Patterns of NPS consumption and perceived risks and benefits: results of online survey in Georgia
Increasing use of new psychoactive substances (NPS) represents growing public health challenge elsewhere. In the country of Georgia research related to psychoactive substance use has been largely focusing on problem/injection drug use. Knowledge related to use of NPS and consumption of drugs in a recreational setting remains very limited. This is the first study in Georgia that aims to explore characteristics of NPS users, types of substances used, patterns of use, and health risks associated with NPS consumption.
Sample and recruitment
Target population for this study was individuals who have used new psychoactive substances during the past 12 months and were fluent in Georgian in order to fill in the survey questionnaire. Data collection took place in June-September 2017. Recruitment strategy included targeted advertisement via Facebook.
The Bio-ethics Committee of the Faculty of Arts and Sciences, Ilia State University approved the study protocol. We used a free web based Google Forms survey platform (https://www.google.com/forms/about/) for data collection. Prior to entering the questionnaire all participants provided informed consent. The questionnaire was adapted from MacLeod et al. (2016) and was tailored to reflect specifics of a local drug scene. We tested the usability and functionality of electronic questionnaire with five potentially eligible respondents, and farther refined it based on the results of pretesting.
The questionnaire took about 25-35 minutes to complete (depending on a number of substances used by the respondent) and included 47 restricted/categorical multi-choice responses. Socio-demographic information included age, gender, sexual orientation, residency location (region/city) and living status. Use of conventional drugs was measured through asking whether or not respondents ever used alcohol, tobacco and any illicit substance, and whether or not they used specific substance in the past 30 days. Use of NPS was measured through asking whether or not participants used specific NPS in the past 12 months and past 30 days. For all NPS that were used in the past 12 month we asked the reason for use, with whom it was usually consumed and where. Perceived effects of NPS were measured through asking respondents to indicate an impact of NPS use on their social functioning and report negative or positive mid-term physical and mental effects of each substance they consumed. Finally, we asked participants to state the source of NPS (from where they usually get the substance) and where do they seek for information about NPS effects.
Data were analysed using SPSS Statistics v.23. There was no missing data as long as all questions were mandatory. Descriptive statistics were reported using frequency tables for categorical variables and using means and standard deviations for continuous variables. 95% confidence intervals were also reported. Bivariate analysis were held using a t-test for continuous dependent variables and a chi-squared test for categorical variables. The significance level for rejecting null hypothesis was set at α=.05.
Socio demographic characteristics of participants
Out of 476 online questionnaires that were filled in, 123 were removed following the check for completeness. The final database consisted of 353 questionnaires. More than two thirds of participants (n=273, 77.3%) were males, mean age was 26.8 years (SD 6.97), and median age was 25 (min 14, max 58). Nine out of ten respondents were heterosexual and 87% (n=307) lived in a capital city.
Virtually all participants have tried alcohol, illicit drugs (traditional) and NPS at least once in their life. A quarter (n=88) admitted injecting traditional drugs and 10% (n=35) reported injecting NPS at least once in a lifetime. Almost all participants reported using cannabis in the past 12 months. The prevalence of past year use of cannabis-type NPS was 79.3% (n=280), and was followed by MDMA-type NPS (22.1%; n=78) and LSD-type NPS (21.2%; n=75). Since the prevalence of use of new psychoactive substances other than cannabis-type, MDMA-type and LCD-type NPS was relatively low, further analysis is focused on these three types of substances. Almost half (n=173, 49%) admitted using NPS currently (defined as use in the past 30 days). Among those, 77 (21.8%) were current users of cannabis-type NPS, 38 (10.8%) were current users of LSD-type NPS, and 31 (8.8%) were current users of MDMA-type NPS. In a bivariate analysis if compared to males, female respondents were more likely to report use of MDMA (p=0.00) and ketamine (p=0.00) in the past 12 month.
