This is an Author's Accepted Manuscript (postprint) version of a work that was published by the European Society for Social

Drug Research, in
G. R. Potter, M. Wouters & J. Fountain (Eds.), Change and Continuity: researching evolving drug landscapes in Europe (pp. 36-50). Pabst
Science Publishers, Lengerich, Germany. http://www.psychologie-aktuell.com/buecher/einzelansicht/article////1413204006-change-andcontinuity-researching-evolving-drug-landscapes-in-europe.html?cHash=6f833fbe47

Harm reduction of novel psychoactive substance use

Levente Mr
University of Turku, Finland
Abstract
During the last few years, the rapid emergence of novel psychoactive substances (NPS)
has significantly reshaped the global drug scene. Emergency hospital admissions and
confirmed or suspected NPS-related deaths are on the rise, and many related health
and social problems may have not yet even been fully recognised. Potential NPS harms
stem from the lack of information, as well as from the general sets and settings of drug
use. As compared with classical drug harm reduction, NPS-related harm reduction has
got a notably more difficult operational environment. In this chapter, I will briefly outline
the emergence, terminology, and appeal of the NPS phenomenon, and introduce a
seven-item list of NPS-related risks and subsequent potential harms that has been
compiled from both academic and anecdotal sources. Moreover, I summarise six
important ongoing NPS harm reduction attempts that can be currently perceived as
best-practices, illustrated by European examples. Finally, I conclude the analyses of
NPS-related harms and harm reduction best-practices by discussing some conceptual,
strategic, practical, and drug policy issues.
Keywords:
drug use, substance use, novel psychoactive substances, NPS, harm reduction,
drug markets, drug policy
Author Note
Correspondence concerning this book chapter should be addressed to Levente
Mr, Centre for Cognitive Neuroscience, University of Turku, Assistentinkatu 7,
Publicum building, FI-20014 Turku, Finland. Tel. +358 2 333 6975. E-mail: leve@utu.fi
Bio-bibliographical Note
LEVENTE MR is a doctoral student at the Centre for Cognitive Neuroscience,
Department of Behavioral Sciences and Philosophy, Faculty of Social Sciences,
University of Turku, Finland.

MR (2014) HARM REDUCTION OF NOVEL PSYCHOACTIVE SUBSTANCE USE

Harm Reduction of Novel Psychoactive Substance Use

Introduction
During the last few years, the rapid emergence of novel psychoactive substances
(NPS) has significantly reshaped the global drug scene. As of May 2014, the EU Early
Warning System monitors more than 350 new psychoactive substances, 81 of which
were notified in 2013 (EMCDDA, 2014b). The NPS phenomenon has induced
fundamental changes on legal and illegal drug markets, in national and international
drug policies, and also in drug use subcultures. While some of the background factors
such as the development of organic chemistry, the spread of internet marketing, and the
cultural demand for mind-altering substances were quite obvious and could be
foreseen, the extent and velocity of the convergence took most societies by surprise.
Emergency hospital admissions and confirmed or suspected NPS-related deaths are on
the rise, and many related health and social problems may have not yet even been fully
recognised. Hence, attempts to bring the NPS issue under control could be seen as
highly experimental at best, struggling with a major lack of information.
Due to fundamental changes induced by NPS, drug prevention and harm
reduction are also facing many new and difficult challenges. In contrast with classical
drugs many of which have been well-known and studied for centuries, or at least for
decades NPS are requiring prevention and harm reduction measures to operate with
vagueness. Moreover, the urge to response to the NPS phenomenon both in time and
with adequate efficiency is clearly calling for unavoidable compromises and trade-offs.
In this chapter, I will briefly outline a few aspects of the NPS phenomenon, list some of
the known risks of NPS use, and suggest novel attempts to reduce NPS-related harm.
In addition to a review of scientific literature, non-academic information has been
collected from drug user online discussion groups, warnings and alerts about drugrelated emergencies, and legislative and policy changes in the last five years.
