ArticlePDF Available

Drugs and Alcohol Today Miaow miaow: a review of the new psychoactive drug mephedrone

Authors:

Abstract

Purpose Mephedrone is a synthetic stimulant drug causing entactogenic and hallucinogenic effects. A systematic review of all existing empirical research and literature from 2009‐2012 on this new psychoactive drug was conducted. This paper aims to report on that review. Design/methodology/approach The review was conducted according to PRISMA guidelines. Electronic databases were utilised using the search terms “mephedrone” and product nomenclature; “Plant Food”, “Feeder”, “Meow Meow”, “Miaow”, “Drone”, “Meph” “Bubbles”, “Charge”, and “MCat”. The search was restricted to publications from 2009‐2012, and produced 702 results. Data were collected by one member of the research team and cross checked by another. A primary screening was carried out to exclude inaccurate search results and drugs other than mephedrone. The results were studied and duplicates removed; 598 results were discarded, with 104 deemed suitable for inclusion. Findings The review underscores mephedrone's popularity despite legislative controls. Drug displacement patterns from illicit to licit were observed prior to controls, with blending of mephedrone and other substitute cathinones with street drugs thereafter. User consumptive choices are grounded in availability, perceptions of legality and safety, curiosity and perceived quality of drug outcomes within poly drug taking repertoires. Clinical reports indicate that mephedrone has high abuse potential and toxicity, with several dependence symptoms. Risk assessment, detection, diagnosis and treatment of mephedrone use are difficult due to polydrug use and associated mental health disorders. Research limitations/implications The review points to the need for further research into the pharmacology and toxicity of mephedrone in order to better equip clinicians with assessment, diagnosis and treatment strategies to reduce morbidity. Practical implications The increasingly diversified new psycho stimulant market where mephedrone is a major player poses unprecedented challenges for drug surveillance, policy, community and clinical practice. Social implications Stricter legislative controls including internet vendor responsibility for supply of mephedrone have been suggested, along with raising public awareness on an international level through coordinated efforts. Originality/value The last review was published in 2009 by the Psychonaut Webmapping Group. This review brings together a comprehensive new set of data sources as they relate to this drug.
Drugs and Alcohol Today
Emerald Article: Miaow miaow: a review of the new psychoactive drug
mephedrone
Rebekah Brennan, Marie Claire Van Hout
Article information:
To cite this document: Rebekah Brennan, Marie Claire Van Hout, (2012),"Miaow miaow: a review of the new psychoactive drug
mephedrone", Drugs and Alcohol Today, Vol. 12 Iss: 4 pp. 241 - 253
Permanent link to this document:
http://dx.doi.org/10.1108/17459261211286654
Downloaded on: 26-11-2012
References: This document contains references to 141 other documents
To copy this document: permissions@emeraldinsight.com
Access to this document was granted through an Emerald subscription provided by Emerald Author Access
For Authors:
If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service.
Information about how to choose which publication to write for and submission guidelines are available for all. Please visit
www.emeraldinsight.com/authors for more information.
About Emerald www.emeraldinsight.com
With over forty years' experience, Emerald Group Publishing is a leading independent publisher of global research with impact in
business, society, public policy and education. In total, Emerald publishes over 275 journals and more than 130 book series, as
well as an extensive range of online products and services. Emerald is both COUNTER 3 and TRANSFER compliant. The organization is
a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive
preservation. *Related content and download information correct at time of download.
Miaow miaow: a review of the new
psychoactive drug mephedrone
Rebekah Brennan and Marie Claire Van Hout
Abstract
Purpose Mephedrone is a synthetic stimulant drug causing entactogenic and hallucinogenic effects.
A systematic review of all existing empirical research and literature from 2009-2012 on this new
psychoactive drug was conducted. This paper aims to report on that review.
Design/methodology/approach – The review was conducted according to PRISMA guidelines.
Electronic databases were utilised using the search terms ‘‘mephedrone’’ and product nomenclature;
‘‘Plant Food’’, ‘‘Feeder’’, ‘‘Meow Meow’’, ‘‘Miaow’’, ‘‘Drone’’, ‘‘Meph’ ’ ‘‘Bubbles’’, ‘‘Charge’’, and ‘‘MCat’ ’.
The search was restricted to publications from 2009-2012, and produced 702 results. Data were
collected by one member of the research team and cross checked by another. A primary screening was
carried out to exclude inaccurate search results and drugs other than mephedrone. The results were
studied and duplicates removed; 598 results were discarded, with 104 deemed suitable for inclusion.
Findings The review underscores mephedrone’s popularity despite legislative controls. Drug
displacement patterns from illicit to licit were observed prior to controls, with blending of mephedrone
and other substitute cathinones with street drugs thereafter. User consumptive choices are grounded in
availability, perceptions of legality and safety, curiosity and perceived quality of drug outcomes within
poly drug taking repertoires. Clinical reports indicate that mephedrone has high abuse potential and
toxicity, with several dependence symptoms. Risk assessment, detection, diagnosis and treatment of
mephedrone use are difficult due to polydrug use and associated mental health disorders.
Research limitations/implications The review points to the need for further research into the
pharmacology and toxicity of mephedrone in order to better equip clinicians with assessment, diagnosis
and treatment strategies to reduce morbidity.
Practical implications The increasingly diversified new psycho stimulant market where mephedrone
is a major player poses unprecedented challenges for drug surveillance, policy, community and clinical
practice.
Social implications Stricter legislative controls including internet vendor responsibility for supply of
mephedrone have been suggested, along with raising public awareness on an international level
through coordinated efforts.
Originality/value – The last review was published in 2009 by the Psychonaut Webmapping Group. This
review brings together a comprehensive new set of data sources as they relate to this drug.
Keywords Mephedrone, Psychoactive drug, Substitute cathinone, Psycho stimulant, Khat, Drugs,
Stimulants
Paper type Research paper
Introduction
The emergent ‘‘legal high’’ phenomenon of recent times has diversified the global drug market
and introduced into social consciousness a new and multifarious range of psychoactive pills,
powders and herbal mixtures (Schmidt, 2009; Long, 2010; McElrath and van Hout, 2011).
These new substances reproduce drug effects similar to illicit street drugs such as ecstasy,
cocaine and cannabis (Measham et al., 2010; Ryall and Butler, 2011; McElrath and van Hout,
2011; van Hout and Brennan, 2011c). The most popular and publicised of these new
‘‘designer’’ drugs proved to be mephedrone or 4-methylmethcathinone (Kavanagh et al.,2010;
DOI 10.1108/17459261211286654 VOL. 12 NO. 4 2012, pp. 241-253, QEmerald Group Publishing Limited, ISSN 1745-9265
j
DRUGS AND ALCOHOL TODAY
j
PAGE 241
Rebekah Brennan is based
at the Addiction Training
Institute, Glendwyr
University, Wrexham, UK.
Marie Claire Van Hout is
based at the School of
Health Sciences, Waterford
Institute of Technology,
Waterford, Ireland.
Morris, 2010b; Schifano et al., 2010; van Hout and Brennan, 2011b; Wood, 2010) known by
pseudonyms such as: ‘‘Plant Food’’[1], ‘‘Meow Meow’’, ‘‘Miaow’’, ‘‘Drone’’, ‘‘Meph’’ ‘‘Bubbles’’,
‘‘Charge’’, MCat’’ amongst others (Winstock et al., 2010; Schifano et al., 2010; Olives et al.,
2012). Due to structural similarities, mephedrone elicits empathogenic[2] and psycho stimulant
effects associated with 3,4-methylenedioxy-N-methylamphetamine (MDMA) and
amphetamine use (Davies et al., 2010a; Morris, 2010b; Schifano et al., 2010, 2011; van Hout
and Brennan, 2011c; Winstock et al., 2011a; Freeman et al., 2012; Olives et al.,2012).
A derivative of the Khat plant (Oyemade, 2010; McElrath and van Hout, 2011; van Hout and
Bingham, 2011), mephedrone’s synthesis was first accounted for in 1929 under the name
‘‘toluyl-alpha-monomethlyaminoethylcetone’’ by French pharmacologist Saem De Burnaga
Sanchez (Europol-European Monitoring Centre for Drugs and Drug Addiction (EMCDDA),
2010a). It quickly disappeared into academic obscurity after being banned due to reports of
acute toxicity (de Buruaga and Sanchez, 1933). Mephedrone was re-detected in 2003 by a
black market chemist who enthusiastically promulgated its effects on ‘‘The Hive’’ web site
(Morris, 2010a). In addition, since 2004, a related form of synthesized cathinone derived from
the khat plant ‘‘Catha Edulis’’ emerged in Israel and was known as ‘‘hagigat’’.
Mephedrone was initially identified by drug trend monitoring project Psychonaut Research
Project in 2008 (Psychonaut Web Mapping Project, 2009; McElrath and O’Neill, 2011), which
acknowledged an online presence in 2007 (Power, 2009). The first seizure of mephedrone
occurred in France in summer of 2007, inspiring a paper entitled ‘‘Is 4-methylephedrone
an ‘ecstasy’ of the twenty first century?’’ (Roussel et al., 2009). An Israeli company called
‘‘Neorganics’’ (Bentur et al., 2008; Power, 2009; Doward and Shah, 2009) sold mephedrone
in ‘‘Neodoves’’ tablets until 2008 when it was illegalised (Davies et al., 2009; Camilleri et al.,
2010). Its presence was noted by Europol in 2008 (Europol – EMCDDA, 2008) and in
the USA by the Drug Enforcement Administration in 2009 (The Drug Enforcement
Administration, 2009). Mephedrone use quickly escalated in the 22 EU member states, the
USA and Australia (Guppy, 2008; Europol EMCDDA, 2010a; Long, 2010; Oyemade, 2010;
Winstock and Ramsey, 2010; Matthews and Bruno, 2010; Winstock et al., 2011a;
Goodnough and Zezima, 2011; Brauser, 2012).
Initially available legally and over-the-counter at ‘‘headshops’ ’[3] and online sites,
mephedrone sold for a fraction of the price of its illegal counterparts (Watson, 2010; van
Hout and Brennan, 2011b). It was most commonly sold as an off-white powder (Olives et al.,
2012), and primarily designed for insufflation and oral administration (Schifano et al., 2010).
The emergence of mephedrone as a fashionable trend was first witnessed on the gay and
underground techno scene, by weekend ‘‘clubbers’’, psychonauts and the student
population (Psychonaut Web Mapping Research Group, 2009; Europol – EMCDDA, 2010a).
