Clinical Toxicology (2014), 52, 678–681 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2014.933346
BRIEF COMMUNICATION
An Internet snapshot study to compare the international availability of the novel psychoactive substance methiopropamine
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
A.-E. VERMETTE-MARCOTTE,1 P. I. DARGAN,2,3 J. R. H. ARCHER,2 S. GOSSELIN,1 and D. M. WOOD2,3 1Emergency
Department & Medical Toxicology Consultation Service, McGill University Health Centre, Montréal, Québec, Canada Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK 3King’s College London, London, UK 2Clinical
Context. With the increased use of novel psychoactive substances, there is an increasing availability of these substances from Internet-based suppliers. Methiopropamine, first reported in 2011, is a recreational drug available over the Internet. The aim of this study was to investigate availability and cost of methiopropamine in three different countries: the UK, France, and Canada. Methods. Using the European Monitoring Centre for Drugs and Drug Addiction Internet snapshot methodology, this study, conducted in June 2013, was undertaken in two different languages: in English (the UK and Canada) and in French (France and Canada), using three Internet searching engines: “google.co.uk”, “google.fr” and “google.ca”. Results. A total of 62 sites were found, most of them were found from the English searches. 45% of the suppliers seemed to originate from the UK. The prices of methiopropamine were comparable between suppliers, no matter which search engine or language was used. The cost of a unit of methiopropamine was inversely related to the purchased quantity, going from 19.49 ⫾ 0.15 GBP per gram for a purchase amount of 500 mg to 3.54 ⫾ 0.13 GBP per gram for a purchase amount of 1 kg. Discussion. The results of the present study demonstrate that the sale of methiopropamine has the potential to reach users across the world. It also appears to support that snapshot studies could be used for toxicovigilance across different countries, by studying the Internet market of novel psychoactive substances. Conclusion. To date, snapshot studies, used to monitor the Internet novel psychoactive substances market, have only been undertaken in Europe. We have shown that the flexibility of this methodology enables comparison of the online activity of drug sellers between different countries and continents and that, at least for methiopropamine, the UK is the predominant source for Internet supply. Keywords
Toxicovigilance; NPS market; Internet; Legal high; Recreational drug; methiopropamine
Introduction
a study methodology known as ‘Internet snapshot surveys’ to standardise the monitoring Internet sites reporting to sell NPS.1 This methodology has been used previously to describe a change in the availability and price of alphamethyltryptamine (AMT) over a six months period in the UK.4 To date, these Internet snapshot surveys have focused on and collected data from within Europe only. Methiopropamine (MPA) (1-(thiophen-2-yl)-2methylaminopropane) is a thiophene ring-based structural analogue of methamphetamine.7 Methiopropamine availability as a recreational drug was first reported in a drug seizure in Finland in January 20113 and users’ reports began to appear on Internet discussion fora during 2011.8 There is no data available on the epidemiology of use of methiopropamine, however, its use has been confirmed by detection in analysis of pooled anonymous urine samples from street urinals in London, UK.9 The aim of this study was to use the EMCDDA Internet snapshot survey methodology to understand the availability and price of methiopropamine in three different countries: the UK, France and Canada. In addition, it was undertaken
With the increased use of novel psychoactive substances (NPS), there is an increasing availability of these substances from Internet-based suppliers.1–6 These NPS are also known by many professionals and users as ‘legal highs’, which are unregulated substances that produce similar psychoactive reactions to the ones caused by illegal drugs. This phenomenon is also known as the NPS market. Monitoring Internet suppliers, the change in their existence and the drugs that they supply over time, can improve the understanding of the availability of NPS. The European Monitoring Centre for Drugs and Drug Addition (EMCDDA) has developed
Received 2 January 2014; accepted 6 June 2014. Address correspondence to Anne-Ericka Vermette-Marcotte, Emergency Medicine FRCP, Post-Graduate Year V, McGill Emergency Medicine Residency Program, Royal Victoria Hospital, McGill University, 687 Pine Avenue West, A4.62, Montreal, QC H3A 1ª1, Canada. Tel: ⫹ 514-934-1934, Ext. 36974. Fax: ⫹ 514-843-2875. E-mail: [email protected]
678
Study of the availability of methiopropamine on Internet 679 in English (the UK and Canada) and in French (France and Canada).
