Ambulances were called out on average six times a day to deal with cases involving so-called legal highs last year, a BBC Scotland investigation has found.
Scottish Ambulance Service figures revealed crews were called out 2,229 times in 2014.
The data showed that ambulance callouts increased by 1,386% over a five-year period.
Nearly half of all callouts last year were made to NHS Lothian ambulances.
Legal highs – or new psychoactive substances (NPS) – are a group of substances designed to mimic the effects of controlled drugs, although the contents and chemical composition of these substances can vary.
Some of these products, although able to be legally sold or supplied for varying purposes, are unsafe.
Sellers frequently attempt to evade prosecution by marking products as “not fit for human consumption”.
The chemical compound can be altered quickly and easily, making it difficult to control the substances under the Misuse of Drugs Act 1971.
Community Safety Minister Paul Wheelhouse warned MSPs last week that deaths from so-called legal highs may not yet have reached their peak.
Mr Wheelhouse said the latest figures showed there were 114 deaths where legal highs had been taken in the last year – up from just four in 2009.
‘More severe impact’
In response to a series of coordinated freedom of information requests, the Scottish Ambulance Service searched its database for the names of more than 80 known brands of NPS.
While this was far from an exhaustive list of all legal highs, for the first time this new data indicated the extent of the fallout from NPS usage in Scotland.
In 2014, the Scottish Conservatives released figures which showed legal highs resulted in 323 hospital admissions over a five-year period.
But the new data obtained by BBC Scotland revealed that the health impact associated with using these substances was arguably more severe than the earlier figures suggested.
‘Human guinea pigs’: A case study
Yvonne Chafey recalls instances when her teenage son pulled a knife on her, and threatened to set his sister on fire.
They may be legal, but Yvonne says the effects of new psychoactive substances are “devastating”.
“He’s a nice boy without the drugs…and I would describe him almost as being possessed [when he takes them]”.
Her son started taking legal highs when he was just 15, often as part of socialising at parties.
Yvonne says: “It says on the back of the packets they’re not for human consumption, so why sell them to kids?
“It’s a legal loophole for drug dealers.
“I just think kids are being used as human guinea pigs, and it’s like a game of Russian roulette”.
Last year, the most callouts were recorded by NHS Lothian (1,063), NHS Tayside (317), and Grampian (241).
And over the last two years, the number of callouts have doubled for NHS Lothian ambulance crews from 451 to 1,063, and quadrupled in number for NHS Forth Valley staff.
The majority of NPS-related cases were transported to the New Edinburgh Royal Infirmary (744), Aberdeen Royal (156), and Glasgow Royal Infirmary (84).
Paul Bassett, a general manager for the southeast division of the Scottish Ambulance Service, said his staff were seeing up to four cases a day in the Lothians.
He said: “We believe overall that drug use in Scotland is on the decrease, especially in the younger age groups, but clearly this [legal highs] is bucking the trend”.
‘He wasn’t this monster’
The increase in NPS-related cases in Scotland was also confirmed by a clinical toxicologist at the New Edinburgh Royal Infirmary.
Dr James Dear said he saw the first big cluster of poisonings in the city in 2010.
Figures from the Scottish Ambulance Service revealed that the number of people brought to the Edinburgh hospital had doubled over the last two years.
Dr Dear said: “Since then they [the poisonings] have almost become normal, in the sense that most days we have somebody in, even five years ago that wasn’t the case, it would be unusual.”
He now sees up to 40 patients a month.
Dr Dear said: “Some of these patients end up in intensive care with organ failure, with kidney failure, with muscle damage.
“Last week a patient who came in had to be held down by six policemen, and we had to get two more security guards to hold them down.
“They were so aggressive, they were so agitated, they were so frankly dangerous.
“Eventually the effect of the drug wore off and actually, you know, he wasn’t this monster – he was a relatively normal person who had used legal highs and it had all gone wrong for him.”
In February an independent expert review group published its report recommending a range of measures to tackle the problem.
The report advised that the Scottish government should consider working with the Home Office to adapt key elements of the Irish approach to the problem.
Legislation introduced in Dublin in 2010 banned the sale of all NPS and exempts some substances, such as alcohol and tobacco.
It is credited with effectively eliminating all shops selling NPS in Ireland, which a United Nations (UN) report said had one of the highest consumption rates of the drugs in the world.
The expert group also recommended a restriction on the sale of NPS and drug paraphernalia when public entertainment or similar licenses were issued, and the establishment of a national centre of excellence in forensic analysis to detect and identify NPS in Scotland.
In the interim period, Police Scotland’s Operation Redwall has aimed to use legal powers to target premises selling legal highs.
A national day of action in August 2014 resulted in more than 6,000 packets of NPS being seized.
A separate freedom of information request revealed six cases of culpable and reckless conduct involving NPS have been reported to the Crown Office since February 2015.
One of these cases resulted in a conviction where the accused pleaded guilty to supplying NPS to another person.
A Scottish government spokeswoman said the use of NPS was “relatively low” with figures showing that 0.5% of adults reported taking “new drugs” in 2012/13.
She added that official statistics showed fewer Scots were taking drugs, with drug taking among young people at its lowest level in a decade.
The spokeswoman said: “The government remains concerned that the number of people who have died with NPS in their system, albeit including cases where NPS may not be a cause of their death, has increased substantially in recent years, with similar trends on NPS use evident across the British Isles and elsewhere.
“The legislative power to take action against NPS currently sits with the UK government, however tackling the use of NPS is a priority for the Scottish government and we remain committed to doing everything we can within existing powers to clamp down on the reckless sale of potentially very harmful products and to raise awareness of their dangers and to discourage people from taking them.”