Transcript `Legal Highs` Nature & Extent of Use And How to

The Game Changer:
the impact of ‘novel highs’
Dr Russell Newcombe
HIT Hot Topics Conference, Liverpool UK
15th November 2013
www.3Dresearch.org.uk
Overview of presentation
1.
2.
3.
4.
5.
Definitions: legal highs and NPS
Types: by source and effects
Legal response
Recent research: prevalence, trends
Conclusions
Definitions: legal highs
(1) Chemicals which alter the normal functioning of the brain
(neurotransmitters and brain-waves), thus producing
changes in our experience and behaviour - a ‘high’
(2) Specifically, a legal high is a chemical which is:
(a) not controlled by the 1971 Misuse of Drugs Act;
(b) not licensed for legal use (like alcohol and tobacco);
(c) not advertised/sold – and therefore not regulated - as
a medicine (Medicines Act 1968) – see next 2 slides;
(d) mimics the effects of popular controlled drugs [?]
Thus, a legal high is a substance which is not legally regulated
– a more accurate term would be ‘legal loophole’ drugs.
Novel psychoactive substances (NPS)
Over the last few years, the term ‘legal high’ has become
replaced by ‘novel psychoactive substance’ (NPS) – because
if and when possession and trafficking of a particular new
drug is prohibited by the government, it literally ceases to be
a ‘legal high’.
For example, use of the term ‘NPS’ allows us to avoid the
confusion which currently exists in relation to drugs like
mephedrone (meow/m-cat), which was banned by the UK
government in April 2010 - but it is still referred to as a ‘legal
high’ by some sources (notably the mass media).
However, it could also be argued that labels like new drugs or
novel highs are enough for many purposes.
In short:
Legal highs: uncontrolled, but can be new drugs
(eg. 6-APB) or older drugs (eg. nitrous oxide)
NPS: new, but can be uncontrolled (eg. 6-APB)
or controlled (eg. mephedrone)
The legal loophole used by NPS
Headshops and online retailers of ‘legal highs’/NPS get
round the 1968 UK Medicines Act by stating that their
products are not for human consumption, i.e. by
definition not a medicine. So: no tests/trials required.
Instead product packaging typically contains a cross/bones
(sign of toxicity), and a warning not to consume the
substance – using euphemisms such as bath salts, pond
cleaner, room odoriser, incense, cream dispenser refills
– and the vaguer product descriptors ‘souvenirs’ and
‘research chemicals’.
Packaging also typically states ‘for sale to adults only’.
Headshops: famous UK chain
Sell ‘legal highs’
and drug-related
paraphernalia
and literature
Dr Hermans at
Bold Street in
Liverpool, UK
Research Chemicals
November 2013
Since the ban on all arylcyclohexylamines last
year there has never been a product to fill that
void in the market for things like mxe, 4-meopcp, n-ethyl-ketamine etc etc. - Until now!
Diphenidine is a novel chemical which fills that
gap perfectly. Its not expensive either and when
researched in amounts from 50-100mg it
produces beautiful results similar to that of the
old recently banned products.
Only £20/1g so click here to give it a go!
bk-2C-B
Diphenidine Powder
MTTA / MEOP (1:1 Mix)
Ethylphenidate
MPA / NM2AI (combo packs)
5-EAPB powder
NM2AI
3,4 CTMP powder
Methiopropamine
Synthacaine crystal
Nitricaine
MDAI
5-Meo-Dalt freebase
2-AI
Benzodiazepines
bk-2C-B Powder & Pellets Also Available Now!
Although phenethylamines are controlled in the
UK, the bk analogs of these compounds are not
and so bk-2C-B was born. 100mg is the ideal
amount based on initial feedback.
You can find out more about the parent
compound, 2C-B, by clicking here (wiki page).
Click here if you wish to buy it from our site.
