Series on Legislative Reform of Drug Policies Nr. 16 October 2011 ‘Legal highs’ The challenge of new psychoactive substances By Adam Winstock1 and Chris Wilkins2 This paper aims to set out some of the pol- icy and public health issues raised by the appearance of a wide range of emergent psychoactive substances of diverse origin, effect and risk profile (commonly referred to as ‘legal highs’). It will start by considering what is meant by the term ‘legal highs’ and consider the his- torical context that has framed their appear- ance and must inform any response. It will then consider some of the approaches that KEY POINTS have been adopted by different nations to Evidence shows that alternatives to control their availability and associated criminalisation exist that attain many harms, including a preliminary assessment desirable outcomes for governments, whilst of their consequences, both intended and minimising the unnecessary consequences not. of criminalising the individual user. To date, the approaches to regulation have While new psychoactive substances pose varied between nations, both with respect a challenge to existing drug control re- to the nature and specificity of the meas- gimes, their appearance provides an oppor- ures taken and their intended outcome. tunity to consider the trial of alternative Such diversity appropriately reflects the policy and legislative approaches to drug marked differences in the existing drug use control. problems and public health approaches to addressing such issues between nations. An objective evaluation based upon scientific evidence is required to evaluate WHAT IS A LEGAL HIGH? the utility of these different control options, as well as their impact on public Over the last decade the term ‘legal high’ health outcomes. has become an accepted addition to media parlance and a lay reference point for dis- Policy makers should not only reflect on cussion among the general public in their the unintended consequences of drug consideration of issues related to drug use. prohibition but also the current and his- However, when critically considered, the torical failures of the adequate regulation of term is often misleading and factually in- the legal markets for alcohol and tobacco, accurate. ‘Legal high’ is a catch term that and for pharmaceuticals. Legislative Reform of Drug Policies | 1 has historically referred to a diverse group and/or manufacture have the explicit aim of naturally occurring and novel synthetic of circumventing legislative restrictions is a compounds whose consumption results in recent phenomenon, the truth is many have widely differing effect and risk profiles.3 been available for several decades. What They have also been variously referred to as has changed is not only the diversity and ‘designer drugs’, ‘herbal highs’, ‘synthetic potency of the products but their wide- drugs’ and more recently ‘research chemi- spread promotion and distribution not cals’. only through the internet and expected suppliers such as “head-shops” but also Because the definition is so broad and the local corner shops, grocery and DVD rental legal status (and availability) of the sub- stores. The development of global web- stances are constantly changing, there is no based marketing and distribution distinct definitive list of legal highs. Substances from illicit street markets seriously limits which have at one time or another been the utility of existing supply reduction considered to fall under this term have strategies.8 Taken in combination with the included traditional plant-based products, rapid increase in openly public marketing often with a long and culturally sanctioned nations, politicians and legislators have history of human consumption, such as been forced to reflect upon and update herbs (e.g. salvia divinorum and kratom), their responses. seeds (e.g. baby Hawaiian woodrose), fungi (e.g. magic mushrooms, fly agaric) and By lumping substances with diverse effect cacti (e.g. peyote). More recently these and risk profiles that appear at different ‘ethnobotanicals’ have been joined by a diz- points in time together, policy makers find zying array of new synthetic compounds themselves in the unenviable position of including the cannabinoid receptor agonists being pressured to make quick decisions (such as JHW-018 and others found in about the risks of harm often based on no herbal smoking blends such as the ‘Spice’ more than unverified media speculation products),4 cathinones (such as mephedro- and uncertain extrapolation from scientific ne, 4-methylmethcathionine)5 and the knowledge on related chemical structures. piperazines (such as benzylpiperazine Although the precautionary principal is (BZP).6 used to support pre-emptive legislative control, the reality is that while such The increase in notifications of new psy- actions may remove harmful substances choactive substances to the European from widespread circulation they are rapid- Monitoring Centre for Drugs and Drug ly replaced by other equally unfamiliar Addiction (EMCDDA) has risen from an molecules that may or may not share a average of five per year between 2000 and similar risk effect and risk profile. 2005 to over 40 in 2010.7 The number of new classes of untested drugs and varia- Such substances like their predecessors tions on molecular structure that may be “parachute” into communities bypassing waiting in various laboratories around the traditional social networks that often pro- world is daunting. In the UK alone, the last vided some opportunity for people to learn two years has seen more than five separate about a new drug in close proximity to additions totalling more than 50 different friends. Thus when considering which compounds to the Misuse of Drugs Act. approach to supply control is most effective This represents more legislative additions with respect to these new substances, it is than in the last two decades put together. worth reflecting upon what gains are made and what potential avenues for optimising While recent media and policy interest may public health are lost when control through suggest that the idea of promoting sub- drug legislation is adopted as opposed to stances whose development, rediscovery other forms of supply control. 2 | Legislative Reform of Drug Policies THE HISTORICAL CONTEXT WITHIN which could be used both as substitutes for WHICH THESE DRUGS HAVE APPEARED MDMA in ecstasy pills and also for sale in their own right. This shift in what is being As noted above psychoactive substances produced has been accompanied by a shift that avoid regulation have been promoted, in the location of manufacture from Europe developed and marketed for decades. What to other regions, notably South East Asia14 has changed in recent years has not only and the burgeoning economies of India and been their diversity and potency but per- China with relatively poorly regulated haps most importantly the globalisation of control mechanisms. drug markets through the internet – truly a drug market without borders. The opening Why the UK in particular may have been up of the global market place has coincided such a ripe market for emergent synthetic with a significant disruption in the interna- drugs such as mephedrone in uncertain. It tional supply of MDMA over recent years. may have had something to do with the fact that the marked reduction in the availabil- The decline in the supply of MDMA is ity of MDMA coincided with a sharp fall in thought to be largely the result of global the purity of cocaine.15 Taken together, dis- disruptions to the illicit supply of key satisfaction with the existing illicit market MDMA precursor chemicals.9 Pharma- would have set the appropriate (receptive cological analysis of so called ‘ecstasy’ pills and cash rich) market conditions for syn- in a number of countries around the world thetic stimulants such as the cathinones has revealed they often contain substances and piperazines.16 With subjective effects other than, or in addition to, MDMA in- similar to MDMA and cocaine17 it is of note cluding caffeine, methamphetamine, that evidence from the Netherlands sug- piperazines and sometimes ketamine.10 Up gests that mephedrone has found its way to half of ‘ecstasy’ seizures made in the into tablets being sold as MDMA.18 Netherlands in 2009 were found to contain no MDMA; rather the pills contained It may also be possible that users chose mCPP (meta-Chlorophenylpiperazine) and these substances because they considered mephedrone (methylmethcathinone) or them better value for money and a more another psychoactive substance.11 consistent product.19 The wide availability and promotion of synthetic cannabinoids These findings are mirrored by user reports has not, however, occurred in such a qual- on the perceived quality of ecstasy pills. In ity vacuum, with high quality cannabis the 2009/10 Mixmag Survey, 76% of almost being widely available across Europe. One 2000 users believed that the quality of might speculate that decades of health pro- MDMA pills had reduced, with 68% report- motion, warning of the risks of traditional 12 ing a decline in 2010/11. Further afield in illicit drugs including cannabis has perhaps New Zealand, ‘ecstasy’ tablets seized by the encouraged some to seek alternative canna- authorities have also been found to contain bis preparations. BZP (benzylpiperazine), MDPV (methyl- enedioxypurovalerone), mephedrone and Certainly, legal high producers have ex- methylone (methylenedioxymethcathi- ploited health and product quality concerns none).13 Taken in