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The Legal High Club

Despite being freely available to buy on the high street and online, many falsely believe this new class of drugs to be harmless

In September 2014 the Royal College of Psychiatrists (RCP) issued a stark warning on so-called 'legal highs'. It said that the NHS was buckling under the pressure caused by new legal highs and the increasing use of club drugs. According to the RCP report, every week a new legal high - also known as a novel psychoactive substance (NPS) - is introduced in Europe.

It said that as things stand, the country's health services are “not equipped” to deal with the rise.

According to the reports, co-author Dr Owen Bowden-Jones, a consultant addiction psychiatrist, the current NHS drug service was designed to deal with the drugs and dangers of the last decade, like heroin and crack cocaine.

“While it is important that this work continues, services now need to widen their front door and adapt to address the serious harms that club drug and NPS users are experiencing.

“It is clear that the NPS and club drug market is rapidly evolving with increasing evidence of harm to users.

“The challenge to the UK's existing drug services is now to keep pace with this growing problem, while continuing to meet the demands of more established substance misuse problems associated with alcohol, heroin and crack cocaine,” he says.

Misuse of legal highs is growing fast in the UK. These substances include more than 200 psychoactive chemicals and are associated with harm to physical and mental health, but are not controlled under the Misuse of Drugs Act 1971 or regulated as a medicine. NPSs are marketed as non-medical products online and are also available on high streets, at petrol stations and through the illicit drug market, and with their increased usage comes an increase in associated deaths.

In 2010-2011, 128 suspected mephedrone-associated fatalities were reported, and mephedrone was identified at postmortem in 90 cases. NPS related hospital admissions also rose by 56% between 2009 and 2012.

However medical professionals can find it difficult to identify NPS users as the substances are not sold or 

traded as medicinal products but as legal experimental substances to people who may not consider themselves to 

be drug misusers.

Isaac Sarpong, a charge nurse in Secure Services at Oxford Health NHS Foundation Trust says that the primary misconception surrounding legal highs is that because they are legal they are not as dangerous as illegal substances. 

“However, as the effects are largely unknown they can be equally as harmful,” he explains.

“They are 'legal' because they are not sold as 'for human consumption' but as things like plant food and bath salts. To consume something labelled as not for human consumption is almost bound to carry some risk,” he warns.

“The producers of these substances are well aware of their intended market and the legality of advertising it for what it really is. This deception circumvents the law and makes vulnerable people believe that because they have purchased it in a shop that it is OK to take.”

He says that many people are also attracted to these drugs because there is currently no drug screening available for them.

“In our experience the patients are aware of these substances but given their prolific drug history (in many cases) they choose legal highs as they cannot be detected with current drug screening”. He says that education is important particularly in the patients who are vulnerable 

and may be tempted to try these drugs believing that they 

are safe.

Earlier this year think-tank the Centre for Social Justice warned that deaths linked to legal highs could surpass those related to heroin use within just two years.

The think-tank estimates that on current trends deaths related to legal highs could be higher than heroin by 2016 - at around 400 deaths a year.

Drugs such as meow meow and Benzo Fury have been outlawed by the government but other substances, such as alpha-methyltryptamine (AMT) are still legal and new drugs flood the market quicker than they can be banned.

The Centre for Social Justice is asking police to adopt a similar policy to one used in Ireland, to close so-called “head-shops” which sell NPS, of which they estimate there are around 250 in the UK.

Earlier this year ministers refused to sign up to European legislation for tackling so-called legal highs but did launch their own expert panel review, which is expected to report sometime this autumn on the Government's 'legislative options' for NPS.

At the time crime prevention minister Norman Baker MP explained: “The coalition government has decided to opt out of the European Commission's proposals for a regulation and a directive on new psychoactive substances.

“The proposals would, as drafted, fetter the UK's discretion to control different new psychoactive substances, binding the UK to an EU system which would take insufficient account of our national circumstances.”

He went on: “We also strongly dispute the evidence base stated in the EU Commission's impact assessment which estimates that 20% of new psychoactive substances have a legitimate use.”

Mr Baker said the British government would remain involved in European Union negotiations to shape the proposals.

According to Mr Baker ten “legal highs” were identified last year for the first time in the UK by a specialist government system that targets music festivals and tobacco shops.

A total of 27 new psychoactive substances, also known as legal highs, have now been detected by the Home Office's Forensic Early Warning System since it was set up in January 2011.

There are numerous issues for the NHS when it comes to the use of NPS which is associated with serious health risks as the drugs are not tested to ensure they are safe for human consumption. 

It is known that some of the substances have negative effects on the cardiovascular system, renal function and mental health, while reduced inhibitions, drowsiness, excited or paranoid states, seizures and coma are common side-effects.

However, it can be difficult to identify NPS users as the substances are not sold or traded as medicinal products but as legal experimental substances to people who may not consider themselves to be drug misusers.

The RCP's report authors have called for drug services to put the needs of club drug and NPS users on “equal footing” with alcohol and opiate treatment.

They also want more training for frontline healthcare staff.

Harry Sumnall, a professor in substance misuse at Liverpool John Moores' University Centre for Public Health, says that in the NHS mental health service providers are particularly concerned because NPS users are not covered under existing policies.

“The NHS is really struggling with this,” he says.

He believes that a combined approach of making these drugs illegal as quick as possible and a local joined-up holistic approach is the way forward.

“Public Health England are helping to support local multi-agency responses to this, so that medics, drug services and education work together and between them have a good communication strategy,” he explains.

In the short term there is no quick fix to solving the problem of the rise in legal high users and to respond to the issues such usage poses health services will need to develop the capacity to respond early to people and to develop timely, strategic interventions to NPS misuse.