Legal highs’ are any psychoactive substances, compounds, plants, or fungi that are chemically related to classified controlled drugs of abuse, such as amphetamine, which mimic similar psychoactive effects to control drugs (Gibbons & Zloh, 2010). Currently, ‘legal highs’ referred to as New Psychoactive Substances (NPS) are either illegal to manufacture, supply and possess under the Misuse of Drugs Act 1971 or still legal due to having slight chemical structural difference compared to controlled drugs, which make these substances to distinguish from others (Archer, 2009). The term ‘New Psychoactive Substances (NPS)’ does not mean newly invented as these substances were known since the 1950s, but these are newly misused substances of abuse that are not controlled by 1961 Single Convention on Narcotic Drug or the 1971 Convention on Psychotropic Substances that can cause risk for the well-being and health of public (UNODC, 2014). In the early 1950s, most NPS belonged to the commonly known ‘Chemical families’ of phenethylamines (amphetamines, methamphetamines, ecstasy, peyote) and tryptamines (N,N-dimethyltryptamine (DMT), psilocybin, 5-methoxy-N,N-imethyltryptamine (5-Meo-DMT)). However, recently wider ranges of ‘Chemical families’ were emerged and known in the market, such as synthetic cathinones (mephedrone, methylone, butylone, methedrone, flephdrone), cannabinoids (cannabis, ‘9 tetrahydrocannabinol), piperazines (1-benzylpiperazine (BZP)) and benzofurans (1-(benzofuran-5-yl)-propan-2-amine (5-APB), 1-(benzofuran-6-yl)-propan-2-amine (6-APB)) (EMCDDA, 2014). To date, around 384 different NPS have been reported to the United Nations Office on Drugs and Crime (UNODC, 2014).
Legislative Issues with NPS
In the UK, the Misuse of Drugs Act 1971 classifies ‘Controlled Drugs’ into Class A, B and C according to the harmful effect they cause when they are misused. The Act clearly defines the identity of the substance according to the chemical structure (MEP, 2012). Thus, NPS have similar chemical structure to existing classified drugs, however to circumvent the legislation and make their sales valid they are synthesised purposely as analogue of the illegal drugs with a slight chemical structural difference to make them distinct. Nevertheless, because of the Misuse of Drug Act 1968, which govern and license medicines for human use, these substances are sold and advertised as ‘bath salts’, ‘plant feeder’, ‘research chemicals’ or ‘pond cleaner’, labelled in its package ‘not for human consumption’. However, it is has been found from open forums on internet survey (Archer, 2009) that these substances are intended for human consumption and are being sold in many night clubs as recreational drugs. They are easily purchased from internet websites, high street shops, night clubs and local drug suppliers (Baron, Elie & Elie, 2011). Since April 2010 many cathinone derivatives such as mephedrone, methedrone, methylone and methylenedioxypyrovalerone (MDPV) became Class B drugs and most recently from 10th of June 2014, ketamine also became Class B drugs (Statutory Instruments, 2014).
The Impact of Internet on The Emergence of NPS
Recently, the numbers of NPS marketed on internet have been increased dramatically to large numbers. As the result, in the last few years, there has been an increase in the sale and use of NPS in the high streets and night clubs. From the survey conducted (Schmidt, Sharma, Schifano & Feinmann, 2010) on UK based ‘legal high’ sellers through internet websites, it has been reported that a total of 1308 products were found from 39 different online retailers. These increases in the number of products and availability of NPS might be associated with recent changes of drug user’s preference and availability of internet access (Archer, 2009). For example, mephedrone, has been a popular ‘legal high’ since 2007. The shift to mephedrone might be due to being it is more powerful, readily available and cheaper than previously used traditional drugs, such as cocaine, cannabis or 3,4-methylenedioxymethamphetamine (MDMA) (Deluca, Schifano, Davey, Corazza, Di Furia & Psychonaut, 2009).
Peoples’ Conception on NPS
Strikingly, NPS are perceived as safe and pure to consume as these substances are marketed on the internet labelled as ‘high-purity’. This gives the public wrong impression, especially to young people as it has been reported by Dal Cason (2001) that teenagers take in up to six tablets of Ecstasy in one go in the night clubs without understanding the identity and the toxic effects of the drug. However, most people do not understand that these drugs, which are marketed online, have never been tested on humans to determine the dose, efficacy or potency of the drug (Baron et al., 2011). It has been found from Fergus, Kellett, Gerhard, (2014) that most of these substances do not contain the claimed active ingredient drugs and often their identities are different to what it is written on their labels. Analysis and characterisation conducted by Baron et al (2011) on seven ‘legal highs’ samples that were purchased from the internet has proved that only one sample found to contain 5,6-methylenedioxy-2-aminoindane (MDAI) as claimed, but the rest contained a mixture of caffeine with controlled substances, such as BZP and 3-Trifluoromethylphenylpiperazine (TFMPP) with no claimed substance on the label. This is one of the reasons for the rise of incidents and deaths related with NPS use. According to BBC report broadcasted on 12th of February 2014, the number of deaths in the UK has increased seven times compared from 10 deaths in 2009 to at least 68 in 2012 (BBC, 2014).
The Present Challenges Concerning NPS
Several of these deaths have been attributed to the use of in particular NPS known as mephedrone, a synthetic cathinones, which is found naturally in the leaves of Khat plant (Catha edulis) (Gibbons & Zloh, 2010). Although mephedrone and many cathinones derivative have been classified as Class B drugs on 16th April 2010, still its popularity has been rising, as five out of six ‘legal highs’ seized or purchased were found to contain mephedrone after the implementation of ban. Following the ban, another study showed that out of 24 ‘legal highs’ that were purchased from 18 UK-based websites, 62.5% of the products contained mephedrone and other cathinone derivatives (Brandt, Sumnall, Measham & Cole, 2010). The increased prevalence of these cathinone derivatives, in which the synthesis of new substance and marketed as being ‘new and better’ when a substances is classified, has increasing clinical, legal and analytical challenges. Clinically, people admitted to A & E Departments due to the intoxication of cathinone analogues is difficult to diagnose as the newly developed substances have showed different signs and symptoms to well-known amphetamines and ecstasy’s intoxication. Another clinical complication is that often these substances are taken with alcohol, benzodiazepines and others control substances. No guidelines have been developed yet to treat cathinone intoxication as there is lack of pharmacological and toxicological data and limited information is available on dosing and side-effects. The present management is based on amphetamines, ecstasy and a cocaine guideline, which is a supportive measure (Prosser & Nelson, 2012). Thus, in order to deal healthcare workers effectively with the new substances of abuse, the knowledge of the chemistry is crucial in providing scientific information to understand the mechanism of action, toxicology profile, pharmacokinetics and pharmacodynamics (Fergus, Kellett & Gerhard, 2014). For forensic and legal investigation fast, reliable and robust identification techniques are required based on scientific information of analytical profiling and development of validated method (Santali, Cadogan, Daeid, Savage & Sutcliffe, 2011).