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
Materials and methods Using the EMCDDA methodology,1,10 an Internet snapshot survey for the availability of methiopropamine was undertaken in June 2013. The Internet search engines ‘google. ca’ and ‘google.co.uk’ were searched in English using the search term ‘buy methiopropamine’ and the Internet search engines ‘google.ca’ and ‘google.fr’ were searched in French using the search term ‘acheter methiopropamine’. The first 100 Internet sites identified, as per EMCDDA methodology, were reviewed in full to understand their content and afterwards, sampling was undertaken to exhaustion, until 20 successive irrelevant Internet links were identified. Data were extracted from each relevant website reviewed on the purchase quantities of methiopropamine sold and their respective costs. The cost of methiopropamine was converted into cost per gram to allow comparison across different purchase quantities. Information on potential identifiers of the country of origin of the website’s suppliers were also collected. Those identifiers were the country of origin mentioned directly on the site and address or phone number given as a contact on the site or through a link.
Results Internet sites selling methiopropamine A total of 62 sites selling methiopropamine were identified. Searching in English on ‘google.co.uk’ identified 56 sites, searching in French on ‘google.fr’ identified 9 sites, searching in English on ‘google.ca’ identified 44 sites and searching in French on ‘google.ca’ identified 9 sites. Among these 62 sites, some were common to more than one searching engine. From the 56 sites identified
by searching on ‘google.co.uk’, 41 (73.2%) of these were found when searching in English on ‘google.ca’ and 6 (10.7%) when searching both ‘google.fr’ and ‘google.ca’ in French; three of these six sites were also common to the ‘google.ca’ English search. A total of nine sites were identified from searching on ‘google.fr’; searching ‘google.ca’ in French also identified all of these. Supplier’s country of origin The majority of the Internet suppliers appeared to originate from/be located in the UK (28; 45%) followed by other European countries (2; 3%) (Fig. 1). Only one (1; 1.6%) supplier appeared to originate from/be located in the USA and one (1; 1.6%) from/be located in China. It was not possible to determine the country that the Internet supplier was located in almost half of sites identified (30; 48%). Methiopropamine prices Methiopropamine was available on Internet sites in powder only, in amounts of 150 mg up to 4 kg. Analysis of the price per gram for different quantities was only undertaken for amounts from 500 mg to 1kg, as very few sites sold in amounts at the extremes. Prices on the Internet sites were quoted in GB pound sterling (£), Euro (€) and/or US Dollar (US $); for comparison all prices were converted into GBP using the official website of the European Union.11 The cost per gram decreased with increasing purchase quantity in all four Internet snapshot surveys undertaken, from 19.49 ⫾ 0.15 GBP per gram (22.78 ⫾ 0.18 Euro; 29.48 ⫾ 0.23 US Dollar; 30.60 ⫾ 0.24 Canadian Dollar) for a purchase amount of 500 mg to 3.54 ⫾ 0.13 GBP per gram (4.14 ⫾ 0.15 Euro; 5.35 ⫾ 0.20 US Dollar; 5.56 ⫾ 0.20 Canadian Dollar) for a purchase amount of 1 kg (Fig. 2). There appeared to be no difference in
Fig. 1. Country of origin for Internet suppliers of methiopropamine identified. Copyright © Informa Healthcare USA, Inc. 2014
680 A.-E. Vermette-Marcotte et al. 25
500 mg 10 g 100 g 1 kg
Mean of prices (GBP/g of MPA)
20
15
10
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
5
0
google.co.uk
google.fr
google.ca (eng)
google.ca (fr)
Fig. 2. Mean of prices for different amount of methiopropamine sold. GBP, pound sterling; MPA, methiopropamine.
costs either in terms of Internet sellers identified from the different country Internet search engines or when different languages were used.
