A total of 22 products marketed as research chemicals, plant food or bath salts were purchased from five different internet sites. A list of products available from more than two of the sites to facilitate comparisons was generated, and eight products were randomly chosen for this research.
The products were handled and tested by an analyst with a Chief Officer of Police's delegated authority to be in possession of controlled substances. The substances were stored in the secure drug store of a local police force and retained by them for destruction at the conclusion of the experiments. Information concerning the marketing, packaging, ingredients, method of use, dosage and warnings over use was noted. Each product was, in turn, analysed qualitatively using a combination of the techniques outlined in box 1.
Additionally, where there was an indication from the spectroscopy that a product contained an illegal substance and that product was analysed with 13 C NMR. Those products supplied as a tablet were ground to a powder, while those supplied as a capsule were emptied.
For both NMR, 0. All instruments were calibrated using calibration sources and correction software supplied by the manufacturers. No specific comparison with reference standards for the illegal chemicals identified was undertaken. Fourier Transform Infrared Spectroscopy analyses the composition of a substance by measuring how much infrared energy is absorbed by different molecules, thereby enabling the molecules present to be determined.
Raman Spectroscopy uses inelastic scattering of monochromatic light usually a laser to excite vibrational modes of bonds in the sample that result in a frequency shift of the emitted light, thereby enabling the composition of the sample to be determined.
The results of the analyses were compared with the information provided by the suppliers and the legality of the active ingredients ascertained.
This information is summarised in table 1. Although methoxetamine was legal when the research was conducted, it was classified as a temporary class drug in March , making its supply illegal. Summary of the 22 legal highs purchased via the internet, including the compounds detected, the accuracy of their description and their legal status. Instead of containing alpha,Dihydroxyalpha-methylpregna-1,4,9 11 -triene-3,dioneacetate, both of the NRG-3 products contained benzofuran 1-benzofuranylpropanamine.
This suggests that the benzofuran mixture is being sold as a number of different products benzofuran and NRG-3 , thus supporting previous research. Benzocaine is a local anaesthetic and a popular cutting agent for cocaine. In contrast to earlier research, 5 there were no traces of mephedrone in either of the Jolly Green Granules. However, both NRG-2 products contained 4-methylethcathinone 4-MEC with a smaller, trace, amount of 4-methylmethcathinone 4-MM C or mephedrone, possibly as an unwanted contaminant, making them illegal.
Consistent with the findings of Brandt et al , 5 no other compounds were found in either NRG-2 samples. Therefore, the product being sold is of a high purity and the amount of illegal cathinone taken is simply the quantity of powder consumed.
Of the four NRG products analysed further by 13 C NMR to confirm their contents, only two were found to contain the illegal compounds 4-methylethcathinone and 4-methylmethcathinone mephedrone. Even though it is not named specifically on the class B drug list, it is a substituted cathinone and therefore subject to the Misuse of Drugs Act Amendment Order. The contaminant 4-methylmethcathinone mephedrone in NRG-2 is also a substituted cathinone and a class B controlled substance in the UK, subject to the Misuse of Drugs Act Amendment Order see figure 3.
Structure of the banned substituted cathinone 4-MMC or mephedrone 4-methylmethcathinone. These findings show illegal cathinones are still being sold online as legal alternatives to illegal substances, which was also a marketing tool used by all the suppliers in this research. Analogies were made between the substances for sale and the recently banned cathinone, mephedrone or illegal drugs like amphetamine, ecstasy MDMA or ketamine. The chemical composition of the products purchased from supplier A and supplier D were identical, as was the packaging, indicating that either two websites are fronting the same company or that both companies purchase goods from the same source.
Specifically, the NRG-2 products tested from suppliers A and D and the relative concentration of each chemical suggested that they originated from the same source. The physical appearance, packaging, labelling not for human consumption and chemical analysis of these products suggest that they originated from the same source, although neither product contained the ingredients listed.
Our study employed a range of recognised analytical techniques to identify the active ingredients in each of the products purchased.
While the analysis carried out here is not in itself a weakness, a limitation of this study is the relatively small sample size. Our study purchased and analysed 22 random products from five internet suppliers and, from the packaging and chemical analyses, two of these suppliers appeared to be selling products from the same source. Thus, at best, we have analysed products from four different sources and only found banned substances in two of the products.
Also, the number of products tested here 22 is far in excess of the number tested in the previous most recent study seven , 4 which failed to find cathinones in any of their products. Our findings show that research conducted immediately after the ban, which found cathinones in a number of legal highs, 4 6 was not merely indicative of the retailers' attempts to sell off surplus stockpiles of mephedrone.
Instead, this research indicates that despite being brought under the Misuse of Drugs Act , substituted cathinones are still being sold illegally over the internet. Although the extent to which substituted cathinones are supplied is still unknown, finding cathinones in the small sample of products tested here indicates that the widespread distribution of cathinones over the internet is highly probable. Even though drugs like benzofuran, bromo-dragonFLY and MPA N-methyl thiophenyl propanamine are legal to buy, little is known about the safety of these substances, how they interact with other drugs, their long-term effects psychologically and behaviourally on humans or their toxicity.
This also applies to the banned drugs naphyrone, 12 13 synthetic cannabinoids 14 and mephedrone. Although there have been no known deaths from benzocaine, the death of a teenager was attributed to cocaine containing four times the toxic dose of lidocaine, 24 illustrating the potential health risks arising from the varied composition of these products.
The arbitrariness of the advertised ingredients and mislabelling of products exacerbates the detrimental consequences for the health of the user. Products do not always contain the advertised active ingredients, 8 even those with the same name. The contents of the NRG products have varied substantially from one type of cathinone, to a combination of cathinones, to banned piperazines, and to inorganic material or benzocaine.
