy (NTE) and its relationship to the use of established illegal drugs.

Surveys were conducted with a convenience sample of 207 adults stopped at random in four town and city centres on Friday nights in Lancashire in November 2010.

Of the adults surveyed, one in ten reported having taken mephedrone within the past year and one in 20 within the past month. Those who used mephedrone were also significantly more likely to report using ecstasy pills, cocaine and amphetamines. Regarding the next generation of “legal highs”, no clear substitute for mephedrone had emerged; instead, there was uncertainty, confusion and a degree of disinterest. In this vacuum, “Bubble” has emerged and evolved as a generic term in the north west of England to refer to any unidentified white powders which are synthetic stimulants.

Despite an emotional investment by advocates and opponents alike in mephedrone being an ecstasy‐type substitute, research now points towards more amphetamine‐type characteristics at a time when national prevalence of amphetamines is at an historic low. The emergence of unidentified white powders sold as “Bubble” in the North West of England is a graphic illustration of the unknown content, effect and risk of current (by contrast with previous) “legal highs”, and the resultant challenges for health service providers and criminal justice agencies. Bubble may be indicative of the enduring popularity but increasingly indiscriminate use of cheap stimulants.

For this cohort of NTE customers, the paper's analyses indicate that mephedrone was added to existing polydrug repertoires, rather than significantly displacing use of established illegal drugs or acting as a gateway for initiation into drug use.

–Khat is a bushy plant whose leaves are chewed for a mild amphetamine effect. The purpose of this paper is to investigate khat's multiple effects, broadly defined to include impacts on producers, traders, and consumers, as well as on the biophysical environment, in northern Madagascar.

This primarily ethnographic study (conducted from 2004 to 2010), includes observation, semi-structured interviews, and orally administered questionnaires.

Khat's effects include strain on the household budgets of consumers, but increased earnings to producers and traders. In addition, there is some evidence of consumers’ strained primary social relationships, yet khat chewing is also positively linked with new forms of urban multiethnic identity.

To evaluate a drug's overall effects, it is critical to understand it within wide-ranging political, economic, biological, and cultural contexts. Many studies of drugs focus on only one component. While this makes for more manageable research designs, it obscures the complex interplay of numerous factors. This impedes general understanding and furthermore makes it difficult to design broadly effective, multisector intervention strategies.

This analysis reveals the intricacy of khat's effects in Madagascar while programmatically proposing a model for doing research with policy implications on other psychotropic substances.

To the best of the authors’ knowledge, no study has previously examined the use of psychoactive substances (PASs) at electronic dance music (EDM) events in Ukraine. Addressing this gap in the research literature, this study aims to: describe the recreational drug scene associated with Ukrainian EDM culture; identify clusters of EDM participants who use PAS, based on their drug use patterns; and assess the uptake of drug checking and investigate associations between drug checking and subsequent drug-related behaviour.

A series of cross-sectional surveys were conducted in 2021 (N = 1,307) among EDM festival participants in Ukraine. The authors performed cluster analysis to identify distinct profiles of PAS users. Trends in drug checking were analysed based on cross-sectional surveys conducted at one recurring festival in 2018 (N = 99), 2019 (N = 195) and 2021 (N = 237).

The substances most often used at EDM events were 3,4-Methylenedioxymethamphetamine (37%), amphetamine (16%), lysergic acid diethylamide (11%) and cocaine (9%). Between 2018 and 2021, the proportion of participants who reported to have ever tested their drugs has increased from 2% to 26% (p < 0.001). Unexpected or inconclusive test results led to a significantly lower chances of drug consumption (p = 0.003). The authors identified three distinct clusters of PAS users among the EDM festival attendees in Ukraine.

This study will inform the development of harm reduction interventions tailored to various subgroups of recreational PAS users taking into account gender-specific patterns of use suggested by the authors’ cluster analysis. Increased availability of drug checking is crucial to reduce the risks of drug-related harm associated with the consumption of mis-sold, mislabeled and/or adulterated substances.