Assessment of Medical Doctors' Knowledge of New Psychoactive Substances and their Neurobehavioural Effects

Abstract

New Psychoactive Substances (NPS), also known as designer drugs, pose significant public health risks due to their potent Psychoactive properties and potential neurobehavioural effects. Medical doctors play a crucial role in identifying and addressing the health risks associated with NPS use. This study assessed medical doctors' knowledge of NPS and their neurobehavioral effects. A cross-sectional online survey of licensed medical doctors was conducted, revealing varying levels of awareness and knowledge regarding NPS. While respondents showed familiarity with NPS terminology and street names, gaps existed, particularly concerning specific NPS categories. This underscores the importance of enhancing medical professionals' understanding of NPS to ensure comprehensive patient care and informed treatment decisions.

Full text

ASSESSMENT OF MEDICAL DOCTORS' KNOWLEDGE OF NEW PSYCHOACTIVE
SUBSTANCES AND THEIR NEUROBEHAVIOURAL EFFECTS
1 1 2
Evelyn Osemhen Eziagu , Eno-obong Nkanga Chidimma Ezinne Nwankwo , Ayoyinka
,
3 4 1
A. Ayorinde , Margaret Egan Erhunmwunsee , Seyi Ogundipe Sunday, Uma Agwu
5 5 6
Uma , Emedoh Thomas Chimezie & Uchechukwu Brian Eziagu
1Department of Mental Health, University of Uyo Teaching Hospital, Uyo,
Akwa Ibom State, Nigeria
2Department of Psychological Medicine, University of Nigeria Teaching Hospital,
Ituku/Ozalla, Enugu, Enugu State, Nigeria
3Department of Mental Health, Obafemi Awolowo University Teaching Hospital
Complex, Ile-Ife, Osun State, Nigeria
4Department of Family Medicine, University of Uyo Teaching Hospital, Uyo,
Akwa Ibom State, Nigeria
5Federal Neuropsychiatric Hospital (FNPH), Calabar,
Cross Rivers State, Nigeria
6Department of Histopathology, University of Uyo Teaching Hospital (UUTH), o, Akwa
Corresponding author: Dr. Evelyn Osemhen Eziagu, Department of Mental Health, University of Uyo Teaching Hospital, P.M.B.
1136, Uyo, Akwa Ibom State, Nigeria. Postal code: 520001. Phone: +2347037151904. Email: evelyneziagu@gmail.com
ABSTRACT
New Psychoacve Substances (NPS), also known as designer drugs, pose significant public
health risks due to their potent psychoacve properes and potenal neurobehavioural
effects. Medical doctors play a crucial role in idenfying and addressing the health risks
associated with NPS use. This study assessed medical doctors' knowledge of NPS and their
neurobehavioral effects. A cross-seconal online survey of licensed medical doctors was
conducted, revealing varying levels of awareness and knowledge regarding NPS. While
respondents showed familiarity with NPS terminology and street names, gaps existed,
parcularly concerning specific NPS categories. This underscores the importance of
enhancing medical professionals' understanding of NPS to ensure comprehensive paent
care and informed treatment decisions.
Keywords: Medical Doctors, Designer drugs, New Psychoacve Substances (NPS),
Neurobehavioral Effects, Familiarity
African Journal of Drug and Alcohol Studies
Journal homepage: www.crisaafrica.org/ajdas
hps://dx.doi.org/10.4314/ajdas.v22i2.3
Volume 22, Numbers 2 2023
INTRODUCTION
New psychoacve substances (NPS) are a
complex and varied group of drugs oen
k n o w n a s ' N o v e l P sy ch oa c ve
Substan c e s ' , ' D e s i gner d r ugs' , o r
'Synthec Drugs' (Feng et al., 2017;
Gilani, 2016; United Naons Office on
Drugs and Crime, 2020, p. 2). The UNODC
defined NPS as “substances of abuse,

