In the last few years, hundreds of new, synthetic recreational "designer drugs" have come onto the market - the legal market - and nobody really knows very much about them.

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Pretty pills...but do you know what is in them?

They come in kid-friendly packets with kid-friendly names, like "Scooby Doo," and are available online, in "head" shops and even in gas stations and convenience stores. They are cheap, legal and they can be deadly.

Also known as "club drugs," MDAT, Eric 3, dimethocaine, bath salts, new psychoactive substances (NPS), 5-IAI and silver bullet are analogs of established illegal drugs.

They are designed to produce the same effects as cocaine, ecstasy and the like, but their chemical structure is sufficiently changed to evade prohibition under the Controlled Substances Act.

Like the drugs that they mimic, so-called legal highs can be classified as depressants, stimulants or hallucinogens.

A dangerous game

Since they are untested and cannot be approved as safe, the new drugs are marketed as bath salts, research chemicals or plant food, and they carry labels like "not for human consumption" or "for novelty use only."

Not being sold for human consumption means they have not been tested for that purpose. Their effects are unknown, and the manufacturers can change the contents without warning.

What is in that bright little packet, and what it will do to you, is a mystery.

It may contain substances that are, in fact, illegal.

Or, it may just be downright dangerous.

Even a list of the chemical ingredients on the package does not guarantee that those are the contents, as forensic testing has shown. What you see may not be what you get, and what you get may be more than you bargained for.

Powders, pills and crystals

The drugs usually come as powders, pills or capsules, ranging in color from white to brown to yellow, and from flour-like powder to crystals in texture. Pills and capsules come in a range of shapes, sizes and colors, sometimes stamped with cute little pictures.

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Legal highs often come as powders or pills.

Synthetic cannabinoids, such as "K2" and "spice," consist of an unspecified mixture of plant matter sprayed with chemical grade synthetic cannabinoids. The chemicals can be in powder form or dissolved in solvents, such as acetone. It is often marketed as "herbal incense."

Synthetic cathinones, known on the street as "salts" or "bath salts," are stimulants, related to amphetamine or "speed." Products such as "Molly" (short for molecule), replicate methylenedioxymethamphetamine (MDMA) or ecstasy. They often consist of methylenedioxypyrovalerone (MDPV), mephedrone and methylone.

Synthetic opioids, such as fentanyl, are particularly dangerous. Used as a strong pain killer for cancer patients, fentanyl and its relatives have been implicated in a number of drug deaths in the US.

Street names for synthetic opioids include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, Tango and Cash. Fentanyl can originate from legal prescriptions, but street fentanyl may be an illegal copycat with altered chemical structure and properties. You cannot be sure what you will get.

Just shop online: discount available

Synthetic drugs are easily and openly available on the Internet, complete with coupons, vouchers, discount codes and clearance sales.

"Simon the Sorcerer," creator of the website, Simon's Legal Highs, gives this advice:

"When you hear the word 'drug,' 'highs' [or] 'narcotics,' you think of something illegal, although it should not necessarily be the case. There are plenty of legal drugs out there. Just take a look at this list of the best legal drugs to change your mind. Many of them are easily available in your grocery store, online or you can pick them yourself if it's the right season."

Simon is careful to caution: "Warning: I do not advocate consumption of legal highs. They can have adverse side effects and if you are allergic, or if you overdose, you might even die."

Or, as teen advice site, Vice, puts it: "Remember: if you smoke synthetic cannabis, and your blood turns into sulfuric acid, and your organs melt, the company isn't responsible. It said right on the package that it wasn't for human consumption!"

Simon's site includes a handy blacklist of outlets selling fake drugs that have no effect.

Effects: from out-of-body experience to coma

A 26-year old mother, Lucy Simms, died in 2013 after taking "Benzo Fury," also known as ABP. The packet, labelled "chemical research pellets," was purchased on the Internet.

Fast facts about illicit drugs
  • In 2015, 48.9% of 12th graders had used illicit drugs at some time in their lives
  • From 2001-2014, the US saw a 2.8-fold rise in overdose-related deaths
  • From 2000-2014, nearly half a million Americans died from a drug overdose.

Learn more about addiction

In the journal Lucy kept of her experiments with different drugs, she noted, "My heart is going to attack." Days after she died of high blood pressure, raised heart rate and hyperthermia, the drug was banned in the UK. She did it "for the buzz."

In 2015, the mother of Owain Vaughan, aged 14 years, was called to the Emergency Room where she found her son having fits, with low blood pressure, vomiting violently, his elbow fractured and burst blood vessels in his face.

He had taken something his friends gave him. He "thought it would be safe because it was legal and [...] he'd never taken drugs before."

People use psychoactive drugs, "legal" or illegal, for the stimulant, sedative or hallucinogenic effects. In some cases, they hope to find an "out-of-body experience."

Since there is no way of knowing what a "new drug" contains, snorting, smoking or swallowing one is a risky business.

Unknown elements exacerbate risk

Legal highs, like their illegal counterparts, have been linked to poisoning, organ failure, mental health problems, long- or short-term cardiovascular issues, nervous and immune system disorders and sometimes death. They can be just as addictive and less predictable, with a high risk of overdose or a "bad trip."

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Injecting unknown substances intensifies the danger.