Users at the time reported mostly positive outcomes leading to some drug displacement
patterns from illicit to licit drug use (Measham et al., 2010; van Hout and Brennan, 2011c;
McElrath and O’Neill, 2011). This preference for mephedrone was related to its comparable
low cost, online availability and perceived low health risk, along with reduced quality of illicit
party drugs ecstasy and cocaine at that time (Psychonaut Web Mapping Research Group,
2009; van Hout and Brennan, 2011c; Winstock et al., 2011a). The EMCDDA issued an early
warning in 2008 (Europol EMCDDA, 2010b; van Hout and Brennan, 2011c) for coordinated
efforts from policy makers, scientific researchers and media to address the increasingly
complex legal drug market (van Hout, 2012). It attracted sensationalistic media coverage
reminiscent of the tabloid propagated anti-ecstasy hysteria in the late 1980s and 1990s
(Ryall and Butler, 2011; Sare, 2011; van Hout and Brennan, 2011c; Forsyth, 2012). In 2010
and 2011, the media reported graphically on mephedrone associated hallucinations,
psychosis, self-mutilation and fatalities (Sare, 2011). Subsequent legislative controls were
enacted throughout the UK, Europe and in parts of the USA to criminalise the sale of new
psychoactive substances such as mephedrone (Bannon, 2010; Oyemade, 2010; Watson,
2010; Kmietowicz, 2010; Olives et al., 2012).
Despite such controls, mephedrone and other substitute cathinones remained embedded
in contemporary drug culture (Bertrand et al., 2011; Toth et al., 2011) through blending with
street drugs and internet retail, with re-structuring of product compounds designed
PAGE 242
j
DRUGS AND ALCOHOL TODAY
j
VOL. 12 NO. 4 2012
to circumvent legislation (van Hout and Brennan, 2011c). Research underscores
mephedrone’s rising popularity amongst ‘‘clubbers’’ who favour it as their drug of choice
(Winstock et al., 2010; Measham et al., 2011a, b) and continue to source it easily (Olives et al.,
2012; Measham and Dargan, 2012). The development of riskier trajectories within intravenous
drug user groups has also been documented since 2010 (van Hout and Bingham, 2011;
Brauser, 2012). Post legislation, prolific media reporting on mephedrone-implicated deaths
continues (Warren, 2011; Olives et al., 2012). Mephedrone has been implicated as an
escalating public health risk, with increasing mortality and toxicity case reporting (Sinclair,
2011; Olives et al., 2012). The majority of the limited but building research into mephedrone is
EU based (Schifano et al., 2010; Winstock et al., 2010; van Hout and Brennan, 2011c).
Recently, there is insufficient research available with regard to long-term effects, toxicity, drug
action and clinical symptomology (Sammler et al., 2010; Toth et al., 2011) to fully equip
emergency physicians in the development of appropriate diagnosis and treatment strategies
(Olives et al., 2012). The failure of legislative control to sufficiently reduce mephedrone’s
consumptive popularity and availability also has implications regarding drug policy
(Winstock et al., 2010; Wood et al., 2012). The review was conducted to present a
collective base of recent empirical research and literature on mephedrone, in order to present
information relating to prevalence and user groups, toxicology and pharmacology, user
reports on drug outcomes, user sourcing and implications on contemporary drug practice
and policy.
Methodology
The researchers conducted the review according to PRISMA guidelines for systematic review
(Moher et al., 2009). Original empirical research in relation to mephedrone was collected
using electronic databases EBSCO Host, ScienceDirect, PubMed, EMBASE, PsycINFO,
Scopus and Google Scholar. The researchers used the key search term ‘‘mephedrone’’ and
product nomenclature ‘‘Plant Food’’, ‘‘Feeder’’, ‘ ‘Meow Meow’’, ‘ ‘Miaow’’, ‘‘Drone’’, ‘‘Meph’
‘‘Bubbles’’, ‘‘Charge’’, and ‘‘MCat’ ’to identify relevant publications containing information on
mephedrone. The search was restricted to publications from 2009 to 2012, and produced 702
results. Data were collected by one member of the research team and cross checked by
another. A primary screening was carried out to exclude inaccurate search results, and drugs
other than mephedrone. The results were studied and duplicates removed. In total, 598 results
were discarded, with 104 deemed suitable for inclusion.
Results
The researchers extracted the data into five categories namely; qualitative, quantitative and
mixed method research; clinical trials; laboratory analysis of products; editorials, reviews
and reports; and clinical case studies. A thematic analysis of key findings was then conducted
and presented as follows: ‘‘pharmacology and toxicology of mephedrone’’; ‘‘prevalence of
use and user groups’’; ‘‘user experiences’’ and ‘‘implications for practice and policy’’.
Pharmacology and toxicology of mephedrone
Mephedrone is a phenethylamine research chemical with stimulant and empathogenic
properties comparable to MDMA, amphetamine and cocaine (Psychonaut Web
Mapping Research Group, 2009; Bajaj et al., 2010; EMCCDA, 2011a; Kelly, 2011; Martı
´nez-
Clemente et al., 2011; Ramoz et al., 2012). It is related to the stimulant cathinone, found in the
Khat plant ‘‘Catha Edulis’’ (Gibbons and Zloh, 2010). Although first synthesized in 1933
(de Buruaga and Sanchez, 1933), there is sparse pharmacological research to date on
mephedrone as a compound (Psychonaut Web Mapping Research Group, 2009; Gibbons
and Zloh, 2010; Hadlock et al., 2011; Schifano et al., 2011). Methyl-cathinones are similar in
drug outcomes to illicit stimulants such as methamphetamine and MDMA (Gibbons
and Zloh, 2010; Martı
´nez-Clemente et al., 2011; Meng et al., 2012; Motbey et al., 2012;
Ramoz et al., 2012) and act through the release and reuptake inhibition of 5-HT (serotonin)
(Hill and Thomas, 2011; Schifano et al., 2011). Toxicity and patterns of use are also similar
to other stimulants (Dargan and Wood, 2010; Wood et al., 2010a; Hill and Thomas, 2011;
VOL. 12 NO. 4 2012
j
DRUGS AND ALCOHOL TODAY
j
PAGE 243
Rosenbaum et al., 2012; Olives et al., 2012; Sivagnanam, 2012; Winstock and Mitcheson,
2012; Wood and Dargan, 2012). However, mephedrone has a distinctive profile with potential
for neurotoxicity leading to acute sympathomimetic toxidrome[4] (Wood et al., 2010c;
Hadlock et al., 2011; Spiller et al., 2011; van Hout and Bingham, 2011). Both anecdotal user
reporting (Psychonaut Web Mapping Research Group, 2009; Advisory Council on the Misuse
of Drugs (ACMD), 2010; Dargan et al., 2010; Winstock et al., 2010; James et al., 2010; Burillo-
Putze et al., 2011; van Hout and Bingham, 2011; McElrath and van Hout, 2011; Olives et al.,
2012) and emergency services case reports discuss mephedrone-related symptomology
including agitation (Sammler et al., 2010; Goodnough and Zezima, 2011; Morbidity and
Mortality Weekly Report (MMWR), 2011; Lusthof et al., 2011; Mackay et al., 2011; Wood et al.,
2011; Kasick et al., 2012), convulsions (Omer and Doherty, 2011), headaches, tinnitus,
infection (McElrath and van Hout, 2011), ulceration, kidney pain and injury (Adebamiro and
Perazella, 2012), numbing sensations, methaemoglobinaemia (Ahmed et al., 2010; van Hout
and Bingham, 2011), psychosis (Bajaj et al., 2010; Mackay et al., 2011; MMWR, 2011;
Spiller et al., 2011; Urban et al., 2011; van Hout and Bingham, 2011), emphysema (Maan and
D’Souza, 2011), hypertension, cardiotoxicity (Psychonaut Web Mapping Research Group,
2009; Davies et al., 2010c; Wood et al., 2010a, 2011; MMWR, 2011; Regan et al., 2011;
Adebamiro and Perazella, 2012; Grandy, 2012; Meng et al., 2012; Motbey et al., 2012;
Olives et al., 2012), and serotonin syndrome (Garrett and Sweeney, 2010).
Prevalence of use and user groups
Pre- and post-legislation, mephedrone’s popularity has been on a steadfast incline amongst a
variety of user groups. Most prevalent in the UK (Elwell, 2010; Schifano et al., 2010;
Winstock et al., 2010), mephedrone also has an increasing presence in over 20 EU member
states (Europol EMCDDA, 2010a). Growing numbers of detections have also been made in
Australia (Bruno et al., 2011; Ness and Payne, 2011; Toby et al., 2011) and in the USA where
mephedrone is still legal in some states (Goodnough and Zezima, 2011; Brauser, 2012). Most
in vogue with polydrug users who frequent the techno and clubbing scene (Baker, 2010;
Europol – EMCDDA, 2010a, b; Bruno et al., 2011; Hill and Thomas, 2011; Corkery et al., 2012;
Wood et al., 2012), mephedrone is primarily a party drug with main settings of use being
nightclubs and house parties (Newcombe, 2009; Wood et al., 2010b; Winstock et al., 2010;
Hill and Thomas, 2011). Its popularity on party drug markets was embraced by seasoned
polydrug users and psychonauts unable to source high-quality MDMA and cocaine
(Psychonaut Web Mapping Research Group, 2009; Baker, 2010; Elwell, 2010; Bruno et al.,
2011; Karila and Reynaud, 2011; Wood et al., 2012). Consequently, mephedrone was
commonly used as an MDMA substitute in ecstasy tablets throughout 2010, indicating its
future market potential on the global drug scene (Brunt et al., 2010). It remains popular on the
gay clubbing scene (van Hout and Brennan, 2011a) with recent research in this area pointing
to mephedrone becoming the primary drug of choice (Measham et al., 2011b). Mephedrone
use has also been reported among a younger demographic of students and teenagers
(Dargan et al., 2010; Maddern, 2010; Carhart-Harris et al., 2011; Hill and Thomas, 2011;
Measham et al., 2011a; McElrath and van Hout, 2011; Brauser, 2012). Intravenous use and
groin injecting of mephedrone have been reported in opiate drug using and street injecting
groups (van Hout and Bingham, 2011).