The NPS phenomenon
Understanding new drugs
The emergence of new drugs is far from being an unexpected phenomenon; it
occurs during the normal course of biotechnological development. For millennia,
humankind has used a plethora of plants for treating various human conditions. Drying
and powdering, making tinctures and ointments are the oldest pharmacological
technologies to transform and apply plant-based compounds for human consumption.
More advanced methods enabled top-down extraction, isolation, and identification of
pharmacologically active principles, such as alkaloids from plant material. Newer
chemical technologies made possible the creation of new substances by tweaking
existing compounds, i.e., by taking a basic chemical skeleton and adding, removing, or
replacing its atoms and molecules. By now, the development in organic chemistry
enables semi-synthesis from natural starting materials (plant essential oils, acids, or
alkaloids), and bottom-up total synthesis from basic petrochemical ingredients.
It is important to grasp the idea that the creation of new substances is not
necessarily clandestine underground activity. Drug development is a vital part of
everyday pharmaco-technological processes driven by legal pharmaceutical companies
and licensed research institutes. With the exception of patentable molecules under
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MR (2014) HARM REDUCTION OF NOVEL PSYCHOACTIVE SUBSTANCE USE

development, manufacturing processes are described in detail and published in journals
of chemistry. Given the chemical knowledge available and the initial legal statuses of
NPS, these substances can be obtained in bulk quantities by ordering a custom
synthesis from any legally operating chemical company worldwide.
The main driving force behind drug design is a commercial utilisation of medicinal
molecules. New compounds should be somewhat similar to existing ones to exert a
preferably larger wanted main effect with fewer unwanted side effects. At the same
time, they should be a bit different in their chemical structures in order to be patented as
new medicinal products. Only a few of these novel molecules reach commercial
production; the vast majority of compounds get disqualified due to various reasons,
such as unfavourable results of preclinical or clinical studiesor simply the high costs
of the bulk manufacturing process. Another important application for novel molecules is
in neuropharmacological research as receptor agonists or antagonists. Experimental
setups may require certain receptors to be blocked before administering a drug, in order
to find out more about that drugs effects. Some of the NPS on current street markets
have a historical background in laboratories: they have been used in research because
of their great affinity to bind to certain receptors. However, great affinity means strong
effects both wanted and unwanted which facilitates the process for these
substances to become recreational drugs.
On NPS terminology
The turbulent scenario of the new drug use boom also manifests in multiple
attempts to bring together all the substances under one common termoften
unsuccessfully. Novel Psychoactive Substances is admittedly the closest terminus
technicus to describe this versatile group of drugs. However, a great many of these
substances are not novel at all, but have been around since many decades, albeit
utilised only marginally. Thus, novelty here may not refer to the existence of a
substance, but only to its recent widespread emergence as a recreational psychoactive
drug. A previously used term, new synthetic drugs (NSD), fails to capture many plantbased compounds, e.g., ibogaine, mitragynine, or salvinorin-A. References to research
chemicals (RC) are similarly inaccurate, as they cover only a subset of these novel
drugs, many of which have never been used in laboratory research. The term designer
drugs (DD) is also an unnecessary narrowing of the wide drug spectrum, along with an
artificial separation between synthetic and naturally occurring molecules (which may
actually belong to the same chemical families). Another confusing term that is also
suggested to be avoided is legal highs (LH) (Corazza, Demetrovics, van den Brink, &
Schifano, 2013). As legal classification is only a temporally and regionally varying
characteristic, it is not recommended to be used as an adjective for substance
categorisation. A legal high may easily count as an illegal one in another country, as
well as it may also have a high probability to become illegal as time passes by.
