oa Editorial (The Popularity of “Legal Highs”)

“Legal highs” or “herbal highs” are becoming increasingly popular substitutes of illicit drugs. These drugs are designed in such manner that they mimic the sedative, stimulant of hallucinogenic effects of illicit drugs. However, they claim to consist of compounds that are legal to sell, use, and possess. Most legal highs are sold via the Internet [1]. Because of different legislation, the drugs may be illegal in some countries but legal in others. The most popular legal highs are gamma-hydroxybutyrate (GHB) and cathinones such as mephedrone [2]. The popularity of legal highs can be explained by the perception of users that they are more natural and safe when compared to illicit drugs [3]. However, in reality the scientific research on legal highs is sparse [2]. In addition, because the pricing of these drugs is competitive with illegal drugs, the marked position of legal highs is increasing rapidly. Policymakers respond by enforcing legislation that prohibits or limits the sale of specific drugs and their analogues, but this is not very effective in reducing overall drug use. For example, when GHB was listed as illicit drug, it was readily replaced by its precursor gammabutyrolactone (GBL) which was not yet listed [4]. Another successful strategy applied by manufacturers of legal highs is to simply replace an ingredient that becomes listed as illicit by another ingredient that is still legal to sell. Traditional illicit drugs such as cocaine and cannabis have been extensively studied, and ongoing research is examining their safety and short- and long-term effects on health and behavior. Also, research has studied effective addiction recovery therapies. This information can be used to educate recreational drug users about the potential risks and benefits of using a drug. This knowledge contributes to the safe use of these drugs. Also, education about the potential risks of illicit drugs may prevent people from using them per se. In contrast, often there is little or no information available about the mechanism of action and the potential risks of using legal highs. There is insufficient or no legislation that makes it mandatory for sellers to provide this data. Internet shops generally only focus on the positive effects of the drugs they sell [5]. Schmidt et al. [6] reviewed 1308 legal highs and found that about 40% did not list any ingredients and 91.9% did not report any adverse effects of the product. Unfortunately, this can make users believe the drugs are safe. It can also be questioned if you actually get the product that you paid for. Recent research by Woods and colleagues [7] showed that the content of legal highs when tested in the laboratory often does not match the description on the website. Also, the content of 25% of legal highs differed from order to order [7]. Thus, although prices are generally lower than illicit drugs, it can be questioned if legal highs are worth the money. Of more concern, some products marketed as legal highs did contain controlled drugs [7, 8]. April 2010, U.K. government banned cathinones such as mephedrone. Nevertheless, Brandt et al. [3] showed that 70% of products claiming to be a legal replacement of mephedrone in fact contained a mixture of compounds that were illegal. The variable content of legal highs and the lack of scientific evidence on their potentially harmful health effects are of ongoing concern. In addition to more research on these compounds, educating adolescents and young adults about the potential but unknown risks of experimenting with legal highs seems warranted.