User sourcing
Mephedrone users prior to legislative control reported sourcing thedrug online, in ‘‘headshops’’
and through dealers and peer networks (Kavanagh et al., 2010; Schifano et al., 2010; van Hout
and Brennan 2011b, c; McElrath and O’Neill, 2011; van Hout and Bingham, 2011; van Hout,
2012). Internet sale has beena powerful ally to pre- and post-ban popularity of psychostimulant
such as mephedrone and other substitute cathinones (Psychonaut Web Mapping Research
Group, 2009; Winstock et al., 2010; Davey et al., 2010; Jones, 2010; Burillo-Putze, 2011;
Measham,2011; Vardakouet al., 2011; Prosserand Nelson, 2011; Solberg, 2012; Davies, 2012;
Forsyth, 2012). Selling under user identifiable nomenclature such as ‘‘Plantfood’’ ‘‘Feeder’’ and
‘‘Bath Salts’’ to name but a few (Schifano et al., 2010) online vending sites have multiplied at an
exponential rate (Psychonaut Web Mapping Research Group, 2009; van Hout, 2012).
The majority of identifiable products containing mephedrone disappeared after the UK issued
PAGE 244
j
DRUGS AND ALCOHOL TODAY
j
VOL. 12 NO. 4 2012
a blanket ban on mephedrone containing products in April 2010, but have since remerged
under new branding, revised compounding and packaging (Brandt et al., 2010; Oyemade,
2010). Substitutes for mephedrone (i.e. NRG-1, NRG-2; MDAi, methylenedioxypyrovalerone
(MDPV)) are currently on sale online, and some of these products have also tested positive for
mephedrone (Brandt et al., 2010). Mephedrone’s street availability also continued after
legislative controls had been introduced, through peer groups and dealers, indicative of stock
piling and internet sourcing (Kelly, 2011; Toth et al., 2011; Measham et al.,2011c;McElrathand
O’Neill, 2011; Wood et al., 2012). Prices ranged between £10 and 15 per gram (ACMD, 2010),
with some street pricing increasing and increased levels of web retail sites offering home
delivery after legislative controls (Psychonaut Web Mapping Research Group, 2009; Vardakou
et al., 2011; van Hout, 2012). The online sale of new psychoactive substances containing
controlled substances remains of global concern (Solberg, 2012) withdrug retail web sites such
as ‘‘Silk Road’’ (Barratt, 2012) changing the face of contemporary drug markets (Davies et al.,
2010b; Long, 2010; Ramsey et al.,2010).
User experiences
Insufflation and oral ingestion were reportedly the most common routes of administration, and
with prolonged and binge drug-taking experiences attributing to cravings and frequent
redosing of the drug within prolonged drug-taking episodes[5] (Deluca et al., 2009; Europol
EMCDDA, 2010b; Schifano et al., 2010; Long, 2010; Elwell, 2010; Brunt et al., 2010;
Dargan et al., 2010; Vardakou et al., 2011; Davies et al., 2010c; Carhart-Harris et al., 2011; van
Hout and Brennan, 2011c; Regan et al., 2011; Hadlock et al., 2012; Freeman et al., 2012;
Olives et al., 2012). Users of mephedrone described desirable empathogenic, entactogenic
and euphoriant effects typical of psychoactive stimulant consumption, such as sensory
enhancement, talkativeness, increased energy and impulsivity, and heightened sexual
arousal (Psychonaut Web Mapping Research Group, 2009; Brunt et al., 2010; Davey et al.,
2010; Debruyne et al., 2010; Dixon, 2010; Europol EMCDDA, 2010a; Hadlock et al., 2011;
Morris, 2010b; Martı
´nez-Clemente et al., 2011; Measham et al., 2010, 2011a; Winstock et al.,
2010; van Hout and Brennan, 2011a; McElrath and van Hout, 2011; Prosser and Nelson, 2011;
Winstock et al., 2011b; Freeman et al., 2012) lasting between 30 minutes and four hours
dependent on dosage and route of administration (Schifano, 2010; Olives et al., 2012). The
drug-taking episode reportedly occurs similarly to that of traditional stimulant drugs of choice
such as MDMA and amphetamine (Morris, 2010b; Debruyne et al., 2010; Brunt et al., 2010;
Burillo-Putze, 2011; Hadlock et al., 2011; Martı
´nez-Clemente et al., 2011; Measham et al.,
2011a; Schifano et al., 2011; Freeman et al., 2012), with some users reporting mephedrone as
giving a more discreet and socially acceptable high (McElrath and van Hout, 2010; van Hout
and Brennan, 2011b, c). Unpleasant side effects include agitation, palpitations, chest pain,
tremors, nausea, anxiety, headache, infections, sweating with distinct acidic odour and
negative comedown symptomatologies (ACMD, 2010; Dargen et al., 2010; Burillo-Putze et al.,
2011; Durham, 2011; Fass et al., 2012; Goodnough and Zezima, 2011; James et al., 2010;
Morris, 2010b; McElrath and van Hout, 2011; van Hout and Bingham, 2011; Olives et al., 2012;
Sinclair, 2011; Winstock et al., 2010). Injectors of mephedrone experienced more chronic
effects such as profuse sweating, weight loss, necrotizing fasciitis[6], long-term numbness in
extremities and development of lower extremity spasms and tremors similar to that of
Parkinson’s disease (van Hout and Bingham, 2011; Brauser, 2012).
Implications for practice and policy
Legislative control has been exercised over mephedrone in the UK (Kmietowicz, 2010) and
many other countries in recent times, yet the novel psychoactive drug market is an
aggressive, dynamic and opportunistic animal (Schifano et al., 2010). An initial post-ban
reduction in popularity and in clinical presentations of mephedrone toxicity may have
indicated some legislative success (Wood et al., 2011; van Hout and Brennan, 2012).
However, research indicates that mephedrone’s displacement from a licit to an illicit drug
market has had little impact on prevalence and patterns of use (Barrett, 2010; Kelly, 2011;
Measham et al., 2011b; National Services Scotland Information Services Division (NSSISD),
2011; Toth et al., 2011; Wood et al., 2012). Mephedrone’s continued post-ban popularity with
loyal user groups illustrates the failure of legislative control to curb its lifespan within the
VOL. 12 NO. 4 2012
j
DRUGS AND ALCOHOL TODAY
j
PAGE 245
dynamic global drug scene (Schifano et al., 2010; Kelly, 2011; Measham et al., 2011b, c;
Corkery et al., 2012; Wood et al., 2012). The successful infiltration of the party drug market
by mephedrone has been largely attributable to its dedicated user base, and continued
online promotion (Measham, 2011). Purchaser anonymity and ease of transaction in the
cyber drugs market, along with discussion forums of communication between users are of
concern (Jones, 2010; Vardakou et al., 2011; Forsyth, 2012). Media sensationalism has also
contributed to the hype surrounding mephedrone and other new psychoactive substances
(Forsyth, 2012; Sare, 2011). Next generation highs set to replace mephedrone in the global
drug market of synthetic stimulants include ‘‘Ivory Wave’’ (Durham, 2011) and MDPV who
have also been marketed as ‘‘Bath Salts’’ (Brandt et al., 2010; Sinclair, 2011).
Of concern given mephedrone’s misuse potential, is that research in the UK has reported
cases of mephedrone toxidrome as being on a steady incline (James et al., 2011). The
current evidence base underscores the difficulties in assessing, detecting and treating
cases of mephedrone use given the co occurrence with poly drug-taking and associated
mental health conditions. Recently, documented clinical outcomes in the USA have reported
on multisystem failure resulting from mephedrone use (Grandy, 2012). Mephedrone
continues to be implicated through post-mortem examination in the UK (Davies et al.,
2010c). The review points to the need for further research into the pharmacology and toxicity
of mephedrone (Schifano et al., 2010, 2011; Spiller et al., 2011; Prosser and Nelson, 2011;
Corkery et al., 2012; Hughes and Winstock, 2012; Rosenbaum et al., 2012) in order to better
equip clinicians with assessment, diagnosis and emergency care treatment
strategies to reduce morbidity (Dargan and Wood, 2010; Olives et al., 2012; Prosser and
Nelson, 2011; Schifano et al., 2011; Corkery et al., 2012; Hughes and Winstock, 2012;
Rosenbaum et al., 2012).
Finally, the increasingly diversified new psycho stimulant market where mephedrone is a
major player poses unprecedented challenges for drug surveillance, policy, community and
clinical practice (Watson, 2010; Winstock and Wilkins, 2011; Dunn et al., 2011; Sumnall et al.,
2011; Davies et al., 2012; Winstock and Mitcheson, 2012). Some research suggests that the
health risks posed by the use of mephedrone and its successors warrants continued
pharmacovigilence, monitoring of use and user groups, and timely drug policy, and at the
very least consumer information (Fass et al., 2012; Kmietowicz, 2011). Stricter legislative
controls including Internet vendor responsibility for supply of mephedrone have been
suggested, along with raising public awareness on an international level through
coordinated efforts (Schifano et al., 2010; Winstock et al., 2010; ACMD, 2010; Barrett,
2010; Spiller et al., 2011; Kmietowicz, 2011; Corkery et al., 2011; Europol EMCDDA, 2011;
Hughes and Winstock, 2012). A pragmatic response to emergent, dynamic and novel drug
trends is needed (Measham et al., 2010; Sare, 2011; van Hout, 2012). Proactive measures
such as evidence-based harm reduction cannot be ignored in a climate of ineffectual
reactive control measures (Dixon, 2010; Govier, 2011; Karila and Reynaud, 2011; Hughes
and Winstock, 2012; Willson, 2011).
Notes
1. ‘‘Plantfood’ ’ is used as a term for products containing mephedrone, MDPV and other
psychostimulants, products are also known as ‘‘Bath Salts’’.
2. Empathogenic drugs produce a sense of empathy with social and emotional effects such as
increased feelings of bonding, connectivity and understanding between users, principal example
being MDMA or ecstasy.
3. A head shop is a retail outlet which specialises in drug paraphernalia related to consumption of
cannabis, other recreational drugs, and new age herbs, as well as counterculture art, magazines,
music, clothing and home decor.
4. Specific syndrome like group of symptoms associated with exposure to a given poison (in this case
mephedrone), which is recognized by an advanced state of toxicity with symptoms such as
tachycardia, hypertension, cardiac arrhythmia and agitation.
PAGE 246
j
DRUGS AND ALCOHOL TODAY
j
VOL. 12 NO. 4 2012
5. Mephedrone gives a short lived ‘‘high’’ or ‘‘peak’ ’ where users experience the most powerful
desirable effects of use. This is followed by a rapid ‘‘come-down’’ period, creating cravings and
urges to ingest additional dosages throughout a drug using episode. This is known as redosing.
6. Rare but deadly bacterial infection often found in injection sites in the arm or groin or intravenous
drug users.
