Action on new drugs
In 2009, 24 new synthetic psychoactive substances were formally notified via the European early-warning system. This is the largest number reported in a single year, and the increase is mainly due to the identification of nine new synthetic cannabinoids in the past year. Also reported in 2009 were new substances belonging to the chemical families usually providing new psychoactive drugs: five phenethylamines, two tryptamines and four synthetic cathinones. No new piperazines or psychoactive plants were reported.
Since the establishment of the early-warning system in 1997, more than 110 substances have been notified to the EMCDDA and Europol. New groups of substances have emerged in the last five years. These include various piperazines, synthetic cathinones and synthetic cannabinoids. However, no piperazines have been identified in the last two reporting years. Only six were plants or of plant origin, and it is likely that synthetic psychoactive substances will continue to be the most frequently reported new substances in the future.
Three substances with medicinal properties were reported in 2009. These include pregabalin, a prescription medicine marketed under the name Lyrica and used to treat neuropathic pain, epilepsy and generalised anxiety disorder. A recent review of pharmacovigilance data indicates concerns related to its misuse in Finland, Sweden and Norway. Information from the early-warning system also suggests that pregabalin may have been involved in the deaths of users in Finland, Sweden and the United Kingdom, where it was found in forensic toxicological analyses. User reports suggest that pregabalin has effects similar to those of alcohol, GHB (gamma-hydroxybutyric acid), ecstasy and benzodiazepines. It is also reported to alleviate heroin (opioid) withdrawal symptoms.
The early-warning system also monitors unregulated psychoactive products — the so-called ‘legal highs’ — sold via the Internet and smart or head shops, advertised with aggressive and sophisticated marketing strategies, and in some cases intentionally mislabelled with declared ingredients differing from the actual composition. The ‘legal highs’ market is distinguished by the speed at which suppliers circumvent drug controls by offering new alternatives.
Synthetic cathinones have been increasingly reported via the early-warning system in the last few years. At present, fifteen of these substances are being monitored, including mephedrone, methylone, methedrone and MDPV (1). These ‘designer’ compounds are derivatives of cathinone, which is one of the psychoactive principles in the plant khat (Catha edulis), and is structurally related to amphetamine (2).
Mephedrone is a derivative of methcathinone — a scheduled drug in the 1971 UN Convention. It appeared for the first time in Europe in 2007, and seems to have gained popularity among young drug users, leading to a specific demand for this substance. This seems to be particularly the case in the United Kingdom, where mephedrone has received attention from the media. Reports from other Member States suggest that it is also used elsewhere in Europe.
Seizures of significant quantities of mephedrone have been reported in 2009 by Germany, the Netherlands, Sweden and the United Kingdom. In Sweden, toxicology results confirmed the role of mephedrone use in a death; and in the United Kingdom a number of deaths are being investigated for possible involvement of mephedrone. Control measures on mephedrone have recently been introduced by Denmark, Estonia, Ireland, Germany, Romania, Sweden, the United Kingdom, Croatia and Norway.
Mephedrone is readily available on the Internet, where it may be sold as a legal alternative to cocaine or ecstasy. The substance is variously advertised as a ‘research chemical’, ‘bath salts’, ‘for botanical research’, ‘plant food’ or ‘plant feeder’, often with a note saying ‘not for human consumption’ in order to circumvent potential control mechanisms. Often, the list of ingredients gives no indication of the presence of psychoactive substances. A search for online mephedrone shops conducted in March 2010 in English showed that at least 77 websites were selling the substance. Most of these websites sold only mephedrone and were based in the United Kingdom. Following the United Kingdom's classifying of mephedrone and other synthetic cathinones as controlled drugs in April 2010, the majority of mephedrone sites have ceased to exist.
