Publication - Research and analysis

Understanding the patterns of use, motives, and harms of new psychoactive substances in Scotland

Published: 30 Nov 2016
Population Health Directorate
Part of:
Health and social care

This report presents the results of mixed methods research on new psychoactive substance use.

133 page PDF

2.3 MB

133 page PDF

2.3 MB

Understanding the patterns of use, motives, and harms of new psychoactive substances in Scotland
References Cited

133 page PDF

2.3 MB

References Cited

56 Dean Street (n.d.) 'What is Chemsex?'. Available at: [last accessed 13/7/2016].

Abdala, N., Stephens, P.C., Griffith, B.P. & Heimer, R. (1999) 'Survival of HIV-1 in syringes '. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 20:1, pp.73-80.

Abdulrahim, D., Whiteley, C., Moncrieff, M., and Bowden-Jones,.O (2016) Club Drug Use Among Lesbian, Gay, Bisexual and Trans ( LGBT) People. NEPUNE guidelines Available at: [last accessed 30/9/16]

Adley, M. (2016) The Drugs Wheel - UK Version 2.0.2. Available at: [last accessed: 17/6/2016].

BBC News (2016) 'Legal Highs Ban Comes into Force across UK' Available at: [last accessed 17/7/2016]

Berger, B.E., Ferrans, C.E. & Lashley, F.R. (2001) 'Measuring Stigma in People with HIV: Psychometric Assessment of the HIV Stigma Scale' Research in Nursing and Health 24(6): 518-529.

Bonn-Miller, M.O., Babson, K.A. & Vandrey, R. (2014) 'Using Cannabis to Help you Sleep: Heightened Frequency of Medical Cannabis Use among those with PTSD' Drug and Alcohol Dependence 136, pp.162-165.

Bootzin, R.R. & Stevens, S.J. (2005) Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness Available at: [last accessed 28/7/16]

Bourgois, P. (2010) Righteous Dopefiend, Berkeley: University of California Press.

Bourgois, P., Martinez, A., Kral, A., Edlin, B. & Schonberg, J. (2006) 'Reinterpreting Ethnic Patterns among White and African American Men who Inject Heroin: A Social Science of Medicine Approach' PLoS Medicine 3:10: e452.

Bourne et al (2014) The Chemsex Study: drug use in sexual settings among gay and bisexual men in Lambeth, Southwark & Lewisham Available at: [last accessed 29/7/16]

Bowden Jones. O. (2014) One new drug a week: Why novel psychoactive substances and club drugs need a different response from UK treatment providers Faculty Report of Addictions Psychiatry, Royal College of Psychiatrists Available at: [last accessed 30/9/16]

Braun, V. & Clark, V. (2006) 'Using Thematic Analysis in Psychology' Qualitative Research in Psychology 3:2: pp.77-101.

Bretteville-Jensen, A.L., Tuv, S.S., Bilgrei, O.R., Fjeld, B. & Bachs, L. (2013) 'Synthetic Cannabinoids and Cathinones: Prevalence and Markets' Forensic Science Review 25:1-2, pp.7-26.

British National Formulary (2016) Prescribing Guidelines: Diazepam. Available at: [last accessed 15/7/2016].

Burroughs, W.S. (2012 [1953]) Junky London: Penguin.

Callon, C., Charles, G., Alexander, R., Small, W. & Kerr, T. (2013) ''On the same level': facilitators' experiences running a drug user-led safer injecting education campaign', Harm Reduction Journal 10:4, pp.1-10.

Cambridge Dictionary (2016) 'Chemsex'. Available at: [last accessed: 17/7/2016].

Campbell, J. and MacLeod, K. (2014) Safer Injecting basics for NPS Available at: [last accessed 31/7/16]

Chen, L., Crum, R.M., Martins, S.S., Kaufmann, C.N., Strain., E.C. & Mojtabia, R. (2013) 'Service Use and Barriers to Mental Health Care among Adults with Major Depression and Comorbid Substance Dependence' Psychiatry Online 64:9, pp.863-870.

Cherubin, C. & Sapira, J. (1993) 'The Medical Complication of Drug Addiction and Medical Assessment of the Intravenous Drug User' Annals of Internal Medicine 119, pp.1017-1028.

