The Language of New Drugs - From Education to Assessment

The KFx Cats, Bees and Dragonflies course explores the subject of newer, emerging drugs. One of the issues we address very early in this course is terms of reference. This inevitably brings up the vexed question of what collective terms to use about newer compounds.

For well rehearsed reasons we should eschew the phrase “Legal Highs.” Many of the compounds are no longer legal, and not all are stimulants. There is debate as to whether or not people construe legality to equate with safety. I am of the mind that ‘legal’ has connotations of being sanctioned or approved. It suggests legality via permission. As this is not the case with our newer compounds, I prefer “unregulated” as opposed to “legal.”

The phrase that has become de rigeur amongst academics and policy experts is Novel Psychoactive Compounds (or substances). It’s the phrase of choice for the EU, and the EMCDDA defines it thus:
“a new narcotic or psychotropic drug, in pure form or in preparation, that is not controlled by the United Nations drug conventions, but which may pose a public health threat comparable to that posed by substances listed in these conventions.”

There are a number of problems with this definition, not least some of the compounds are not that new: Nitrous Oxide has been around since the latter half of the 19^th Century, 4-mmc was first synthesised in 1929 and a lot of the benzo-type drugs doing the rounds at the moment were first synthesised in the 1960s.
It also creates the small problem that as soon as the drug is controlled by the UN drug conventions it ceases to be a Novel Psychoactive Compound (NPC).

Most problematically for me it has little or no relevance as a term to end users. A resource, service or awareness session entitled referring to Novel Psychoactive Compounds will not register with key target groups. Asking people “what NPCs have you used in the last month” won’t elicit the information that I am looking for. It’s akin to when the language switched from talking about “glue sniffing” to “volatile substance abuse.” The language may be more accurate but what it gains in accuracy it loses in comprehension.

The other thing that is interesting about all the widely used phrases: “Novel Psychoactive Compounds,” “Legal Highs,” and “Research Chemicals” is that the word Drugs is absent. According to Rick Bradley at KCA, presenting at a seminar in 2014, about 85% of NPS users do not recognise themselves as drug users.

The language we have all adopted contributes to the sense that these are somehow distinct from other drugs.

In turn, this linguistic sleight of hand has, to my mind, disempowered drugs workers. The recurrent theme from training sessions is a sense of not understanding this new world of NPS. These are often experienced workers who can deal with the full spectrum of “traditional” drugs. Reminding these workers that these are still drugs, much like ones they can and have worked with, does much to overcome this sense of disempowerment.

So over time I have tried to find a language that works to address these problems. I ended up finding that the phrase “Newer Unregulated Drugs” worked reasonably well. Except when the law changes. But it’s largely immaterial as I am not egotistical enough to think the phrase will ever catch on. What’s more important is that we have the discussion and explore the role language and terminology plays in constructing paradigms.

Language of Assessment:

What we call our emerging drugs also has a bearing on the assessment process. If we don’t ask and prompt about newer drugs, we may not get this information volunteered. And when it comes to newer drugs this brings with some very specific challenges.

1: Not perceiving substances to be drugs:
As highlighted earlier, there’s some evidence that some people may not consider their “legal” substances to be drugs, so if they are asked about other drugs may not volunteer emergent drugs.

2: Unfamiliar with collective terms:
We want to try and avoid the term “legal highs” for reasons mentioned and use of phrases such as Novel Psychoactive Compounds may not have a high recognition factor with young people.

3: May not be familiar with drug families or link drugs to families
Routinely we would ask people about (for example) their benzodiazepine use. But asking this doesn’t automatically mean that the respondent will link their Etizolam use to the use of benzos, and volunteer this as a response. Similarly, although we ask about cannabis use, the respondent may not volunteer that they are smoking synthetic cannabinoids.

4: May not know what they have used or have misidentified it:
The emergence of generic slang such as “legals” could cover a wide range of drugs. Regionally, slang such as “Monkey Dust” or “Bubble” could refer to a specific compound such as mephedrone or any unknown white powder.  In turn “mephedrone,” once referring to 4-mmc, could now be used interchangeably for other white powder drugs. So assumptions both by user and worker as to what a person is actually using could be both misleading and dangerous.

5: We don’t want to give people a shopping list:
Especially when working with younger, naïve users, it is important that the assessment process doesn’t end up introducing the client to a whole list of substances with which they were unfamiliar. So while initially tempting, an assessment form which either lists or illustrates a wide range of different products is risky. It is still unlikely to be comprehensive – there are SO many brands on the market now. But it also risks introducing substances to a client who was hitherto unaware of that compound of family of drugs. We need to prompt, but without exposing the respondent to still more compounds.

