If it’s not one drug it’s another. There are so many to choose from. While the Australian government remains focused on methamphetamine (ice), described as the single biggest drug threat to civil society, elsewhere in the world fears over novel psychoactive substances (predominantly synthetic cannabinoids), appear to have taken centre stage.

These substances are sometimes also referred to as “designer drugs” or “herbal highs,” and although they mimic the effects of illicit drugs, synthetic cannabinoids are generally not as nice and carry a greater risk of harm.

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Many countries have seen a decline in the use of novel psychoactive substances, including Australia. This seems to be because better quality drugs have become more widely available in the last couple of years.

Despite this decline among the wider drug-using population, it is clear that some continue to use novel psychoactive substances. Synthetic cannabinoid products are the most popular, and headlines about escalating Emergency Room presentations follow where they’re used.

Anecdotal evidence suggests a similar trend in Australia. Findings from the Global Drugs Survey 2015 support these concerns, with more people seeking the Emergency Room after using them than any other drug.

So why would people use drugs like this? Because they’re cheap. My view on this is supported by the findings from the Global Drugs Survey 2015, which rated “value for money” as being the most important driver for people using novel psychoactive substances (n > 4000 last year users).

People who use drugs are, for the most part, not idiots. For new drugs to be “successful” they will need to attract new users or offer something to displace existing users from an old product.

Given the choice, most people will opt for a drug (or form of a drug) with the nicest effects and the smallest risk of harm. Not having much money limits that choice. Where the variety of drugs are limited, cost will influence the quality or type of preparation that one uses: think crack versus cocaine, or cask wine versus a posh bottle. Or, for that matter, natural cannabis versus synthetic cannabinoid products.

There’s nothing like poverty to make a serious drug problem harder to deal with. Poverty hampers access to better quality drugs, healthcare and, when needed, expert legal advice.

So I am starting to think that many novel psychoactive drugs may finally have found their resting place in the market place – at the bottom. The drugs that carry the greatest risk have migrated to those most vulnerable to drug-related harm. Continued use will lead them to the emergency room agitated, sweaty, paranoid and psychotic.

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That new drugs are about to become the target of a new drugs war worries me. And given all we know about the effects of early-onset cannabis use on the developing brain, I think that use of synthetic cannabinoids by young people might be a real public health issue. I have to remind people that to let their brain grow before they try to “expand” it.

So this year the Global Drugs Survey is continuing its assessment of synthetic cannabis products. We’ll explore whether the preparations and routes of use are changing, and whether or not the widespread availability of vaporisers are leading to a whole new range of health risks (or benefits).

We will keep assessing the risk of seeking emergency medical treatment. And we’ll keep hoping that the manufacturers revise the potency and effect profile of what they are adding in, to make these products safer.

If you have dabbled with drugs (old or new), please add your experiences to thousands of other peoples’ in the Global Drugs Survey 2016, the largest drugs survey the world has ever seen at www.globaldrugsurvey.com/GDS2016