Clinical Knowledge Summaries (2015) ' NICE guidelines: Benzodiazepine and Z-Drug Withdrawal'. Available at: [last accessed 12/7/2016].

Curriculum for Excellence (2010) Experiences and outcomes: Health and wellbeing Available at: [last accessed 30/7/2016]

Department of Health (England) and the Devolved Administrations (2007) Drug Misuse and Dependence: UK Guidelines on Clinical Management, London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive.

Dolliver, D.S. (2015) 'Evaluating Drug Trafficking on the Tor Network: Silk Road 2, the Sequel' International Journal of Drug Policy 26:11, pp.1113-1123.

Elliott, S. & Evans, J. (2014) 'A Three-Year Review of New Psychoactive Substances in Casework' Forensic Science International 243: 55-60.

EMCDDA (2016) Health Responses to New Psychoactive Substances. Available at: [last accessed: 15/7/16].

EMCDDA (2015) NPS in Europe An update from the EU Early Warning System March 2015. Available at: [last accessed: 28/7/2016]

EMCDDA (1996) Estimating the Prevalence of Problem Drug Use in Europe Available at: [last accessed 29/7/16]

Fraser, F. (2014) New Psychoactive Substances - Evidence Review, Scottish Government. Available at: [last accessed: 25/5/2016].

Gillies, A. (2015) Closing the Evidence Gaps on the Prevalence and Harms of New Psychoactive Substances in Scotland, Scottish Government. Available at: [last accessed: 25/5/2016].

Gillies, Allan (2014a) Mapping Current and Potential Sources of Routine Data Capture on NPS in Scotland, Scottish Government

Gray, R. (2010) 'Shame, Labeling and Stigma: Challenges to Counseling Clients in Alcohol and Other Drug Settings' Contemporary Drug Problems 37:4, pp.685-703.

Greeno, C, Zimmerman, T, Kelly, M, Weaver, A and Anderson, C (2012) '"What is Therapy?": A Therapist-Developed Intervention to Reduce Missed Appointments in Community Mental Health' Social Work in Mental Health 10(1): 1-11.

Henden, E. (2013) 'Heroin Addiction and Voluntary Choice: the Case of Informed Consent' Bioethics 27:7, pp.395-401.

Heyerdahl, F, Hovda, K, Giraudon, I, Yates, C, Dines, A, Sedefov, R, Wood, D and Dargan, P (2014) Current European data collection on emergency department presentations with acute recreational drug toxicity: gaps and national variations Clinical Toxicology 52: 1005-1012

HM Inspectorate of Prisons (2015) Changing Patterns of Substance Misuse in Adult Prisons and Service Responses London: HM Inspectorate of Prisons.

Home Office (2014) New Psychoactive Substances Review, report of the expert panel Available at: [last accessed 30/9/16]

Home Office (2016) Psychoactive Substances Act 2016: Guidance for Retailers. Available at: [last accessed 17/7/2016].

Home Office (2011) Temporary Class Drugs. Available at: [last accessed: 14/7/16].

Hopwood, M., Lea, T. & Aggleton, P. (2015) 'Drugs, Sex and Sociality: Factors Associated with the Recent Sharing of Injecting Equipment among Gay and Bisexual Men in Australia' International Journal of Drug Policy 26:2, pp.210-213.

Hoyte, CO, Jacob, J, Monte, AM, Al-Jumaan, M, Bronstein, A, Heard, KJ (2012) 'A Characterization of Synthetic Cannabinoid Exposures Reported to the National Poison Data System in 2010' Annals of Emergency Medicine 60(4): 435-438;

ISD (2016) Estimating the National and Local Prevalence of Problem Drug Use in Scotland 2012/13 Available at: [last accessed: 28/7/16]

Kelly, B.C., Wells, B.E., Pawson, M., Leclair, A., Parsons, J.T. & Golum, S.A. (2013) 'Novel Psychoactive Drug Use among Younger Adults involved in US Nightlife Scenes' Drug and Alcohol Review 32(6): 588-593.

Lafferty, C., Smith, L., Coull, A. & Shanley, J. (2016) 'The Experience of an Increase in the Injection of Ethylphenidate in Lothian, April 2014 - March 2015' Scottish Medical Journal, online ahead of print. doi: 10.1177/0036933016649871.

