Heroin is a known illegal drug, but many alternatives are now appearingTackling the problem of illegal drug abuse continually exercises governments and police forces. But in this week's Scrubbing Up health column, toxicologist Dr John Ramsey warns authorities are struggling to deal with the growing problem of new "herbal highs" - and says simply banning them is not the answer.
Heroin is a known illegal drug, but many alternatives are now appearingTackling the problem of illegal drug abuse continually exercises governments and police forces. But in this week's Scrubbing Up health column, toxicologist Dr John Ramsey warns authorities are struggling to deal with the growing problem of new "herbal highs" - and says simply banning them is not the answer.
While the government consults its advisors on the harms caused by cannabis and ecstasy and then disregards the evidence they produce, UK based websites and high-street "head" shops are exploiting the naivety of young people by marketing to them chemicals never before used as drugs.
While the government consults its advisors on the harms caused by cannabis and ecstasy and then disregards the evidence they produce, UK based websites and high-street "head" shops are exploiting the naivety of young people by marketing to them chemicals never before used as drugs.
It started early this decade in New Zealand when benzylpiperazine (BZP) was marketed as an alternative to crystal meth, or "pure" as it became known locally, which had taken hold as a major drug of abuse.
It started early this decade in New Zealand when benzylpiperazine (BZP) was marketed as an alternative to crystal meth, or "pure" as it became known locally, which had taken hold as a major drug of abuse.
BZP was supposed to be a safer legal alternative. The only problem was that it has never been tested for safety or efficacy by the pharmaceutical industry or anyone else.
BZP was supposed to be a safer legal alternative. The only problem was that it has never been tested for safety or efficacy by the pharmaceutical industry or anyone else.
The labelling on the packaging is almost universally misleading or just plain wrong
It was sold as tablets or capsules and often passed off as a "herbal high".
It was sold as tablets or capsules and often passed off as a "herbal high".
Pretty soon it gained popularity and became big business. This presented the NZ authorities with a problem.
Pretty soon it gained popularity and became big business. This presented the NZ authorities with a problem.
They chose to add an additional category (Class D) to their misuse of drugs legislation, based on that in the UK, and introduced an age-related prohibition on the sale of BZP and related products.
They chose to add an additional category (Class D) to their misuse of drugs legislation, based on that in the UK, and introduced an age-related prohibition on the sale of BZP and related products.
Side effects
Side effects
BZP is one of a family of compounds derived from piperazine - an innocuous compound available over-the-counter to treat intestinal worms in children. Piperazine itself is safe and has no stimulant properties.
BZP is one of a family of compounds derived from piperazine - an innocuous compound available over-the-counter to treat intestinal worms in children. Piperazine itself is safe and has no stimulant properties.
A study was commissioned to investigate the consequences of the use of BZP as a recreational drug but it was abandoned because of the unpleasant side effects reported by volunteers.
A study was commissioned to investigate the consequences of the use of BZP as a recreational drug but it was abandoned because of the unpleasant side effects reported by volunteers.
Eventually BZP was reclassified as a Class C drug in New Zealand and its sale was prohibited by law.
Eventually BZP was reclassified as a Class C drug in New Zealand and its sale was prohibited by law.
But meanwhile an international trade, supplied predominantly from New Zealand, had developed.
But meanwhile an international trade, supplied predominantly from New Zealand, had developed.
A range of tablets and capsules containing various piperazine derivatives appeared in shops and websites in the UK and throughout Europe, marketed as legal alternatives to ecstasy.
A range of tablets and capsules containing various piperazine derivatives appeared in shops and websites in the UK and throughout Europe, marketed as legal alternatives to ecstasy.
It became apparent that these compounds did indeed have many of the pharmacological properties of amphetamine and ecstasy but also that they had many side effects, which were sometimes quite severe - young people presented at hospital accident and emergency units with panic attacks, fits and high blood pressure.
It became apparent that these compounds did indeed have many of the pharmacological properties of amphetamine and ecstasy but also that they had many side effects, which were sometimes quite severe - young people presented at hospital accident and emergency units with panic attacks, fits and high blood pressure.
