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New and
emerging
drugs
Not for human
consumption:
new and emerging
drugs in Australia.
What do clinicians, allied health
and youth workers, researchers
and policy makers need to know?
By Stephen Bright
Peninsula Drug and Alcohol
Program & Curtin University
April 2013
Prevention
AUSTRALIAN DRUG FOUNDATION • ALCOHOL & DRUG INFORMATION
ISSN 1832-6013
About the author
Stephen Bright is a clinically
trained psychologist who has
worked in the AOD eld for
almost 10 years.
He is currently the
senior clinician at
Peninsula Health’s
Drug and Alcohol
Program and
Youth Services.
Stephen is also a PhD candidate
at Curtin University where he
has coordinated the teaching of
Addiction Studies since 2006. He has
published papers on psychotherapy,
psychometrics, and drug policy.
Key messages
02
1. New drugs are emerging
at an unprecedented rate as
manufacturers of legal high products
use new chemicals to replace
those that are banned. There are
two primary categories of product
available in Australia: powders/
pills and synthetic cannabis. Both
are being marketed and sold on
the internet as well as in Australian
tobacconists and adult stores.
2. While it is unclear how many
Australians use new and emerging
drugs due to limitations in
monitoring, some indicators suggest
that use is increasing. These drugs are
highly accessible, touted as legal and
perceived as safe. They may evade
drug testing and are inadvertently
promoted through media attention.
3. Because there is little information
about the pharmacology and toxicity
of new and emerging drugs, it is
dicult to establish their harm
potential, however:
a. 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.
b. Synthetic cannabis may be more
harmful than natural cannabis,
and has been linked to psychosis,
seizures and heart problems.
4. Given the rapidly changing market,
a new drug could emerge that has the
potential to cause widespread harm.
Early monitoring systems are required
to identify such drugs, and warn
clinicians and AOD workers as well as
individuals who use these drugs.
a. The Psychonaut Web Mapping
Project provides an exemplar of
a monitoring system. It might
be further enhanced by analysis
of wastewater and of products
available in Australian stores.
5. Typically, individuals will not
spontaneously admit to using
new and emerging drugs and
traditional assessment tools do not
elicit this information.
a. Allied health and youth workers
need to assess for the use of new
and emerging drugs, and provide
harm reduction and treatment
where appropriate.
b. Clinicians working in acute and
treatment settings need to be
aware that some presentations
may relate to the use of new and
emerging drugs. These patients
should be treated similarly to
presentations of the drug that the
new substance is mimicking.
6. Online user-driven forums and
educational resources such as
Erowid can be used to gather
useful information about new and
emerging drugs.
7. Banning individual chemicals
as they emerge does not appear to
create any meaningful change in
the availability of emerging drugs.
It may also inadvertently increase
harm by raising awareness of the
products and by encouraging
people to access newer and lesser-
known chemicals. Innovative policy
responses need to be implemented
to address this challenging issue:
a. A model that regulates the sale
of new and emerging drugs
is being implemented in New
Zealand and may provide a
useful template for Australia.
b. At this time policy makers should
focus on early monitoring systems
and gathering toxicological data
on new and emerging drugs.
Alcohol and
drug information
Part of the prevention series
Keep an eye out for the
Prevention in Action publication
and the prevention seminar on
new and emerging drugs.
druginfo.adf.org.au
What are new and emerging drugs?
A range of terms have been used to describe new and emerging
drugs, including legal highs, herbal highs, party pills, emerging
psychoactive substances, novel psychoactive substances, or
simply synthetics*. Products containing these new and emerging
drugs have been available in some Australian adult stores and
tobacconists, in addition to being sold from overseas and local
websites, for the past two years. They are often professionally
packaged and labelled ‘not for human consumption’ (see Figure 1).
Such pre-packaged products have been 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 4. These are often sold
as research chemicals.
Most new and emerging drug products are promoted as legal,
however the complexity of Australian law means such claims
are often tenuous (see Box 1). Most reportedly produce marked
psychoactive eects resulting from the various chemicals in
them. However, when analysed, some products have been found
to include only caeine or no active ingredients at all 5, 6.
There is a broad array of new and emerging drugs available in
Australia, but they will be classied into two basic categories
for the purposes of this paper:
• powders/pills
• synthetic cannabis.
* The term ‘synthetics’ is problematic since many traditional
drugs such as amphetamine, ecstasy and LSD are synthetic.
03
PreventionResearch
Introduction
New recreational drugs are being developed at an
unprecedented rate. In 2011, 49 new drugs were detected
by the European Centre for Monitoring Drugs and Drug
Abuse (ECMDDA); double the number of new drugs that
the ECMDDA detected in 20091. An interaction between
the multi-million dollar international legal highs industry
and policy makers appears to be fuelling this increase.
Each time an existing chemical
is banned, a new drug enters
the market to replace it.
Some of these emerging recreational drugs are professionally
packaged and aggressively marketed on the internet. Online user-
driven drug forums are also enabling the rapid dissemination of
information about these new drugs.
New and emerging drugs are initially highly accessible. Overseas
some have become as popular as more traditional illicit drugs 2.
The potential harms associated with these new drugs are dicult
to quantify as there is virtually no human testing conducted
prior to them being released into the market. There is therefore
little information about whether the substances are toxic or even
carcinogenic. We have no idea what the long-term eects might
be. Most informants that contributed to the development of
this paper were concerned that the next new drug might cause
signicant widespread harm. Is this a potential public health crisis
waiting to happen?
Professor Farrell, Director of the National Drug and Alcohol Research
Centre, stated that emerging drugs represent one of the biggest
challenges in the alcohol and other drugs (AOD) eld in 2013 3. This
paper addresses what clinicians, allied health and youth workers,
researchers and policy makers need to know about new and
emerging drugs to make eective assessments and reduce harms. It
will also discuss the need for early monitoring systems to detect the
emergence of potentially dangerous new drugs, and recommend
that policy makers consider innovative options to minimise harm.
Get your ePub version of this issue of
Prevention Research at druginfo.adf.org.au
...article continued page 5
04
Alcohol and
drug information
Products have been
available in some
Australian adult stores
and tobacconists for
the past two years.
The law
There is a complex relationship between state
and federal laws in Australia. 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.
Existing federal government laws
At the federal level, the Therapeutic Goods Administration
(TGA) has a legislative document called the Poisons Standard.
The Poisons Standard contains schedules that determine the
degree of restriction that is placed on a substance. For example,
Schedule 3 substances can only be purchased from a pharmacy
(though don’t require a prescription), while substances in
Schedule 4 can only be accessed with a prescription.
Changes to the Poisons Standard occur four times each
year following a public consultation process. In addition to
making decisions about which schedule is most appropriate
for any given medicine, the TGA can place a substance in
Schedule 9, meaning that it is an illegal substance with no
approved medical use.
While the relevant legislation in some states, such as Victoria,
refers to the TGA’s legislation 76, drug laws in other states, such
as New South Wales, do not 77. In these states, prosecution
using the TGA’s legislation can only occur in federal
jurisdictions and requires the involvement of federal agents.
Federally, there is also the Criminal Code Act 1995, which
includes an analogues clause. The clause bans chemicals
based on their structural similarity to chemicals that are
already scheduled. For example, mephedrone could be
considered an analogue of the illegal drug methcathinone,
or even amphetamine (see Box 2). Individuals prosecuted
for importing mephedrone have typically been convicted
under this Act.
State government legislative response
Most states have banned a range of chemicals contained
in synthetic cannabis and pills/powders. Some states have
also added analogue clauses to their drug legislation.
The Queensland Government has proposed banning any
product that is intended to ‘have a substantially similar
pharmacological eect’ to an illicit substance 78. From a legal
perspective, this means that selling a product containing
only caeine that is marketed as a substitute for ecstasy,
could be treated in the same way as selling ecstasy. As such,
an individual carrying a pill containing only caeine could
potentially be charged with possession of a dangerous drug.
