Several countries already prohibit or regulate the sale of semi-synthetic hexahydrocannabinol (HHC), with the Czech Republic becoming the latest to restrict its sale after 12 children, who had eaten sweets containing the psychoactive substance, were admitted to hospital.
There is currently no restriction on the use or sale of products containing HHC in the country – like vaping liquids, oils and sweets – which have become increasingly popular in recent years, including among children who often buy them from vending machines.
But rising numbers of overdoses after consumption of the products have led to calls to restrict their sale, leading the government to announce that it will put HHC on a list of prohibited substances, making its sale illegal.
However, some experts believe this is counterproductive, suggesting regulation would be better.
“If you just ban (a substance) it gets replaced with something else, possibly worse, almost immediately. We saw this in France: they banned HHC last year and a few months later new substances came on to the market to replace it,” Jindrich Voboril, the Czech National Anti-Drug Co-ordinator, told The Lancet.
“Banning something also creates a black market for it immediately. It’s better to regulate and allow the least risky product on the market,” he added.
HHC was first synthesised in 1940, but has only recently appeared on global drug markets, appearing in the USA at the end of 2021, and then in Europe the next year.
Synthesised from cannabidiol, its effects have been reported to be broadly similar to those of δ-9-tetrahydrocannabinol (THC), the main psychoactive substance in cannabis. HHC is not scheduled under the 1961 and 1971 UN Conventions on Drugs. Where it is not banned, it is often sold openly as a legal replacement for cannabis.
Since a report on HHC and its potential risks was published last year by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), though, many European countries, including the UK, France, Finland, Austria, Denmark, Sweden, and Greece, have either banned or restricted its sale.
Experts say data on HHC are extremely limited – namely, the EMCDDA report was based on a small number of laboratory studies – and its potential risks are poorly understood.
“In terms of risks, we know little about it, but it is reasonable to assume it will have a similar risk profile to THC. HHC products aren’t going to be safe – no drugs are – but at least with cannabis, we know its risks,” Steve Rolles, senior policy analyst at the UK-based Transform Drug Policy Foundation, told The Lancet.
“In a service provider setting, such as paramedics and other medical staff interacting with drug users, the fact that we don’t know much about these drugs is another risk in itself,” he added.
“Edibles that look like sweets are a really bad idea. If you have drugs that look like confectionaries, is an increase in paediatric poisoning incidents surprising?”
Daniel Nasrallah, assistant professor at Roanoke College in Virginia, who has led research into HHC products, said that many commercial producers of HHC do not disclose the chemical methods they use.
HHC is synthesised through hydrogenation, which traditionally involves the use of a transition metal catalyst. Transition metals are toxic at low concentrations when consumed.
Nasrallah pointed out that his research had looked at the certificates of analysis of more than 60 commercially available HHC products and found none gave any indication of whether testing had been carried out for common transition metals used in hydrogenation.
“Users of HHC should have concerns about the potential of toxic metals in HHC products,” he warned. “Due to the processes probably involved in making HHC and the absence of these tests, we simply do not know if the products contain them.”
It is expected that HHC would be listed as a prohibited substance in the Czech Republic within weeks. However, the government has said the ban would be temporary until legislation currently going through Parliament is passed, which could allow the sales of HHC products under strict regulation.
Voboril, who helped draft the Bill, said this would involve, among other restrictions, sales being limited exclusively to specialist shops under licence, although HHC products in edible form would be banned.
Addiction experts said restricting the availability of HHC products, especially to children, was essential.
Tomas Jandac, a paediatric addiction specialist at Charles University Medical Faculty in Prague, said the effects of HHC seen in clinical practice, including blackouts, anxiety, affective symptoms, panic attacks, and sleep and short-term memory problems, were “more acute for children due to the (ongoing) development of their neural system and metabolism”.
“Regulation would be better than a ban. We can regulate so there are no sales to underage people, and not in shops close to schools and restaurants; we can control the products’ content – no other toxins, heavy metals – and advertising and packaging, so products are not attractive to children.”
The Lancet article – Czech Republic latest country to ban hexahydrocannabinol (Restricted access)
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