New psychoactive substances (NPS) identified in Canada: Results of the online NPS survey (2020–2023)

Abstract

Purpose and scope

New psychoactive substances (NPS) are a broad class of compounds that are typically designed to mimic illicit substances and circumvent legislative controls. It is often difficult to predict their toxicity and other health effects due to a lack of research and data. In this study, NPS are defined as substances that are not controlled under the Controlled Drugs and Substances Act (CDSA) or otherwise regulated in Canada. Health Canada conducted the Online NPS Survey between March 2020 and March 2023 as a first step to identifying NPS used in Canada. The survey additionally aimed to characterize NPS use patterns in Canada and identify trends in the chemistry and pharmacology of reported substances. The online, self-administered questionnaire was regularly promoted on substance use discussion forums, harm reduction network sites, and social media. The questionnaire asked participants for information pertaining to an episode of NPS use in the past 12 months.

Results

Two hundred sixty-two (262) episodes of NPS use were reported, from which 38 unique NPS were identified. Twenty-four (24) were hallucinogens (63.2 %); six were sedatives (15.8 %); three were opioids (7.9 %); three were stimulants (7.9 %); one was a dissociative (2.6 %); and one was an antidepressant (2.6 %). The most common NPS chemical classes were tryptamines (34.2 %), lysergamides (18.4 %), and phenethylamines (7.9 %) all of which belong to the hallucinogen pharmacological class. The prevalence of hallucinogens reported in the survey may be largely due to the definition of NPS used in the study, which was restricted to substances that are not regulated in Canada.

The three most commonly reported NPS were 1-propionyl lysergic acid diethylamide (1P-LSD), 4-acetoxy-dimethyltryptamine (4-AcO-DMT), and 4‑hydroxy-N-methyl-N-ethyl tryptamine (4-HO-MET). Polysubstance use was reported in 131 (50.0 %) episodes of NPS use. Cannabis was reported as the most concurrently used substance (102 cases, 77.9 %) with NPS, followed by tobacco and alcohol in 34 (26.0 %) and 29 (22.1 %) cases, respectively. Of the responses that reported a source for the NPS in question, the majority claimed to have purchased the NPS from an online store. Unwanted health effects were reported in over 50 % of cases.

Conclusions

Structural trends amongst reported NPS were analysed, with a focus on hallucinogens of the tryptamine, lysergamide, and phenethylamine chemical classes. The survey provides valuable insight into NPS use and trends in Canada. More research is required to address specific concerns such as polysubstance use and health outcomes. More than half of reported episodes indicated unwanted health effects, indicating a need for further clinical research in NPS toxicology.