References
ACMD (2010), ‘‘Advisory Council on the Misuse of Drugs on consideration of the cathinones’’, Advisory
Council on the Misuse of Drugs, available at: www.homeoffice.gov.uk/publications/drugs/acmd1/acmd-
cathinodes-report-2010 (accessed 22 March 2012).
ACMD (2011), Consideration of the Novel Psychoactive Substances (‘‘Legal Highs’’), 1st ed.,
Home Office, London.
Adebamiro, A. and Perazella, M.A. (2012), ‘‘Recurrent acute kidney injury following bath salts
intoxication’’, American Journal of Kidney Diseases, Vol. 59 No. 2, pp. 273-5.
Ahmed, N., Sew Hoy, P.B. and McInerney, J. (2010), ‘‘Methaemoglobinaemia due to mephedrone
(‘snow’)’’, British Medical Journal Case Reports, doi: 10.1136/bcr.04.2010.2879.
Bajaj, N., Mullen, D. and Wylie, S. (2010), ‘‘Dependence and psychosis with 4-methylmethcathinone
(mephedrone) use’’, British Medical Journal Case Reports, doi: 10.1136/bcr.02.2010.2780.
Baker, M. (2010), ‘‘A study into the recreational use of mephedrone among regular, poly-drug users’’,
MSc dissertation, University of Portsmouth, Portsmouth, unpublished.
Bannon, M. (2010), ‘‘So called legal highs’’, Quarterly Journal of Medicine, Vol. 103 No. 10,
pp. 725-6.
Barratt, M.J. (2012), ‘‘Silk road: eBay for drugs’’, Addiction, Vol. 107 No. 3, p. 683.
Barrett, D. (2010), ‘‘Why a new UN resolution on ‘legal highs’ matters’’, The Huffington Post, available at:
www.huffingtonpost.co.uk/politics (accessed 12 May 2012).
Bentur, Y., Bloom-Krasik, A. and Raikhlin-Eisenkraft, B. (2008), ‘‘Illicit cathinone (‘Hagigat’) poisoning’’,
Clinical Toxicology, Vol. 46 No. 3, pp. 206-10.
Bertrand, X., Gensburger, M. and Steckx, E. (2011), ‘‘Mephedrone’’, Revue Medicale de Liege, Vol. 66
No. 10, pp. 540-4.
Brandt, S.D., Sumnall, H.R., Measham, F. and Cole, J. (2010), ‘ ‘Second generation mephedrone: the
confusing case of NRG-1’’, British Medical Journal, Vol. 341, p. 3564.
Brauser, D. (2012), ‘‘Injection of ‘bath salts’ linked to necrotizing fasciitis’’, Orthopedics, Vol. 35,
pp. 124-7.
Bruno, R., Matthews, A.J., Dunn, M., Alati, R., McIlwraith, F., Hickey, S., Burns, L. and Sindicich, N.
(2011), ‘‘Emerging psychoactive substance use among regular ecstasy users in Australia’’, Drug and
Alcohol Dependence, Vol. 124 Nos 1/2, pp. 19-25.
Brunt, T.M., Poortman, A., Niesink, R.J. and van den Brink, W. (2010), ‘‘Instability of the ecstasy
market and a new kid on the block: mephedrone’’, Journal of Psychopharmacology, Vol. 25 No. 11,
pp. 1543-7.
Burillo-Putze, G., Dominguez-Rodriguez, A., Abreu-Gonzalez, P. and Nogue Xarau, S. (2011), ‘‘Khat,
Mephedrone & Chest Pain’’, Med Clin (Barc), Vol. 137 No. 15, pp. 712-3.
Camilleri, A., Johnston, M., Brennan, M., Davis, S. and Caldicott, D. (2010), ‘‘Chemical analysis of four
capsules containing the controlled substance analogues 4-methylmethcathinone,
2-fluoromethamphetamine, alpha-phthalimidopropiophenone and N-ethylcathinone’’, Forensic
Science International, Vol. 197 Nos 1-3, pp. 59-66.
Carhart-Harris, R.L., King, L.A. and Nutt, D. (2011), ‘‘A web-based survey on mephedrone’’, Drug and
Alcohol Dependence, Vol. 118 No. 1, pp. 19-22.
Corkery, J.M., Schifano, F. and Ghodse, A.H. (2012), ‘‘Mephedrone-related fatalities in the United
Kingdom: contextual, clinical and practical issues’’, in Gallelli, L. (Ed.), Pharmacology,
InTech, Croatia.
VOL. 12 NO. 4 2012
j
DRUGS AND ALCOHOL TODAY
j
PAGE 247
Corkery, J., Schifano, F. and Corazza, O. (2011), Consideration of the Novel Psychoactive Substances
(‘‘Legal Highs’’), Health and Human Sciences Research Institute, Hatfield, available at: http://hdl.
handle.net/2299/7490 (accessed 24 March 2012).
Dargan, P.I., Albert, S. and Wood, D.M. (2010), ‘‘Mephedrone use and associated adverse effects in
school and college/university students before the UK legislation change’’, Quarterly Journal of Medicine,
Vol. 103, pp. 875-9.
Davey, Z., Corazza, O., Schifano, F., Deluca, P. and Psychonaut Web Mapping Group (2010),
‘‘Mass-information: mephedrone, myths, and the new generation of legal highs’’, Drugs and Alcohol
Today, Vol. 10, pp. 24-8.
Davies, B. (2012), ‘‘Dangerous drugs online’’, The Australian Prescriber, Vol. 35 No. 1, pp. 32-3.
Davies, S., Ramsey, J. and Archer, R. (2009), Analytical Profiles of Methcathinone Related Compounds,
London Toxicology Group, London, available at: www.ltg.uk.net/admin/files/Methcathinones.pdf
(accessed 12 March 2012).
Davies, S., Button, J., Archer, R. and Holt, D. (2010a), Methcathinone Derivatives: Findings from Test
Purchases of Capsules and Powders from the Internet, St George’s University of London, London.
Davies, S., Wood, D.M., Smith, G., Button, J., Ramsey, J., Archer, R., Holt, D.W. and Dargan, P.I. (2010b),
‘‘Purchasing ‘legal highs’ on the internet – is there consistency in what you get?’’, Quarterly Journal of
Medicine, Vol. 103, pp. 489-93.
Davies, S., Puchnarewicz, M., Button, J., Dargan, P.I., Wood, D.M., Archer, R., Ramsey, J., Lee, T. and Holy,
D.W. (2010c),Two Cases of Confirmed Ingestion of the Novel Designer Compounds: 4-Methyl methcathinone
(Mephedrone) and 3-Fluoromethcathinone, St George’s University of London, London.
de Buruaga and Sanchez, J. (1933), ‘‘Revista de la Academia de Ciences’’, Vol. 29, p. 199.
Debruyne, D., Courne, M.A., Le Boisselier, R., Djezzar, S., Gerardin, M., Boucher, A., Karila, L.,
Coquerel, A. and Mallaret, M. (2010), ‘‘La me
´phe
´drone: une designer drug d’usage re
´cent en France’’,
Therapie, Vol. 65 No. 6, pp. 519-24.
Deluca, P., Schifano, F., Davey, Z., Corazza, O., Di Furia, L. and The Psychonaut Web Mapping Research
Group (2009), Mephedrone Report, Institute of Psychiatry Kings College, London.
Dixon, B. (2010), ‘‘Worries over legal drugs’’, Current Biology, Vol. 20 No. 7, pp. 298-9.
Doward, J. and Shah, O. (2009), ‘‘There are many drugs that help people get out of their minds yet stay
within the law – they’re called ‘legal highs’’’, The Observer, available at: www.guardian.co.uk/politics/
2009/apr/26/drugs-legal-substances-highs (accessed 24 March 2012).
Dunn, M., Bruno, R., Burns, L. and Roxburgh, A. (2011), ‘‘Effectiveness of and challenges faced by
surveillance systems’’, Drug Test Analysis, Vol. 3, pp. 635-41.
Durham, M. (2011), ‘‘Ivory wave: the next mephedrone?’’, Emergency Medical Journal, Vol. 28 No. 12,
pp. 1059-60.
Elwell, A. (2010), ‘‘Britain moves to curtail new drug craze’’, Canadian Medical Association Journal,
Vol. 182 No. 9, pp. 393-4.
EMCDDA (2011), Report on the Risk Assessment of Mephedrone in the Framework of the Council
Decision on New Psychoactive Substances, European Monitoring Centre for Drugs and Drug Addiction,
Lisbon.
Europol – EMCDDA (2008), EMCDDA 2008 Annual Report, European Monitoring Centre for Drugs and
Drug Addiction, Lisbon.
Europol – EMCDDA (2010a), Joint Report on a New Psychoactive Substance: 4-Methylmethcathinone
(Mephedrone), European Monitoring Centre for Drugs and Drug Addiction, Lisbon.
Europol – EMCDDA (2010b), Risk Assessment of New Psychoactive Substances – Operating
Guidelines, European Monitoring Centre for Drugs and Drug Addiction, Lisbon.
Europol – EMCDDA (2011), Report on the Risk Assessment of Mephedrone in the Framework of the
Council Decision on New Psychoactive Substances, European Monitoring Centre for Drugs and Drug
Addiction, Lisbon.
PAGE 248
j
DRUGS AND ALCOHOL TODAY
j
VOL. 12 NO. 4 2012
Fass, J.A., Fass, A.D. and Garcia, A.S. (2012), ‘‘Synthetic cathinones (bath salts): legal status and
patterns of abuse’’, The Annals of Pharmacotherapy, Vol. 46 No. 3, pp. 436-41.
Forsyth, A.J.M. (2012), ‘‘Virtually a drug scare: mephedrone and the impact of the internet on drug news
transmission’’, International Journal of Drug Policy, Vol. 23 No. 3, pp. 198-209.
Freeman, T.P., Morgan, C., Vaughn-Jones, J., Hussain, N., Karimi, K. and Curran, V. (2012), ‘‘Cognitive
and subjective effects of mephedrone and factors influencing use of a ‘new legal high’’’, Addiction,
Vol. 107 No. 4, pp. 792-800.
Garrett, G. and Sweeney, M. (2010), ‘‘The serotonin syndrome as a result of mephedrone toxicity’’,
British Medical Journal Case Reports, doi: 10.1136/bcr.04.2010.2925.
Gibbons, S. and Zloh, M. (2010), ‘‘An Analysis of the Legal High Mephedrone’’, Bioorg Med Chem Lett,
Vol. 20 No. 14, pp. 4135-9.
Goodnough, A. and Zezima, K. (2011), ‘‘An alarming new stimulant, sold legally in many states’’,
NYTimes.com, available at www.nytimes.com/2011/07/17/us/17salts.html (accessed 24 May 2012).
