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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 paper aims to investigate the role of aripiprazole once monthly as a maintenance treatment in a sample of patients with schizophrenia comorbid with alcohol and substance use disorder (AUD/SUD).

A sample of 24 Italian adult patients has been recruited and treated with aripiprazole once monthly after clinical stabilization with oral aripiprazole during May 2021 and June 2022. Clinical evaluations have been performed at the baseline (T0) and after 12 (T1) and 24 (T2) weeks.

During the study period, an improvement of both the clinical condition and general health from baseline was observed, as well as a reduction of craving for alcohol/substances. However, from T0, the number of patients who continued with this study decreased at T1 (n = 8) and then at T2 (n = 4). No serious adverse events were reported, including changes in weight, lipid/glucose metabolism, electrocardiogram and extra-pyramidal side effects.

Although limited by the high number of drop outs, this observational real-world study provided insights into the use of aripiprazole once monthly among a sample of patients with schizophrenia and comorbid SUD/AUD. Further studies of longer duration and on a larger sample are needed.

“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.

The online sourcing, supply, and purchase of illicit drugs is fast transforming drug markets worldwide. Although the long-term development of simple communications technology over time (from pagers to mobile phones) continues to impact and extend local drug supply dynamics, it is the recent developments of dark web cryptomarkets, social media applications (like Instagram), encrypted messaging applications (like WhatsApp), and surface web platforms, such as LeafedOut, that are changing the drug supply landscape online. The use of technology in drug supply has tended to go hand in hand with improving the efficiency of supply and opportunities to reduce exchange-related risks for both buyers and sellers. In relation to app-mediated supply, for example, the use of encrypted messaging provides enhanced security for arranging purchases beyond the lurking surveillance of law enforcement. Despite the perception of improved safety, however, the use of social media apps and other online platforms can expose both buyers and sellers to risk scenarios they may not fully appreciate. Drawing on two recent studies on the use of social media apps and the online platform LeafedOut as mediators of drugs supply, this chapter will consider how these mid-range (between cryptomarkets and traditional telecommunications such as basic texting/calling and material ‘street’ markets) virtual spaces are being utilised for drug supply and the extent to which this is ‘just more of the same’ or provides new structures and experiences for those engaging with it and in what ways. Consideration will also be given to contradictions in the mid-range market space where the broad perception of reduced risk from the use of encrypted messaging can in fact produce greater levels of risk for some buyers and sellers depending on how they engage with the process/es.

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.

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.

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.

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.

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.

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.

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.

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 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.