Synthetic Dialectic

Banning New Drugs: What is the Path Forward?

Eighteen months ago, in a post on novel synthetic drugs in the cannabinoid and cathinone families, I wrote that the new fake marijuana and fake Ecstasy were “very nearly the perfect overdose drugs.”  An MDMA-like stimulant called PMMA was implicated in a number of deaths in Florida, Chicago, and Ireland back then. PMMA, like many synthetic highs, is toxic at low doses, and takes a fair amount of time to take effect, thereby encouraging double dosing.

A year and a half later, what has changed? Today’s synthetic pharmaceuticals are not coming from secret underground laboratories, but rather from legitimate, existing Chinese pharmaceutical and chemical companies. In a commentary published in Addiction, Michael Evans-Brown and Roumen Sedefov of the European Monitoring Centre for Drugs and Drug Addiction in Lisbon present an unusually dystopian picture of new psychoactive substances fueling ever-increasing complexities in the world drug market. The authors refer to the situation as a textbook example “of what can happen when entrepreneurs exploit globalization and technology.” They write:

The market continues to grow. Consumers are no longer limited to psychonauts and clubbers, but include the vulnerable and marginalized, such as problem drug users and prisoners… manufacturers have replacement substances ready for sale even before a substance is controlled; the recipes for many thousands more are in the scientific and patent literature ripe for the picking.

The authors provide a grisly list of recent synthetic cannabinoid incidents: In Russia, products containing MDMB-FUBINACA were implicated in more than 600 poisonings and 15 deaths in two weeks in 2014. The same drug was linked to as many as 700 suspected adverse events in a single month in Mississippi in 2015, and in Europe, more than 200 people were hospitalized in Poland last year after smoking something called Mocarz. The causes of these mass poisonings, according to the authors include “high potency of synthetic cannabinoids, producers guess[ing] how much substance to use, and poor manufacturing processes leading to uneven distribution of the substance in the product—manufacturing flaws that are a recipe for disaster.” When users have no idea—not even a reasonable guess—at what chemical they are actually using, regulation and public health initiatives become exceedingly difficult.

In a bold and, according to some drug policy analysts, deeply misguided move, UK officials, tired of the drugs “arms race,” and the cat-and-mouse game of enforcement, made an attempt to do away with synthetic drugs in one monumental swipe, passing the Psychoactive Substances Act. In its earlier incarnations, the measure banned just about everything, including foods with caffeine and alcohol. Having straightened that out somewhat, the United Kingdom now faces a synthetic highs crackdown that drug charity DrugWise said will only push the market underground, “from the shops to the street.” If you think that’s a major improvement, raise your hand.

Another drug policy group, Transform, believes that the ban was aimed rather cynically at “visible sales,” in an effort to demonstrate some political PR success stories. Jane Slater, head of operations for Transform, told Huffington Post UK : “Far from making our communities safer the ban has resulted in increased health harms and criminality.”

“Laws just push forward the list of compounds,” according to Dr. Duccio Papanti, a psychiatrist at the University of Trieste who studies the new drugs. “The market is very chaotic, bulk purchasing of pure compounds are cheaply available from China, India, Hong-Kong, but small labs are rising in Western Countries, too.”

A spokesman for the UK Home Secretary pushed back, saying that “These drugs are not legal, they are not safe and we will not allow them to be sold in this country.”

Still, this negative spiral is not steady or inevitable. “Given how fashions and societies change," the authors note, "it is true that we do not know what the fate will be for many substances [remember that Quaaludes, not MDMA were the original disco biscuits]: but it is also fair to say that suppliers are not looking for the next cannabis, MDMA, heroin or diazepam; they simply make substances that can mimic their effects and that can be produced, transported and sold freely.”

It continues. On September 1, the Irish Examiner  reported that a related cannabis drug, MDMB-CHMICA, often peddled as Black Mamba, has been linked to more than two dozen death in Europe. The European Monitoring Centre for Drugs and Drug Addiction confirmed 25 cases, involving comas, heart problems or seizures. “The high potency of MDMB-CHMICA and the highly variable amounts of the substances in ‘legal high’ products constitute a high risk of acute toxicity.”

In 1975, underground chemist Alexander Shulgin wrote that the variety of drugs capable of causing abuse problems was expanding rapidly. He did not envision an adroit way out of that spiral: “As these materials become better defined and their use better controlled, they will be replaced with substitute compounds, which will provide society with new, unknown, and unmanageable substances.” Managing these new risks effectively will require new and almost unimaginably sophisticated early warning systems to protect the public from new toxic offerings.

Mephedrone, the New Drug in Town

Bull market for quasi-legal designer highs.

