A blanket ban on ‘new psychoactive substances’ should have come into effect this week. The Psychoactive Substances Act was due to come into force on April 6 but has now been delayed until at least May. Why is this of interest to eye care practitioners?
I first discussed this area back in 2011 when figures showed a significant increase in the use of so-called ‘legal highs’ in the UK (Optician 16.12.2011).
My argument at the time was that too little information was being published about the widespread use of a variety of easily obtainable compounds, many of which had significant ocular consequences. Most recent publicity has surrounded a case study in the British Medical Journal about sight loss in a young person who used amyl nitrite (‘poppers’). This case should be of little surprise as poppers have been around for a long time. Indeed, the vasodilatory impact of the drug has been the reason it has been used in the past to alleviate symptoms of acute angina and has included at least one former prime minister as a user. Its impact is known and understood, as is the impact of, say, Viagra which also has a vasodilatory effect and is the reason why some users of this drug report a blue tinge change to their vision and for which there is also reported sight loss incidents including cases of anterior ischaemic optic neuropathy. We should be more worried about the drugs we don’t know about.
Most of the compounds currently used are serotonin agonist type drugs aiming to offer a cheap cocaine-like euphoria. Sleep loss, pupil effects, tear film disruption, accommodative instability and decompensated phorias are all anecdotally reported. Previous attempts to ban substances have led to chemical tweaking and the market being flooded with untested substitute substances. Prohibition is unlikely to stop use. Rather, careful regulation and licensing is required if we are to understand what goes into people’s systems.