EU Drug Market: New psychoactive substances — Global context
This resource is part of EU Drug Market: New psychoactive substances — In-depth analysis by the EMCDDA and Europol.
Before 2008, the NPS market was characterised by a small number of new psychoactive substances and low numbers of consumers, typically in high-income countries. The substances were mostly stimulants and psychedelics, made in amateur and illicit laboratories in Europe. Certain new psychoactive substances were mis-sold as amphetamine or ecstasy, including PMMA, which was implicated in a number of fatalities in the early 2010s. They were popular at electronic dance music events and raves. Others were used by ‘psychonauts’ interested in exploring their effects. Few were seized in large amounts (EMCDDA, 2022a).
Since then, the number, type and availability of new psychoactive substances have expanded rapidly across the globe. Globalisation of the chemical and pharmaceutical industry and new technologies such as the internet have fuelled this market. This has allowed new psychoactive substances, their precursors and the equipment used to make and package them to be produced, sold and supplied on an industrial scale. In particular, during this period, more novel and sometimes highly potent substances from a wider set of chemical classes have been introduced onto the market. The use of new psychoactive substances by high-risk drug users and other marginalised and vulnerable populations also appears to have increased in some places (EMCDDA, 2022a).
Between 2009 and 2022, a total of 139 countries and territories reported the emergence of 1 182 different new psychoactive substances to the United Nations Office on Drugs and Crime (UNODC), through the UNODC Early Warning Advisory on NPS (UNODC, 2022). This is almost four times the number of psychoactive substances that were under international control by 2023 (318). Meanwhile, in Europe, between 1997 and 2023, EU Member States reported the emergence of more than 960 different new psychoactive substances to the EU Early Warning System. Around 860 (90 %) of these have been detected since 2008, when the market began to expand rapidly (EMCDDA, 2022a). This growth is also reflected in the number of NPS seizures and the quantity seized by law enforcement agencies and in reports of poisonings and other harms.
New psychoactive substances affect regions, countries and localities in different ways. In some cases, new psychoactive substances are encountered only sporadically as one-off events; in others, they may become more widespread but temporary features; while in some they may re-shape drug markets, and become more prevalent, persistent and problematic. As new psychoactive substances are easily available, they can emerge, often rapidly, in any place. Importantly, the specific types of new psychoactive substances that emerge and the threats they pose are shaped by global supply chains and local drug situations, both of which can change over time.
In North America, for example, new opioids, benzodiazepines and now xylazine are established elements of the ongoing opioid epidemic. These substances are either mis-sold as or used to adulterate established drugs such as fentanyl that are driving the epidemic. In this case, consumers are unaware that they are using new psychoactive substances (Bowles et al., 2021; Friedman et al., 2022; Laing et al., 2021; Pardo, 2022; Reyes et al., 2022; Wong et al., 2008). More generally, in 2021, new psychoactive substances accounted for 7 (28 %) of the 25 most identified drugs reported to the US National Forensic Laboratory Information System (NFLIS), a drug surveillance programme that systematically collects data on drugs that are seized by law enforcement and submitted to and analysed by forensic laboratories.
In West Africa, an increased supply from India of fake tablets and capsules (‘pills’) containing tramadol – an opioid medicine – resulted in a recent increase in both use and harm (UNODC, 2021). This is fuelled by unapproved high-dose pills that are not available through the regulated medicine supply chain, which are imported and then distributed by criminal networks. The tramadol is concealed using various methods and imported by air and sea cargo. The criminals exploit states’ vulnerabilities, including by using corruption to avoid control and seizure (UNODC, 2021). Following the control of tramadol in India in 2018, the supply has at least partially diversified into other substances, including tapentadol (UNODC, 2021).
In China, recent reports from wastewater analysis and police seizures suggest an increase in the use of synthetic cannabinoids commonly found in Europe and the United States (Fan et al., 2022; Liu et al., 2022), while use of ketamine-like new psychoactive substances, such as 2-fluorodeschloroketamine, has also been reported (Shao et al., 2021). New benzodiazepines have been increasingly identified in fake medicines in Australia (Blakey et al., 2022; Syrjanen et al., 2023). In Australia and New Zealand, fake oxycodone tablets containing potent nitazene opioids have been identified (Australian Federal Police, 2023; Drug Information and Alerts Aotearoa New Zealand, 2022). In Brazil, similar to Europe, papers infused with synthetic cannabinoids and smuggled into prisons have been reported (Rodrigues et al., 2022). Smoking mixtures made of synthetic cannabinoids, controlled drugs and herbal material have also been reported recently in Egypt (Hussien et al., 2022). Meanwhile, in Argentina, the one-off adulteration of cocaine with carfentanil, an ultra-potent opioid, caused an outbreak of poisonings including deaths during 2022 (Di Nicola, 2022; Ministerio de Salud, 2022).
There is a limited understanding of the epidemiology of new psychoactive substances. Commonly used methods for studying drug use, including those for estimating prevalence, may not be suitable or appropriate for many new psychoactive substances. This may especially be the case for those substances that have recently appeared on the market, rapidly disappeared, have low levels of use or are mis-sold as or used to adulterate other drugs. Standard data collection tools do not account for such instances. These issues have left gaps in our understanding of the size, scale and impact of the market.
Prevalence
In Europe, the prevalence of new psychoactive substances use in the general population tends to be lower than that of established controlled drugs (see Box Prevalence of use of new psychoactive substances in Europe). There are some exceptions to this, such as ketamine, which has become established in some places. Nitrous oxide is an example of a new psychoactive substance that has recently emerged rapidly in some countries, such as the Netherlands, with relatively high levels of use among the general population, especially young people (see Box Recreational use of nitrous oxide: a growing concern for Europe).
In addition, the use of some new psychoactive substances, such as synthetic cathinones, synthetic cannabinoids, opioids and benzodiazepines, may be relatively common among high-risk drug users and other marginalised groups in some areas and settings. Despite what appear to be relatively low levels of use, some of these substances, in particular the synthetic opioids, have the potential to cause high levels of harm (see Section Distribution and supply in Europe: new opioids).
References
Consult the list of references used in this module.