Novel Psychoactive Substances are synthetic or “designer” drugs which have increased in popularity in recent years. Such drugs include Foxy, Smiles, “bath salts” such as Flakka and Meow Meow, psychedelics such as NBOMe (pronounced “N-bomb” a.k.a.: “25i”), and synthetic cannabinoids (commonly referred to as Spice and K2 drugs). Many of these new drugs are marketed as “legal” highs, appearing on the drug market and out in the open in an effort to circumvent controlled substance legislation.

New street drugs continue to emerge at a rapid rate. According a recent UN World Drug Report, in 2015 alone, the emergence of 75 new drugs were detected, bringing the overall world-wide count to almost 700 “new” street drugs identified. However, in the U.S., national drug use surveys only ask respondents about their use of a couple of non-specific categories of new street drugs such as “bath salts”. Furthermore, few studies in the U.S. have focused on use among one of the highest-risk populations—electronic dance music (EDM) nightclub and festival attendees.

Researchers at New York University Center for Drug Use and HIV Research (CDUHR) and Kings College London set out to rectify this dearth of information. Their paper, “Examine Correlates of New Psychoactive Substance Use Among a Self-Selected Sample of Nightclub Attendees in the United States,” was recently published in The American Journal on Addictions.

“We found that among a self-selected sample of nightclub attendees in the U.S., a large range of novel substances were reported,” noted said Joseph J. Palamar, PhD, MPH, an affiliate of CDUHR and an assistant professor of Population Health at NYU Langone Medical Center (NYULMC). “And, young attendees, males, and those who attended nightclubs more frequently were at increased risk of reporting use.”

The data were drawn from the Global Drug Survey, led by senior author Dr. Adam Winstock, MD, founder and director of the Global Drug Survey, Ltd, which surveys tens of thousands of nightclub attendees around the world every year. The analysis focused on the 2,282 U.S. residents who reported attending a nightclub within the last year. Respondents were asked whether they have ever used 58 specific new street drugs, and the researchers examined correlates of self-reported use.

Almost half the sample (46.4%) reported ever using a new street drug, and the most commonly reported new drug used (by a quarter of the sample) was synthetic cannabinoids, commonly referred to as “Spice” and “K2” in the U.S.

“Spice drugs have been a major problem here in the U.S. in recent years,” notes Dr. Palamar, “especially here in the big cities. Prevalence has dropped significantly in recent years, but antithetically, we found that nightclub attendees are still at very high risk for at least trying such products.”

Trypatmines such as DMT and 4-AcO-DMT were reported used by 23% of the sample, and alarmingly, 5% reported use of the new psychedelic called NBOMe (pronounced “N-bomb”).

“It’s alarming that 5% of nightclub attendees reported use of NBOMe as this drug is extremely potent, dangerous, and hard to dose,” said Dr. Palamar.

About one out of ten surveyed reported use of synthetic cathinones—commonly referred to as “bath salts” in the U.S. Methylone (“M1”) was the mostly commonly used “bath salt” in this study with one out of ten respondents reporting lifetime use. However, the researchers caution that many club-goers may be using “bath salts” without knowing it.

“Since Molly powder is so adulterated here in the U.S., it is very likely that many respondents used bath salts unknowingly—in their Molly,” said Dr. Palamar. “We actually found last year that many club-goers who reported Molly use had their hair samples test positive for bath salts”.

The researchers found that more frequent nightclub attendance was strongly associated with increased risk of use of new street drugs. Attending nightclubs every week more than doubled the odds of reporting use.

“We found nightclub attendance was not related to self-reported use of synthetic cannabinoids,” said Dr. Winstock. “Therefore, while synthetic cannabinoids are the most prevalent new street drug in the U.S. and worldwide, we found that these drugs tend to be used more often by individuals who do not frequent the nightclub scene.”

The researchers also found that being unemployed increased the odds for reporting use of synthetic cathinones or synthetic cannabinoids.

The researchers stress that prevention and harm reduction initiatives need to be adapted to reduce the risk of harm among in this population, where increased rates of experimentation and environmental characteristics may augment and combine to increase risks associated with consuming lesser-known psychoactive substances.

The researchers also note, as the data is drawn from web surveys, there will be biases inherent in the respondents—the ones who chose to respond may be more experienced in the drug culture, and as such may not be representative of the wider population, so it is important not to interpret the findings reported as prevalence estimates.

“Every year we conduct the Global Drug Survey to help identify emerging substances and new trends in drug use,” said Dr. Winstock. “The web-based design actually improves our capacity to access otherwise hidden populations to answer these kinds of questions among people who use illicit drugs.”

Researcher Affiliations:

Joseph J. Palamar, PhD,1,2 Monica J. Barratt, PhD,3,4,5 Jason A. Ferris, PhD,6,7 Adam R. Winstock, MD8,9,10

1Department of Population Health, New York University Langone Medical Center, New York City, New York

2Center for Drug Use and HIV Research, New York University College of Nursing, New York City, New York

3Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, Australia

4National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia

5Centre of Population Health, Burnet Institute, Melbourne, Australia

6Institute for Social Science Research, University of Queensland, Brisbane, Australia

7ARC Centre of Excellence for Children and Families over the Life Course, Institute for Social Science Research,The University of Queensland, Brisbane, Australia

8South London and Maudsley NHS Trust, London, United Kingdom

9Addictions Clinical Academic Group, King’s College London, Maudsley Hospital, London, United Kingdom

10Global Drug Survey Ltd, London, United Kingdom

Acknowledgements: We would like to thank the participants who gave so generously of their time to complete the Global Drug Survey. We are grateful for the promotion of GDS by a long list of world media partners, see www.globaldrugsurvey.com. We are also indebted to Stuart Newman for his programming skills and patience.

No external funding was received specifically for this study. J.P. was supported by the National Institutes of Health (NIH) to lead this secondary data analysis (K01 DA-038800, PI: Palamar). The National Drug and Alcohol Research Centre at UNSW Australia and the National Drug Research Institute in the Faculty of Health Sciences at Curtin University are supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund. M.B. is a recipient of a National Health & Medical Research Council Early Career Researcher Fellowship (APP1070140). M.B. gratefully acknowledges the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute. J.F. is a recipient of a National Health & Medical Research Council Early Career Researcher Fellowship (APP1089395). The funders played no further part in the research process, and the views expressed in this paper should not be seen as representative of the views of the funders.

Declaration of Interest

Dr. Winstock is founder and managing director of Global Drug Survey, the independent drug use data exchange hub that conducted the study. There is nothing further to declare.

About CDUHR

The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit www.cduhr.org.

About the Global Drug Survey

GDS is comprised of experts from the fields of medicine, toxicology, public health, psychology, chemistry, public policy, criminology, sociology, harm reduction and addiction. Using anonymous on-line research methods Global Drug Survey runs its annual survey in 10 languages and is hosted by partners in over 20 countries. GDS promises its subjects total anonymity. Survey findings are frank, honest, and revealing. GDS insights into personal decision-making about drug use are unparalleled. Our international networks of researchers and specialists have extensive experience in data analysis and report writing. We prepare reports for government, public health institutions, corporate health organizations and policy groups.

About NYU Langone Medical Center

NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation’s premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals—Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center’s dedicated inpatient orthopaedic hospital; and Hassenfeld Children’s Hospital, a comprehensive pediatric hospital supporting a full array of children’s health services across the Medical Center—plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center’s tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to www.NYULMC.org, and interact with us on Facebook, Twitter, and YouTube.