EZIAGU ET AL.
either in a pure form or a preparaon,
that are not controlled by the 1961
Single Convenon on Narcoc Drugs or
the 1971 Convenon on Psychotropic
Substances, but which may pose a public
health threat” (United Naons Office On
Drugs and Crime, 2020, p. 2). The
UNODC further noted that the term
“new” does not necessarily refer to new
invenons — several NPS were first
synthesized decades ago — but to
substances that have recently become
available on the market”(United Naons
Office on Drugs and Crime, 2020, p. 2).
NPS has evolved and mulplied over
the years, with the UNODC declaring
over 900 NPS as of 2019, from about 600
in 2015 (Feng et al., 2017; United
Naons Office on Drugs and Crime,
2020). This high number, as well as the
rapid evoluon, make these substances
a crical challenge to the government,
the general public as well as clinical, and
scienfic communies (Gilani, 2016;
Shafi et al., 2020).
NPS includes a wide range of
chemical structures, all of which have
the po tena l to p ro duc e different
neurobehavioral effects (Shafi et al.,
2020). Studies by Shafi et al and Gilani
have shown that not only is there a wide
range of chemical compounds, but
products labeled with the same name
may also contain different compounds,
somemes with several compounds in
one product (Gilani, 2016; Shafi et al.,
2020). The neuropsychological effects
might range from euphoria to serious
c o gn i v e i mp a irm e n t a nd li fe -
threatening symptoms (Abdulrahim &
Bowden-Jones, 2015; Gilani, 2016;
Kronstrand et al., 2018). Consequently,
N P S u s e r s o  e n e x p e r i e n c e
unpredictabl e outcomes, inc luding
acute intoxicaon, overdose, and other
mental health issues (Abdulrahim D. &
Bowden-Jones O., 2015; Kronstrand et
al., 2018).
Medical doctors play a key role in
diagnosing and treang people with
su bstan ce use pro ble ms (Miller &
Sheppard, 1999). Managing a paent
who has used NPS may be quite
challenging and not straighorward for
clinicians (Aguirre-Molina & Gorman,
2003; Awuchi et al., 2023; Shafi et al.,
2020). This is due in part to the wide
array of chemical structures and the
constantly changing formulaons of the
substances (Shafi et al., 2020; Sherri L.
Kacinko & Donna M. Papsun, n.d.).
Furthermore, regular toxicology screens
may not be well suited to detect these
NPS, thus, treang clinicians may not
know which guideline to reference
(Grafinger et al., 2020; Sherri L. Kacinko
& Donna M. Papsun, n.d.). Owing to the
a b o v e , u n r a v e l i n g t h e e x a c t
neu ro b e h avio ra l e ff e c t(s ) of t he
substance(s) becomes a bit problemac
(Feng et al., 2017; Gilani, 2016; Grafinger
et al., 2020; Kronstrand et al., 2018).
Unfortunately, less is known about the
level of medical doctors' knowledge of
NPS and its neurobehavioral effects,
parcularly within the context of Uyo,
Nigeria. To the best of our knowledge, no
prior published studies have undertaken
this assessment among medical doctors
in this region. However, this absence of
data does not imply a low prevalence of
NPS ulizaon in Uyo or the broader
115