The emerging NPS phenomenon
The rapid and massive emergence of NPS poses novel societal challenges to be
addressed. For adequate responses, it is important to understand cultural, economic,
legislative, and health aspects, as well as the factors and background processes that
have converged into the NPS phenomenon. While recreational party drug use has been
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relatively widespread, self-experimenting with little-known substances has long been
marginal, mostly only as a part of psychonaut subcultures (Mr, Simon, Brd, &
Rcz, 2011). Since the late 1960s, substances that have been used for self-exploring
the mind were typically hallucinogenic phenethylamines and tryptamines developed and
described by the extraordinary chemist Alexander Sasha Shulgin (1925-2014) (see
e.g., Shulgin, 1969). Stimulant drugs, such as piperazine party pills surfaced in the early
to mid-2000s. Simultaneously, cannabinoid receptor agonists (e.g., the JWH-series)
escaped from regular laboratory use around 2004 to start up the Spice phenomenon,
which became properly detected only as late as in 2008 (Griffiths, Sedefov, Gallegos, &
Lopez, 2010). As of recently, these substances were followed by novel cathinones
most notably, mephedrone (Schifano et al., 2011) and other -ketones appearing as
plant foods or bath salts (UNODC, 2013).
Some of the many causes for drug market turbulence on the supply-side could
have been caused by the destabilisation of Ecstasy pill markets, precursor regulations,
appearance of bulk crystalline MDMA, a high-profile EU ban on some phenethylamines,
and the low quality of speed powders (in some countries). At the same time, new
forms of psychoactive substance use have become essential cultural elements at
certain dance parties due to curiosity, coolness, or trend factors. The ultimate
easiness and anonymity of internet purchase has accelerated legal drug trade in
unforeseen ways and created vivid online markets (Van Hout & Bingham, 2013).
Simultaneously, internet communication between sellers and potential buyers have
become virtually unlimited, while even larger masses of people became NPS-aware by
the conventional public medias (often exaggerated) news stories (Dbrowska &
Bujalski, 2013) that have served also as unintended advertisements for these new
substances.
The appeal of NPS
The history of psychoactive substances may rightfully blur our modern division
between medicinal drugs and recreational drugs. It appears that substances have been
used for enhancing all aspects of life quality in generaland not only for restoring
health. Therefore, a modern-day demand for modern-day drugs that fulfil age-old
functions is not at all surprising. In this sense, NPS are merely contemporary
alternatives to some classical drugs that have been consumed to relieve anxiety, to
enhance sociability, to increase alertness, etc. Many NPS are energising drugs, similar
in their effects to amphetamine type stimulants (ATS) that have been on the streets
since the 1960s. In a similar fashion, traditional euphorising drug use included the
ingestion of various processed forms of the cannabis plant (such as marijuana, hashish,
or charas), as well as eating and drinking various preparations of the opium poppy.
During the last two decades, major advances in neuropharmacology and organic
chemistry have been made by discovering the endocannabinoid system in detail, and in
synthesising hundreds of compounds to affect CB1 and CB2 receptors.
A couple of global NPS use trends seem consistent across borders. An important
observation is that due to their initial legal statuses, new drugs had been successfully
marketed to new consumers who previously had no access to (or will to access) illegal
drugs (UNODC, 2013). In line with this, good availability of classical drugs (e.g.,
cannabis) counterbalances the prevalence of NPS use (e.g., synthetic cannabinoids) in
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some countries. Even though recreational drug use is often a subject of moral and
ethical counterarguments, the demands for extra strength and extra joy seem to be a
constant part of the human experience (Siegel, 1989). However, societies are indeed
justified to intervene whenever potential social problems occur while satisfying these
demandsassuming that countermeasures and responses are in proportion with those
problems. Therefore, proper interventions should definitely take into account and
understand the fundamental appeal of NPS as an important cultural factor.
Set and setting of NPS use
So, if the demand for drugs is not a new phenomenon at all, then what exactly
caused the recent surge in NPS demand? In order to answer the questions, it may be
necessary to involve the concepts of set and setting of drug use (Zinberg, 1984). In
here, set refers to the intentions, attitudes, and psychological characteristics of the drug
user, while setting denotes the physical, social, and cultural environments of drug use.