The European agency responsible for monitoring drug misuse has recommended that all member states should introduce legislation to control its sale of BZP by March 2009.
The European agency responsible for monitoring drug misuse has recommended that all member states should introduce legislation to control its sale of BZP by March 2009.
This legislation is still pending in the UK. The UK Medicines and Healthcare Regulatory Agency (MHRA) pursued some suppliers because, they asserted, they were making medicinal claims for their products and were consequently guilty of an offence under the Medicines Act.
This legislation is still pending in the UK. The UK Medicines and Healthcare Regulatory Agency (MHRA) pursued some suppliers because, they asserted, they were making medicinal claims for their products and were consequently guilty of an offence under the Medicines Act.
'Alphabet soup'
'Alphabet soup'
However the cat was out of the bag and importers, wholesalers and retailers had a taste of the money they could make by selling herbal highs.
However the cat was out of the bag and importers, wholesalers and retailers had a taste of the money they could make by selling herbal highs.
As the change in NZ legislation and the promise of EU legislation began to bite, producers began marketing "BZP free" herbal highs containing chemicals unrelated to the piperazines.
As the change in NZ legislation and the promise of EU legislation began to bite, producers began marketing "BZP free" herbal highs containing chemicals unrelated to the piperazines. If we rely solely on the law to control the supply of new compounds we will continually be chasing a new chemical demon
The websites also began to promote the products as "plant feeder", "plant growth inhibitor" and even "bath salts" in order to try to avoid the MHRA's "medicinal claims" assertion.
The websites also began to promote the products as "plant feeder", "plant growth inhibitor" and even "bath salts" in order to try to avoid the MHRA's "medicinal claims" assertion.
The labelling on the packaging is almost universally misleading or just plain wrong - often being a long list of vitamins, herbs and only obliquely referring to the active ingredient as "piperazine blend" or "ketones".
The labelling on the packaging is almost universally misleading or just plain wrong - often being a long list of vitamins, herbs and only obliquely referring to the active ingredient as "piperazine blend" or "ketones".
The result of controlling BZP is that we now have an ever-expanding illicit pharmacopoeia of chemicals never before used as drugs being sold to vulnerable youngsters by unscrupulous vendors with neither understanding the risks they are taking.
The result of controlling BZP is that we now have an ever-expanding illicit pharmacopoeia of chemicals never before used as drugs being sold to vulnerable youngsters by unscrupulous vendors with neither understanding the risks they are taking.
One consequence of these compounds not having been evaluated as legitimate drugs is that they do not have trivial names, so rather than use the full chemical name they become known by abbreviations assigned usually by the laboratory that first detected them.
One consequence of these compounds not having been evaluated as legitimate drugs is that they do not have trivial names, so rather than use the full chemical name they become known by abbreviations assigned usually by the laboratory that first detected them.
This means we now have a menu of herbal highs offering an "alphabet soup" of chemical entertainment.
This means we now have a menu of herbal highs offering an "alphabet soup" of chemical entertainment.
The risk is that the producers stumble upon a compound with unforeseen toxicity.
The risk is that the producers stumble upon a compound with unforeseen toxicity.
There is an unfortunate precedent - MPTP, a piperidine derivative which causes irreversible symptoms mimicking Parkinson's disease in humans.
There is an unfortunate precedent - MPTP, a piperidine derivative which causes irreversible symptoms mimicking Parkinson's disease in humans.
It was identified as an impurity in "synthetic heroin". It is a highly toxic, cumulative poison causing irreversible Parkinsonism by inhalation or skin contact.
It was identified as an impurity in "synthetic heroin". It is a highly toxic, cumulative poison causing irreversible Parkinsonism by inhalation or skin contact.
We need to communicate to both the vendors and their young customers the risks they are exposing themselves to.
We need to communicate to both the vendors and their young customers the risks they are exposing themselves to.
If we rely solely on the law to control the supply of new compounds we will continually be chasing a new chemical demon.
If we rely solely on the law to control the supply of new compounds we will continually be chasing a new chemical demon.
Dr Ramsey is head of the Tic Tac Communications drugs database at St George's Medical School in London.
Dr Ramsey is head of the Tic Tac Communications drugs database at St George's Medical School in London.