Data on the use of 29 substances, including a number of ‘legal highs’, were collected in an online survey conducted in late 2009, in collaboration with the United Kingdom’s dance music magazine Mixmag (3). Mephedrone was reported as the fourth most commonly used drug (after cannabis, ecstasy and cocaine) and the most used ‘legal high’ among the 2 295 respondents. About one third (33.6 %) reported using it in the last month, 37.3 % in the last year and 41.7 % ever. The figures for methylone were 7.5 %, 10.0 % and 10.8 % respectively. The small difference between last month and lifetime prevalence suggests a new and rapidly spreading phenomenon. These findings cannot, however, be considered as representative of the wider population of club-goers, due to the methodological limitations of online surveys; such surveys may, however, provide rapid access to specific populations (Verster et al., 2010).
Monitoring online drug shops
The early-warning system has been monitoring the marketing of new psychoactive substances on the Internet each year since 2006. Changes in the methods used have increased the quality and coverage of the surveys, but data for different years are not directly comparable.
In 2010, 170 online drug shops were identified, 30 of which offered both ‘legal highs’ and hallucinogenic mushrooms, typically with a wide selection of products from both groups: 34 offered only hallucinogenic mushrooms; and 106 sold ‘legal highs’ but not hallucinogenic mushrooms (4).
The number of vendors of hallucinogenic mushrooms seems to have increased since 2006, when 39 shops were identified selling these products (EMCDDA, 2006). In 2010, 64 online shops were identified selling hallucinogenic mushrooms; with most of them selling grow kits, spores and fly agaric mushroom (Amanita muscaria) rather than psilocybin-containing mushrooms.
In the 2009 online survey, which focused only on ‘legal highs’, the largest number of online shops were based in the United Kingdom, followed by Germany and the Netherlands. The 2010 snapshot, with its extended scope showed a different pattern, with 38 online shops based in the Netherlands, 20 in the United Kingdom and 20 in Germany. Countries in which at least five online shops were located include Poland, France and Hungary, while smaller numbers were based in the Czech Republic, Spain, Portugal, Slovakia, Italy and Sweden. Thirty-eight online shops were based in the United States, and the location of 15 online shops could not be determined. Unlike the online shops located in the United Kingdom, many of those based in the Netherlands are associated with specialist shops. Overall, 73 % of the online shops used English, with 42 % offering no other language.
The ‘Spice’ phenomenon
‘Spice’ is sold on the Internet and in specialised shops as a smoking mixture. In 2008, forensic chemists discovered that it is not the harmless herbal product that it claims to be. The real psychoactive constituents of ‘Spice’ were identified as synthetic additives; substances, such as the cannabinoid receptor agonist (5) JWH-018, that mimic the effects of tetrahydrocannabinol (THC) in cannabis.
The so-called ‘Spice’ phenomenon continued to receive considerable attention in 2009. Throughout the year, the names and brand packaging of ‘Spice’-like products have diversified. The psychoactive compounds added to these products have also being changing, in response to new control measures (EMCDDA, 2009). Nine new synthetic cannabinoids were reported through the early-warning system in 2009 (6).
The variety and number of synthetic cannabinoids, or other substances, that can be added to herbal products poses challenges in terms of their identification, monitoring and risk appraisal. Almost nothing is known about the pharmacology, toxicology and safety profiles of these compounds in humans. The type and amount of added synthetic cannabinoids may also vary considerably, and some of these compounds may be highly active at very small doses. As a result, accidental overdosing with a risk of severe psychiatric or other complications cannot be excluded.
None of the synthetic cannabinoids is controlled under the UN conventions, and there is no information on any of them having been authorised as medicinal products in the European Union. At the time of writing, several Member States had banned or otherwise controlled ‘Spice’, Spice-like products and related compounds (7). The purported herbal ingredients of ‘Spice’ products are not internationally controlled, but some Member States (Latvia, Poland, Romania) have placed one or more of them on their lists of controlled substances. Outside the European Union, Switzerland controls ‘Spice herbal mixes’ under its food regulation.