Govier, M. (2011), ‘Research chemicals: an approach to filling the information gap’’, Drugs and Alcohol
Today, Vol. 11 No. 2, pp. 71-6.
Grandy, J.K. (2012), ‘‘Case report: drug toxicity following trip to the local head shop’ ’, The Journal of
Urgent Care Medicine, Vol. 6 No. 9, pp. 22-5.
Guppy, D. (2008), ‘‘Killer pills hit Cairns’ ’, Cairns.com.au, available at: www.cairns.com.au/article/2008/
06/18/4685_local-news.html (accessed 27 June 2012).
Hadlock, G.C., Webb, K.M., McFadden, L.M., Wen Chu, P., Ellis, J.D., Allen, S.C., Andrenyak, D.M.,
Vieira-Brock, P.L., German, C.L., Conrad, K.M., Hoonakker, A.J., Gibb, J.W., Wilkins, D.G., Hanson, G.R. and
Fleckenstein, A.E. (2011), ‘‘4-Methylmethcathinone (mephedrone):neuropharmacological effects of a designer
stimulant of abuse’’, Journal of Pharmacology and Experimental Therapeutics,Vol.339No.2,pp.530-6.
Hill, S. and Thomas, S.H. (2011), ‘‘Clinical toxicology of newer recreational drugs’’, Clinical Toxicology,
Vol. 49 No. 8, pp. 705-19.
Hughes, B. and Winstock, A.R. (2012), ‘‘Controlling new drugs under marketing regulations’’, Addiction,
Vol. 107 No. 11, pp. 1894-9.
James, D., Adams, R.D., Spears, R., Cooper, G., Lupton, D.J. and Thompson, J.P. (2010), ‘‘Clinical
characteristics of mephedrone toxicity reported to the UK National Poisons Information Service’’,
Emergency Medicine Journal, Vol. 28 No. 8, pp. 686-9.
James, D., Adams, R.D., Spears, R., Cooper, G., Lupton, D.J., Thompson, J.P., Thomas, S.H. and on behalf
of the National PoisonsInformation Service(2011), ‘‘Clinical characteristics of mephedrone toxicityreported
to the UK National Poisons Information Service’’, Emergency Medical Journal, Vol. 28 No. 8, p. 686.
Jones, A.L. (2010), ‘‘Legal ‘highs’ available through the internet-implications and solutions?’ ’, Quarterly
Journal of Medicine, Vol. 103 No. 7, pp. 535-6.
Karila, L. and Reynaud, M. (2011), ‘‘GHB and synthetic cathinones: clinical effects and potential
consequences’’, Drug Testing and Analysis, Vol. 3 No. 9, pp. 552-9.
Kasick, D.P., McKnight, C.A. and Klisovic, E. (2012), ‘ ‘‘Bath salt’: ingestion leading to severe intoxication
delirium: two cases and a brief review of the emergence of mephedrone use’’, The American Journal of
Drug and Alcohol Abuse, Vol. 38 No. 2, pp. 176-80.
Kavanagh, P.V., McNamara, S., Angelov, D., McDermott, S., Mullan, D. and Ryde, S.A. (2010), The
Characterization of ‘‘Legal Highs’’ Available from Head Shops in Dublin, The Drug Treatment Centre
Board, Dublin.
Kelly, B.D. (2011), ‘‘Head shop drugs: they haven’t gone away’’, Irish Journal of Psychological Medicine,
Vol. 28 No. 1.
Kmietowicz, Z. (2010), ‘‘Home secretary bans mephedrone after taking advice from depleted council’’,
British Medical Journal, Vol. 340, p. 1784.
Kmietowicz, Z. (2011), ‘‘Whole class ban on substances is needed to control designer drugs, says UN
agency’’, British Medical Journal, Vol. 342, p. 1450.
VOL. 12 NO. 4 2012
j
DRUGS AND ALCOHOL TODAY
j
PAGE 249
Long, J. (2010), ‘‘Headshop drugs across Europe: data from the EMCDDA’’, paper presented at the
National Regional Drugs Task Force ‘ ‘Legal Highs’’ Conference, Mullingar, Ireland, January.
Lusthof, K.J., Oosting, R., Maes, A., Verschraagen, M., Dijkhuizen, A. and Sprong, A.G. (2011), ‘‘A case
of extreme agitation and death after the use of mephedrone in The Netherlands’’, Forensic Science
International, Vol. 206 Nos 1-3, pp. 93-5.
McElrath, K. and O’Neill, C. (2011), ‘‘Experiences with mephedrone pre- and post-legislative controls:
perceptions of safety and sourcesof supply’ ’, International Journal of Drug Policy, Vol. 22 No. 2, pp. 120-7.
McElrath, K. and van Hout, M.C. (2011), ‘‘A preference for mephedrone: drug markets, drugs of choice
and the emerging ‘legal high’ scene’’, Journal of Drug Issues, Vol. 41 No. 4, pp. 487-507.
Maan, Z.N. and D’Souza, A.R. (2011), ‘‘Spontaneous subcutaneous emphysema associated with
mephedrone usage’’, Annals of the Royal College of Surgeons of England, Vol. 94 No. 1, pp. 38-40.
Mackay, K., Taylor, M. and Bajaj, N. (2011), ‘‘The adverse consequences of mephedrone use: a case
series’’, The Psychiatrist, Vol. 35, pp. 203-5.
Maddern, K. (2010), ‘‘Schools wage war on ‘meow meow’ as pupils lap up new ‘legal high’’’, Times
Educational Supplement, Vol. 4874 No. 2, pp. 18-19.
Martı
´nez-Clemente, J., Escubedo, E., Pubill, D. and Camarasa, J. (2011), ‘‘Interaction of mephedrone
with dopamine and serotonin targets in rats’’, European Neuropsychopharmacology, Vol. 22 No. 3,
pp. 231-6.
Matthews, A. and Bruno, R. (2010), Mephedrone Use Among Regular Ecstasy Consumers in Australia:
EDRS Drug Trends Bulletin, National Drug and Alcohol Research Centre and University of New South
Wales, Sydney, December.
Measham, F. (2011), ‘‘Legal highs: the challenge for government’ ’, Criminal Justice Matters, Vol. 84
No. 1, pp. 28-30.
Measham, F., Moore, K. and Østergaard, J. (2011a), ‘‘Emerging drug trends in Lancashire: night time
economy surveys phase one report, April 2011’’, LDAAT Emerging Drug Trends – Phase 1 Report,
Lancashire Drug and AlcoholAction Team, Dept of AppliedSocial Science,Lancaster University, Lancaster.
Measham, F., Moore, K. and Østerguard, J. (2011b), ‘‘Mephedrone, ‘bubble’ and unidentified white
powders: the contested identities of synthetic ‘legal highs’’’, Drugs and Alcohol Today, Vol. 11 No. 3,
pp. 137-46.
Measham, F., Moore, K., Newcombe, R. and Welch, Z. (2010), ‘‘Tweaking, bombing, dabbing, and
stockpiling: the emergence of mephedrone and the perversity of prohibition’’, Drugs and Alcohol Today,
Vol. 10 No. 1, pp. 14-21.
Measham, F., Wood, D.M., Dargan, P.I. and Moore, K. (2011c), ‘‘The rise in legal highs: prevalence and
patterns in the use of illegal drugs and first- and second-generation ‘legal highs’ in South London gay
dance clubs’’, Journal of Substance Use, Vol. 16 No. 4, pp. 263-72.
Meng, H., Cao, J., Kang, J., Ying, X., Ji, J., Reynolds, W. and Rampe, D. (2012), ‘‘Mephedrone, a new
designer drug of abuse, produces acute hemodynamic effects in the rat’’, Toxicology Letters, Vol. 208
No. 1, pp. 62-8.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. and The PRISMA Group (2009), ‘‘Preferred reporting
items for systematic reviews and meta-analyses: the PRISMA statement’ ’, PLoS Medicine, Vol. 6 No. 7,
p. e1000097.
MMWR (2011), ‘‘Emergency department visits after use of a drug sold as ‘bath salts’’’, Morbidity and
Mortality Weekly Report, Vol. 60 No. 19, pp. 624-7.
Morris, H. (2010a), ‘‘Hamilton’s Pharmacopeia. Mephedrone: the phantom menace’ ’, Vice Magazine,available
at: www.viceland.com/int/v17n6/htdocs/hamilton-s-pharmacopeia-455.php (accessed 12 May 2012).
Morris, K. (2010b), ‘‘UK places generic ban on mephedrone drug family’’, The Lancet, Vol. 17,
pp. 1333-4.
Motbey, C.P., Hunt, G.E., Bowen, M.T., Artiss, S. and McGregor, I.S. (2012), ‘‘Mephedrone
(4-methylmethcathinone, ‘meow’): acute behavioural effects and distribution of Fos expression in
adolescent rats’’, Addiction Biology, Vol. 17 No. 2, pp. 409-22.
PAGE 250
j
DRUGS AND ALCOHOL TODAY
j
VOL. 12 NO. 4 2012
Ness, A. and Payne, J. (2011), ‘‘Patterns of mephedrone, GHB, ketamine and rohypnol use among
police detainees: findings from the DUMA program’’, Australian Institute of Criminology, Research in
Practice: DUMA Quarterly Report No. 16, pp. 1-6, www.aic.gov.au/documents/0/6/0/%7B0605DBE8-
C4C4-46C6-807E-042F849D1826%7Drip16_003.pdf
Newcombe, R. (2009), Mephedrone: Use of Mephedrone (M-Cat, Meow) in Middlesbrough, Lifeline
Publications, Manchester.
NSSISD (2011), Drug Misuse Statistics Scotland, National Services Scotland Information Services
Division, Edinburgh.
Olives, T.D., Orozco, B.S. and Stellpflug, S.J. (2012), ‘‘Bath salts: the ivory wave of trouble’’, Western
Journal of Emergency Medicine, Vol. 13 No. 1, pp. 58-62.
Omer, T.A. and Doherty, C. (2011), ‘‘Posterior reversible encephalopathy syndrome (PRES)
complicating the ‘legal high’ mephedrone’’, British Medical Journal Case Reports,doi:
10.1136/bcr.02.2011.3904.
Oyemade, A. (2010), ‘‘Meow meow or miaow miaow: a new drug of concern’’, Psychiatry (Edgmont),
Vol. 7 No. 12, p. 10.
Power, M. (2009), ‘‘Mephedrone: the future of drug dealing’’, Drug Link, Vol. 6-7, March/April, p. 9.
