The sale of nitrous oxide, or laughing gas, to the public will be banned and the police will be given enhanced drug-testing powers as part of Rishi Sunak’s attempt to crack down on antisocial behaviour “with urgency”.

The levelling up secretary, Michael Gove, 

 the proposals would stop parks being turned into drug-taking arenas, and would help ministers stamp out antisocial behaviour.

The ban comes a month after the independent Advisory Council on the Misuse of Drugs (ACMD) 

 and said it would be disproportionate with the level of harm associated with nitrous oxide. It said such control could create “significant burdens” for legitimate uses of the substance.

Experts have criticised the “same old tired drug policy” from the Conservatives, insisting the ban will not stop young people from using it.

Rishi Sunak to ignore independent advice and ban laughing gas in UK

By Sam Craft, Michael Dunn, Dan Vidler, Jane Officer, Ian S. Blagbrough, Christopher R. Pudney, Graeme Henderson, Ahmed Abouzeid, Pual I. Dargan, Michael Eddleston, Jamie Cooper, Simon L. Hill, Clair Roper, Tom P. Freeman and Simon H. L. Thomas.

Novel psychoactive substances (NPS) are a broad range of drugs that are not controlled by the United Nations international drug conventions, but may pose a threat to public health. Previously marketed as ‘legal highs’ or ‘designer drugs’, NPS are often structural analogues of conventional illicit drugs or medicinal products designed to mimic their effects while evading legal control. Their prevalence in the general population is low, with ~0.5% of those ages 16 to 59 reporting past year use in the United Kingdom (UK) in 2019. However, NPS are often considerably more harmful than the drugs they were designed to mimic and pose a significant challenge to health-care services. In 2020, the Office for National Statistics (ONS) recorded 137 deaths involving NPS use in the United Kingdom. In 2017, data from the three UK hospitals reporting to the European Drug Emergencies Network (EURO-DEN) show that patients reported NPS use in 15% of all drug-related hospital emergency presentations. Definitions and classifications of NPS vary between data collection systems, but those most commonly encountered are benzodiazepines, cathinones, and synthetic cannabinoid receptor agonists (SCRAs).

With over 200 different compounds currently being monitored by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), SCRAs are the largest group of NPS, and in recent years they have been involved in the greatest proportion of deaths and emergency hospital presentations. Although structurally diverse, SCRAs elicit their effects via interaction with the endocannabinoid system, typically acting as full agonists at CB1 and CB2 receptors. The main psychoactive compound of cannabis, delta-9-tetrahydrocannabinol (THC), is a partial CB1 and CB2 receptor agonist, and comparatively SCRAs show considerably greater potency and binding affinity at these receptors.

The individual SCRAs most commonly encountered have changed with time, presumably to evade national and international legislative changes. In the United Kingdom, following classification under consecutive amendments to the Misuse of Drugs Act (MDA)—first in 2009 and then in 2013—novel groups of compounds with structural modifications that circumvented these controls quickly emerged with a general increasing trend in potency. In response, and in attempt to end the open sale of SCRAs and other ‘legal highs’ in high-street retailers, the United Kingdom introduced the Psychoactive Substances Act (PSA) on the 26th May 2016 to be used alongside the MDA. Whereas the MDA controls individual or small groups of compounds according to chemical structure, the PSA made illegal the importation, production, and supply (but not possession, except in custodial settings) of all psychoactive substances (not already controlled under the MDA), although with several named exemptions including alcohol, nicotine and licensed medications. Alongside this, a third amendment to the MDA in December 2016 (although based on recommendations made by the Advisory Council for the Misuse of Drugs [ACMD] in 2014) increased the scope of the generic definition of SCRAs to include the then emerging third generation compounds that were controlled as Class B substances in line with the compounds already scheduled, thereby extending sanctions beyond those covered by the PSA (including penalties for possession).