These two modulating factors are not to be underestimated: previous studies had found
out that the total drug experience may be more substantially affected by set and setting
than by the type of drug used (Strassman, 2001).
While it may be true that certain drugs are more typically related to certain
subcultures than to others, the fast spread of NPS seems to have enabled multiple entry
points into societies. With NPS having a high abuse and health risk liability (Winstock et
al., 2011), it becomes also apparent that occasional fatal overdoses or acute toxic
symptoms (Hermanns-Clausen, Kneisel, Szabo, & Auwrter, 2013) are often picked up
and grossly exaggerated to the level of moral panic by the public media (Alexandrescu,
2013). In some countries, NPS have entered into pre-existing intravenous drug user
populations, which may further increase risks in unforeseeable ways. Despite a sheer
number of NPS, only a few are used by larger numbers of users, or for longer periods,
which fortunately limits the harm of most NPS.
NPS-related harms
Risks of the novel NPS market
High profits and minimal risks associated with the trading of temporarily legal
drugs have attracted vast masses of new NPS manufacturers, importers, distributors,
and sellers. These (mostly online) drug traders have thus formed a novel segment on
the supply side of the global drug market, next to conventional illicit drug dealers.
Some of the NPS vendors have been known to operate as franchises, some utilise a
multi-level marketing (MLM) scheme, and some aim at international markets by
operating multilingual web shopping applications and by registering their branded
domain names in several countries. Strikingly, many of these new entrepreneurs may
have no idea about the products they are selling. Even worse, sellers are obviously
financially motivated to recommend higher doses and to promote more frequent drug
use.
Concepts in NPS harm reduction
Approaches to drug-related harm reduction are highly suggested to be based on
wholesome concepts originated from the bio-psycho-social model of health. There
seems to be a widespread practice of metaphoric thinking of transferring the agency
and responsibility from the poor victim drug user to the evil drug. In order to avoid
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MR (2014) HARM REDUCTION OF NOVEL PSYCHOACTIVE SUBSTANCE USE

this materialistic demonising, pharmaco-chemical properties of a drug must be
separated from bio-psycho-social consequences of drug use. A central claim here is
that current drug policies have been incapable of making a difference between these
two domains. This prevailing misconception may seriously slow down or stall harm
reduction work, if public interest (along with the available resources) is directed at
materia, not at people. On one hand, a matter-oriented approach to drug-related
problems poses a strong limit on any conceptual solutions addressing these problems,
as it points a finger at lifeless compounds in an attempt to limit the negative
consequences of related human behaviour. On the other, the imbalanced material
emphasis may also hinder practical harm reduction measures by overly focusing on
drugs instead of drug users.
In theory, each substance must have a certain dosage, route of administration,
and usage frequency that produces an optimal ratio between preferred main effects and
unwanted side effects. Pharmaceutical companies have found optimal dosages also for
many classical psychoactive drugs in legal clinical use. Some of these drugs have
been put under international control with no recognised medical benefits (e.g., heroin),
but some are still in clinical use (e.g., cocaine, d-amphetamine, and ketamine).
However, the sheer number of NPS makes it practically impossible even to have up-todate databases with proper drug identifications, which renders pre-clinical doseresponse studies to the level of wishful thinking for a long time. This vagueness
regarding NPS information is, in fact, a major limitation; nevertheless, it must be
accepted as one of the most typical characteristics of NPS-related work. For harm
reduction to be able to respond quickly and efficiently relative to the novel
circumstances it is essential to rely on vague, incomplete, unverified, and anecdotal
data. It is indeed a big challenge to make reliable information patterns out of fragmented
bits and pieces of NPS data (Sumnall, Evans-Brown, & McVeigh, 2011).
