{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:46:05Z","timestamp":1755225965099,"version":"3.43.0"},"reference-count":74,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2018,4,11]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.<\/jats:p>","DOI":"10.1136\/jramc-2018-000927","type":"journal-article","created":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T05:05:18Z","timestamp":1529643918000},"page":"450-457","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Phantom menace: novel psychoactive substances and the UK Armed Forces"],"prefix":"10.1136","volume":"164","author":[{"given":"Alys H","family":"Hunter","sequence":"first","affiliation":[{"name":"MDHU Portsmouth, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Ayres","sequence":"additional","affiliation":[{"name":"Department of Criminology, University of Leicester, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Moreland","sequence":"additional","affiliation":[{"name":"Directorate of Army Legal Services, Aldershot, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Cox","sequence":"additional","affiliation":[{"name":"Clinical Sciences, St George\u2019s, University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,6,22]]},"reference":[{"key":"2025081314492889000_164.6.450.1","unstructured":"Stephenson G , Richardson A . New Psychoactive Substances in England: A review of the Evidence. London: Crime and Policing Analysis Unit, Home Office Science, 2014:5\u20136."},{"key":"2025081314492889000_164.6.450.2","unstructured":"Ladler D . Drug Misuse: Findings from the 2014\/15 Crime Survey for England and Wales. 2nd Edn. London: Home Office, 2015:5\u20136."},{"key":"2025081314492889000_164.6.450.3","unstructured":"Shapiro H . NPS Come of Age: A UK overview. 2016 http:\/\/www.drugwise.org.uk\/wp-content\/uploads\/NPSComeofAge.pdf."},{"key":"2025081314492889000_164.6.450.4","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq056"},{"key":"2025081314492889000_164.6.450.5","unstructured":"Shapiro H . Not for Human Consumption. An updated and amended status report on new psychoactive substances (NPS) and \u2018club drugs\u2019 in the UK. London: Drugscope, 2015:45\u20136."},{"key":"2025081314492889000_164.6.450.6","unstructured":"Ministry of Defence. Freedom of Information request reference FOI2016\/09506. https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/600304\/Number_of_service_personnel_discharged_for_illegal_drug_possession.pdf (10 May 2017)."},{"key":"2025081314492889000_164.6.450.7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1080\/03071840701863125","article-title":"Compulsory Drugs Testing in the British Army: Assessing the data","volume":"152","author":"Bird","year":"2007","journal-title":"RUSI"},{"key":"2025081314492889000_164.6.450.8","unstructured":"Ministry of Defence. JSP 835: Alcohol and Substance Misuse and Testing Version 2.0. 2013 https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/425401\/20131101-JSP_835-V2_0-U.pdf."},{"key":"2025081314492889000_164.6.450.9","unstructured":"Ministry of Defence. Army General Administrative Instruction 64, para 64.042, 2016."},{"key":"2025081314492889000_164.6.450.10","unstructured":"Savage M . Is the Army losing its war against drug abuse? Independent. http:\/\/www.independent.co.uk\/news\/uk\/home-news\/is-the-army-losing-its-war-againsgranet-drug-abuse-1921415.html."},{"key":"2025081314492889000_164.6.450.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7043.1411"},{"key":"2025081314492889000_164.6.450.12","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-12-00180"},{"key":"2025081314492889000_164.6.450.13","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2011.637610"},{"key":"2025081314492889000_164.6.450.14","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-10-00356"},{"key":"2025081314492889000_164.6.450.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2012.09.147"},{"key":"2025081314492889000_164.6.450.16","unstructured":"Brantley CL . Spice, Bath Salts, Salvia Divinorum, and Huffing: A judge advocate\u2019s guide to disposing of designer drug cases in the military. Army Lawyer 2012:16\u201337."},{"key":"2025081314492889000_164.6.450.17","unstructured":"Ministry of Defence. UK armed forces biannual diversity statistics. https:\/\/www.gov.uk\/government\/statistics\/uk-armed-forces-biannual-diversity-statistics-2016."},{"key":"2025081314492889000_164.6.450.18","doi-asserted-by":"publisher","DOI":"10.1002\/dta.155"},{"key":"2025081314492889000_164.6.450.19","first-page":"139","article-title":"Effects and risks associated with novel psychoactive substances: mislabeling and sale as bath salts, spice, and research chemicals","volume":"111","author":"Hohmann","year":"2014","journal-title":"Dtsch Arztebl Int"},{"key":"2025081314492889000_164.6.450.20","unstructured":"Bush DM , Woodwell DA . The CBHSQ Report. Update: Drug-Related Emergency Department Visits Involving Synthetic Cannabinoids. SAMHSA 2014:1\u20138."},{"key":"2025081314492889000_164.6.450.21","unstructured":"Berry-Cab\u00e1n CS , Kleinschmidt PE , Rao DS , et al . Synthetic cannabinoid and cathinone use among US soldiers. US Army Med Dep J 2012:19\u201325."