Assessment to Prompt, not Promote:

After a numerous training sessions and a number of false starts, a screening process emerged which addressed all my key concerns. It sits alongside an existing standard screen and looks specifically at newer drugs. Rather than exploring specific substances it looks at types of compound and routes. So for example by asking about smoked substances it can elicit synthetic cannabinoids, kratom, or salvia without naming the substances. Even vague references to “I smoked something, I’m not sure what it was…” can be incorporated.

 

Likewise, by asking about “white powders” we can explore all the different brands and unbranded substances, again without having to give names. Using the same format, the tool asks about Pills and Pellets, and Other Substances (swallowed, inhaled etc) to cover other drug groups.

In training we use the Drug Map to explore the relative location of different drugs. We can use it to explore

potency, duration and effects. In the context of assessment it is left blank, so the respondent can describe how the substance affected them – strong stimulant effect, very hallucinogenic, drowsy and so on. This is useful, not least because it ensures that the client can articulate their experience of the substance. It can also highlight where there’s a high chance they have used something other than their names substance – where the effects described are at variance with typical reports of that drug.

The assessment tool goes on to explore key issues stemming from use and develop an action plan. Sample pages are shown below.

As with other KFx resources this Assessment Tool can be downloaded from the KFx website here. It is free to download and use. If you have any feedback I would be keen to hear it and will revise the tool as feedback is received.

Ideally use of the tool will be combined with staff training to increase awareness and confidence of responding to Newer Unregulated Drugs. Such training is of course available via KFx.

LINKS: 

 The KFx NPS Screening Tool

The KFx Newer Unregulated Drugs Briefing - includes Look-Up Table (August 2014 update)

Newer Unregulated Drugs - Just the Look-Up Table (August 2014 update)

Mephedrone Briefings (revised August 2014)

Krokodil Feeding Frenzy

Bad journalism and dodgy bulletins increase confusion and fear over desomorphine

 About twenty years ago, the Observer ran an article entitled "Ice Storm Cometh," detailing the experience of Crystal Meth in Hawaii, with police chiefs warning how it would devastate here next. Cue numerous senior Police Officers undertaking 'fact-finding missions' overseas, and American DEA bods coming here and briefing on the peril.

Since then it's been fairly quiet on the meth front; use has crept up slowly and is becoming a more significant issue in London in some parts of the club scene. But like the crack epidemic of which we were also warned, we've been spared the worst excesses so far.

But the media do love a good drug scare story. And the new villain in town is desomorphine. Except that's not very exciting so the Russian slang term Krokodil gets used instead.

Despite the fact that there's not been a single, toxicology-confirmed case of desomorphine use in the UK, it hasn't stopped the media running hyperbolic stories, shot through with factual errors and topped off with salacious graphic images of infected wounds. The mainstream media have been bad enough but the on-line and 'citizen media' have been just as irresponsible in their reporting.

So what's been said and what do we really know?

About the drug: 

 Desomorphine is the shortened chemical name of the drug dihydrodesoxymorphine. This drug was first synthesised and patented in the 1930s. It was marketed in Europe under the brand name Permonid as a short acting potent opiate analgesic.

As a drug in its own right it shares the same risks as other powerful opiates - risk of dependency, overdose, and risks relating to non-sterile injecting practices. As a drug, correctly synthesised in sterile conditions, it is not going to destroy body tissues or cause infections. So it is utterly erroneous to describe it as the "drug that eats addicts." The drug itself does no such thing. But contaminants in the drug and injecting practice can and will cause infections. The drug is widely referred to by its slang name Krokodil. The exact reason for this are unclear. Numerous articles claim it's because the necrotised, wounded skin of injectors looks reptilian. Others argue that during the conversion process an intermediate product called Clorocodide is produced, and Krokodil is a play on this term.

Desomorphine is synthesised from codeine ( 3-methylmorphine). There are a number of ways this can be done. One uses some of the same processes involved in the conversion of pseudoephedrine to methamphetamine, chemicals including phosphorous and iodine.

Often the chemicals involved in a synthesis will sound far more dangerous than they really are, especialy in the hands of a journalist. So for example ammonia may be involved in a synth or an extraction. it was widely used to make freebase cocaine in the sixties and seventies. So when reports say "ingredients include household cleaners" it is probably a reference to ammonia. Likewise, solvents are often required. So the presence of solvents like petroleum or kerosene are not going to be uncommon. Hydrochloric acid is routinely used to acidify base drugs, including pharmaceutical compounds. It just sounds much more spectacular in the media.

A key source of codeine will be pain-killer tablets. Tablets also contain lots of other material besides the active drug: fillers and binders, coating, flavourings and so on. A commonly available source of codeine, co-codamol tablets will contain a low dose of codeine alongside a high dose of paracetamol. If the paracetamol isn't successfully removed, it will end up causing significant liver damage with repeat use.

