‘Legal highs’ have been used in the last few years as a way of promoting designer drugs. On 17 April 2010 mephedrone and the other cathinone derivatives were made illegal Class B drugs by the Home Office after recommendation by the Advisory Council on the Misuse of Drugs. The rapid rise in popularity of mephedrone as a ‘legal high’ and the urgency with which it had to be made an illegal class B drug has been part of a worrying trend. GBL, BZP and synthetic cannabinoids like ‘spice’, which were available as ‘legal highs,’ were also made illegal drugs in December 2009 just a few months before mephedrone was made illegal. The Home Office classified GBL and BZP as illegal Class C drugs whereas synthetic cannabinoids such as 'spice' are now controlled Class B drugs alongside cannabis.7
Mephedrone had already been popular in other European countries before it became popular in UK. Sweden classified 4-MMC as a ‘health hazard’ or ‘hazardous substance’ pending further legislation and a ban on 4-methylmethcathinone came into effect on 15 December 2008 making its sale illegal.8
Denmark's Minister for Health and Prevention banned mephedrone, flephedrone and ethylcathinone on 18 December 2008.9
Finland, through the Medicines Act, classified 4-methylmethcathinone as a ‘medicinal product’, making it illegal to manufacture, import, possess, sell or transfer it without a prescription. 4-Methylmethcathinone was added to Israel's list of controlled substances, making it illegal to buy, sell or possess in December 2007. The case in our report is in keeping with the symptoms reported in the Advisory Council on the Misuse of Drugs report on mephedrone.10
Commonly reported clinical effects associated with mephedrone use include tachycardia, palpitations, agitation, anxiety, mydriasis, chest pain, breathlessness, nausea, vomiting, headache, hypertension, confusion, hallucinations, peripheral vasoconstriction and, rarely, convulsions. Despite a number of ‘legal highs’ being made illegal this trend is likely to continue. NRG-1, chemically ‘napthyl analogue of pyrovalerone’, and 5,6-methylenedioxy-2-aminoindane (MDAI) are already on sale as ‘legal highs’ on various internet sites and are being advertised as replacements for mephedrone. More research and appropriate legislation into ways of effectively controlling the rapid rise of ‘legal highs’ as recreational drugs is required. Education and awareness, especially among teenagers, of the harm ‘legal highs’ in general and mephedrone in particular can cause is urgently needed.
- Mephedrone use can be associated with auditory and visual hallucination, persecutory ideation, agitation, irritability, pressured speech, poor concentration, insomnia, reduced appetite and weight loss.
- There is risk of dependence on mephedrone.
- ‘Legal highs’ should not be perceived as safe for recreational use as long-term effects of their use on mental and physical health and the potential to cause addiction remains unknown.
- Physicians should be aware of asking not only about prescribed and illicit drugs but also drugs that the patient may consider to be ‘legal highs’.