DOCTORS' KNOWLEDGE
Af rican con nent. Notably, recent
studies by Dumbili et al. in Nigeria and
Oka for et al. in Calab a r r eveal e d
escalang rates of NPS ulizaon, with a
diverse array of substances, including
indigenous variees, idenfied among
paent populaons (Dumbili et al., 2021;
Okafor C. J. et al., 2022). Similarly,
rese a r c h co n d uc t e d in Ke n y a b y
Kahuthi a - G a t h u do c u m ented t h e
emergence o f over forty new N PS
( K ah u th i a- G at h u e t al . , 2 0 13 ) .
Comparable trends have also been
observed in South Africa and other
regions of Africa (Kahuthia-Gathu et al.,
2 0 1 3 ; O na o l a p o e t a l. , 2 0 2 2 ).
Importantly, a high level of knowledge of
NPS and their neurobehavioral effects
among medical doctors will have great
clinica l impli caon s parcula rly as
regards good clinical outcomes in the
medical management of the paents
who use NPS in our environm ent .
Therefore, this study aimed to assess
medical doctors' knowledge of NPS and
its neurobehavioral effects. Also, our
findings will be compared with exisng
relevant literature. This understanding is
c r uc i al to d ev e lo p in g eff ec  ve
educaonal intervenons, improving
clinical pracce, and promong paent
safety in the medical management of
NPS and their neurobehavioral effects.
METHOD
Study design: This study was a cross-
seconal survey conducted a mong
medical doctors from diverse speciales
and geographic regions, both within
Nigeria and among Nigerian medical
profe s s i ona l s re s i d in g in va r i ous
countries abroad, encompassing the
Nigerian diaspora. The selecon of
parcipants from varied geographical
locaons aimed to enrich the depth of
research findings, enable comparave
analyses and foster a comprehensive
understanding of the invesgated topic.
The study used a survey instrument that
contained both closed and open-ended
quesons to collect data. Data analysis
involved descripve stascal analysis
and themac (qualitave) analysis.
Study instrument: We designed a survey
instrument that was pre-tested by two
independent reviewers who found that
the quesonnaire was good enough and
made few correcons to it which include
rephrasing of a queson and adding a
queson to th e ques onn aire. T he
quesonnaire comprised 24 quesons
subdivided into six secons. Secon one
contained an introducon to the survey,
including an explanaon of the study
ob j e c ve . Th e ot her s ec  o ns , in
chronological order, contained quesons
th a t as se ss e d so c io de m og rap h ic
informaon; fa m i l i a r i t y wi t h N P S
terminology, common street names and
categori es o f NPS; neurobehavioral
effects of NPS; management-related
issues (e.g., clinical encounters involving
paents who disclosed their NPS use and
their confidence in addressing NPS-
related health concerns); and conclusion.
S am p l i n g a n d da ta c o l le c  o n
Proc edures: The res pon dents were
recruited through convenience sampling
via an online Google survey form and the
link was shared across medical doctors'
online groups (i.e., professional medical
116

associaons) on the WhatsApp social
media plaorm. The inclusion criteria
were being a licensed medical doctor
and consent to parcipate in the study.
Data collecon went on for two (2)
weeks. The survey was launched on the
25th of July 2023 and the dataset used
in this study was extracted on the 8th of
August 2023.
Data analysis
Descripve Analysis: The data analysis
was d on e us i n g G oo g l e S hee t s .
Frequencies and percentages were
computed for most of the quesons
including those assessing demographic
i n fo rm a on , qu e s o ns te s n g
fa m iliari t y w ith the ter m i nology,
common street names and categories of
NPS, knowledge of neurobehavioral
effects, etc.
Themac Analysis: For open-ended
quesons, qualitave themac analysis
was carried out to idenfy common
themes in respondents' responses.
Inially, responses were familiarized
with to gain an understanding of their
content. Subsequently, an open coding
app ro a c h wa s u l i z e d to a s si g n
descripve codes to relevant segments
of the data. These codes were then
collated to idenfy overarching themes
that emerged from the data. Through
iterave review and refinement of these
t h e m e s , a c o m p r e h e n s i v e
unde rstanding of the dataset was
achieved. Ulmately, conclusions were
dra wn b ased on the synt h e sized
themes, providing valuable insights into
th e perspec ve s and exp erience s
conveyed by the respondents.
A total number of 101 respondents filled
out the survey form within the study
period. More males (65.9%) responded
than females (33%), with a male-to-
female rao of 2:1. The age range of
respondents was 29 to 63 years, with a
mean age of 38 ± 6.59 years. The
respondents comprised almost enrely
(99%) of praccing medical doctors from
Nigeria, praccing in Nigeria (95%) and in
the diaspora (5%). Of those praccing in
Nigeria, approximately 84% work in
teaching hospitals or other federal
government-owned health facilies
while the rest are in private facilies,
pr i m ar y he al t h c e n t ers , ge n er a l
hospitals, and educaonal instuons.
The majority of the respondents have
between 5 to 20 years of experience in
medical pracce (Table 1).
EZIAGU ET AL.
Ethical consideraons: Formal ethics
approval was not needed because the
research entailed no harm to parcipants.
Ho w ev e r, et h i c al gu id el in es and
principles outlined in the Declaraon of
Helsinki were adhered to. Before the
respondents saw the quesonnaire page,
a thorough explanaon of the research's
goals and objecves were given to them.
Informed consent was obtained from the
respondents and the confidenality of
th e infor ma on th ey provid ed was
assured. None of the respondents was
compelled in any form nor given survey
inducement to complete the online
survey quesonnaire. The authors also
declared that all the respondents were
fully anonymous. The enre cost of this
research was borne by the authors.
117
RESULTS