Discussion Internet snapshot surveys are a relatively recent study methodology to monitor the availability and price of NPS. It has the advantage that it is a flexible study methodology, which can easily be adapted as the NPS market changes. By conducting four Internet snapshot surveys in different countries and languages, using a consistent methodology,1 we were able to demonstrate that the sale of the NPS methiopropamine has the potential to reach users across the world and that methioprompamine is being marketed in non-English language. The prices of methiopropamine were comparable between suppliers, no matter which search engine or language was used. Similar to the trend seen for other NPS,2,4 significant price reductions were noted for purchasing methiopropamine in ‘bulk’ quantities. User discussion fora suggest that the typical ‘recreational dose’ of methiopropamine is 5–60 mg but that as much as 300 mg could be ingested over several hours in a single recreational use episode.12 Therefore, it seems reasonable to speculate that purchase amounts in excess of a few grams are unlikely to be for individual recreational use purposes and more likely to represent ‘bulk’ purchases either for dealing or smaller group distribution amongst friends. For all the searching engines used and in both languages, the availability of methiopropamine from Internet-based suppliers seems to come from the same sources. More than half of the suppliers appear to be in the UK, regardless of the search engine used. Only one appeared to be in the USA, compared to previous findings in which the USA appeared to be the most prevalent online suppliers country of origin for different ‘legal highs’ sold in European countries.10 It is
worth noting that the single American supplier found in the present study was identified only through the google.co.uk Internet search engine search. Methiopropamine is not actually regulated by law in any of the studied countries. However, its status is currently being questioned in the UK. Therefore, British, French and Canadian consumers at the time of the study can legally buy methiopropamine from a range of Internet suppliers. Our study shows that Internet snapshot studies have the potential to be used for toxicovigilance across different countries through the identification and monitoring of the Internet market for NPS. It was suggested in the 2013 World Drug Report that the UK is Europe’s largest market for NPS.13 The results of this study support that UK seems to be also a large supplier for emerging NPS. Furthermore, we have shown, similar to previous studies, that the google.co.uk search engine is likely to be an Internet search engine of choice for users looking to purchase NPS,14 and therefore this Internet search engine could be used as an initial screening tool for toxicovigilance. Future studies should also explore the impact of drug legislation on drug availability on the Internet: some authors have proposed a ‘balloon effect’ whereby the suppression of a product by drug legislation could move the drug business to other geographical locations or products.15 Clinicians caring for patients using NPS should remain vigilant that new substances are continually appearing on the market and that their clinical effects are neither clearly known nor described in the medical or ‘grey’ literature. Considering the absence of official quality control in the manufacture of these products, clinicians are encouraged to analyse biological specimens when patients present with acute toxicity suspected to be related to the use of NPS. This will provide greater understanding of the true spectrum of toxicity of an individual NPS. There are limitations with using the Internet snapshot survey methodology. The surveys were conducted on different calendar days (google.co.uk: June 11th 2013, google.fr: June 18th 2013, google.ca [English]: June 16th 2013, google. ca [French]: June 18th 2013). The NPS market is a rapidly evolving phenomenon, and therefore has the potential to change in a very short period of time. However, we feel that the time between the first and last Internet survey undertaken in our study is unlikely to be of major significance; in particular during this time frame, there was no specific media interest or legislative change in methiopropamine or any other NPS that may have driven a change in the NPS market. The survey results relates only to reported methiopropamine for sale. It is possible that the products were not available for actual sale had we attempted to purchase them, and there is no confirmation that the actual products being marketed/sold actually contain methiopropamine. Results regarding the country of origin of online suppliers might also suffer from bias. As explained in previous studies, ‘in cyberspace, with its lack of geographical boundaries, it is not difficult for sites to present as originating from a particular country while operating from another. In addition, review of available indicators, such as contact information, country code domain, currency and shipping information, can point Clinical Toxicology vol. 52 no. 7 2014
Study of the availability of methiopropamine on Internet 681
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
to more than one country’.10 The country of origin of our current studies online suppliers was deducted by an assessment of all parameters available online but it is possible they are not accurate. The fact that searching engines from three specific countries were studied also adds potential bias for the countries of origin of online suppliers. Another limitation is the use of a single Internet search engine, for three countries and in two languages only. Therefore, we cannot generalise the present data to all countries worldwide. Replication of our study to multiple countries with multiple search engines would provide more information but require additional resources. As this study methodology evolves, there needs to be greater agreement on the search methodologies, to enable ease of future comparison between different studies and/or research centres.
3.
4.
5.
6.
7.
