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Drugs & Alcohol: New pill on the block


Over the past few years there has been rapid growth in the number and range of new and emerging drugs, posing serious implications for worksites where safety is a priority, writes Dr Ken Pidd.


drug-&-alcoholThe European Centre for Monitoring Drugs and Drug Abuse recently reported that the number of notifications of new substances each year grew from 14 in 2005 to 81 in 2013 (more than one per week). These drugs are designed to mimic established illicit drugs, such as cannabis, cocaine, amphetamines, ecstasy and LSD, but are manufactured with structurally different chemicals. These new and emerging drugs are often sold on the internet on local or overseas websites, and until recently, were legally available in some Australian ‘sex shops’ and tobacconists. They may be sold as nutritional supplements, bath salts, plant food, herbal highs, herbal incense, party pills, and synthetic cannabis.

Some of these drugs have been available for some time. However, many are new with little known about the short or long term effects of use. They appear to have become more widely used in recent years and there is concern that their popularity is increasing. The use of these drugs not only has implications for the health and safety of the user, but also for workplace safety and productivity if the user is employed.

WHAT ARE NEW & EMERGING DRUGS?
These new and emerging drugs are most commonly referred to as ‘synthetic drugs’, but are also known as ‘legal highs’, ‘herbal highs’, and ‘party pills’. However, terms such as synthetic drugs or legal highs are misnomers. Any legal (e.g., prescribed medications) or illegal (e.g., amphetamines) drug that is manufactured is a synthetic drug. Only naturally occurring drugs such as cannabis or opium are non-synthetic. Also, while these drugs have been promoted as ‘legal’, the complexity and changing nature of relevant Australian law means such claims are at best tenuous.

A more appropriate term, used by researchers and clinicians to describe these drugs, is ‘emerging psychoactive substances’ (EPS). The term psychoactive means these substances act on the brain to cause changes in thought, mood and/ or behaviour. There are a broad range of EPSs available both overseas and within Australia, but they can be classified into two broad categories:

  • Pills and powders
  • Synthetic cannabis

PILLS & POWDERS
Pills and powders are marketed as natural supplements that increase energy or mood, with effects similar to ecstasy or amphetamines. Party pills (herbal highs) first came to prominence in the UK in the early 2000s and contained legal chemicals such as benzylpiperazine. Health concerns later resulted in benzylpiperazine being banned. More recently benzylpiperazine-free herbal highs have emerged, claiming to contain natural chemicals such as octopamine synephrine (citrus aurantium extract) and geranamine (geranium extract). However, research has indicated they usually contain less expensive synthetic chemicals. Common marketing brand names include Loaded, HyperDrive and NeuroBlaster. Herbal highs are often available as pills or in liquid format and are usually swallowed.

Powder products include synthetic cocaine, synthetic amphetamine, and ‘bath salts’. These products act as stimulants and originally contained mephedrone. Following the banning of mephedrone, more recent versions contain chemicals such as methylenedioxypyrovalerone (MDPV). Both mephedrone and MDPV are related to cathinone, a chemical compound found in the Khat plant. Overseas brand names include Ivory Wave, Bubble Bliss and Vanilla Sky, while local Australian brand names include Sharman’s Dust, White Bull, Smokin’ Slurrie, and White Revolver. In 2012 MDPV was banned in Australia, however, new products have emerged that contain other chemicals such as ?-pyrrolidinovalerophenone (?-PVP) and methyl-?-pyrrolidinopropiophenone. These ‘powders’ are usually swallowed, smoked, injected, or snorted. Another powder product that is swallowed is Jack3d, which contains a stimulant known as DMAA (dimethylamylamine). DMAA is often claimed to be a “natural” stimulant that is included in some dietary and sports supplement products.

More recently Australia has seen the emergence of the NBOMe group of drugs, sometimes referred to as “synthetic LSD”. NBOMes are hallucinogens or ‘psychedelics’, and change the way a person perceives the world by altering the user’s thoughts, emotions and sense of time and space. NBOMes have brand names such as N-Bomb, Bom-25, Pandora, Solaris, Divination, Wizard and Smiley Paper. They can be in the form of infused blotting paper (similar to LSD) labelled with pop culture images or logos, clear liquid, powder or a pill. NBOMes can be inactive if swallowed, and the most common method of use is sub-lingual (held under the tongue or cheek until dissolved and absorbed).


…workplace drug testing is likely to continue to be an important workplace safety strategy with testing programs expanded to include tests for synthetic cannabis.