Contextual factors of NPS consumption
The most often reported reason for using specific NPS was because participants liked the effect of a substance. For all three focus drugs the second and third most frequently named reasons respectively were “because it was easy to obtain” and “because it was cheap”. All three types of substances were most frequently used with friends. Respondents identified variety of places where they used NPS. Most frequently cannabis-type substance was consumed at home (34.7%; n=25), while MDMA-type (83.9%; n=26) and LSD-type (34.2%; n=13) were most often used in a club or festival setting. In a bivariate analysis if compared to two other drugs MDMA-type NPS users were more likely to use the substance with partner, cannabis-type NPS users were more likely to use the substance at home, and MDMA-type NPS users were more likely to use the substance in a club/festival.
Health and social consequences linked to NPS use
Among 283 participants who responded to this question 60.5% (n=147) reported that they had to hide NPS use from others, 10.6% (n=30) admitted they had troubles with fulfilling their responsibilities, 10.9% (n=31) said they took other substances to ease the effects of NPS. Thirty six percent (n=100) reported that NPS had negative impact on their relationships with family members, 56.5% (n=156) claimed the influence was neutral, and 7.2% (n=20) said the impact was positive. Majority of cannabis-type substance users (55%; n=143) reported having difficulties when trying to quite. Difficulties when quitting were reported by 50.7% (n=35) of MDMA-type and 14% (n=8) of LSD-type NPS users.
- or negligible negative effects of NPS use on a physical health were reported by 58.1% (n=161) of cannabis-type, 68.9% (n=51) of MDMA-type, and 75% (n=54) of LSD-type substance users (not shown in the table). No or negligible negative effects on mental health were reported by 53.6% (n=148) of cannabis-type, 53% (n=39) of MDMA-type, and 59% (n=43) of LSD-type NPS users. Eight in ten (83.1%; n=226) cannabis-type substance users said they had less energy and 68.7% (n=169) admitted they become more depressed as a result of this substance. In terms of perceived positive effects 57.5% (n=150) believed the drug helped them to normalize their sleep and 70.5% (n=191) believed it improved their appetite. Seventy three percent (n=54) of MDMA-type users reported they had difficulties to sleep, 72% (n=54) claimed having more energy, and 79.2% (n=57) said they lost appetite as a result of the substance. Among LSD-type NPS users 78.6% (n=55) reported difficulties with sleep, 62.9% (n=44) said they were less energetic, and 78.9% (n=56) claimed they lost appetite due to the use. In a bivariate analysis if compared to users of MDMA-type and LSD-type NPS users cannabis-type NPS users were more likely to report that the substance helped them with slip and that they become more depressed. They were also more likely to report increased appetite.
Source of NPS and source of information about NPS effects
Among 297 respondents who answered the question regarding the source of NPS, more than half (n=175, 58.9%) reported obtaining NPS from friends, 24.5% (n=73) reported purchasing drugs using mobile applications, and 20% (n=60) admitted purchasing from dealers. Compared to female participants male respondents were more likely to report purchasing drugs using mobile applications (p=0.025). When asked to indicate where they usually look for information related to NPS effects, 37.5% (n=128) said they did not search for any information, 36.3% (n=124) reported looking for such information among friends, and 29.9% (n=102) said they try to search for information in Internet and social media. Female respondents were more likely to look for NPS related information among their friends if compared to male respondents (p=0.001).
This was the first study describing the NPS use in Georgia. Respondents most often used cannabis-type, MDMA-type and LSD-type NPS. NPS and conventional drugs were used interchangeably, however we were unable to conclude which drugs were first and whether or not NPS displace or supplement traditional drugs. Clubs and home setting were most popular places to use NPS. Respondents link range of negative health and social effects to consumption of particular substances. They also reported perceived benefits of NPS use. Results of this pilot study can guide future efforts and suggest topics for future targeted studies, risk assessments, and possibly help to elaborate prevention and harm reduction strategies targeting NPS. Our results suggest that the role of peers (using with friends, obtaining from friends) shall be further explored in Georgian context.
Limitations: We cannot exclude that this self-selected sample may differ from other NPS users in Georgia. Nevertheless, we believe that understanding the patterns of specific behaviors and associations between variables of interest in any sample accessible to researchers is beneficial. Farther, to address the issue of NPS definitions, we carefully selected terms (and street names) for NPS and consulted field experts and drug user community groups to make sure those terms were clear and understandable to potential participants.