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Article
Publication date: 4 September 2017

Raven Egheosa Owie, Paul Gosney, Andrew Roney and Aileen O’Brien

The purpose of this paper is to measure the level of experience and knowledge of novel psychoactive substances (NPS) amongst psychiatrists, asking them to rank NPS against…

Abstract

Purpose

The purpose of this paper is to measure the level of experience and knowledge of novel psychoactive substances (NPS) amongst psychiatrists, asking them to rank NPS against other psychoactive substances in terms of concern and the role they believe NPS play in the diagnosis and management of psychiatric disorders.

Design/methodology/approach

An online survey was created and emailed to all 217 psychiatrists working for a large city Mental Health Trust.

Findings

In total, 108 of 217 psychiatrists responded to the survey. A majority of the respondents believed that their level of knowledge of NPS was inadequate and stated that they would like to receive more training. Half of them either named only one or no NPS that they had encountered within the last five years. There was a correlation between the experience of the respondent and the number of NPS that they could name.

Practical implications

Most of the respondents assessed their own knowledge of NPS as either poor or basic. Psychiatrists’ knowledge of NPS could be improved by having regular NPS-related training, by being sent regular updates on NPS and by including lectures in the Membership of the Royal College of Psychiatrists courses. Psychiatrists should also be encouraged to access online resources such as NEPTUNE and the European Monitoring Centre for Drugs and Drug Addiction.

Originality/value

This is the first survey of the UK psychiatrists of their knowledge and experience of NPS.

Details

Drugs and Alcohol Today, vol. 17 no. 3
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 21 August 2017

Charlie Place, Andy Scally, Laura Gow, Amy Wade, Rob Barrowcliff, Iram Nasim and Miriam Nyamuchiwa

Novel psychoactive substances (NPS) – often known as “legal highs” – are a varied group of substances that are causing concern due to their possible effects on mental…

Abstract

Purpose

Novel psychoactive substances (NPS) – often known as “legal highs” – are a varied group of substances that are causing concern due to their possible effects on mental health. Particular concerns have been raised about synthetic cannabinoid receptor agonists often known as “Spice”. The purpose of this paper is to identify the prevalence of NPS use and explore any association with acute psychological disturbance.

Design/methodology/approach

The authors reviewed the case notes for 153 admissions to a male acute inpatient ward. Prevalence of reported NPS use and admissions to psychiatric intensive care unit (PICU) were recorded.

Findings

In total, 18.9 per cent of individuals admitted to acute inpatient care were reported to have used NPS. NPS users were almost ten times as likely as their non-NPS using peers to require care in PICU. This result was statistically significant (Fisher exact test: p<0.001). Although caution is required given the limitations of this study, the data and clinical experience suggest that synthetic cannabinoids may be the specific type of NPS that is being used by this group.

Practical implications

Mental health professionals can expect to care for people using NPS in acute inpatient environments, and so they need to understand the nature and effects of these substances. It is possible that NPS use may be associated with sustained acute psychological disturbance.

Originality/value

There have been few studies on the prevalence of NPS use in inpatient environments and none of them have published that explore the association with PICU admission. Despite the limitations of this study, it has significant value by identifying an urgent need for comprehensive research in this area.

Article
Publication date: 19 February 2018

Elizabeth Hughes, Dan Bressington, Kathryn Sharratt and Richard Gray

There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The purpose of this paper is to undertake a scoping…

Abstract

Purpose

There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The purpose of this paper is to undertake a scoping survey to explore the inpatient mental health workers’ perceptions of NPS use by consumers.

Design/methodology/approach

A cross-sectional online survey of mental health professionals is used in the study. The participants were opportunistically recruited through social media and professional networks.

Findings

A total of 98 participants (of 175 who started the survey) were included in the analysis. All reported that some patients had used NPS prior to admission. Over 90 per cent of participants reported observing at least one adverse event relating to NPS use in the previous month. The majority of participants reported that patients had used NPS during their inpatient admission. Three quarters were not clear if their workplace had a policy about NPS. Most wanted access to specific NPS information and training. The participants reported that they lacked the necessary knowledge and skills to manage NPS use in the patients they worked with.