Risks related to NPS use
From the drug users perspectives, the majority of risks related to NPS are not
derived from the material properties of a drug per se, but from inappropriate drug use,
perhaps most importantly dosing. Potential NPS harms stem from the lack of
information, as well as from the general sets and settings of drug use. The following
seven-item list of NPS-related risks and subsequent potential harms has been compiled
from both academic and anecdotal sources.
Online purchase scams. As much as online ordering has revolutionised also drug
trade, the phenomenon came along with some of the negative sides of internet
shopping. Sending money in advance and receiving nothing in return is indeed a basic
scam also in regular cases of mail ordering. Internet marketplaces for selling items can
be set up easily, anonymously, and for free in a few minutes. By using intractable email
addresses and money wiring services, orders and payments can be accepted within a
short timeframe. Even though online drug purchase scams are not specific to NPS, but
due to high demand and legality, operating fake NPS web stores for even a few weeks
could be profitable and risk-free.
Drug misidentification. Receiving nothing for money is still safer as compared
with receiving a different drug than expected. Misidentification of a substance can be
potentially lethal if the dosage of the (absent) intended substance is greater than the
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MR (2014) HARM REDUCTION OF NOVEL PSYCHOACTIVE SUBSTANCE USE

dosage of the actually consumed other substance. This situation may indeed occur also
with classical drugs, but the market and usage context poses definitely greater risks
for NPS users. With a few exceptions of brand-name NPS in pill or capsule form, the
majority of NPS appears to be a bulk quantity of white or off-white powder. Lacking
laboratory equipment, there is no reliable way of identifying NPS apart from their label
providedif provided.
Drug mixtures. Additional risks are posed due to the innovative habit of some
vendors to sell mixtures of NPS, which have been confirmed by forensic laboratory
analyses of seized NPS batches. Experimenting with multiple drugs at the same time is
also a cultural pattern, where the bravest pioneers of mind exploration receive
appreciation from their peers. NPS mixtures aim to be stronger than its separate
ingredients by combining substances that potentiate each others effects. However,
neuropharmacological processes behind drug effect potentiation are complex in nature
and possibly mean more risks for the user. For most NPS, there is no reliable data on
pharmacological interactions with other substances, such as alcohol, prescription and
over-the-counter medications, herbal products, or recreational drugs. The currently
available information on these topics is mostly from online sources, such as drug
discussion boards, and hence highly anecdotal.
Substance naming. Beside their proper systematic IUPAC 1 chemical names and
2
CAS registry numbers, NPS are often known also by colloquial street names and/or
vendor-promoted brand names (fantasy names). Practically, both of these naming
practices are inadequate and potentially risky for proper substance identification. Street
names for NPS show great regional variability, with multiple naming appearing in
parallel (Brandt, Sumnall, Measham, & Cole, 2010). Drug mnemonics are often based
on linguistic approximation, i.e., they are being referred by partially similar-sounding
words in the local language. For example, the cathinone derivative mephedrone has
been named Mephisto, Katy, Cat, or the further associable Meow. Even worse,
such approximations of NPS chemical names may result in inaccurately abbreviated
street names, such as PV instead of MDPV or PV8, but also AMT instead of 5-MeOAMTa different drug with a different dose range and effects. In practice, constantly
ongoing product name changes are largely fuelled by regulatory transitions in the
statuses of NPS (i.e., scheduling from legal to illegal). Moreover, newer and/or less
known substances are routinely sold under the more popular names of previous and/or
better known substances.