Federal government
legislative response
In May 2012, the TGA placed MDPV and eight broad
synthetic cannabinoid agonist chemical groups in
Schedule 9 11. This has eectively banned thousands of
chemicals based on their chemical structure at the federal
level, and in those states that refer to the TGA’s legislation.
Many chemicals that will be considered illegal under
these changes have not yet been synthesised. In addition,
the TGA scheduled synthetic cannabinomimetics, which
means any synthetic product that has similar eects to
cannabis, though no formal denition is provided in the
legislation and it has not yet been tested in court.
Most recently, new laws have been introduced by the federal
government to allow for emergency scheduling. Under this
new law, the Attorney-General or Minister for Justice will
not have to introduce legislation to amend the Criminal
Code Act. Instead, a minister can simply issue an emergency
determination that can last 18 months. Barrister Greg Barns
has stated that this “will not curtail in any way the demand for
drugs and the ability of the market to supply them to millions
of Australians” 79. Indeed, despite all of the aforementioned
legislative changes, new and emerging drug products remain
widely available in many Australian states.
Matthew Wielenga, owner of the company that
manufactured Kronic, was arrested in Melbourne on 7
December 2012 after he was found with more than 100kg of
Kronic and 1kg of white powder reported to be a synthetic
cocaine 80. It will be interesting to see how the case proceeds
in this new legislative environment.
BOX 1: IN DEPTH
05
PreventionResearch
What are new and emerging drugs?
Powders/pills
Party pills
In the early 2000s, the legal high/party pill industry emerged
in the United Kingdom (UK) and New Zealand (NZ) where legal
piperazines, such as benzylpiperazine (BZP), were professionally
packaged and marketed as a harm reduction strategy by the
industry. Following some health concerns, BZP was banned in
NZ and the UK in 2008 and 2009 respectively. In an endeavour to
continue selling party pills, the legal high manufacturers sought
to develop new BZP-free products. Unlike BZP products, which
were already prohibited in Australia, these new products were
alleged to be legal and marketed to Australians.
BZP-free products were often
mislabelled as plant food in
an attempt to conceal the
product’s intended use.
For example, a London Underground packet stated that the pills
are ‘best suited for tropical plants. Use one … per square meter
around garden beds. For potted plants less than one metre in
height, half to a quarter... should be sucient’ (see Figure 1). Such
products contained a range of cathinone analogues such as
mephedrone (see Box 2 ).
Bath salts/synthetic cocaine
In 2010, mephedrone was banned in both the UK and Australia.
New products subsequently emerged containing a range of
new chemicals, including naphyrone (naphthylpyrovalerone),
MDPV (methylenedioxypyrovalerone) and ephedrone
(uromethcathinone) 7-10. These new products have been sold as
powders intended to be snorted. At rst, they were imported from
Europe and the USA where they were sold as bath salts. However,
it appears that they are increasingly being manufactured in
Australia and sold as synthetic cocaine in adult stores. Some
popular overseas brand names include Ivory Wave, Bubble Bliss
and Vanilla Sky. Local brands have included Sharman’s Dust, White
Bull and Smokin’ Slurrie.
Because some of the chemicals contained in these new
products, such as MDPV, are active at very low doses, the pre-
packaged products are often cut with llers to ensure that the
dose is similar to that of the illicit substances that they mimic.
Many also contain numbing agents to replicate the subjective
experience of using cocaine 5.
In May 2012, MDPV was banned federally in Australia 11. However,
other synthetic cocaine products are currently available in
Australia. These second generation bath salt products may
contain the range of chemicals that were found in synthetic
cocaine available in the USA after MDPV was banned. These
new chemicals include α-pyrrolidinovalerophenone (α-PVP) and
methyl-α-pyrrolidinopropiophenone 12. Anecdotal evidence from
a few presentations in Victorian acute settings indicates that
some products might also contain methoxetamine – a ketamine
analogue that has recently been banned in the UK.
Research chemicals
Once information about the active ingredient of a new drug
becomes widely available, there have been anecdotal reports of
people ordering the pure chemical directly from overseas online
chemical vendors. For example, after mephedrone was identied
as an active ingredient in a popular legal highs product, people
began to seek the pure chemical 4. Such demand for a specic new
chemical in the recreational drug market has not been seen since
MDMA (or ecstasy) emerged in the late 1980s.
Synthetic cannabis
Synthetic cannabis refers to products containing an herbal
mixture that is laced with a range of synthetic chemicals to mimic
tetrahydrocannabinol (THC), the primary psychoactive chemical
contained in cannabis. Kronic is the most well-known brand of
synthetic cannabis in Australia. Kronic has produced a range of
blends, including Skunk, Purple Haze, Tropical, Pineapple Express
and Black Label.
In April 2011, Western Australian (WA) media began reporting the
use of Kronic by workers on mine sites to evade drug screening 13. By
June, the WA Government had banned seven chemicals that Kronic
was thought to contain 14. In the lead up to this ban, the manufacturer
of Kronic endeavoured to sell its remaining stock 15. Customers
reportedly stockpiled Kronic after the company used social media,
especially Facebook and Twitter, to engage its customers. The night
before the bans took eect, a ‘smoke ‘em party’ was organised in Perth
for people to consume their remaining Kronic 16.
Facebook had never before been used to
sell drugs so openly in Australia, nor had
there been such organised efforts to use
drugs in a social setting prior to a ban.
Other states, including Victoria, soon followed WA’s lead. However,
new synthetic cannabis blends have appeared that claim to
contain new unscheduled chemicals. This is consistent with the UK
experience where analysis of synthetic cannabis blends available after
bans have found the presence of a new range of chemicals 17. Even
if these new synthetic cannabis products contain new chemicals,
consumers could be charged with possessing prohibited drugs.
Figure 1: Professionally packaged party pill product
displaying information that obscures its intended use.
...continued from page 3
06
Alcohol and
drug information
What are new and
emerging drugs?
Cathinone
analogues
After BZP was banned in the UK and NZ, legal high
manufacturers began marketing new products. The
rst analysis of such products by Camilleri et al.70 found
a range of novel chemicals, including several cathinone
analogues. Cathinone, a chemical contained in the
khat tree which is native to North East Africa, is just
one atom dierent to amphetamine. While the legal
status of the khat tree is state-dependent in Australia
(see Box 1), cathinone is banned both federally and in
all states and territories. Methcathinone is a synthetic
cathinone analogue that has eects that are similar
to methamphetamine and has been banned in most
countries, including Australia, for many years.
One of the cathinone analogues identied by
Camilleri et al. was phthalimidopropiophenone. This
cathinone analogue is a pro-drug, which means it is
an inactive, legal substance until it is broken down by
stomach acids into cathinone which is an illegal and
active compound.
In effect, this means the
drug is legal outside of
the body but becomes
illegal once ingested.
Mephedrone, or 4-methylmethcathinone, was another
cathinone analogue identied by Camilleri et al.70. Once
identied, there was a rapid increase in its popularity.
Mephedrone was dubbed miaow miaow by the media,
and people began seeking out the raw chemical
rather than products alleged to contain mephedrone.
Signicant media coverage quickly developed 74 with 52
mephedrone-related fatalities reported in the UK alone
by July 2010. However, only two or three cases were
ever conrmed, and it was discovered that 12 of these
people had not consumed mephedrone 81. Nonetheless,
in the midst of this media coverage, governments
worldwide moved to quickly ban mephedrone and
other cathinone analogues. Unfortunately this has led
to a range of new chemicals being used in legal high
products, including naphyrone (naphthylpyrovalerone),
MDPV (methylenedioxypyrovalerone), ephedrone
(uromethcathinone), α-pyrrolidinovalerophenone
(α-PVP) and methyl-α-pyrrolidinopropiophenone.
BOX 2: IN DEPTH
How prevalent is
the use of new and
emerging drugs
in Australia?
While the use of new and emerging drugs has been
identied as signicant in the USA and Europe 2, the
exact degree to which these drugs are being used in
Australia is unclear. Nonetheless, some indicators
suggest an increasing trend. For example, the
Australian Federal Police has noted a signicant
increase in the quantity of non-traditional drugs
seized18, and there have been numerous Australian
media reports about new and emerging drugs19-21.