Etizolam
Fluromazepam
Diclazepam
Cannabinoids
5fAKB-48
5f-PB22
STS-135
BB-22
2NE1
http://www.megachems.com
Trends in number of new NPS marketed in Europe
80
73
70
60
49
50
41
40
30
20
24
13
10
0
1
2008
2
2009
2010
3
4
2011
52012
EMCDDA Early Warning System - DrugNet Europe 81, Jan-March 2013
50 of the
73 new
NPS in
2012 were
synthetic
cannabinoid
products
Trends in number of NPS websites (EMCDDA/Europol 2012)
800
690
700
600
Google
results
(August
2012):
‘buy legal
highs’ =
2.74 million
500
400
300
‘buy
research
chemicals’
= 6.91
million
314
200
170
100
0
Jan12010
Jan 22011
3
Jan 2012
Problems with legal high/NPS sales
Headshops/websites cannot give out information about
the safer use of the drugs they sell
No testing/trials of risks & harms of NPS sold
No guarantee that different batches of same product will
contain (a) same dose of drug, or (b) even same drug
Huge variety of NPS available, with different chemical/
trade/slang names, making drug/health service
responses & research work very difficult
2. Types of legal high/NPS
Based on last-year prevalence of use among young adults
in 2012/13 in England & Wales (British Crime Survey):
What are the most popular legal highs?
What are the most popular NPS among those
banned since 2005?
www.gov.uk/government/uploads/system/uploads/attac
hment_data/file/225122/Drugs_Misuse201213.pdf
Most popular legal highs & NPS
- last-year use: 16-24s, E&W, 2012/13
Legal highs
nitrous oxide
poppers
salvia
6.1%
1.2%
1.1%
2nd
7th
8th
NPS banned
since 2005
mephedrone
1.6%
ketamine
0.8%
magic mushrooms 0.6%
5th
9th
10th
Traditional
Illegal drugs
cannabis 1st, cocaine 3rd, ecstasy 4th,
amphets 6th, LSD & tranx 11th/12th
Nitrous oxide used by 350,000 young people in past year
Home Office figures show 'hippy crack' is second most popular
drug among 16- to 24-year-olds. Guardian, 25 July 2013
“sniffing
balloons full
of the gas has
become the
summer
recreational
drug of choice,
particularly for
festival goers”
Nitrous oxide: whippets
Nitrous oxide (N2O, laughing gas)
Young adults in UK report N2O as most popular legal high in
online and media surveys (see later slides on prevalence)
16-24 year olds: N2O is 2nd most popular of all drugs used in last
year in 2012/13 CSEW – reported by about 400,000 (6%) in
E&W – only cannabis use is more prevalent
Yet:
Gets no or very little attention from mass media
Coverage by educational publications poor/missed
Relatively little research compared to other NPS
3 TYPES OF NPS BASED ON SOURCE
Herbal highs: plant/fungi or animal part/product
Synthetic highs: substance made by means of chemistry
(semi-synthetic if started with natural precursors)
Mixed herbal/synthetic: synthetic drugs mixed into
natural drugs, esp. herbal material + cannabinoids
-------------------------------------------------------------------------------------------------------
Electronic highs: perceptual, electrical (eg. brain tuners)
-------------------------------------------------------------------------------------------------------
Herbal Highs:
Khat:
cathinone
(stimulant)
Chewed, smoked
or brewed/drank
Salvia divinorum
salvinorin A
(hallucinogen)
Kratom:
mitragynine
(stimulant/
opioid-like)
Synthetic highs: white powders & pills
BUBBLE
-------------------
UPPERS
or TRIPS
Some common NPS/legal highs
Mephedrone: methylmethcathinone
4MMC
m-cat
meph
drone
fert
Mephedrone injecting problems
Mephedrone
injecting:
Photograph
of left upper
limb of
Patient 3 post
debridement
Dorairaj J, Healy C,
McMenamin M, Eadie P
(2012). The untold truth
about “bath salt” highs: A
case series demonstrating
local tissue injury.
Journal of Plastic, Reconstructive & Aesthetic
Surgery, 65, 37-41.
