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Tracy DK, Wood DM, Baumeister D. 
“Novel psychoactive substances: types, mechanisms of action, and effects”. 
BMJ. 2017 Jan 26;356:i6848.
[Excerpt] In 2016 the Psychoactive Substances Bill banned trading but not possession of all current and future novel psychoactive substances (NPS), sometimes incorrectly called legal highs, in an attempt to overcome rapid proliferation of these compounds. Over 560 substances are currently monitored by the European Monitoring Centre for Drugs and Drug Addiction, with 100 new agents identified in 2015 alone. Stimulants and synthetic cannabinoids account for the vast majority and are the types most commonly clinically encountered.1 Online purchases are increasing according to the 2016 Global Drug Survey,2 potentially in response to legislative changes, as is overall NPS use: lifetime consumption was reported by 8 of younger individuals in 2015, up from 5 in 2011, with figures relatively similar between sexes and different countries.3

Professionals report feeling less confident about managing NPS compared with established recreational drugs.4 There were 15 485 accesses to UK National Poisons Information Service TOXBASE relating to legal highs, branded products, synthetic cannabinoids, and mephedrone in 2014-15.5 Regarding harms from longer term dependence, the UK National Drug Treatment Monitoring System (NDTMS) report in 2015 described 3048 and 1370 adults with documented problematic use of mephedrone and other NPS respectively.6

Information on NPS primarily stems from case reports and case series. However, there is evidence that risks associated with NPS are often different from those seen with established recreational drugs. This article classifies NPS into their major groupings and provides information on the desired effects of these compounds, their pharmacology, and the risks associated with their use. The linked Practice article7 provides advice on what to ask and do when consulting with a patient who may be using NPS.
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