Humans have found or created a truly staggering number of psychoactive substances. Some, like cannabis, various opioids and cocaine, have a long history of use and come (in some way or another) from plants or fungi. We also have a fairly long record of creating drugs in labs, like LSD and methamphetamine. It’s this latter category where things have exploded in recent years.
Now, most major classes of drugs include wholly human-made and often poorly understood members. Beyond fentanyl and its analogues, the list of potent opioids includes isotonitazene, while the sedative xylazine, developed in the 1960s and used in veterinary medicine, is frequently and harmfully found in unregulated opioid supplies. Newer additions to the psychedelic group include the NBOMe family and the five impenetrably named substances that the DEA has recently been trying to ban.
Its list, which is certainly not exhaustive, currently sits at over 2,100 unique entries.
But such examples are only the tip of the iceberg. An effort out of the University of Copenhagen called HighResNPS collects mass spectrometry data on novel psychoactive substances (NPS) from around the world. Its list, which is certainly not exhaustive, currently sits at over 2,100 unique entries.
NPS—also called “designer drugs” and “research chemicals”—are often made and sold to circumvent existing drug laws within a country. To a large degree, then, they are a product of legal restrictions and prohibitions.
Their spread, combined with myriad associated health issues up to and including deaths, have caused governments around the world to scramble to address them—typically with more bans. In the United Kingdom, for instance, the 2016 Psychoactive Substances Act was drafted in direct response to the speed at which such drugs come onto the market. It created a blanket ban of all psychoactive drugs—with exceptions such as medicines, alcohol, caffeine and nicotine (which has its own synthetic version, which the United States is now hastily attempting to regulate).
The sheer number of available NPS causes headaches for governments that seek to enforce bans, but does the same for people who use drugs and harm reduction organizations. It also complicates efforts to legalize and regulate drugs—even if such prospects lie far in the future for many jurisdictions.
“Having this kind of zoo of alien drugs that nobody knows anything about … is just a total nightmare for service providers,” Steve Rolles, senior policy analyst with the UK-based Transform Drug Policy Foundation, told Filter. “A white powder,” he noted, “could be one of any number of different things.”
It presents many dangers when compounds may not appear on databases of known drugs—if harm reduction organizations even have access to a mass spectroscopy machine to identify chemicals in the first place, Rolles said. And relatively accessible resources like fentanyl test strips might simply not be up to the task in this environment.
There’s a dearth of information about neurotoxicity, cardiotoxicity or appropriate methods of treating ill-effects.
Even if the NPS is identified, emergency services and harm reductionists are “effectively driving blind,” he added, because, by definition, the compounds are new and poorly understood. “It makes life that much more difficult for service providers,” when there’s a dearth of information about neurotoxicity, cardiotoxicity or appropriate methods of treating ill-effects.
Quite often, discussions about NPS surround potent synthetic opioids, their appearance in supplies of other drugs like stimulants, and the additional presence of other drugs like benzodiazepines. However, according to Stefanie Jones, a harm reduction consultant and founder of Safer Partying, NPS first broke into public consciousness in the party and music festival scene, with analogues of MDMA or LSD. NPS, including the stimulant class cathinones, are still present there, she told Filter, even amid a growing concern about fentanyl and other potent opioids appearing in “party” drugs. “The most obvious [problem] is that you have even less of a chance of understanding what you’re getting.”
In terms of responses to pursue before the goal of full legal regulation, Aaron Ferguson, a member of the Urban Survivors Union leadership team, suggested that harm reduction organizations push harder for safe supply programs to allow people to know what they’re consuming. Otherwise, “Harm reduction is only going to be scrambling to keep up with all these things,” he told Filter.
Both Rolles and Jones described how prohibition and the drug war have driven the spread of NPS. The banning of certain drugs resulted in newer compounds being created to sidestep criminal penalties. It has also incentivized the creation of more potent compounds—active in smaller doses, and therefore easier to transport inconspicuously—in a phenomenon known as the Iron Law of Prohibition. Health risks are the collateral damage. Synthetic cannabinoids came about to mimic the effects of THC while avoiding either drug laws or drug tests that pick up cannabis, Rolles noted, but their use has been linked to harms and deaths.
This is why he believes that any government that looks to legalize and regulate drugs—as opposed to simple decriminalization, which can be done on a blanket basis—will most likely not extend the effort to the vast majority of NPS. He said that drugs should not be marketed without a certain minimum risk assessment, which very few NPS have. If researchers could develop risk profiles, it could help a government decide which NPS end up making the cut. However, doing so for literally thousands of substances isn’t an imminently realistic possibility.
But Rolles believes most people who use drugs wouldn’t want to use most NPS anyway, if better-known and better-studied equivalents were legally and widely accessible.
Jones agreed that future legalization efforts will likely start with the substances that are already familiar and popular—though she noted that some NPS have, over time, shown themselves to be popular. But it will be important, she added, that governments don’t continue to criminalize and persecute people who use drugs that don’t make this cut.
As for investigating the thousands of less-understood drugs as future candidates for legalization, “that’s down the line, in the future,” she said. “But that’s the kind of thing we should be thinking about as a society.”
People who use drugs must play a key role in the process of deciding who substances are legal and which are simply decriminalized, Jones said. While research and science are also invaluable, people with lived or living experience have a critical wealth of knowledge. “But in the past, people who use drugs have rarely or only at low levels been involved in creating drug policy, and that’s something that ought to change,” she said.
Going forward, Jones said, scientists could work to deliberately create less risky, more pleasurable NPS.
Despite some documented harms and plenty of media scare stories, it’s perfectly possible that the ever-growing list of NPS includes drugs with lower risk profiles—and similar or better recreational value—compared to their kin with longer histories of human use. And there’s real potential in this area. In the current situation, NPS are often just stumbled upon, or created because they’re relatively easy or cheap to manufacture. But going forward, Jones said, scientists could work to deliberately create less risky, more pleasurable NPS.
“It would be kind of nice to be in a future where there was a much more reasonable, understandable rationale for … what intoxicating substances are available for people, and at what level,” she said.
However, until countries begin rolling out legalization frameworks—if that ever happens—people who use drugs and harm reduction organizations will keep grappling with an increasingly long list of substances with relatively unknown effects.
Some harm reduction basics apply regardless: Check drugs as much as possible; start low and go slow; follow safe injection or inhalation practices as applicable; use drugs around other people whenever possible; and carry naloxone. And as Jones pointed out, the practical impossibility of staying well informed on all the new substances that hit the market doesn’t diminish the importance of education and knowledge for people who use drugs and those who work with them.
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