In 2010, the Australian Ecstasy and Related Drugs Reporting
System (EDRS), an annual national survey of regular ecstasy
users, identied the use of mephedrone among a number of
informants22. Between 2011 and 2012, there was an increase in
the number of EDRS participants reporting use of other new
and emerging substances. However, the people that the EDRS
is sampling from (i.e. regular ecstasy users) are not necessarily
representative of the population using new and emerging drugs
and therefore cannot be used to estimate the prevalence of use
among the general Australian population.
Analysis of wastewater provides more objective evidence for
the use of emerging drugs. Chen et al. have shown a peak in the
level of mephedrone detected in Adelaide wastewater during
2010, and an increasing trend in the level of MDPV detected
between 2009 and 201123. However, because there is little data
on the metabolism of new drugs, there are no algorithms to
determine the prevalence of use based on the amount of any
chemical detected in samples. It is also unclear whether the
chemicals identied in the waste analysis originated from pre-
packaged products, were acquired as research chemicals, or
were contained in products sold within the illicit market.
The Australian Federal
Police has noted a
significant increase in
the quantity of non-
traditional drugs seized.
07
PreventionResearch
How harmful are new and emerging drugs?
Powders/pills
The potential harms associated with powder/pill products
are dicult to establish. Each product may contain dierent
chemicals with varying toxicity proles, and analyses of products
have found that a product may also contain dierent chemicals
at dierent points in time 5. For example, the 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 24, 25. It is unclear how comparable these risks are to
those associated with the use of methamphetamine/cocaine.
Chemicals containing chlorine or uorine atoms are called
halogenated chemicals and are generally neurotoxic. Some
powder/pill products have been found to contain halogenated
chemicals 5, 7, 8, 26-29. Such products might increase the risk of an
individual experiencing a brain injury – particularly if the product
is used frequently and in high doses.
Synthetic cannabis
The harm potential of a synthetic cannabis product will
depend on the specic chemicals that it contains, and many
products contain more than one chemical. Generally speaking,
synthetic cannabis might be more harmful than cannabis for
a range of reasons. THC, the primary psychoactive ingredient
in cannabis, has a very low toxicity prole and does not tend
to interact with many other drugs. There is very little data on
the toxicity of the chemicals contained in synthetic cannabis
and their metabolites. In addition to THC, cannabis contains a
host of other chemicals, such as cannabidiol (CBD), which have
antipsychotic and anticonvulsant properties. The absence of
chemicals such as CBD in synthetic cannabis might increase
the likelihood of psychotic symptoms or possibly seizures
30. Finally, the eects of synthetic cannabis are shorter than
those of natural cannabis, which may increase the likelihood of
addiction through reinforcement of use from frequent dosing 31.
While there are anecdotal reports of people successfully using
synthetic cannabis to reduce their dependence on cannabis,
others have reported signicant withdrawal symptoms.
Hospital presentations
It is unclear how many people have presented to Victorian
hospitals with problems resulting from the use of new and
emerging drugs as hospitals have no way of coding such
presentations. At least two unveried Australian deaths
associated with the these drugs have been reported by the
media 21, 32. The media has also reported on other Australian
deaths that may have resulted from such drugs being sold as
traditional drugs such as LSD 33.
Sta at call centres such as DirectLine and the Drug and Alcohol
Clinical Advisory Service (DACAS), report that they have received
calls about new substances. However, limitations in the amount
of information that is recorded prevents any quantitative
analysis. Nonetheless, 17 per cent of calls received by the
Victorian Poisons Information Centre (VPIC) about ‘street drugs’ in
2012 were coded as ‘other’. Je Robinson, Manager of VPIC, was
able to conrm that a number of these calls concerned new and
emerging drugs. These are the only indicators currently available
about the incidence of new and emerging drug-related harms.
Why do people use new and emerging drugs?
Increased awareness and publicity
Unlike previously available legal high products, new and
emerging drugs reportedly produce marked psychoactive eects.
Greater awareness of this fact, disseminated through the media
and online user forums (see Box 3), is likely to have increased
demand for the products. This was particularly evident with the
emergence of synthetic cannabis in Australia during 2011. Bright
et al. 19 have shown that there was a strong connection between
the volume of media coverage and the number of internet
searches for Kronic and synthetic cannabis. Many of the initial
online newspaper articles about the ban on Kronic contained
Google advertisements that linked directly to online vendors. A
Queensland newspaper quoted one man as saying, “I saw Kronic
on the news and thought... holy smoke, I’m going to order this” 34.
Legality
Some people are attracted by the alleged legal status of new
and emerging drugs 35. There may also be a perceived degree
of safety attached to a product that is professionally packaged
(see Figure 1) and apparently legal 36.
Avoidance of positive drug screens
Synthetic cannabis became widely known in Australia when the
media reported that mine workers in WA and Queensland used
the drug to avoid positive drug urine screening tests 37. Perrone
et al. have found similar motivation among users of synthetic
cannabis in the USA 38. Most of their sample of synthetic
cannabis users were attending abstinence-only drug treatment
programs under community corrections orders, or were seeking
a career in the US military, and were therefore motivated to use
synthetic cannabis to avoid positive drug tests.
Availability
Increased availability of any drug is positively associated with
increased use, and emerging drug products are highly accessible
in adult stores and online. This should be considered in the context
of a reported worldwide decline in the purity of ecstasy tablets.
As such, some people who are dissatised with the quality of
ecstasy might be inclined to purchase legal highs39, 40. Finally, some
people might consume new and emerging drugs unwittingly –
there have been reports of the drugs being detected in samples
of ecstasy and LSD (www.ecstasydata.org).
08
Alcohol and
drug information
Example discussion from an
online user forum
TABLE 1
#1 Original Poster
Hi I received a sample yesterday of the latest LU
'Doves Love'. According to the packet it contains a
compound "2β-(3-(4-Methylphenyl)isoxazol-5-yl)-3β-(4-
chlorophenyl)tropane", allegedly a dopamine reuptake
inhibitor. http://en.wikipedia.org/wiki/(-)-2%C...phenyl)
tropane. Just wondered if anyone had tried these yet or
had any other info on them, and if they could post a trip
report. I will probably post one after this weekend.
#2 Person A
The Admin of the Aussie herbal incense forum imported
some and said they were all right. He reviewed them.
#3 Person B
Interesting, might have to try some. The LU Doves
ive tried have always tested up to be a Beta Ketone
substance – My guess butylone or methylone.
perhaps a mix.
#4 Person A
Does anyone know what the legality of this
compound is? These are being imported.
#5 Person C
tried these three times. Im from the USA. These are the
bomb. Honestly can say one of the best legal pills Ive
tried. Started feeling full eects about an hour after
taking it. So euphoric, Rushes, Very like MDMA. I took
one and then two hours later took the Second. Total
duration About 4-6 hours. But denately give them
a try. I f***in love em. Ive ordered them three times
already and Im waiting on a fourth order and I can't
wait for them to come they are awesome.
#6 Person A
Most of the online reviews for these are glowing.
Someone on the other forum last night posted that
they had a bad experience though. It will be good
to see more reviews so that we can get a better idea.
Apparently the Phenyl Tropane alkaloids should test
yellow with the Mandelin reagent also.
#10 Person D
(Originally posted by Person C)
tried these three times. Im from the USA. These are the
bomb. Honestly can say one of the best legal pills Ive
tried. Started feeling full eects about an hour after
taking it. So euphoric, Rushes, Very like MDMA. I took
one and then two hours later took the Second. Total
duration About 4-6 hours. But denately give them
a try. I f***in love em. Ive ordered them three times
already and Im waiting on a fourth order and I can't
wait for them to come they are awesome.
shill much?
#12 Person E (Senior Moderator)
Please do report if you have those suspicions.
