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‘Legal highs’ – what's in a name?

  • John Lally (a1)
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This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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1 Di Forti, M, Marconi, A, Carra, E, Fraietta, S, Trotta, A, Bonomo, M, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case–control study. Lancet Psychiatry 2015; 2: 233–8.
2 Papanti, D, Schifano, F, Botteon, G, Bertossi, F, Mannix, J, Vidoni, D, et al. ‘Spiceophrenia’: a systematic overview of ‘spice’-related psychopathological issues and a case report. Hum Psychopharmacol 2013; 28: 379–89.
3 Baumeister, D, Tojo, LM, Tracy, DK. Legal highs: staying on top of the flood of novel psychoactive substances. Ther Adv Psychopharmacol 2015; doi: 10.1177/2045125314559539.
4 Bowden-Jones, O. ‘Legal highs’ and other ‘club drugs’: why the song and dance? Psychiatrist 2013; 37: 185–7.
5 Meacher, BMC. Drug policy reform – the opportunity presented by ‘legal highs’. Psychiatrist 2013; 37: 249–52.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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‘Legal highs’ – what's in a name?

  • John Lally (a1)
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Legal Highs, NPS, Head Shop Drugs? Whatever you call them, we need to know more about prevalence.

Andrew P Moore, Consultant Psychiatrist, Devon Partnership Trust
Elly Lesser, General Practice Trainee (GPST2), Devon Partnership Trust
01 October 2015

In his letter (1) John Lally rightly highlights the on-going issue of limited information on the important clinical topic of NPS (aka Legal Highs, Head Shop Drugs) use in mental health patients, highlighting his prevalence study (2) in community mental health services, which remains, to our knowledge, the only one of its kind. This knowledge gap chimes with the College Addictions Faculty Report on Novel Psychoactive Substances (3) pointing out that currently, mental health services in the UK have no system-wide method to record psychological harm related to club drugs and NPS.

In an effort to estimate local NPS prevalence rates in patients presenting to acute mental health services in North Devon we undertook a small retrospective survey of 100 consecutive acute psychiatric presentations (50 Crisis Team, 50 inpatient admissions) in January-February 2015. Electronic patient clinical records allowed easy identification of cases with disclosed and documented use of legal highs in the immediate period leading up to acute Crisis Team contact or inpatient admission.

Overall prevalence in our survey of acute presentations was 8%, which is a little lower than the 13% described by Lally in his community sample. Prevalence was higher in the inpatient admissions (12%) than the Crisis Teams (4%). In Lally’s study he found, by asking the individuals themselves, that 54% of his community patients reported that the substance taken had an adverse effect on their mental state (mainly psychosis). In our acute setting, the supervising Consultant Psychiatrists felt that in the majority (7/8, or 87%) of cases the NPS use was of significant clinical relevance to their clinical presentation. ICD-10 diagnoses of our acute cases were also predominantly psychotic (5/8 cases).

The locality service covers a large, geographical catchment area, with a well-dispersed population (approx. 150,000, over 420 square miles). Of the 7 cases living locally (one case involved a patient transferred from outside the locality catchment area), 6 had residential addresses within a mile of a shop known to be openly selling legal highs, and the remaining case within 2 miles. There were no cases from towns without known legal high shops. Whilst we are unable to draw any conclusions from this as to causality, it is nevertheless of potential interest and relevance to any public health or local government interventions.

This was a small sample, with much more simplistic methodology than Lally’s study, making any firm comparisons, conclusions, further generalisations difficult. Given its retrospective nature, and reliance on individual’s disclosure and clinicians’ documentation of substance use, our results are likely to be an underestimate of the true prevalence. However, we are aware of no other published record of prevalence rates in an acute psychiatric population; given the clinical importance of both NPS-use and acute mental health service pressures in UK, we hope this knowledge gap will be more sufficiently rectified soon.


1.Lally J. “Legal highs”- what’s in a name. BJPsych Bulletin 2015, 39: 206

2.Lally J et al. Prevalence study of head shop drug usage in mental health services. The Psychiatrist 2013, 37: 44-48

3.One New Drug a Week, Faculty Report FR/AP/02, Faculty of Addictions Psychiatry, Royal College of Psychiatrists, 2014

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