Legal Highs - Dual Diagnosis Leeds

 Animals (toads)
 Seeds
 Powders
 Capsules
 Designed to be smoked
 Some are now reclassified and illegal
Legal highs are manufactured, often in unlicensed
laboratories in China and south east Asia, using a
variety of chemicals which are often very similar to
those contained in illegal drugs, but are often far less
In some cases, chemists attach a few additional
molecules to an illegal drug’s chemical formula in
order to make sure the new variant evades UK drug
They are sold either over the internet, in head shops
or on the streets by drug dealers. Because they are
cheaper to buy than illegal drugs and widely
available over the internet, they can be more
appealing and accessible to young people.
Stimulate receptor
› Opiates
Increase release of
Prevent reuptake of
IV mcat use
› Reported in London,
Lancashire, South
› Very damaging to
soft tissue resulting in
severe cytoxic
Opiates: euphoria, analgesia, drowsiness
o morphine like
o partial agonists
Stimulants: overactive, talkative, confident
o entactogens
o amphetamines and cocaine
Depressants: relaxation, disinhibition
o cannabinoids
o alcohol
o benzodiazepines
Hallucinogens: altered perception, mood
o solvents
o LSD and psylocibin
› Euphoria, relaxation, drowsiness
› Nausea and vomiting (novice users)
› Pinpoint pupils
Adverse consequences
› Respiratory depression
› Anorexia, constipation, weight loss
› Runny eyes and nose, hot and cold sweats
› Dilated pupils
› Stomach cramps and muscle aches
› Insomnia
› Euphoria
› Overactivity, talkativeness, energy,
› Empathy
› Perceptual awareness, illusions (dance
Adverse consequences
› Hypertension
› Dehydration (dance drugs)
› Blood clotting
Withdrawal symptoms
› Dysphoria with insomnia and nightmares
› Fatigue and prolonged sleep episodes
› Tingling in body and head – dizziness and
lightheadedness, tachycardia
› Intensification of mental associations
› Relaxed, calm, disconnected from reality,
incoherent conversation
› Heightened perception and distortion of
› Drowsiness, muscle weakness
› Increased appetite
› Craving, irritable
› Insomnia, strange dreams, loss of appetite
› Altered perceptions with visual, tactile and
auditory hallucinations
› Intensification of colours and sound
› Mood change
Adverse consequences
› Flashbacks
› Psychosis
Enzyme induction reduces plasma levels of aminophylline
(asthma) and coumarin (anticoagulant). Alcohol slows glucose
production and reduces glycogen stores – risk of hypoglycaemia. H2
antagonists (gastric ulcer) block gastric ADH – increase BAC.
Chlorpropamide (diabetes), mushrooms and metronidazole (fungal
infections) block acetaldehyde dehydrogenase – disulfiram like reaction.
H2 antagonists and alcohol induce enzymes
reducing plasma levels of long acting benzodiazepines. Oral
contraceptives increase effects of long acting ones.
Risk of respiratory depression and death when used with
other depressants. Antihistamines can enhance analgesia and reduce
emetic effect. Avoid MAOIs – encephalopathy with meperidine.
Risk of hypertension, CVA, heart attack and sudden
death with other sympathomimetics. Potentiated by MAOIs. Combined
amphetamine and beta blockers may cause alpha adrenergic
overactivity – hypertension.
Interactions are rare. Psychosis may occur with disulfiram
or SSRIs. Enzyme induction reduces plasma levels of theophylline and
Stimulant effects may be increased with
other stimulants – seizures,hyperthermia.
Legal highs mimic or are variations on
“known” substances
 The pharmacology is not well researched
 Effects and adverse consequences are
as the existing categories of substances
 Treatment should follow the same
pathway as any other substance use
treatment package
39 year old male, married with a twelve week old son
History of compulsive behaviour from age 17 including
promiscuity, drinking, drug taking notably cocaine
Low moods - started taking ketamine to combat them.
Taking ¾ gram per day
Dislikes psychedelic effects – believes he has telepathic
powers and can communicate to a god or aliens, vivid
memory recall of sexual abuse
Neglecting wife, child and career. Wife has asked him to
move out
37 year old male, single, unemployed
‘Legal highs’ since April 2010 including mephedrone,
methylone, naphyrone, MDAI, 5-AIA, ‘Benzofury’, ‘Ivory
wave’, methoxetamine on a near-daily basis
Describes effects as ‘cosmic, spiritual, out of this world,
unbelievable’. ‘TV talking to me’,’forces pulling me to do
things’, ‘seeing mist and light’
Evidence of dependence: tolerance, salience, relief
dosing (for comedowns) and continued use despite
harms (including probable police charge for possession
with intent to supply; and total expenditure of £20 000+)