tag:theconversation.com,2011:/id/topics/novel-psychoactive-substances-13202/articlesnovel psychoactive substances – The Conversation2016-06-06T10:02:00Ztag:theconversation.com,2011:article/603852016-06-06T10:02:00Z2016-06-06T10:02:00ZBanning psychoactive substances is not enough, we need education too<figure><img src="https://images.theconversation.com/files/124953/original/image-20160602-23298-1vlxgah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nitrous oxide. OK to use in food, but not to get high.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?autocomplete_id=&language=en&lang=en&search_source=&safesearch=1&version=llv1&searchterm=legal%20high&media_type=images&media_type2=images&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=416874211">IanRedding/Shutterstock.com</a></span></figcaption></figure><p>More than 40 years ago, the synthetic chemist Alexander Shulgin said that, <a href="https://www.erowid.org/archive/rhodium/chemistry/shulgin.futuredrugs.html">in the future</a>, underground researchers would synthesise novel psychoactive stimulants. Shulgin’s prophecy came true. Over the past ten years, we have witnessed the rapid emergence of novel psychoactive substances (NPSs), sold over the internet and in “head shops”. The content, interactions, side effects and abuse potential of these NPSs are often unknown, not only to users but also to doctors. </p>
<p>Last week, the <a href="http://www.legislation.gov.uk/ukpga/2016/2/contents/enacted">Psychoactive Substances Act 2016</a> came into force in the UK. The law says that if a person produces, distributes, supplies, imports or exports a substance capable of having a psychoactive effect – nicotine, alcohol, caffeine and medicinal products are excluded – they could receive a prison sentence of up to seven years. Possession is not an offence. </p>
<p>Worryingly, the government delayed this legislation because it had not established exactly how substances will be <a href="http://www.itv.com/news/2016-03-31/blanket-ban-on-legal-highs-delayed/">tested for psychoactivity</a>. This will be difficult given the wide range of the psychoactive substances that fall under this bill. However, enforcement of this bill will be vital to eradicate the open sale of NPSs on high streets, on UK websites and in our <a href="http://www.itv.com/news/2016-03-31/blanket-ban-on-legal-highs-delayed/">prisons</a>. But the fact that Ireland has struggled to enforce their NPS law – in fact, use among <a href="http://ec.europa.eu/public_opinion/flash/fl_401_fact_ie_en.pdf">young people</a> has gone up since their bill was introduced in 2010 – is cause for concern.</p>
<p>If the law is consistently enforced, the fear of imprisonment will no doubt deter open high street and internet sales of NPSs in the UK. But prohibition will not address supply of NPSs via the largely untraceable area of the internet, the <a href="http://www.independent.co.uk/news/uk/crime/legal-high-ban-could-force-dealers-onto-the-dark-web-police-chief-warns-a7042451.html">dark web</a> nor will it address drug demand – the basic human desire for seeking pleasure and altered states of consciousness.</p>
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<img alt="" src="https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124971/original/image-20160602-23285-1meygy7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Alexander Shulgin predicted the rise of novel psychoactive substances.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/3/3a/Shulgin_alexander_2009_hanna_jon.jpg">Jon R Hanna/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Demands for well-known NPSs made illegal under the <a href="http://www.legislation.gov.uk/ukpga/1971/38/contents">Misuse of Drugs Act 1971</a>, such as mephedrone, have not significantly changed in the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2015-09-03#new-psychoactive-substances-including-legal-highs">last three years</a>, indicating that simply making something illegal seems to have little impact on demand. There is also an early indication that future demand is unlikely to shift. A <a href="http://www.independent.co.uk/news/uk/home-news/legal-highs-two-thirds-of-young-people-who-take-the-substances-intend-to-ignore-incoming-ban-new-a7047476.html">survey</a> of 1,000 16-24-year-olds found that nearly two thirds of respondents said that they are likely to continue to use NPSs, despite the ban.</p>