Conclusion The use of NPS is an international phenomenon that is continually evolving.13 To date, snapshot studies used to monitor the Internet NPS market have only been undertaken in Europe. We have shown that the flexibility of this methodology enables comparison of the online activity of drug sellers between different countries and continents and that, at least for methiopropamine, the UK seems to be the predominant source for Internet supply.
8.
9.
10.
11.
Declaration of interest The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Hillebrand J, Olszewski D, Sedefov R. Legal highs on the Internet. Subst Use Misuse 2010; 45:330–340. 2. European Monitoring Centre for Drugs and Drug Addiction. Risk Assessment. Report on the risk assessment of mephedrone in the
Copyright © Informa Healthcare USA, Inc. 2014
12.
13.
14.
15.
framework of the Council Decision on new psychoactive substances. 2011 [cited 2013 December]. Available from:http://www.emcdda. europa.eu/attachements.cfm/att_116646_EN_TDAK11001ENC_ WEB-OPTIMISED FILE.pdf. European Monitoring Centre for Drugs and Drug Addiction. Annual Report 2012: The State of the Drugs Problem in Europe. 2012 [cited 2013 December]. Available from: http://www.emcdda.europa.eu/ attachements.cfm/att_190854_EN_TDAC12001ENC_.pdf. Wood DM, Dargan PI. Using Internet snapshot surveys to enhance our understanding of the availability of the novel psychoactive substance alpha-methyltryptamine (AMT). Subst Use Misuse 2013; 49:7–12. Dargan PI, Wood DM. Novel and emerging recreational drugs: routes of supply and the role of the Internet. Clin Toxicol (Phila) 2011; 49:199–200. Dargan PI, Albert S, Wood DM. Mephedrone use and associated adverse effects in school and college/university students before the UK legislation change. QJM 2010; 103:875–879. Blicke FF, Burckhalter JH. α-Thienylaminoalkanes. J Am Chem Soc 1942; 64:477–480. Erowid. Methiopropamine Reports The Vaults of Erowid2011–2013 [cited 2013 December]. Available from: http://www.erowid.org/ experiences/subs/exp_Methiopropamine.shtml. Archer JR, Dargan PI, Hudson S, Wood DM. Analysis of anonymous pooled urine from portable urinals in central London confirms the significant use of novel psychoactive substances. QJM 2013; 106:147–152. European Monitoring Centre for Drugs and Drug Addiction. Briefing Paper. Online sales of new psychoactive substances/‘legal highs’: summary of results from the 2011 multilingual snapshots. 2011 [cited 2013 December]. Available from: http://www. emcdda.europa.eu/attachements.cfm/att_143801_EN_Snapshot Summary.pdf. European Commission. Financial Programming and Budget. Currency Converter [cited 2013 June]. Available from: http://ec.europa.eu/ budget/contracts_grants/info_contracts/inforeuro/inforeuro_en.cfm. Erowid. Methiopropamine Dose The Vaults of Erowid2011 [cited 2013 December]. Available from: http://www.erowid.org/chemicals/ methiopropamine/methiopropamine_dose.shtml. United Nations Office on Drugs and Crime. World Drug Report 2013 2013 [cited 2013 December]. Available from: http://www.unodc.org/ unodc/secured/wdr/wdr2013/World_Drug_Report_2013.pdf. Forsyth AJ. Virtually a drug scare: mephedrone and the impact of the internet on drug news transmission. Int J Drug Policy 2012; 23:198–209. Bagley BM. Colombia and the war on drugs. Foreign Affairs 1988; 67.