Synthetic cannabinoids can cause severe agitation and anxiety, racing heartbeat and high blood pressure, intense hallucinations, psychotic episodes and sometimes death.

They have been associated with thousands of poisonings throughout the US, as previously reported by Medical News Today.

Synthetic cathinones, like "Molly," can cause powerful reactions and violent behavior, nausea, vomiting, paranoia, hallucinations, delusions, suicidal thoughts, seizures, chest pains, high blood pressure and heart rate and death from overdose.

Synthetic opioids, such as fentanyl, reduce pain and induce euphoria, relaxation and sleepiness, but they also suppress and even stop breathing. Fentanyl is often stronger than heroin, and mixing the two can multiply the effect, increasing the risk of overdose.

US law enforcement agencies have linked a spike in overdose deaths with the increased availability of fentanyl.

As MNT recently reported, fentanyl is highly addictive. A dose that works one day may not be sufficient even a few days later.

Legal highs are mostly swallowed or snorted, but some people inject them, adding to the dangers. Combining them with other drugs or alcohol can exacerbate the effects.

Joseph J. Palamar, PhD, assistant professor in the Section on Tobacco, Alcohol, and Drug Use in the Department of Population Health at New York University, Langone Medical Center, has carried out extensive research into illicit drug use and, more recently, new psychoactive substances. MNT asked him what he thinks is the main danger of legal highs.

He told us:

"'Legal highs' is a bit of a misnomer because most of these drugs are in fact illegal.  For all illegal drugs, I'd say the biggest risk is arrest, because arrest and incarceration can ruin your life, oftentimes much worse than an adverse health outcome. Other than risk of arrest, I think the biggest risk associated with novel drugs is taking them unknowingly. All too often people think they're using a drug such as ecstasy, and it winds up being something much more dangerous."

Why do people use legal highs?

People use recreational drugs for the "buzz" or because they are already addicted. Legal highs have the added attraction of supposedly being legal.

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People use recreational drugs "for the buzz."

As the Vice website says, "For many people, especially very young people, legal highs are the easiest way to pleasantly scramble your brain the weekend after midterms."

The National Institute on Drug Abuse (NIDA) estimate that in the year previous to 2015, 5.2% of 12th graders had used synthetic marijuanas (K2 or spice) and 1% had used "bath salts."

MNT asked Palamar why people are using these drugs.

He explained that most people do not want to use the drugs, but they resort to, say, K2 or spice, because marijuana is illegal and could lead to arrest. He added that they may use them to pass drug tests.

An example of this would be someone who is on probation.

However, he added:

"Most other novel drugs are used unintentionally, as they are commonly sold as more traditional and desired drugs such as ecstasy and LSD. For example, we've been finding 'bath salts' in the hair of people in my study who say they only use ecstasy. These people are actually taking 'bath salts' and thinking it is ecstasy or MDMA."

When we asked Palamar what is currently the most dangerous drug in the US, he said: "I think most drug users and drug researchers would agree that NBOMe (pronounced "N-bomb") is the most dangerous new drug going around. Many people take it thinking it is LSD and wind up experiencing severe adverse effects because it is really easy to take too much."

Legal highs are clearly undesirable, but what can - or does - the law do?

What does the law say?

Legislation is difficult, since the drugs exist precisely to evade the law. Drug laws tend to ban substances by their chemical content, and a number of US states have banned certain substances.

But as fast they are banned, illegal chemists modify the structures to create newer ones that are not covered by the ban.

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Drugs become illegal, but new ones are created to avoid the ban.

For example, in 2012, the Controlled Substances Act (CSA) of 1970 was amended to place several types of synthetic cannabis into Schedule I, the most restrictive regulatory category, which covers drugs like heroin and LSD.

Between then and 2014, the Drug Enforcement Agency (DEA) had to exercise emergency scheduling powers five times to do the same for 25 additional synthetic cannabinoids.

In the UK, a blanket ban will come into force from April 6th this year on "any substance intended for human consumption that is capable of producing a psychoactive effect," with a 7-year jail sentence for anyone producing or supplying them. Critics say the definition of psychoactive substances is too broad.

Similar bans are in force in some US states. In 2014, stores in Indiana faced a 1-year loss of their retail business certificates plus the cost of laboratory testing if found selling the substances.

Previous research by Palamar's team has indicated that if marijuana is legalized, some people who did not intend to use it before would become at risk of starting.

On the other hand, he told MNT recently that the people who would use marijuana if it was legalized may be the same people who would have used them later, anyway.

He told us:

"Most novel drugs wouldn't exist today if the traditional drugs people wanted were legal and regulated.  Very few people would be using dangerous spice drugs if they were free to use the marijuana they desire. Every time we ban a novel drug, a new one pops up to take its place, so I doubt these drugs will ever go away. If we want to destroy the market for novel drugs, the traditional drugs they're replacing would need to be legally available."

There is no easy answer.

Synthetic drugs are an ongoing hazard, and law enforcement agencies predict that abuse of them is likely to increase as long as the producers are able to change one or two substances to create new compounds.

Commenting on efforts to tackle the challenges posed by these substances, a document issued by The Office of National Drug Control Policy for the White House says:

"The Administration has been working with Federal, Congressional, state, local, and non-governmental partners to put policies and legislation in place to combat this threat, and to educate people about the tremendous health risk posed by these substances."