<p>Surely then the odds are stacked against this bill influencing NPS demand unless there is also a clear communication of the consequences of consuming NPSs. Also, we must not lose sight of the fact that far more prevalent “lawful” psychoactive substances taken in the UK, alcohol and tobacco (exempt of this ban) are <a href="https://en.wikipedia.org/wiki/David_Nutt#/media/File:HarmCausedByDrugsTable.svg">more harmful</a> than many illegal drugs. </p>
<p>This new bill makes no distinction between very harmful psychoactive substances, such as synthetic opiates, and relatively safe ones, such as laughing gas (nitrous oxide). Ironically, while alcohol is legal, “<a href="http://www.telegraph.co.uk/finance/economics/11350365/Pop-a-sober-up-pill-or-guzzle-synthetic-booze-to-avoid-hangovers.html">alcosynth</a>”, being developed as a safer alternative to alcohol, is now banned. </p>
<p>Surely the message the government needs to convey, alongside any drugs prohibition bill, is that all substances (legal or illegal), including foods, drinks and medical products are harmful if consumed in the wrong amounts. Even water. There have been a number of cases where people have died as result of drinking too much water (hyponaetremia) while on ecstasy.</p>
<h2>Drug education is the key to prevention</h2>
<p>The misleading term, “legal highs”, has not helped the perception that there has been some process of assessment deeming them safe for human consumption. Alongside the bill, education is needed to emphasise that “if something is legal it does not mean it is safe”. Anything you consume is potentially unsafe, it is simply a matter of how much of it you consume. </p>
<p><a href="http://ec.europa.eu/public_opinion/flash/fl_401_fact_ie_en.pdf">Public opinion</a> in Europe ranks information and prevention campaigns as the second most important way for the policymakers to tackle society’s drug problems. Second, that is, to punishing the drug dealers and traffickers, which this new bill will do.</p>
<p>The UK government has pledged to work with experts to develop a new drugs strategy but, as yet, there is <a href="https://www.gov.uk/government/news/landmark-law-to-tackle-legal-highs-commences-later-this-month">no commitment</a> to fund their information services (such as <a href="http://www.talktofrank.com/">Talk to Frank</a> and <a href="http://mentor-adepis.org/">Alcohol and Drug Education and Prevention Information Service</a>) or drugs education programmes at schools and universities. </p>
<p>Fortunately, this new bill will not criminalise people for possession of psychoactive substances (unless they’re already locked up). But surely educating people (particularly those in the most vulnerable, risk-taking 16-24 age group) about the various risks of psychoactive substances is key to preventing harm. </p>
<p>Prohibition coupled with easier global sales channels has fuelled the recent demand for legal alternatives. Surely further prohibition will only help reduce demand and, ultimately, harm if everyone is aware of the risks of using psychoactive substances. Only then can we make informed and educated choices about whether or not to use these substances, legal or not.</p><img src="https://counter.theconversation.com/content/60385/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Lione does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Psychoactive Substances Act will have little effect unless it’s backed up by a drugs education programme.Lisa Lione, Senior lecturer in Neuropharmacology, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/554782016-03-03T14:50:24Z2016-03-03T14:50:24ZWhy new law banning all psychoactive substances will be just another ‘war on drugs’ disaster<figure><img src="https://images.theconversation.com/files/113550/original/image-20160302-25912-5od321.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hopefully they'll go back to taking MDMA.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=N-O59cGP6bVpdNNfReew4A&searchterm=underground%20rave&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=65675167">Radyukov Dima/Shutterstock.com</a></span></figcaption></figure><p>The recent passing of a new addition to the British statute books, which will come into effect on April 6th, is the latest in a long line of poorly drafted drug laws. <a href="http://www.legislation.gov.uk/ukpga/2016/2/contents/enacted/data.htm">The new law</a>, to act in parallel with the <a href="http://www.legislation.gov.uk/ukpga/1971/38/contents">Misuse of Drugs Act 1971</a>, effectively bans all substances – with the exception of alcohol, tobacco and caffeine – with a “psychoactive effect” on “normal brain functioning”. The awful irony of a UK government exempting <a href="https://theconversation.com/the-five-most-addictive-substances-on-earth-and-what-they-do-to-your-brain-54862">two of the most individually and socially harmful substances</a> has not been lost on concerned commentators. </p>