It is possible, with time and effort, to remove all these adulterants, and using a clean synthesis process end up with desomorphine.

In practice the end product will invariably be highly impure, and will include tablet residue, leftovers of the chemicals used in the synth, and other additives which may or may not intensify the hit - antihistamines, anti-nausea tablets, caffeine, benzos etc.

Desomorphine, if of high quality, would (according to wikipedia) be 8 - 10 times the strength of morphine (or effectively 3 times the strength of heroin/diamorphine) but with a shorter period of effect 1-3 hours.

Problems related to desomorphine use:

As a strong, short acting opiate, desomorphine use is likely to cause significant problems, especially when injected. The short duration of effect means that dependent users will need to use more frequently - starting to enter withdrawal after three or four hours will get in the way of sleep or other activities.
The short duration of effect also means more injections and this inevitably speeds up vein damage and wounding.

All these problems are going to be worsened by poorly-made street 'krokodil,' the slang name for the home-made desomorphine used in Russia and the Ukraine. The various chemicals used may be toxic, especially in high doses, and the presence of other contaminants increases the risk of infection. 

These problems are made much worse in Russia by the limited availability of treatment services for drug injectors. There is a desperate shortage of effective needle exchange, woundcare and opiate substitution therapy. This means that injectors will routinely reuse equipment, that wounds will go untreated until they are life-threatening, and alternatives such as methadone hard to come by.

So the pictures of "krokodil" with the clains that the drug is "eating victims" should be properly captioned stressing that a combination of poor chemistry, lack of sterile injecting equipment and poor treatment interventions caused these problems.

Desomorphine in the UK? 

So far there have been no confirmed cases of desomorphine use in the UK. However that hasn't stopped various commentators and the media talking up the drug. And if there's one way to increase interest in a substance amongs potential users, it's to write incessantly about how strong and dangerous it is. 

Concern about desomorphine in the UK have been fuelled by some ill-advised bulletins, some commentary from medical sources and some abysmal journalism. 

In July 2013 a warning started to circulate in Gwent, Wales,saying "
"there is in circulation mephedrone (MCAT)cut with petrol.  This is being both sniffed and injected.  It does smell of petrol.  Injecting is resulting in burns / serious wounds / necrosis around injecting sites.  It is reported to be being cut in Wales, following attempts to replicate what is being sold in and around Bristol.  It is being called various things including Fert and Crocodile."

This warning and follow up discussions were highly confusing. They were largely based on second-hand reports from users and there was no analysis (as far as I know) of this "mephedrone cut with petrol." What the bulletin and the subsequent media coverage did was create the idea that a product being called "Crocodile" was being sold, that it involved petrol in the mix, and that it was causing serious injecting complications.

So for example Wales Online cited Controlled Drugs liaison officer Roger Booth, saying  "there is a circulation of mephedrone cut with petrol.This is being sniffed and injected.Injecting results in burns and wounds leading to necrosis, it’s called crocodile – not to be confused with Krokodil.”

Interviewed in the same article  Booth goes on to say "The only reason I can think they are using petrol [to cut with mephedrone] is because it allows them to take it in another way as it’s normally in powder form.”


This all sounds very serious but makes very little sense. Mephedrone is a water soluble drug which means it needs no further chemical treatment to make it injectable. The idea that adding petrol would be added either as a 'cut' or to 'take it another way'  is nonsense of the first order. 

Further, petrol is highly volatile (vaporises easily at room temperature) and so even if mephedrone were contaminated with a solvent like petrol, it would rapidly vaporise from the powder if left open at room temperature. 

Possible explanations include that someone was trying to remove another contaminant from mephedrone using a hydrocarbon as a solvent or it was another drug imported dissolved in a solvent. Possibly some mephedrone being sold was cut with something insoluble in water and users were using a solvent like petrol to make it injectable. But importantly this whole story so far lacks any of the drug being analysed.

One would hope the local drugs agency would help stop the myths spreading but instead Kaleidescope seemed to have added even more speculation, with Martin Blakeborough quoted in the same article saying: "It’s a very nasty concoction. It reacts to your skin , creating abscesses and it effectively burns your skin. It’s a very nasty drug because in many ways petrol is worse than mephedrone.Normally when people snort glue or petrol they do so because it acts as a hallucinogenic but in this instance I’m not totally sure what they get from it, perhaps it gives them a bit more of a rush.”

A couple of months later the issue of desomorphine was given a major lift in the media thanks to an article in the Gloucester Citizen in which local Doctor, Allan Harris rattles through a list of drugs that he's heard a bit about and makes some loosely factual statement about each. On Krokodil he says "Another drug coming into fashion is Krokodil. It is caused nasty necrosis, or cell death. It has come from Russia and is very unpleasant. There are plenty of warning signs that it could be in Gloucester. It is cheap and nasty and causes damage to the point where you can see someone’s bones through their skin."


