This paper aims to set out some of the policy and public health issues raised by the appearance of a wide range of emergent psychoactive substances of diverse origin, effect and risk profile (commonly referred to as ‘legal highs’). It will start by considering what is meant by the term ‘legal highs’ and consider the historical context that has framed their appearance and must inform any response. It will then consider some of the approaches that have been adopted by different nations to control their availability and associated harms, including a preliminary assessment of their consequences, both intended and not.

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To date, the approaches to regulation have varied between nations, both with respect to the nature and specificity of the measures taken and their intended outcome. Such diversity appropriately reflects the marked differences in the existing drug use problems and public health approaches to addressing such issues between nations.

KEY POINTS

• Evidence shows that alternatives to criminalisation exist that attain many desirable outcomes for governments, whilst minimising the unnecessary consequences of criminalising the individual user.
• While new psychoactive substances pose a challenge to existing drug control regimes, their appearance provides an opportunity to consider the trial of alternative policy and legislative approaches to drug control.
• An objective evaluation based upon scientific evidence is required to evaluate the utility of these different control options, as well as their impact on public health outcomes.
• Policy makers should not only reflect on the unintended consequences of drug prohibition but also the current and historical failures of the adequate regulation of the legal markets for alcohol and tobacco, and for pharmaceuticals.