We always look into it, so it wont get anyone in
trouble if it's unwarranted
BOX 3
Online user forums
Social interactions involving drugs are increasingly
occurring online. For over a decade, bulletin boards (or
forums) such as Bluelight (www.bluelight.ru) and Drugs
Forum (www.drugs-forum.com) have allowed people
from around the world who use drugs to interact with
one another with a degree of anonymity.
Social interactions on drug forums may involve:
• Requests for information about a drug or route of
administration
• Posts that describe a person’s experience with a
particular drug or pill (i.e. a trip report or pill report)
• Instructional information, such as how to reduce the
likelihood of experiencing drug-related harm (e.g. pill
testing or bad drug use combinations)
• How to enhance the subjective drug use experience
(e.g. a good setting for a trip) 82.
Online user forums have the potential to both reduce
and increase drug-related harms:
• Information provided by peers is likely to be perceived
as more credible than that obtained from government
websites or the mainstream media 83. However, the
degree to which harm is reduced will depend on the
information provided and the interpersonal dynamics
that develop between participants. Fortunately, there
are moderators that censor the content, provide
additional information where appropriate, and remove
posts that break forum rules.
• In her study of 837 online drug forum participants,
Barratt found that 80 per cent of participants said
that their drug use was inuenced by information on
forums82. The most common behavioural inuence was
the introduction of a new substance, followed by dosage
information, and then information about content/purity.
Monitoring new
drugs through forums
Interactions through online user forums provide allied
health and youth workers, clinicians and researchers
with an eective method for monitoring the emergence
of drug use trends and accessing information about
new and emerging drugs. This methodology comprised
part of the Psychonaut Web Mapping Project, which led
to a range of new drugs being identied 71 , however
it does require a healthy level of scepticism. Table 1
provides an example of a relatively recent thread on
Bluelight, which suggests that a new legal high product
called London Underground Dove Love contains a
cocaine-like analogue, RTI-336. The fth post from
ludovelover appears to be somebody associated with
the manufacture or distribution of the product. This
participant has a history of three posts on the site
promoting the product and is subsequently identied as
a shill (i.e. a person who publicises or praises something
or someone for reasons of self-interest).
Excerpt taken from Bluelight.ru. Identifying user names
and dates have been removed for anonymity.
09
PreventionResearch
How can allied
health and youth
workers respond?
Most people who use emerging drugs will not
experience harm 41, 42. Indeed, Barratt et al. found that
less than one per cent of participants experienced
problems associated with their use of synthetic
cannabis that were severe enough to seek assistance35.
Allied health and youth workers
are uniquely placed to identify
this hidden population.
However, they will need to assess specically for the use of
new and emerging drugs (see Box 4) as people do not typically
spontaneously admit to their use, and might not perceive these
products to be drugs. If the use of new and emerging drugs is
identied, workers can then provide education, harm reduction,
brief intervention and referral to treatment if required.
Education about the potential harms associated with these
drugs needs to be framed carefully and credibly as Australians
can be sceptical of traditional drug education where harms
are sometimes overstated. Workers must provide a balanced
discussion that acknowledges the perceived reduction in harms
associated with using these products in comparison to traditional
illicit substances (e.g. reduced legal harms, not aliating with
illicit drug dealers), while also highlighting the potential harms
that could arise from using products containing chemicals that
we know little about.
Assessment
Clinicians working in mental health, AOD services
and acute settings, as well as allied health and
youth workers, need to be aware that some of their
clients may be using new and emerging drugs. Most
traditional assessments do not ask about these drugs,
and clients may not spontaneously admit to their use
as they may not be perceived as drugs. It is therefore
important to ask the following questions:
• Have you used anything that has been bought
online or from adult stores?
• Have you taken any herbal supplements, legal
highs, party pills, herbal highs, research chemicals,
bath salts or incense?
• What chemical or brand have you used?
• What were the eects of it (e.g. stimulant,
depressant or hallucinogen)?
• Was it like any other substance you have used?
• Did you experience any negative health eects?
This information must be collected sensitively to
prevent the process from increasing awareness and
subsequent use of new and emerging drug products.
If use of these drugs is established, further information
about the specic substance can be obtained from
online user forums. (An example of how forums can
be used to obtain information is provided in Table 1.)
Educational websites, such as Erowid (www.erowid.org),
may also be useful. However, with the ever increasing
number of brands, many of which may now be made
locally, this approach might be less helpful.
Lastly, provide the individual who is using, or is
potentially going to use these drugs, with the
intervention appropriate to the setting. (For harm
reduction see Box 5 and for acute settings see Box 6.)
BOX 4
10
Alcohol and
drug information
How can clinicians
in acute settings
respond?
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 (loss of co-ordination), sweating,
tachycardia (fast heart rate), arrhythmia (irregular heart
beat), hypertension (high blood pressure), hyperthermia
(over-heating), rhabdomyolysis (breakdown of muscle
tissue), kidney failure, seizures, bruxism (clenched jaw/
teeth grinding), nausea, anxiety, agitation, confusion,
paranoia and hallucinations 43-53. The most severe
symptoms reported include stroke, cerebral oedema (brain
swelling), cardiorespiratory collapse and death 51, 54-57.
Synthetic cannabis presentations have included symptoms
such as sweating, tachycardia, arrhythmia, hypertension,
nausea, anxiety, agitation, seizures, confusion, paranoia
and hallucinations 30, 31, 58-62.
Laboratory results are limited in identifying the
contribution of new and emerging drugs to presentations.
Tests are not yet available for
many of these substances as
the drugs are emerging faster
than tests can be developed.
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 63, 64. Therefore, it is
essential to determine whether the person presenting has
consumed any new and emerging drugs through careful
questioning (see Box 4).
BOX 5
Harm reduction
While the safest option is to abstain from consuming new and
emerging drugs, some individuals will continue to use them.
Information should be provided to these individuals that
reduces their likelihood of experiencing harm:
• Avoid driving, swimming and operating machinery while
under the inuence of new and emerging drugs.
• Only use new and emerging drugs with another person
who is not using any AOD and who can call triple zero if
things go wrong. If using alone, then at least tell somebody
and write down the name of the product or chemical.
• Conduct a test to ensure that no allergy exists by ingesting
a minute quantity an hour or more before using the
product. Given that the chemicals contained in products
can vary over time 5 , this step is recommended even
when a product has previously been used as there is no
guarantee that the contents will be the same.
• People with pre-existing mental health conditions should
not consume these products. Most deaths from new and
emerging drug products, such as suicides, have involved
poly-drug use or underlying mental health conditions 41.
As these drugs can lead to a reoccurrence of psychotic
symptoms among people with a history of drug-induced
psychosis, such individuals need to be given information
about harms and dissuaded from use as the new drugs
might be perceived as less problematic than the substance
that originally caused the psychosis 30, 60. Further, it is
recommended that these products are not consumed with
AOD, including caeine. Given caeine is contained in many
products, sometimes in high quantities, additional caeine
consumption could lead to toxic eects 6.
• Older people and people with pre-existing cardiovascular
conditions should avoid using new and emerging drugs. The
chemicals contained in some products might be cardiotoxic,
lead to hypertension, or cause fast/irregular heartbeats.
• Injection of pre-packaged products is highly discouraged
given the unknown contents of the products. Not only
are the active chemicals unknown, many products also
contain a range of llers and even numbing agents that
could lead to health problems if injected. A number of
needle and syringe program workers in Victoria have
reported negative outcomes from attempts to inject
pre-packaged powders/pills and this has reportedly led
to at least one Australian death 21. Dorairaj et al. reported
a recent rise in soft tissue complications associated with
injecting new and emerging drug products in Ireland,
including extensive abscess formation 84.
• People using research chemicals must be aware that
packaging can be misleading. A package stating that
it contains chemical ‘a’ active at 250mg, may actually
contain chemical ‘b’ active at 1mg and so ingesting
250mg will lead to an overdose. Use of scientic scales
is encouraged as it is impossible to visually identify
dierences of 1mg or even 10mg.
