The last few months have seen a dramatic increase in use of –
and media interest in – ‘legal highs’, especially mephedrone or ‘miaow/meow’.
David Gilliver takes a look at a legislative minefield

When the government announced its intention last year to ban a range
of ‘legal highs’ and make them class C drugs, Release accused it of
‘chasing its tail’ in an attempt to ‘stay ahead of the demand for drugs
and those who supply them’ (DDN, 7 September 2009, page 4).
The chemicals were BZP and related piperazines, GBL and a related chemical
and the synthetic cannabinoids used to make smoking products like Spice.
Release’s accusation seemed to be vindicated very quickly, however. Anecdotal
evidence soon started to filter through about a sharp increase in use of the
stimulant mephedrone (4-methylmethcathinone), known as ‘miaow’. After the drug was implicated in the death of a young woman in Brighton late last year, there was a rash of mephedrone stories in the press, followed – a couple of weeks later – by stories about how that coverage had led to a huge boost in sales, with many online suppliers selling out altogether. Luci Hammond is a young person’s alcohol worker at Brighton-based service ruok? She started to notice a very sharp increase in miaow use in the second half of last year. ‘It just hit very quickly,’ she says. ‘We started getting reports of it being used by young people and we had parents and professionals asking questions about it, but since then we’ve had a lot of young people coming to us themselves.’

There has been much talk about the drug’s growing use in clubs, with people
turning to it because of the poor quality of available ecstasy and cocaine – as little as 2 per cent purity in the latter case (DDN, 21 September 2009, page 5).
However, what Hammond has found – and what the press has been quick to pick
up on – is the worrying popularity of the drug among children. So far, her youngest client to have used miaow is 12. The majority are 14 and up, but ‘14 is common’ she says. Where are they taking it – presumably they can’t get into nightclubs? ‘The majority of them can’t, but there are under-18 nights where they use it, as well as at parties and out on the streets. They’ll sit in parks and cemeteries, so they’re putting themselves at risk just through the location.’
And what about other legal highs? ‘This is the big one. We’re hearing bits about
BZP and Spice but nothing compared to this.’ John Ramsey runs the TICTAC drug-testing database at St. George’s, University of London, and has seen a dramatic increase in the use of legal highs. ‘We analyse the contents of club amnesty bins and we test purchase stuff from websites – that’s how we come to be pretty up-to-date on new and emerging compounds,’ he says. ‘We’ve been doing this for ten or 15 years and at one time it was really unusual to find anything new. Now we find something new virtually weekly. We go to Glastonbury each year and there were huge amounts of mephedrone there last
time – there was one seizure of 120g. Two or three years ago there wasn’t any.’
Legal highs are available in ‘head’ shops but anecdotal evidence – and the
scale of use being reported – would suggest that most people are buying them
quickly and easily online. Indeed, many of the press mephedrone stories have
practically been guides to getting hold of the drug, couched in obligatory
disapproving language. ‘If you go online and put in ‘legal highs’ you get hundreds of results,’ says Renato Masetti, training coordinator at Suffolk DAAT, who puts on conference workshops to essentially it’s an online phenomenon – you’ve got comments, forums, you can write in and say which one was good and which wasn’t, just like on Amazon. There’s a whole community out there – the online forums have gone mad.’

But presumably most 13 and 14-year-olds aren’t buying the drugs online,
unless they’re using their parents’ credit cards? ‘A lot of our young people are
getting it from friends, but we’re hearing of dealers specialising in miaow and
selling it to school-age children,’ says Hammond. ‘They’re buying it in bulk online,
possibly cutting it, and selling it on. We’ve also heard reports of young people
dealing because they think it’s risk-free, a legal substance. At the start the reports were “you get no comedown, it’s all legal”. It was seen as pure – everything sounded lovely. Now it’s being used more frequently we’ve discovered it’s not so lovely.’ She’s started to see behaviour change in her clients, like paranoia, aggression and anxiety, and even signs of dependency. ‘We’ve heard about shakes and poor co-ordination with withdrawal,’ she says. How widespread is the problem in Brighton? ‘I would say in terms of speaking to young people, it’s probably about five a day,’ she says. ‘One young person will tell us that their friends are doing it, or a teacher will ring up and say that the whole class is talking about it. I’m a young person’s alcohol worker but almost all my clients have tried miaow, even the ones who’ve always said “I’d never do drugs”,
because it isn’t considered a dangerous drug. This is the message we’re trying to
get across – that it does seem to be a dangerous drug.’ How are they taking it? ‘Most are snorting, which is what we’re trying to advise against – if you are going to use it we’d rather it was bombed [swallowed]. We’ve had people smoking it as well, in a bong or cone. But it’s really painful to snort, and we’re hearing of nosebleeds that recur for days afterwards, as well as spinal and joint ache. And miaow isn’t enough now – they want to do it with ketamine or acid or nitrous oxide. There seems to be a cocktail culture out there.’