BRIEF COMMUNICATION
An Internet snapshot study to compare the international availability of the novel psychoactive substance methiopropamine
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
A.-E. VERMETTE-MARCOTTE,1 P. I. DARGAN,2,3 J. R. H. ARCHER,2 S. GOSSELIN,1 and D. M. WOOD2,3 1Emergency
Department & Medical Toxicology Consultation Service, McGill University Health Centre, Montréal, Québec, Canada Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK 3King’s College London, London, UK 2Clinical
Context. With the increased use of novel psychoactive substances, there is an increasing availability of these substances from Internet-based suppliers. Methiopropamine, first reported in 2011, is a recreational drug available over the Internet. The aim of this study was to investigate availability and cost of methiopropamine in three different countries: the UK, France, and Canada. Methods. Using the European Monitoring Centre for Drugs and Drug Addiction Internet snapshot methodology, this study, conducted in June 2013, was undertaken in two different languages: in English (the UK and Canada) and in French (France and Canada), using three Internet searching engines: “google.co.uk”, “google.fr” and “google.ca”. Results. A total of 62 sites were found, most of them were found from the English searches. 45% of the suppliers seemed to originate from the UK. The prices of methiopropamine were comparable between suppliers, no matter which search engine or language was used. The cost of a unit of methiopropamine was inversely related to the purchased quantity, going from 19.49 ⫾ 0.15 GBP per gram for a purchase amount of 500 mg to 3.54 ⫾ 0.13 GBP per gram for a purchase amount of 1 kg. Discussion. The results of the present study demonstrate that the sale of methiopropamine has the potential to reach users across the world. It also appears to support that snapshot studies could be used for toxicovigilance across different countries, by studying the Internet market of novel psychoactive substances. Conclusion. To date, snapshot studies, used to monitor the Internet novel psychoactive substances market, have only been undertaken in Europe. We have shown that the flexibility of this methodology enables comparison of the online activity of drug sellers between different countries and continents and that, at least for methiopropamine, the UK is the predominant source for Internet supply. Keywords
Toxicovigilance; NPS market; Internet; Legal high; Recreational drug; methiopropamine
Introduction
a study methodology known as ‘Internet snapshot surveys’ to standardise the monitoring Internet sites reporting to sell NPS.1 This methodology has been used previously to describe a change in the availability and price of alphamethyltryptamine (AMT) over a six months period in the UK.4 To date, these Internet snapshot surveys have focused on and collected data from within Europe only. Methiopropamine (MPA) (1-(thiophen-2-yl)-2methylaminopropane) is a thiophene ring-based structural analogue of methamphetamine.7 Methiopropamine availability as a recreational drug was first reported in a drug seizure in Finland in January 20113 and users’ reports began to appear on Internet discussion fora during 2011.8 There is no data available on the epidemiology of use of methiopropamine, however, its use has been confirmed by detection in analysis of pooled anonymous urine samples from street urinals in London, UK.9 The aim of this study was to use the EMCDDA Internet snapshot survey methodology to understand the availability and price of methiopropamine in three different countries: the UK, France and Canada. In addition, it was undertaken
With the increased use of novel psychoactive substances (NPS), there is an increasing availability of these substances from Internet-based suppliers.1–6 These NPS are also known by many professionals and users as ‘legal highs’, which are unregulated substances that produce similar psychoactive reactions to the ones caused by illegal drugs. This phenomenon is also known as the NPS market. Monitoring Internet suppliers, the change in their existence and the drugs that they supply over time, can improve the understanding of the availability of NPS. The European Monitoring Centre for Drugs and Drug Addition (EMCDDA) has developed
Received 2 January 2014; accepted 6 June 2014. Address correspondence to Anne-Ericka Vermette-Marcotte, Emergency Medicine FRCP, Post-Graduate Year V, McGill Emergency Medicine Residency Program, Royal Victoria Hospital, McGill University, 687 Pine Avenue West, A4.62, Montreal, QC H3A 1ª1, Canada. Tel: ⫹ 514-934-1934, Ext. 36974. Fax: ⫹ 514-843-2875. E-mail: [email protected]
678
Study of the availability of methiopropamine on Internet 679 in English (the UK and Canada) and in French (France and Canada).
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
Materials and methods Using the EMCDDA methodology,1,10 an Internet snapshot survey for the availability of methiopropamine was undertaken in June 2013. The Internet search engines ‘google. ca’ and ‘google.co.uk’ were searched in English using the search term ‘buy methiopropamine’ and the Internet search engines ‘google.ca’ and ‘google.fr’ were searched in French using the search term ‘acheter methiopropamine’. The first 100 Internet sites identified, as per EMCDDA methodology, were reviewed in full to understand their content and afterwards, sampling was undertaken to exhaustion, until 20 successive irrelevant Internet links were identified. Data were extracted from each relevant website reviewed on the purchase quantities of methiopropamine sold and their respective costs. The cost of methiopropamine was converted into cost per gram to allow comparison across different purchase quantities. Information on potential identifiers of the country of origin of the website’s suppliers were also collected. Those identifiers were the country of origin mentioned directly on the site and address or phone number given as a contact on the site or through a link.