This article didn't elaborate on these "plenty of warnings," but the Independent picked up on the Story giving Doctor Harris a whole article to expand on this. And the evidence in the Independent? . in an article shot through with errors Harris says "To date I have only seen one patient where I suspected he’d used Krokodil." The reason for this suspicion? Client saying they'd used this substance? Toxicology? No. "He had been a long-term heroin user, but suddenly lost a great deal of muscle tissue from gangrene at the site of an injection."

Dr Harris didn't get to expand on the evidence for this being Krokodil in this article. But Vice picked up on the Independent story and piled error on top of error with the willing help of Dr Harris, who had by this time clearly developed a taste for media attention.. So in an article entitled Has Krokodil, the Flesh-Eating Street Drug, Made Its Way to the UK?a 'journalist' conducts an interview with Dr Harris. 

Near the start there's an interesting point - where the writer says "We tried to negotiate whether to call the drug “krokodil” (from the Russian) or to Anglicise it now that it had made its way over from the mainland and start referring to it as “crocodile”. (I've used the former here, but Dr Harris was pretty adamant about using the latter.)" Two important points here, both underlined:

• the article now asssumes it is "over here" and
• the term Krokodil and term Crocodile are being mixed up, when Crocodile was already causing confusion as as term in Wales for some mephedrone that may have a petrol smell.

So the interviewer asks about the case mentioned in the Independent which Dr Harris thinks may have been Krokodil. He says:

"It’s a bit retrospective really because it was a few years ago now. At the time, I just thought it was the citric acid burns of a heroin user, but looking back the tissue destruction was far, far in excess [of what you'd expect from that]. When you get citric acid issues you usually get second-degree burns, but this actually took out a huge crater of all the forearm muscle. When you took out the dead tissue you could actually see the tendons moving at the base of this crater and the bones as well – so pretty much like these horrific pictures you see on the warning leaflets for krokodil... Looking back, it didn’t fit at all with citric acid because that’s an irritant but no worse, really, than a slight infection. This was actually very, very disproportionate."

The person in question had subsequently died, and the interviewer asks if it has been confirmed that Krokodil was involved. Dr Harris says "Investigations are ongoing. I couldn’t say for sure, I’m afraid. We’re still waiting on the toxicology results from the coroner."

Based on this Dr Harris appears to have had a client who had a very severe bacterial infection following injection. Many bacterial infections can cause the severe tissue damage and necrosis described by Dr Harris. In point of fact many of the injuries attributed to desomorphine and it's "flesh eating" properties are the result of bacterial infection through contaminants in the mix or non-sterile injecting practice. 

By the sounds of it no tissue samples were taken, and no identification of the pathogen causing the wound or the drug injected is now possible. but based on it looking like pictures of krokodil wounds, Dr Harris has been willing to be quuoted repeatedly saying he thinks it may have been Krokodil.

Astonishingly, before the end of the article, it does get worse, and goes in a loop back to the Welsh Mephedrone/Petrol/Crocodile story when Dr Harris abandons chemistry and grammar in one fell swoop saying "They’re krokodilising Mkat – you know, “meow meow” – to make it injectable and more potent so we’ve seen more intravenous mephedrone use recently to compensate for the reduction in heroin."

So the claim being made now is that the rationale for adding petrol to mephedrone was to make it more potent and injectable.Mephedrone should be water soluble without addition of any other chemicals, provided it hasn't been adulterated with an insoluble cut. And petrol only features in the production of desomorphine as a solvent. 

So thanks to a confusing, unsubstantiated briefing from Wales and a Doctor in Gloucester who has piled further unwarranted assertions on top of each other, and some journalists unable to fact check and take unconfirmed single-sources we end up in a position where the following has become "fact"

• krokodil is in the UK
• MCAT is being treated with petrol as a way of "krokodilising it.

Not wanting to miss out on the Krokodil feeding frenzy, the Huffington Post arrives late at the table  with an attention-grabbing headline: 'Krokodil' Trend Of Flesh-Rotting Drugs Hits UK.

Having little new to add the article is salaciously padded with pictures of injecting wounds. The article starts with the claim "Branded "cannibal heroin" for literally rotting users from the inside out, it costs £5 a hit on the street and contains a toxic mix of codeine, gasoline, paint thinner, industrial cleaning oil, and alcohol."