Research limitations/implications

Whilst the authors are cautious about the generalisability (due to methodological limitations), the findings provide useful insight into the perceptions of inpatient staff regarding the extent and impact of NPS use including concerns regarding the impact on mental and physical health, as well as ease of availability and a need for specific training and guidance.

Practical implications

Mental health professionals require access to reliable and up-to-date information on changing trends in substance use. Local policies need to include guidance on the safe clinical management of substance use and ensure that NPS information is included.

Originality/value

To the best of the authors’ knowledge, this is the first survey of the perceptions of mental health staff working in inpatient mental health settings regarding NPS. The findings suggest that NPS is a common phenomenon in inpatient mental health settings, and there is a need for more research on the impact of NPS on people with mental health problems.

Details

Advances in Dual Diagnosis, vol. 11 no. 1
Type: Research Article
ISSN: 1757-0972

Keywords

Article
Publication date: 25 February 2014

Alistair David Sweet

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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).

Details

Drugs and Alcohol Today, vol. 14 no. 1
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 2 March 2015

Fabrizio Schifano

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…

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Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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

Social implications

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.

Originality/value

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

Article
Publication date: 1 June 2015

Amira Guirguis, John M. Corkery, Jacqueline L. Stair, Stewart Kirton, Mire Zloh, Christine M. Goodair, Fabrizio Schifano and Colin Davidson

– The purpose of this paper is to determine pharmacists’ knowledge of legal highs (novel psychoactive substances (NPS)).

Abstract

Purpose

The purpose of this paper is to determine pharmacists’ knowledge of legal highs (novel psychoactive substances (NPS)).

Design/methodology/approach

A questionnaire was handed out at two London pharmacist continuing education events in mid-2014. These events update pharmacists about developments of interest/relevance to the profession and to improve their practice. A total of 54 forms were returned; a response rate of 26 percent.

Findings

Most pharmacists had poor knowledge of NPS and many considered that NPS were not important to their work, with few having had to advise customers in this area. Despite this, the majority thought that they had insufficient information about NPS. There was a negative correlation between the age of the pharmacist and knowledge of NPS.

Research limitations/implications

The sample is a self-selected one drawn from registered pharmacists working in community pharmacies in northwest London, and thus does not include hospital pharmacies. Self-selection means that respondents may only reflect those who are interested in the NPS phenomenon and not the wider pharmacy community. The geographical area covered may not be representative of London as a whole, or indeed other parts of the UK or other EU countries.

Practical implications

It is clear that pharmacists do not know much about NPS but would like to know more. This information might improve their practice.

Social implications

Pharmacists, easier to see than general practitioners, could be a useful source of information for NPS misusers.

Originality/value

There have been no previous attempts to gauge the level of knowledge by pharmacists of legal highs/NPS in the UK or elsewhere to our knowledge.

Details

Drugs and Alcohol Today, vol. 15 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Article
Publication date: 6 June 2016

Liviu Gabriel Alexandrescu

The purpose of this paper is to investigate a group of Romanian injecting substance users “migrating” from heroin to novel psychoactive substances (NPS) as a counterpublic…

Abstract

Purpose

The purpose of this paper is to investigate a group of Romanian injecting substance users “migrating” from heroin to novel psychoactive substances (NPS) as a counterpublic seeking to escape the stigma of drug abjection.

Design/methodology/approach

The findings are drawn from interview and observational data collected mainly at drug services sites in Bucharest, Romania.

Findings

The stimulant powders sold by head shops appealed to experienced drug users because they seemed to emulate a consumerist ethos and cultivate a healthy, rational agent that popular discourses of addiction deem incompatible with drug careers. NPS and head shops were thus initially understood as a possibility of escaping “junk identities”. However, they ultimately sealed injectors as abject bodies that obstructed the collaborative goals of rehabilitation and health restoration. A sense of symbolic distance shaped by notions of moral and bodily hygiene separated heroin and NPS users, as the latter increasingly came to be seen and see themselves as flawed consumers of health and freedom.

Practical implications

NPS retail spaces could present valuable opportunities to insert harm-reduction resources and harness counterpublic health strategies.

