The Wall Street Journal

The Low-Down on Legal Highs


Europe’s battle with “new psychoactive substances” shows disproportionate consumption in the UK


The results of the largest study of drug use worldwide, which surveyed 80,000 respondents in the last year, offers conflicting messages to public officials and legislators.

In line with the most recent figures available within the U.K., which indicate that deaths related to new, psychoactive substances increased to 68 in 2012 from 10 in 2009, the 2014 Global Drug Survey strongly suggests that the products often referred to as "legal highs"—designed to mimic the effects of cannabis, cocaine and ecstasy—present particularly large risks to Great Britain.

The study, released last week, corroborates reports published in 2013, which suggested that one in 10 young people in Britain has used these products in the previous year. It also suggests that synthetic cannabinoids are associated with a 30-times greater risk of hospitalization compared to illicit varieties of marijuana. Often sold by websites and "head shops" as "smoking blends," they prompted 3.3% of users to seek emergency hospitalization following ingestion, according to the survey.

Such figures support the position of U.K. Home Office Minister of State Norman Baker. Mr. Baker has already said the U.K. will opt out from the European Commission's plans to control legal highs within member countries, due to his concern that the EU measures may "fetter the U.K.'s discretion" to enable the fast enactment of future, domestic bans. The European Commission's directive would offer what has been described as a more "graduated" approach to criminalization, where only the products considered most harmful to consumer health could face full, permanent banning. Those products with "legitimate commercial and industrial uses," in the commission's words, would face less punitive measures.

Drug legislation in Britain is widely considered to be among the harshest in Europe. But as the statistics highlighted in this report suggest, the U.K. still experiences trends in its use of new, psychoactive substances that are significantly greater than those elsewhere in Europe. Mr. Baker commented in a ministerial statement in January that a U.K. opt-out "should not in any way be considered to diminish our commitment to tackle this issue" [sic] and has stated, separately, that the U.K. has successfully banned "hundreds of these drugs."

However, Britain's problem is significant. The European Monitoring Centre for Drugs and Drug Addiction reported that 57 substances—or one new drug per week—arrived in Great Britain between 2009-2012, while the U.K. government had only successfully banned 15. Figures provided by the Office for National Statistics state that the number of deaths attributed to the use of these substances rose to 52 in 2012 from 29 in 2011. Meanwhile, the U.K. Centre for Social Justice has stated that the U.K. is not only a major consumer, but also a key supplier of new synthetic drugs, with 130 websites that sell the products based there.

Mr. Baker also strongly disputes "the evidence base stated in the EU Commission's impact assessment which estimates that 20% of new psychoactive substances have a legitimate use," which is highly divisive, as it may contradict established medical practices within other parts of the EU. One example of a drug that has legitimate medical uses elsewhere in the world—but is considered a legal high in Britain—is the thienodiazepine tranquilizer Etizolam.

The Global Drug Survey's founder, Dr. Adam Winstock, warned last week against excessive preoccupation with legal-high drugs. While conceding that the rise in their use was notable, he said these substances only accounted for 11% of the drugs actually mentioned by users surveyed.

As the independent organization's previous studies have concluded, established legal substances present respondents with greater cause for alarm: "Alcohol remained the biggest concern among friends," said Dr. Winstock, an addiction medicine specialist and consultant psychiatrist at King's College, London, in an interview. Dr. Winstock added that alcohol was also "the biggest culprit in sending people to the Emergency Department."

Reports submitted by respondents to the Global Drug Survey who were deemed to be alcohol-dependent revealed large disparities in understanding regarding the health risks associated with their alcohol use. While approximately 70% of dependent drinkers in America understood the level of harm they were causing themselves, only 15% from Portugal did. By contrast, Denmark proved home to the best informed drinkers. And despite being one of the world's largest alcohol producers and consumers, only 0.7% of French drinkers sought emergency medical treatment—which falls below the global average of 1%—while 2%, or double the mean, required care in Ireland.

"The World Health Report shows alcohol is a major contributor to disability adjusted life years in European countries through depression and alcohol use disorders," confirmed Dr. Iain Smith, a consultant addiction psychiatrist at the Gartnavel Royal Hospital in Glasgow, in a separate interview. "However, when compared to Western European countries, this is more the case in the U.K. and Ireland, judging by recent statistics."

Economic factors of drug use highlighted in the Global Drug Survey may also indicate why the U.K. is experiencing greater difficulties with legal highs. The survey notes that high-quality cannabis currently sells for as little as €6 per gram in parts of Spain, with the cost rising to more than €20 for the same quantity in Ireland. The high price tag for cannabis thus increases the appeal of other, cheaper substances, for instance synthetic drugs.

The use of legal-high drugs in Great Britain is also linked, in some part, to a perceived deterioration in the purity of illegal drugs over the past decade. A small group of users said their preference for new, psychoactive substances was due to what they deemed lower cost and higher purity versus the old, illegal products. However, the Global Drug Survey finds extremely high purity amongst some drugs—notably ecstasy, which has not only doubled in cost this year, but also in strength.

"MDMA was voted the best value for money drug in the world," Dr. Winstock says. "Regardless of price, cocaine was voted the worst value for money drug—with a mean score of 3.4 out of 10."

Last week's report confirms that Britain is increasingly isolated from the rest of the world with respect to its consumption of legal-high drugs. Since punitive measures have failed to effect significant change in the use of substances controlled by the Misuse of Drugs Act, if the U.K. elects to implement a policy different from the European Commission's, it must understand that wider societal changes are needed to avert harmful drug use—instead of simple law:

"Any criminalization or legalization of either legal or illicit drugs will lead to increased consumption," adds Dr. Smith. "Each will lead to different types of drug-related harm from that currently seen."

Mr. Nicoll is British writer and journalist, who has been short-listed twice for the Shiva Naipaul Memorial Prize.