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Drugs in the Internet era

By Les Iversen

 

When Drugs: A Very Short Introduction was published in 2001 drugs were relatively hard to obtain. Recreational users could buy illegal drugs from back-street dealers, while prescription medicines required a trip to the doctor to obtain a script. The Internet has changed all that. Nowadays in Western Europe and in North America there are dozens of website dealers offering novel psychoactive drugs (“legal highs”) and prescription medicines at modest prices. The market for designer drugs has grown hugely.

The chemical structure of amphetamine

By clever changes in the chemical structures of existing banned drugs these novel synthetic substances, which mimic the effects of banned drugs such as amphetamine, cannabis, cocaine, or ecstasy, escape legal prohibition. Because they are clearly marked “not for human consumption”, and labelled frivolously as “plant food”, “fish food”,  or “bath salts” they avoid other laws prohibiting the sale of new substances for human use. The European Monitoring Centre for Drugs and Drug Addiction listed 49 new psychoactive substances in 2011, and have been registering a new one every week in 2012. The commonest legal highs are synthetic chemicals which mimic the intoxication caused by herbal cannabis. Ironically, many such chemicals were made and tested 40 years ago by the pharmaceutical industry, in an attempt to find medically useful mimics of cannabis which lacked its intoxicant effects. This aim was never achieved, but detailed records of the many potent synthetic cannabinoids that were made and tested are available in scientific literature. Forty years later some of these have been resurrected and incorporated into a herbal “smoking mixture” called “Spice”. Dozens of such compounds are involved in different variants of Spice, and many are also available on their own, sometimes with exotic brand names such “Black Mamba” and “Annihilation”.

Chemists find it relatively easy to make new drugs, while governments struggle to keep up with the flood of new legally available substances.  All this might be viewed as harmless fun, but there are very real dangers in offering new untested chemicals for human use. For a new human medicine to be approved, it requires years of careful safety assessment in animal and clinical trials, and the medicine must pass stringent standards of purity. The legal highs escape all such requirements – their safety is assessed directly in the users, who play a potentially dangerous game of Russian roulette.

The harmful effects of these drugs are not always immediately apparent. For example, some long term recreational users of the illegal veterinary anaesthetic ketamine develop severe painful inflammation of the urinary system, which may require surgical removal of the bladder. The weight-loss drug d-fenfluramine, although hugely popular and used by millions, turned out to have an unexpected effect on the valves of the heart in some patients, leading to severe cardiac malfunction and in some cases death.

Internet sales are not limited to novel psychoactive drugs. Many websites offer online sales of prescription medicines. Whereas such medicines were previously only available from pharmacies with a script signed by a doctor, many of these sites offer medicines either without a script or after a perfunctory online medical diagnosis. In the USA in particular the high cost of medicines has lead many patients to seek cheaper online supplies. But there is no quality control for the online medicines, and patients play a different form of Russian roulette: thinking that the supplier is a reputable US or Canadian based pharmacy, whereas in reality it may be based in China, India, or Eastern Europe and be of poor quality. Prescription medicines can also be purchased online for recreational rather than medical use. Strong pain-killers such as fentanyl or oxycodone (®Oxy Contin) can be purchased as alternatives to back street heroin. The misuse of prescription medicines has already reached epidemic proportions in USA, where in 2012 the President issued an urgent warning on the “Epidemic of Prescription Drug Abuse”.

There seems very little that governments can do to regulate the Internet markets for legal highs or prescription medicines, although some attempts have been made. In 2012 the US Justice Department and the Drug Enforcement Agency announced the closure of many websites offering “legal highs” (sold commonly in the USA as “bath salts”) but it remains to be seen if this is a legally acceptable course of action. In Eire the government raided and closed virtually all of the High Street “head shops” – which offer another sources of legally available psychoactive drugs. However, regulating Internet commerce has so far eluded governments around the world. The online sale of drugs has become a huge Internet business, with an estimated size of $25 billion dollars in 2010 for prescription medicines. Sooner or later some effective means of regulating these markets will have to be found, but it may take a shocking wake-up call – such as the discovery of serious unpredicted harm associated with one or other of the legal highs.

Les Iversen is Emeritus Professor of Neuropharmacology of the University of Oxford and Chairman of the Advisory Council on Misuse of Drugs

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Image Credit: Amphetamine structure (public domain via Wikimedia Commons)

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