Intended for healthcare professionals

Rapid response to:

Letters Second generation mephedrone

The confusing case of NRG-1

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3564 (Published 06 July 2010) Cite this as: BMJ 2010;341:c3564

Rapid Response:

PMMA in 'ecstasy' and 'legal highs'

Developing effective and efficient responses to new psychoactive
substances (so-called 'legal highs') is a major challenge to public
health. This is particularly apparent in an increasingly globalised market
where the Internet is playing a pivotal role in diffusion. The use of
these substances is driven, in part, by their licit nature, and, in some
cases, control measures have been introduced to restrict their
availability. It is well recognised that some of these newly controlled
substances continue to be detected in products sold as 'legal highs' (as
well as being available on the illicit market).[1,2] However, substances
that were controlled many years ago are also now being detected in
products sold as 'legal highs'. One such example is PMMA (para-
methoxymethamphetamine). PMMA is controlled as a Class A drug in the UK
and was subject to a risk assessment carried out by the European
Monitoring Centre for Drugs and Drug Addiction (EMCDDA),[3] that led to an
EU-wide ban in 2002. Over the past year or so, the EMCDDA has received
reports of 'legal highs' containing this drug (figure 1). At the same time
it is also being detected on the illicit market, in tablets sold as
ecstasy (figure 2) and in white powders. Reports of PMMA-associated deaths
have also increased during this time and warnings have been issued to
users.[4,5] It is clear that the boundary between licit and illicit
markets have become blurred. What might have originally been an
opportunity for legal high entrepreneurs may have now become, in part, the
domain of organised crime.[6]

Simon D Brandt1, Michael Evans-Brown2, Harry R Sumnall2, Andrew Cunningham3, Ana Gallegos4, Roumen Sedefov4*

1 School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF


2 Centre for Public Health, Liverpool John Moores University, Liverpool L3 2AJ


3 Scottish Crime and Drug Enforcement Agency, Paisley PA3 2RE


4 Action on New Drugs, Supply reduction and new trends Unit, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal


*Correspondence to: Roumen Sedefov, roumen.sedefov@emcdda.europa.eu

References:

[1] European Monitoring Centre for Drugs and Drug Addiction. EMCDDA-
Europol 2010 annual report on the implementation of Council Decision
2005/387/JHA. European Monitoring Centre for Drugs and Drug Addiction,
2011.

[2] Brandt SD, Sumnall HR, Measham F, Cole J. Second generation
mephedrone. The confusing case of NRG-1. BMJ 2010;341:c3564.

[3] Council Decision of 28 February 2002 concerning control measures
and criminal sanctions in respect of the new synthetic drug PMMA
(2002/188/JHA)

[4] Scottish Crime and Drug Enforcement Agency. Drug alert PMMA
(paramethoxymethylamphetamine), 22 July 2011.
www.sdea.police.uk/Downloads/ACPOS/DOC%2020110722%20PMMA%20alert.pdf

[5] 1 Death in Austria. EMCDDA Early-warning system report, 9 March
2011. 16 deaths in Norway. EMCDDA Early-warning system report, 31 May
2011.

[6] European Monitoring Centre for Drugs and Drug Addiction. Report
on the risk assessment of mephedrone in the framework of the Council
Decision on new psychoactive substances. Publications Office of the
European Union, 2011.

Figure 1. ‘Legal high’ sold in a Head Shop in the UK that contained PMMA and MDPBP (Credit: Scottish Crime and Drug Enforcement Agency).

Figure 2. ‘Ecstasy’ tablet from the illicit market in Norway that contained PMMA (Credit: Norwegian Reitox national focal point).

Competing interests: ME-B is contracted by the Department of Health to coordinate the early-warning system on new psychoactive substances for the UK Reitox national focal point, reporting to the European Monitoring Centre for Drugs and Drug Addiction under the terms of European Union Council Decision 2005/387/JHA. The views expressed here are personal and do not represent those of the UK focal point nor the Department of Health.HRS was appointed to the Advisory Council on the Misuse of Drugs (ACMD) in January 2011 and receives expenses payments to attend Council meetings. The views expressed here are personal and do not represent those of the ACMD.

08 August 2011
Roumen Sedefov
Head of Unit, Action on New Drugs, Supply reduction and new trends Unit
Simon D Brandt, Michael Evans-Brown, Harry R Sumnall, Andrew Cunningham, Ana Gallegos
European Monitoring Centre for Drugs and Drug Addiction