In 2018, the UK Home Office conducted a review into the effectiveness of the PSA. The report concluded that although ending the open sale and reducing use of NPS within the general population, SCRAs (and other NPS) had been integrated into the illicit market and use had increased within vulnerable populations, such as the homeless or those in prison. More recently, a multidisciplinary study interviewing SCRA users and various stakeholders (e.g. emergency services, outreach engagement workers etc.) outlined several detrimental impacts of the PSA on the UK SCRA market, which the authors conclude have increased the risk of individual and societal harm. This is supported by mortality data from the ONS and National Program on Substance Abuse Deaths (NPSAD), which show that since the PSA, the number of deaths where SCRAs are implicated and/or detected at post-mortem have increased.

Data from hospital presentations can also provide important insight into the nature and epidemiology of SCRA related harm; however, there is currently a lack of routinely collected, systematic data of this kind in the UK or elsewhere. Data from the National Poisons Information Service, a service for clinicians seeking advice for the diagnosis/management of individual cases of poisoning, has demonstrated that telephone enquiries citing NPS exposure have decreased since the enactment of the PSA, however, the impact on the number of enquiries citing SCRA exposure specifically was not reported. Poison centre data have several limitations and are not representative of the true number of clinical exposures or hospital admissions, see Wood et al. Previous studies analysing data from individual hospitals in Edinburgh and London have reported that the number of NPS-related toxicity presentations did not significantly change following the implementation of the PSA, although in London, there were changes in the types of NPS involved and the number of SCRA-related presentations had increased in the year after its implementation. However, confirmatory toxicological analysis is not typically available in acute clinical settings, and previous studies have relied on details of drug exposure reported by the patient (or witness). This is unreliable because there may be substantial variability in the composition of NPS products that may not be known to the user, and patients may report SCRAs when they have not been used or fail to report them when they have. Therefore, without analytical confirmation, clinical data may not accurately reflect trends in SCRA related harm.

The Identification of Novel Psychoactive Substance (IONA) study has been collecting clinical data and biological samples from patients attending emergency departments across the UK with severe toxicity associated with suspected NPS use since 2015. By conducting time series analysis using IONA data, we aimed to examine trends in the number of hospital presentations for severe acute toxicity involving analytically confirmed SCRA exposure before and after the implementation of the PSA between July 2015 and December 2019. For comparison, we also examined trends in the number of non-SCRA drug toxicity presentations during the same period.

Trends in hospital presentations following analytically confirmed synthetic cannabinoid receptor agonist exposure before and after implementation of the 2016 UK Psychoactive Substances Act

Health and social responses to drug problems: a European guide 2021

 was developed to support practitioners and policymakers in tackling the negative consequences of drug use. The guide is composed of four sets of 

that look at responses to a range of drug problems in Europe. Framing the miniguides are two central resources: an 

 for developing responses and a set of 

 frame issues cross-cutting the different components.

Action framework and strategies for successful implementation

These two resources provide support to those planning health and social policy or interventions to address drug problems. The 

 helps to clarify current thinking about the response process and the factors to consider at each stage, while the 

(to be published in 2022) detail a number of activities that may help to support successful implementation.

Action framework: health and social responses

Strategies for successful implementation (coming soon)

Miniguides considering problems from the perspective of particular patterns of drug use and the specific substances that are of concern in many EU countries will be published starting on 19 October 2021.

Drug-related harms require specific responses. Miniguides focusing on them will be published at the end of 2021.

An important factor that can influence drug use, the problems that may be associated with use and the selection of appropriate responses is the setting in which use occurs. Miniguides focusing on different settings will be published in 2022.

Some sub-groups of the population have particular drug problems, needs or vulnerabilities that require specific interventions. Miniguides addressing the needs of vulnerable groups will be published in 2022.