There's not a single source mentioned for this availability or price point. And it hadn't been branded "Cannibal heroin" until the Huff needed a snappy name for it. Once again Dr Harris appears for a quote, saying ""I've already treated one case and I'm sure that in the coming years I will see more." Other drugs workers who tried to balance the piece, stressing that there was no confirmed evidence that Krokodil was on sale in the UK were selectively quoted and their caveats disregarded.

The article also builds on the mephedrone/petrol idea saying Mephedrone "after a spate of alleged deaths...disappeared into obscurity. Now, it has been reincarnated as an injected drug to rival crack and heroin, with experts warning its use is parallel to the deadly krokodil...Police have warned mephedrone is being mixed with petrol and the toxic combination, unsurprisingly, reacts to skin, creating abscesses as it effectively burns flesh. Dr Harris, along with police officials, have branded the trend "krodilising" for having the same fixing process and level of addictiveness."

Despite the unwarranted reporting in the Huff article, it was recirculated by agencies including, unbelievably, Drugscope, who should have been writing corrective pieces not redistributing the offending article.

In Conclusion

 The use of Krokodil in Russia is clearly a significant health issue The loss of life and wounds are horrific but importantly are not caused by the drug desomorphine per se. The risks stemming from a poorly-made short acting drug are worsened by poor access to needle exchange, healthcare and treatment.

There may be desomorphine being prepared and used in the UK. It's certainly possible. But there's no evidence of it at this time.  Relatively low access to OTC Codeine should reduce the risk of it becoming a mass-market drug as is claimed in Russia.
 
There are certainly people injecting mephedrone and, since prohibition the quality of mephedrone has become more variable. Irrespective of the addition of petrol or not, there is plenty of evidence that mephedrone injecting can cause serious soft tissue infections. 

And we have plenty of things to be aware and concerned about - some potentially stronger-than-average heroin in Wales and Milton Keynes; deaths related to PMA in pills sold as Ecstasy.

What we desperately don't need is wildly inaccurate articles which start off as supposition and hearsay, and over a couple of months morph into fact thanks to poor journalism and professionals who should really be more careful with what they say. There is clearly a public health lesson here. But it's not about desomorpine. It's the reporting of desomorphine.

NRG -1: analysis indicates batches contain MDPV

Thanks to the previous Governments rush to prohibit MMCAT and MDPV manufacturers were left holding stockpiles of their now-illegal drugs. What to do? Emerging test results suggest that they are repackagaging and relabelling it as NRG-1 and passing it off as the still-legal drug Naphyrone.

Reports that batches of "NRG-1" in Scotland had been analysed an found to contain MDPV were reported at the start of June by ACPOS.

Further and more detailed work was undertaken by Drugs-Forum who confirmed and expanded on Police reports.

Drugs Forum have once again been outstanding. There is a detailed report and recommendations on the website, a stark difference to FRANK's somewhat anodyne observation "it is likely that substances sold as naphyrone or “NRG-1” actually contain one or more Class B cathinone derivatives, the most well known one of which is mephedrone.

It is not clear who in the supply chain knows that drugs being passed off as legal Naphyrone are in fact illegal MDPV. The suspicion is that dealers left holding stock of MDPV are passing it down to smaller retailers as NRG-1, who then sell it under the misaprehension that it is lawful NRG-1. ALternatively it could be that the smaller internet retailers are aware that they are selling end users MDPV under the guise of NRG-1, to get rid of old stock.

At this stage it is not clear how much "real" Naphyrone is on the market; user reports as to the appearance and effect of substances sold as NRG-1 vary widely and little consistency has emerged. With the summer festival season on us, this is a dangerous situation.

Two key pieces of advice must get out to end users:

1: any substance containing MDPV or MMCAT can result in action being taken for possession of a Class B drug; people in possession of large quantities could be charged with Supply.

Ignorance or confusion as to the nature of the substance will not be a defence and so anyone in possession of a compound that they bought in the belief that it was legal NRG-1 and in practice turns out to be MDPV could be prosecuted.

2: The dose ranges for NRG-1 are far smaller than those for MDPV. The size of a dose of MDPV that would provide a reasonable effect would be far too strong if the batch contained Naphyrone. A normal MDPV dose would be probably ten times the range suitable for naphyrone.

Conversely, the low doses advised for taking NRG-1 would not provide an effect if it were actually Naphyrone.

So anyone offered or buying white powder should exercise extreme care regardless of the label on the packet. The best advice is to stay away from any compounds unless you are certain of the composition and strength, and how to take it with as much safety as possible.

Remember: a 'normal' size dose of powders such as ketamine, speed, coke, mmcat or mdpv could be fatal if the powder in question contains naphyrone.

If you are uncertain of the constituents of a powder, or think you have bought NRG-1 take a tiny dose first - a dose about the size of a grain of rice AT MOST. It would be safer to use a professionaly-calibrated set of scales but this will not be feasible for most people. The cheap scales you bought of E-bay are not accurate for this sort of thing and won't be callibrated properly so don't leave you in a safe position.