Synthetic opioids: bromadol
Bromophenyldimethylaminophenylethylcyclohexanol
500 times stronger than morphine:
20 mg morphine / 10 mg heroin = 0.04 mg bromadol [40 mcg]
Short-term effects include analgesia, sedation, euphoria,
constipation, itching & respiratory depression
Longer-term effects include tolerance and dependence
VX-Chem
http://www.vxchem.com/buy/bromadol
Bromadol: C22H28BrNO
Purity: 99%
Minimum Order Quantity: 500 grams
Price: $3,440 for 500 grams ($6.88 a gram)
Herbal products containing synthetic cannabinoids
Usually sold as
herbal preparations
containing inert
herbal material (leaf
etc.) saturated with
synthetic cannabinoids (SCs) & other
drugs. The pure SC
powder can also be
obtained online.
New legal synthetic cannabinoids
Latest batch of legal synthetic cannabinoids sold
online include: 5F-PB22, AKB-48F, STS-135 & BB-22:
from £15 a gram to £3,000 a kg – e.g.
http://chemicalwire.com/cannabinoids.html
“Acute Kidney Injury Associated with
Synthetic Cannabinoid (SC) Use”
In 2012, Wyoming Department of Health investigated 16 cases
of Acute Kidney Injury (AKI) following SC use, across 6 states.
5 of the 16 patients had used a new SC called XLR-11
Also: SCs are 2 to 3 times more likely than cannabis to produce
sympathomimetic effects (tachycardia, hypertension), and 5
times more likely to produce hallucinations – with an
increased risk of seizures.
“No antidote exists”
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Morbidity & Mortality Weekly Report, Vol. 62 (6), 93-8 (February 15, 2013)
http://www.cdc.gov/mmwr/pdf/wk/mm6206.pdf
Types of novel psychoactive drugs
Phenethylamines
Piperazerines
Cathinones
Tryptamines
Cannabinoids
Miscellaneous
Main illegal drugs being mimicked
ecstasy (MDMA), amphetamines
ecstasy, amphetamines
ecstasy, amphetamines, cocaine
LSD, psilocin, DMT
THC, hallucinogens, sedatives
stimulant/sedative/hallucinogen/opioid
Source: EMCDDA-Europol Annual Report on the implementation of Council Decision 2005/387/JHA [April 2012]
Recent guide to NPS, Nov 2013
http://www.kfx.org.uk/drug_facts/drug_facts_im
ages_and_pdfs/researchchemicals2013.pdf
3. Legal responses to NPS
Misuse of Drugs Act amendments (see Appendices)
Temporary Class Drug Orders - ban trafficking for 1 year
while ACMD review (max 14 years prison)
> methoxetamine (made class B, 2013)
> June 2013: 5APB & 6APB (Benzo Fury) & NBOMe
Importation bans: 2DPMP, phenazepam (class C, 2012)
Intoxicating Substances Supply Act 1985 (2008-11: 0)
Trade/consumer legislation
Anti-social Behaviour, Crime & Policing Bill 2013
Response of NPS marketers to NPS bans
Continuing to sell banned NPS in countries which have
not yet banned them
‘Tweaking’ banned chemical to produce new legal
version with similar effects
Producing new NPS in unbanned groups
Banned NPS move into illicit drug market, usually with
rise in price & adulterants and fall in purity, eg.
mephedrone banned in 2010 but still 5th most
popular last-year drug for 16-24s in 2012/13 BCS
(after cannabis, nitrous oxide, cocaine and ecstasy)
4. Recent research and
notable studies
New Musical Express Drugs Survey – October 2013
Sample: 5,295 respondents: 63% male, 56% in FT education,
55% 18-24 years (20% U-18)
Lifetime drug use: 78% - 4 in 10 had tried legal highs
Last-year drug use: 74%: legal highs 2.6%, mephedrone 1.1 %
First drug used: legal highs 1.6%, mephedrone 1.2%
Attitudes: 54% believed legal highs should not be banned
Global Drug Survey 2013
Online survey advertised in Mixmag, Guardian & Gay
Times 2012, n = 22,000 (80% aged 18-30)
NPS/Legal Highs – 12% had ever used
Unknown drugs – 14% had used a drug at a party/club
without knowing what it was
Bought drugs online: 22%
Past-month use in UK (n = 7,000+)
Nitrous oxide
26.9%
Mephedrone
13.8%
Poppers
13.6%
NPS obtained from internet, UK, late 2011
A total of 22 ‘legal high’ products were purchased from 5
different internet sites in late 2011, and each substance was
screened to determine its active ingredients.