In addition to the miniguides, a series of short ‘Spotlights’ focus on a number of hot topics requiring special attention:

Addressing sexual health issues associated with drug use

Comorbid substance use and mental health problems

Health and social responses to drug problems during the Covid-19 pandemic

Health and social responses to drug problems: a European guide

“CHECK” is a magazine for people who use drugs, experts and advocates working in the EECA region, and those who want to learn more about the drug policy and harm reduction in the region. It is published by the Eurasian Harm Reduction Association (EHRA) and the Eurasian Network of People Who Use Drugs (ENPUD).

The first issue of the magazine “Check” is dedicated to exploring the topic of new psychoactive substances, existing responses to the emergence of these substances and thoughts of peers from the EECA region.

CHECK the first issue of the magazine here ↓↓↓

CHECK - First issue - (IL)legal highs

This resource is intended for people who use new psychoactive substances (NPS) and the organizations that help them. It contains useful information on the prevention of HIV infection and other drug-related diseases, on various substances, including synthetic psychostimulants, examples of responses to the challenges of NPS.

Useful information for people who use stimulant drugs - Videos

According to the European Monitoring Centre on Drugs and Drug Addiction (2015), ‘there has been an unprecedented increase in the number, type and availability of new psychoactive substances [NPS] in Europe’. This is particularly true in the countries of Eastern Europe and Central Asia, where anecdotal reports indicate NPS use is growing, creating new challenges for health and drug services.

This webinar will present the findings of the first detailed multi-country study of NPS use and markets in the region.

The study examined the use of NPS and the harm reduction response in eight Eurasian countries: Belarus, Moldova, Serbia, Kazakhstan, Kyrgyzstan, Georgia, Estonia and Lithuania. The aim was to identify current patterns of NPS use and related harms in each country through recording the perspectives and lived experience of people who use drugs and people who provide harm reduction services in order to inform the harm reduction response. The research was conducted jointly between the Swansea University and the Eurasian Harm Reduction Association between April 2019—December 2020, and funded by the Global Challenges Research Fund.

New psychoactive substances in Eastern Europe and Central Asia

By Daan van der Gouwe (Trimbos Institute) / EHRA

This report draws on a study conducted by the School of Law, Swansea University, in collaboration with the Eurasian Harm Reduction Association (EHRA).1 Within the framework of this project, 8 country reports were drafted, targeting the use of new psychoactive substances (NPS) in Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, and Serbia. The assignment was undertaken to generate a more accurate picture of the use of NPS in these countries. For this study, two sources were used: (1) desk research of available literature and (2) additional structured interviews and focus groups with key respondents.

Throughout the Eastern Europe and Central Asia (EECA) region, the use and variety of NPS are relevant issues, although the nature and extent differ among the EECA countries and subregions, with better awareness of their presence among health professionals and people who use drugs. Synthetic cannabinoids and synthetic cathinones are predominant groups of NPS and widely available, whereas synthetic opioids seem to be more present in Estonia and Lithuania. Among people who use NPS, there are two key populations: those who have more experience with use of drugs, who have shifted to the use of NPS for a variety of reasons, and young people with no previous history of drug use. Drivers for use of NPS include the unavailability of drugs of choice, context-driven motives, as many NPS are not detected in blood and urine, and the aggressive marketing of NPS throughout the EECA region. NPS are marketed on social media channels, but also on public walls in many cities. A main risk of NPS is the absence of (chemical) analysis: that is, you do not know what you are actually consuming. Other health-related risks include mental health issues and increased risk of transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) caused by unsafe use (mainly by injections), often combined with unsafe sex. So far, in the EECA region, no specific treatments are available for people with NPS dependency issues, as the focus has remained on traditional drugs, in particular opioid use. Similarly, harm reduction services are mostly not equipped to address the need of people who use NPS. In the EECA region, data-driven and science-based publications on NPS are almost non-existent.