Clubbers of the ’80s and ’90s were sometimes described as the ‘guinea pig
generation’, as no one really knew what effects long-term ecstasy use might have. But with mephedrone and other legal highs – anecdotal chat room accounts aside – there really is no information, because there’s been no research. ‘How can there be – who’s going to pay for it?’ says John Ramsey. ‘For example the cannabinoids in things like Spice are completely untested and yet they clearly work – the legislation has got to control about 240 of the things. Who can research 240 new chemical compounds?’ Indeed even the names seem something of a moveable feast, with a variety of drugs passed off as miaow depending on who’s selling it and in what part of the country. ‘There are fewer dealers in the chain and there does seem to be some evidence of people selling allegedly illegal drugs which when they’re tested are found to be legal, so you have this fascinating phenomenon of the illegal market pinching from the legal market and pretending it’s illegal – because people think illegal stuff is better,’ says Masetti. ‘We’ve been told that miaow can be made up of different compounds, and it’s also being mixed with stuff now,’ says Hammond. ‘It started off a few months ago at £15 per gram and now it’s £3.50. You can get pure mephedrone but you don’t really know from mix to mix what you’re getting.’ However the miaow John Ramsey has tested has been consistent. ‘Every time we’ve analysed it it’s been 4-methylmethcathinone, and there appear to be vast amounts of it about. I get a lot of calls from police officers who are being asked what they’re going to do about it. Of course the answer is “nothing”, because it’s not illegal.’

The legal status does really appear to mean that many people think the drugs
are safe and harmless. ‘We’ve had parents saying “we’re telling our kids not to do
illegal things” and they’re saying “but it’s not illegal” says Hammond. ‘I don’t think many teenagers would think that they could buy something from a high street head shop that’s going to cause them to end up in an A&E department,’ says Ramsey. ‘They wouldn’t think people would be allowed to sell things that would do that.’ And A&E, it seems, is not an exaggeration. Luci Hammond visits regularly and whereas before her clients were there through drink or illegal drugs, now it’s often miaow. ‘We’re starting to see people coming in with miaow overdoses – anxiety, excessive aggression, disturbed sleep, being sick. One parent brought her child in because he was screaming and shaking in his sleep and they put that down to a miaow overdose. One client did it at a party and kept collapsing – his knees would just buckle underneath him.’ ‘I’ve seen a couple of forums where there was talk about it causing blue knees and blue elbows,’ adds John Ramsey. ‘That means it could be an inhibitor of muscle metabolism – that’s not beyond the realms of possibility.’ Does he think the government is really chasing its tail when it comes to legislating on legal highs? Won’t the chemists just come up with a slightly different compound? ‘To some extent, but the new legislation includes piperazines – BZP and that whole family – and it is proper generic classification, not a list of compounds, so it should cut off the piperazines as a family. While there’s always scope for somebody to innovate something that hasn’t been foreseen, it makes it much more difficult to do that. But obviously the legislation completely ignores the cathinones, like mephedrone, which haven’t even been risk-assessed yet. The alternative is to do nothing, but you’ve got teenagers buying chemicals which are completely untested for safety and using them as drugs – you’ve got to try and prevent that.’ ‘It’s an interesting challenge,’ says Renato Masetti. ‘I think we need to be creative about other responses, rather than just straight legislation. You’ve got the example of GHB and GBL – GHB was made class C a while back and yet you found the same amount of seizures of GHB as GBL. The fact that you’ve classified doesn’t seem to have made much difference. Legislation is a very heavy hammer, and it’s too clumsy with chemicals that can be altered quickly. Legislation becomes really difficult because if it’s too broad it captures useful products in industry.’ He’s also unconvinced that people are switching to these drugs on a large scale because of the declining quality of cocaine and ecstasy. ‘That upshares/downshares has been going on for ages – purity rates go up and down. I think to some extent this
is probably a separate thing – experimental people who don’t wish to break the law and are looking for legal alternatives. This happened years ago when there was a big ‘herbal highs’ thing, but they were awful, caffeine-based things. I think people have been quite surprised this time – they’ve found that actually they’re effective.’