(Over)dosing. It is strongly claimed here that the gravest adverse effects of NPS
use can be attributed to accidental overdosing in the lack of possibilities to find out
about their normal dosage. NPS have very serious dosing disadvantages compared
with traditional drugs in pill or capsule forms. Common doses for NPS may vary several
magnitudes: around 100 mg for mephedrone, around 10 mg for 2C-E, around 1 mg for
DOB, and down to the sub-milligram range for NBOMe substancesan amount smaller
than a head of a match! Thus it is impossible to measure out exact doses of bulk
powders by visual approximation (colloquially: eyeballing) without using a milligram-

1
2

International Union of Pure and Applied Chemistry

Chemical Abstracts Service
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MR (2014) HARM REDUCTION OF NOVEL PSYCHOACTIVE SUBSTANCE USE

range precision digital scale. Even more risk is taken by intranasal or intravenous NPS
users who, unfortunately, prefer these routes of administration for a more rapid and
intense onset. As NPS cannot be sold for human consumption, plant food or bath
salt sellers do not attach dosage (or other) instructions with their shipped packages.
Legal consequences. Rapidly changing (and often incoherent) legislative
measures to control the trading and consumption of NPS are also posing serious legal
risks. In the lack of proper drug identification, buyers might order a (still) legal NPS, but
instead receive an illegal NPS without knowing it. These incidents are in part provoked
by the periodical banning of groups of NPS: upon knowing about a forthcoming ban,
vendors may start mixing and replacing their other substances with the very-soon-to-bebanned substancein order to get rid of their stockpiles still legally and in time. Beside
the possible physical risks of ingesting a misidentified substance, there could be also
serious legal consequences due to possession or consumption of a banned substance
that is believed to be legal (Sumnall, et al., 2011). Furthermore, legislative practices in
some countries use analogue or generic laws in addition to explicit lists of controlled
substances. It may be practically impossible for the average NPS user to know whether
or not a single chemical is implicitly banned because of substantial similarity, or
implicitly covered by a general chemical formula.
Psychosocial risks. Drug-related problems are not exclusively caused by certain
properties of a drug or its inappropriate use. A comprehensive harm reduction approach
should be aware also about psychosocial risks of drug use, some of which originate
from drug users social environments. Compared with the serious legal risks of
classical drugs that are controlled by criminal law, NPS users are relatively safe from
harsh legal sanctions. However, NPS use may lead to external psychosocial risks such
as stigmatisation, marginalisation, and discrimination. These consequences can be also
understood as potential moral sanctions against the use of non-mainstream
psychoactive substances. It is unfortunate that these negative interactions leading to
psychosocial harm are particularly fuelled by an extremely sensation-seeking public
media. Unfortunately, the NPS phenomenon cannot be adequately discussed in public
due to a lack or biased selection of expert statements and drug user opinions, and to
false beliefs and prejudices of the uninformed and misled general population.
NPS harm reduction best-practices
Difficulties of previous harm reduction strategies
As compared with classical drug harm reduction, NPS-related harm reduction
has got a notably more difficult environment to operate in. To start with the fundamental
problem: even the scope of the NPS phenomenon is impossible to know exactly. Unlike
neatly compiled international and national schedules of controlled substances, the NPS
scenario is scattered with hundreds of chemical formulae, dubious mixtures, street
names, brand names, fantasy names, drug analogues, pharmaceutical products and byproducts, pro-drugs, precursors, metabolites, and so on. With new substances
appearing weekly, this turbulent situation is notably different from the previous operating
environments where, for instance, information leaflets about a fixed number of drugs
and their constant effects could be printed and distributed year after year. Furthermore,
the quasi-simultaneous explosion of hundreds of new drugs has made their
differentiation practically impossible. With the exception of a few pre-packaged and
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branded products, the majority of NPS are imported and sold as bulk powders that are
virtually indistinguishable from each other by their buyers. This is in high contrast with
the somewhat manageable situation of the last 10-15 years, when a relative stability of
the Ecstasy pill market made it possible to maintain searchable databases that could
find a pill by its logo, colour, and shape. Moreover, the pills ingredients such as
MDMA, amphetamines, or ketamine were easily identifiable and well-known
substances. The recent change toward drug appearance homogeneity poses a huge
challenge to harm reduction professionals, who will need fast responses in drug
information exchange, and innovative experimental approaches in order to develop and
implement novel drug identification measures (Mr & Rcz, 2013).