Six products - 4 sold as Benzo Fury & 2 as NRG3 - contained 6APB; three contained MDAI; three contained 5-IAI; three
contained methoxetamine; three contained benzocaine;
two (labelled NRG2) contained cathinones, including the
banned mephedrone; and two contained MPA.
Overall, 23% did not contain the listed active ingredients
Source: Ayres T & Bond J (2012). A chemical analysis examining the
pharmacology of novel psychoactive substances freely available over the
internet and their impact on public (ill)health. Legal highs or illegal highs?
BMJ Open, July 31, 2012; 2(4).
Emergence of multi-drug NPS
products, e.g. 11 drugs in E tablet
Analysis of RockStar ecstasy tablet in 2013
found ELEVEN different drugs present,
including MDMA, amphetamine, cathinones,
BZPs & methoxetamine
Scottish Police Authority, reported by Crew2000
pic.twitter.com/6MPb2DfoZR
The NPS are mutating…
Many new NPS identified in Japan in 2012, including a product
containing both URB-754* (inhibitor of an endo-cannabinoid
deactivating enzyme) & 4-Me-MABP (cathinone derivative)
Also, a 3rd unknown compound - N,5-dimethyl-N-(1-oxo-1-(ptolyl)butan-2-yl)-2-(N′-(p-tolyl)ureido)benzamide) – was also
found in the product, and deduced to be an unexpected
reaction between URB-754 and 4-Me-MABP.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* 6-methyl-2-[(4-methylphenyl)amino]-1-benzoxazin-4-one
~ 4-methylbuphedrone
.
Uchiyama N et al. (2012). URB-754: A new class of designer drug and
12 synthetic cannabinoids detected in illegal products. Forensic
Science International, October 2012.
Deaths related to NPS, England & Wales
mephedrone/cathinones
BZP/TFMPP
GHB/GBL
novel psycho. substances
2008
0
0
20
25
2009
0
9
16
26
2010
6
5
12
22
2011
6
2
20
29
2012
18
..
..
52
NPS includes current legal highs and former legal highs like mephedrone
Office of National Statistics (2013). Deaths related to drug poisoning in England & Wales, 2012
Deaths related to NPS, Scotland
novel psycho. substances
2008
0
2009
2
2010
8
2011
9
NPS: substances which were legally available at the time of the death
National Records of Scotland (2013). Drug-related deaths in Scotland, 2012.
2012
17
Deaths from legal highs in 2012
An average of:
 one death per week in England & Wales
 One death every 3 days in Scotland
Given differences in population size, this means
that the annual mortality rate for legal highs is
three times higher in Scotland (about 1 in
300,000) compared with England & Wales
(about 1 in a million)
5. Conclusions
NPS are a ‘game-changer’ - they have:
> hugely expanded the number of psychoactive drugs
> sidestepped drug-related laws (legal loophole), and
banned NPS are rapidly replaced by more legal NPS
> introduced new drug-related risks and harms;
> caught many drug services unprepared/untrained
> AND they require a harm-reduction approach more
than a recovery approach – but the UK drug
strategy’s primary aim is recovery
Legal high users = guinea pigs
Source:
Lifeline
(2013).
“Big Blue
Book of
Drugs”.
[Available
from:
Exchange
Supplies]
What should we do next?
Take an evidence-based approach
Take a principled approach: theory & models – not
common-sense or counter-productive bans
Cross-national/regional comparisons: especially New
Zealand – Psychoactive Substances Act 2013
Take a harm-reduction approach based on categories
of NPS - stimulant, sedative, hallucinogen etc. – as
well as the effects/harms of specific substances
Involve NPS users: representation, participation
NPS/legal high use
interventions: need
consultation with
and representation
of NPS users on
policy-making and
drug service groups
Dr Russell Newcombe
[email protected]
www.3Dresearch.org.uk
Research, Training & Consultancy
on Drugs, Disorder & Deviancy