},{"key":"2025081314492889000_164.6.450.22","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.11010176"},{"key":"2025081314492889000_164.6.450.23","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1111\/j.1360-0443.2010.03119.x","article-title":"Warning: Legal Synthetic cannabinoid-receptor agonists such as JWH-018 May precipitate psychosis in vulnerable individuals","volume":"105","author":"Every-Palmer","year":"2010","journal-title":"Addiction"},{"key":"2025081314492889000_164.6.450.24","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2011.609822"},{"key":"2025081314492889000_164.6.450.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2012.11.034"},{"key":"2025081314492889000_164.6.450.26","doi-asserted-by":"crossref","first-page":"1320.e5","DOI":"10.1016\/j.ajem.2011.05.013","article-title":"Cardiotoxicity associated with the synthetic cannabinoid, K9, with laboratory confirmation","volume":"30","author":"Young","year":"2012","journal-title":"Am J Emerg Med"},{"key":"2025081314492889000_164.6.450.27","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-3823"},{"key":"2025081314492889000_164.6.450.28","doi-asserted-by":"crossref","first-page":"431","DOI":"10.5348\/ijcri-201612-CS-10073","article-title":"Not safe for consumption: Synthetic cannabinoids causing fatal acute rhabdomyolysis in two young men","volume":"7","author":"Paul","year":"2016","journal-title":"Int J Case Rep Images"},{"key":"2025081314492889000_164.6.450.29","first-page":"93","article-title":"Acute kidney injury associated with synthetic cannabinoid use--multiple states, 2012","volume":"62","author":"Centers for Disease Control and Prevention (CDC)","year":"2013","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025081314492889000_164.6.450.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.08.005"},{"key":"2025081314492889000_164.6.450.31","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1505328"},{"key":"2025081314492889000_164.6.450.32","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1111\/j.1360-0443.2010.03119.x","article-title":"Warning: legal synthetic cannabinoid-receptor agonists such as JWH-018 may precipitate psychosis in vulnerable individuals","volume":"105","author":"Every-Palmer","year":"2010","journal-title":"Addiction"},{"key":"2025081314492889000_164.6.450.33","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/hup.2423","article-title":"Deaths of individuals aged 16-24\u2009years in the UK after using mephedrone","volume":"30","author":"Loi","year":"2015","journal-title":"Hum Psychopharmacol"},{"key":"2025081314492889000_164.6.450.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2012.03.009"},{"key":"2025081314492889000_164.6.450.35","doi-asserted-by":"publisher","DOI":"10.1080\/15504263.2012.697447"},{"key":"2025081314492889000_164.6.450.36","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1107097"},{"key":"2025081314492889000_164.6.450.37","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-011-0202-2"},{"key":"2025081314492889000_164.6.450.38","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/1067828X.2013.803942","article-title":"A Review of \u201cBath Salts\u201d: Evolving Designer Drugs of Abuse","volume":"24","author":"Airuehia","year":"2015","journal-title":"Journal of Child and Adolescent Substance Abuse"},{"key":"2025081314492889000_164.6.450.39","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkv011"},{"key":"2025081314492889000_164.6.450.40","first-page":"572","article-title":"Synthetic cathinones (\u2019bath salts'): legal and health care challenges","volume":"37","author":"Gershman","year":"2012","journal-title":"P T"},{"key":"2025081314492889000_164.6.450.41","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4172\/2161-0495.1000108","article-title":"Alarming Trends in a Novel Class of Designer Drugs","volume":"01","author":"Grane","year":"2011","journal-title":"J Clin Toxicol"},{"key":"2025081314492889000_164.6.450.42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2012-000977","article-title":"A chemical analysis examining the pharmacology of novel psychoactive substances freely available over the internet and their impact on public (ill)health. Legal highs or illegal highs?","volume":"2","author":"Ayres","year":"2012","journal-title":"BMJ Open"},{"key":"2025081314492889000_164.6.450.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2012.05.003"},{"key":"2025081314492889000_164.6.450.44","doi-asserted-by":"publisher","DOI":"10.5694\/mja13.00203"},{"key":"2025081314492889000_164.6.450.45","unstructured":"Toxbase. Synthetic Cathinones. 2014 https:\/\/www.toxbase.org\/poisons-index-a-z\/s-products\/synthetic-cathinones\/."},{"key":"2025081314492889000_164.6.450.46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/734749","article-title":"25C-NBOMe: preliminary data on pharmacology, psychoactive effects, and toxicity of a new potent and dangerous hallucinogenic drug","volume":"2014","author":"Bersani","year":"2014","journal-title":"Biomed Res Int"},{"key":"2025081314492889000_164.6.450.47","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3109\/15563650.2015.1115056","article-title":"Case series: toxicity from 25B-NBOMe--a cluster of N-bomb cases","volume":"54","author":"Gee","year":"2016","journal-title":"Clin Toxicol"},{"key":"2025081314492889000_164.6.450.48","doi-asserted-by":"publisher","DOI":"10.1007\/BF03178273"},{"key":"2025081314492889000_164.6.450.49","first-page":"1","article-title":"Chemistry Bromo-DragonFly: Pharmacology and Toxicology of a Benzodifuran Derivative Producing LSD-Like Effects","volume":"3","author":"Coppola","year":"2012","journal-title":"J Addict Res Ther"},{"key":"2025081314492889000_164.6.450.50","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2174\/157488411796151129","article-title":"Designer drugs on the internet: a phenomenon out-of-control? the emergence of hallucinogenic drug Bromo-Dragonfly","volume":"6","author":"Corazza","year":"2011","journal-title":"Curr Clin Pharmacol"},{"key":"2025081314492889000_164.6.450.51","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-13-00470"},{"key":"2025081314492889000_164.6.450.52","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bku052"},{"key":"2025081314492889000_164.6.450.