11
PreventionResearch
How can clinicians and workers
in AOD settings respond?
Presentations to AOD treatment services primarily for new
and emerging drugs appear to be limited. For example, the
Victorian Earlier Identication of Drug Harms Project (EIDHP),
which interviews AOD workers from approximately 20 services
six times a year to identify changing and/or emerging drug
use patterns and behaviours, has not noted an increase in
presentations related to these drugs. This might be because the
use patterns for new and emerging drugs are similar to those for
other party drugs such as ecstasy. Despite a higher incidence of
ecstasy use than drugs such as heroin in Australia 65 , relatively
fewer individuals present to AOD services seeking treatment for
ecstasy. Nonetheless, a number of people who present in an AOD
setting have used ecstasy. This may also be the case for new and
emerging drugs. Workers therefore need to ask whether these
drugs are being used to get a more accurate understanding of
the patient’s drug use (see Box 4).
Where use of new and emerging drugs is identied as
the secondary cause of a patient’s presentation, this drug
use should also be addressed in the treatment plan. For
example, education and harm reduction can be provided to
some individuals, while for others, treatment might include
abstaining from the use of new and emerging drugs. If the use
of new and emerging powders/pills is the primary presenting
problem, Winstock and colleagues advise that AOD workers
should provide those evidence-based treatments that are
recommended for amphetamine dependence 41. Similarly,
AOD workers can provide individuals presenting with concerns
about their synthetic cannabis use with those evidence-based
treatments that are recommended for cannabis dependence.
Workers need to ask
whether these drugs are
being used to get a more
accurate understanding of
the patient’s drug use.
BOX 6
Acute clinical
treatment of new
and emerging drugs
When consumption of a new and emerging drug is
suspected to have contributed to an acute medical
presentation, most clinicians recommend that the patient
be treated as though they have consumed the prototype
drug that the new drug has been developed to mimic. For
example, adverse symptoms from ingesting powders and
pills can generally be treated in a similar fashion to those
caused by amphetamine and cocaine intoxication since most
have similar eects on the central nervous system25, 85, 86.
Mas-Morey et al. recommend that acute severe medical
complications arising from drug toxicity such as
hyperthermia be treated through aggressive cooling using
ice, while kidney injury and rhabdomyolysis should be
treated with intravenous saline and other resuscitative
measures. Psychosis, agitation, seizures and adverse
cardiovascular eects associated with pills and powders
should be treated with benzodiazepines87. Where psychotic
symptoms and agitation do not diminish, Mas-Morey et al.
recommend subsequently administering an antipsychotic
agent. Oral therapy is preferred over intravenous or
intramuscular administration of medications to manage
acute symptoms. Castellanos and Thornton recommend
similar intervention for individuals presenting with
agitation and psychosis associated with acute synthetic
cannabis intoxication31.
12
Alcohol and
drug information
How can policy makers respond?
The emergence of new drugs has presented a
signicant challenge for policy makers worldwide.
To date, the Australian policy response has
primarily focused on supply control. Individual
substances have been banned and analogue laws
introduced (see Box 1), however this approach has
not been successful in reducing the availability of
new and emerging drugs. Innovative approaches
will be required to effectively reduce harm.
Banning individual chemicals
The legal appeal of new and emerging drugs is reduced by
banning their component chemicals as they are identied.
However, this approach renders legislators and service providers
playing ‘catch up’ to an ever increasing array of new substances.
It may also contribute to increased harm by driving newer and
lesser known products onto the market. Further, the notoriety
that some emerging substances gain by their prohibition, such
as mephedrone, can prompt increased demand that is met by
the illicit market – sold as either the chemical itself or used in
other illicit drugs such as ecstasy 66.
Analogue laws
Analogue laws ban broad categories of substances. Chemicals
have been banned based on their structural similarity to other
prohibited drugs. Similarly, substances that activate the same
brain systems as other prohibited drugs have been banned
(e.g. cannabinomimetics). However, this assumes that drugs
of a similar category, or that act on similar parts of the brain,
have similar harm proles, which is not necessarily the case. To
date, many of these broader laws have not been successfully
prosecuted, and the USA’s Drug Enforcement Agency recently
recommended that this approach be avoided 67. Some
researchers have also expressed concern that analogue laws
might impede the development of medicines 68, 69.
Consumer/medicinal law
Current Australian laws for the regulation of consumer and
medicinal products are unlikely to oer much control over new
and emerging drugs. For example, the Therapeutic Goods Act 1989
only applies to those chemicals already scheduled as medicines
within the Poisons Standard (see Box 1) or to ‘therapeutic’ products.
Either scenario would be dicult to establish when a product
is labelled ‘not for human consumption’. Similarly, prosecution
under consumer law would be dicult as it would require that
the product be demonstrated to fail to work for the purposes
advertised (e.g. plant fertilisers, bath salts).
Regulation
New Zealand has established a specic regulatory regime
for new psychoactive substances that will come into eect
this year. Under this system, distributors will be required to
determine the safety of their products at their own expense
before they may legally be sold. This new regulatory regime
oers an alternative policy response to mitigate the harmful
cycle of new, untested drugs being sold as legal highs. This
policy also restricts the sale and marketing of products to
minors, and contains labelling requirements. A recent UK
inquiry into new and emerging drugs recommended that
this model be implemented 67.
While the efficacy of the NZ
model is yet to be established, it
might provide a good framework
for developing Australian policy
given the absence of evidence-
based options.
Demand reduction
In addition to supply control, Australian policy must target a
reduction in demand for new and emerging drugs. Campaigns to
reduce demand for traditional drugs are not necessarily helpful
as they may inadvertently raise awareness of new and emerging
drugs. Hence, novel approaches must be considered.
In the case of synthetic cannabis, initial demand for the product
was fuelled by eorts to avoid positive drug urine screening
tests, which detect the presence of THC metabolites for up to
three months after an individual’s last use. The move to saliva
screening, which has been designed to detect only recent
cannabis use, may reduce demand for an undetectable synthetic
substance over cannabis.
The aforementioned UK inquiry into new and emerging drugs
also noted that they ‘are substitutes for similar and possibly
less dangerous traditional drugs’. The inquiry suggested that
decriminalisation of these traditional drugs would reduce
demand for new and emerging drugs 67, p. 9, and recommended
a model similar to that which has been implemented in
Portugal. Indeed, it would be interesting to compare the
prevalence of new and emerging drug use in countries that have
decriminalised or regulated the use of drugs, with countries
that prohibit drug use through criminal sanctions. Such analysis
might provide the impetus, both in Australia and internationally,
to reconsider the current overarching legislative frameworks.
13
PreventionResearch
The need for early
warning systems
Given how rapidly new drugs are entering the
market, there is the potential for one to emerge that
could cause signicant harm. In this environment,
early warning systems could prevent a potential
public health crisis.
Survey-based systems such as the EDRS are responsive –
researchers need to be aware of a new drug to be able to
question participants about it – so they have limited use as
an early warning system. For example, mephedrone use was
occurring in Australia as early as 2007 yet the EDRS did not
identify it until 2010. This was despite an Australian analysis of
products containing mephedrone being published on Bluelight
– an online forum for drug-related harm reduction – in 2007
70. This limitation of the EDRS has been addressed by including
an open-ended question asking participants whether they
have used any new drugs not included in the survey. However,
the accuracy of the responses is questionable, particularly in
relation to the contents of pre-packaged blends.
Monitoring of acute presentations, such as hospital
emergency department presentations or ambulance statistics,
could be helpful in providing early identication of potentially
harmful new drugs. However, given the aforementioned
limitations in coding procedures, trends are unlikely to be
identied at an early stage unless large numbers present at
one site. The use of biochemical testing, such as urine drug
screens, by hospital emergency departments to identify types
of drugs used is also inconsistent and limited by clinician
awareness and laboratory capabilities.
As Australia’s traditional monitoring systems struggle to detect
the emergence of new and potentially dangerous drugs, there
is a need to develop more eective early warning systems.