Those repeatedly buying the same product and expecting the same effects may actually be taking a completely different and more potent substance. The user is also exposed to the risks arising from the potentiating effect of any drug interactions and their subsequent metabolites produced inside the body. However, any adverse effects brought on by these drugs are unlikely to be identified by clinicians, as drug screening does not identify these new and unique compounds, 27 and despite recent publications examining specific toxicity case studies, 28 their toxicological detection in biological specimens is challenging.
Medical practitioners need to be made more aware of these substances, their effects and potential health risks. The healthcare professionals who are aware of the problems associated with NPSs are ill equipped to deal with them due to the paucity of scientific and medical research in this area.
The public health risks associated with these drugs are compounded by the lack of safety guidance ie, use and dosage information provided by websites. All substances are labelled as not fit for human consumption, with some advocating medical assistance if swallowed. While this does not seem to deter use, it means that NPSs can be sold having undergone no checks and adhering to no regulations, which means that they could contain anything.
Therefore, the growth in NPSs poses insurmountable challenges to clinicians attempting to identify and diagnose the adverse health effects arising from the ingestion of un-researched, unknown and unidentifiable chemicals. The small sample 22 products analysed in this study means the question of how many sites are selling products containing banned substances, how widespread the purchase of these substituted cathinones actually is and the extent to which they are being taken by unsuspecting consumers remains unknown.
Therefore, future research should investigate a much wider range of internet suppliers and their products to establish the chemical composition of these substances and to help identify which products contain prohibited substances like mephedrone. Future research could also usefully investigate low-level contaminants in these substances, not least as a possible means of linking sites of manufacture.
There is a need for more medical research to be conducted in this area examining the potential impact NPSs have on public health. This article illustrates more training for clinicians is required and demonstrates the need for a centralised system, which collates and stores information that medical practitioners can draw on when faced with a suspicious case.
Surprisingly, there has been no public health campaign highlighting the risks associated with NPSs to raise awareness among the public or the medical profession, despite the potential risks to health. The imposition of legislative controls banning certain substances has had little effect on the chemical composition of NPSs or their availability, indicating that bringing in new laws on drugs as quickly as they emerge is not tackling the problem of supply or demand. Instead, it displaces the problem and invites chemists to modify the molecular structure of chemicals to create legal alternatives to the newly banned substances.
The continual evolution of chemical compounds designed to evade the law is potentially creating more dangerous and unknown synthetic substances than the ones currently being legislated on.
Although these substances are potentially more harmful than their illegal counterparts, many remain legal to buy and consume, thus undermining the scientific calculation of harm that underpins drug legislation, a calculation, which has come under increasing criticism in recent years. Although new substances are constantly being created to evade the law, illegal ones are also being sold openly on the internet, indicating that the police are unable to enforce current legislation and prohibit supply.
Unsuspecting buyers are breaking the law and are buying substances that are potentially harmful. NPSs have the potential to cause serious public health problems to a new generation of drug users who see them as a safer alternative to their illicit counterparts.
The medical profession are facing a new genre of NPS induced illnesses and an increase in toxicity cases but lack the methodology required to detect these drugs and their metabolites in biological samples or recognise the symptoms of toxicity.
Prohibition is intended to protect public health by limiting the availability and use of drugs like substituted cathinones. Under current UK legislation, even if individuals are not aware that they have purchased a controlled drug, they could not use this as a defence if arrested and they would be subject to the same penalties as if they had knowingly purchased a controlled drug.
All of the 18 products purchased prior to the changes to the UK Misuse of Drugs Act that came into force on the 16 April contained one or more active ingredient. These active ingredients were all legal at the time of purchase under the Misuse of Drugs Act in force at that time. However, of the 18 products purchased and analysed, 17 of the products contained one or more active ingredient that would now be controlled under the updated Misuse of Drugs Act Therefore, individuals who purchased these products legally prior to the changes in the law would now be subject to prosecution under this Act, if they were found in possession of these products.
They would not be able to use the fact that they had purchased them legitimately prior to the changes in the law as a defence. In this study, we have shown that products with the same name purchased from different vendors may contain different active ingredients.
There is the potential for significant toxicity associated with these agents 2 , 11 and this variation in content of legal highs, together with the potential for different potency between the agents, puts users at greater risk of acute toxicity associated with their use. The relative potency of the differing active ingredients is often not clearly known as there is little scientific literature on the pharmacology and toxicology of these compounds.
The recent media interest in the acute harm and risk of death associated with mephedrone perversely seemed to increase interest in and purchase of mephedrone, rather than to have the desired effect of increasing public awareness of the harms associated with its use. This should not only focus on the public health issues relating to the harm associated with their use, but also include sufficient relevant information so that individuals are aware that they may be purchasing controlled substances and what the potential consequences of this could be if they were found to be in possession of these substances.
There was no specific funding source for this study and therefore the researchers conducted this study with complete independence from funders. Conflict of interest : D.
All authors were involved in the design of the purchase of the products; analysis of the products was undertaken by M. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation.
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Select Format Select format. Permissions Icon Permissions. Abstract Background: Recreational drug use in the UK is common; sources of recreational drugs are changing, with increasing purchase of legal highs from the Internet. Serious side-effects. Michael Gafoor, from the Alcohol and Drug Service, said some islanders may have taken the drug unwittingly.
Mr Gafoor said that, although it may appear harmless, mephedrone could be very dangerous. He said: "Mephedrone was reclassified as a Class B drug in April of this year and obviously some websites and drug dealers have been left with stocks of mephedrone to sell.
Mr Hussey said that it was easy for them to spot when people had purchased the products, but there had been an increase in the number of seizures. He said: "They appear to be coming from single sources or maybe a couple of websites and they are identical in nature so it is easy to pick them out.
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