Indonesian Version
(+62) 021-7252964New Psychoactive Substances: A Treatment Provider Perspective
In the rapidly evolving world of drug use, the rise of new psychoactive substances (NPSs) poses a new challenge for treatment services worldwide. The United Nations Office on Drugs and Crime (UNODC) defines NPSs
as “substances of abuse, either in a pure form or preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but which may pose a public health threat” (p. 2). Up to December 2015, there have been more than 100 countries reporting at least one or more NPS, and governments, partner organizations, and laboratories have identified more than 600 substances to the UNODC Early Warning Advisory (UNODC, 2016). Out of these, there are 46 listed substances that have entered Indonesia’s borders, which include synthetic cannabinoids, synthetic cathinones and its derivatives, phenethylamine derivatives, and piperazine derivatives, but only 18 substances are controlled by the Ministry of Health’s regulations (BNN, 2016). The fact that these substances are not tested for medicinal use, has no identified long-term effects, and is operated by “cryptomarkets” (dark markets operated in the internet) increases the burden for treatment and prevention services in designing appropriate treatment methods for NPS users (Van Buskirk, et al. 2017).
For the substance abuse population, the largest misconception is that they are safer than regulated and illicit substances, hence the term legal highs. Therefore, the rising concern is that it may attract new or naïve groups of drug users (Stephenson & Richardson, 2014). Similar to traditional drugs, NPSs are prepared in a variety of forms, and can also be administered through intravenous, oral, intranasal, and inhalation routes; therefore, its psychophysiological effects tend to mimic or more intense with its illegal counterparts (Khaled, et al. 2016). However, its risks may be more troublesome. A review by Hohmann, Mikus and Czock (2014) found several notable adverse effects, including cardiovascular (chest pain, arrhythmia, tachychardia, arterial hypertension), neurological (seizures, parkinsonism, stroke, tremor, amnesia), psychiatric (hallucinations, anxiety, suicidality, anhedonia, aggression, insomnia), and gastrointestinal (nausea, abdominal pain) problems. Hohmann et al. (2014) also suggests that the differences in active compounds in each batch of NPS causes a lack of reliable dosing, which increases the risk of severe intoxication, overdose, and possible mortality.
As a major trafficking hub in the Asia Pacific region, Indonesia is in desperate need of a fast ‘blanket ban’ response on specific compounds that have analogous psychoactive effects to currently regulated substances, as our neighbors in Australia have done so (Alcohol and Drug Foundation Australia, 2016). With the lack of treatment guidelines, treatment services in Indonesia are still slowly building efforts to respond to the demand for acute and emergency care for NPS cases. By this, we should keep in mind that although NPSs are still lacking control, they are still potentially hazardous on public health.
References:
Alcohol and Drug Foundation Australia. (2016). Drug info: Facts and resources about alcohol and drugs. Retrieved from: https://www.druginfo.adf.org.au/drug-facts/legal-highs
Badan Narkotika Nasional. (2016). Daftar New Psychoactive Substances (NPS) yang Beredar di Indonesia. Retrieved from: https://www.bnn.go.id/_multimedia/document/20161024/nps_new_psychoative_substances_46.pdf
Hohmann, N., Mikus, G., Czock, D. (2014). Effects and risks associated with novel psychoactive substances, Deutsches Ärzteblatt International, 111(9), 139-147. Retrieved from: https://www.aerzteblatt.de/pdf/DI/111/9/m139.pdf
Khaled, S. M., Hughes, E., Bressington, D., Zolezzi, M., Radwan, A., Badnapurkar, A., & Gray, R. (2016). The prevalence of novel psychoactive substances (NPS) use in non-clinical populations: a systematic review protocol. Systematic Reviews, 5, 195. https://doi.org/10.1186/s13643-016-0375-5
Stephenson, G. & Richardson, A. (2014). New psychoactive substances in England: A review of the evidence. Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/368587/NPSevidenceReview.pdf
UNODC. (2012). New psychoactive substances. Retrieved from: https://www.unodc.org/documents/drugs/printmaterials2013/NPS_leaflet/WDC13_NPS_leaflet_EN_LORES.pdf
UNODC. (2016). UNODC Early Warning Advisory on New Psychoactive Substances. Retrieved from: https://www.unodc.org/LSS/Page/NPS
Van Buskirk, J., Griffiths, P., Farrell, M., Degenhardt, L. (2017). Trends in new psychoactive substances from surface and “dark” net monitoring, Lancet Psychiatry, 4(1), 16-18.
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