European examples of best-practices
In order to summarise ongoing NPS harm reduction activities that can be
currently perceived as best-practices, six important attempts are listed below. These
approaches are illustrated by European examples involving both governmental and nongovernmental organisations, as well as self-help activities initiated by drug users.
Drug checking services. Given the plethora of NPS, proper drug identification is
core essential for harm reduction. In practice, NPS testing is a difficult task due to the
enormous variety of substances, high laboratory costs, and scarce availability of
reference compounds. Apart from using quick field testing kits, the procedure requires
professional expertise and laboratory equipment that is difficult to access for drug users.
As some of the unidentified drug samples may contain illegal substances (hence cannot
be legally returned to the submitting owners), drug checking procedures must be carried
out with an official approval and under controlled circumstances. Anonymous drug
checking could be offered as a mobile service at electronic dance music events (as
provided by, e.g., the municipal ChEckiT! team in Vienna, Austria), or as a stationary
walk-in service (as provided by, e.g., the youth advisory service in Zurich, Switzerland)
(Hungerbuehler, Buecheli, & Schaub, 2011), or as an analysis of drug samples sent in
by postal mail (as provided by, e.g., the WEDINOS project of Public Health Wales).
Drug identification results from forensic laboratories should be unified with relevant data
from other licensed drug checking services, and rapidly disseminated via media
channels that actually reach drug users.
Public drug databases. Drug checking would not have much benefit without
detailed information on the identified substances. For global drug information, the
Erowid.org website has served for many years as the most comprehensive source,
while promoting also responsible psychoactive drug use (Erowid & Erowid, 2009).
Besides publicly available up-to-date and continuously expanding databases, there is
also a need for concise, easy-to-read drug information. This may also include practical
hints and tips for harm reduction for the presumably young drug user target audience.
For this task, mobile and internet technologies and computer-based programs have
been found effective in addressing recreational drug users (Wood et al., 2014). E.g., the
Recreational Drugs European Network (ReDNet) project maintains a New Database on
Legal Highs that is based on a Wiki concept for wider collaboration, and is easily
accessible via mobile devices (ReDNet, 2014).
Global and local information. Even though the emergence of NPS is a global
phenomenon, notable local differences exist between countries and regions in the
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usage of these substances. Epidemiologic data, i.e., reports about the sites of
appearance of NPS, is therefore important in finding out drug usage trends. Moreover,
local data helps in focusing local harm reduction measures on those substances that
are the most probable to appear at or near a certain location. Official networks, such as
the Early Warning System of the European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA), are established to exchange NPS information mainly between
governmental institutions (EMCDDA, 2014a). However, a huge amount of essential
NPS information is going on outside official channels, most notably on internet
discussion forums. This local information should be also constantly monitored in order
to be up to date and able to appropriately reflect on the local NPS situation. E.g., the
Bluelight discussion board allows regional groups to chat about various NPS that are of
local interest (Bluelight, 2014).
Drug user empowerment. It can be safely stated that for all modern societies,
there is a notable level of negative emotions against drug users, with not much
distinction between occasional or problem use, or between illegal or legal substances.
As long as drug users are considered either criminal or ill, it may be extremely difficult to
involve them into visible societal activities that aim to improve their own health
conditions by reducing drug-related harms (Goossens, 2008; Hunt, Albert, & Montas
Snchez, 2010). However, with the help of internet-provided anonymity and of
researchers and NGOs acting as buffers, there are novel possibilities for information
exchange between drug users and mainstream society. This trend could be observed
particularly in connection with NPS: drug user groups are increasingly discovered and
surveyed by those who need more in-depth information than a scarce amount of
epidemiologic data. E.g., the Eurasian Harm Reduction Network (EHRN) is a regional
network with a mission to promote evidence-based harm reduction approaches to drug
use (EHRN, 2014).
