Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo Research Paper New psychoactive substance use as a survival strategy in rural marginalised communities in Hungary Róbert Csák a, ⁎ , Judit Szécsi b , Sziliva Kassai c , Ferenc Márványkövi a , József Rácz c,d,e a Hungarian Association on Addictions, 46 Izabella street, 1064 Budapest, Hungary b Faculty of Social Sciences, Eötvös Loránd University, 1/A Pázmány Péter sétány, 1117 Budapest, Hungary c Institute of Psychology, ELTE Eötvös Loránd University, 1-3 Egyetem tér, 1053 Budapest, Hungary d Faculty of Health Sciences, Department of Addictology, Semmelweis University, 17 Vas street, 1088 Budapest, Hungary e Blue Point Drug Counselling and Outpatient Centre, 25 Gát street, 1095 Budapest, Hungary ARTICLE INFO Keywords: New psychoactive substances Survival strategy Marginalised communities Risk environment ABSTRACT 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 unafected 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 re- corded 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 efects 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 attribu- tions of marginalised groups, for example disafliation. 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. Efective responses have to address substance use and social integration; we need complex interventions addressing structural factors. Background New psychoactive substances (NPS) are increasingly seen as a sub- stance disproportionately used in deprived populations (EMCDDA, 2017). NPS use in marginalised, socially disadvantaged, vulnerable groups is a clear trend in the European context. Synthetic cannabinoid receptor agonist (SCRA) use in high risk drug-using po- pulations has been reported in two-thirds of the countries reporting to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA); problematic use of synthetic cathinones has been reported in half of the EMCDDA reporting countries (EMCDDA, 2017). SCRA use has been described in prison populations (Ralphs, Williams, Askew & Norton, 2017), amongst homeless people (MacLeod et al., 2016) and socially vulnerable young people (Blackman & Bradley, 2017). Syn- thetic cathinones are frequently used by syringe programme popula- tions (Windelinckx, 2015) and NPS injecting has been associated with https://doi.org/10.1016/j.drugpo.2019.102639 ⁎ Corresponding author. International Journal of Drug Policy 85 (2020) 102639 Available online 03 January 2020 0955-3959/ © 2019 Elsevier B.V. All rights reserved. T