One potential methodology is that used by the European
Psychonaut Web Mapping Project 71-73 (see Box 7).
Raimondo Bruno, Senior Lecturer at the University of Tasmania,
proposes a combination of approaches to develop an eective
early warning system in Australia. He recommends using the
Psychonaut Web Mapping Project methodology to identify
new trends that can be veried using surveys and wastewater
analysis. In addition, samples of products from adult stores
and Australian online vendors should be sought for analysis to
provide further verication and to identify new substances as
they emerge.
Communication of warnings
Once a drug has been identied, the dissemination of this
information needs to be carefully managed. The Australian
media has played a signicant role over the past two years
in framing the emergence of new drugs as problematic –
sometimes fuelling a moral panic 19. The information is often
provided by experts who highlight the potential dangers of
the new drug. While such assertions are presumably intended
to reduce the likelihood of individuals using these substances,
they may be inaccurate given an absence of toxicological data,
and they do not appear to act as a deterrent. For example,
Forsyth found that the most signicant increases in interest in
purchasing mephedrone occurred following each report of an
alleged mephedrone-related death 74. As such, it is important
that information about potentially harmful products be
targeted to specic networks, such as AOD and mental health
services, emergency departments, outreach workers, peers and
user-based forums.
BOX 7
An exemplar of
monitoring: the
Psychonaut Web
Mapping Project
The Psychonaut Web Mapping Project provides a useful
model for developing early warning systems. It involves
monitoring the web for new and emerging drugs using
scanning software. Key word searches are also monitored.
Yin and Ho have identied a strong connection between
specic search terms and the number of calls to a US
poisons centre about new and emerging drug products 88.
Once a new drug is identied, further information about
the drug is gathered through purposeful website sampling,
including online user forums 71. A technical report on the
newly identied substance is then developed and passed
on to the EMCDDA for validation.
Raimondo Bruno, Senior Lecturer at the University of
Tasmania, and PhD candidate Rosalie Poesiat, are currently
conducting an Australian replication of the Psychonaut
Web Mapping Project.
Psychonaut
Web Mapping
Project
14
Alcohol and
drug information
References
1. European Monitoring Center for Drugs and Drug Addiction 2012
EMCDDA – Europol 2011 Annual Report on the Implementation of
Council Decision 2005/387/JHA, [Lisbon]: EMCDDA.
2. Winstock AR, Mitcheson LR, Deluca P, Davey Z, Corazza O &
Schifano F 2011 “Mephedrone, new kid for the chop?”, Addiction,
106:1, pp. 154-61.
3. Farrell M 2012 “Emerging psychoactive substances remain one of the
biggest challenges for the year ahead”, Centrelines, p. 34.
4. Vardakou I, Pistos C & Spiliopoulou C 2011 “Drugs for youth via
Internet and the example of mephedrone”, Toxicology Letters,
201: 3, pp. 191-5.
5. Davies S, Wood DM, Smith G, Button J, Ramsey J, Archer R et
al. 2010 “Purchasing ‘legal highs’ on the Internet – is there
consistency in what you get?”, QJM: Monthly Journal of the
Association of Physicians, 103: 7, pp. 489-93.
6. Davies S, Lee T, Ramsey J, Dargan PI & Wood DM 2011 “Risk
of caeine toxicity associated with the use of ‘legal highs’
(novel psychoactive substances)”, European Journal of Clinical
Pharmacology, 68: 4, pp. 435-9.
7. Brandt SD, Freeman S, Sumnall HR, Measham F & Cole J 2011 “Analysis
of NRG ‘legal highs’ in the UK: identication and formation of novel
cathinones”, Drug Testing and Analysis, 3: 9, pp. 569-75.
8. Brandt SD, Sumnall HR, Measham F & Cole J 2010 “Analyses of second-
generation ‘legal highs’ in the UK: initial ndings”, Drug Testing and
Analysis, 2: 8, pp. 377-82.
9. De Paoli G, Maskell PD & Pounder DJ 2011 “Naphyrone: analytical
prole of the new ‘legal high’ substitute for mephedrone”, Journal of
Forensic and Legal Medicine, 18: 2, p. 93.
10. Vardakou I, Pistos C, Dona A, Spiliopoulou C & Athanaselis S 2012
“Naphyrone: a ‘legal high’ not legal any more”, Drug and Chemical
Toxicology, 35: 4, pp. 467-71.
11. Therapeutic Goods Administration website 2012 “Final decisions and
reasons by delegates of the Secretary to the Department of Health
and Ageing” at www.tga.gov.au/industry/scheduling-decisions-1202-
nal.htm (accessed 13/03/13)
12. Shanks KG, Dahn T, Behonick G & Terrell A 2012 “Analysis of rst
and second generation legal highs for synthetic cannabinoids and
synthetic stimulants by ultra-performance liquid chromatography
and time of ight mass spectrometry”, Journal of Analytical
Toxicology, 36: 6, pp. 360-71.
13. Hastie H 2011 “WA ‘Kronicles’ detection of synthetic cannabinoids”
at http://www.sciencewa.net.au/topics/technology-a-innovation/
item/90-wa-%E2%80%98kronicles%E2%80%99-detection-of-
synthetic-cannabinoids (accessed 1 August 2012).
14. Misuse of Drugs Act 1981 (WA) O 2 (2012)
15. Rickard L 2011 “Kronic ban sparks ‘re-sale’ fears”, at www.WAtoday.
com.au 14 June (accessed 2/04/13).
16. “Kronic party plans up in smoke” ABC News, 16 June 2011.
17. Dresen S, Ferreirós N, Pütz M, Westphal F, Zimmermann R & Auwärter
V 2010 “Monitoring of herbal mixtures potentially containing
synthetic cannabinoids as psychoactive compounds”, Journal of Mass
Spectrometry, 45: 10, pp. 1186-94.
18. Australian Crime Commission 2012 Illicit drug data report 2010-11,
Canberra: ACC.
19. Bright SJ, Bishop B, Kane R, Marsh A & Barratt M “Kronic hysteria:
exploring the intersection between Australian synthetic cannabis
legislation, the media, and drug-related harm”, International Journal
of Drug Policy, Article in Press.
20. Noone R 2012 “Warning to students of pill danger after the LSD death
of teenager Nick Mitchell”, The Australian, 7 December.
21. Olding R 2012 “Naked and psychotic: legal cocaine substitute oers a
deadly high”, Sydney Morning Herald, 3 November.
22. Matthews A & Bruno R 2010 “Mephedrone use among regular ecstasy
consumers in Australia” EDRS Drug Trends Bulletin, December, National
Drug and Alcohol Research Centre.
23. Chang C, Kostakis C, Camilleri AM, Felgate PD, Irvine RJ & White JM
“Use of MDMA and other synthetic stimulants monitored by waste
water analyses”, College on Problems of Drug Dependence 74th Annual
Meeting, June 9-14 2012, Palm Springs, CA.
24. Baumann MH, Ayestas MA, Jr., Partilla JS, Sink JR, Shulgin AT, Daley
PF et al. 2012 “The designer methcathinone analogs, mephedrone
and methylone, are substrates for monoamine transporters in brain
tissue”, Neuropsychopharmacology, 37: 5, pp. 1192-1203.
Conclusion
There has recently been a signicant increase in the
availability of new drugs, including synthetic cannabis, a range
of professionally packaged powders and pills, and drugs sold
as research chemicals. Van Amsterdam et al. have stated that ‘a
strict ban on the use of and trade in conventional recreational
drugs is one of the most important reasons for the popularity
of [these new and emerging drugs]’ 68, p.1. Demand for drugs
will always exist, and entrepreneurial individuals will develop
innovative ways of meeting this demand. 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.
While a dramatic change in global drug policy may provide
some answers to supply and demand issues, in its absence,
early warning systems must be developed and implemented.
Such systems could detect the emergence of signicantly
harmful new drugs and alert key stakeholders to a potential
public health crisis.
In the meantime, 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.