Most people in the United States have never heard of it. Very few have ever tried it. But if Europe is any kind of leading indicator for synthetic drugs (and it is), then America will shortly have a chance to get acquainted with mephedrone, a.k.a. Drone, MCAT, 4-methylmethcathinone (4-MMC), and Meow Meow--the latter nickname presumably in honor of its membership in the cathinone family, making it chemically similar in some ways to amphetamine and ephedrine. But its users often refer to effects more commonly associated with Ecstasy (MDMA), both the good (euphoria, empathy, talkativeness) and the bad (blood pressure spikes, delusions, drastic changes in body temperature).

Some of the best stateside coverage has come from the anonymous NIH researcher who blogs on science topics as DrugMonkey. The whole business of what mephedrone does is complicated, he writes. The cathinone structure is “very similar to amphetamine and supports parallel modifications,” but there is clearly an “MDMA-like component to this mephedrone stuff.” (See additional DrugMonkey coverage here  and here.)

Until earlier this year, mephedrone was in that weird state of limbo LSD found itself occupying in the mid-1960s: legal, but not for long. States are attempting to sweep synthetic drugs of abuse like Spice and other cannabinioid derivatives into a proscribed package that includes mephedrone.  Federal authorities are able to prosecute under The Analogue Drug Act of 1986, which was designed to combat this dilemma in the United States by outlawing drugs “substantially similar” to any drug that is already illegal. However, “chemical experts disagree on whether a chemical is 'substantially similar' in structure to another chemical—so much so that Federal Analogue Act litigation often degenerates into a 'battle of experts,' which is founded more on opinion than on actual scientific evidence,” writes Gregory Kau in an article for the University of Pennsylvania Law Review.

It is clear by now that this cat-and-mouse game is rigged in favor of the designers and suppliers of new drugs under the sun. Exploiting the gray zone of quasi-legality is extremely profitable. One outlaw chemist told Jeanne Whalen of the Wall Street Journal that by the time law enforcement closes in, “we are going to bring out something else.” At which point, prosecutorial mechanisms put in place for mephedrone must be laboriously recreated for the new drug.

This drug entrepreneur, and others like him, makes extensive use of the Internet, especially in Europe, since mephedrone is not universally banned. To keep the business technically legal, sellers label mephedrone “not for human consumption” and market it as anything from plant food to bath salts.  Sometimes they draw unwanted attention to themselves through the purchase of lab equipment, like the rotary evaporator pictured above. 

Mephedrone has lately been covered relentlessly by the British press, after the deaths of three young people in the U.K. and Sweden were attributed to mephedrone. Part of the difficulty in assessing the danger and addictiveness, if any, of these newer substances is that most of them have not been subjected to controlled clinical testing on humans. (One hardy purveyor of mephedrone snorted half a gram of the drug on a Belgian news program to demonstrate his side of the argument.)

Media hysteria in the U.K. led to reports of dozens of deaths due to mephedrone, none of which have thus far proven to be indisputably the result of ingesting mephedrone. As British politicians rushed to enact a ban, Danny Kushlick of the drug charity Transform told the U.K. Guardian in April: “The misreporting of mephedrone deaths is a crass example of the potentially lethal alliance between press and politicians that by default ends in a ban that often creates far greater harms than those caused by use.”  In July, BBC News reported that the mephedrone crackdown was “floundering”, even though the ban had been widened to included a near-beer version of mephedrone called Naphyrone (sold as NRG1). But a spokesperson for Lifeline, another British drug charity, argued that “you can’t just ban your way out of a problem because it could result in far more dangerous chemicals coming onto the market.” According to the European Monitoring Centre for Drugs and Drug Addiction, which operates the EU early-warning system on new drugs in cooperation with Europol,  “24 new psychoactive substances were officially notified for the first time to the two agencies in 2009.”

The National Drug Intelligence Center at the U.S. Department of Justice reported that early in the year, “several individuals in the Bismarck [North Dakota] area ingested or injected illicit products containing mephedrone and required hospitalization. In addition, the Oregon State Police Forensic Laboratory (Bend, Oregon) received two submission of white power that users referred to as ‘sunshine.’ Both submissions tested as mephedrone.”

And now comes a report from North Carolina of two fatalities allegedly linked to the use of mephedrone, as reported by David Kroll at Terra Sigillata.

Narcotics officials and toxicologists say that the raw materials for many of the new drugs appear to be manufactured in China and trans-shipped to other countries in Southeast Asia and the Middle East. DrugMonkey also notes that it will be interesting to see “if actions such as Cambodia, Vietnam, and Thailand finally getting serious about controlling the production of the safrole oil used as a precursor in MDMA manufacture is having a lasting effect on world markets.”

Photo Credit: http://www.ipfw.edu/