Uncontrolled Substances

A preview of MATTER’s latest investigation into the chemical underground.

AT MIDDAY ON A THURSDAY this past April, a radio call crackled through from an ambulance team to the emergency department of Calvary Hospital in Canberra, Australia. Dr. David Caldicott, who was leading the shift as admitting officer, immediately noticed a tense quality in the ambulance driver’s voice. His tone was higher-pitched than normal, and his words came fast and clipped. Two young men had been found unconscious in the grounds of the local university, the ambulance driver said. They would both require immediate tracheal intubation. That was it: the line closed. No further information. The ambulance raced through the city traffic towards the hospital, sirens wailing.

“Emergency medicine is like flying a plane,” says Caldicott. “Hours of mundanity punctuated by moments of sheer terror. If you’re worth your salt, you’re not scared, though. Just focused.”

The men arrived, deeply unconscious and in need of immediate intensive care. Neither patient could breathe properly without assistance, and the ER teams scrambled to stabilize them by splinting open their airways and ventilating their lungs with breathing tubes.

What had happened to the men? They were inert and unresponsive as if they had overdosed on heroin, but they had no injection marks and their pupils were not constricted. Still, they were injected with Naloxone, a safe and rapid heroin antidote. It didn’t do a thing.

Tests showed none of the standard drugs in the men’s systems. There was no evidence to suggest they had suffered heart attacks or strokes. They had no names, no ages. Nurses draped the men, who were cold, in a pair of warming blankets. All investigations were drawing a blank.

Through the confusion, Caldicott’s instincts told him that he had seen this before, three years previously, on the other side of the world. He had treated an overdose of something called methoxetamine or MXE—a designer drug based on the horse tranquilizer ketamine—in the small market town of Abergavenny, South Wales, in 2010.

“The guy had face planted in a quantity of white powder,” he says. “It was everywhere, all over his face. Like Scarface. The patient was out of it, but very happy. But once again, it didn’t seem to be something typical, like cocaine. So we sorted him out and sent a sample to the labs to work out, and they found it was MXE.”

Caldicott couldn’t quite believe it might be the same rare drug he’d seen 10,000 miles away. Nor could his colleagues. “They looked at me as if to say, ‘Who is this crazy man? What are you talking about?”

But when the tests came back, Caldicott’s hunch was right. The men were treated by putting them into a chemically induced coma, which gave them time to purge the drug from their system. It was a lucky escape: MXE overdoses have been linked to at least two deaths.

IN 2011, CALDICOTT HELPED FOUND WEDINOS, a Welsh-government-funded group that identifies and investigates new psychoactive substances. In the years before, there had been a sharp increase in the number of cases in which patients arrived at emergency departments requiring help for drug overdoses, but clinicians—and often even the patients themselves—were unsure what they had taken. After moving there to Australia in 2012, Caldicott set up a similar project, called ACTINOS.

“We are tracking the arrival of new species as they arrive in a society,” he says. “It’s toxico-surveillance.”

Methoxetamine is just one of the novel drugs identified by these groups. It has existed for just over three years, and while it remains legal in much of Europe, and in many other countries in the world, it was made illegal in the UK in 2012. It is closely chemically related to ketamine, but several times more potent. Many of its effects are the same: extreme dissociation, hallucinations, and a semi-paralyzed overdose. And above all, in nearly every country on earth, it is entirely legal to buy it.

MXE is part of a cultural shift that started a generation ago, but has taken on a new edge in the last few years. In 2008, the first in a wave of new, legal, synthetic drugs emerged into the mainstream. They had little to no history of human use. Instead, they were concocted in labs by tweaking a few atoms here and there—creating novel, and therefore legal, substances. Sold mainly online, these designer drugs cover every category of intoxication imaginable, and their effects resemble the full range of banned drugs, from the mellowness of marijuana to the extremes of cocaine and LSD. They are known as “legal highs,” and they have exploded in popularity: the 2012 Global Drugs Survey found that one in twelve people it surveyed worldwide takes them.

Legislators around the world have been put off-balance by the emergence of this massively distributed, technically complex and chemically sophisticated trade. And the trade is growing rapidly.

In 2009 The European Monitoring Centre for Drugs and Drug Addiction’s early warning system identified 24 new drugs. In 2010, it identified 41. In 2011, another 49, and in 2012, there were 73 more. By October 2013, a further 56 new compounds had already been identified—a total of 243 new compounds in just four years.

In its latest World Drug Report, the United Nations acknowledged this extraordinary expansion: “While new harmful substances have been emerging with unfailing regularity on the drug scene,” it said, “the international drug control system is floundering, for the first time, under the speed and creativity of the phenomenon.”

Technology and drugs have always existed in an easy symbiosis: the first thing ever bought and sold across the Internet was a bag of marijuana. In 1971 or 1972, students at Stanford University’s Artificial Intelligence Laboratory used ARPANET—the earliest iteration of the Internet—to arrange a marijuana deal with their counterparts at the Massachusetts Institute of Technology.

That groundbreaking deal connected two teams of people who were separated by a 45-hour drive east-west across the entire continent. Today, buying drugs online is far easier and faster—and in many cases, you don’t even have to break the law.

Caldicott, speaking from his office in Canberra, says we are living through tumultuous times.

“I compare the phenomenon of illicit drug use to influenza. During the course of a year influenza changes slightly, which is why you get a new jab every year. But every 10 to 15 years we see a major shift. The year-to-year swaying and back-and-forth of influenza is called antigenic drift: the world and the bug interacting. When avian or pig flu or something like that appears, that’s called an antigenic shift. When these big changes occur, our immune response is negligible. We can’t fight it. And then we need completely new vaccines.”

He continued: “I would argue that we have seen an antigenic shift in the drugs market with the emergence of legal highs since 2008. But the truly extraordinary thing about this is that it’s not just the products that are new. We have all this supplementary stuff: the change in delivery and payment and information and communication systems. All of them have exponentially increased the hazard. It is one of the biggest shifts we have ever seen in the drugs world, to my mind.”

Forty years into the war on drugs, getting your own narcotics made to order is not only easier than ever—it can be totally legal, too. How do we know? Because we did it.

Visit MATTER to find out how the system now allows almost anyone to design, commission, and manufacture their own legal high. It’s just 99c to get the remaining 6,000 words, on the web, in ebook and audiobook form.

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