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AUSTRALIAN MEDICAL ASSOCIATION (WA)
The lack of regulation and testing around New and Emerging Drugs means we know little about their acute effects or long-term harm.
Online and on the street, they go by various names – White Revolver, Benzo Fury, Aurora and Northern Lights. More formal monikers include ‘synthetics’*, new and emerging drugs (NEDs) or emerging psychoactive substances (EPS).
The names sound attractive enough, but what are they and what do they do? Given these are relatively new substances, we do not always know their risk. Yet for some people, their use can be disastrous. Angela Munn** is a 35-year-old single, unemployed mother of three children. She is also someone who is drug dependent – one of many thousands of Australians using ‘synthetic drugs’. Three years ago a friend introduced her to the now-banned synthetic cannabinoid Kronic. Since then, Angela has become a regular user of a range of NEDs, sometime smoking up to five grams a day. “It offers me a break from reality, and helps to take the edge off,” she says. The effect of these drugs has left Angela a broken woman – physically, mentally and financially. She admits to having “mad” episodes where she snaps at her children, and having wasted a lot of money. Each day is a listless haze. “I have no energy and usually sleep most of the time.” Angela says she is trying to kick the habit, but admits “it is touch and go”.
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The number of new drugs infiltrating the market is unprecedented. In 2011, 49 new drugs were detected by the European Centre for Monitoring Drugs and Drug Abuse (ECMDDA) – double the number the ECMDDA detected in 2009. Access in Australia is on the rise too, with products containing these new and emerging drugs available in many adult stores, tobacconists and even online. Professor Steve Allsop, from Curtin University agrees. “While we don’t have good evidence about prevalence in Australia, in the past five years or so in the US and some parts of Europe, we have seen significant increases in rates of use of these drugs – and ever increasing varieties,” he says. “We have very limited information about their acute effects and know virtually nothing about long-term harms.” These products are often professionally packaged and labelled ‘not for human consumption’.
They are sold as nutritional supplements, herbal ecstasy, plant food, bath salts, party pills, room deodorisers, incense and synthetic cocaine. Some people have bought the active chemicals that these products have been speculated to contain from online vendors. These are often sold as research chemicals. While it is unclear how many Australians use new and emerging drugs – for obvious reasons their use is a ‘hidden behaviour’ – some indicators suggest that use is increasing. These drugs are easily accessible, often touted as legal and perceived as safe. They may be deliberately marketed and taken to evade drug testing and are unintentionally promoted through media attention.
While the effects produced by NEDs mirror those of more established drugs such as cannabis, stimulants (such as amphetamine or cocaine) or hallucinogens such as LSD, there is concern that they are sometimes more potent. The Australian Drug Foundation warns that a lack of information about the pharmacology and toxicity of new and emerging drugs means it is difficult to establish their harm potential.
However Clinical Psychologist Stephen Bright who has worked in the AOD field for almost 10 years, says some of the chemicals contained in the powder/pill products may increase the risk of psychosis, dependence and brain injury. “It is unclear how these harms compare to traditional illicit drugs such as methamphetamine or cocaine,” he writes in his report New and Emerging Drugs.
Mr Bright also warns that synthetic cannabis may be more harmful than natural cannabis, and has been linked to psychosis, seizures and heart problems. The potential harms associated with powder/pill products are equally difficult to establish. Each product may contain different chemicals with varying toxicity profiles, and analyses of products have found that a product may also contain different chemicals at different points in time. For example, the effective dose for MDPV is almost 100 times smaller than mephedrone, which means there is an increased risk of overdose. Like methamphetamine and cocaine, MDPV is also a potent dopaminergic agent, which means that there is an increased risk of psychosis and compulsive re-dosing.
New and emerging drugs are also sometimes referred to as ‘legal highs’ although the term is questionable as their legal status is highly complex. The relationship between state and federal laws in Australia is byzantine. While importation falls under federal legislation, most drug laws are state-based and unique to each state. This means that although a chemical may be illegal to import under federal law, outside of federal jurisdictions (e.g. universities, airports, international mail and other border controls) it might be legal to possess in one state, yet illegal to possess in another. Gary Kirby, Director of Prevention and Workforce Development, Drug and Alcohol Office says the states, territories and the Commonwealth need to unite in order to fight the scourge of ‘synthetics’. “All of the states and territories as well as the Federal Government need to work together to achieve a systemic, appropriate response,” Mr Kirby says. In June 2011, Western Australia became the first state in the country to ban synthetic cannabis – with the AMA (WA) being one of the foremost organisations leading the charge.
