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A national newsletter on substance misuse management in primary care NETWORK

Fabrizio Schifano gives us insight into the fast growing and often confusing world of legal highs, and provides a few tips on how to identify and meet the needs of those who are using them. Ed.

eventually controlled in the UK in July 2010. Soon afterwards, a number of novel products (including NRG-2, NRG-3, NRG-4, NRG-5 and NRG-6) appeared online. The situation is even more complex, because products labeled as NRG-1 (naphyrone) may indeed contain either mephedrone or a range of different non psychoactive, and possibly toxic, chemicals.

Legal highs: novel psychoactive substances

Novel psychoactive chemicals, sometimes called designer drugs or legal highs represent a rapidly expanding problem that is being increasingly recognised as associated with both psychological and physical threats for misusers and society as a whole. Although legal highs may be derivatives of well known, mostly classified, psychoactive chemicals such as phenethylamines, tryptamines, piperazines, cathinones and ketamine, they are advertised as legal and of high purity, making them more attractive to users and particularly to teenagers. However, the content of these products is often unknown.

Typically, the history of diffusion of any novel psychoactive compound starts in closed settings, within restricted groups of ‘educated’ and technologically literate users, the psychonauts. Most recreational drugs consumers access the internet to obtain and exchange drug-related information. As legal highs become known to government officials and are banned, new molecules appear on the market and the cycle repeats itself.

A well known example of this cycle in the UK is the latest NRG- series molecules, which started to be energetically advertised online in April 2010, just days after mephedrone (a cathinone derivative) was controlled.

toxicological, epidemiological and clinical data are available in scientific literature. As a consequence, it is difficult for the practicing clinician to be kept regularly updated

“very few related pharmacological,

Mephedrone elicits stimulant and empathogenic effects similar to amphetamine, methylamphetamine, cocaine and MDMA. Due to its sympathomimetic actions, mephedrone may be associated with a number of both physical and psychopathological side effects. Recent preliminary analysis of recent UK data carried out in 65 related cases have provided positive results for the presence of mephedrone at post mortem. Within the UK, diffusion of mephedrone may have been associated with an unprecedented combination of a particularly aggressive online marketing policy and a decreasing availability and purity of both ecstasy and cocaine.

Just a few days following the mephedrone ban, NRG-1 was proposed as a legal cathinone derivative, prior to being


Most European Union (EU) countries are taking into account the possibility of classifying a drug following the completion of some level of risk assessment. However, this is problematic because the technical knowledge on novel recreational compounds is hardly obtained through reference books and scientific journals. In fact, very few related pharmacological, toxicological, epidemiological and clinical data are available in scientific literature. As a consequence, it is difficult for the practicing clinician to be kept regularly updated. At the EU-wide level, most popular novel psychoactive substances seem at present to include a range of molecules, most typically associated with stimulant and/or psychedelic effects (see table 1).

Table 1: Overview of some of the most popular novel psychoactives

6-APB 6-(2-aminopropyl) benzofuran Benzo fury An hallucinogenic compound which seems to be fairly popular at present.

Benzydamine HCl An over-the-counter drug marketed as an antiseptic for external use only. However, the misuse of this drug, through ingestion, can be identified in some EU countries. In the UK only, low-dosage formulations are available. Hallucinogenic effects have been described following intake of large dosages.

Bromo Dragonfly 1-(8-bromobenzo[1,2-b;4,5-b’]difuran-4-yl)-2- aminopropane. B-fly A very powerful hallucinogenic molecule.

Butylone bk-MBDB, B1 A synthetic cathinone derivative.

BZP benzylpiperazine

Sometimes identified together with other psychoactive molecules in ‘fake’ ecstasy tablets.

Flephedrone 4-FMC A synthetic cathinone derivative.

GBL, GHB, 1,4-butanediol gamma-butyrolactone, gamma-hydroxybutyrate. Increasing levels of consumption are apparently being recorded in the UK. These molecules may present with both a GABA-A and GABA-B receptor agonist activities. Treatment of the detoxification itself may be problematic.

Kratom Mytragina speciosa May present with some opiate-like agonist activities.

MDPV MethyleneDioxyPyroValerone Super coke, Peevee, Magic Sometimes identified in ‘bath salts’ preparations.

Mephedrone 4-MMC, drone, meow meow

A synthetic cathinone derivative, banned in April 2010 but may still be available in products offered to online with different nicknames. Psychoactive effects may resemble those of cocaine and MDMA taken together.

Methylone ; bk-MDMA, M1 A synthetic cathinone derivative

Naphyrone NRG-1

Banned in July 2010 in the UK, may still be available in products offered online with different nicknames.

NRG-2, NRG-3, NRG-4 Sometimes offered to online customers as alternatives to mephedrone and/ or MDMA. May contain a range of different products, including cathinone derivatives and MDMA-like drugs.

Pregabalin; gabapentin Medicinal drugs licensed for the treatment of a range of neuropsychiatric conditions. The misuse potential of these drugs is being increasingly recognised.

Salvia Active molecule, Salvinorin A, Salvia divinorum K opioid receptor agonist.

Spice drugs JWH-018;CP-47,497 and a dozen of others. Synthetic cannabinoid receptor agonists, typically offered as herbal smoke, or mystical incense.

…continued overleaf

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