New Psychoactive Substances

The phenomenon of new psychoactive substances (NPS) started decades ago with the growth and production of drugs that replicate the effects of controlled drugs (such as amphetamines, cocaine, cannabis and heroin) but avoid legislative control based on different chemical structures.

In recent years, the increasing use of NPS has led to new threats for health of people who use drugs (PWUD) – including overdose, psychotic reactions, high HIV risks due to multiple injections and increased number of sexual contacts. However, in many countries service providers such as harm reduction, drug treatment programs and ambulance services are not prepared to provide PWUD with quality support and counselling to reduce risks of NPS.

In the Central and Eastern Europe and Central Asia (CEECA) region the situation with NPS is truly alarming and has become one of the major challenges for the national public health systems, local NGOs, communities PWUD.

Eurasian Harm Reduction Association (EHRA) stands at the forefront of advocating for PWUD and community needs in CEECA region. With relation to NPS, EHRA believes it is crucial to start a multistakeholder dialogue and discuss the potential solutions to the rising problem associated with NPS use.

Key facts

  • According to United Nations Office on Drugs and Crime (UNODC), there have been more than 643 NPS reported by 101 countries to UNODC by the end of 2015i. The same figure by the end of 2013 was 348, demonstrating unprecedented increase in NPS emergence in recent years. Current estimate for new NPS emergence is one substance per week.
  • Use of NPS is mostly concentrated among young men and women aged 16 to 24, but other age groups can be also involved.

  • Most of NPS are sold via internet (mobile applications, specialized web forums, webs, etc.): normally the client makes an order, pays through e-wallet, and receives SMS with the specific location where to collect the product. Thus, the dealer can’t be found or identified.

  • NPS have lower price in comparison with ‘natural’ drugs, which can make them accessible for young people.

  • NPS injecting use may occur with those injecting drug users, who previously injected other drugs, including opioids. The most common use among people who have not used ‘traditional’ injecting drugs before, is nasal.

  • OST and naloxone provision are not effective in case of NPS. Needle and syringe programs are relevant for NPS, but the number of syringes needed should be considerably higher than in case of opioid use due to intensity of injections.

  • Another common effect of many NPS use is increase in sexual activity, which in its turn may lead to unprotected sex.

Potentially useful harm reduction interventions targeting the use of NPS

  • Smoking or sniffing is safer than injecting (i.e., as conventional drugs are becoming expensive, injections are used to maximize effectiveness. In case of NPS they are so potent that any means of consumption can cause same effects even during micro-dosing. Therefore, it makes no sense to do frequent injections, while other, non-invasive modes are better),
  • having your own paraphernalia (own pipe or making them by yourself),

  • using clean syringes in case of injecting,

  • using a drug with the ‘opposite’ effect in order to calm down can be dangerous and lead to overdose (for example using alcohol or heroin in case of a panic attack),

  • in case of panic attack – avoiding loud environments, reducing contact with people, at the same time not staying alone;

  • Provide users and service workers with information about each substance available on local drug scene and its side effects;

  • Increase services for experimental users, in nightlife settings as well;

  • Provide drug tests for harm reduction clients and in night clubs to ensure users know what they consume and are empowered to make safer choices;

  • Secure good coverage of already existing needle exchange services and increase the number of syringes per person for those who inject NPS;

  • Avoid waiting lists in substitution programmes, provide sufficient slots in substitution treatment services, avoid drop offs or other sanctions due to the programme’s strict rules;

  • Promote self-help and exchange reliable information between users;

  • Promote drug consumption rooms;

  • Build a communication/reporting line between outreach teams and intervention/reporting/public health services to speed up the process in case of changes in drugs supply;

  • Establish close cooperation between toxicological laboratories and medical institutions providing care to users in cases of overdose;

  • Train service providers (including ambulance staff in particular) how to communicate with users under the influence of NPS and educate them about NPS and their use in general.

i United Nations Office on Drugs and Crime. New psychoactive substances: overview of trends, challenges and legal approaches [Internet]. Vienna: UNODC; 2016 [cited 2017 Aug 10]. Available from