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In January 2006 ketamine shifted from medical regulation through the Medicines Act to a Class C drug through an amendment to the Misuse of Drugs Act. In the debate surrounding this criminalisation, interest has grown in prevalence and patterns of ketamine consumption. Such information is scarce however, particularly given that ketamine has yet to be included in the British Crime Survey or most other surveys of youth and young adult drug use. Here Karenza Moore and Fiona Measham reveal the true extent of ketamine use, who is using it and how.

Ketamine intoxication has been mooted as a model of some of the signs and symptoms of psychosis. However, little research has focused on the self‐report experience of ketamine users. The purpose of the current study is to quantify (the frequency of occurrence of) ketamine induced phenomenology in recreational users. The paper also seeks to meaningfully group these experiences into facets and their principal components.

Respondents completed a checklist of experiences, the Ketamine Experiences Questionnaire (KEQ). Two samples were recruited via opportunity and snowball sampling one in 2009 (n=52) and one in 2010/11 (n=35).

The “Q‐sort” and principal component analysis (PCA) indicate that there are two factors, factor one representing aversive ketamine experiences (accounting for 48.2 per cent of the variance) and factor two representing appetitive ketamine experiences (accounting for 20.1 per cent of the variance). Ketamine induces a raft of appetitive, aversive and transcendental experiences many of which are illustrated. The data suggest that a decision about whether to continue using ketamine (and if so, how often) depends in part on an intuitive cost‐benefit analysis of the phenomenology that it induces.

There are some notable limitations to the current study; the small sample size to variable ratio necessitated a “Q‐sort” before PCA; the sampling procedure prohibited the generation of a representative sample; and there were no means of independently verifying ketamine use.

This study represents a novel exploration into ketamine phenomenology and the principal components of these experiences.

The opioid epidemic in the USA, the new psychoactive substances emerging on the market and the recent increase in cocaine treatment demands in Western Europe, all emphasise the importance of monitoring the use and harms of drugs over time. To be informed about new consumption patterns, this study aims to study the trends among people entering treatment for substance use in Belgium.

Belgian data from the Treatment Demand Indicator collected between 2015 and 2019 were used. A reference group of treatment units was selected to allow for comparisons between the different years. Trend analysis was performed by using a joinpoint regression among different regions and groups of clients.

The drugs of choice that were most frequently mentioned among the 23,000 analysed treatment episodes were alcohol and cannabis. Both remained relatively stable over time. Heroin seemed to be decreasing significantly at the national level, but increased in Brussels. Benzodiazepines decreased significantly in Flanders and Brussels, but not in Wallonia. On the other hand, reports of crack cocaine increased significantly in the three regions with a more pronounced trend in Wallonia and Brussels. Substances such as fentanyl, methamphetamine, ketamine or volatile inhalants have been mentioned significantly more by people entering treatment in 2019, although their contribution to the total number is still limited.

To the best of the authors’ knowledge, this study is the first to evaluate trends for all drugs of choice at a national and regional level. These results might not only benefit national policymakers but also other countries with similar alcohol or drug use patterns.

The purpose of this paper is to explain how international drug policy continues to have a hugely damaging effect on population health, human rights and wellbeing, not only on individuals who consume and/or sell drugs but also on societies as a whole. And to review whether anything has changed after United Nations General Assembly Special Session.

UNGASS had been seen as a real opportunity for scientific evidence to become the driver of future drug policy. This paper looks at any changes that have since taken place that might support such an aspiration.

The authors found the criminalisation and incarceration of people who use drugs, mainly from the most marginalised sections of society, remains the primary response in almost every member state of the UN and there are at least 33 countries that retain the death penalty for drug offences. The impact on the health of people who inject drugs (PWIDs) living with HIV is devastating and overdose and AIDS related mortality are the leading causes of death. Hepatitis C infections among PWIDs are increasing at epidemic levels even though this now a curable disease.

Changes in drug policy urgently needed.

This paper is an important review of the health implications of bad drug policy.

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.

Drug-related web forums have been argued to be an effective way to investigate the latest generation of drug users. The purpose of this paper is to explore discussions about drugs and new psychoactive substances (NPS) on an Italian psychonauts’ online community in order to gain a better understanding of the psychonauts’ profiles by scrutinising their main motives for consumption, which is mainly addressed to psychedelic drugs.