To better address the phenomenon of NPS in the EECA region, recommendations include the following:

implement a pilot program to check consumer drug samples (drug checking);

establish a regional Early Warning System (EWS) for NPS, similar to the EWS for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA);

develop and disseminate evidence-based, comprehensive information on NPS, including their risks and a suggested action for those overdosing on NPS;

scale-up harm reduction services to meet the needs of people who use NPS, to address the emerging and potentially very risky unsafe drug use and unsafe sexual practices in various chemsex scenes (for example, men having sex with men and young people communities); and,

implement measures to address the aggressive marketing of NPS in public spheres and via social media

The time of governments to bury their heads in the sand, hoping this phenomenon would disappear one day, is behind us. NPS are here to stay, and immediate action is urged to address NPS, in particular the needs of people who use NPS.

New psychoactive substance use in Eastern Europe and Central Asia: Regional report

New psychoactive substances (NPS) started to appear on the Lithuanian drug market in 2005. However, they have gained momentum only in the last few years. For comparison, in 2012 there were 62 cases of confiscation of NPS, while in 2016 there were 433, and in 2017, 441.14 The most commonly used NPS by people who have drug use experience in Lithuania are synthetic opioids and cannabinoids, whereas young people who use drugs occasionally tend to use synthetic cathinones, as well as dissociative hallucinogen NPS and classic hallucinogen NPS.

Drug policy laws in Lithuania were changed in 2017 with the aim to decrease drug supply and demand. However, different data (see Chapter 4) show that drug use is stable or, in some populations, increasing. Meanwhile, more people are being punished for minor drug offenses, and the State is investing in the persecution of people who use drugs, while treatment and harm reduction programs are suffering and struggling to survive. There is no sustainability of funding, and existing funding is not covering the entire need.

The project “New Psychoactive Substance Use in Kazakhstan, Kyrgyzstan, Georgia and Serbia” was undertaken to generate a more accurate picture of the use of new psychoactive substances (NPS) in Kazakhstan, Kyrgyzstan, Georgia, Serbia, and additionally in Estonia and Lithuania, to assess harm reduction and law enforcement responses to the emerging issues related to the use of NPS. In 2019, similar research was conducted in Belarus and Moldova. Results from this project will supplement scarce international data on the use of NPS in these countries, present a more accurate picture of their use, and provide information to national civil society organizations for political advocacy.

The present report provides research results from Lithuania. The study was conducted in partnership between the Eurasian Harm Reduction Association (EHRA) and the School of Law, Swansea University, and supported by the Global Challenges Research Fund. The Principal Investigator for the overall project was Dr. Rick Lines of the Swansea University School of Law, and the research methodology was reviewed and approved by the Ethical Review Committee at Swansea University. This report was prepared by the coordinator and researcher for this project, Eliza Kurcevič, Senior Program Officer at EHRA.

New psychoactive substance use in the Republic of Lithuania

April 29th through May 2nd, hundreds of Students for Sensible Drug Policy members, alumni, community members, and allies will come together from around the globe for our second virtual drug policy conference.

Registration is live! Click here to register

#Sensible2021: The Virtual Drug Policy Conference, Students for Sensible Drug Policy’s annual international conference made by and for young grassroots advocates, will bring hundreds of activists and allies together online April 29th through May 2nd.

 The cutting-edge core conference program includes prominent keynote speakers and panels addressing urgent and emerging subjects in drug policy reform, harm reduction, leadership, organizing, and advocacy.

Ample opportunities for virtual networking will be available throughout the week.

Panel: Law Reforms for Effective Response to Drugs and Related issues

Sunday, May 2nd at 1:15pm-2:15pm / 5:15-6:15 GMT

Maria-Goretti Ane Loglo *15, Africa Consultant for International Drug Policy Consortium

Wilson Box, Executive Director, Zimbabwe Civil Liberties and Drug Network

Charity Monareng, PhD Candidate at UCT and Parliamentary and Policy Research Officer, TB HIV Care

The theme of this topic will be purely related to the law Reforms in different country in Africa Sierra Leone to be specific, especially laws that are related to incarceration of people who use drug with no alternative for rehabilitation. This topic will help highlight some of these sections and clauses in some of our law books in some Africa countries that are unfriendly to drug user and humanity. This will prepare us for our advocacy for law reforms with specific references in the various law books.