Results Internet sites selling methiopropamine A total of 62 sites selling methiopropamine were identified. Searching in English on ‘google.co.uk’ identified 56 sites, searching in French on ‘google.fr’ identified 9 sites, searching in English on ‘google.ca’ identified 44 sites and searching in French on ‘google.ca’ identified 9 sites. Among these 62 sites, some were common to more than one searching engine. From the 56 sites identified
by searching on ‘google.co.uk’, 41 (73.2%) of these were found when searching in English on ‘google.ca’ and 6 (10.7%) when searching both ‘google.fr’ and ‘google.ca’ in French; three of these six sites were also common to the ‘google.ca’ English search. A total of nine sites were identified from searching on ‘google.fr’; searching ‘google.ca’ in French also identified all of these. Supplier’s country of origin The majority of the Internet suppliers appeared to originate from/be located in the UK (28; 45%) followed by other European countries (2; 3%) (Fig. 1). Only one (1; 1.6%) supplier appeared to originate from/be located in the USA and one (1; 1.6%) from/be located in China. It was not possible to determine the country that the Internet supplier was located in almost half of sites identified (30; 48%). Methiopropamine prices Methiopropamine was available on Internet sites in powder only, in amounts of 150 mg up to 4 kg. Analysis of the price per gram for different quantities was only undertaken for amounts from 500 mg to 1kg, as very few sites sold in amounts at the extremes. Prices on the Internet sites were quoted in GB pound sterling (£), Euro (€) and/or US Dollar (US $); for comparison all prices were converted into GBP using the official website of the European Union.11 The cost per gram decreased with increasing purchase quantity in all four Internet snapshot surveys undertaken, from 19.49 ⫾ 0.15 GBP per gram (22.78 ⫾ 0.18 Euro; 29.48 ⫾ 0.23 US Dollar; 30.60 ⫾ 0.24 Canadian Dollar) for a purchase amount of 500 mg to 3.54 ⫾ 0.13 GBP per gram (4.14 ⫾ 0.15 Euro; 5.35 ⫾ 0.20 US Dollar; 5.56 ⫾ 0.20 Canadian Dollar) for a purchase amount of 1 kg (Fig. 2). There appeared to be no difference in
Fig. 1. Country of origin for Internet suppliers of methiopropamine identified. Copyright © Informa Healthcare USA, Inc. 2014
680 A.-E. Vermette-Marcotte et al. 25
500 mg 10 g 100 g 1 kg
Mean of prices (GBP/g of MPA)
20
15
10
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
5
0
google.co.uk
google.fr
google.ca (eng)
google.ca (fr)
Fig. 2. Mean of prices for different amount of methiopropamine sold. GBP, pound sterling; MPA, methiopropamine.
costs either in terms of Internet sellers identified from the different country Internet search engines or when different languages were used.