Keep up to date with news on NRG-1 at Drugs Forum.

meow!

Only the most optimistic (or intoxicated) observer could have expected a different outcome, but in a very short period of time, mephedrone (MMCAT, Meow, Bubble etc) will have been added to the rapidly expanding list of "Controlled Drugs." The only thing that may have been a suprise was the speed with which the Government managed to push through legislation in the Parliamentary 'wash-up' period. That, and, perhaps the spineless compliance of the ACMD and a collection of Politicians who saw fit to rubber-stamp the whole process in the hope that they may garner a few votes on the back of this prohibition.

Having driven itself in to a full state of rabid, indignant, hysterical and ill-informed froth over Mephedrone, (see previous post MMCAT Madness) the media calls for it to be banned "immediately" were clearly being heard loud and clear within Government. But what could the Government do? With a Statutory obligation to consult the ACMD, the Government could not simply legislate. And the recent travails at the ACMD would normally have slowed the process a little. But the timescales here were tight and critical: receive advice from the ACMD AND put legislation before the Commons and then the Lords and then secure an Order in Council, all before the Prorogation of Parliament on the 8th April 2010.

But the Government appears to have done it. The Home Office widely announced that the prohibition of Mephedrone and related compounds would come in to force on the 16th April 2010. This announcement, made on the 29th March, was two days before the ACMD Published their reccomendations, and a week before the matter went before Parliament. It was very clear at this stage that the matter was a "done deal" and that Parliamentary approval was a mere formality.

The ACMD appears to have dutifully played their part. Interim Chair, Les Iversen, formally wrote to the Home Office on the 31st March 2010 to offer the ACMD's consideration and on Mephedrone. It had presumably been offered to the Home Office, privately, sometime before this.

The drafted legislation was put before the House of Commons on the 7th April (see HANSARD) and a Motion to approve it was passed; then it went before the Lords, and was briefly discussed (Hansard record) where it was similarly rubber-stamped.

Contributions from Victor Adebowale, a member of the ACMD, Chief Executive of Turning Point and a member of the Lords were noticeable by their absence. One would hope that his reticence was a reflection of his shame at having been a part of this wholesale abandonment of evidence-based legislation and policy making.

The whole process, and the media storm that has driven it, is deeply depressing and distasteful. It may well be that Mephedrone will ultimately prove to be a harmful and dangerous substance. But at the time of the drug being added to the list of Controlled Drugs, not one fatality in the UK had been conclusively attributed solely to Mephedrone. The jury was still out on how risky the drug was, and how to manage this risk. But the Government clearly felt that, with a close-fought general election looming, they could not allow for the perception of being soft on drugs to offer a soft target for electoral attacks. And likewise, the Conservatives and Liberal Party could equally not appear to oppose legislation that would prohibit Mephedrone. So all three parties signed up to a process that abandoned an evidence base and proceeded on the basis of supposition and assumption.

The complicity of the ACMD, with the notable exceptions of Eric Carlin and Polly Taylor who resigned rather than participate in the charade is disappointing. It does not bode well for the future if the Interim Chair and remaining members feel sufficiently cowed by an outgoing Goverment at the end of a Parliament that they need to rush through their recommendations - without them being put to the full Council. In the end only the Technical Group of the ACMD looked at the drug.

This matter was forcefully brought home by LD MP Dr Evan Harris who, along with Dr Brian Iddon are the only politicians to appear to have come out of this with any integrity. Harris stressed the extent to which the rules on consultation had been disregarded and warned of possible consequences, saying "the Government, who acted not just without considering the report-which they were bound to consider under the Government principles issued on Budget day-but before it had even been published. In fact, according to Eric Carlin, who resigned last week, when the chair of the ACMD left to brief the Home Secretary for a press conference the ACMD had not even finished the report. The Government responded to the press not only on a report that had not been considered, that had not been published and would not be published for three days, but on a report that had not yet been completed. That makes a travesty of the advisory process.

If, as a result of that, this statutory instrument, if-or rather, I suspect, when-it is passed by both Houses-is challenged in the courts as being ultra vires and the Government lose the case, something which, as has been said, should have been done much earlier, will be delayed by months." (Hansard)

Ironically, in the small window between deciding to prohibit Mephedrone, and being able to enact legislation, the Government suddenly found a collection of measures that they could use to restrict and reduce availability without needing to Schedule the drug. They could stop the compound being imported outright; Trading Standards could act where the drug was being "mis-sold" as Plant Food or Bath Salts; Frank could be used to provide more awareness and publicity rather than whittering on about Pablo the Drug Mule Dog. Further, schools could confiscate the drug if pupils brought it in; head-shops could be visited and warned. So without any changes to the MDA 1971, measures could be taken.

