A three-level drug epidemiology of novel psychoactive substances use and health-related harms from an international perspective

This thesis investigated on the use of a large, ever-evolving group of natural and synthetic drugs, Novel Psychoactive Substances (NPS) generally uncontrolled by the UN International Conventions on Drugs that rises concerns due to the health harms they may involve. To this purpose, a three-level drug epidemiology framework, encompassing individual (positive drug epidemiology), socioeconomic (social drug epidemiology) and structural (legal drug epidemiology) was elaborated. This research shows that public health challenges associated with NPS result from the combination of individual characteristics (poor mental health), specific high-risk drug use patterns (poly/injecting drug use, chemsex), social risk factors (unemployment, poverty, social exclusion), and policy-induced structural factors (drug market resilience, availability of drug treatment and harm reduction services). As NPS use remains marginal, there is a need for tailored drug treatment and harm reduction services for different at-risk users’ profiles, along with pharmacological and toxicological knowledge enabling the appropriate clinical management of NPS-related adverse effects, including mental health problems, intoxications, and overdoses.