<p>So where exactly has this nonsensical law come from? How on earth have we got ourselves into this situation? And will it work? To answer that, it’s worth reflecting on the emergence of novel psychoactive substances (NPS), or so called legal highs. </p>
<h2>New highs</h2>
<p>In 2009, club drug researchers <a href="http://www.emeraldinsight.com/doi/abs/10.5042/daat.2010.0123">first heard talk</a> of the stimulant NPS mephedrone or “M-Cat” at UK clubs and after parties. At that time, there was growing disillusionment among users with the purity of popular illegal club drugs – as one of our interviewees put it, there was “a dire drug drought” characterised by low purity MDMA tablets. As another interviewee claimed, there were “<a href="http://eprints.lancs.ac.uk/26504/1/DAAT-MDMA.pdf">no drugs in drugs anymore</a>”. Indeed, between 2007-2009, the MDMA content of pills plummeted, fake ecstasy pills containing the headache-inducing, banned substance benzylpiperazine (BZP) were rife, and cocaine purity dropped to less than 10%.</p>
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<img alt="" src="https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/113258/original/image-20160229-4096-j0qxmo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">No drugs in the drugs.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=sUXC_zm4pxdcVmStBd8_ew&searchterm=cocaine&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=122598247">www.shutterstock.com</a></span>
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<p>As a consequence, those drug-takers who could afford it, switched from ecstasy pills to <a href="http://www.emeraldinsight.com/doi/abs/10.1108/17459265200900004">purer MDMA crystal or powder</a>. And by 2009, club goers – especially those in <a href="http://www.tandfonline.com/doi/abs/10.3109/14659891.2011.594704">South London’s gay club scene</a> – also began adding mephedrone to their polydrug repertoires, sometimes with tragic consequences (it is, after all, chemically similar to amphetamine). </p>
<p>Although mephedrone was banned in 2010 by the UK government, its use continues, especially among injecting drug users in poor communities. And there are now many other novel psychoactive substances, principally cheap stimulants and potent herbal smoking mixtures, such as Spice, which are available online, in so-called headshops, or from street dealers who are likely to pick up any business from those shut down by this new law. </p>
<p>One group of novel psychoactive substances which has received less media and academic attention are the benzodiazepine analogues (drugs similar to benzodiazepines or “benzos”). There were 372 fatalities in England and Wales involving benzodiazepines in 2014-15, up 8% on the previous year, and the highest number since records began in 1993 according to the <a href="http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2015-09-03#benzodiazepines">Office for National Statistics</a>. </p>
<p>There were also more than 10m prescriptions for benzodiazepines dispensed in England in 2014, with use not recommended to go beyond four weeks. Yet there are growing concerns about illicit supply through web-based sales. Long-term benzo users suffer both short and long-term harms and need <a href="http://www.benzo.org.uk/index.htm">medical support</a> to get off these drugs. </p>
<h2>Putting the genie back in the bottle</h2>
<p>Certainly, novel psychoactive substances are the nasty genie that prohibition let out of the bottle. To get around the law, NPA chemists created analogues of existing drugs (such as MDMA, LSD and methamphetamine) that were tweaks to the chemical structure and hence entirely legal. And as soon as the law caught up with them, they’d just tweak their formulas again. The UK government, by passing this new legislation, is desperately trying to stuff this genie back inside, once and for all. </p>
