DRUGS NOW

1. DRUGS NOW ‘LEGAL HIGHS’, NEW TRENDS, NEW ISSUES 2012

3. Increase in Benzodiazepine Use • Diazepam, Tramodol and Phenazepam seen significant rise in use. • Heroin ‘drought’ most likely explanation. • Increased access to very strong benzos via the internet. • “I order them from my uncle who is a chemist in India. I get 2,000 pills delivered via DHL each month. I pay £20 per that amount but sell them here 20 for £20.” Raj, 34

5. 'Legal highs' created at an 'unprecedented pace' • Record number reported across Europe in 2011, with four times as many found in the UK than any other country. • The EMCDDA found 48 new substances found in 2011. 24 were found in 2010 and 13 in 2009. • Includes synthetic cannabinoids, synthetic cathinones and synthetic derivatives of well-established drugs. (MDAI, DMC, Kanna, etc)

6. Guardian/Mixmag Study of 7,700 UK drug users 2012 • 20% of respondents admitted taking ‘mystery white powders’ without any idea what they contain. • A third admitting it was supplied by someone they didn’t trust. • James (Financial Advisor) told Guardian: “My daily life is sensible, regimented and stressful so at the weekend I want the opposite. Part of the fun is trying things out and waiting to see what happens.’

7. MOST FREQUENTLY IDENTIFIED ‘LEGAL HIGHS’ ONLINE • Kratom (natural) • Salvia (natural) • Hallucinogenic mushrooms (natural) • MDAI (synthetic) • MXE (synthetic) • Benzo Fury/ 6-APB (synthetic) • Dimethocaine (synthetic) • JWH-122/250 (synthetic cannabinoids)

8. Kratom (Mitragyna speciosa) • Kratom is a tree native to Southeast Asia. • Leaves of kratom have been chewed as an herbal ‘spiritual’ drug for centuries. • In low doses (10 g) induces mild euphoria. • In strong doses (20-50 g) the effects are profoundly euphoric. Typically, people describe the effects as dreamy, ecstatic, and blissful. • Bought in UK in extract powder form and mixed with fruit juice/tea. (users usually take on an empty stomach).

9. ‘Ocean Snow’ phenomenum • Very powerful stimulant in form of white powder as ‘legal high’. • Actual contents unknown but acts like Naphyrone (NRG-1) or MDPV. • £20 a gram. • March 2012 huge rise in admissions to A and E (and drugs services) in Northern Ireland. • Severe mood swings, insomnia, paranoia, palpitations, psychosis.

10. Darren , Belfast University Student • ‘I started taking it when MM-Cat got banned. You think ‘its o.k. because its legal’ but I ended up completely screwed up on it. My head was telling me that I couldn’t even talk to people unless I’d had some.’ • ‘The more we bought online the cheaper we got it, the more we took. Our student loans weren't going on books, it was going on buying Ocean Snow in bulk.’ • ‘I knew it was damaging me mentally and physically but just couldn’t stop using it.’

12. Forensic Analysis of ‘legal highs’ • 22% contained some Class B cathinone derivitives. Some pure Mephedrone. • 18% contained some quantity of Class B cannabinoids • 22% contained some quantity of class c piperazines. • (SOCA, 2011)

13. New ‘temporary bans’ legislation • Any ‘new’ drug causing concern will be banned from being supplied for 12 months while ACMD consider ‘ potential for harm’ • Use will not be prohibited only supply, but police can seize and dispose of the substance. • Methoxetamine (MXE) first ‘legal high’ to be subject to ‘temporary ban’. • Max penalties for supply/import: 6 months and £5,000 fine.

14. Alexander Shulgin and the ‘Psychonaut’ movement • Chemist credited with making MDMA popular in 1970s especially for treatment of depression. • Shulgin discovered over 230 new psychoactives. • In 1991 and 1997, he and his wife Ann authored books PiHKAL and TiHKAL • Discovered 2C-I and 2-CB (now Class A’s). • ‘psychonaut’ movement on web experimenting with these (and new) compounds – and online then sharing the experiences

15. Phenyletheylamines I Have Known and Loved’ (1991)

17. ‘Tryptamines I Have Known and Loved’ • (1997) Dosage, chemical structure and user experiences of 55 psychedelic compounds.