‘ Drug taking is here to stay and
one way or another, we must
all learn to live with drugs’ 75, p. 207
15
PreventionResearch
25. Watterson LR, Kufahl PR, Nemirovsky NE, Sewalia K,
Grabenauer M, Thomas BF et al. 2012 “Potent rewarding
and reinforcing eects of the synthetic cathinone
3,4-methylenedioxypyrovalerone (MDPV)”, Addiction
Biology, Article in Press.
26. Prosser JM & Nelson LS 2012 “The toxicology of bath
salts: a review of synthetic cathinones”, Journal of Medical
Toxicology: ocial journal of the American College of Medical
Toxicology, 8: 1, pp. 33-42.
27. Sorensen LK 2011 “Determination of cathinones and related
ephedrines in forensic whole-blood samples by liquid-
chromatography-electrospray tandem mass spectrometry”,
Journal of Chromatography B, Analytical Technologies in the
Biomedical and Life Sciences. 879: 11-12, pp. 727-36.
28. Davis S, Rands-Trevor K, Boyd S & Edirisinghe M
2012 “The characterisation of two halogenated
cathinone analogues: 3,5-diuoromethcathinone and
3,5-dichloromethcathinone”, Forensic Science International,
217: 1-3, pp. 139-45.
29. Meyer MR, Vollmar C, Schwaninger AE, Wolf E & Maurer
HH 2012 “New cathinone-derived designer drugs
3-bromomethcathinone and 3-uoromethcathinone:
studies on their metabolism in rat urine and human liver
microsomes using GC-MS and LC-high-resolution MS and
their detectability in urine”, Journal of Mass Spectrometry:
JMS, 47: 2, pp. 253-62.
30. Every-Palmer S 2011 “Synthetic cannabinoid JWH-018
and psychosis: an explorative study”, Drug and Alcohol
Dependence, 117: 2-3, pp. 152-7.
31. Castellanos D & Thornton G 2012 “Synthetic cannabinoid
use: recognition and management”, Journal of Psychiatric
Practice, 18: 2, pp. 86-93.
32. Phillips Y 2011 “Kronic blamed for death as Government
ban widens”, Herald Sun, 5 August.
33. Piotrowski D 2013 “’Red alert’ over bizarre killer drug”,
The Australian, 22 February.
34. Green S 2011 “Kronic made me ‘bloody useless’”, CQNews,
18 November.
35. Barratt M, Cakic V & Lenton S 2012 “Patterns of synthetic
cannabinoid use in Australia”, Drug and Alcohol Review,
Article in Press.
36. Corazza O, Demetrovics Z, van den Brink W & Schifano
F 2013 “’Legal highs’ an inappropriate term for ‘Novel
Psychoactive Drugs’ in drug prevention and scientic
debate”, The International Journal on Drug Policy, 24: 1,
pp. 82-3.
37. Macdonald K 2011 “Drug invisible to mine site tests”,
The West Australian, 13 April.
38. Perrone D, Helgesen RD & Fishcher RG 2012 “United States
drug prohibition and legal highs: how drug testing may
lead cannabis users to spice”, Drugs: Education, Prevention
and Policy, Article in Press.
39. Measham F, Moore K, Newcombe R & Welch Z 2010
“Tweaking, bombing, dabbing and stockpiling: the
emergence of mephedrone and the perversity of
prohibition”, Drugs and Alcohol Today, 10: 1, pp. 14-21.
40. Brunt TM, Poortman A, Niesink RJM & van den Brink W
2012 “Instability of the ecstacy market and a new kid on
the block: mephedrone”, Journal of Psychopharmacology,
25: 11, pp. 1543-7.
41. Winstock AR & Mitcheson L 2012 “New recreational drugs
and the primary care approach to patients who use them”,
British Medical Journal, 344, p. e288.
42. Advisory Council on the Misuse of Drugs 2011
Consideration of the novel psychoactive substances (‘legal
highs’), London: Advisory Council on the Misuse of Drugs
43. Antonowicz JL, Metzger AK & Ramanujam SL 2012
“Paranoid psychosis induced by consumption of
methylenedoxypyrovaleron: two cases”, General Hospital
Psychiatry, 33: 6, p. 640.
44. Borek HA & Holstege CP 2012 “Hyperthermia and
multiorgan failure after abuse of ‘bath salts’ containing
3,4-methylenedioxypyrovalerone”, Annals of Emergency
Medicine, 60: 11, pp. 103-5.
45. Boshuisen K, Arends JE, Rutgers DR & Frijns CJ 2012 “A
young man with hemiplegia after inhaling the bath salt
‘Ivory wave’”, Neurology, 78: 19, pp. 1533-4.
46. Boulanger-Gobeil C, St-Onge M, Laliberte M & Auger PL
2012 “Seizures and hyponatremia related to ethcathinone
and methylone poisoning”, Journal of Medical Toxicology:
ocial journal of the American College of Medical
Toxicology, 8: 1, pp. 59-61.
47. Derungs A, Schietzel S, Meyer MR, Maurer HH,
Krahenbuhl S & Liechti ME 2011 “Sympathomimetic
toxicity in a case of analytically conrmed recreational
use of naphyrone (naphthylpyrovalerone)”, Clinical
Toxicology, 49: 7, pp. 691-3.
48. Kasick DP, McKnight CA & 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, 38:
2, pp. 176-80.
49. Murphy CM, Dulaney AR, Beuhler MC & Kacinko S 2012
“’Bath salts’ and ‘plant food’ products: the experience
of one regional US poison center”, Journal of Medical
Toxicology: ocial journal of the American College of
Medical Toxicology, 9: 1, pp. 42-8.
50. Regunath H, Ariyamuthu VK, Dalal P & Misra M 2012
“Bath salt intoxication causing acute kidney injury
requiring hemodialysis”, Hemodialysis International
Symposium on Home Hemodialysis, 16:1, pp. S47-9.
51. Ross EA, Reiseld GM, Watson MC, Chronister CW &
Goldberger BA 2012 “Psychoactive ‘bath salts’ intoxication
with methylenedioxypyrovalerone”, The American Journal
of Medicine, 125: 9, pp. 854-8.
52. Shields JE, Dargan PI, Wood DM, Puchnarewicz M,
Davies S & Waring WS 2012 “Methoxetamine associated
reversible cerebellar toxicity: three cases with analytical
conrmation”, Clinical Toxicology, 50: 5, pp. 438-40.
53. Thornton SL, Gerona RR & Tomaszewski CA 2012 “Psychosis
from a bath salt product containing ephedrone and MDPV
with serum, urine, and product quantication”, Journal of
Medical Toxicology: ocial journal of the American College of
Medical Toxicology, 8: 3, pp. 310-3.
54. Kovacs K, Toth AR & Kereszty EM 2012”[A new designer
drug: methylone related death]”, [Article in Hungarian]
Orvosi hetilap, 153: 7, pp. 271-6.
55. Murray BL, Murphy CM & Beuhler MC 2012 “Death
following recreational use of designer drug ‘ bath salts’
containing 3,4-Methylenedoxypyrovalerone (MDPV)”,
Journal of Medical Toxicology, 8, pp. 69-75.
56. Pearson JM, Hargraves TL, Hair LS, Massucci CJ, Frazee
CC, 3rd, Garg U et al 2012 “ Three fatal intoxications due
to methylone”, Journal of Analytical Toxicology, 36: 6,
pp. 444-51.
57. Wikstrom M, Thelander G, Dahlgren M & Kronstrand R 2012
“An accidental fatal intoxication with methoxetamine”,
Journal of Analytical Toxicology, 37: 1, pp. 43-46.
58. Every-Palmer S 2010 “Warning: legal synthetic
cannabinoid-receptor agonists such as JWH-018 may
precipitate psychosis in vulnerable individuals”, Addiction,
105: 10, pp. 1859-60.
59. Muller H, Huttner HB, Kohrmann M, Wielopolski
JE, Kornhuber J & Sperling W 2010 “Panic attack
after spice abuse in a patient with ADHD”,
Pharmacopsychiatry, 43: 4, pp. 152-3.
