The Government this week received Royal Assent to pass a bill outlawing all legal highs. But when the Psychoactive Substances Bill has been slammed by Parliament’s own drugs advisory body and a plethora of doctors, is it going to prove more dangerous than the current laws?
Loaded spoke to a team of experts to investigate the ramifications…
Saturday February 13 2010, 10:30am. Emergency services are called to an address in south Wales where a 35-year-old man has collapsed.
Unresponsive when the ambulance arrives, he lies face down in white powder, bleeding from his left nostril. Next to him is a small empty plastic bag, marked only with an unknown chemical structure. Unsure what they are dealing with, medical staff rush him to A&E at Nevill Hall Hospital in Abergavenny.
The consultant on duty is Dr David Caldicott. “He was covered in what he was attempting to snort when he collapsed – he looked like some kind of snowman,” explains Dr Caldicott. Not presenting with any usual signs of a cocaine overdose, the medical staff set to work. “It was clearly something different to what we had seen before and, frankly, bizarre.”
“He described being in contact with heaven, hell and the spirit of his dead father”
Dr Caldicott and his staff did not recognise the compound marked on the package. Only later did it become clear that he had taken a legal high – Novel Psychoactive Substance (NPS) to give the medical term.
“Prior to the arrival of NPS, we had a fairly reliable picture of what overdosing for different substances looked like, called toxidromes,” Dr Caldicott says. “All of a sudden we were seeing very unreliable presentations. That is very uncomfortable territory for doctors in an emergency department.”
The patient’s heart rate was far higher than average, the team monitored his breathing and blood pressure. “It comes down to intuition, as we’re just speculatively managing these people, trying to maintain the various organ systems while whatever they have taken works itself out of the body.”
Doctors usually assess urine and blood, but with NPS, it often offers little help. “If something has never been seen before, you don’t know what to test for.”
Once stabilised, the man quickly regained consciousness. “He was highly delusional,” Caldicott explains. “His behaviour was erratic and he described being in contact with heaven, hell and the spirit of his dead father. These substances have a far more profound impact on individuals than the more classic recreational drugs.”
Once the team had identified the leftover product, they established it was methoxetamine (MXE), a synthesised ketamine-type drug later criminalised in the UK in 2012. It was one of the first recorded cases of human consumption of MXE.
MXE was amongst the first legal highs. The first to gain mass appeal was club drug mephedrone, an amphetamine-like stimulant banned in 2010. Both are from the range of rapidly growing NPS compounds which are an increasing area of concern for doctors and politicians.
In response to this concern, the Government announced plans last year to blanket ban NPS under the Psychoactive Substances Bill. That bill was given Royal Assent this week, meaning it will become law this spring. The Psychoactive Substances Act 2016 will prohibit the production, supply and importation, but not the possession of them.
“The genie is out the bottle, and it isn’t going to be put back in very easily”
“This landmark act will change the way we tackle these drugs and put an end to unscrupulous suppliers profiting from their trade,” said Karen Bradley, minister for preventing abuse and exploitation. “Our message is clear: offenders will face up to seven years in prison. We cannot tolerate the open sale on our high streets and over the internet of these potentially harmful substances.”
The Bill bans anything that has a “psychoactive effect” on humans – with the exception of nicotine, alcohol, caffeine and medicines – was passed in the House of Commons last week without a vote.
This is all despite the fact it goes against much of the advice given by the Advisory Council on the Misuse of Drugs, who inform Government drug policy. It has also been met by wide criticism by experts and journalists alike.
They argue the bill only serves to increase the risk of harm from substance abuse, not minimise it, by reducing the knowledge and information about NPS. So will blanket banning them only result in driving them further underground, and thus even less control of the market?
Previously, the Home Office has been locked in what they describe as a game of cat and mouse with NPS manufacturers, predominantly in China, India and Pakistan. Those manufacturers closely monitor new laws and apply minor chemical tweaks to controlled substances in order to take them back outside legislation, faster than authorities can ban them.
According to figures from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), NPS compounds hitting the market peaked in 2014 at 101, up on 82 in 2013. They steadily increased since 2008, when only 14 new compounds were recorded.
The influx started when drugs like cocaine and ecstasy were at their lowest purity. When a reliably potent stimulant became available, delivered legally by post for £10 a gram, it created a perfect storm.
“The difference between cannabis and synthetic cannabinoids is the same as that between a Ferrari and a Fiat Punto”
“NPS emerged as a result of drug prohibition. It’s the unintended consequence of enforcing a blanket ban on more traditional drugs,” explains Danny Kushlick, founder of Transform Drug Policy Foundation. “When you squeeze the traditional market, people start looking in places that they really shouldn’t for highs. Why would you want to use an unknown substance if there’s a regulated alternative? There would be virtually no market for them.”
Kushlick feels blanket banning NPS only makes the situation worse. “It’s treating a symptom with a cause. These things only exist because of prohibition in the first place. It fails to recognise the fundamental fact that people want to get high.
