ResearchFact Sheets

Novel psychoactive substances (NPS) have been emerging in the US and worldwide at an unprecedented rate, with more than 450 NPS detected in Europe by 2014, up from 166 in 2009.[1] Research suggests that NPS may increase sexual desire and sexual risk behavior, but the impact of NPS on HIV and other STI transmission are unclear.

Self-reported NPS in a general population sample [2]

• In the 2009-2013 National Surveys of Drug Use and Health, a nationally representative sample of non-institutionalized individuals in the US, 1% of subjects self-reported any use of the 57 NPS examined.
• Psychedelic tryptamines (primarily DMT) were the most commonly reported NPS, followed by psychedelic phenethylamines and synthetic cannabinoids.
• The prevalence of self-reported NPS use increased from 2009 to 2013 and use was most common among males, whites, older people, those with low socioeconomic status, and those living in cities.

• NPS reports to the NYC PCC increased from 7% in 2011 to 13% in 2014. 82% involved synthetic cannabinoids, followed by phenethylamines/synthetic cathinones (“bath salts”, 10%), and psychedelic phenethylamines (4%).
• Compared to other drug-related reports to the PCC (including licit and illicit drugs), NPS users were more likely to be young, male, and to not use other drugs.
• Synthetic cannabinoid reports increased sharply in 2014 and the average age of users rose. Females using synthetic cannabinoids were younger than males, and in 2014, synthetic cannabinoid users calling the PCC were more likely to report concomitant use of alcohol than users of other NPS.

• The Monitoring the Future (MTF) study is a nationally representative survey of high school seniors.
• In 2011-2013, 1% of MTF participants reported using “bath salts” and 10% synthetic cannabinoids in the last 12 months. Those who used either drug were more likely to use other drugs than non-NPS users. Bath salt users had more weekly income that was not from a job, while synthetic cannabinoid users were more likely to be male.

Collectively, these studies suggest that the use of NPS are on the rise and males are at
increased risk for use. NPS use appears to be underreported on surveys so prevalence is likely underestimated. Unintentional use also appears to be common—with individuals taking NBOMe, thinking it is LSD, or taking “bath salts”, thinking it is MDMA. [6]

As NPS continue to emerge, users, researchers, policy makers and practitioners need to be more educated about NPS and their potential harms, to develop appropriate programs. The relationship between NPS and sexual risk behavior should be further studied. Finally, surveillance systems that are sensitive to changes in NPS are needed, as NPS emerge rapidly and existing prevalence estimates from population-based surveys are likely underestimates.

Synthetic cannabinoids mimic Δ-9-tetrahydrocannabinol (THC), the main psychoactive component in cannabis, and are often marketed as a “legal” alternative to marijuana (e.g., K2, Spice), although they tend to be much more dangerous than real marijuana. They are typically herbal mixtures that have been sprayed with the synthetic cannabinoid and then smoked.

Synthetic cathinones, also known as “bath salts,” are amphetamine-like compounds related to cathinone, a stimulant compound found in the khat plant. They are often marketed as an alternative to amphetamines or MDMA (i.e., ecstasy or “Molly”). They are typically available as crystallike powder that can be swallowed, smoked, snorted, or injected. Much use appears to be unintentional as synthetic cathinones are commonly sold as adulterants in ecstasy.

Psychedelic tryptamines mimic psychedelics like Psilocybin (i.e., magic mushrooms). 5-MeO-DiPT (a.k.a.: “Foxy”) is included in this group. Psychedelic tryptamines have hallucinogenic and sometimes stimulant-like effects.

Psychedelic phenethylamines are drugs like amphetamines and cathinones that have stimulant, allucinogenic, and/or psychedelic effects. The most common drugs in this class are those in the 2C series (e.g., 2C-B, 2C-I) and the NBOMe series (e.g., “25i”). These drugs are sold in a variety of formulations including tablets, capsules, powders, liquids, sprays, and blotters (i.e., paper infused with the drug).

1. European Monitoring Centre for Drugs and Drug Addiction. New psychoactive substances in Europe. An update from the EU Early Warning System. www.emcdda.europa.eu/publications/2015/new-psychoactive-substances, Accessed 3 Feb 2016.
2. Palamar JJ, Martins SS, Su MK, Ompad DC. Self-reported use of novel psychoactive substances in a US nationally representative survey: Prevalence, correlates, and a call for new survey methods to prevent underreporting. Drug Alcohol Depend. 2015;156:112-9.
   doi: 10.1016/j.drugalcdep.2015.08.028.
3. Palamar JJ, Su MK, Hoffman RS. Characteristics of novel psychoactive substance exposures reported to New York City Poison Center,
   2011-2014. Am J Drug Alcohol Abuse. 2015:1-9. doi: 10.3109/00952990.2015.1106551.
4. Palamar JJ. “Bath salt” use among a nationally representative sample of high school seniors in the United States. Am J Addict. 2015 Sep;24(6):488-91. doi: 10.1111/ajad.12254.
5. Palamar JJ, Acosta P. Synthetic cannabinoid use in a nationally representative sample of US high school seniors. Drug Alcohol Depend. 2015;149:194-202. doi: 10.1016/j.drugalcdep.2015.01.044.
6. Palamar JJ, Salomone A, Vincenti M, Cleland CM. Detection of “bath salts” and other novel psychoactive substances in hair samples of
   ecstasy/MDMA/”Molly” users. Drug Alcohol Depend. 2016. [Epub ahead of print] doi:10.1016/j.drugalcdep.2016.02.001.
7. Schifano F, Orsolini L, Duccio Papanti G, Corkery JM. Novel psychoactive substances of interest for psychiatry. World Psychiatry.
   2015;14(1):15-26. doi: 10.1002/wps.20174.
8. Zawilska JB, Andrzejczak D. Next generation of novel psychoactive substances on the horizon–A complex problem to face. Drug Alcohol Depend. 2015;157:1-17. doi: 10.1016/j.drugalcdep.2015.09.030.
9. NIDA DrugFacts. drugabuse.gov/publications/finder/t/160/DrugFacts. Accessed 3 Feb 2016.