SYNTHETIC CANNABIS
Synthetic cannabis is produced with manufactured chemicals that create similar effects to delta-9 tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis. These chemicals are mixed with solvents (e.g., acetone) and sprayed on dried natural herbs or other plant material. While this product is usually sold as a ‘legal’ herb-based alternative to cannabis, it is also marketed under other general terms such as aphrodisiac tea, herbal incense and potpourri.

In Europe, synthetic cannabis first gained popularity in 2004 under the brand name of ‘Spice’, which fast became the most commonly recognised brand name. However, since then a number of competing products made by other manufacturers also became available. In Australia, ‘Kronic’ is perhaps the best known brand name. Other brands include Northern Lights, Mojo, Voodoo, Kaos and Mango Kush. Synthetic cannabis is usually sold in professionally produced packaging that is colourful and branded, and typically contains between 1-3 grams of dried plant matter. Synthetic cannabis is usually smoked, but is sometimes infused in hot water and drunk as a tea.

EMERGING PSYCHOACTIVE SUBSTANCES & THE LAW
The laws regarding EPS are complex and can differ between states and territories. While laws regarding the importation of drugs and the chemicals used to manufacture drugs come under federal legislation, most illicit drug legislation is state based and can be unique to each state and territory. Under federal law it may be illegal to import a chemical, but it might be legal to possess the same chemical in one state and illegal to possess it in another state.

In the past, state based laws have largely relied on banning individual EPS as they are identified. This has resulted in an on-going game of ‘catch-up’, with manufacturers using new chemicals to replace those that were banned and constantly changing the chemical structure of the drugs to try to stay ahead of the law. However, state based laws are increasingly becoming stronger and several states such as Queensland, New South Wales, and South Australia have introduced ‘blanket bans’ on possessing or selling any substance that has a psychoactive effect other than alcohol, tobacco and food. To-date, the effectiveness of these laws has yet to be fully tested in the courts.

THE EFFECTS OF USING EMERGING PSYCHOACTIVE SUBSTANCES
While there is a substantial amount of research concerning the effects of established illicit drugs such as cannabis and amphetamines, very little is known about the short or long term effects of EPS. One reason for this is the relatively short time period that these drugs have been in existence. The majority of these drugs have only emerged in the last few years, with many unheard of prior to 2000. Given how rapidly these new drugs are emerging, it is difficult to know their effects and what dose levels cause what effects.

Compounding this is wide variability in the nature, quality, and quantity of the chemicals being used to manufacture these drugs. For example, research has shown variability in the combinations and concentrations of the synthetic cannabinoids used to make synthetic cannabis. This means that using different brands, or even different batches of the same brand, can produce dramatically different effects. In addition, manufacturers of EPS often change the chemical structure of these drugs in an attempt to stay ahead of changes in legislation, which in turn can lead to changes in their effect.

Despite the lack of research concerning the health and safety consequences of EPS, there is sufficient anecdotal and case study information to indicate that use of these drugs can have serious adverse effects. The use of EPS has been associated with negative health outcomes including organ failure and death. In some cases the use of EPS has been reported to have more serious side-effects than the established illicit drugs they are designed to mimic. For example, synthetic cannabis products can cause effects not normally experienced when using cannabis, such as serious seizures and increased heart rate. Similarly, NBOMes can have effects on the body not experienced with established hallucinogens such as LSD, including agitation, seizures, hypothermia, metabolic acidosis, and organ failure.

Some of the health effects of EPS use include:

  • Hypertension
  • Headache
  • Nausea and vomiting
  • Seizures
  • Anxiety
  • Acute psychosis
  • Paranoia

Effects of EPS use which have particular implications for workplace safety include:

  • Agitation and confusion
  • Alteration of time perception
  • Hallucinations
  • Aggression, violence and unpredictable behaviour
  • Amnesia

The negative side-effects of EPS use and possible overdose are more likely when these drugs are taken in combination with alcohol or other established illicit drugs.


This has resulted in an on-going game of ‘catch-up’, with manufacturers using new chemicals to replace those that were banned and constantly changing the chemical structure of the drugs to try to stay ahead of the law.


THE USE OF EMERGING PSYCHOACTIVE SUBSTANCES IN AUSTRALIA
The extent of EPS use in Australian is largely unknown. The most recent (2013) National Drug Strategy Household Survey indicated that only a small proportion of the population (1.2%) had used synthetic cannabinoids in the last 12 months, and 0.4% had used other forms of EPS. Even among regular cannabis users, the proportion who had used synthetic cannabis in the past 12 months was low (4.5%). However, the prevalence rate is likely to be much higher among specific population groups. Those who are most likely to use EPS include teenagers and young adults (in particular males) aged in their 20s and 30s.

