Prevalence of New Psychoactive Substances Use Among Outpatient of Addiction Management Clinic in Assiut University Hospital

In 2014, the estimated population who were suffering from drug abuse and drug-related disorders reached over 29 million worldwide, making it a global health challenge. Moreover, 43.5 per million people die annually from associated drug use. According to the United Nations Office on Drugs and Crime [UNODC] World Drug Report, the annual prevalence of drug use seemed to be stable for the past few years. However, new psychoactive substances (NPS) have increased drastically in both supply and demand.

The term "new psychoactive substances" had been legally defined earlier by the European Union as a new narcotic or psychotropic drug, in pure form or in a preparation, that is not scheduled under the Single Convention on Narcotic Drugs of 1961 or the Convention on Psychotropic Substances of 1971, but which may pose a public health threat comparable to that posed by substances listed in those conventions. Although the NPS terminology seems to imply the creation of novel drugs, many are not new. In fact, most psychoactive drugs (that later became abused) have been in use for at least a century. Many NPS were discovered at the same time as other drugs, and it was simply, for whatever reasons, these other drugs became popular. The majority of these substances are chemicals produced by tweaking or altering the molecular structure of previous well-known psychoactive agents such as cannabis, cocaine, methylenedioxymeth-amphetamine (or MDMA, commonly known as ecstasy), and lysergic acid diethylamide (or LSD), which are being sold as "legal highs," "research chemicals," "herbal highs," "party pills," or "plant food" in an attempt to stay ahead of the law prohibiting the sale and use of psychoactive drugs.

On the basis of that definition, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) identified the following groups of substances covered by its early warning system on NPS:

• Phenethylamines, which encompass a wide range of substances that may exhibit stimulant, entactogenic or hallucinogenic effects.
• Tryptamines, which include a number of substances that have predominantly hallucinogenic effects.
• Piperazines, which are represented, inter alia, by mchlorophenylpiperazine (mCPP) and BZP, both of which are central nervous system stimulants.
• Synthetic cathinones, which have stimulant effects. The main cathinone derivatives are the semi-synthetic methcathinone and the synthetic compounds mephedrone, methylone and MDPV.
• Synthetic cannabinoids are functionally similar to THC, the active compound of cannabis.
• Other substances reported to the early warning system include various plant-derived and synthetic psychoactive substances (e.g. indanes, benzodifuranyls, narcotic analgesics, synthetic cocaine derivatives, ketamine and phencyclidine derivatives), which do not strictly belong to any of the above-mentioned drug families. Also included are a number of medicinal products and derivatives.

NPS are formulated in a variety of forms, and when sold in the market, many contain mixtures of different substances some including controlled drugs. Smoked, ingested, snorted, or injected NPS can produce a variety of psychotropic effects, which can be similar to those related to the controlled substances they contain or to the chemical entities that they are derived from. Based on their clinical effects, NPS can be classified as stimulants, empathogens-entactogens, sedative-hypnotic-anxiolytics, dissociatives, and hallucinogens. Alternatively, they can be classified according to their chemical class as phenethylamines, piperazines, tryptamines, synthetic cathinones, alkylindoles (synthetic cannabinoids), and arylcyclohexylamines.