Pubdate: Sun, 26 Apr 2009
Source: Observer, The (UK)
Copyright: 2009 Guardian News and Media Limited
Author: John Ramsey, The Observer
Note: Dr John Ramsey is a toxicologist and director of the Tictac 
Communications drugs
database at St George's medical school in London

No One Can Possibly Know the Risks of Taking These Drugs

Although we have laws to control access to drugs such as cocaine and
cannabis, we tolerate so-called "head shops" on our high streets which
sell the paraphernalia (snorters, pipes, rolling paper, scales) used
to consume them. Over the last few years, the stimulant tablets and
capsules also sold by these shops and market stalls have changed.
Previously, they were fairly benign herbal products containing mostly
caffeine or ephedrine from the herbs guarana and ephedra, whose
effects were not much more than a strong cup of coffee.

Recently, products containing compounds not previously used as drugs
have been added. These are intended to be legal alternatives to
amphetamine, cocaine or ecstasy. The products originated in New
Zealand and contained benzylpiperazine (BZP). A multi-million pound
industry exported these products all over the world. BZP has never
been tested or marketed as a pharmaceutical, so its health
consequences were unknown. It proved to be a moderately powerful
stimulant, but with unpleasant side effects. Consequently, New Zealand
added it to its controlled drugs legislation, as did the European
Union - all member states were required to control it by March 2009
(the UK legislation is expected to be enacted by late summer).

The response of the producers was to market a new generation of
"BZP-free" products. They needed to find compounds that were not
controlled as drugs and were already available or could be readily
synthesised. Many compounds are minor modifications of chemical
structures - just enough to bring them outside legal controls.

There is a risk that these minor modifications might result in a
dramatically different toxicity profile. They may also interact with
legitimate medication; e.g. the contraceptive pill, or HIV medication.
The chemicals are also not necessarily very pure. The packaging is
usually misleading and they are often marked "not for human
consumption", "plant feeder", "plant growth inhibitor", or even "bath
salts". This is an attempt to avoid an assertion from the Medicines
and Healthcare Products Regulation Agency (MHRA) that they are
illegally selling medicines. There is usually a list of vitamins and a
hint at the active ingredient such as "ketones". Products labelled as
"BZP-free" have, on our analysis, been found to contain BZP.

No one can know what the risks of taking these products are. Tictac
Communications at St George's University of London has, in an ad hoc
fashion, monitored the appearance of these products for several years
by test purchasing from shops and websites and analysing the contents
of club "amnesty bins".

The results are disseminated through Tictac, a drug identification
database, to healthcare and law and order professionals.

However, the consequence of controlling emerging compounds is to
encourage the production of new ones. In order to get off this
treadmill we need to honestly inform retailers and consumers of the
risks. People buying a tablet from a high street shop may make
unwarranted assumptions about its safety and not expect to end their
night out in their local A & E with cardiovascular toxicity or seizures.
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MAP posted-by: Richard Lake