"Legal highs" ruling leaves illegal labs laughing

Where would you find the world's most productive pipeline of new drugs? Not in the pristine research institutes of big pharma companies, but in unregulated labs in the back streets of Shanghai and other Asian cities.  
China has become the world's factory for the psychoactive substances known as 'legal highs', and its output is prodigious: drug control agencies have identified more that 400 new products, and the list is growing all the time.  
They include stimulants, sedatives and psychedelic agents designed to alter mood or consciousness. Legal highs have been available in 'head shops' on the streets of most UK cities, but this does not mean they are safe. The synthetic cannabinoid Spice can cause seizures, paranoid delusions and psychosis, and the Centre for Social Justice recorded 97 deaths from legal highs in the UK in 2012.  
So from May 2016, the Psychoactive Substances Act made it illegal to produce or supply legal highs in the UK. But yesterday, a landmark court decision called the legislation into question, as many of the products are approved for medical use. These include the anaesthetic nitrous oxide, or laughing gas.  
N2O has been used as a recreational drug since 1799, when 'laughing gas parties' were popular among the ruling classes. It has now made a comeback at raves and music festivals (where discarded silver canisters are a common sight) and among students, possibly to numb the pain of tuition fees. The gas is widely obtainable because it is used by the food industry to aerate whipped cream. This could explain the popularity of Bake Off and the reason so many Brits seem addicted to cake.  
Anyone who has experienced the benefits of nitrous oxide in dentistry or childbirth will confirm what a powerful euphoric effect it has. I once found myself walking out of the dentist laughing out loud after paying a thousand pounds for root canal work. And after inhaling a lungful of Entonox, my wife just chuckled when the obstetrician said she needed an episiotomy.  
People who use legal highs may be in it for the shits and giggles, but they are unwittingly taking part in the world's largest (uncontrolled) clinical trial. The labs who produce these designer drugs are using their customers as guinea pigs in a real-life game of molecular roulette, where the user takes all the risks. A small variation in chemical structure or manufacturing processes can produce entirely different and unpredictable psychoactive effects.  
Aside from the latest ruling, there are many blurred lines between legal and illegal drugs. There is a huge amount of off-label use of licensed medicines by medically qualified prescribers. There are also many agents that have crossed the line from illegal to legal use, such as cannabinoids for MS, as well as previously approved medicines that have now been outlawed.  
Our agency was responsible for the EU launch of OxyContin and the first sublingual formulation of fentanyl, a powerful opioid that is abused by many drug addicts. So we are acutely aware of the devastation caused by the opioid epidemic in the US, and the criticism aimed at Purdue, the maker of OxyContin.  
We have also worked on ketamine (known on the street as Special K) and a range of painkillers, hypnotics and antidepressants that have addictive properties or potential for abuse. We have also pitched for agents designed to treat opioid overdose and alcohol abuse.  
We all belong to an ethical industry and have a responsibility not just to adhere to regulations, but to consider the impact our products have on people who misuse them. It's incumbent on us to do all we can to ensure that are used appropriately, and that all stakeholders are aware of the safety issues relating to them.  
Drug abuse is a massive medical and social problem in the UK, and it has been compounded by the availability of new psychoactive agents virtually everywhere. People who go to prison for innocuous crimes and in good health are often released with a Spice habit and in debt to criminal gangs.  
Banning legal highs had been criticised by many groups because 'head shops' were replaced by criminal street dealers, and drugs could be ordered like a takeaway using smartphones and social media. The recent court case leaves the issue in limbo, but it may also present an opportunity to rethink our national policy towards drug use and misuse. Every day we are reminded of the power - medical, social and political - of the substances we deal with.  

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