Use of new and uncommon synthetic psychoactive drugs among a nationally representative sample in the United States, 2005–2017, Joseph J. Palamar & Austin Le, 2019

Use of new and uncommon synthetic psychoactive drugs among a nationally representative sample in the United States, 2005–2017

Joseph J. Palamar & Austin Le

Human Psychopharmacology Clinical and Experimental, 2019, e2690

DOI: 10.1002/hup.2690



Objectives : This study aims to examine patterns and first mentions of reported use of new or uncommon drugs across 13 years, among nationally representative samples in the United States.

Methods : Participants (ages ≥12) in the National Surveys on Drug Use and Health (2005–2017, N = 730,418) were provided opportunities to type in names of new or uncommon drugs they had ever used that were not specifically queried. We examined self‐reported use across survey years and determined years of first mentions.

Results : From 2005 to 2017, there were 2,343 type‐in responses for use of 79 new or uncommon synthetic drugs, and 54 were first‐ever mentions of these drugs. The majority (65.8%) of mentions were phenethylamines (e.g., 2C‐x, NBOMe), which were also the plurality of new drug mentions (n = 22; 40.7%). Mentions of 2C‐x drugs in particular increased from 30 mentions in 2005 to 147 mentions in 2013. We estimate an upward trend in use of new or uncommon drugs between 2005 and 2017
(p < 0.001).

Conclusion : Although type‐in responses on surveys are limited and underestimate prevalence of use, such responses can help inform researchers when new compounds are used. Continued surveillance of use of new and uncommon drugs is needed to inform adequate public health response.

KEYWORDS : new psychoactive substances, phenethylamines, psychedelics, synthetic cathinones, tryptamines


New psychoactive substances (NPS) continue to emerge throughout the United States and Europe. In fact, dozens of NPS are detected for the first time in Europe every year, with 51 having been discovered in 2017 and over 100 discovered in 2014 (European Monitoring Centre for Drugs and Drug Addiction, 2018). Likewise, at least 36 NPS were discovered in the United States for the first time via drug seizures
in 2016/2017 (U.S. Drug Enforcement Administration, 2017; U.S. Drug Enforcement Administration, 2018). Drug identifications from seizures have been the primary source for determining which
new drug compounds are diffusing throughout the drug market, but seizure data are epidemiologically limited as confiscations do not necessarily reflect the wide variety of drugs used by the population.
Reports of adverse outcomes to Poison Control Centers are another common method of tracking use of various drugs, but reports are limited by their dependence on users experiencing an adverse outcome
and by users or health care professionals reporting the adverse outcome (Palamar, Su, & Hoffman, 2016; Warrick et al., 2013). Hospitalization and mortality data are similarly limited due to underreporting and underdetection of use (European Monitoring Centre for Drugs and Drug Addiction, 2017; Slavova et al., 2017). Therefore, further methods of tracking use of new or uncommon drugs are needed. In addition to drug identification data derived from seizures and adverse drug‐related outcomes, we believe that survey data can offer additional insights by providing a more comprehensive picture on use of new or uncommon drugs.

Tracking emergence and prevalence of use of new and uncommon drugs is important for informing prevention and educational efforts. For example, the quick emergence of synthetic cannabinoids and synthetic cathinones (“bath salts”) in the United States was associated with tens of thousands of poisonings (American Association of Poison Control Centers, 2016; Cordeiro, Daro, Seung, Klein‐Schwartz, & Kim, 2018), suggesting the need for better monitoring of emerging drugs in order to help prevent adverse outcomes associated with use. Surveys are the leading source of gathering data on use of drugs, but they tend to focus heavily on the most common drugs (e.g., cannabis and cocaine) and drugs known to be associated with high rates of dependence (e.g., heroin and methamphetamine; Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2018; Kann et al., 2018; Substance Abuse and Mental Health Services Administration, 2017). Little focus, however, is paid to less common or newly emergent drugs unless there are quick surges in popularity—for example, synthetic cannabinoids and synthetic cathinones (Johnston et al., 2018). This lack of attention represents a problem, given that there are hundreds of potentially dangerous drugs that are new or relatively uncommon. Although some national surveys in the United States have begun including questions about use of some new drug classes (e.g., “synthetic marijuana” and “bath salts”; Johnston et al., 2018), specific drugs within these classes are not queried.

In this paper, we describe patterns and emergence of selfreported use of various new or uncommon drugs, assessed via typein responses, from 13 consecutive cohorts assessed by a nationally representative survey in the United States. We believe these data can help fill in the gaps with regard to the sparsity of epidemiological data focusing on NPS and other uncommon psychoactive drugs.


2.1 | Procedure
Data came from the 13 most recent cohorts (2005–2017) of the National Survey on Drug Use and Health (NSDUH), an ongoing cross‐sectional survey of noninstitutionalized individuals ages ≥12 in the 50 U.S. states and District of Columbia (Substance Abuse and Mental Health Services Administration, 2017). Each year, NSDUH surveys over 55,000 respondents. We included 2005 as the first year to ensure that results are comparable with the annual European Drug Report, which presents the number of new NPS identified throughout Europe each year by the EU Early Warning System (European Monitoring Centre for Drugs and Drug Addiction, 2018). NSDUH is a nationally representative multistage area probability sample. Surveys are administered via computer‐assisted interviewing conducted by an interviewer and audio computer‐assisted self‐interviewing (ACASI). For the computer‐assisted interviewing, interviewers administered a computer‐based survey to participants. For the ACASI, respondents were provided with a computer and headphones and asked to complete the survey; interviewers were trained to not look at the screens during administration in order to maintain privacy and confidentiality and to increase honest reporting. The ACASI collected variables including the type‐in response data. The weighted interview response rates between 2005 and 2017 ranged from 68.4% to 76.0%.