Table 1: Frequency distribuon table displaying the respondents' sociodemographic data
Characteriscs Frequency Percentage (%)
Gender
Male 66 65.35
Female 34 33.66
Prefer not to say 1 0.99
Total
101
100
Age
Age categories
< 30
2
1.98
30 to 39
65
64.36
40 to 49
25
24.75
50 to 59
5
4.95
= 60
2
1.98
Missing
2
1.98
Total
101
100
Years of experience as a doctor
Duraon (in years)
< 5
2
1.98
5 to 10
54
53.47
10 to 20
35
34.65
> 20
10
9.9
Are you currently praccing?
Yes
100
99.01
No
0
0
Prefer not to say
1
0.99
Total
101
100
Place of current pracce
Teaching hospital/other
federal govt. Instuon
85
84.16
Private health facility
7
6.93
Educaonal instuons
3
2.97
Primary health center/general
hospital
4
3.96
Others
2
1.98
Country of residence/pracce
Nigeria 96 95.05
Diaspora 5 4.95
Total 101 100
DOCTORS' KNOWLEDGE
The level of familiarity with the term
NPS and the common street names used
to describe them, as reported by the
respondents, are shown in Table 2. More
than half of the respondents idenfied
the statements that correctly described
NPS as psychoacve substances that
recently became available in the market
(approximately 54%) as well as those that
are de signed to mimic estab lis hed
psychoacve substances (55%) (Table 2).
118

Table 2: Frequency distribuon table displaying respondents' familiarity with NPS
Degrees of agreement
I am familiar with the term NPS
I am familiar with common
street names of NPS
Answer
Frequency
Percentage
(%)
Frequency
Percentage
(%)
Strongly agree
20
19.8
11
10.9
Agree
37
36.6
51
50.5
Neutral
20
19.8
17
16.8
Disagree
19
18.8
18
17.8
Strongly disagree
5
5
4
4
Statements that describe NPS
The statements
Frequency
Percentage (%)
Newly invented psychoacve
substances (PS)
28
27.7
Newly discovered
psychoacve substances
38
37.6
Recently available
psychoacve substances in
the market
54
53.5
PS designed to mimic
established PS
56
55.4
Not sure
1
0.99
Classes of NPS
The classes
Frequency
Percentage (%)
Synthec cannabinoids
63
62.4
Synthec cathinones
38
37.6
Synthec hallucinogens
41
40.6
Synthec opioids
45
44.6
Designer benzodiazepines
33
32.7
Not sure
29
28.7
Others
3
3.0
EZIAGU ET AL.
Regarding the different categories of
NPS , t h e respon d e nts wer e m ost
familiar with synthec cannabinoids
(62%) and least familiar (33%) with
designer benzodiazepines. Some (29%)
of the respondents were unsure of the
classes of NPS (Table 2). It should be
n o te d th a t t he fi rs t 20 su r ve y
respondents did not respond to the
queson requiring specific names of NPS,
because this queson was added to the
s u rv ey fo rm a  e r i t h ad b e e n
disseminated. Interesngly, 91.4% (81) of
th e res pond ent s res pond ed to t he
queson that required them to list some
street names of substances known to
them. A total of 82.7% of the responses
given were correct, while 2.5% were
119

Figure 1: A bar chart showing the frequency distribuon of respondents' knowledge
of how drug users obtain NPS
DOCTORS' KNOWLEDGE
wrong, and the remaining 14.8% were
either not sure or had no idea. The
r e s p o n d e n t s g a v e s o m e
unconvenonal street names e.g. eye
shiner, pawpaw leaves, dried human
an d liz a r d du ng , gb aj a, , an d a
combinaon of cough syrup and tom-
tom sweets. The most popular means by
wh ich users obtain s ubstances for
c o n s u m p  o n a c c o r d i n g t o th e
respondents was through street dealers
(8 0.2%) whi le online m arketplac es
(25.7%) and smoke shops (25.7%) were
the least popular sources (Figure 1).
Figure 2: A bar chart showing the frequency distribuon of respondents' knowledge
of short-term neurobehavioral effects of NPS
120