Prosser, J.M. and Nelson, L.S. (2011), ‘‘The toxicology of bath salts: a review of synthetic cathinones’’,
Journal of Medical Toxicology, Vol. 8 No. 1, pp. 33-42.
Psychonaut Web Mapping Research Group (2009), Mephedrone Report, Institute of Psychiatry, London.
Ramoz, L., Lodi, S., Bhatt, P., Reitz, A.B., Tallarida, C., Tallarida, R.J., Raffa, R.B. and Rawls, R.B. (2012),
‘‘Mephedrone (‘bath salt’) pharmacology: insights from invertebrates’’, Neuroscience, Vol. 208,
pp. 79-84.
Ramsey, J., Dargan, P.I., Smyllie, M., Davies, S., Button, J., Holt, D.W. and Wood, D.M. (2010), ‘‘Buying
‘legal’ recreational drugs does not mean that you are not breaking the law’’, Quarterly Journal of
Medicine, Vol. 103 No. 10, pp. 777-83.
Regan, L., Mitchelson, M. and MacDonald, C. (2011), ‘‘Mephedrone toxicity in a Scottish emergency
department’’, Emergency Medicine Journal, Vol. 28 No. 12, pp. 1055-8.
Rosenbaum, C.D., Carreiro, S.P. and Babu, K.M. (2012), ‘‘Here today, gone tomorrow.. .and back
again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom,
Salvia divinorum, methoxetamine, and piperazines’’, Journal of Medical Toxicology, Vol. 8 No. 1,
pp. 15-32.
Roussel, O., Perrin, M., Herard, P., Chevance, M. and Arpino, P. (2009), ‘‘La 4-me
´thyle
´phe
´drone
sera-t-elle une ‘Ecstasy’ du XXIe
`me sie
`cle’’ (‘‘Is 4-methylephedrone, an ‘ecstasy’ of the twenty first
century?)’’, Annales de Toxicologie Analytique, Vol. 21 No. 4, pp. 169-77 (in French).
Ryall, G. and Butler, S. (2011), ‘‘The great Irish head shop controversy’’, Drugs: Education, Prevention
and Policy, Vol. 18 No. 4, pp. 303-11.
Sammler, E., Foley, P., Lander, G., Wilson, S., Goudie, A. and O’Riordan, J. (2010), ‘A harmless high?’’,
The Lancet, Vol. 376 No. 9742, p. 742.
Sare, J. (2011), ‘‘How the media helped ban mephedrone’’, British Medical Journal, Vol. 24 No. 342,
p. 1138.
Schifano, F., Albanese, A., Fergus, F., Stair, J.L., Deluca, P., Corazza, O., Davey, Z., Corkery, J.,
Siemann, H., Scherbaum, N., Farre, M., Torrens, M., Demetrovics, Z., Ghodse, A.H. and Psychonaut
Web Mapping and ReDNet Research Groups (2011), ‘‘Mephedrone 4-methylmethcathione: ‘meow
meow’: chemical pharmacological and clinical issues’’, Psychopharmacology, Vol. 214, pp. 593-602.
Schifano, F., Corkery, J., Naidoo, V., Oyefeso, A. and Ghodse, A.H. (2010), ‘‘Comparison between
amphetamine/methylamphetamine and ecstasy (MDMA, MDEA, MDA, 4-MTA) mortality data in the UK
(1997-2007)’’, Neuropsychobiology, Vol. 61, pp. 122-30.
Schmidt, M. (2009), ‘‘Legal highs in the UK: overview and the results of a user survey’’, paper presented
at the Psychonaut Conference, Ancona, Italy, September.
VOL. 12 NO. 4 2012
j
DRUGS AND ALCOHOL TODAY
j
PAGE 251
Sinclair, L. (2011), ‘‘Designer drug’s rapid spread causes alarm on several fronts’’, American Psychiatric
Association, Vol. 46 No. 8, pp. 8-9.
Sivagnanam, G. (2012), ‘‘‘Drug abuse’ of a different ‘wave’ length’’, Journal of Pharmacology and
Pharmacotherapy, Vol. 3, pp. 85-6.
Solberg, U. (2012), ‘‘Websites as a source of new drugs/‘legal highs’’’, Recreational Drugs European
Network (RedNet News), 8 February.
Spiller, H.A., Ryan, M.L., Weston, R.G. and Jansen, J. (2011), ‘‘Clinical experience with and analytical
confirmation of ‘bath salts’ and ‘legal highs’ (synthetic cathinones) in the United States’’, Clinical
Toxicology, Vol. 49 No. 6, pp. 499-505.
Sumnall, H., Evans-Brown, M. and McVeigh, J. (2011), ‘‘Social, policy, and public health perspectives on
new psychoactive substances’’, Drug Test Analysis, Vol. 3, pp. 515-23.
The Drug Enforcement Administration (2009), ‘‘DEA microgram bulletin – 4-methylmethcathinone in
Oregon’’, available at: www.usdoj.gov/dea/programs/forensicsci/microgram/mg0709/mg0709.pdf
(accessed 12 May 2012).
Toby, L., Reynolds, R. and De Wit, J. (2011), ‘‘Mephedrone use among same-sex attracted young
people in Sydney, Australia’’, Drug and Alcohol Review, Vol. 30 No. 4, pp. 438-40.
Toth, A.R., Hideg, Z. and Instito
´ris, L. (2011), ‘‘Mephedrone – an old new drug of abuse’’, Orvosi Hetilap,
Vol. 152 No. 30, pp. 1192-6.
Urban, M., Rudecki, T., Wroblewski, D. and Rabe-Jablonska, J. (2011), ‘‘Psychotic disorders related with
chronic use of mephedrone: case report’’, Psychiatria Polska, Vol. 45 No. 3, pp. 431-7.
van Hout, M.C. (2012), ‘‘Designer psychoactive drugs, the ‘headshop’ phenomenon and legislative controls
in Ireland’’, in Lewis, C. (Ed.), Ireland: Economic, Political and Social Issues, Nova Science, Hauppauge, NY.
van Hout, M.C. and Bingham, T. (2011), ‘‘A costly turn on: patterns of use and perceived consequences
of mephedrone based head shop products amongst Irish injectors’’, International Journal of Drug Policy,
Vol. 23 No. 3, pp. 188-97.
van Hout, M.C. and Brennan, R. (2011a), ‘‘Bump and grind: an exploratory study of mephedrone users’
perceptions of sexuality and sexual risk’’, Drugs and Alcohol Today, Vol. 11 No. 2, pp. 93-103.
van Hout, M.C. and Brennan, R. (2011b), ‘‘Heads held high: an exploratory study of legal highs in pre
legislation Ireland’’, Journal of Ethnicity of Substance Abuse., Vol. 10 No. 3, pp. 256-72.
van Hout, M.C. and Brennan, R. (2011c), ‘‘Plant food for thought: a qualitative study of mephedrone use
in Ireland’’, Drugs: Education, Prevention and Policy, Vol. 18 No. 5, pp. 371-81.
van Hout, M.C. and Brennan, R. (2012), ‘‘Curiosity killed M-Cat: a post-legislative study on mephedrone
use in Ireland’’, Drugs: Education, Prevention and Policy, Vol. 19 No. 2, pp. 156-62.
Vardakou, I., Pistos, C. and Spiliopoulou, C.H. (2011), ‘‘Drugs for youth via internet and the example of
mephedrone’’, Toxicology Letters, Vol. 201 No. 3, pp. 191-5.
Warren, T. (2011), ‘ ‘Snorting bath salts pushed a St. Tammany man to suicide’’, The Times-Picayune,
available at: www.nola.com/crime/index.ssf/2011/01/snorting_bath_salts_pushed_st.html (accessed
22 March 2012).
Watson, R. (2010), ‘‘EU drug monitoring agency voices concerns over ‘legal highs’’’, British Medical
Journal, Vol. 341, p. c6491.
Willson, K.M. (2011), ‘‘What was the deal with mephedrone?’’, MSc dissertation, University of
Portsmouth, Portsmouth, unpublished.
Winstock, A.R. and Mitcheson, L. (2012), ‘‘New recreational drugs and the primary care approach to
patients who use them’’, British Medical Journal, Vol. 344, p. 288.
Winstock, A.R. and Ramsey, J.D. (2010), ‘‘Legal highs and the challenges for policy makers’’, Addiction,
Vol. 105, pp. 1685-7.
Winstock, A.R. and Wilkins, C. (2011), ‘‘‘Legal highs’: the challenge of new psychoactive substances’’,
Legislative Reform of Drug Policies No. 16, International Drug Policy Consortium, London.
Winstock, A.R., Marsden, J. and Mitcheson, I. (2010), ‘‘What should be done about mephedrone’’,
British Medical Journal, Vol. 340, p. c1605.
PAGE 252
j
DRUGS AND ALCOHOL TODAY
j
VOL. 12 NO. 4 2012
Winstock, A.R., Mitcheson, L.R., Deluca, P., Davey, Z., Corazza, O. and Schifano, F. (2011a),
‘‘Mephedrone, new kid for the chop?’’, Addiction, Vol. 106, pp. 154-61.
Winstock, A.R., Mitcheson, L.R., Ramsey, J., Davies, S., Puchnarewicz, M. and Marsden, J. (2011b),
‘‘Mephedrone: use, subjective effects and health risks’’, Addiction, Vol. 106 No. 11, pp. 1991-6.
Wood, D.M., Greene, S.L. and Dargan, P.I. (2010b), ‘‘Clinical pattern of toxicity associated with the novel
synthetic cathinone mephedrone’’, Emergency Medicine Journal, Vol. 28 No. 4, pp. 280-2.
Wood, D.M., Greene, S.L. and Dargan, P.I. (2011), ‘ ‘Emergency department presentations in
determining the effectiveness of drug control in the United Kingdom: mephedrone
(4-methylmethcathinone) control appears to be effective using this model’ ’, Emergency Medicine
Journal, doi: 10.1136/emermed-2011-200747.
Wood, D.M., Measham, F. and Dargan, P. (2012), ‘‘Mephedrone still popular one year after ban’’, Journal
of Substance Use, Vol. 17 No. 2, pp. 91-7.
Wood, D.M., Davies, S., Greene, S.L., Button, J., Holt, D.W., Ramsey, J. and Dargan, P.I. (2010a), ‘ ‘Caseseries
of individuals with analytically confirmed acute mephedrone toxicity’’, Clinical Toxicology, Vol. 48, pp. 924-7.