#Sensible2021: The virtual drug policy conference

By Villu Kangur, for the Eurasian Harm Reduction Association (EHRA) and the School of Law, Swansea University.

The Republic of Estonia is a country on the eastern coast of the Baltic Sea in Northern Europe. It is bordered to the north by Finland across the Gulf of Finland, to the west by Sweden across the Baltic Sea, to the south by Latvia, and to the east by Lake Peipus and Russia. With a population of 1.3 million people, Estonia is one of the least populous members of the European Union.

According to the general population study on drug use in Estonia4 in 2018, 25% of people aged 16–64 have tried an illegal substance at least once during their lifetime, 7% within the last year, and 3% within the last month. Cannabis was the most commonly used drug, with 24% of the population having tried cannabis during their lifetime. In addition, the use of stimulants (e.g. amphetamine, ecstasy, and cocaine) was reported more frequently than that of other narcotic substances (amphetamine 6%, ecstasy 5%, and cocaine 5% lifetime use). While drug use, including cannabis use, was more common among people under the age of 35, more frequently among men, there was no difference between men and women in the youngest age group (16–24 years).

Estonia has a high prevalence of people who inject drugs (PWID), of whom about half are living with human immunodeficiency virus (HIV). According to a study done between 2010 and 2015, there are an estimated 6,000 to 17,300 PWID. In 2015 the prevalence of PWID was estimated to be 8,600. Among key populations, the prevalence of HIV is 54% among PWID, 13% among prison inmates, 4% among men who have sex with men (MSM), and 13% among sex workers (SWs).

Opioid substitution treatment (OST) with methadone has been available in Estonia since 1999. Currently OST is being offered in nine different institutions across the country (excluding prisons and detention centers, where methadone treatment is also available). In 2018 there were 1,052 registered patients who received OST. OST coverage remains low (under 20%).

New psychoactive substance use in the Republic of Estonia

Spurred by media panic around a so-called “chemsex crimewave,” the United Kingdom’s independent drug policy advisors are recommending that people involved with the highly stigmatized depressant gamma-hydroxybutyrate and related substances (GHB-RS) be subject to harsher criminal penalties.

But the Advisory Council on the Misuse of Drugs (ACMD) did not make its recommendation to escalate punitive responses unanimously. An unspecified number of ACMD experts on the Technical Committee, which deliberated GHB-RS’s change in classification under the Misuse of Drugs Act 1971, objected. They warned that intensifying criminalization will only inflict, not reduce, harm—particularly for queer and trans people.

The ACMD was commissioned by UK Home Secretary Priti Patel to investigate GHB-RS at the beginning of 2020—shortly after the conviction of, and ensuing media fixation on, a gay man of color for committing large-scale sexual violence that was allegedly facilitated by GHB-RS. On November 20, the ACMD published its assessment of the harms of GHB-RS and its recommendations in response.

UK Drug Council knows GHB crackdown targets queer people, recommends it anyway

Many countries started slowly to adopt alternatives to punishment, abolishing criminal sanctions for use and possession of psychoactive substances and replacing them with the administrative measures, such as fine, compulsory or voluntary treatment and other social interventions. However, not in all cases these alternatives brought positive outcomes for people who use psychoactive substances and society at large.

Thus, we need to review new approaches or update old ones, to ensure that measures adopted by the state are proportionate and in line with human rights.


Global Commission on Drug Policy (Pavel Bem)
Kyrgyzstan (Erkinbek Iriskulbekov)
Germany (Alexandra Gurinova, Deutsche AIDS Hilfe)
The Netherlands (Machteld Buch, Mainline)
Estonia (Mart Kalvet, LUNEST)
Lithuania (Eliza Kurcevic, EHRA)
UNODC (Zhannat Kosmukhamedova)