In a somewhat prophetic statement, Henderson wrote in 1988:
‘It is likely that the future drugs of abuse will be synthetics rather than plant products. They will be synthesised from readily available chemicals, may be derivatives of pharmaceuticals, will be very potent, and often very selective in their action. In addition, they will be marketed very cleverly.’1
Indeed, despite an overall decline in drug misuse in recent years, the use of so-called ‘legal highs’ or novel psychoactive substances (NPS) has seen exponential growth, with new brands, chemicals, and products proliferating rapidly in a new and evolving market. The United Nations Office on Drugs and Crime recently reported more than twice the number of new substances now available as compared with 2 years ago.2 In addition, the European Monitoring Centre for Drugs and Drug Addiction report that in Europe two new NPS are available on the market almost every week.3 In the face of such a rapidly growing market, it is difficult to keep pace with what these products contain, what psychoactive effects they have, and how best to manage patients who are taking them.
Although we may feel fairly confident in managing a patient who has injected heroin, with Toxbase guidelines at the ready, managing a patient who has smoked ‘Blast Off’, snorted ‘Charly Sheen’, or injected ‘Magic Dragon’ may not be quite as straightforward. Toxbase guidelines for synthetic stimulants, hallucinogens, and empathogens are sparse, if present at all,4 and the fact that there is no way of knowing what chemicals these products contain compounds the issue because treating clinicians cannot know which chemicals to reference on Toxbase. Further, data show that products …
