Use of NPS has been strongly associated with influence of friends, social settings and sourcing via street and web-based platforms such as the darknet. Here we investigate whether the COVID-19 pandemic and lockdown measures have altered NPS use, preferences, substances resource and risk awareness internationally.


The Bristol Online Survey was in English and advertised on the drug forum Bluelight and social media Facebook pages and via University email between 8 August 2020 and 3 March 2021 (308 responses; 72 NPS users). This pharmacoepidemiologic study was evaluated using SPSS software (IBM SPSS Statistics version 27; MacOS Sierra 10.12.3).


Specifically the main motivations for NPS use prior to the pandemic was to ‘’experience something new and different’’ (55.1%), ‘’get a good high’’ (47.8%) and ‘’get help to cope with boredom and anxiety’’ (44.9%) whilst during the pandemic main motivations were to ‘’ cope with depression and anxiety’’ (53.8%), ‘’get happier and more optimistic about life’’ (44.2%), and ‘’get a good high’’ (36.5%). There remains a low perception of health risk associated with NPS use (75.7%). The preferred NPS of users prior and during Covid-19 was magic mushrooms psilocybin (61.8%; 49%) often in combination with alcohol (41.4%) and cannabis (37.1%). One out of two users stated that they changed the use of their favorite NPS during the pandemic; either increased NPS use due to anxiety (26.3%) and/ or because they had more available time (24.6%); or decreased due to their own choice to use less (29.8%). Covid-19 pandemic and associated lockdown measures had an effect on settings of NPS use; prior the pandemic users mainly reported NPS use outdoors in nature with social gatherings (43.9%), in house parties (39.4%), in music festivals (37.9%) whilst during the pandemic reported use at home alone (48.1%), with household members at home (35.2%), outdoors in nature with other people (33.3%). Prior and during the pandemic there was no change in source(s) of NPS; the main sources remain friends/acquaintances and dealers (98%; 85.5%). One out of three users reported reduced availability of substances on the recreational drug market in their country when in contrast 30% reported no change. Respondents with underlying health conditions (asthma, mental health issues) vulnerable to Covid-19 reported significantly higher use of NPS (p<0.05) compared to respondents with no underlying health issues. Gender, age, living area, sexual orientation, place of living, educational background, smoking, alcohol consumption frequency and employment significantly affected (p<0.05) NPS use. Male respondents, residents of suburban and rural areas, smokers, respondents reporting frequent and high alcoholic consumption and respondents with low educational level represented the majority of NPS users as well as the employed, the unable to work and retired groups. Similarly, sexual orientation and religion significantly affected (p<0.001) NPS use.


Users’ low perception of NPS safety profile especially in Covid-19 vulnerable with underlying health conditions makes it crucial to provide better education and information on NPS health risks and patterns during these emerging times. The fact that NPS use correlates with a lower level of education, indicates a need for enhanced statutory targeted prevention interventions in schools and colleges. Although the fact that many users during the pandemic have found an emotional healing, a source of happiness to cope with boredom, anxiety, and depression due to NPS use makes it important to investigate the therapeutic effects of these substances in clinical setting.


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