Purchasing 'legal highs' on the Internet--is there consistency in what you get?

Davies, Susannah; Wood, David M.; Smith, Gina; Button, Jennifer; Ramsey, John; Archer, Roland; Holt, David W.

doi:10.1093/qjmed/hcq056

Cited by 194 publications

(121 citation statements)

References 9 publications

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“…It is possible that the Internet suppliers themselves may be confused as to which substance they are intending to sell, since in some user discussion fora, there appears to be confusion between 4-methylaminorex and 4,4′-dimethylaminorex [13,14]. In addition, there are numerous studies that have demonstrated that the contents of NPS products purchased from the Internet, high street headshops or street-level drug dealers are variable and the actual contents may not reflect the stated contents [15][16][17][18][19][20]. The main limitation of the Internet snapshot methodology is that the products are not purchased and analysed; therefore, it is not possible to be certain of the actual contents of the products being sold.…”

Section: Discussionmentioning

confidence: 99%

Using Internet Snapshot Surveys to Enhance Our Understanding of the Availability of the Novel Psychoactive Substance 4-Methylaminorex and 4,4′-Dimethylaminorex

Nizar

Dargan

2014

J. Med. Toxicol.

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Section: Discussionmentioning

confidence: 99%

Using Internet Snapshot Surveys to Enhance Our Understanding of the Availability of the Novel Psychoactive Substance 4-Methylaminorex and 4,4′-Dimethylaminorex

Nizar

Dargan

2014

J. Med. Toxicol.

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“…Consistency of ingredients is also unpredictable. "Legal high" brand name products, analyzed over a 6-month period, changed ingredients in 25% of the samples [24].…”

Section: Contentsmentioning

confidence: 99%

“…Selfreported doses range from a few milligrams to over 1 g of powder [6,17,25,27]. Users cannot be certain of the actual contents or the purity of the drug, therefore actual exposure is highly variable [22,24].…”

Section: Patterns Of Usementioning

confidence: 99%

The Toxicology of Bath Salts: A Review of Synthetic Cathinones

2011

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Synthetic cathinones have recently emerged and grown to be popular drugs of abuse. Their dramatic increase has resulted in part from sensationalized media attention as well as widespread availability on the Internet. They are often considered "legal highs" and sold as "bath salts" or "plant food" and labeled "not for human consumption" to circumvent drug abuse legislation. Cathinone is a naturally occurring beta-ketone amphetamine analogue found in the leaves of the Catha edulis plant. Synthetic cathinones are derivatives of this compound. Those that are being used as drugs of abuse include butylone, dimethylcathinone, ethcathinone, ethylone, 3-and 4-fluoromethcathinone, mephedrone, methedrone, methylenedioxypyrovalerone (MDPV), methylone, and pyrovalerone. Synthetic cathinones are phenylalkylamines derivatives, and are often termed "bk-amphetamines" for the beta-ketone moiety. They may possess both amphetaminelike properties and the ability to modulate serotonin, causing distinct psychoactive effects. Desired effects reported by users of synthetic cathinones include increased energy, empathy, openness, and increased libido. Cardiac, psychiatric, and neurological signs and symptoms are the most common adverse effects reported in synthetic cathinone users who require medical care. Deaths associated with use of these compounds have been reported. Exposure to and use of synthetic cathinones are becoming increasingly popular despite a lack of scientific research and understanding of the potential harms of these substances. The clinical similarities to amphetamines and MDMA specifically are predictable based on the chemical structure of this class of agents. More work is necessary to understand the mechanisms of action, toxicokinetics, toxicodynamics, metabolism, clinical and psychological effects as well as the potential for addiction and withdrawal of these agents.

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“…However, in a patient population with sympathomimetic toxicity, it cannot be reliably distinguished whether caffeine contributed to the clinical manifestations of sympathomimetic toxicity or not. Furthermore, there are several reports of novel psychoactive substances, specifically those claiming to be synthetic cathinones, that were analyzed and found to contain significant concentrations of caffeine with some containing only caffeine [11][12][13].…”

Section: Limitationsmentioning

confidence: 99%

Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants

et al. 2014

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Synthetic cathinones have emerged as popular drugs of abuse and produce sympathomimetic toxicity. It is unknown if rhabdomyolysis occurs more frequently following the use of synthetic cathinones compared to other stimulants. This retrospective study sought to determine the prevalence of rhabdomyolysis in patients with sympathomimetic toxicity and compare rates among patients using specific agents. Patients greater than 14 years of age with sympathomimetic toxicity and detection of a stimulant agent in urine via gas chromatography-mass spectroscopy (GC-MS) were included. Patients were excluded if clinical sympathomimetic toxicity was not present, a serum creatine kinase (CK) was not measured, or urine GC-MS was not performed. Rhabdomyolysis and severe rhabdomyolysis were defined as CK>1000 and 10,000 IU/L, respectively. Prevalence of rhabdomyolysis and severe rhabdomyolysis were reported. Logistic regression was performed to determine the relative effect in single-agent exposures of a synthetic cathinone compared to other sympathomimetics on rhabdomyolysis. A secondary outcome, a composite endpoint defined as need for mechanical ventilation, renal replacement therapy, development of compartment syndrome, or death, was also analyzed. One hundred two subjects met inclusion criteria; median age (IQR) was 32 (25-42)years with a range of 14-65 years; 74 % were male. Rhabdomyolysis occurred in 42 % (43/102) of subjects. Patients whose sympathomimetic toxicity could be ascribed to a single agent were considered for further statistical analysis and placed into four groups: methamphetamine (n=55), synthetic cathinone (n=19), cocaine (n=9), and other sympathomimetic (n=6). In 89 subjects with single stimulant exposure, the prevalence of rhabdomyolysis was as follows: synthetic cathinone, 12/19 (63 %); methamphetamine, 22/55 (40 %); cocaine, 3/9 (33 %); and other single agent, 0/6 (0 %). The occurrence of severe rhabdomyolysis (CK>10,000 IU/L) for each of the four groups was synthetic cathinone with 5/19 (26 %), methamphetamine with 2/55 (3.6 %), cocaine with 1/9 (11 %), and other with 0/6 (0 %). Median maximal CK (range) by groups was as follows: synthetic cathinone, 2638 (62-350,000+)IU/L; methamphetamine, 665 (61-50,233)IU/L; cocaine, 276 (87-25,614)IU/L; and other, 142 (51-816)IU/ L. A statistically significant difference (p=0.004) was found when comparing maximal CK among the four groups. Exposure to a synthetic cathinone compared with other sympathomimetics was associated with increased risk of developing rhabdomyolysis and severe rhabdomyolysis with odds ratios of 3.09 and 7.98, respectively. In this cohort of patients with sympathomimetic toxicity, 42 % developed rhabdomyolysis. Synthetic cathinones were associated with an increased risk of rhabdomyolysis and severe rhabdomyolysis compared with other stimulants.

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Purchasing 'legal highs' on the Internet--is there consistency in what you get?

Cited by 194 publications

References 9 publications

Using Internet Snapshot Surveys to Enhance Our Understanding of the Availability of the Novel Psychoactive Substance 4-Methylaminorex and 4,4′-Dimethylaminorex

Using Internet Snapshot Surveys to Enhance Our Understanding of the Availability of the Novel Psychoactive Substance 4-Methylaminorex and 4,4′-Dimethylaminorex

The Toxicology of Bath Salts: A Review of Synthetic Cathinones

Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants

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