Wood, D.M., Davies,S., Puchnarewicz,M., Button, J., Archer, R., Ovaska,H., Ram-sey, J., Lee, T., Holt, D.W.
and Dargan, P.I. (2010), ‘‘Recreational use ofmephedrone (4-methylmethcathinone,-MMC) with associated
sympathomimetic toxicity’’, Journal of Medicine Toxicology, doi: 10.1007/s13181-010-0018-5.
Wood, D.M., Davies, S., Puchnarewicz, M., Button, J., Archer, R., Ovaska, H., Ramsey, J., Lee, T.,
Holt, D.W. and Dargen, P. (2010c), ‘‘Recreational use of mephedrone (4-methylmethcathinone, 4-MMC)
with associated sympathomimetic toxicity’’, Journal of Medical Toxicology, Vol. 6, pp. 327-30.
Wood, D.M., Measham, F. and Dargan, P. (2012), ‘‘Mephedrone still popular one year after ban’’,
Journal of Substance Use, Vol. 17 No. 2, pp. 91-7.
Wood, D., Measham, F. and Dargan, P. (2012), ‘‘‘Our favourite drug’: prevalence of use and preference
for mephedrone in the London night-time economy 1 year after control’’, Journal of Substance Use,
Vol. 17 No. 2, pp. 91-7.
Further reading
Blom, J.D. (2009), A Dictionary of Hallucinations, 1st ed., Vol. 14, Springer, New York, NY, p. 434.
Daly, M. (2010), ‘‘Teenage kicks’’, available at: www.drugscope.org.uk/Resources/Drugscope/
Documents/PDF/Good%20Practice/DruglinkJanFeb10.pdf (accessed 24 March 2012).
Dickson, A.J., Vorce, S.P., Levine, B. and Past, M.R. (2010), ‘‘Multiple-drug toxicity caused by the co
administration of 4-methylmethcathinone (mephedrone) and heroin’’, Journal of Analytical Toxicology,
Vol. 34 No. 3, pp. 162-8.
Hillebrand, J., Olszewski, D. and Sedefov, R. (2010), ‘‘Legal highs on the internet’’, Substance Use and
Misuse, Vol. 45, pp. 330-40.
Kelly, J.P. (2011), ‘ ‘Cathinone derivatives: a review of their chemistry, pharmacology and toxicology’’,
New Psychoactive Substances, Vol. 3 Nos 7/8, pp. 439-53.
McNamara, S., Stokes, S. and Coleman, N. (2010), ‘‘Head shop compound abuse amongst attendees of
the Drug Treatment Centre Board’’, Irish Medical Journal, Vol. 103 No. 5, pp. 134-7.
Mephedrone.com (2010), available at: www.mephedrone.com, cited in Schifano, F., Albanese, A.,
Fergus, F., Stair, J.L., Deluca, P., Corazza, O., Davey, Z., Corkery, J., Siemann, H., Scherbaum, N.,
Farre, M., Torrens, M., Demetrovics, Z., Ghodse, A.H., Psychonaut Web Mapping and ReDNet Research
Groups (2011), ‘‘Mephedrone 4-methylmethcathione: ‘meow meow’: chemical pharmacological and
clinical issues’’, Psychopharmacology, Vol. 214, pp. 593-602.
Corresponding author
Marie Claire Van Hout can be contacted at: mcvanhout@wit.ie
To purchase reprints of this article please e-mail: reprints@emeraldinsight.com
Or visit our web site for further details: www.emeraldinsight.com/reprints
VOL. 12 NO. 4 2012
j
DRUGS AND ALCOHOL TODAY
j
PAGE 253
... Efectos agudos y subagudos en la esfera cognitiva, psicopatológica y conductual Según la revisión sistemática (n=104) de Brennan y Van Hout (2012) los principales efectos deseados del consumo de mefedrona son empatógenos, entactógenos, euforia, estimulación del habla, aumento de energía, impulsividad e incremento del deseo sexual; además de cercanía con los demás, sociabilidad, experiencias sensoriales (Loeffler et al., 2012), estimulación mental, apertura, desinhibición (Paillet-Loilier et al., 2014) mayor concentración y supresión del sueño y apetito . Los consumidores califican los efectos como más discretos y socialmente aceptados (Brennan y Van Hout, 2012). Sin embargo, el 56% de encuestados (n=205) afirma haber experimentado efectos adversos (Capriola, 2013). ...
... Inicialmente, los efectos deseados de la intoxicación leve incluyen, entre otros, componentes de una elevada activación psicomotriz (Brennan y Van Hout, 2012y Paillet-Loilier et al., 2014. Sin embargo, cuando el consumo es continuado en el tiempo o bien, se dan dosis elevadas, comienzan los efectos adversos propios de un estadio de intoxicación moderada-grave. ...
Article
Full-text available
Resumen La mefedrona (4-metilmetcatinona) es una droga de diseño con efectos psicoestimulantes y psicoticomiméticos que puede generar alteraciones psicóticas donde se incrementa el riesgo de agresiones. Al no ser un compuesto detectable en pruebas toxicológicas convencionales, se dificulta el diagnóstico de la intoxicación. Luego, este artículo tiene como objeto comprender los fundamentos y la etiopatogenia del comportamiento agresivo bajo la intoxicación por mefedrona o sustancias análogas. Para ello se ha realizado una revisión sistemática en cinco bases de datos que ha generado un cuerpo de 38 artículos. Mediante un análisis clúster de los resultados, se plantea un modelo que contempla tres fases en la intoxicación y la abstinencia aguda. Secundariamente, se observa un continuo en la expresión sindrómica de la intoxicación con respecto al síndrome del delirium agitado. Esto posibilita una perspectiva holística de los efectos de la mefedrona desde su manifestación más leve hasta la más severa. La secuenciación temporal puede facilitar una valoración en términos de imputabilidad, además de determinar los principales factores de riesgo útiles en la práctica pericial forense. PALABRAS CLAVE: mefedrona, catinonas, agresión, imputabilidad, delirium agitado. Abstract Mephedrone (4-methylmethcathinone) is a designer drug with psychostimulant and psychotomimetic effects that can generate psychotic alterations where the risk of aggression is increased. As it is not a detectable compound in conventional toxicological tests, it makes the diagnosis of intoxication difficult. Then, this article aims to understand the bases and etiopathogenesis of aggressive behavior under intoxication by mephedrone or analogous substances. For this purpose, a systematic review has been carried out in five databases that have generated a body of 38 articles. Using a cluster analysis of the results, is proposed a model that contemplates three phases in intoxication and acute withdrawal. Secondly, a continuum in the syndromic expression of intoxication with respect to pathognomonic features of the agitated delirium is observed. This makes possible a holistic perspective of the effects of mephedrone from its slightest manifestation to the most severe. The temporal sequencing can facilitate an assessment in terms of criminal capacity, in addition to determining the main risk factors useful in forensic practice.
... Po zakazie jego używania w roku 2010, nadal pozostaje on szeroko rozpowszechniony w brytyjskim środowisku uczestników dyskotek. Pozostałe NSP także cieszyły się dużym powodzeniem (Brennan, Van Hout, 2012;Wood i in., 2012a;. ...
Book
Full-text available
Niniejsza publikacja podejmuje zagadnienie „dopalaczy” jako nowe ryzyka i wyzwania dla służby zdrowia, oświaty, polityki społecznej, wymiaru sprawiedliwości, nauki, a także dla rodziców, zbiorowości lokalnych czy całego społeczeństwa.
... Mephedrone was placed under control by EU Member States (EMCDDA, 2011a), yet it continued to be available, even via online drug shops (EMCDDA, 2012), and despite it having been classified illegal, mephedrone remained one of the most popular synthetic drugs among club-goers and recreational drug users (e.g. Brennan and Van Hout, 2012;Wood, Hunter et al., 2012;. ...
Article
In recent years, increasing intravenous mephedrone use was reported in several countries. The aim of this study was to describe the characteristics of such a form of mephedrone use, while identifying the differences between injectors and non-injectors in patterns of mephedrone use and psychiatric symptom status. One hundred and forty-five mephedrone users were surveyed on patterns of mephedrone use using a structured questionnaire as well as the Brief Symptom Inventory. Majority of users received mephedrone from acquaintances and used it in discos/parties settings regarding both first and current mephedrone use. Intranasal use was the most typical route of administration (84.4%). Injectors (11%) used the drug more frequently and in higher dosages. This group included a greater proportion of opiate users (37.5%) and showed more diffuse psychiatric symptoms. Regarding the predictors of being an injector, heroin use showed the highest odds ratio. Intravenous mephedrone use is associated with a higher risk of harmful drug use, elevated psychiatric symptom profile and increased possibility of mephedrone being considered as an addictive substance. These findings might be important in efficient treatment planning. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
... Bizarre at-risk behaviors, such as hangings, stabbings, and self-mutilation, have also been reported amongst synthetic cathinone users (Schifano et al. 2012; Marinetti & Antonides 2013). Despite these incurred user consequences, use of synthetic cathinones is increasingly embedded in contemporary drug culture, whether through blending in existing street-available drugs such as MDMA and cocaine, or through chemical restructuring of compounds (Van Hout & Brennan 2011a; 2010b; 2012). By 2013, more than 30 different synthetic cathinones were recorded by the EMCDDA as potential drugs of abuse (for current reviews on these synthetic cathinones, see Wood & Dargan 2012; Coppola & Mondola 2012; Brennan & Van Hout 2012; German et al. 2013; Capriola 2013). ...
Article
Full-text available
Abstract A synthetic cathinone called 4-methylethcathinone (4-MEC) emerged online in 2010, and was cyber-marketed to be a replacement for mephedrone. The study aimed to present user experiences of 4-MEC as reported on the Internet, with a focus on user profiles, sourcing and product characteristics, routes of administration, dosage, positive and undesirable effects, and comparisons to mephedrone. Twenty-three individual, anonymous trip reports of the sole use of 4-MEC, and 112 screenshots of general 4-MEC user discussion boards, were taken from a purposeful sample of public drug-related sites. A content textual analysis was conducted on extracted qualitative information and produced 41 categories compiled into five general themes: "Type of 4-MEC user"; "Sourcing, informed decision making, product characteristics, and quality assurance"; "Routes of administration, gauging of dosage, and consumption of other drugs"; "Time course effects and outcomes"; and "Comparisons with mephedrone." 4-MEC is sold as white beads, crystalline shards, or green balls. User motives centered on curiosity, pricing, and ease of web sourcing. Oral, nasal, injecting, eyeball, and rectal routes of administration were described. Testing for purity, "allergy testing," and gauging of dosage were common. Users described euphoric but short-lived effects, with little comedown. Continued research is vital to inform harm reduction.