The respondents were generally
knowledgeable about the short-term
neurobehavioral effects of NPS. The
mo s t pop u l ar sh or t-t e r m e ffe c t
idenfied by respondents was euphoria
(83.2%) followed by hallucinaons
(78.2%), poor judgment (75.2%), and
memory impairment (49.5%) (Figure 2).
Psychoc illness was the long-term
effect o f substance use that most
(90.1%) respondents were familiar with.
EZIAGU ET AL.
On the other ha nd, only 1% of the
respondents opined that insomnia could
be a long-term effect, while another 1%
bel i e ved that enga g i ng i n c r iminal
a c  v i  e s c o u l d b e a l o n g- te r m
co n seque nce of usi n g psychoac  ve
substan ces . (Figure 3). M ost of the
respondents opined that oral ingeson
(71.3%), inhalaon (81.2%), injecon
(56.4%), and smoking (76.2%) are usual
routes of administraon of NPS (Figure 4).
Figure 3: A bar chart showing the frequency distribuon of respondents'
knowledge of the long-term effects of NPS
Figure 4: A bar chart showing the frequency distribuon of respondents'
knowledge of routes of administraon of NPS
121

Some of the respondents (38.6%) stated
that they rarely (once or twice a year)
encountering paents in their pracce
who used NPS. This was closely followed
by 35.6% of the respondents who
reported occasionally (a few mes a
year) seeing paents who had used NPS,
20.8% who regularly (several mes a
month) see such paents. Only 5% said
that they frequently (several mes a
week) encounter such paents.
The respondents expressed different
levels of confidence in their ability to
idenfy NPS-related health issues in
th e i r pa  en t s ra n gi n g fr o m n o t
co n fident a t a ll (17.8 5 %) to ver y
confident (25.7%). Also, 60.8% of the
respondents opined that they do not
feel that they are adequately trained to
address NPS-related health issues, but
27.7% felt they were adequately trained
while 11.9% were unsure. The majority
of the doctors said that they typically
manage paents who disclose NPS use
by g iv i ng th em n on - ju d gm e nt a l
counseling (86.1%), referring them to a
substance abuse specialist (84.2%),
while 2% stated that they would report
such a paent to the police.
The responders kept abreast with
knowledge of NPS through connuing
me d i c a l e du c a  o n, p r o fes s i ona l
conferences, webinars, etc.
DISCUSSION
Thi s st u d y ai m ed t o pr o v ide a n
e v a lu a  on o f m e dic a l d o cto r s'
understanding of new psychoacve
s u b s t a n c e s ( N P S ) a n d t h e i r
neurobehavioral consequences. Many
respondents were familiar with the term
NPS, were able to give common street
names of NPS, even the unconvenonal
ones, and were largely conversant with
t h e s h o r t a n d l o n g - t e r m
neurobehavioral effects of NPS. The
majority of respondents praccing in
t e a c hi ng ho sp i ta ls a nd fe de ra l
government-owned health facilies
indicate the potenal influence of their
working environment on their exposure
to diverse paent populaons.
The respondents' demographics show
a diverse representaon of medical
p r o f e s s i o n a l s , w i t h a m a l e
predominance, which is consistent with
ea rli er st udies ind icang a high er
frequency of men in the medical system,
although this trend has begun to change
in some countries (Frédéric Michas,
2022). The vast majority of respondents
work in Nigeria, mostl y at federal
government-owned teaching hospitals
or o t h e r h e a lthca r e i nstu  o n s ,
ind ica n g a s izea ble samp l e with
potenal influence over healthcare
policies and clinical pracce within their
respecve domains. The mean age of 38
± 6.59 years of respondents matches the
demographic profile of experienced
medical doctors in Nigeria as shown in a
previous study (Fawibe et al., 2017). This
lends credibility to the study findings.
The findings on medical doctors'
knowledge of the word "NPS" and
common street names show that there is
a high-level of awareness among the
r e s p o n d en t s . A f u n d a m e n t a l
un d e rs t a nd i n g of NP S n at u re is
highlighted by the idenficaon of NPS
as recently available psychoacve drugs
and their funcon in mimicking well-
established p sycho a c  v e a gents.
122
DOCTORS' KNOWLEDGE

