Novel Psychoactive Substances (NPS) related health responses implemented in Europe through the lens of an intersectional risk environment approach

NPS users are diverse in their motivations and social profiles, and so are the health needs and harms associated with their drug use behaviour. Health responses accompanying enforcement measures adopted across Europe seem to mitigate health harms among NPS regular users, yet they have failed in hindering use and thus preventing the exposure to risk.As relational matters, drug-related risks and harms are differently experienced across drug-using populations. We applied an intersectional risk environment approach to analyse public health responses to NPS use implemented at national and supranational levels across Europe. It involves the analysis of the social and physical spaces in which risk and harm are produced or mitigated by intersecting micro- and macro-level environmental factors exogenous to individuals.NPS-related health responses accompanying enforcement measures across Europe have mostly focused on prevention, monitoring and harm reduction. Policy developments at both national and supranational levels have generally adopted a one-dimensional approach that merely focus on singular social locations such as sexual orientation (men who have sex with men) or age (school students and young people). As a result, they have failed in developing approaches that account for complexity between and within groups of NPS users, which are given by specific environmental risk factors such as drug use settings, peer relationships, sociocultural contexts, availability/accessibility of drug services, and enforcement practices.As other drug-related issues such as opioids overdose crisis, public health responses to NPS use should utilize an intersectional risk factor framework to better assess social differences (and inequities) between and among NPS users that yield specific health needs and rend some groups more exposed to harm. Including and collaborating with NPS users themselves in the policy-making processes may also contribute to designing and implementing more pertinent public health strategies that limit barriers to access drug services while minimizing health risks.