Latkin, C.A., Kuramoto, S.J., Davey-Rothwell, M.A. & Tobin, K.E. (2010) 'Social Norms, Social Networks, and HIV Risk Behavior among Injecting Drug Users' AIDS Behavior 14, pp.1159-1168.

Leffler, A.M., Smith, P.B., de Armas, A. & Dorman, F.L. (2014) 'The Analytical Investigation of Synthetic Street Drugs containing Cathinone Analogs' Forensic Science International 234, pp.50-56.

Lloyd, B., Barratt, M.J., Ferris, J., Best, D. and Lubman, D. (2013) 'Factors Influencing Mortality among Alcohol and Drug Treatment Clients in Victoria, Australia: The Role of Demographics and Substance Use Characteristics' Australia and New Zealand Journal of Psychiatry 47:9, pp.859-867.

Martin, J (2014) Drugs on the Dark Net: How Cryptomarkets are Transforming the Global Trade in Illicit Drugs New York: Springer.

Martinotti, G., Lupi, M., Acciavatti, T., Cinosi, E., Santacroce, R., Signorelli, M.A., Bandini, L., Lisi, G., Quattrone, D., Ciambrone, P., Aguglia, A., Pinna, F., Calo, S., Janiri, L. & di Giannantonio, M. (2014) 'Novel Psychoactive Substances in Young Adults with and without Psychiatric Comorbidities BioMed Research International 2014, pp.1-7.

McCall, H., Adams, N., Mason, D. & Willis, J. (2015) 'What is Chemsex and Why does it Matter?' British Medical Journal 351: h5790.

McKeganey, N., Russell, C., Barnard, M. (2014) Findings from the 2014 Legal High National Online Survey Available online at: [last accessed 30/7/16]

Measham, F, Wood, DM, Dargan, PI, and Moore, K (2011) 'The Rise in Legal Highs: Prevalence and Patterns in the Use of Illegal Drugs and First- and Second-Generation 'Legal Highs' in South London Gay Dance Clubs' Journal of Substance Use 16(4): 263-272

Mental health network (2014) The future's digital Mental health and technology

Meltzer, H., Bebbington, P., Brugha, T., Farrell, M. & Jenkins, R. (2013) 'The Relationship between Personal Debt and Specific Common Mental Disorders' The European Journal of Public Health 23:1, pp.108-113.

Merrall, E. L. C., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., Hutchinson, S. J. and Bird, S. M. (2010), Meta-analysis of drug-related deaths soon after release from prison. Addiction, 105: 1545-1554. doi:10.1111/j.1360-0443.2010.02990.x

Miserez, B., Ayrton, O. & Ramsey, J. (2014) 'Analysis of Purity and Cutting Agents in Street Mephedrone Samples from South Wales' Forensic Toxicology 32:2, pp.305-310.

Morris, Z., Gannon, M. (2008) Drug misuse treatment services in Scotland: predicting outcomes. International Journal for Quality in Health Care 2008, 20 (4) 271-276; DOI:10.1093/intqhc/mzn019

National Institute of Health (2013) 'Synthetic Marijuana Lands Thousands of Young People in the ER, Especially Young Males'. Available at: [last accessed 1/7/2016].

Neale, J., Nettleton, S. & Pickering, L. (2012) The Everyday Lives of Recovering Heroin Users; London: RSA.

Neal, J (2001) Homelessness amongst drug users: a double jeopardy explored International Journal of Drug Policy

Neale, J, Tompkins, C and Sheard, L (2008) 'Barriers to Accessing Generic Health and Social Services: A Qualitative Study of Injecting Drug Users' Health and Social Care in the Community 16(2): 147-154.

Newcombe, R. (2009) The Use of Mephedrone (M-cat, Meow) in Middlesbrough Available at: [last accessed 28/7/16]

Newcombe, R. (2010) 'Wobbled Up" The illicit use of diazepam in Redcar. Available at: [last accessed 30/7/2016]

Nielsen, S. (2013) 'Benzodiazepine Withdrawal after Long-Term Use' Australian Pharmacist 32:10, pp.42-45.