Article
Background: Self-substitution is the conscious switch from one drug to another for reasons such as price, availability, desired effect, or perceived benefit of the substitute drug. Purpose/Objectives: This study aimed to describe drug use patterns and motivations associated with substitution. We examined correlates of lifetime substitution among individuals with substance use disorder. Methods: A cross-sectional study of 771 treatment-enrolled individuals. We used self-report for determining the lifetime prevalence, correlates, and motivations for substitution. Results: Of the 771 respondents, 570 (73.9%) reported ever substituting their preferred substance. The main incentives for substitution were availability (23.7%) and curiosity (20.2%). Among heroin or cannabis preferers, improved effects or less adverse effects of the substitute drug, self-medication, and managing withdrawal symptoms were significant substitution incentives. Increased odds for substitution were observed for past 12 months use of cannabis (OR = 1.51, CI = 1.06-4.52), prescription opioids (OR = 2.86, CI = 1.81-4.52), novel psychoactive substances (OR = 2.68, CI = 1.64-4.36), and repeated admission (OR = 1.50, CI = 1.05-2.14). Older age at onset-of-use was negatively associated with substitution (OR = 0.95, CI = 0.93-0.98). Conclusions: Self-substitution of one substance for another is a highly prevalent behavior among treatment-enrolled patients with substance use disorder. Clinicians caring for substance use disorder patients should be aware of substitution patterns involving the use of highly potent substances, which constitutes a risk to patients. Results underscore the benefit of substitution patterns analyses, as they reveal important information on the characteristics of persons who use drugs and their motivations.
Article
Full-text available
Background: Substitution can be defined as the consciously motivated choice to use one drug, either licit or illicit, instead of another, due to perceptions of cost, availability, safety, legality, substance characteristics, and substance attributions. Substitution represents a potential risk to drug users, mainly when substitutes are of higher potency and toxicity. This study offers a basic conceptualization of illicit substitution behavior and describes substitution patterns among users of two highly prevalent drugs of abuse-heroin and cannabis. Methods: Here, 592 high-risk drug users undergoing pharmacological and psycho-social treatment were interviewed. Patients were asked questions about current drug use, lifetime substitution, and substitution patterns. Descriptive statistics, chi-square tests of independence, and multinomial logistic regressions were used to identify and test correlates of substitution patterns for heroin and cannabis. Results: Of the 592 drug users interviewed, 448 subjects (75.7%) reported having substituted their preferred drug for another illicit substance. Interviews yielded a total of 275 substitution events reported by users of cannabis, and 351 substitution events reported by users of heroin. The most frequently reported substitution substances for responders who preferred heroin were illicit non-prescribed "street" methadone (35.9%), followed by oral and transdermal prescription opioids (17.7%). For responders who preferred cannabis, substitution for synthetic cannabinoid receptor agonists (33.5%) followed by alcohol (16.0%) were the most commonly reported. Age at onset-of-use (p < 0.005), population group (p = 0.008), and attending treatment for the first time (p = 0.026) were significantly associated with reported lifetime substitution. Past-year use of stimulants, heroin, hallucinogens, methylenedioxymethamphetamine (MDMA), and novel psychoactive substances were-at the 95% confidence level-also significantly associated with reported lifetime substitution. In multivariate analysis, the odds for methadone substitution among heroin users were significantly affected by age at onset-of-use, type of treatment center, and education. Odds for substitution for synthetic cannabinoid receptor agonists among cannabis users were significantly affected by age, population group, type of treatment center, and education. Conclusion: Self-substitution behavior should be considered by clinicians and policymakers as a common practice among most drugusers. Substitution for street methadone provides evidence for the ongoing diversion of this substance from Opioid Maintenance Treatment Centers, while the prominence of substitution of synthetic cannabinoids among dual-diagnosis patients should be regarded as an ongoing risk to patients that needs to be addressed by clinicians. Analysis of additional substitution patterns should provide further valuable insights into the behavior of drugusers.
Chapter
Neue psychoaktive Substanzen (NPS) werden in Deutschland, auch im internationalen Vergleich, nur in geringem Maße konsumiert; der Konsum von NPS scheint zudem aktuell wieder rückläufig zu sein. Unter den NPS dominiert hierzulande eindeutig der Gebrauch synthetischer Cannabinoide. Regelmäßiger NPS-Konsum wird vor allem von Personen im jungen bis mittleren Erwachsenenalter ausgeübt, besonders in Regionen mit vergleichsweise repressiver Drogenpolitik, insbesondere in Bayern. Dort sind die Substanzen teilweise auch unter intravenösen Problemdrogenkonsumenten sowie in Partyszenen relativ weit verbreitet. Neben diesen beiden Szenebereichen lassen sich vor allem zwei Grundtypen regelmäßig NPS-Konsumierender identifizieren: Zum einen Cannabiskonsumenten, die wegen Verfügbarkeitsproblemen, aus Angst vor Repressionen oder Verkehrskontrollen zumeist nur zeitweilig auf synthetische Cannabinoide umsteigen. Die andere Gruppe sind besonders experimentierfreudige „Psychonauten“, für die der legale Status der Substanzen allenfalls eine Nebenrolle spielt.
Article
Full-text available
Background Although illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature. Objectives To inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems. Design A scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work. Results A total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations. Limitations Scoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention. Conclusions Key research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent. Future work The validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public. Study registration The systematic review element of this study is registered as PROSPERO CRD42016026415. Funding The National Institute for Health Research Public Health Research programme.
Chapter
Neue psychoaktive Substanzen (NPS) werden in Deutschland, auch im internationalen Vergleich, nur in geringem Maße konsumiert; der Konsum von NPS scheint zudem aktuell wieder rückläufig zu sein. Unter den NPS dominiert hierzulande eindeutig der Gebrauch synthetischer Cannabinoide. Regelmäßiger NPS-Konsum wird vor allem von Personen im jungen bis mittleren Erwachsenenalter ausgeübt, besonders in Regionen mit vergleichsweise repressiver Drogenpolitik, insbesondere in Bayern. Dort sind die Substanzen teilweise auch unter intravenösen Problemdrogenkonsumenten sowie in Partyszenen relativ weit verbreitet. Neben diesen beiden Szenebereichen lassen sich vor allem zwei Grundtypen regelmäßig NPS-Konsumierender identifizieren: Zum einen Cannabiskonsumenten, die wegen Verfügbarkeitsproblemen, aus Angst vor Repressionen oder Verkehrskontrollen zumeist nur zeitweilig auf synthetische Cannabinoide umsteigen. Die andere Gruppe sind besonders experimentierfreudige „Psychonauten“, für die der legale Status der Substanzen allenfalls eine Nebenrolle spielt. Die meisten wiederholt NPS-Konsumierenden erleben diverse negative psychische und physische Nebenwirkungen. Gerade bei synthetischen Cannabinoiden zeigen sich zum Teil schwerwiegende Effekte, die nicht mit möglichen Nebenwirkungen von Cannabis vergleichbar sind. Auch Notfälle, die im Zusammenhang mit NPS auftreten, sind zumeist auf Überdosen mit synthetischen Cannabinoiden zurückzuführen. Die häufigsten Symptome bei NPS-Notfällen sind Angstzustände, Tachykardie, Zittern und Unruhe. Es gibt des Weiteren einige dokumentierte Todesfälle, die auf den Konsum von NPS zurückzuführen sind.
Article
Full-text available
Purpose In this fourth paper in a series on emergent drug trends in the UK (2006 ketamine, 2009 MDMA powder/crystal, 2010 mephedrone), the authors consider how the pharmacological landscape has changed since substituted cathinones (including mephedrone) were controlled in April 2010 and in particular assess the prevalence of mephedrone in the general night time economy (NTE) and its relationship to the use of established illegal drugs. Design/methodology/approach Surveys were conducted with a convenience sample of 207 adults stopped at random in four town and city centres on Friday nights in Lancashire in November 2010. Findings Of the adults surveyed, one in ten reported having taken mephedrone within the past year and one in 20 within the past month. Those who used mephedrone were also significantly more likely to report using ecstasy pills, cocaine and amphetamines. Regarding the next generation of “legal highs”, no clear substitute for mephedrone had emerged; instead, there was uncertainty, confusion and a degree of disinterest. In this vacuum, “Bubble” has emerged and evolved as a generic term in the north west of England to refer to any unidentified white powders which are synthetic stimulants. Social implications Despite an emotional investment by advocates and opponents alike in mephedrone being an ecstasy‐type substitute, research now points towards more amphetamine‐type characteristics at a time when national prevalence of amphetamines is at an historic low. The emergence of unidentified white powders sold as “Bubble” in the North West of England is a graphic illustration of the unknown content, effect and risk of current (by contrast with previous) “legal highs”, and the resultant challenges for health service providers and criminal justice agencies. Bubble may be indicative of the enduring popularity but increasingly indiscriminate use of cheap stimulants. Originality/value For this cohort of NTE customers, the paper's analyses indicate that mephedrone was added to existing polydrug repertoires, rather than significantly displacing use of established illegal drugs or acting as a gateway for initiation into drug use.
Article
Full-text available
Significant changes in British recreational drug use were seen throughout 2009, with the emergence and rapid growth in the availability and use of substituted cathinones or ‘M-Cats’ (most notably mephedrone and methylone), a group of psychoactive drugs not currently controlled under the Misuse of Drugs Act 1971 (HM Government, 1971), with similar effects to ecstasy, cocaine and amphetamines. The reasons for the appearance and appeal of this group of so-called ‘legal highs’ are explored here in relation to availability, purity, legality and convenience. The authors argue that a reduction in the availability (and thus purity) of illegal drugs such as ecstasy and cocaine and resultant disillusionment among users was a key motivation for displacement to substituted cathinones, conveniently and legally purchased online. Finally, we explore policy considerations around the likely criminalisation of substituted cathinones and the challenge of providing rapid yet considered harm reduction responses to emergent drug trends in the face of a minimal scientific evidence base and eager press demonisation.
Article
Full-text available
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7]. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Completing a Systematic Review Is an Iterative Process The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Article
The risks associated with self-medication chave been amplified by the ability to corder prescription, non-prescription and ccomplementary medicines online. cProducts bought over the internet may cbe counterfeits or contain undeclared cingredients. Undeclared pharmaceuticals are cincreasingly being found in complementary cmedicines. cMarketing of medicines on the internet has cnot been limited to therapeutic drugs. There cis a growing variety of new recreational or c'designer' drugs. cWithout effective methods for detecting cemerging drugs and with limited knowledge cof their effects on users, online ordering cpresents a new challenge to public health.