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January 2014 |
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John Ramsey
There’s a whole group of stimulants that cause damage to heart valves, for
example. There was an appetite suppressant called fenfluramine that was
marketed for years until people established that it could cause valve damage, and
some people who took it had quite serious heart problems.’
While the pharmaceutical industry carries out post-market surveillance, if any of
the new psychoactive substances were causing similar problems ‘we’d never
associate those health ill effects with them’, he says, and although with most
compounds it would probably take a significant amount of time before issues
became apparent, the potential is still there. ‘A classic example is ketamine,’ he
states. ‘When used for its intended purposes it’s quite harmless, but when used
inappropriately it can cause the bladder damage that everybody’s now focusing on.’
The ACMD recently recommended that ketamine be upgraded from class C to B,
and the government has also announced a wide-ranging review of the laws
relating to new psychoactive substances to report in the spring (see news stories,
page 4 and 5). But what can realistically be done from a legal point of view – is
New Zealand’s attempt to regulate them the right way to go? ‘I think everybody’s
watching that with interest,’ he says. ‘I’m rather pleased they’re doing it but the
thing that worries me is that clearly the compounds aren’t going to be evaluated
to the same standard that the pharmaceutical industry would, purely because of
the amount of money it costs and the amount of time it takes. Why as a society
should we accept a lower standard of safety for a recreational drug than we do for
a pharmaceutical?’
In the pharmaceutical industry it’s usually around five years before new drugs
are tested on humans, he explains. ‘The processes are getting better, as we
understand more about genetics and how these things might act, but there’s an
awful lot of animal experimentation done before a compound ever gets near a
human. So that’s the other issue with the New Zealand situation – we’ve then got
the ethics of killing hundreds of animals to test the safety of these compounds. Is
that right? I don’t know how much truth there is in this, but I’ve heard that some
people who have applied for these new licences are getting death threats from
animal rights protesters.’
The best approach, he believes, is firstly to clearly explain the risks to people –
‘the classic risk assessment of “is a small amount of pleasure on a Saturday night
worth the risk of taking an unknown chemical?” and secondly, perhaps, to ‘just let
the market regulate’.
‘If compounds are unpleasant and don’t work very well, people will stop buying
them and they’ll disappear. Presumably we’ll finish up with the compounds that
people like and we’ll then have a reasonable chance of observing what happens
and deciding what the risks are. If we ban everything as soon as it appears all we
do is spawn the production of new ones and expose people to more and more
compounds.’
In terms of that sort of staying power, mephedrone has proved remarkably
resilient, surviving its 2010 ban and with presentations to treatment services for
problems with the drug doubling in the last year (
DDN
, December 2013, page 15).
‘I don’t know if that’s a good thing or a bad thing,’ he says. ‘There have been
suggestions that falls in the number of cocaine deaths could be attributed to
people using mephedrone instead – perhaps it’s a safer stimulant. But because
mortality monitoring is so unregulated, and because the hospital A&E
departments don’t really collect information in a way that we can collate it – and
indeed don’t analyse samples from people who present with problems – we don’t
really know what the health issues are.’
*****
As well as drugs from police and border forces, TICTAC analyses the contents of
amnesty bins at nightclubs and festivals. ‘With Glastonbury it’s more of an
amnesty skip but, having said that, we don’t actually see many legal highs there.
It’s MDMA, cannabis, cocaine – the usual suspects,’ he says.
The organisation also regularly carries out test purchases from online shops –
buying drugs with a credit card the same as any other customer – and although
more and more new drugs are identified via the EU early warning service each
year, whether those numbers ‘really mean anything’ or how many of the drugs
could go on to pose a significant problem is difficult to determine. While it’s easy
to test purchase and analyse any compounds that are offered for sale, what’s
harder to know is how many people are actually using them, he stresses.
To find out more, TICTAC has been carrying out waste water analysis as part of
SEWPROF, an EU-funded project studying sewage epidemiology. ‘Once drugs
become sufficiently established they can be detected in the sewage treatment
works – we can detect mephedrone and most of the other drugs,’ he says, with
MDMA levels unsurprisingly peaking sharply at weekends.
However, a relatively new drug won’t be used by enough people for that to be
an appropriate method, so TICTAC also installs public urinals and carries out
anonymous, non-attributable analysis as ‘an early indicator of what’s being used
and potentially where and when. If we stick a public urinal in Liverpool Street
station on a Friday night we know that anyone who contributed to that did it over
the past day or two, so that pinpoints their drug use to a few days and we hope to
be able learn a bit about consumption this way. Just because a compound’s offered
for sale doesn’t mean that anybody uses it.’ Although the urine testing is still in its
early stages – and clearly won’t include female samples – there are already
conclusions that can be drawn, he explains.
‘The new drugs are present in all the urine samples we’ve tested – we’ve never
tested a public urinal that doesn’t have one of the new compounds in. One of the
things a lot of people are concerned about is the cannabinoid receptor agonists,
and kids getting themselves into trouble using those. Well, we don’t detect those
in the public urinals. I don’t know whether that’s because our analytical
methodology’s not up to the mark or because they’re not there, so there’s still
research that needs to be done in evaluating our ability to detect these things. Of
course it might well be that if they’re used it’s not in an environment that would
result in them being in city centre urinals – if they’re used by younger people,
maybe at home. There’s quite a lot of subtlety that needs considering when we
draw conclusions.’
As to the question of where all the new compounds are coming from, most are
still manufactured in China, he believes. ‘It’s difficult to know for certain, but
certainly the work we’ve done with the UK Border Agency looking at importations
into Heathrow from Shanghai shows a significant number of these new
compounds, and if you type the name of a new compound into Google you’ll get
an awful lot of Chinese chemical companies offering to sell them to you, so I’m
pretty sure. It’s not exclusive to China – it’s a lucrative market, so anyone with the
capability of doing it is likely to try.
‘Different drugs and precursors come from different places and people get stuff
from wherever they can. It’s a free market, so people will just buy the stuff where
they can get it cheapest.’
www.tictac.org.uk
‘If we ban everything as
soon as it appears all we
do is spawn the
production of new ones
and expose people to more
and more compounds...’