In February 2012, WA banned MDPV, a synthetic drug similar to methamphetamine. A few months later, in May, synthetic cannabinoids were banned Australia-wide. New South Wales recently introduced new laws that target the manufacture, supply and even advertising of synthetic drugs such as synthetic cannabis, cocaine and LSD. While WA has some of the toughest drug laws in Australia, new and emerging drugs are entering the market on what seems like a weekly basis. When one substance is banned, another is waiting in the wings to take its place.
In fact, the ease of procuring these substances is downright frightening, and despite the strict laws WA has in place, law enforcement agencies are finding it increasingly difficult to police these substances. Yet it isn’t in dark alleyways and the homes of dodgy drug dealers that these substances are found. Instead they are being sold in legitimate businesses across Perth and the internet.
NEDs also exist in a grey legal area as manufacturers tweak their recipes to sidestep illegal drug classifications. However, it is not known how safe the end results really are as they each vary in their potency and duration of action. There are concerns about what is actually contained in ‘legal highs’ given quality control checks aren’t compulsory. There is limited research on the short-, medium- and long-term effects of these substances. The current WA law on ‘legal-highs’ is that any analogues of chemicals already listed on the Therapeutic Goods Administration’s Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP) list can be regarded as illegal. Most synthetic cannabinoids and other ‘legal highs’ are listed as Schedule 9 substances – meaning they are regarded as illegal substances with no proven medical benefits. However, the process in which substances are tested and classified is an arduous one to say the least – if a substance is seized on suspicion of being illegal by the police, it is sent to the ChemCentre laboratory to test if it is an analogue of any previously banned substances. This often takes weeks to confirm, by which time a new substance is already on the market. In New Zealand, the law requires regulatory testing prior to a product’s elease in the market. If a psychoactive substance is listed on an approved regime, it is regarded as legal and is managed accordingly.
The clinical presentation in acute settings varies depending on the chemical that has been consumed.Presentations associated with the use of powders/pills have included symptoms such as ataxia, sweating, tachycardia, arrhythmia, hypertension, hyperthermia, rhabdomyolysis, kidney failure, seizures, bruxism, nausea, anxiety, agitation, confusion, paranoia and hallucinations. The most severe symptoms reported include stroke, cerebral oedema (brain swelling), cardiorespiratory collapse and death. Synthetic cannabis presentations have included symptoms such as sweating, tachycardia, arrhythmia, hypertension, nausea, anxiety, agitation, seizures, confusion, paranoia and hallucinations. Laboratory results cannot be solely relied upon for identifying the contribution of NEDs to presentations given that tests have not yet been developed for many of these substances. In interpreting laboratory results, it is also important to note that many of these drugs can produce false positive results for other more traditional drugs. For example, mephedrone and MDPV can produce a false positive for amphetamine and/or cocaine use.
Careful assessment and questioning is therefore crucial to determine whether the person presenting has consumed any new and emerging drugs.
Without doubt, the consumption of NEDs is here to stay and Stephen Bright warns that new drugs will become available in place of banned chemicals, which are potentially more harmful than the banned substances. In this environment, policy makers and service providers are constantly playing catch up, while individuals are exposed to potentially toxic new drugs.3 He recommends the development of and implementation of early warning systems that can detect the emergence of significantly harmful new drugs and alert key stakeholders to a potential public health crisis.3 In the meantime, he says, clinicians, and allied health and youth workers need to brace for new drugs and new methods of drug procurement. They need to be vigilant in ensuring that these trends are considered in assessment as well as treatment planning and delivery.
* The term ‘synthetics’ is confusing because it doesn’t distinguish these newer drugs from illicit drugs such as LSD, ecstasy and speed that are also synthesised from chemicals (rather than extracted from plants like cannabis, cocaine and heroin).
** Name changed for privacy reasons.
For more in-depth coverage on NEDS, please refer to the latest edition of Medicus