Synthec cannabinoids were found to
be the most well-known NPS category,
which is consistent with earlier studies
(Gilani, 2016; Shafi et al., 2020). A recent
r e v i ew sh ow e d t h a t sy n t h e c
cannabinoids are the first formally
reported, largest, and most structurally
diverse group of NPS (Shafi et al., 2020).
The study also shows gap in knowledge
study also finds gaps in knowledge of
so me NPS catego ries, p arc ular ly
designe r be nzodiaze p i n e s , a n d a
significant proporon of respondents
who were unsure of the NPS classes. This
reve a l s an a r e a w h e r e te a ch i n g
p r o g ra m s a i m e d at i m pr o v i n g
knowledge NPS and their classificaons
are needed. The complexity and quick
evoluon of these drugs can explain the
fa c t th at o v e r on e- t hi r d of t h e
respondents weren't sure about the NPS
classificaons. The idenficaon of
unconvenonal street names buresses
the findings from previous local studies
t h a t r e v e a l e d s o m e
unconvenonal/non-classical NPS used
in Nigeria (Dumbili et al., 2021; Okafor C.
J. et al., 2022). It also emphasizes how
crucial it is to stay current with street
slang because doing so could help
medical doctors idenfy probable NPS
usage among paents as well as advance
clinical and epidemiological research on
NPS.
The respondents' understanding of
the methods of administering NPS,
including oral ingeson, inhalaon,
injecon, and smoking, reveals a good
kn owle dge of the pra ccal iss ues
regarding NPS use. The finding that
street dealers are the main source of
NPS for users is consistent with the
findings from other studies (Gilani, 2016;
Hill, 2020; van Amsterdam et al., 2023). In
the United Kingdom, the fact that the
main source of NPS for drug users is
street dealers was said to have been due
to the Psychoacve Substance Act 2016,
but in Nigeria, this is likely due to the
comparavely limited use of online
shopping plaorms (Haden et al., 2017;
Hill, 2020; Psychoacve Substances Act
2016 - GOV.UK, n.d.). Recognizing street
dealers as the main source of NPS for
users highligh ts the importance of
ad d r e s si n g t h e d r ug m ar ket a nd
emphasizing public health measures to
curb distribuon. It is impressive that the
respondents were aware of the short-
term neurobehavioral effects of NPS,
such as euphoria, hallucinaons, and
poor judgment, although some studies
have shown that these effects need to be
studied more because of the complex
nature of NPS (Dumbili et al., 2021; Feng
et al., 2017; Shafi et al., 2020).
The re spo nde nts ' aware ness of
psychoc illness as a potenal long-term
effe c t o f N P S aligns with exis n g
knowledge about the mental health risks
associated with substance use (David
Semple & Roger Smyth, 2013; First &
American Psychiatric Associaon, n.d.). It
is also possible that this awareness is due
in part to, or reinforced by, the prevailing
myth in Nigeria that drug use is the cause
o f m en ta l i l l n e s s ( A d e w u y a &
Makanjuola, 2008). The low level of
awareness of cri minal acvit y and
insomnia as potenal long-term effects
point to a need for further awareness and
educaon.
T h e r ep or te d f r e q u e n cy o f
encountering paents using NPS varies,
123
EZIAGU ET AL.