Discussion Internet snapshot surveys are a relatively recent study methodology to monitor the availability and price of NPS. It has the advantage that it is a flexible study methodology, which can easily be adapted as the NPS market changes. By conducting four Internet snapshot surveys in different countries and languages, using a consistent methodology,1 we were able to demonstrate that the sale of the NPS methiopropamine has the potential to reach users across the world and that methioprompamine is being marketed in non-English language. The prices of methiopropamine were comparable between suppliers, no matter which search engine or language was used. Similar to the trend seen for other NPS,2,4 significant price reductions were noted for purchasing methiopropamine in ‘bulk’ quantities. User discussion fora suggest that the typical ‘recreational dose’ of methiopropamine is 5–60 mg but that as much as 300 mg could be ingested over several hours in a single recreational use episode.12 Therefore, it seems reasonable to speculate that purchase amounts in excess of a few grams are unlikely to be for individual recreational use purposes and more likely to represent ‘bulk’ purchases either for dealing or smaller group distribution amongst friends. For all the searching engines used and in both languages, the availability of methiopropamine from Internet-based suppliers seems to come from the same sources. More than half of the suppliers appear to be in the UK, regardless of the search engine used. Only one appeared to be in the USA, compared to previous findings in which the USA appeared to be the most prevalent online suppliers country of origin for different ‘legal highs’ sold in European countries.10 It is
worth noting that the single American supplier found in the present study was identified only through the google.co.uk Internet search engine search. Methiopropamine is not actually regulated by law in any of the studied countries. However, its status is currently being questioned in the UK. Therefore, British, French and Canadian consumers at the time of the study can legally buy methiopropamine from a range of Internet suppliers. Our study shows that Internet snapshot studies have the potential to be used for toxicovigilance across different countries through the identification and monitoring of the Internet market for NPS. It was suggested in the 2013 World Drug Report that the UK is Europe’s largest market for NPS.13 The results of this study support that UK seems to be also a large supplier for emerging NPS. Furthermore, we have shown, similar to previous studies, that the google.co.uk search engine is likely to be an Internet search engine of choice for users looking to purchase NPS,14 and therefore this Internet search engine could be used as an initial screening tool for toxicovigilance. Future studies should also explore the impact of drug legislation on drug availability on the Internet: some authors have proposed a ‘balloon effect’ whereby the suppression of a product by drug legislation could move the drug business to other geographical locations or products.15 Clinicians caring for patients using NPS should remain vigilant that new substances are continually appearing on the market and that their clinical effects are neither clearly known nor described in the medical or ‘grey’ literature. Considering the absence of official quality control in the manufacture of these products, clinicians are encouraged to analyse biological specimens when patients present with acute toxicity suspected to be related to the use of NPS. This will provide greater understanding of the true spectrum of toxicity of an individual NPS. There are limitations with using the Internet snapshot survey methodology. The surveys were conducted on different calendar days (google.co.uk: June 11th 2013, google.fr: June 18th 2013, google.ca [English]: June 16th 2013, google. ca [French]: June 18th 2013). The NPS market is a rapidly evolving phenomenon, and therefore has the potential to change in a very short period of time. However, we feel that the time between the first and last Internet survey undertaken in our study is unlikely to be of major significance; in particular during this time frame, there was no specific media interest or legislative change in methiopropamine or any other NPS that may have driven a change in the NPS market. The survey results relates only to reported methiopropamine for sale. It is possible that the products were not available for actual sale had we attempted to purchase them, and there is no confirmation that the actual products being marketed/sold actually contain methiopropamine. Results regarding the country of origin of online suppliers might also suffer from bias. As explained in previous studies, ‘in cyberspace, with its lack of geographical boundaries, it is not difficult for sites to present as originating from a particular country while operating from another. In addition, review of available indicators, such as contact information, country code domain, currency and shipping information, can point Clinical Toxicology vol. 52 no. 7 2014
Study of the availability of methiopropamine on Internet 681
Clinical Toxicology Downloaded from informahealthcare.com by University of Toronto on 08/11/14 For personal use only.
to more than one country’.10 The country of origin of our current studies online suppliers was deducted by an assessment of all parameters available online but it is possible they are not accurate. The fact that searching engines from three specific countries were studied also adds potential bias for the countries of origin of online suppliers. Another limitation is the use of a single Internet search engine, for three countries and in two languages only. Therefore, we cannot generalise the present data to all countries worldwide. Replication of our study to multiple countries with multiple search engines would provide more information but require additional resources. As this study methodology evolves, there needs to be greater agreement on the search methodologies, to enable ease of future comparison between different studies and/or research centres.
3.
4.
5.
6.
7.
Conclusion The use of NPS is an international phenomenon that is continually evolving.13 To date, snapshot studies used to monitor the Internet NPS market have only been undertaken in Europe. We have shown that the flexibility of this methodology enables comparison of the online activity of drug sellers between different countries and continents and that, at least for methiopropamine, the UK seems to be the predominant source for Internet supply.
8.
9.
10.
11.
Declaration of interest The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Hillebrand J, Olszewski D, Sedefov R. Legal highs on the Internet. Subst Use Misuse 2010; 45:330–340. 2. European Monitoring Centre for Drugs and Drug Addiction. Risk Assessment. Report on the risk assessment of mephedrone in the
Copyright © Informa Healthcare USA, Inc. 2014
12.
13.
14.
15.
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