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Novel psychoactive substances

Novel psychoactive substances

Novel psychoactive substances is the medical term for the many new substances which are chemically related to established recreational drugs such as MDMA and cannabis. They are often referred to as 'legal highs' although this is a misnomer in the UK, as their distribution and sale have been illegal since 2016.

The information below describes some of the common types:

Stimulants
  • similar to MDMA, amphetamines and cocaine, resulting in increased levels of serotonin, dopamine and noradrenaline, resulting in a 'high' and feeling of euphoria
  • a common example is a stimulant NPS is mephedrone ('bath salts','M-CAT'.'meow meow'). It is a cathinone and structurally similar to khat, a plant found in East Africa
  • another example is benzylpiperazine ('Exodus', 'Legal X', 'Legal E')
  • typically swallowed as a pill/powder ('bombing') or snorted
  • adverse effect profile similar to MDMA/cocaine, with the risk of serotonin syndrome

Cannabinoids
  • termed synthetic cannabinoid receptor agonists
  • commonly referred to as 'spice'
  • typically sprayed on to herbal mixtures which are then smoked. Also available in liquid form which is then inhaled using e-cigarettes
  • similar adverse effects to cannabis

Hallucinogenics
  • can be either dissociatives and psychedelics
  • dissociatives produce a similar effect to ketamine, with a sense of not being connected to the physical body or time. A common dissociative NPS is methoxetamine ('mexxy')
  • psychedelics have a similar effect to LSD although NPS versions may also be a stimulant

Depressant
  • can be either opioid or benzodiazepine-based
  • usually taken as a pill or a powder
  • often structurally very similar to the original drug class, hence the adverse effects are similar
  • benzodiazepine NPS often have a significantly longer half-life

Gamma-hydroxybutyric acid (GHB)
  • colourless liquid used as a recreational drug
  • causes euphoria followed CNS and respiratory depression. When taken with other respiratory depressants, most commonly alcohol, this can be potentially life-threatening
  • features of toxicity:
    • ↓ GCS
    • ↓ respiratory rate
    • ↓ heart rate
    • ↓ temperature
  • management is supportive, focused on airway and respiratory support

For a more detailed overview please see the excellent review in BMJ 2017;356:i6848
+PassMedicine Notes

Novel psychoactive substances is the medical term for the many new substances which are chemically related to established recreational drugs such as MDMA and cannabis. They are often referred to as 'legal highs' although this is a misnomer in the UK, as their distribution and sale have been illegal since 2016.

The information below describes some of the common types:

Stimulants
  • similar to MDMA, amphetamines and cocaine, resulting in increased levels of serotonin, dopamine and noradrenaline, resulting in a 'high' and feeling of euphoria
  • a common example is a stimulant NPS is mephedrone ('bath salts','M-CAT'.'meow meow'). It is a cathinone and structurally similar to khat, a plant found in East Africa
  • another example is benzylpiperazine ('Exodus', 'Legal X', 'Legal E')
  • typically swallowed as a pill/powder ('bombing') or snorted
  • adverse effect profile similar to MDMA/cocaine, with the risk of serotonin syndrome
Cannabinoids
  • termed synthetic cannabinoid receptor agonists
  • commonly referred to as 'spice'
  • typically sprayed on to herbal mixtures which are then smoked. Also available in liquid form which is then inhaled using e-cigarettes
  • similar adverse effects to cannabis
Hallucinogenics
  • can be either dissociatives and psychedelics
  • dissociatives produce a similar effect to ketamine, with a sense of not being connected to the physical body or time. A common dissociative NPS is methoxetamine ('mexxy')
  • psychedelics have a similar effect to LSD although NPS versions may also be a stimulant
Depressant
  • can be either opioid or benzodiazepine-based
  • usually taken as a pill or a powder
  • often structurally very similar to the original drug class, hence the adverse effects are similar
  • benzodiazepine NPS often have a significantly longer half-life
Gamma-hydroxybutyric acid (GHB)
  • colourless liquid used as a recreational drug
  • causes euphoria followed CNS and respiratory depression. When taken with other respiratory depressants, most commonly alcohol, this can be potentially life-threatening
  • features of toxicity:
    • ↓ GCS
    • ↓ respiratory rate
    • ↓ heart rate
    • ↓ temperature
  • management is supportive, focused on airway and respiratory support

For a more detailed overview please see the excellent review in BMJ 2017;356:i6848



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