with a significant poron of respondents
indicang these differences occasional
encounters. Paent groups, geographic
locaons, and specific clinical pracce
environments may vary, which could
account for these differences. Inability
to idenfy clinical manifestaons of NPS
may also possibly account for the low
fre q u e n c y o f encount e rs. T his i s
bu r e s s ed b y t h e f a c t t h a t fe w
respondents expressed confidence in
their ability to idenfy health-related
NPS effects in paents. This could be a
result of the fact that close to two-thirds
of the respondents felt that they had not
been adequately trained to manage
NPS-related health problems.
The main limitaon of this study is
that the researc h q u e sons that
assessed knowledge of neurobehavioral
effects were not phrased to show a
connecon between specific substances
and their potenal neurobehavioral
effects. This points to the need for more
in-depth studies to more accurately
gauge know ledg e of psycho a cve
substances and their consequences on
mental health. In addion, the survey
inially didn't include a queson about
specific names of NPS. Consequently,
the first 20 respondents didn't get to
answer this queson. As a result, the
responses on specific NPS names may
not fully represent the enre sample
since they were only obtained from a
subset of respondents. Moreover, the
number of parcipants in the diaspora
were too few to allow a reasonable
co m p ariso n o f t h e experi e nce of
medical doctors in Nigeria and the
diaspora. Further, laboratory research
using animal subjects are needed to
beer understand the neurobehavioral
effects of locally available NPS.
Conclusion
This study sheds light on medical
doctors' knowledge of New Psychoacve
S u b s t a n c e s ( N P S ) a n d t h e i r
neurobehavioral effects. Although the
r e s p o n d e n t s s h o w a b a s i c
com p r e hension of NPS, there are
kn o w l ed g e an d c on fi d e nc e ga p s ,
especially with regard to some NPS
categories and long-term consequences.
The findings highlight the crical need for
focused educaon and training to give
m e d i ca l doc t ors t he k now l ed g e
necessary to efficiently detect, manage,
and educate paents about health-
relate d dange rs connec ted to NPS.
Medical doctors could make a significant
co ntri buon t o earl y i nte r venon,
paent care, and public health iniaves
aiming to address NPS use and related
harms.
Acknowledgments
We extend our profound gratude to all
the medical doctors who parcipated in
this study, contribung their valuable
insights and experiences.
REFERENCES
Abdulrahim, & Bowden-Jones. (2015).
(PDF) Neptune clinical guidance:
Guidance on the Clinical
Management of Acute and
Chronic Harms of Club Drugs and
Novel Psychoacve Substances.
hps://www.researchgate.net/p
ublicaon/314033780_Neptune_
124
DOCTORS' KNOWLEDGE

clinical_guidance_Guidance_on_
the_Clinical_Management_of_Ac
ute_and_Chronic_Harms_of_Clu
b_Drugs_and_Novel_Psychoacv
e_Substances
Adewuya, A. O., & Makanjuola, R. O. A.
(2008). Lay beliefs regarding
causes of mental illness in
Nigeria: paern and correlates.
Social Psychiatry and Psychiatric
Epidemiology, 43(4), 336–341.
hps://doi.org/10.1007/S00127-
007-0305-X
Aguirre-Molina, M., & Gorman, D. M.
(2003). Community-Based
Approaches for the Prevenon of
Alcohol, Tobacco, and Other
Drug Use.
Hps://Doi.Org/10.1146/Annure
v.Pu.17.050196.002005, 17,
337–358.
hps://doi.org/10.1146/ANNUR
EV.PU.17.050196.002005
American Psychiatric Associaon.
(2022). Diagnosc and stascal
manual of mental disorders :
DSM-5-TR (First B. Michael, Ed.;
Fih). American Psychiatric
Associaon publishing.
Awuchi, C. G., Aja, M. P., Mitaki, N. B.,
Morya, S., Amagwula, I. O.,
Echeta, C. K., & Igwe, V. S. (2023).
New Psychoacve Substances:
Major Groups, Laboratory
Tesng Challenges, Public Health
Concerns, and Community-Based
Soluons. Journal of Chemistry,
2023.
hps://doi.org/10.1155/2023/58
52315
David Semple, & Roger Smyth. (2013).
Oxford Handbook of Psychiatry.
In Oxford Handbook of Psychiatry.
Oxford University Press.
hps://doi.org/10.1093/MED/97
80199693887.001.0001
Dumbili, E. W., Ebuenyi, I. D., & Ugoeze,
K. C. (2021). New psychoacve
substances in Nigeria: A call for
more research in Africa. Emerging
Trends in Drugs, Addicons, and
Health, 1, 100008.
hps://doi.org/10.1016/J.ETDAH.
2021.100008
Fawibe, A. E., Odeigah, L. O., Akande, T.
M., Salaudeen, A. G., &
Olanrewaju, I. (2017). Self-
reported medical care seeking
behaviour of doctors in Nigeria.
Alexandria Journal of Medicine,
53(2), 117–122.
hps://doi.org/10.1016/J.AJME.2
016.04.003
Feng, L. Y., Baulga, A., Han, E., Chung,
H., & Li, J. H. (2017). New
psychoacve substances of
natural origin: A brief review.
Journal of Food and Drug
Analysis, 25(3), 461–471.
hps://doi.org/10.1016/J.JFDA.20
17.04.001
Frédéric Michas. (2022, September).
Registered doctors by gender and
specialty in the UK 2021 |
Stasta.
hps://www.stasta.com/stasc
s/698260/registered-doctors-
united-kingdom-uk-by-gender-
and-specialty/
Gilani, F. (2016). Novel psychoacve
substances: the rising wave of
'legal highs.' The Brish Journal of
General Pracce, 66(642), 8.
hps://doi.org/10.3399/BJGP16X
125
EZIAGU ET AL.

