The use of new psychoactive substances (NPS) in young people and their role in mental health care: a systematic review

ABSTRACT

Introduction: Over the past 10 years, a large number of New Psychoactive Substances (NPS) have entered the recreational drug scenario. NPS intake has been associated with health-related risks, and especially so for vulnerable populations such as the youngsters. Currently, most knowledge on the NPS health effects is learnt from both a range of users’ reports, made available through the psychonauts’ web fora, and from the few published, related toxicity, clinical observations.

Areas covered: This paper aims at providing an overview of NPS effects on youngsters’ mental health, whilst performing a systematic review of the current related knowledge.

Expert opinion: NPS consumption poses serious health risks, due to both a range of unpredictable clinical pharmacological properties and the typical concomitant use of other psychoactive molecules; overall, this can lead to near misses and fatalities. In comparison with adults, the central nervous system of children/adolescents may be more vulnerable to the activity of these molecules, hence raising even further the levels of health-related concerns. More research is needed to provide evidence of both short- and long-term effects of NPS, related health risks, and their addiction potential.

KEYWORDS:

• NPS
• novel psychoactive substances
• ‘legal highs’
• mental health
• youngsters

Article Highlights

• Over the last decade, a growing number of NPS has been identified. They include a range of substances which are being used for recreational purposes. The large availability and easy access to NPS through both rogue websites and the ‘deep web’ make them popular among vulnerable clients, including young people and those with a history of drug abuse and/or mental health issues. Synthetic cannabinoids, central nervous system stimulants (e.g. cathinones), phenethylamines, and dissociatives account for most NPS being identified. Moreover, NPS may be self-administered in combination with remaining recreational drugs such as alcohol, cocaine or opioids.

• NPS-related clinical toxidromes differ according to the type of NPS ingested and range from sympathomimetic effects, euphoria, and agitation to respiratory depression. Fatalities have been recorded as well.

• High levels of NPS use are being identified in people diagnosed with psychotic; personality; or bipolar disorders.

• Unlike remaining recreational drugs, e.g. cocaine and 3,4‐methylenedioxymethamphetamine (MDMA; ecstasy), NPS are typically going undetected. Hence, the provision of targeted clinical treatments to counteract toxicity and overdose may be problematic.

• Health-care professionals, and especially so child and adolescent psychiatrists, should be aware of new trends in drug scenarios so that they will be able to better identify possible NPS-related psychiatric symptoms.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was supported in part by grants of the European Commission (Drug Prevention and Information Programme 2014-16; contract no. JUST/2013/DPIP/AG/4823; EU-MADNESS project). Further financial support was provided by the EU Commission-targeted call on cross border law enforcement cooperation in the field of drug trafficking - DG Justice/DG Migrations and Home Affairs (JUST/2013/ISEC/DRUGS/AG/6429) Project EPS/NPS (Enhancing Police Skills concerning Novel Psychoactive Substances; NPS).