Social implications

Dominant definitions of substance use as unavoidable paths into self-destruction push users towards unknown compounds they can attach more fluid meanings to. This suggests that prohibitionist language still obscures rational dialogue about existing and emerging drugs.

Originality/value

The paper traces ATS/NPS in an Eastern European context offering an alternative vantage point to harm-focused perspectives.

Details

Drugs and Alcohol Today, vol. 16 no. 2
Type: Research Article
ISSN: 1745-9265

Keywords

Abstract

Details

Drugs and Alcohol Today, vol. 15 no. 1
Type: Research Article
ISSN: 1745-9265

Article
Publication date: 18 December 2019

Emma Mckenzie and Joel Harvey

New psychoactive substances (NPS) are increasingly being used in secure mental health settings. Within these settings, NPS use presents a range of challenges and staff…

Abstract

Purpose

New psychoactive substances (NPS) are increasingly being used in secure mental health settings. Within these settings, NPS use presents a range of challenges and staff currently lack adequate training to manage these challenges. The purpose of this paper is to explore nursing staffs’ perception of the challenges of working with patients who use NPS and to explore nursing staffs’ perception of their training needs in relation to NPS.

Design/methodology/approach

A cross-sectional qualitative design was employed. Semi-structured interviews were conducted with eight nursing staff from a medium secure unit (MSU).

Findings

A thematic analysis identified three overarching themes: “There Will Always Be Something”, “We Are Doing Our Best” and “If We Know More, We Can Do More”. The findings describe how nursing staff manage NPS use at present, and their perceptions of how training could improve their management of NPS use in the future.

Practical implications

The findings suggest that MSUs require a local policy for managing NPS use. The research implies that staff training programmes should recognise the existing methods staff use to manage NPS use. The findings also suggest that NPS interventions should target the whole peer group and not just the individual using NPS.

Originality/value

This paper contributes to the limited literature on NPS. The findings demonstrate the importance of developing evidence-based mechanisms for managing NPS use. Changes to practice are suggested, with the view of developing ways in which staff currently manage NPS use by complementing this with specific training on NPS.

Details

Journal of Forensic Practice, vol. 22 no. 1
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 12 August 2014

Duccio Papanti, Laura Orsolini, Giulia Francesconi and Fabrizio Schifano

“Spice” products are synthetic cannabimimetics (SC; also called “synthetic cannabinoids”)-based designer drugs used as a legal alternative to cannabis for their very…

Abstract

Purpose

“Spice” products are synthetic cannabimimetics (SC; also called “synthetic cannabinoids”)-based designer drugs used as a legal alternative to cannabis for their very strong tetrahydrocannabinol (THC)-like effects. The purpose of this paper is to provide an analysis of more recent clinical and pharmacology/toxicology findings relating to SC and describe how they could impact on health, with a particular focus on mental health.

Design/methodology/approach

A systematic search and descriptive analysis of the available evidence on psychopathological issues related to misuse was performed here, whilst taking into account the Pubmed/Medline databases, a range of conference proceedings and national/international agencies’ reports.

Findings

While THC is a partial agonist, SC are full agonists on the cannabinoid receptors (CB-rs) and the administration of multiple SC can produce additive and/or synergistic agonistic interaction effects on the endocannabinoid system. These levels of strong CB-rs’ activation may be high enough to produce severe physiological and psychological disturbances. The available evidence suggests an existing relationship between SC use and psychosis (“Spiceophrenia”). The acute SC intoxication is usually characterized by tachycardia/hypertension; visual/auditory hallucinations; mydriasis; agitation/anxiety; tachypnoea; nausea/vomiting; and seizures.

Research limitations/implications

The absence of clinical trials and longitudinal studies, together with the heterogeneity of SC compounds does not facilitate a precise assessment of the health risks related to their use, with long-term effects being of particular concern.

Originality/value

Appropriate, non-judgemental, prevention campaigns with a special focus on the differences between SC and cannabis may need to be organized on a large scale. At the same time, clinicians need to be regularly updated about novel psychoactive substances, including SC, to promptly recognize signs/symptoms of intoxication.

Details

Advances in Dual Diagnosis, vol. 7 no. 3
Type: Research Article
ISSN: 1757-0972

Keywords

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