Call for action on 'legal high' drugs

Government drug advisers have today called for tighter regulation of ‘legal highs’ - recreational drugs sold legally due to loopholes in the law. In a new report the Advisory Council on the Misuse of Drugs (ACMD) has published details of how drugs such as ‘meow meow’ (mephedrone), which was banned last year, have been openly sold over the internet under the guise of being ‘plant food’ or ‘research chemicals’.

The report also highlighted the false perception that just because a drug is technically legal it must be safe, pointing out that there have been at least 42 deaths associated with the use of mephedrone, and dozens more where its use has been suspected.

While the mephedrone family of drugs has now been banned, the ACMD said those manufacturing legal highs are increasingly tweaking the chemical formulas of banned legal highs to bypass bans on specific substances. In response, it suggested that legislation should be used to make it illegal to produce substances with similar effects to banned drugs, rather than just banning specific chemicals as they emerge.

In its report, the ACMD made further recommendations aimed at trying to reduce sales, demand and harms.

What are legal highs?

Legal highs are drugs that are intended to mimic the effects of illegal drugs but can technically be sold or possessed legally. However, the lack of legal control does not imply that they are safe, and a number of substances sold as legal highs in the past have since been associated with health problems and even death. For example, until it was banned in 2010, the substance mephedrone (also known as meow meow) was legally allowed to be sold when labelled as a research chemical or as a plant food. However, recent data has shown that despite perceptions that it was safe, the drug has contributed to at least 42 recorded deaths. Its use has also been suspected in dozens of further deaths.

While many substances that were once sold as legal highs have since been banned, the ACMD says that chemists are constantly using their knowledge to develop new ‘legal highs’ that fall outside existing drug legislation. These are often chemically similar to banned substances and produce similar effects, but due to them having different chemical compositions they may not technically be governed by existing laws. Given the new, or novel, nature of legal highs, the ACMD refers to them as Novel Psychoactive Substances (NPS).

The ACMD says legal highs generally fall into four broad categories:

products with names that give no indication of what they contain
substances that are designed to be similar to specific controlled drugs
substances related to medicines
herbal or fungal materials or their extracts

NPS products cannot be marketed, sold or labelled as being intended for human consumption, which would make them subject to strict pharmaceutical legislation. To circumvent these laws they are often labelled as something else; for example, plant food, bath salts, research chemical or boat cleaner, with disclaimers saying they are ‘not for human consumption’.

What issues did the report consider?

The report considered a number of different factors relating to NPS, their use and measures to tackle them. Among the specific issues examined were:

legal highs’ place in the UK drug scene
personal harm
societal impact
measures to reduce demand
measures to reduce supply
current and future legislation
ways to future-proof drug laws

The ACMD was keen to point out that the report does not provide a solution to the current problem or guidance on specific NPS products, but rather options that may help reduce the harmful impact of legal highs. However, in considering the issue in general, the report described cases studies for mephedrone, which was banned in 2010, and Ivory Wave (also known as Desoxypipradrol or 2-DPMP), an NPS that has not yet been classified as a controlled substance.

In the case of mephedrone the report highlighted how quickly the novel drug rose in popularity, but also that there has been a growing number of adverse incidents reported, and at least 42 deaths where the drug played a significant role. The report also stated that a few months after mephedrone was banned, those manufacturing legal highs started producing a similar (and technically legal) substance called naphyrone, highlighting how quickly existing laws can be circumvented.

Desoxypipradrol, the main active ingredient in Ivory Wave, is not yet a ‘controlled substance’ (illegal to supply or possess), although its import into this country has been banned. However, testing of Ivory Wave products has shown its chemical contents can vary, and at times it may contain controlled substances. This means that a person who had bought an Ivory Wave product thinking it was legal could still subject to prosecution if they were stopped by the police and found to carrying a controlled substance.

What are the dangers from using legal highs?

Generally, there is a lack of safety data on the legal highs, which mostly appear to be untested and unregulated compounds. Aside from these obvious risks, the contents of products are often variable and not specified on packaging, meaning people can never be sure exactly what they are taking, even if they have used a product before.

Even though there is limited data available on these substances, there appears to have been an increase in hospital admissions and medical appointments due to the toxicity of legal highs. In addition, health services are starting to see health problems caused by regular use of legal highs, including, dependence that requires detoxification treatment.

Testing has also shown that many NPS are synthetic amphetamine-like stimulants, meaning they are likely to share many of the well-documented adverse effects of amphetamines, such as dependence. It also means that it is possible that the more potent NPS are likely to carry an overdose risk at just a few milligrams, which is likely to be associated with acute toxic effects.

How popular are legal highs?

The ACMD says that NPS use is such a new phenomenon that it is hard to gauge how popular and readily available these substances are. However, while the council says that robust data on the issue is often unavailable, sources such as the British Crime Survey have recently started collecting data on their use. The council highlights some of the survey’s data on mephedrone for 2010/11, which suggested that:

4.4% of people aged 16-24 had used mephedrone in the past 12 months, the same proportion that had used cocaine. (This data related to both the period when mephedrone was considered to be legal high and when it became a controlled substance and was banned).
Across all adults surveyed (ages 16-59), 1.4% had used mephedrone in the past 12 months, a similar level of usage to ecstasy.

The report also cited a 2011 survey run by the dance music magazine Mixmag, which asked clubbers several question on their use of drugs. Although the survey was aimed specifically at clubbers, 75% of them said it was easy or very easy to obtain mephedrone prior to the ban. Post-ban 38% of respondents said it was easy or very easy to obtain. The same survey, however, said that 42% of respondents had tried the drug pre-ban, but that 61% had tried it post-ban.

The ACMD report noted that British Crime Survey figures suggested that overall drug use is coming down in the UK.

What recommendations does the council make?

The report made extensive recommendations relating to policy, the law, public health messages and how to close loopholes that mean that drugs are legal until they are specifically deemed controlled substances. Some suggested measures recommend that:

The UK should develop EU and international networks to address the issue of legal highs.
Countries involved in the manufacture of the legal highs should be encouraged to stop.
The UK government should put in place processes that would allow the Misuse of Drugs Act 1971 to be updated quickly and easily when minor changes are required.
Chemical detection and testing methods need to be developed so that illegal compounds present in legal highs can be easily detected.
That new legislation should be considered, possibly similar to the Analogue Act 1986 used in the US. This would mean that chemical substances similar to controlled chemicals would automatically be banned, that is, it would be automatically be illegal to create a chemical with similar properties to a banned substance.
The burden of proof should be placed upon the supplier to establish beyond reasonable doubt that the product being sold is not for human consumption and is safe for its intended use - in other words, to prevent it being marketed as bath salts or plant food.
Specific legislation, namely the Consumer Protection from Unfair Trading Regulation and General Product Safety Regulations (2005), should be applied to the sale of legal highs, and the Advertising Standards Agency should investigate claims made by the websites selling legal highs.
Research into the chemistry, pharmacology, toxicity and social harm of legal highs should be increased.
Moves to increase public awareness should be implemented.