<p>But it is unlikely to do any good. There is little or no provision for resources to enforce it, nor anything like sufficient funding for drug education, harm reduction, outreach, and mental health and drug treatment services to help people who may be in trouble with psychoactive substances, not least those in our prisons. </p>
<p>When it comes to taking drugs, at least we know about drugs such as cannabis, MDMA and cocaine – although we don’t always know what some of them are cut with. Purity and availability of these traditional street drugs have returned to or exceeded pre-2007-2008 levels, although this may <a href="http://www.mixmag.net/feature/ecstasy-in-2015">bring its own problems</a>. </p>
<p>But at least we know something about the effects of these more familiar substances and can help people mitigate against possible harms. What is clear is that the human desire for intoxication, usually in the pursuit of pleasure, but sometimes at the cost of a person’s health, wealth and even liberty, endures. Without a recognition that demand for psychoactive substances will not go away, banning all psychoactive substances won’t work, just as it hasn’t in the past. </p>
<h2>Those who ignore history</h2>
<p>Governments worldwide need to learn one crucial lesson from the emergence of NPS. Their emergence is directly related to global prohibition and the war on drugs we have been fighting for over 100 years, a war that has had few successes. Crucially, many concerned commentators continue to chronicle the harmful unintended consequences of prohibiting drugs. </p>
<p>Drug history is always useful in understanding drug presents and futures. This new law gives us more of the same, and so is unlikely to work if success is judged on producing a safer world for the many millions who continue to consume psychoactive substances.</p><img src="https://counter.theconversation.com/content/55478/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karenza Moore does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As of next month, all legal highs will be banned in the UK when a new law comes into effect. Don’t expect it to work.Karenza Moore, Lecturer in Sociology, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/335672014-10-29T13:59:04Z2014-10-29T13:59:04ZLegal highs: regulation won’t work – the only answer lies in prevention<figure><img src="https://images.theconversation.com/files/63019/original/kbyxrc9k-1414505350.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tool kit.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/fixersphotos/3899983231/in/photolist-9siRYW-5maXHz-5maWNp-5mfeP7-5mfeJJ-dnd4f9-dntgBB-53DwoS-9ukSAr-7Tx3yN-5TnncS-kmD4mt-9nTrJR-4LuJAs-ohKuME-6WCr9c-HTTY4-HTThM-4FTUAH-35WLma-4Qdhxo-pFrJ2H-bB3gbF-oSamsE-7rrhNi-Q5cVR-dCTGDF-9pSoYT-d8kB6-9XvBqu-7LbxmA-4XYNEc-p1VmNy-pjihwB-piqjCT-p1Ksfp-pgof2q-pifutV-pgcM1w-9rwZVU-eW6jTq-f3nupH-83fduR-83ikG5-83infE-83imFJ-83fcpc-83fdnz-83imnY-83imBG">thefixer</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>In one respect, the world’s drug problem is not getting much worse. The <a href="http://www.unodc.org/unodc/en/press/releases/2014/June/global-drug-use-prevalence-stable-says-unodc-world-drug-report-2014.html">UN believes</a> that the use of drugs such as cocaine and heroin has stabilised, for example. In fact, the ground in the drugs battle has just shifted. The focus is now increasingly on legal highs. </p>
<p>People might be aware that altered versions of ecstasy or cannabis are available nowadays, but the true range of what we in the trade call novel psychoactive drugs is far more varied. There are derivatives of everything from ketamine to cocaine, from opiates to psychotropics. Their <a href="http://www.unodc.org/unodc/en/press/releases/2014/June/global-drug-use-prevalence-stable-says-unodc-world-drug-report-2014.html">use is rising</a>, and <a href="http://www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/england-and-wales---2013/index.html">so is</a> the number of fatalities. <a href="http://www.telegraph.co.uk/news/10722809/Legal-highs-claim-36-lives-in-Scotland-in-2012.html">Some people fear</a> that the figures are only going in one direction. </p>
<h2>Enforcers vs chemists</h2>