60. Muller H, Sperling W, Kohrmann M, Huttner HB,
Kornhuber J & Maler JM 2010 “The synthetic cannabinoid
Spice as a trigger for an acute exacerbation of cannabis
induced recurrent psychotic episodes”, Schizophrenia
Research, 118: 1-3, pp. 309-10.
61. Hoyte CO, Jacob J, Monte AA, Al-Jumaan M, Bronstein AC &
Heard KJ 2010 “A characterization of synthetic cannabinoid
exposures reported to the National Poison Data System in
2010”, Annals of Emergency Medicine, 60: 4, pp. 435-8.
62. Hermanns-Clausen M, Kneisel S, Szabo B & Auwarter V
2012 “Acute toxicity due to the conrmed consumption of
synthetic cannabinoids: clinical and laboratory ndings”,
Addiction, 108: 3, pp. 534-44.
63. Ojanpera IA, Heikman PK & Rasanen IJ 2011 “Urine analysis
of 3,4-methylenedioxypyrovalerone in opioid-dependent
patients by gas chromatography-mass spectrometry”,
Therapeutic Drug Monitoring, 33: 2, pp. 257-63.
64. Davies B 2010 “Dangerous drugs online”, Australian
Prescriber, 35: 1, pp. 32-3.
65. Australian Institute of Health and Welfare 2011 2010 National
Drug Strategy household survey report, Canberra: AIHW.
66. McElrath K & O’Neill C 2011 “Experiences with
mephedrone pre- and post-legislative controls:
perceptions of safety and sources of supply”, The
International Journal on Drug Policy, 22: 2, pp. 120-7.
67. All Party Parliamentary Group for Drug Policy Reform
(UK) 2012 Towards a safer drug policy: challenges and
opportunities arising from legal highs, London: All Party
Parliamentary Group for Drug Policy Reform.
68. van Amsterdam J, Nutt D & van den Brink W 2013
“Generic legislation of new psychoactive drugs”,
Journal of Psychopharmacology, 27: 3, pp. 317-24.
69. McNabb CB, Russell BR, Caprioli D, Nutt DJ, Gibbons S
& Dalley JW 2012 “Single chemical entity legal highs:
assessing the risk for long term harm”, Current Drug Abuse
Reviews, 5: 4, pp. 304-19.
70. Camilleri A, Johnston MR, Brennan M, Davis S &
Caldicott DG 2010 “Chemical analysis of four capsules
containing the controlled substance analogues
4-methylmethcathinone, 2-uoromethamphetamine,
alpha-phthalimidopropiophenone and N-ethylcathinone”,
Forensic Science International, 197: 1-3, pp. 59-66.
71. Davey Z, Schifano F, Corazza O & Deluca P on behalf of
Psychonaut Web Mapping Group 2012 “e -Psychonauts:
conducting research in online drug forum communities”,
Journal of Mental Health, 21: 4, pp. 386-94.
72. Deluca P, Davey Z, Corazza O, Di Furia L, Farre M, Flesland
LH et al. 2012 “Identifying emerging trends in recreational
drug use; outcomes from the Psychonaut Web Mapping
Project”, Progress in Neuro-Psychopharmacology &
Biological Psychiatry, 39: 2, pp. 221-6.
73. Schifano F, Deluca P, Baldacchino A, Peltoniemi T,
Scherbaum N, Torrens M et al 2006 “Drugs on the
web; the Psychonaut 2002 EU project”, Progress
in Neuro-Psychopharmacology & Biological
Psychiatry, 30: 4, pp. 640-6.
74. Forsyth AJ 2012 “Virtually a drug scare: mephedrone and
the impact of the internet on drug news transmission”,
International Journal of Drug Policy, 23: 3, pp. 198-209.
75. Gossop M 2007 Living with drugs, Michigan,
Ashgate Publishing.
76. Drugs, Poisons and Controlled Substances Act
1981, Victoria.
77. Drug Misuse and Tracking Act 1985, New South Wales.
78. Criminal and Other Legislation Amendment Bill
2011, Queensland.
79. Barns G 2012 “Australia’s long and illogical war on drugs” at
The Drum Opinion www.abc.net.au/unleashed/4391146
(accessed 2/03/13).
80. Leask A 2012 “Kronic ‘ king’ on bail after facing drug charges
in Australia”, The New Zealand Herald, 11 December.
81. Nutt D 2012 Drugs without the hot air: minimising the harms
of legal and illegal harms, Cambridge: UIT Cambridge
82. Barratt MJ 2011 Beyond internet as tool: A mixed-
methods study of online drug discussion, Melbourne,
National Drug Research Institute, Faculty of Health
Sciences, Curtin University.
83. Barratt MJ, Lenton S & Allen M 2012 “Internet content
regulation, public drug websites and the growth in hidden
Internet services”, Drugs: Education, Prevention and Policy,
Article in Press.
84. Dorairaj JJ, Healy C, McMenamin M & Eadie PA 2012
“The untold truth about ‘bath salt’ highs: A case series
demonstrating local tissue injury”, Journal of Plastic,
Reconstructive & Aesthetic Surgery: JPRAS, 65: 2, pp. e37-41.
85. Coppola M & Mondola R 2012
“3,4-methylenedioxypyrovalerone (MDPV): chemistry,
pharmacology and toxicology of a new designer drug of
abuse marketed online” Toxicology Letters, 208: 1, pp. 12-5.
86. Simmler LD, Buser TA, Donzelli M, Schramm Y, Dieu LH,
Huwyler J et al. 2012 “Pharmacological characterization
of designer cathinones in vitro”, British Journal of
Pharmacology, 168: 2, pp. 458-70.
87. Mas-Morey P, Visser MH, Winkelmolen L & Touw DJ 2012
“Clinical toxicology and management of intoxications with
synthetic cathinones (‘Bath Salts’)”, Journal of Pharmacy
Practice, Article in Press.
88. Yin S & Ho M 2012 “Monitoring a toxicological outbreak
using Internet search query data”, Clinical Toxicology, 50: 9,
pp. 818-22.
Acknowledgements
The work of the author, Stephen Bright,
was supported by a reference group that
included: Peter Nguyen and David Wain,
Department of Health; Cameron Francis,
Dovetail; Chris McDonnell, Victorian
Alcohol and Drug Association; Eddie
Micallef, Ethnic Communities Council
of Victoria; Matthew Frei, Turning Point;
Prof Iain McGregor, University of Sydney;
Julie Rae, Geo Munro and Kate James,
Australian Drug Foundation. A number
of key informants also assisted the
author: Dr Monica Barratt, Dr Raimondo
Bruno, Dr Belinda Lloyd, Angela
Matheson, Fiona Patten, Je Robinson
and Dr Adam Winstock.
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Glossary
Analogue: A chemical that is similar in
structure to another chemical.
Benzylpiperazine (BZP): A
psychostimulant that was contained in
many of the rst generation legal highs.
Cathinone: A naturally occurring
psychostimulant that is contained in the
khat tree. Many of the second generation
legal highs were cathinone analogues.
Dopaminergic agent: A chemical that
leads to increased dopamine in the brain.
Dopamine is implicated in reinforcing
behaviour and also psychosis.
Legal highs: Psychoactive products that
are sold as legal alternatives to illegal
drugs. Unlike legal highs that were
available in the past, many of today’s
legal highs are pre-packaged products
containing novel psychoactive chemicals
that produce pronounced eects. These
chemicals might not necessarily be legal.
Metabolites: The chemicals that are
produced as the body breaks down a
drug that has been ingested.
Mephedrone (4-methyl-methcathinone):
The most popular cathinone analogue that
was contained in the second generation
legal highs. Also called miaow miaow.
Research chemicals: Raw active
chemicals, as opposed to those contained
within pre-packaged products.
Synthetics: A term often used to describe
new and emerging drugs. It is not very
accurate as many traditional drugs, such
as LSD and amphetamines, are also
synthetic as opposed to naturally derived.