“The government’s job is to keep people safe. But this bill is a facade of protection that doesn’t work. We’ve had a blanket ban of opiates, opium and cocaine since 1961, which has created a vast criminal market place and destabilised entire regions of the world. It builds stupidity upon stupidity.
Kushlick says the Home Office approach to drug policy is vastly out-dated. “As Abraham Maslow said: ‘If the only tool you have in your toolbox is a hammer, everything begins to look like a nail.’ The only tool the Home Office have in their toolbox to deal with drugs is prohibition. So they see a drug and they hit it with it.”
The risks associated to a lack of regulation within the market is something that Fiona Measham, professor of criminology at Durham University, agrees with. During a recent study in Blackburn, where local authorities banned the sale of legal highs, she found concerning results.
“Most people are not idiots and want to avoid harm”
“Sales of NPS clearly shifted from the shops to the street, rather than stopping it,” she explains. “Street dealers were breaking up labelled commercial packaging and selling smaller, unlabelled baggies to people of any age. You ended up with less idea of what was in the bags and with the most vulnerable people even more vulnerable.”
As part of the Advisory Council on the Misuse of Drugs (ACMD), Measham explains that there was a proposition by the Ministerial expert panel on NPS to regulate low-harm substances rather than ban them: “The safety valve clause”.
“That seems to have been lost,” she explains. “You have certain controls if you’ve got a regulated market, such as more responsible retail practices and a control on manufacture. But they are all out the window with a blanket ban.”
Measham believes prohibition is going to be difficult to enforce. “There isn’t a test you can do to establish what is psychoactive,” she said. “What defines it is massively disputed between chemists, biologists, pharmacologists and social scientists.
“How can they define ‘psychoactive’ but not criminalise things they don’t want to, like vitamins and sports supplements? There is no easy answer, so they’re going to tie themselves in knots to do it.”
Indeed. Lawyers, police and experts are still confused as to what exactly falls under the law. Measham argues that you could classify chocolate as “psychoactive”, and that it’s still unclear whether substances such as lavender oil and St John’s wort are excluded.
This difficulty is something that Harry Shapiro, formerly of DrugScope, agrees with. “Since the Dangerous Drugs Act in 1920, we’ve never had a situation like it. The genie is out the bottle, and it is not going to be put back in very easily.”
He suggests there’s already evidence of the sale of NPS shifting online, where substances are shipped in from outside the UK. “Cocaine and ecstasy are banned and they are easily available over the darknet,” Shapiro concludes.
This relationship to already banned substances is something Professor Fabrizio Schifano of ACMD is keen to point out. “No toxicologist in their right mind would suggest cannabis is as dangerous as synthetic cannabinoids [the synthetic legal high that works on the brain in a similar way to cannabis].
“If we treat an infection with an antibiotic for 100 years it would adapt. That’s what the drug market is doing”
“It’s the difference between driving a Ferrari on the highway or a Fiat Punto in the countryside. It’s a different car and it’s going much faster. But that means the psychopathological disturbances are much higher, as is the potential for dependency.”
Former addict James Birchill, a 20-year-old from Kirkstall, Kent, first smoked a synthetic cannabinoid when he was 16. By 17, he was smoking between three and five grams a day. “I couldn’t eat,” he says. “I ended up smoking it to feel normal. I was depressed, anxious and short tempered. They made me a terrible person.”
Birchill remembers when he eventually managed to stop. “Your mind is telling you that you need it. Your body is rejecting food, not letting you sleep and is sweating everything out.”
Despite these risks, consultant addiction psychiatrist Dr Adam Winstock, who started the Global Drugs Survey in 2012, still feels Government policy needs to be about harm reduction. “At the moment, legislation makes these drugs more dangerous than they need to be, by not allowing any information. You end up with more people overdosing as the law makes them more dangerous.
Dr Winstock says legislation should be targeted at protecting people. “The government suffers from tunnel vision on drug policy and considers the only way to reduce drug related harm is to ban a drug. Currently, it shies away from the requirement to have an open dialogue with people who like taking drugs. Having an honest conversation might be a better place to start – most people are not idiots and want to avoid harm.
“Simply saying ‘you cannot do this’ is not going to stop people doing it”
“What we need is a world of new drug education. Clearly, the smart thing is not to take them. But we’re failing to educate the people at greatest risk, by giving them no information. Simply banning everything makes that even more difficult.”
Since the MXE overdose in 2010, Dr Caldicott has dealt with a vast number of cases of NPS abuse, but he still thinks that banning everything isn’t going to help. “We have been treating the drug problem with prohibition for 100 years,” he explains. “If we treat an infection with an antibiotic for that long, it would adapt and become immune to it. That is what the drug market is doing. We aren’t stemming demand.
“Every single patient I have dealt with has taken substances to have fun. Simply saying ‘You cannot do this’ is not going to stop them doing it.”
Loaded reporter Robert McCallum has written for many leading culture magazines and websites about music, sport, science, politics, fashion and arts. Follow Robert at @therobmccallum