NHS GGC (2016) 'Taking away the chaos' Available at: [last accessed 28/7/2016]

NRS Scotland (2016) Drug Related Deaths in Scotland - 2015. Available at: [last accessed: 18/9/16].

Parkin, S. & McKeganey, N. (2000) 'The Rise and Rise of Peer Education Approaches', Drugs: Education, Prevention and Policy 7:3, pp.293-310.

PÉTURSSON, H. (1994), The benzodiazepine withdrawal syndrome. Addiction, 89: 1455-1459. doi:10.1111/j.1360-0443.1994.tb03743.x

Peer worker research team, St George's University of London (2015) Introducing peer workers in to mental health services: An organisational toolkit Available online: [last accessed 30/9/16]

Poll, R, Allmark, P and Todd, AM (2016) 'Reasons for Missing Appointments with a Hepatitis Outreach Clinic: A Qualitative Study' International Journal of Drug Policy Article in Press.

Public Health England (2015) Substance misuse services for men who have sex with men involved in chemsex Available at: [last accessed 30/6/16]

Radcliffe, P. & Stevens, A. (2008) 'Are Drug Treatment Services only for 'Thieving Junkie Scumbags'? Drug Users and the Management of Stigmatised Identities' Social Science and Medicine 67:7, pp.1065-1973.

Richardson, T., Elliott, P. & Roberts, R. (2013) 'The Relationship between Personal Unsecured Debt and Mental and Physical Health: A Systematic Review and Meta-Analysis' Clinical Psychology Review 33:8, pp.1148-1162.

David B. Rosengren (2009) Building Motivational Interviewing Skills: A Practitioner Workbook pp.171-172

Roy KM, Hutchinson SJ, Wadd S, Taylor A, Cameron SO, Burns S, Molyneaux P, McIntyre PG & Goldberg DJ (2007) Hepatitis C virus infection among injecting drug users in Scotland: a review of prevalence and incidence data and the methods used to generate them. Epidemiology and Infection, 135(3): 433-442.

SALSUS (2016) Technical Report 2015. Available at: [last accessed: 31/10/2016].

SALSUS (2016) Drug Use Report 2015. Available at: [last accessed 31/10/16].

SCJS (2016) Scottish Crime and Justice Survey 2014/15: Drug Use. Available at: [last accessed: 15/7/16].

Scottish Drugs Forum, UK Drugwatch (2014) Etizolam briefing Available at: [last accessed 30/7/16]

Seddon, T. (2014) 'Drug policy and global regulatory capitalism: The case of new psychoactive substances ( NPS)' International Journal of Drug Policy 25, pp.1019-1024.

Sheridan, J & Butler, R (2010) ''They're Legal so They're Safe, Right?': What did the Legal Status of BZP-Party Pills mean to Young People in New Zealand?' The International Journal of Drug Policy 21:1, pp.77-81.

Shiner, M (1999) 'Defining Peer Education' Journal of Adolescence 22:4, pp.555-566.

Silverman, M.S. (2016) 'Controlled Substance Management: Exit Strategies for the Pain Practitioner' in Staats, P.S. & Silverman, M.S. (eds) Controlled Substance Management in Chronic Pain; Springer, pp.251-280.

Smith G.W., Farrell, M, Bunting B.P., Houston J.E., Shevlin M. (2011) Patterns of polydrug use in Great Britain: findings from a national household population survey. Drug and Alcohol Dependence 113 (2011) 222-228

Soussan, C. & Kjellgren, A. (2016) 'The Use of Novel Psychoactive Substances: Online Survey about their Characteristics, Attitudes and Motivations' International Journal of Drug Policy 32, pp.77-82.

Stanley, J.L., Mogford, D.V., Lawrence, R.J. & Lawrie, S.M. (2015) 'Use of Novel Psychoactive Substances by Inpatients on General Adult Psychiatric Wards' BMJ Open 6: e009430, doi:10.1136/bmjopen-2015-009430.

Stephenson, G and Richardson, A (2014) New Psychoactive Substances in England: A Review of the Evidence London: Home Office.

Stuart, D (2013) Sexualised drug use by MSM Background, current status and response HIV nursing journal spring edition 2013.

