Several hundred new synthetic drugs, novel psychoactive substances (NPS) or “legal highs” have in recent years appeared on the drug market. These can effortlessly be obtained from on-line vendors, offering an easy access to a plethora of new and untested substances, often with unknown or dangerous effects. Several different attempts to reduce the availability of NPS and to prevent accidents and fatalities have been applied by governments around the world. Nonetheless this complex and constantly evolving situation provides palpable dilemmas and challenges to legislators and prevention strategists. One unintended consequence from prohibition and current drug policies occurs when possibly more precarious substances are used to substitute older and more well-known illicit drugs; so called “substance displacement”. We have performed extensive research on the use of NPS, by analyzing Internet resources (drug discussion forum, on-line questionnaires), and published several NPS studies. During our research we observed how substance displacement is a common issue, with implications for both clinical practices, drug prevention strategies, as well as for legislators. In the present review we discuss two common themes of substance displacement: 1) Synthetic cannabinoids replace herbal cannabis, and 2) Different attempts for self-medication using NPS. Incitements for substance displacement, that exposes the user to possibly more harmful substances, are founded both in legislation (availability of substances and fear of legal repercussions) as well as from certain policies or cultural perceptions of various medical conditions. We offer no obvious solutions to these complications, but would like to contribute to awareness of how these factors effects drug users and how measures intended to reduce harm in many cases have the opposite effects. Further studies on the divergent motivations and different groups of NPS users are highlighted as imperative to find new and realistic solutions going forward.
Aim: The purpose of this qualitative study was to investigate the effects experienced by users of a novel psychoactive substance, the benzodiazepine flubromazolam, by analysing users' own accounts on the Swedish forum Flashback.org. Method: A thematic analysis of anonymous self-reports published on the forum was performed and generated five general themes describing effects and experiences by flubromazolam users. Results: The themes which emerged were: Onset and duration, Desired effects, Adverse effects and addiction, Loss of control, General estimations and evaluations. The main reported characteristics of flubromazolam were heavy hypnotic and sedative effects, long-lasting amnesiac effects and the rapid development of tolerance. Flubromazolam was also anxiolytic and acted as a muscle relaxant for many users. Some users experienced euphoria or intense wellbeing. Other prominent characteristics were loss of control (leading to poor choices and actions, with unpleasant consequences) and long-lasting, often severe withdrawals. There were also serious incidents where users had been admitted to hospital, acute psychiatric treatment or taken into custody by the police. Conclusion: Flubromazolam appears to be a highly addictive and precarious benzodiazepine with many, possibly severe, side effects. The substance is generally described as very potent and with long-lasting effects. Memory loss and loss of control are common adverse effects, and withdrawals appear to be severe for many users
Background: Psychedelic microdosing is the trending practice of using tiny repeated doses of psychedelic substances to facilitate a range of supposed benefits. With only a few published studies to date, the subject is still under-researched, and more knowledge is warranted. Social media and internet discussion forums have played a vital role in the growing visibility of the microdosing phenomenon, and the present study utilized YouTube contents to improve comprehension of the microdosing practice as well as the social interactions and discussions around microdosing. Methods: Microdosing self-disclosure in YouTube videos and their following comments were qualitatively analyzed by inductive thematic analysis. Various software was utilized to enable gathering and sorting relevant data. Results: Microdosing of psychedelic substances, primarily LSD and psilocybin, was used for therapeutic and enhancement purposes, and predominantly beneficial effects were reported. Many different applications and outcomes were discussed, and therapeutic effects for depression appeared especially noteworthy. Intentions for use were recognized as an influencing factor for the progression and outcomes of microdosing. The function of social interactions was mainly to discuss views on the microdosing phenomenon, strategies for optimal results, minimize risks, and share emotional support. Conclusions: Potentially, microdosing could provide some of the same benefits (for certain conditions) as full-dose interventions with less risk of adverse reactions related to the sometimes intense experiences of higher doses. Microdosing may well also mean additional benefits, as well as risks, through the repeated exposure over extended periods.
Background: Treatment resistant cluster headache and migraine patients are exploring alternative treatments online. The aim of this study was to improve comprehension regarding the use of non-established or alternative pharmacological treatments used by sufferers of cluster headaches and migraines.
Methods: A qualitative thematic analysis of the users’ own accounts presented in online forum discussions were conducted. The forum boards https://shroomery.org/, http://bluelight.org, and https://clusterbusters.org/ met the inclusion criteria and were used for the study.
Results: The analysis resulted in six themes: a desperate need for effective treatments; the role of the forum—finding alternative treatments and community support; alternative treatment substances; dosage and regimens; effects and treatment results; and adverse effects. The results provide an insight into why, how, and by which substances and methods sufferers seek relief from cluster headache and migraines.
Conclusions: These patients are in a desperate and vulnerable situation, and illicit psychoactive substances are often considered a last resort. There appeared to be little or no interest in psychoactive effects per se as these were rather tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both prophylactic and acute treatment of cluster headache and migraines. Treatment results with cannabis were more unpredictable. No severe adverse events were reported, but it was observed how desperation sometimes spurred risky behavior when obtaining and testing various treatment alternatives. The forum discourse mainly revolved around maximizing treatment results and minimizing potential harms.
Background
The increasing number of legally ambiguous and precarious Novel Psychoactive Substances (NPS) constitutes a challenge for policy makers and public health. Scientific and more in-depth knowledge about the motivations for using NPS is scarce and often consist of predetermined, non-systematic, or poorly described reasons deduced from top-down approaches. Therefore, the aim of the present study was to explore and characterize the users’ self-reported reasons for NPS use inductively and more comprehensively.
Methods
The self-reported reasons of a self-selected sample of 613 international NPS users were collected via an online survey promoted at the international drug discussion forum bluelight.org and later analyzed qualitatively using inductive thematic analysis.
Results
The analysis showed that the participants used NPS because these compounds reportedly: 1) enabled safer and more convenient drug use, 2) satisfied a curiosity and interest about the effects, 3) facilitated a novel and exciting adventure, 4) promoted self-exploration and personal growth, 5) functioned as coping agents, 6) enhanced abilities and performance, 7) fostered social bonding and belonging, and 8) acted as a means for recreation and pleasure. The consumption of NPS was also driven by 9) problematic and unintentional use.
Conclusion
The present study contributed to a more comprehensive understanding of the users’ own and self-reported reasons for using NPS, which needs to be acknowledged not only in order to minimize drug related harm and drug user alienation but also to improve prevention efforts and reduce the potentially counter-intuitive effects of strictly prohibitive policies.
Background: The growing number of novel psychoactive substances (NPS), also labelled as “legal highs”, constitutes a challenge to public health. It is uncertain whether this trend is related to the increase in number of poising cases reported by emergency rooms. The aim of this study was to investigate the occurrence of NPS in acute cases of poisoning in the Swedish county Värmland. The numbers of NPS casualties were correlated with poisoning by other substances. Both, the gender and age distribution of the reported cases were recorded.
Method: Records classified as poisoning casualties at the emergency rooms in Värmland during 2007- 2013 were collected and analyzed.
Results: NPS and illicit drugs constituted only a small part (1.67% and 7.84% respectively) of the total poisoning casualties. The results also revealed that alcohol and pharmaceuticals were present in the majority of cases (91.2%), and were to a larger extent involved in polydrug abuse and suicide attempts. Furthermore, the results uncovered an alarming poisoning problem among women who had taken pharmaceuticals and for suicidal young people.
Conclusions: It is unclear whether the comparatively low prevalence of NPS and illicit drug related poisoning casualties reflect the real prevalence of injury cases or a possible under-reporting.