<p>Why has this happened? In recent years there was a worldwide decrease in the purity of drugs like amphetamine and cocaine and the MDMA content of ecstasy. This decrease helped fuel demand for alternatives (though admittedly there are <a href="http://www.unodc.org/documents/data-and-analysis/WDR2014/World_Drug_Report_2014_web.pdf">signs</a> that this purity decrease is now reversing). The internet has also made possible the sort of sharing of information that makes it much easier to sell these substances nowadays. And as has been <a href="https://theconversation.com/legal-highs-need-regulation-not-an-outright-ban-32462">well documented</a>, banning these drugs is difficult because the manufacturers can constantly bring out new varieties with slight alterations to the chemistry. </p>
<p>It has turned into a battle between the drug enforcers and the drug chemists, who are <a href="http://asiancorrespondent.com/104900/in-depth-chinas-burgeoning-legal-highs-trade/">typically based</a> in the Far East, for example in China and Hong Kong. There are many databases online with information on the molecular structures of existing drugs. This makes it easier for these people to modify them to create a new product. </p>
<p>The market is <a href="http://www.bbc.co.uk/news/magazine-23453028">very strong in the UK</a>. You might think it is because the information online is often written in English. This would explain why Ireland <a href="http://www.independent.ie/lifestyle/health/legal-highs-fear-as-ireland-ranks-third-for-drug-deaths-30310007.html">has a big problem too</a>, but then again the US does not. And other problem countries <a href="http://www.ecad.net/269-riga-public-protests-against-legal-highs">include</a> Latvia, Hungary, Estonia and Russia. </p>
<h2>The big worries</h2>
<p>Certain categories particularly worry us. One is the ecstasy derivatives known as phenethylamines. One of the well-known ones in the UK is PMA, which <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/dr-death-what-is-new-party-drug-and-what-are-the-risks-9644008.html">has been</a> nicknamed “Dr Death” because of the number of fatalities. Another is known as “blue mystique”. These have been made illegal in a number of European countries, but many more keep appearing. A related group is known as NBOMe, which are very powerful and therefore also a great concern.</p>
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<a href="https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/63062/original/xqfbqkgc-1414530788.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Heightened anxiety: legal high fatalities.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/oliverquinlan/8082569356/in/photolist-djehh5-fHTJFB-7aDhgH-6KssF7-8XbFpQ-fHTKkx-5KUN7i-c7Hzmf-oRMrnm-bopm7D-b27j6t-bNCNJV-aGUncD-oRKVrT-aEHY1N-aGUqZp-br59ER-aXRyWH-bMwmTa-e4K4ez-nLG1x5-ecurM6-bakBkz-ecAbMb-bkPp5h-dU49mn-p7eaVG-aEE24K-e1MUEt-dzCCvo-p9edMC-dzCDmA-br5h6g-ciLDsC-aNvNwv-aYNT1X-nNGE3F-ebNtCX-aGSREM-gyiVve-aXRMRB-aEYubm-oRMsJP-p9fJBt-bqBAn4-dT5LCs-ev4sxA-o17wMo-pnnDXm-bkQ8sC">Oliver Quinlan</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Then there are cannabimimetics, which are sometimes known as the “spice drugs”. There are a few hundred known variations, many of which are very powerful, sometimes thousands of times more than cannabis. They were behind the “spiceophrenia” epidemic <a href="http://www.addictionhelper.com/blog/russias-love-affair-spice-symptomatic-legal-high-problem/">in Russia</a>, but are prevalent closer to home too. Last week a new HM Prisons report <a href="http://www.bbc.co.uk/news/uk-29706890">mentioned them</a> among a number of legal-high concerns in British prisons. To make matters worse, they are very easy to modify and have the big selling point that they can’t always be traced in urine. </p>
<p>Sometimes legal highs are marketed as a solution to a problem that an illegal drug might cause. For example ketamine (“special K”) is known to damage the intestine and bladder, so a new drug reached the market called methoxetamine, or “special M,” which claimed to be bladder-friendly. But in fact <a href="http://knowthescore.info/drugs-a-z/methoxetamine">it is still</a> toxic for the bladder and also the kidney and central nervous system. And after it was made illegal, a number of other derivatives appeared such as diphenidine. The health risks associated with this class makes the new versions particularly scary. </p>
<h2>The unwinnable battle?</h2>
