New PsychoactIve Substances - Evidence Review

5 Impacts

Key Findings

• Evidence is limited, but indications are that the health implications of NPS can be just as serious as for other illicit drugs including a range of physical and psychological symptoms (from kidney failure to psychosis).
• NPS use can result in death. In Scotland, NPS were implicated in 132 deaths between 2009-2013 (although in only 18 of these was an NPS the only drug implicated).
• Drug treatment services in the UK are seeing increased presentations from people using NPS, and in reports of problems related to their use.
• Other impacts associated with NPS are an increase in acquisitive crime and the increased involvement of organised crime.

Health implications

5.1 Research on the health implications of most NPS is very limited, but what evidence there is suggests that the adverse effects can be just as serious as for controlled drugs. The recent UNODC report (2013a) gathers together the limited available evidence to list the main adverse effects associated with each main NPS groupings. These range from a variety of physical symptoms - e.g. cardiovascular problems, hyperthermia (over heating), kidney failure, fluid on the lungs, seizures - to psychological disorders, including anxiety, agitation, memory loss, depression and psychosis. Health impacts will also depend upon whether other drugs and/or alcohol were used at the same time as NPS, and the method of use, for e.g. swallowing, snorting, injecting, etc. Deaths have been associated with drugs in each of the main NPS groups, with the exception of plant based substances, which to date have not been directly linked to any fatalities (UNODC, 2013a)^[9].

5.2 There is currently no evidence of an increase in presentations at drug treatment services associated with NPS use in Scotland. However, deaths where NPS were found to be present in the body have increased over the period, from 4 in 2009, to 113 in 2013. Deaths where it was reported that one (or more) NPS was implicated in the death were lower, but again have increased, from 3 in 2009 to 60 in 2013 (totalling 132 over 2009-2013, less than 5% of all drug related deaths). In 2013, 5 out of 60 deaths occurred where NPS were identified as being the only substances implicated (a total of 18 over 2009-2013, less than 1% of all drug related deaths).

5.3 In 39 cases, the only NPS present were benzodiazepines (usually phenazepam); in 19 cases, other types of NPS were present (e.g. AMT, BZP, PMA or PMMA); there were two deaths for which both benzodiazepine NPSs and other types of NPS were present (NRS, 2014).

5.4 2,000 people in treatment in England during 2011/12 cited problems related to mephedrone use, over half of whom were under the age of 18. In England and Wales, from 2009 to 2012, NPS were implicated in 129 deaths (although in only 64 of these was an NPS the only drug mentioned). In 2012, there were 52 deaths related to NPS, a sharp increase from 29 deaths in 2011. This follows a period of stability (23 in 2010, 25 in 2009) after a large rise from nine in 2007 to 25 in 2008. (ONS, 2013).

Other impacts

5.5 There are indications of other adverse impacts emerging in relation to the use and supply of NPS. For example, the Welsh Government has reported that in parts of Wales the increased use of mephedrone may be causing an increase in some forms of acquisitive crime - particularly house burglaries. (Welsh Government, 2013).

5.6 Recent reports have also noted the potential for organised criminals to become more active in the 'legal high' market (EMCDDA, 2013a). Reports indicate the involvement of organised crime in both the targeting and marketing of NPS, although the extent of this is unclear (EMCDDA, 2012).