Legal high problems
Legal highs, or novel psychoactive substances (NPS), have been causing unusual presentations at A&E (Emergency Room) departments in European cities. Because these are relatively new drugs, doctors and other healthcare professionals are not always familiar with them. They are not easy to test for either, requiring specialist forensic laboratories in the main.
Legal high problems include:
- A lack of information
- Trouble identifying what’s wrong
- Not being able to detect the drug
It doesn’t help that the drugs are used widely without obvious major harm, so that when toxicity occurs it is relatively rare. It’s not so rare that it’s not causing concern here in Scotland; not just in acute receiving hospitals, but also in mental health units where the number of people presenting is beginning to cause alarm.
Researchers in Germany have published a study looking at this phenomenon and focusing on effects and risks of NPS. They bemoan the lack of information and outline how hard NPS are to study.They point out that legal highs are often of synthetic cannabinoid or cathinone (amphetamine-like) varieties, though there are others too.
- Alter mood
- Alter perception
And in intoxication
- Cause agitation
- Tachycardia (fast heart rate)
- Arterial hypertension (high blood pressure)
Synthetic cathinones (e.g. bath salts, Burst)
- Are hallucinogenic stimulants
And in intoxication
- Cause cardiovascular side effects
- Cause psychiatric problems (including agitation, aggression, psychosis)
- Can cause serotonin syndrome (a dangerous excitatory state)
- And rarely can cause rhabdomyolysis (a breakdown of muscle tissue)
From 2010 to 2012, 163 substances were reported to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), mostly either synthetic cannabinoids (39.3%) or synthetic cathinones (16.6%)… The Young persons who present with agitation and cardiovascular and/or psychiatric manifestations of unclear origin and whose drug screening tests are negative may be suffering from an intoxication with a novel psychoactive substance. Physicians should know the classes of such substances and their effects. Targeted toxicological analysis can be carried out in a toxicology laboratory or a facility for forensic medicine.
What does it mean for us at home?
I remember hearing an Australian addiction psychiatrist speak at an international conference on methamphetamine. He was talking about the challenges of managing patients presenting with aggression, psychosis and extreme behaviours. At the time I thought, ‘Thank goodness we don’t have much methamphetamine use at home.” Not any more.
The landscape is changing so fast with regard to the novel psychoactive substances. Young people’s drugs workers used to have caseloads full of opioid users, but now they are mostly using NPS. Governments are struggling to keep up and the place of legislation is uncertain. Treatment services are weighted towards alcohol and opiate addictions. In many places there little experience in helping those with stimulant dependence – indeed in many reports, there is not much (if any) recognition that dependence is an issue; instead there is talk of “problems”. Notwithstanding this there are anecdotal reports of plenty of newcomers in Cocaine Anonymous and SMART meetings locally. 80% of people using synthetic cathinones ended up using more than they planned. They are very ‘moreish’ and that’s a recipe for addiction. Junior doctors at a recent BMA conference called for the government to act, but I think this applies to healthcare professionals too. Our treatment services need to wake up because the problem is already here.
There’s a nationwide survey (My legal high) being done at the moment to try to get a handle on this and I think it’s well worth publicising.
Hohmann N, Mikus G, & Czock D (2014). Effects and risks associated with novel psychoactive substances: mislabeling and sale as bath salts, spice, and research chemicals. Deutsches Arzteblatt international, 111 (9), 139-47 PMID: 24661585