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.03.007"},{"key":"2025081314492889000_164.6.450.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2014.08.011"},{"key":"2025081314492889000_164.6.450.55","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/FBP.0000000000000241","article-title":"Methoxetamine, a novel psychoactive substance with serious adverse pharmacological effects: a review of case reports and preclinical findings","volume":"27","author":"Zanda","year":"2016","journal-title":"Behav Pharmacol"},{"key":"2025081314492889000_164.6.450.56","unstructured":"Gussow L . W-18, a synthetic opioid 100 times more potent than fentanyl. The Poison Review. http:\/\/www.thepoisonreview.com\/2016\/02\/04\/w-18-a-synthetic-opiate-100-times-more-potent-than-fentanyl\/."},{"key":"2025081314492889000_164.6.450.57","unstructured":"Toxbase. \u00a0Etizolam. 2014 https:\/\/www.toxbase.org\/poisons-index-a-z\/e-products\/etizolam\/."},{"key":"2025081314492889000_164.6.450.58","unstructured":"Toxbase. Phenazepam. 2014 https:\/\/www.toxbase.org\/poisons-index-a-z\/p-products\/phenazepam\/."},{"key":"2025081314492889000_164.6.450.59","unstructured":"Cadogan M , Nickson C . Life in the Fast Lane Blog (Internet). Australia: Mike Cadogan and Chris Nickson, 2009."},{"key":"2025081314492889000_164.6.450.60","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/MEJ.0000000000000310","article-title":"SODAS: Surveillance of Drugs of Abuse Study","volume":"24","author":"Lowe","year":"2017","journal-title":"Eur J Emerg Med"},{"key":"2025081314492889000_164.6.450.61","unstructured":"Talk to Frank. Drugs A-Z: Phenazepam. http:\/\/www.talktofrank.com\/drug\/phenazepam."},{"key":"2025081314492889000_164.6.450.62","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkv122"},{"key":"2025081314492889000_164.6.450.63","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.forsciint.2015.07.033","article-title":"Phenazepam: A review of medico-legal deaths in South Scotland between 2010 and 2014","volume":"254","author":"Shearer","year":"2015","journal-title":"Forensic Sci Int"},{"key":"2025081314492889000_164.6.450.64","unstructured":"Toxbase. Amphertamine related drugs of abuse. https:\/\/www.toxbase.org\/poisons-index-a-z\/a-products\/amphetamine-related-drugs-of-abuse\/."},{"key":"2025081314492889000_164.6.450.65","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12053"},{"key":"2025081314492889000_164.6.450.66","first-page":"268","article-title":"The use of intralipid in the management of a mixed overdose","volume":"1194","author":"Orr","year":"2010","journal-title":"JICS"},{"key":"2025081314492889000_164.6.450.67","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00499.x"},{"key":"2025081314492889000_164.6.450.68","unstructured":"Institute of Medicine. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press, 2013."},{"key":"2025081314492889000_164.6.450.69","unstructured":"Ministry of Defence UK Armed Forces Mental Health. Annual Summary & Trends Over Time, 2007\/08. https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/619133\/20170615_Mental_Health_Annual_Report_16-17_O_R.pdf."},{"key":"2025081314492889000_164.6.450.70","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3109\/03602532.2015.1029635","article-title":"Synthetic cannabinoids pharmacokinetics and detection methods in biological matrices","volume":"47","author":"Castaneto","year":"2015","journal-title":"Drug Metab Rev"},{"key":"2025081314492889000_164.6.450.71","unstructured":"Ministry of Defence. Alcohol Usage in the UK Armed Forces. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/630184\/20170718_Alcohol_Usage_bulletin__-_O.pdf."},{"key":"2025081314492889000_164.6.450.72","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20140401-62"},{"key":"2025081314492889000_164.6.450.73","unstructured":"Office of National Statistics. Deaths related to drug poisoning in England and Wales: 2015 Registrations. London: ONS, 2016."},{"key":"2025081314492889000_164.6.450.74","doi-asserted-by":"publisher","DOI":"10.1111\/1556-4029.12202"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2018-000927","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T21:49:43Z","timestamp":1755121783000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2018-000927"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,22]]},"references-count":74,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,11,6]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/jramc-2018-000927"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2018-000927","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"type":"print","value":"0035-8665"},{"type":"electronic","value":"2052-0468"}],"subject":[],"published":{"date-parts":[[2018,6,22]]}}}