"Opioid toxicities are a public health crisis in North America that has been amplified in severity by the COVID-19 pandemic.

"After rapid expansion between 2009 and 2018, the number of distinct NPS found on global drug markets has now stabilized at around 550, i.e. at around half the number of NPS ever identified on drug markets. In 2020, Member States reported 548 NPS on the market, of which 77 were identified for the first time.

"This work adds to a growing body of literature on how increased criminal penalties for drug possession and distribution affect health. Prior work has documented that the criminal legal system can be a stigmatizing revolving door that people often struggle to escape (Jones & Sawyer, 2019; LeMasters et al., 2023a).

"The opioid overdose epidemic continues to evolve in the United States (US). While the epidemic began with prescription opioids in the 1990’s, it evolved to consist largely of heroin by 2010, and synthetic opioids by 2013, driven by high-potency illicitly manufactured fentanyl and fentanyl analogs (Centers for Disease Control and Prevention, 2023).

"Across a unique field survey of authorities in targeted regions, a large-scale field survey of the same regions, and an experiment conducted online, results consistently showed that higher perceived governmental support for comprehensive drug policies inclusive of harm reduction measures would lead to increased public trust in local government. This medium-sized effect was evident in both the assessments of local authorities and the self-reported perception of community residents.

"Comprehensive substance use services should include not only behavioral interventions to reduce substance use but also harm reduction services aimed at mitigating the adverse effects of substance use [23, 24]. For example, medication therapies, such as administering opioid agonists like methadone and buprenorphine, alleviate withdrawal symptoms and enhance treatment compliance.

"Although harm reduction interventions for substance use disorder have been repeatedly shown to reduce the risk of overdose, mortality, and drug-related crime [1, 2], the journey to their acceptance and implementation has been fraught with challenges.

"Derived from, and thus similar to, the 2C class of amphetamines made popular by the late self-experimenting chemist Alexander Shulgin, NBOMes are now used recreationally by adolescents and young adults for their sympathomimetic and serotonergic effects. Often sold in microgram doses on blotter paper and marketed as “legal” or “natural LSD,” NBOMes are also available as liquid, powder, capsules, tablets, or sprays [2].

"In 2010, a potent new synthetic hallucinogen known as “N-Bomb” emerged on the international recreational drug market [1]. First synthesized in 2003 by German chemist Ralph Heim, 2-(4-Iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine, or 25I-NBOMe, was discovered to be a potent serotonin 2A (5-HT2A) receptor agonist [2].

"Lifetime use of MDMA, which also mainly affects men (11.7% compared to 4.9% of women), rose sharply between 2017 and 2023 (increasing from 5.0% to 8.2%), and its current use has doubled (from 1.0% to 1.8%), 25–34-year-olds being the most likely to have tried it (13.8%). This increase was proportionally greater for women (0.6% to 1.3%) than men (1.5% to 2.4%)."