It's a worry that almost a year after Mephedrone became an issue, the Government only now arrives at these measures. None of them require ACMD guidance; none required Parliamentary time. All that was required was the imagination and will to act, which seems to have emerged late in the day and coincidentally close to an Election.

Historically, when the Government wants to add or reschedule drugs, there is a period of consultation prior to legislation being passed. While the Government has a statutory obligation to consult the ACMD, the wider public consultation is not mandatory, but has happened with all previous drugs legislation. Most recently, when the Government was considering adding GBL and synthetic cannabinoids to the list of Controlled Drugs, public consultation took place. Ironically, even though the drug has been conclusively attributed to at least one fatality, the demands of Industry were held of greater importance than the risk to users. Although a decision was made to make GBL a controlled drug (Class C) because of its uses by industry a decision was made to make it "illegal to possess, supply, produce and import/export GBL and 1,4-BD for purposes of personal ingestion." http://www.opsi.gov.uk/si/si2009/em/uksiem_20093209_en.pdf


The irony of this outcome cannot be under-played. In order to protect jobs, industry and the economy, GBL is added to the list of controlled drugs but provided it is not supplied for human consumption, such supply will remain lawful. In this regard, the Government has created a "plant-food" model akin to the Mephedrone situation. Supply GBL "not for human consumption" and require people to sign some sort of statement and it would be difficult, if not impossible, to prosecute suppliers for selling GBL. Prosecuting users for possession is also well-nigh impossible, as any savvy user will know to say that their possession is for alloy cleaning, nail-polish removing or some other purpose and the onus is on the CPS to prove that the purpose of possession was ingestion.

The "mephedrone as plant-food" problem contributed directly to the risk and lack of information relating to the drug. The situation arose thanks to the MHRA's "borderline products" category which created and caused the problem.

Products which may contain pharmacologically active substances, but are not intended for medicinal use may fall in to this category of Borderline Products, which the MHRA assesses on a case by case basis. They take in to account "any information which may have a bearing on the product's status, for example, the claims made for the product, the pharmacological properties of the ingredients, whether there are any similar licensed products on the market, and how it is presented to the public through labelling, packaging, promotional literature and advertisements."

Selling a medicine which has not been approved can carry a two year sentence. But by ensuring a product is not labelled or sold or promoted for ingestion, this problem can be avoided. Hence the "plant food" or "bath salts" labelling.

But the problem that came on the back of it was that the dodge of labelling effectively prevented retailers from providing dosing or harm reduction information. With a licensed product, information about not mixing with other drugs, hydration or health risks could have been provided. But having been boxed in to a position of selling it as "plant food" no chance of providing dosing information was possible.

It's worth contrasting this with how magic mushrooms were sold prior to them being made illegal. Then, information about the relative potency of mushrooms could be offered, and guidance on dose ranges was offered. Instead the MHRA creates an incentive to "prove" a substance is not a medicine, and hence create increased risk when such substances are used as intoxicants. Strange then that the Home Office should endorse exactly the same model for GBL control. Money talks - money walks.

The GBL situation emerged in part thanks to lobbying by Industry during a consultation period before the legislation being drafted. The ACMD recommended consultation, and the Government, without the incentive of an election, consulted over a three month period. However, with Mephedrone (callow ACMD, media storm, election) the Home Office felt that there was such danger that "in light of the urgent need to act to protect public health, no public consultation has been carried out prior to the laying of this Order. In providing its advice, the ACMD consulted a range of experts in this field and concluded that the drugs subject to this Order have no legitimate use (ref)

But the story doesn't wholly end with the passing of the legislation. Buried in all the papers that have started to come out from the ACMD, from the Home Office and the Parliamentary Stationery office, a few little gems have come out which are worthy of further comment.
The first is the significant amounts of Revenue that the Government has received from what Gordon Brown described as "evil" drug.
A Written Question from Mr Burrowes MP on the 7th April 2010 asked "how much has been collected in import duty on mephedrone in each of the last three years."

The figure for 2009 was just over £250,000 - representing a taxation at a rate of 6.5%. This means that the minimum declared value over Mephedrone imported in 2009 must have been in the region of £4m.

The figures for 2010 haven't been made available yet, and will obviously be incomplete as will only be for the first three months of the year until imports were banned. But it will be interesting to learn the 2010 figure, as it will indicate how much volume of imported mephedrone changed. Interestingly, The amounts collected in 2007 and 2008 were also significant - between £150-170,000.