<p>We often don’t know how these drugs affect people. Researchers like myself <a href="http://www.eumadness.eu/">are working on this</a>, but the number of new substances is increasing too quickly for us to keep up. By the time we publish papers focusing on more popular versions, the market has changed. When something goes wrong, doctors don’t know how to treat the effects – in many cases they can’t even ascertain the exact drug. </p>
<p>We have reached the point where I am now more worried about legal highs than illegal drugs. Whenever I see a heroin client in my clinic, I know exactly what to do. That is often not the case with legal highs. And as a psychiatrist I know that they potentially have far more psychiatric consequences than heroin. Whenever you tamper with very sensitive mechanisms in your brain, it’s difficult to know what will happen. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/63063/original/j428fjjt-1414531030.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">You know where it comes from…</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/avlxyz/2572137473/in/photolist-4VhSRP-eK3dQy-eW6jTq-aXRseg-aVXbe2-byK1Ue-drZBNZ-eQzfxq-btpm6E-c973nd-bbzgAP-ese2Lw-aXgSxK-exW6QV-duXSdJ-ebHFEq-ex17tp-8GZMxN-a5oF29-4gD4zF-dUCPyJ-bJBes4-e2MHkD-e4QDbJ-eR3cTE-aEHKRb-aVyKVF-dwaBv8-eQQS8D-aEHSTj-aWkobF-dcMYN3-bD5sqg-cpXHuw-e5y9ij-eo7nyP-eURwxe-by5a3p-aXcn4z-enigHG-eU1SzV-dvdPPQ-e17zHR-dvdRXd-bMwnPX-eVzGMd-dt7sbn-bopqk2-ecokK1-aXZN6Z">Alpha</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>One argument is that we should keep these drugs legal since we are facing an unwinnable battle. But the big drawback with this is that it makes adolescents and other susceptible people think that the drug must be safe. New Zealand tried this approach by permitting drugs to remain in circulation if the producers could demonstrate they were low risk, but this year the <a href="http://www.rsc.org/chemistryworld/2014/04/new-zealand-government-legal-highs-drugs-ban">government U-turned</a> after there were a number of adverse incidents.
Now its approach is similar to the UK with its expanding prohibition schedule. </p>
<p>The problem with the New Zealand low-risk policy is that establishing the safety of a drug is a very slow process if you are going to do it properly. Proving through clinical trials that a drug works, is safe and is not toxic takes upwards of 10 years. Anything less would be cutting corners. If a manufacturer were to go through that process and prove that a drug was low risk, that might be a different discussion, but it’s not going to help with today’s problem. </p>
<p>Similarly there has been <a href="http://www.hauraki-dc.govt.nz/news_page/2014/october/legal_highs_policy">some debate</a> about permitting the supply of legal highs but keeping it tightly restricted – perhaps allowing one distributor per town, for example. But this both ignores the reality of the internet and offers no answer to the safety problem. </p>
<p>Another possibility is to legalise the illegal drugs that we know much more about, so that people are encouraged to take them instead. But even if this was politically possible, it doesn’t sound like the right course of action either. I see disasters from drug-taking on a daily basis. And it wouldn’t necessarily stop people from taking legal highs anyway. </p>
<p>The answer to what we actually should do is complex. The answer probably lies in prevention: we need dedicated resources and funding, we need new ideas to try and convince youngsters that these drugs are not safe just because they are legal. This requires a big change in how we see these substances. These are not just some marginal concern. This is the new drug battle for the decades ahead.</p><img src="https://counter.theconversation.com/content/33567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fabrizio is a member of the UK advisory council on the misuse of drugs. He has also received EC funding in relation to researching the effects of novel psychoactive substances. These views are his own and in no way represent either the council or the EC.</span></em></p>In one respect, the world’s drug problem is not getting much worse. The UN believes that the use of drugs such as cocaine and heroin has stabilised, for example. In fact, the ground in the drugs battle…Fabrizio Schifano, Chair in Clinical Pharmacology and Therapeutics, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.