In the 2010 online survey, the number of online shops offering ‘Spice’ dropped sharply compared with the previous year. Despite having a broader coverage, the 2010 survey identified only 21 shops offering ‘Spice’-like products, compared with 55 in 2009. This year, two online shops offering ‘Spice’ were based in the United Kingdom, down from 23 last year. In the most recent snapshot, 15 shops claimed to have ‘Spice’ available, with eight of them revealing where they are located: three in the United States and one in Spain, Poland, Portugal, Romania and the United Kingdom. The remaining six online shops which offered ‘Spice’-like products reported to be out of stock, and were possibly using the brand’s name to attract customers.
Unlike illicit drugs, no large seizures of ‘Spice’-like products were reported, and there is a lack of reports of criminality associated with the phenomenon. This, combined with the limited knowledge about the chemistry and effects of the new compounds, creates a ‘grey zone’ around the monitoring of such products.
Prevalence of ‘legal-highs’ use
The term ‘legal highs’ encompasses a wide range of products, from herbal mixtures to synthetic or ‘designer’ drugs and ‘party pills’, which are used in different ways (smoked, snorted, ingested). In addition, these products can be marketed as room odourisers, herbal incenses or bath salts, though they are intended for a different use. This diversity makes it difficult to collect and interpret prevalence data on ‘legal highs’.
Few recent surveys report prevalence data on the use of ‘legal highs’. A 2008 Polish study among 18-year-old students found that 3.5 % had used ‘legal highs’ at least once, a figure comparable to the one for hallucinogenic mushrooms (3.6 %). The use of ‘legal highs’ during the last 12 months was reported by 2.6 % of students (8).
A survey conducted among 1 463 students aged between 15 and 18 years at schools providing general and vocational training in Frankfurt found that about 6 % of respondents reported having used ‘Spice’ at least once, and 3 % had used it during the last 30 days. These figures could have been influenced by the media attention given to ‘Spice’ at the time of the survey, as just 1 % of respondents reported having taken ‘Spice’ more than five times. Almost two-thirds of those reporting having ever used ‘Spice’ also reported using cannabis in the last month.
The latest Mixmag online survey, which targets club-goers in the United Kingdom, found that 56.6 % of respondents reported having used ‘legal highs’. These included the herbal products ‘Spice’ and ‘Magic’, BZP party pills and other party pills, with last month prevalence of use of respectively 2.0 %, 4.6 % and 5.3 %. Respondents reported obtaining these drugs from friends (95 %), or to purchasing them on websites (92 %), in shops (78 %), from festival stalls (67 %) or dealers (51 %).
(1) Mephedrone (4-methylmethcathinone); methylone (3,4-methylenedioxymethcathinone); methedrone (4-methoxymethcathinone); and MDPV (3,4-methylenedioxypyrovalerone).
(3) Personal communication from Adam Winstock, King’s College London.
(4) See the box ‘Snapshot on online drug shops: methods’.
(5) An agonist is a chemical substance that binds to a specific receptor of a cell and triggers an activity by the cell. An agonist often mimics the action of endogenous or naturally occurring substances.
(6) See the Drug profile ‘Synthetic cannabinoids and ‘Spice’ on the EMCDDA website.
(7) Denmark, Germany, Estonia, Ireland, France, Latvia, Lithuania, Luxembourg, Austria, Poland, Romania, Sweden, United Kingdom.
(8) 2008 CBOS survey, sample of 1 400 adolescents of final grades at post middle schools; 15% of participants reported having used drugs in the last 12 months.
EMCDDA (2006), Hallucinogenic mushrooms, EMCDDA Thematic paper, European Monitoring Centre for Drugs and Drug Addiction (available online).
EMCDDA (2009), Understanding the ‘Spice’ phenomenon, EMCDDA Thematic paper, European Monitoring Centre for Drugs and Drug Addiction (available online).
Verster, J.C., Kuerten, Y., Olivier, B. and van Laar, M.W. (2010), ‘The ACID-survey: methodology and design of an online survey to assess alcohol and recreational cocaine use and its consequences for traffic safety’, Open Addiction Journal 3, pp. 24–31.