Party harm reduction. NPS are extensively used for recreational purposes by
youngsters at public dance events at clubs, parties, and festivals. For the last decade,
an increasing number of harm reduction NGOs have operated their peer-help outreach
programs at such venues. It is indeed reasonable to offer up-to-date drug information
about NPS at the exact sites of their well-assumable purchase and consumption, and to
be prepared for handling drug emergencies by a team of trained helpers. Mass dance
events offer also good opportunities to peek into the emerging drugs scene by just
chatting with party people about drugs; however, for this, a base of trust and good
reputation needs to be established first. E.g., the EU-sponsored Nightlife
Empowerment & Well-being Implementation Project (NEWIP) proposes specific
responses to the new challenges in the fields of harm reduction and health promotion,
using recreational settings as initial outreach locations (NEWIP, 2014).
Media regulation. The role of public media in popularising drugs in particular,
NPS is unfortunately much disregarded. It would certainly not be possible for a drug
vendor to publicly advertise a new, trendy, legal, strong, cheap, and easily available
psychoactive substance that can be delivered home just by googling its name.
Nevertheless, the public media is allowed to perform an equivalently blatant marketing
actby calling it a piece of news. Clearly, instead of spreading scary stories and
misinformation, the public media could do a lot of useful harm reduction by
disseminating practical hints and tips that may reduce actual (and not fictional) risks of
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NPS use. For this to happen, it would be essential for drug experts and professional
harm reduction activists to step forward and proactively approach the media to have
their voices and messages heard. E.g., the Media Monitor program of the Hungarian
Civil Liberties Union (HCLU) collects and checks anything published or broadcasted in
the media on drugs. When incorrect information or false assertions are found, the
program activists publish responses including commentary and references to accurate
and credible data (HCLU, 2014).
Conclusions
From the above analyses of NPS-related harms and harm reduction bestpractices, several conclusions can be logically drawn. Evaluations of evidence-based
drug policies reveal increasingly that efficient prevention strategies cannot be based on
unrealistic ideologies, such as the ideal goal of a drug-free world. Instead, it should be
admitted that psychoactive substance use as a cultural phenomenon have always
existed and will exist in some form within all societies. Thus, it must be accepted that
the lifecycle of drugs cannot be stopped by force, but their course may be partially
affected by carefully chosen interventions which may also reduce drug use related
harms.
By looking at its background factors, ongoing processes and future directions, it
becomes clear that the NPS phenomenon should be primarily addressed also as a
cultural and economic issue, not as a merely legislative and public health issue. As a
first step, the trust of NPS users should be re-obtained by public measures to protect
them as consumers, while simultaneously letting them to promote responsible
substance use and to develop smart drug user subcultures on their own. The risk of
overdosing on little-known NPS could be decreased by provision of drug checking
services and rapid dissemination of reliable drug information that originates from highquality academic research. It should be also clear that the public media deserves
quality-enhancing regulatory measures that would counterbalance the psychosocial
harms caused by its dirty scare strategies. Databases on substance legality and
vendors may also help to clarify the legal situation and to harness market forces in order
to induce competition, which may ideally result in an increased social responsibility and
additional resources to harm reduction.
The most difficult overarching strategy would be, however, to reduce the
prevailing hypocrisy in alcohol and tobacco policies. Certainly, it goes beyond any
rational explanation why NPS with unknown risks get banned, while alcohol and
tobacco products with well-known grave risks remain legal? Policies toward illegal drugs
may also deserve a rethinking: it could be even asked provocatively whether well-known
classical drugs should be recommended instead of little-known or unknown NPS? A
crucial step in handling this core issue would be to orient toward an integrated
psychoactive substance policy that is coherent, evidence-based, and proportional.
Nevertheless, smaller steps in harm reduction such as those described above are
more urgently needed to directly protect NPS users. Despite the complex and everchanging NPS situation, there are plenty of resources and dedication to save lives and
health, which gives a reason for optimism concerning the future.

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