683053
Grafinger, K. E., Liech, M. E., & Liakoni,
E. (2020). Clinical value of
analycal tesng in paents
presenng with new
psychoacve substances
intoxicaon. Brish Journal of
Clinical Pharmacology, 86(3),
429.
hps://doi.org/10.1111/BCP.141
15
Haden, M., Wood, D. M., & Dargan, P. I.
(2017). The impact of the
Psychoacve Substances Act
2016 on the online availability of
MDMB-CHMICA. QJM : Monthly
Journal of the Associaon of
Physicians, 110(10), 619–622.
hps://doi.org/10.1093/QJMED/
HCX045
Hill, R. G. (2020). Understanding the UK
Psychoacve Substances Act.
Brish Journal of Clinical
Pharmacology, 86(3), 499–504.
hps://doi.org/10.1111/BCP.141
68
Kahuthia-Gathu, R., Okwarah, P.,
Gakunju, R., & Thungu, J. (2013).
Trends and emerging drugs in
Kenya: A case study in Mombasa
and Nairobi County. Journal of
Applied Biosciences, 67(0), 5308.
hps://doi.org/10.4314/JAB.V67
I0.95055
Kronstrand, R., Guerrieri, D.,
Vikingsson, S., Wohlfarth, A., &
Gréen, H. (2018). Fatal
Poisonings Associated with New
Psychoacve Substances.
Handbook of Experimental
Pharmacology, 252, 495–541.
hps://doi.org/10.1007/164_20
18_110
Miller, N. S., & Sheppard, L. M. (1999).
The role of the physician in
addicon prevenon and
treatment. The Psychiatric Clinics
of North America, 22(2),
489–505.
hps://doi.org/10.1016/S0193-
953X(05)70089-7
Okafor C. J., Essien E. A., Edet B. E.,
Okoro A. C., & Udofia I. O.
(2022). Drugs of Abuse among
In-Paents Receiving Treatment
for Substance Use Disorders in a
Terary Health Care Center in
South-South Nigeria: An
Exploratory Qualitave Study.
West African Journal of
Medicine, 147–153.
www.wajmed.org
Onaolapo, O. J., Olofinnade, A. T., Ojo,
F. O., Adeleye, O., Falade, J., &
Onaolapo, A. Y. (2022).
Substance use and substance
use disorders in Africa: An
epidemiological approach to the
review of exisng literature.
World Journal of Psychiatry,
12(10), 1268.
hps://doi.org/10.5498/WJP.V12
.I10.1268
Psychoacve Substances Act 2016 -
GOV.UK. (n.d.). Retrieved August
18, 2023, from
hps://www.gov.uk/government
/collecons/psychoacve-
substances-bill-2015
Shafi, A., Berry, A. J., Sumnall, H.,
Wood, D. M., & Tracy, D. K.
(2020). New psychoacve
substances: a review and
updates. Therapeuc Advances
126
DOCTORS' KNOWLEDGE

in Psychopharmacology, 10,
204512532096719.
hps://doi.org/10.1177/2045125
320967197
Sherri L. Kacinko, & Donna M. Papsun.
(2018). Sci-Hub | The Evolving
Landscape of Designer Drugs. LC-
MS in Drug Analysis, 129–135 |
10.1007/978-1-4939-8823-5_13.
In Langman Loralie J. & Snozek
Chrisne L. H. (Eds.), LC-MS in
Drug Analysis: Methods and
Protocols, Methods in Molecular
Biology (Vol. 1872, pp. 129–135).
© Springer Science+Business
Media, LLC, part of Springer
Nature. hps://sci-
hub.se/10.1007/978-1-4939-
8823-5_13
United Naons Office On Drugs and
Crime. (2020). NPS New
psychoacve substances.
van Amsterdam, J., Burgess, N., & van
den Brink, W. (2023). Legal
Approaches to New Psychoacve
Substances: First Empirical
Findings. European Addicon
Research, 1–10.
hps://doi.org/10.1159/0005315
03
127
EZIAGU ET AL.