Expert opinion

Analytical chemist Dr John Ramsey of TIC TAC is the media’s go-to man for an authoritative voice on new psychoactive substances. He talks to DDN’s David Gilliver.

John Ramsey‘It’s a really difficult phenomenon to name,’ says Dr John Ramsey of the new drugs he’s constantly adding to his organisation’s database. ‘None of the terms really work, and nobody understands them in any case. “Legal highs” is inappropriate because a lot of them don’t remain legal and a lot are depressant rather than highs, and “new psychoactive substances” nobody understands. We used to call them designer drugs, which I suppose is pretty much accurate but, again, nobody really understood it. It’s a bit like “Hoover” and “Biro” – we revert to “legal highs” because that’s what everyone understands.’

TICTAC Communications is a commercial company that’s part of St. George’s, University of London. It collects drugs into a huge database used by both the health and criminal justice sectors, and has existed in various guises since the early 1980s. ‘It was originally set up because the laboratory I was running at the time investigated deaths on behalf of coroners who needed to identify tablets and capsules, so it seemed a good idea to have a filing cabinet with samples and just look for them,’ says Dr Ramsey. ‘TIC TAC is actually older than the personal computer and the CD-Rom. All the changes in technology have allowed us to deliver the same data in different ways, but it’s still the same filing cabinets full of drugs.’

The plethora of new substances, however, means that he’s become a regular on drug-related news items, ‘purely because we’ve got them all here,’ he says. ‘We don’t do much else apart from collect drugs, legal and illegal, so we’re a source for news stories – a one-stop shop for drugs, I suppose.’

The speed at which new drugs are emerging makes it hard for people to keep up – treatment services and, particularly, legislators – and users often have absolutely no idea what’s in the substances they’re taking. ‘And even if we know what’s in them, we don’t know what they do,’ he adds. ‘It’s not too difficult to analyse drugs and find out chemically what they are, but knowing what the hazards and dangers are – and indeed whether they work as drugs – is a fairly major undertaking.’

As compounds are tweaked to stay ahead of the law, people are exposed to an ever-changing list of new chemicals, he points out. While there’s always the chance of another compound like MPTP – accidentally made by someone trying to make the analgesic MPPP and which led to irreversible Parkinson’s-like symptoms in everyone who took it – determining the scale of the risk is a challenge.

‘Everybody concentrates on deaths, and we all pick the alarming effects because they’re easy to talk about and dramatic, but there’s a lot of scope for harm below that,’ he stresses. ‘They could cause birth defects, all sorts of issues. There’s a whole group of stimulants that cause damage to heart valves, for example. There was an appetite suppressant called fenfluramine that was marketed for years until people established that it could cause valve damage, and some people who took it had quite serious heart problems.’

While the pharmaceutical industry carries out post-market surveillance, if any of the new psychoactive substances were causing similar problems ‘we’d never associate those health ill effects with them’, he says, and although with most compounds it would probably take a significant amount of time before issues became apparent, the potential is still there. ‘A classic example is ketamine,’ he states. ‘When used for its intended purposes it’s quite harmless, but when used inappropriately it can cause the bladder damage that everybody’s now focusing on.’

The ACMD recently recommended that ketamine be upgraded from class C to B, and the government has also announced a wide-ranging review of the laws relating to new psychoactive substances to report in the spring (see news stories, page 4 and 5). But what can realistically be done from a legal point of view – is New Zealand’s attempt to regulate them the right way to go? ‘I think everybody’s watching that with interest,’ he says. ‘I’m rather pleased they’re doing it but the thing that worries me is that clearly the compounds aren’t going to be evaluated to the same standard that the pharmaceutical industry would, purely because of the amount of money it costs and the amount of time it takes. Why as a society should we accept a lower standard of safety for a recreational drug than we do for a pharmaceutical?’

In the pharmaceutical industry it’s usually around five years before new drugs are tested on humans, he explains. ‘The processes are getting better, as we understand more about genetics and how these things might act, but there’s an awful lot of animal experimentation done before a compound ever gets near a human. So that’s the other issue with the New Zealand situation – we’ve then got the ethics of killing hundreds of animals to test the safety of these compounds. Is that right? I don’t know how much truth there is in this, but I’ve heard that some people who have applied for these new licences are getting death threats from animal rights protesters.’