In the myriad of online forums, the effects of mephedrone are often described
as a kind of mix of amphetamine and MDMA, but with a shorter-lasting effect than the latter. ‘The chemical structures are based on the khat plant, but the
compounds have nothing to do with the plant – they’re modifications of a molecule derived from the plant – so from a chemical point of view you’d predict that it’s going to be a stimulant,’ says Ramsey. ‘I can’t see how it’s likely to be
empathogenic like MDMA, it’s more likely to be like amphetamine or even
methylamphetamine. But it’s never been used as a drug before so there’s no data
on its half-life, its potency or anything.’ The similarity with methylamphetamine/ methamphetamine is borne out by the behaviour of Hammond’s clients. ‘We’re hearing of people aged 14 or 15 who are doing three-day binges, seven-day binges. They’re not able to go to school and we’ve had people saying “I feel like I’m dying, I can’t stop.” We’ve had people who’ve used illegal drugs saying this is the most addictive thing they’ve ever had.’

So what’s the answer – is it better education? ‘Absolutely, but it’s a fine line
between educating and promoting,’ says Ramsey. ‘We’re used to that in the drug
field, but we do need some sort of generic education.’ What about the FRANK ‘crazy chemist’ campaign launched last year? (DDN, 5 October 2009, page 4). ‘That’s not based on any sound knowledge,’ he says. ‘Just anecdotal observations.’ ‘I’m a trainer so I’m biased but I think training is really important,’ says Masetti. ‘It’s important for drug teams to know the specifics about these drugs, but not because treatment is going to be any different from what they’re doing already – it’s more around confidence-building. I’d like to see awareness-raising in services so they can engage with these clients who don’t see themselves as traditional illegal drug users. We know very little about these drugs but because they’re synthetic mimickers that work similarly to the illegal drugs they’re mimicking, the treatments will be very similar – you don’t need to learn any special techniques. But we do need to get some research going on these drugs asap, along with general harm reduction advice.’ Late last year two members of the Advisory Council on the Misuse of Drugs (ACMD) told The Times that the council had serious concerns about drugs like mephedrone and was proposing a more rapid system of appraisal, and the ACMD had in fact constituted a working group on cathinone compounds of which John Ramsey was a member. ‘But all of that’s collapsed now because everybody’s resigned,’ he says. Sacked ACMD chair Prof David Nutt has said his new organisation, the Independent Council on Drug Harms, plans to produce guidance on legal highs, but they will be operating outside of government (see page 4). ‘It’s definitely getting to the “something must be done” stage,’ says Ramsey. ‘It’s not going to go away, and it’s not likely to be controlled by the Misuse of Drugs Act in the foreseeable future as they can’t legislate under that without ACMD.

ACMD would normally conduct a risk assessment and then recommend control or
non-control but, given the disarray ACMD seems to be in, the alternative is the
same process through the EMCDDA in Lisbon. They’ve collected information about
these compounds, and it may well be that they’ll do a risk assessment and
recommend control throughout Europe, with all member states expected to follow.’ In fact the EMCDDA has called Britain the online capital of Europe for legal highs, with 37 per cent of all retailers operating from the UK compared to just 14 per cent in the Netherlands. ‘True, but we bought some from a website that had a UK address – the credit card was debited in France and the material was shipped from New Zealand,’ says Ramsey. ‘But one thing is certain – there’s very big money in it.
Source: drinkanddrugsnews 18 January 2010