New psychoactive substance use as a survival strategy in rural marginalised communities in Hungary.

Background: New psychoactive substance (NPS) use has become a widespread phenomenon among marginalised communities in Hungary. Since 2010, a growing number of reports in grey literature and anecdotal information among professionals have become available on NPS use among previously unaffected groups, such as people living in rural, socioeconomically deprived communities. In our research, we aimed to explore NPS use among these communities.

Methods: We conducted a mixed method research with convergent parallel design. Data collection took place in 2017 in marginalised communities in villages in two regions in Hungary, where 150 questionnaires were recorded and 50 interviews were conducted with current NPS users.

Results: According to the survey results, NPS is very easy to access, synthetic cannabinoid receptor agonist (SCRA) are easily bought in marginalised rural communities (79% found SCRA easy to obtain). Both SCRA and synthetic cathinones are used regularly; 57% of SCRA users and 37% of synthetic cathinone users used the respective substance at least once a week in the past 30 days. Besides NPS, sedative use (without prescription) and alcohol consumption are common among the respondents. 17% of the sample has already injected NPS. The overwhelming majority of the respondents rated regular consumption of NPS as "very dangerous" (SCRA: 75%, synthetic cathinones 72%). NPS users have limited knowledge of consequences and the social and health treatment options available. Most themes in the interviews are associated with surviving stress, crisis and anxiety, as well as the wish to escape from insecurity and chaotic life. Positive effects of substance use (community, joy, energy) are rarely present.

Conclusion: People who use drugs (PWUD) living in these rural communities face the consequences of the rural risk environment: easy access to NPS, inadequate access to services, poor labour market situation and attributions of marginalised groups, for example disaffiliation. NPS use is not a recreational activity in this population; individuals mainly use NPS to get away from reality, problems, pain, poverty and marginalisation. NPS use is a survival strategy. Effective responses have to address substance use and social integration; we need complex interventions addressing structural factors.