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?

Abstract

ObjectivesPublic Health England aims to improve the nation's health and acknowledges that unhealthy lifestyles, which include drug use, undermine society's health and well-being. Recreational drug use has changed to include a range of substances sold as ‘research chemicals’ but known by users as ‘legal highs’ (legal alternatives to the most popular illicit recreational drugs), which are of an unknown toxicity to humans and often include prohibited substances controlled under the Misuse of Drugs Act (1971). Consequently, the long-term effects on users' health and inconsistent, often illegal ingredients, mean that this group of drugs presents a serious risk to public health both now and in the future. Therefore, the aim of this study was to ascertain what is in legal highs, their legality and safety, while considering the potential impact, these synthetic substances might be having on public health.DesignA total of 22 products were purchased from five different internet sites, 18 months after the UK ban on substituted cathinones, like mephedrone, was introduced in April 2010. Each substance was screened to determine its active ingredients using accepted analytical techniques.SettingThe research was conducted in Leicestershire but has implications for the provision of primary and secondary healthcare throughout the UK.ResultsTwo products, both sold as NRG-2 from different internet suppliers, were found to contain the banned substituted cathinones 4-methylethcathinone (4-MEC) and 4-methylmethcathinone (4-MMC), the latter being present in much smaller quantities. Although sold as research chemicals and labelled ‘not for human consumption’, they are thinly disguised ‘legal highs’, available online in quantities that vary from 1 g to 1 kg.ConclusionsDespite amendments to legislation, prohibited class B substances are still readily available in large quantities over the internet. The findings suggest that these prohibited substances are being manufactured or imported into the UK on a large scale, which has serious implications for public health and clinicians who are ill equipped to deal with this newly emerging problem.

A New Beginning: An Overview of New Psychoactive Substances

“…This again, produces another issue for the government to act against. Overall, it is clear that the government is failing to control NPS use and are displacing drug use as opposed to reducing it [51].…”

“…For example, in a previously mentioned study conducted on 446 students to explore experience and the perception of risk association, 15.7% of respondents reported they did not know what drug they had taken and as a result, could not predict the effects of the substance, or report it to health professionals [42]. Additionally, in a study conducted by Ayres et al [51] containing 22 analysed products, 23% were found to not contain the active ingredient that was claimed on the packet, and 9% of the products did not have a list of active ingredients at all [51]. Moreover, the analysis of 24 products purchased from 18 UK-based websites claiming to be legal, discovered that 62.5% of these products contained controlled substances [53].…”

“…Despite this limited understanding of NPS, individuals working in these emergency settings have had to develop their knowledge and skills relating to acute care management and protocols, so they are able to respond more proactively to the increasing number of patients with NPS-related symptoms [56]. It is emphasised by Public Health England, that it is important to have 'an effective, highly trained and professionally skilled Public Health workforce' and as a result, based on the increasing number of users who require medical treatment for NPS use, it is vital that health professionals are made more aware of these substances and their potential health risks [51]. For example, Wood et al [29] found that healthcare professionals have reported less knowledge of NPS and therefore show less confidence in treating NPS toxicity when compared with traditional illicit drug effects.…”

“…This inaccuracy, leads to issues relating to dosage for example, it is common that websites and packaging do not contain information relating to safety, ingestion and recommended dosages (77% of 22 products purchased from five different websites selling NPS). Consequently, any dosage instructions would create inconsistent and unpredictable health effects in the user (51)(52)(53). This lack of dosage information is concerning, as a varying supply of substances can be purchased in a range of amounts from 1 gram to 1 kilogram of product [51].…”

“…Consequently, any dosage instructions would create inconsistent and unpredictable health effects in the user (51)(52)(53). This lack of dosage information is concerning, as a varying supply of substances can be purchased in a range of amounts from 1 gram to 1 kilogram of product [51].…”