Synthetic cannabinoid products have been available in Australia for some time via the internet or through specialist adult stores such as sex shops and tobacconists. However, it appears that it was not until around 2011 that Australian authorities began focusing their attention on EPS following a number of media reports concerning synthetic cannabis. A number of recent deaths among Australian teenagers who had used NBOMes has increased the focus on these products.

WHY PEOPLE USE
Despite the potential legal and health implications of EPS use, some people still choose to use these drugs. There are a number of explanations for this. The main reason may be curiosity and a desire to experience the drug’s effects. Another reason is that certain individuals (young males in particular) are inherently attracted to risk taking behaviours such as drug use. Others may be attracted by the alleged legal status of these drugs and the fact that they are easily accessible in adult stores and online. Moreover, the professional packaging and marketing of these drugs may lead to a perception that they are safer to use than established illicit drugs. In addition, one unintentional outcome of recent media attention on EPS is increased awareness of their existence, which in turn can lead to increased demand. Research has indicated a strong association between the volume of related media coverage and the number of internet searches for synthetic cannabis.

Another motivation to use EPS, of particular relevance to the mining industry, is the desire to avoid a positive workplace drug test. Recent research has indicated that the desire to experience a drug’s effects without returning a positive drug test was a motivator to use EPS for a substantial proportion of users. This motivation may explain the growth in the prevalence of EPS use among mining workers. While little hard prevalence data is available, police reports of EPS related seizures and arrests in mining towns located in Queensland and West Australia indicate the prevalence of EPS use is higher in these locations. A coronial inquest into the death of the West Australian miner who died in 2011 after consuming DMAA (the chemical in Jack3d) mixed with alcohol found he was primarily motivated to use this EPS to avoid a positive workplace drug test.

MINIMISING THE RISK TO WORKPLACE SAFETY
While workplace drug testing is an important strategy utilised by the mining industry to minimise drug related risk to workplace safety, until relatively recently no workplace tests had been developed that could specifically detect EPS. However, recent advancements in workplace drug testing technology have led to the development of tests that can detect some types of synthetic cannabis. Moreover, while workplace tests cannot detect many other types of EPS, substances such as mephedrone and MDPV can produce a (false) positive result for amphetamine and/ or cocaine use. Thus, while the test may not detect the actual EPS used, it can detect potential drug related risk to safety.

Therefore, workplace drug testing is likely to continue to be an important workplace safety strategy with testing programs expanded to include tests for synthetic cannabis. However, it is also important to recognise the inherent limitations of testing as a stand-alone strategy. One unintended outcome of workplace testing is that rather than changing their behaviour to reduce drug related risk to safety, employees may change their behaviour to avoid detection. This may explain growth in the prevalence of EPS use among mining industry employees. That is, rather than ceasing use entirely, drug using employees may switch from the use of established illicit drugs to the use of EPS in order to avoid a positive drug test.

Given the rapid and on-going growth in the range and type of EPS, it is unlikely that drug testing on its own will provide the solution to EPS related risk to workplace safety. For many of these substances tests have not yet been developed and new forms of these substances are emerging much faster than testing technology. Advances in drug testing technology are likely to continually lag behind advances in EPS technology. Workplace drug testing is likely to be most effective when it is combined with a comprehensive approach to education and training that increases employees’ awareness of the health and safety risks of EPS (and other drug use) and builds supervisor and managerial capacity to identify and manage drug related risk to safety and productivity. Such comprehensive approaches are not only likely to reduce drug related risk to safety, but also contribute to enhancing the overall workplace safety culture.


Recent research has indicated that the desire to experience a drug’s effects without returning a positive drug test was a motivator to use ePs for a substantial proportion of users.


PROFILE
ken_piddDR KEN PIDD
Deputy Director of the National Centre for Education and Training on Addiction (NCETA)
Ken Pidd is the Deputy Director of the National Centre for Education and Training on Addiction (NCETA), located at Flinders University Adelaide.  His research and practice work focuses on the management of alcohol and drug related risk to workplace safety and productivity.  Prior to working at NCETA he managed an industry based alcohol and drug program and for many years worked in occupational health and safety and trade related roles in the mining and construction industries.

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AMSJ April 2022