Legal highs and lows: Illicit drug use around the world

The World Drug Report is produced annually by the UN Office on Drugs and Crime (UNODC), to summarise information on the worldwide manufacture and marketing of illicit drugs and to guide appropriate actions by legal authorities and public health agencies. Although the overall situation is described as “stable”, the 2013 report highlights a striking rise in the availability of new psychoactive substances (NPS). As illustrated by Carrie Arnold in this issue of The Lancet, so-called legal highs have swiftly gained attention and notoriety in the UK and other countries; with serious health outcomes not unknown, governmental responses have struggled to keep pace with this new and evidently enticing phenomenon.

Part of the challenge of NPS lies in their variety—some are derived from plants, for instance Salvia divinorum, with synthetic cathinones and cannabinoids also being major contributors in different countries. Chemical heterogeneity is a hallmark of this group of drugs, with the number of NPS identified in the European Union having risen from 14 in 2005 to 236 at the end of 2012. Creativity in synthesis appears to have been accompanied by resourceful marketing. Information provided via the internet, together with ease of manufacture in and transport from distant regions, especially countries in Asia, seems to have encountered an opportunity created by sluggish legislative machinery.

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