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“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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Cannabis treatment entries rose significantly from 2004/2005 to 2013/2014, but there has been limited investigation into why this increase has occurred. The purpose of this paper is to evaluate the plausibility of different explanations within the English context and identifies gaps in the literature.

Explanations have been categorised under: misreporting, increased probability of entering treatment and increased incidence of cannabis use disorder (CUD). The explanations are evaluated through published literature, data in the public domain and interview data. Interview participants included four practitioners, one senior manager, one commissioner, one journalist, one academic and one clinician.

Plausible and influential explanations are that an expanding treatment offer occurred alongside an expanding cohort of people needing support for CUD. The evidence suggests increased prevalence in the 1990s to early 2000s, and an increase in high-potency cannabis, led to a significant rise in need for cannabis treatment. Minor explanations relating to funding formulas, criminal justice referrals and the emergence of synthetic cannabinoids could also cumulatively have a substantial effect on the data.

Due to the dearth of research in use and attitudes towards cannabis, there are some explanations which cannot be ruled out.

More research is needed on user perceptions of cannabis harms and how intensively people are using cannabis.

Wider implications are that a genuine and increasing need for support relating to cannabis within the English population requires an appropriate response from national bodies, commissioners and service providers.

A more comprehensive understanding of why this new cohort is emerging can inform better service provision and commissioning.

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.

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

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.

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.

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

This paper aims to research the prevalence of a new drug which appeared at the era of economic crisis in Greece, called “shisha.” Shisha, a rather cheap form of crystal meth, has spread fast among drug users in Greece with the deepening of the economic crisis. The present paper is concerned with the socio-demographic characteristics of drug users who choose this type of drug and reveals the conditions under which this drug is used. In addition, perceptions of drug users about the specific drug are also explored.

In total, 148 drug users took part in this study. Of these 73 percent were men and 27 percent women. The average age of participants was approximately 37 years. All participants in the study were interviewed face-to-face on the basis of a structured brief questionnaire with closed and open-ended questions.

The data suggests that the majority of drug users who use “shisha” are mainly heroin users (63.2 percent) and they use this new drug as a second choice to heroin. Shisha can be found in the center of Athens and it is usually smoked through a glass pipe. The cost for buying the drug is relatively low (two to three euros) and the drug is produced in small illegal labs. Most participants argued that shisha is linked to violent and aggressive behavior, loss of weight, insomnia, sexual arousal and a psychotic state that may cause death. The drug is made out of a form of crystal meth produced by amphetamines and liquid acids found in batteries liquids.

This drug is mainly used by homeless drug users in the center of Athens. Its exact synthesis cannot be identified given the fact that drug users use various recipes to produce it. Taking the drug is extremely dangerous for the health of the users.

Research of the use of a new drug linked to the economic crisis in Greece. Researchers in this paper approached street drug users who are highly unlikely to seek help from health or other types of treatment providers.

Secure Children’s Homes are safe environments where many of the most troubled children in British society are resident. These children are from either a criminal background or referred for protection of themselves and others from harm. There is often a history of drug use and diagnoses of mental health problems before admission. The purpose of this paper is to examine one Secure Children’s Home to determine the level of drug use prior to admission compared to surveys of children not in this environment and to examine the veracity of the mental health diagnoses.

This paper is a retrospective examination of case notes for admissions from 2014 to 2015.

The study found much higher levels of drug use than in the general population at similar age and a wide diagnosis of mental health problems prior to admission.

Levels of harm from traumatic childhood events need to be recognised by referrers as maybe leading to attachment disorders and not mental health problems. More research is needed into the outcomes form Secure Children’s Homes in the long term.

The children in these homes do have as anticipated much higher levels of drug use than in the general population and high levels of mental health diagnoses which are not always borne out during their admission to the children’s home.

This is an examination of a special population of young people indicating high levels of drug use and mental health problems.

The purpose of this study was to explore the social needs and experiences of older prisoners who were attending one of two social initiatives in a prison in England.

This paper is based on an interpretative phenomenological study, conducted in a prison in the South West of England. Older prisoners attending an initiative implemented for those over 55, a purposive activity or a social task group, participated in focus groups, which were audio recorded and thematically analysed.

Two overarching themes were identified. Firstly, the need to feel safe: prisoners felt attending an initiative provided them with a safe haven away from noisy and boisterous younger prisoners, who they perceived as different from them and who received preferential treatment. Secondly, being provided with a purpose: prisoners felt they belonged among their peers, which motivated them to attend and support group activities.

This study was completed in one prison. However, both initiatives supported the social needs of older prisoners and enabled them to leave their cells, although they felt unsafe when not attending an initiative.

There remains a need to support the process of integrating younger and older prisoners, by the provision of both integrated and separate initiatives, with the aim of developing cross-generational and bi-directional peer support.

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.

This paper aims to examine knowledge production and problem representation with regard to new psychoactive substances (NPS) in Her Majesty’s Chief Inspector of Prisons (HMCIP) annual reports.

Seven annual reports published by HMCIP for England and Wales between 2014 and 2020 have been systematically reviewed drawing on thematic analysis.

This paper demonstrates how framing in HMCIP annual reports produced a characterisation of NPS in prisons that inadvertently obstructed gender-sensitive knowledge production and problem representation. The framing formalised knowledge silences about spice in women’s prisons.

HMCIP annual reports monitor drugs in prisons and this affects how these spaces are represented to government and other stakeholders. This paper provides theoretical and practical insights into how gender-blind knowledge is produced by discussing examples of gender-blind drug representations in a specific policy context.