It will be more interesting still to learn if the Treasury will take the £1m plus earned from Import duties, and the income from VAT received from Mephedrone sales, and will be donating that money to drugs education or treatment. Given the swingeing cuts faced by drug services in the coming financial year, such a modest windfall could be highly useful.


Alternatively the money could be refunded to the numerous retailers who paid the money to the Government in Import Duty. Given the news that the Local Government Association is trying to impound remaining stocks prior to a ban coming in to force, it would seem only reasonable that import duty paid on a legitimate product should be refunded if the state arbitrarily deems the substance illegal, especially without a reasonable notice period,


The other paper which is worthy of comment is the appalling Explanatory Memorandum and Equality Impact Assessment which the Home Office was required to carry out prior to putting the Legislation before Parliament. This document recaps the legislative proposals and looks at the potential impact of them. The document is dated March 2010. Importantly it is signed off by the Minister David Hanson on the 30th March 2010. This is the day before the ACMD published their advice on Mephedrone, which were dated 31st March 2010. Given the content of the Equality Impact Assessment, and the drafting time required, it is obvious that the Home Office received the ACMD reccomendations in a draft form prior to their official publication - in order presumably to prepare the required legislative paperwork within the tight timeframe of the dissolution of Parliament.

A close look at the Explanatory Memorandum and Equality impact assessment highlights how quickly and badly this piece of legislation has been prepared, and with how little consideration.

The first thing that is woefully apparent is the extent to which this is legislating without a clear idea of the scale of the problem, or the impact of the solution; so the report says "Any real costs associated with [prohbition] cannot be predicted. Not only is the scale of the availability of mephedrone and other cathinone derivatives unknown, but the impact on the police and consequently the CJS is dependent on the policing response to its control as Class B drugs." So in short we don't know how many people use mephedrone, how it should be policed post prohibition, and how many people, especially young people will be criminalised as a result.
The report admits that "there is no current direct evidence that mephedrone cause any significant social harms such as acquisitive crime and anti-social behaviour."

The Equality Impact Assessment is meant to look at if any particular population is disproportionately affected by the legislation. The only group noted is young people; the EIA says "Age Indications: from small-scale surveys (e.g.Mixmag, Frank Website) and anecdotally suggest young people are the largest consumers of these substances. The change in policy will protect the huge number of young people currently using these substances or intending to do so fromthe harms caused by these substances."

This is a very loaded assertion. Having already acknowledged that we have no evidence of the scale of mephedrone use, the EIA makes the unwarranted assertion that there are "huge numbers" currently using the drug, and that prohibition will protect them from harm. There is no acknowledgement that prohibition may criminalise young people, drive up the price, or bring young people in to contact with other controlled drugs. Indeed the evidence that was available suggested that the biggest user groups were young adults with a mean age of use of 23, and the biggest group contacting helplines about Mephedrone were 19-25 year olds. So the primary user group were young adults. It's probably one of the benefits of products primarily sold to people who hold credit or debit cards, or PayPal accounts. It makes it that much harder for young people to access.

The EIA goes on to say "It is not anticipated that the change in policy will have any significant adverse impact on this group of users." Which given that some young people will receive criminal records as a result of the change is hard to fathom. Maybe this isn't counted as an "adverse impact."

One of the areas where the EIA is most misleading is in the section entitled "How did your engagement exercise highlight positive and negativeimpacts on different communities?" This section says, in the age section "No concern expressed in response to the public consultation over the impact of controlling these drugs on age." This is a complete misrepresentation. There was no Public Consultation, and so it is disingenuous to say that no concern was expressed.

The deliberately misleading statements continue, in the section asking "What were the main findings of the engagement exercise and what weight should they carry?" The answer given is "The engagement exercise showed support for control measures for these drugs, but did not raise any findings associated with equality issues." Again, a lie. There was no "engagement exercise." So to claim that is showed support for the measures is not true.

And while no consideration has been given to the direct impact of prohibition there was no awareness or consideration of the indirect impact - that as a controlled drug the cost of mephedrone will go up, quality will drop, and trade will switch to people prepared to take the risks of dealing in controlled drugs. Mephedrone won't go away; it will shift to a different market. And as availability drops, we will probably see a switch back to cocaine. The cartels will be celebrating even while a credulous media congratulate themselves on bumping a Government in to action.

This isn't the first time that rushed drugs legislation has been pushed through prior to an election: the proposed revision to Section 8 of the MDA was squeezed through in the wash-up period, and later revoked. Likewise, the Drugs Act 2005 received assent in April 2005, the month before the General Election. Much of it has never been used since, or was since abandoned.

The only thing robustly evidenced base is that the Government has a poor track-record of passing drugs legislation prior to elections. They've done it again with mephedrone. And, sadly, will not be in office in a month's time to be held to account for it.