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PMMA (paramethoxymethamphetamine) in "legal highs" in Spain

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Energy Control (www.energycontrol.org) is an ABD’s drug prevention program developing and implementing, since 1997, risk reduction strategies within the nightlife sectors including peer community group interventions, training for nightlife and health professionals, publication and promotion of specific prevention materials, new media tools and guidelines and development of drug checking programs.

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Concerning about drug checking strategy its objectives are three:

1. Establish contact with drug users with the objective to provide them with information about the composition of their drugs.

2. Improve our knowledge about the situation of the illegal drug market and early detection of new trends.

3. Make this information available to all stakeholders involved. I remark the third objective because the following case is a great example.

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At the end of July of 2011 we received a sample of a legal high named “Red Doves” from a man from Palma de Mallorca who had bought it in a grow shop. After taking one pill of this legal high, he suffered a steep climb in body temperature and sweating.

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The sample was analysed by gas chromatography mas spectrometry (GC/MS). The analysis confirmed the presence of 4-MEC (4.methylethcathinone), MDPPP (3',4'-Methylenedioxy-α-pyrrolidinopropiophenone), PMMA (paramethoxymethamphetamine) and the finally compound that we were not able to identify. The finding of

PMMA was very surprising for us because it is a very dangerous substance whose active dose is very close to the fatal dose. The symptoms produced by this substance are hyperthermia and sweating, among others, and can cause rhabdomyolysis and death.

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In fact, PMMA has been involved in 49 deaths in Europe and one death in Australia during 2011. The Scottish Crime And Drug Enforcement Agency launched a drug alert about several legal highs products and tablets with PMMA, involved in 19 deaths. This alert was launched 5 days before our alert. The Early Warning System of Belgium advised about PMMA related deaths in Europe, mostly in Norway.

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Due to the danger associated with PMMA a set of actions to inform both users and other interested partners (including the supplier of these legal high) were launched:

1. We contacted the user and possible other users:

a. At first, we informed the man who had sent us the sample about the composition of it and we recommended him not to use it again.

b. We alerted other possible users of this product through our web site (www.energycontrol.org), our fan page in Facebook, Twitter, our internet forum, and other Spanishonline drug forums.

c. We sent the information to Erowid, the most popular drug information website of the world with the aim to spread the information as much as possible.

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2. We contacted with the seller and supplier:

a. The grow-shop where the man had access to this product.

b. The supplier (AM-HI-CO) to inform them that they were selling a dangerous and illegal substance (PMMA is illegal in Spain from 2002).

c. We sent a letter to a large number of grow-shops through two magazines (Cañamo and Cannabis Magazine) and through the Spanish Cannabis Federation (FAC). We received a lot of e-mails from several Grow-shops, telling us the lack of confidence they had in these products and showing the commitment to with the withdrawal of their stocking.

3. We informed the administration of this finding, the National Plan on Drugs’ Department from our Ministry of Health and the European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA).

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The main results of those actions were as follow.

First of all, the grow-shop withdrew the product from selling.

Second, the supplier believed that the composition of Red Doves was 6-APB, methylone and fenfuramide and after our feed-back he researched it and he noticed that he had sold other 20 different brands with PMMA in their formulations.

This coincided with the alert of the Scottish police of July 22nd where other AM-HI-CO legal highs with PMMA appeared: E=XTC, Mind Candy, Xtacy Ultra, Red Doves and Red Doves Ultra. We provided them with the product reference to help them in the search of it and the withdrawal of their stocking. The supplier said us: we recalled and destroyed tens of thousands of pills. For now we urgently need to have our other 5 formulations tested so that we can be 100% sure that they do not contain any banned substances.

Today these brands are selling in the AM-HI-CO site. We are unaware of their composition.

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On August 7th the news agency Europa Press broadcast this alert from information published by us on our website. This news was picked up in turn by numerous media, mainly in Spain but some from other countries (Portugal, Italy, Honduras, Venezuela, Argentina, etc.). In total, the news was publicated in 76 newspapers, 100 on-line articles and came in 7 radios (Radio Cadena SER, Radio Nacional de España, etc.) and 8 television channels (TVE1, Tele5, TeleMadrid, Canal 3/24, Canal Sur, La Sexta, Cuatro, Antena 3) and another news agency EFE. This warning generated many debates in international online drug forums.

In google we found 7.400 spanish results for "Alerta PMMA en Doves Red".

We think that the media created an unjustified alarm because this product was only found in one occasion and we have no notice of more intoxications in other places of Spain. Also this big diffusion could have caused a call effect: irresponsible and curios users could have wanted to taste this product after so much publicity.

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Conclusions about this case.

1. One. As previously highlighted by other studies, the legal highs market itself possesses risks related to its instability. Although unusual, this case shows too how some products can contain very dangerous substances like PMMA. For this reason, it's important to monitor the content of legal highs products and to inform users via early warning systems in order to avoid or minimize some risks. Drug Checking Services led by some NGOS and the dissemination of the information generated by research groups across Europe, could serve to this objective.

2. Second. But not only this kind of information has to reach users and agencies. Sellers (online shops, grow shops in our country, smart shops in others) who could not know the exact composition of the products they are selling, must be aware of all this kind of incidences and collaborate with a rapid withdrawal of very

dangerous substances when they are detected. In our case, the great collaboration of FAC and two cannabis related magazines allowed us to reach a very large number of shops. In this sense, this kind of collaborations must be considered in the planning and implementation of an early warning system.

3. Third, the experience reported today, also has shown that at least some suppliers can be unaware too of the exact composition of their products. He didn't know the presence of this substance. This lack of knowledge makes the rapid identification and withdrawal of very dangerous substances more difficult. However, it is necessary to obtain their collaboration in the process of withdrawal very dangerous substances from the market.

4. Fourth, although it wasn't our intention, media echoed this case and created an unnecessary alarm among the general population without contributing to a rapid dissemination of accurate and useful information. In contrast, media transmitted messages that didn't help users to get an idea of the dangers associated with PMMA and could have caused a call effect on this little popular substance but very dangerous.

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The big question is why someone decided one day to introduce PMMA in legal highs? And trying to imitate the effects of how far are they willing to go to achieve this?

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