Stuart, D., Nneka, N., McOwan, A., Bracchi, M., Boffito, M. (2016) ChemSex: Data on Recreational Drug Use and Sexual Behaviour in MSM from a Busy Sexual Health Clinic in London. Available at: [last accessed 28/7/16]

Tennant, R (2015) No Light at the End of the Tunnel: Tracking the impact of Welfare Reform across Glasgow Poverty Alliance, GCVS, SDF publication Available at: [last accessed 28/7/16]

Thom, B. (2010) 'Women in Recovery', in Yates, R. & Malloch, M. (eds) Tackling Addiction Pathways to Recovery London: Jessica Kingsley Publishers.

Thompson, R.G., Wall, M.M., Greenstein, E., Grant, B.F., Hasin, D.S. (2013) 'Substance-Use Disorders and Poverty as Prospective Predictors of First-Time Homelessness in the United States. American Journal of Public Health 103:S2, S282-S288.

TNS Political & Social (2014) Flash Eurobarometer 401: Young People and Drugs. Available at: [last accessed: 15/7/16].

UNODC (2016) World Drug Report, Vienna: UNODC.

UNODC (2013) The Challenges of New Psychoactive Substances; Vienna: UNODC.

Vandrey, R., Smith, M.T., McCann, U.D., Budney, A.J. & Curran, E.M. (2011) 'Sleep Disturbance and the Effects of Extended-Release Zolpidem during Cannabis Withdrawal' Drug and Alcohol Dependence 117:1, pp.38-44.

Van Hout, C.M. and Brennan, R. (2011) '"Bump and grind": An exploratory study of Mephedrone users' perceptions of sexuality and sexual risk', Drugs and Alcohol Today, 11(2), pp. 93-103.

Van Hout, M .C. and Bingham, T. (2012) 'A costly turn on: patterns of use and perceived consequences of mephedrone based head shop products amongst Irish injectors'. Int J Drug Policy. 2012 May;23(3):188-97.

Wallace, I. (2016) New Psychoactive Substances ( NPS): results of a questionnaire on the definition of NPS, proposals to establish a forensic centre for excellence, and improving data collection and information sharing, Scottish Government. Available at: [Last accessed: 17/6/2016].

Wampold, B.E. (2015) 'How Important are the Common Factors in Psychotherapy? An Update' World Pyschiatry 14:3, pp.270-277.

Weaver, M., Hopper, J., and Gunderson, E. (2015) Designer drugs 2015: assessment and management Addition Science and Clinical Practice 10:8 doi 10.1186/s13722-015-0024-7

Winstock, A.R. & Ramsey, J.D. (2010) 'Legal Highs and the Challenges for Policy Makers' Addiction 105:10, pp.1685-1687.

Winstock, A et al (2010) Assessment and management of cannabis use disorders in primary care Available at: [last accessed 28/7/16]

Winstock, A (2012) Global Drug Survey 2012 Findings Available at: [last accessed 29/9/16]

Winstock, A (2016) Global Drug Survey 2016 Findings Available at: [last accessed 29/7/16]

Wood, D.M., Measham, F., and Dargan, P.I. (2012) ''Our Favourite Drug': Prevalence of Use and Preference for Mephedrone in the London Night-Time Economy 1 year after Control' Journal of Substance Use 17(2): 91-97.

Wood, D.M., Greene, S.L., and Dargan, P.I. (2011) 'Clinical Pattern of Toxicity associated with the Novel Synthetic Cathinone Mephedrone' Emergency Medicine Journal 28: 280-282.

Wyckmans, C., van Nuijs, A., Neels, H. & Covaci, A. (2015) 'Novel Psychoactive Substances: a worldwide problem that requires an adequate approach', Journal de Pharmacie de Belgique 1, pp.4-7.

Zilcha-Mano, S. (2016) 'New Analytic Strategies Help Answer the Controversial Question of Whether Alliance is Therapeutic in Itself' World Psychiatry 15:1, pp.84-85.


Misuse of Drugs Act 1971 (including the 2011 amendment for Temporary Class Drug Orders). Available at: [last accessed: 25/5/2016]

New Psychoactive Substances Act 2016. Available at: [last accessed 25/5/2016]