To collect data, a keywords list was used in the forum search engine. The first five most recent conversations (threads) for each of ten most frequently mentioned substances were selected. In addition, ten posts written by new forum members to introduce themselves were added to the data set, bringing the total number of threads to 60. The data were coded using Atlas.ti 7 applying a template model analysis (King, 1998).

The forum members present themselves as well-educated, informed drug users, and connoisseurs of the pharmacological properties of chemical compounds: accordingly, they claim to be aware of drug effects and possible risks. The analysis of the motives for using psychedelic drugs substantially confirms previous studies, indicating that the main reasons include spiritual needs, self-exploration and self-treatment. The shift from a recreational use towards more “committed” aims such as self-development is seen as a step forward in a drug user’s career. A generalised interest in harm reduction suggests that the psychonauts’ attitude may be a protective factor against adverse consequences of drug use. The most problematic users represented in the data are those who use drugs for self-treatment, since their discourse focusses on suffering rather than on pleasure.

Most efforts to analyse and monitor drug-related forums have focussed on “leading edge” English-language international websites. No studies have dealt with Italian forums. Furthermore the study address a misleading use of the term e-psychonauts recently introduced by some scholars whose’s studies were focussed on NPS.

This chapter discusses the genealogy and development of the ‘access abyss in palliative care and pain relief’ affecting 80 per cent of the world’s people. It argues that the larger context is an epistemic abyss constituted by incomplete information about the need for controlled medicines for pain relief, and that decades of drug policy based on supply control have prevented development of the necessary knowledge base in many countries. Transnational civil society organisations are working to map and bridge this abyss through education, advocacy and action. Deeper (original) systemic and tensions in the original multilateral drug control narrative produced the current epistemic/clinical abysses and now provide space for more participatory civil society involvement. Where the earlier narrative focussed on a fear-based drive to discipline and punish non-medical use of controlled substances, the evolving (and still contested) ‘world drug problem’ narrative foregrounds person centred, human rights based, public health approaches to drug policy that explicitly support improved access to internationally controlled essential medicines. Recommended policies can only be operationalised through a concerted ‘all hands on deck’ effort guided by the international law principle of ‘mutual and shared responsibility’ for improving access within the context of the 2030 Agenda for Sustainable Development. This calls for enhanced communication, concerted advocacy, collaboration and pluralist praxis to fill the often gaping abyss between ‘black letter law’ — what is actually written in the drug control conventions — and how member states learn to interpret and operationalise it.

The purpose of this paper is to describe and summarize the recent emergence of NPS onto the drug market. To show the international and national responses, legal and guidance. To indicate some of the challenges NPS present to jurisdictions. To indicate some of the challenges NPS present to treatment agencies. To outline what is known about prevalence and effects.

A narrative account of the substances becoming known and the response made by jurisdictions.

The use and effects of NPS are slowly becoming known and exchanged between jurisdictions and treatment agencies. The user group appears to differ from the “traditional” substance users groups with which agencies are familiar. The use of the internet is a characteristic of this new market and user group.

New substances are constantly being identified. Previous treatment approaches may not be fully relevant to NPS. The new area of cognition enhancement is being gradually realized.

Treatment agencies need to develop new approaches, both to treat the effects of NPS use and to attract NPS users, who do not identify as “drug users”.

A new user group appears to be emerging. Cognition enhancement is a feature of NPS composition and use/attraction.

An attempt to summarize existing understanding of NPS use and marketing and to predict future trends and needs.

The purpose of this paper is to analyse dynamics amongst members to better understand in what terms and to what extent marketplace forums can be seen as new forms of harm reduction.

This is a qualitative analysis focused on conversations about psychoactive substances on the forum community of AlphaBay Market. A sample consists of 100 online threads. The data, collected in July 2016, were analysed by applying the grounded theory approach with the support of Atlas.ti.

Conversations in the marketplace forum focus mostly on the purchase. Concerns and disputes are voiced in a significant proportion of them, and interactions are affected by a climate of distrust where stigmatisation processes can emerge between users of different drug categories. This casts a certain amount of doubt on the thesis that marketplace forums – like online forums – are new forms of harm reduction and peer-led communities.

The study focuses on only one marketplace forum. Other such forums should be analysed to corroborate its findings.

Harm reduction interventions in the online environment should take different form according to the forum type, and take the differences and boundaries that separate users of different substances into account.

Thanks to its infrequently used qualitative approach, the study provides a more thorough understanding of the relationships on marketplace forums.

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.