The best approach, he believes, is firstly to clearly explain the risks to people – ‘the classic risk assessment of “is a small amount of pleasure on a Saturday night worth the risk of taking an unknown chemical?” and secondly, perhaps, to ‘just let the market regulate’.

‘If compounds are unpleasant and don’t work very well, people will stop buying them and they’ll disappear. Presumably we’ll finish up with the compounds that people like and we’ll then have a reasonable chance of observing what happens and deciding what the risks are. If we ban everything as soon as it appears all we do is spawn the production of new ones and expose people to more and more compounds.’

In terms of that sort of staying power, mephedrone has proved remarkably resilient, surviving its 2010 ban and with presentations to treatment services for problems with the drug doubling in the last year (DDN, December 2013, page 15). ‘I don’t know if that’s a good thing or a bad thing,’ he says. ‘There have been suggestions that falls in the number of cocaine deaths could be attributed to people using mephedrone instead – perhaps it’s a safer stimulant. But because mortality monitoring is so unregulated, and because the hospital A&E departments don’t really collect information in a way that we can collate it – and indeed don’t analyse samples from people who present with problems – we don’t really know what the health issues are.’ 

As well as drugs from police and border forces, TIC TAC analyses the contents of amnesty bins at nightclubs and festivals. ‘With Glastonbury it’s more of an amnesty skip but, having said that, we don’t actually see many legal highs there. It’s MDMA, cannabis, cocaine – the usual suspects,’ he says.

The organisation also regularly carries out test purchases from online shops – buying drugs with a credit card the same as any other customer – and although more and more new drugs are identified via the EU early warning service each year, whether those numbers ‘really mean anything’ or how many of the drugs could go on to pose a significant problem is difficult to determine. While it’s easy to test purchase and analyse any compounds that are offered for sale, what’s harder to know is how many people are actually using them, he stresses.

To find out more, TIC TAC has been carrying out waste water analysis as part of SEWPROF, an EU-funded project studying sewage epidemiology. ‘Once drugs become sufficiently established they can be detected in the sewage treatment works – we can detect mephedrone and most of the other drugs,’ he says, with MDMA levels unsurprisingly peaking sharply at weekends.

However, a relatively new drug won’t be used by enough people for that to be an appropriate method, so TIC TAC also installs public urinals and carries out anonymous, non-attributable analysis as ‘an early indicator of what’s being used and potentially where and when. If we stick a public urinal in Liverpool Street station on a Friday night we know that anyone who contributed to that did it over the past day or two, so that pinpoints their drug use to a few days and we hope to be able learn a bit about consumption this way. Just because a compound’s offered for sale doesn’t mean that anybody uses it.’ Although the urine testing is still in its early stages – and clearly won’t include female samples – there are already conclusions that can be drawn, he explains.

‘The new drugs are present in all the urine samples we’ve tested – we’ve never tested a public urinal that doesn’t have one of the new compounds in. One of the things a lot of people are concerned about is the cannabinoid receptor agonists, and kids getting themselves into trouble using those. Well, we don’t detect those in the public urinals. I don’t know whether that’s because our analytical methodology’s not up to the mark or because they’re not there, so there’s still research that needs to be done in evaluating our ability to detect these things. Of course it might well be that if they’re used it’s not in an environment that would result in them being in city centre urinals – if they’re used by younger people, maybe at home. There’s quite a lot of subtlety that needs considering when we draw conclusions.’

As to the question of where all the new compounds are coming from, most are still manufactured in China, he believes. ‘It’s difficult to know for certain, but certainly the work we’ve done with the UK Border Agency looking at importations into Heathrow from Shanghai shows a significant number of these new compounds, and if you type the name of a new compound into Google you’ll get an awful lot of Chinese chemical companies offering to sell them to you, so I’m pretty sure. It’s not exclusive to China – it’s a lucrative market, so anyone with the capability of doing it is likely to try.

‘Different drugs and precursors come from different places and people get stuff from wherever they can. It’s a free market, so people will just buy the stuff where they can get it cheapest.’

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