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Should “legal highs” be regulated as medicinal products?

BMJ 2011; 342 doi: (Published 23 February 2011) Cite this as: BMJ 2011;342:d1101
  1. Michael Evans-Brown, senior researcher in emerging drug issues1,
  2. Mark A Bellis, director1,
  3. Jim McVeigh, deputy director1
  1. 1Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University
  1. Correspondence to: M Evans-Brown m.j.evans-brown{at}

In the United Kingdom legislators are using the term “legal highs” as shorthand for emerging psychoactive substances that are not controlled under the Misuse of Drugs Act 1971 but that in their opinion cause similar harm to those that are.1 It assumes defined causal links between the use of such substances and serious harm to individuals and society. This is compounded by anecdotal accounts in the media of widespread use and (suspected) serious adverse drug reactions that are presented as typical experiences. The term is misleading in defining the problem and its solution, to the exclusion of other policy measures that may be more effective and efficient, such as the medicines regulatory framework.

In such an environment fear and panic can weaken the ability to collect the valid and precise data needed for risk assessments—it is of limited value if we can’t discriminate between pharmacological effects, nocebo (undesirable placebo) effects, or other causes.2 3 The opportunity for rational debate and effective policy making is also limited.4 Policy measures that reflect such errors may be regarded as disproportionate and illegitimate by the sections of society that are the intended focus, which in turn could bring …

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