19. Internet user forums • Erowid • Bluelight • Drugsforum • Partyvibes • And hundreds more…..

20. Origins of MM-Cat (Meow, Bubble) • May 2004 on psycohnaut web forum ‘The Hive’ a chemist by the web name of ‘Kinetic’ wrote: • ‘I’ve been bored the last couple of days and had a few fun reagents lying around. Mixed them together to make 4-methylmethcathinone’. • Reports making 5 grams then taking it. • ‘I could feel the rushes of energy coming across me, and after that, a fantastic sense of well being . Its cocaine like with a touch of MDMA empathy. Certainly has potential’

21. Mephedrone (4-methylmethcathinone) • Synthetic stimulant – cathinone/ephedrine based. • First appeared on ‘psycohnaut’ websites 2004, then in ‘Neodove’ pills 2007. • Reported use in online ‘diet pills’. • Pre ban sold as ’plant food’, ‘bath salts’, room odouriser’ and ‘not for human consumption’ to avoid MHRA regulation. • ‘Loved up’ feeling of MDMA (mild) and reward and ego of cocaine (mild).

23. London Club Goers Survey • Study conducted in two gay friendly clubs. • July 2010 27% reported that they had or were going to take MM-Cat that night. • July 2011 figure rose to 41%. 24% GHB/GBL. • “Since we carried out our first study purity has fallen, the price has risen, yet the results of the second study showed both use and popularity had increased since the ban.’ Fiona Measham, Lancs Univ. • Source: Journal of Substance Use, March 2012

24. Study of users in Lancashire • 207 adults stopped at random on Friday night in four towns/cities . • 1 in 10 had used MM-Cat in last year, 1 in 20 in last month (despite ban). • Many had used ‘white powders’ (such as ‘Bubble’) without knowing whether it was MM-Cat or another substance. • Source: Measham, Moore, Ostergaard (2011), Drugs and Alcohol Today, vol 11.

25. Mephedrone related deaths • 60 deaths where drug identified at post mortem and considered to be related to death. Poly drug use common. • Mean age 28.7 years. • Most in employment, 25% unemployed, 18% students. • Suicide was most common cause of death (16 deaths). 13 hanging. • Acute toxicity next most common. • Source: Mephedrone Related Fatalities in the U.K. Corkery, Schifano, Ghodse. Univ of London and Univ. of Herts. April 2012.

26. MM-Cat:Methods of Use • Snorted (can hurt /burn nose/nosebleeds). Effects peak within 30 mins and fade after hour. Effective ‘high’ but tissue damage. • Swallowed in drink (stomach ache, bad taste, oral damage) • ‘bombed’ (wrapped in Rizla and swallowed). Longer to kick in, but lasts longer.

27. MM- Cat: Potential Risks • Causes vasoconstriction (blood vessels narrow) – raises blood pressure and reduces blood flow to parts of body. • Strain on heart. • Nasal/oral damage – nose bleeds, burns, ulcers etc. • Extreme weight loss/anorexia. • Panic attacks and paranoia after bingeing. • Reports of low mood, depression and irritability especially after extended use.

28. MM-Cat: harm reduction tips • Don’t use if history of depression/ anxiety. (both are triple neurotransmitter reuptake inhibitors) • Avoid mixing it with alcohol and other stimulants. • Don’t use if you have high blood pressure or history of heart problems. • Swallow rather than snort. • If snorting use clean devices and clean out nasal passages afterwards. • If swallowing in drink – drink quickly and swill with water to avoid ulcers, etc

29. MM – CAT: Harm reduction tips • Drink water to reduce dehydration. • Eat healthily before and after to replenish body and neurotransmitters. • Online forums advise taking magnesium supplements – this helps relax muscles and stops the jaw clenching/’gurning’. • Get medical help if chest pains, prolonged numbness, changes in skin colour. • Have regular, long breaks to recover.

30. Synthetic cannabinoids • Collection of herbs sprayed with synthetic cannabinoids. Brand names ‘Spice’, ‘Amsterdam Gold’, ‘Devils Weed.’ • More than one type identified but all mimic effects of THC. Most compounds come from JWH chemical family. • Some of the herbs (dwarf skullcap, blue water lily) have cannabis like effects.

32. BLACK MAMBA • Light green herbal product containing sythetic cannabinoid AM-2001 and Oleamide (oleic acid) • Legal in UK - £10 a gram. £25 3G packet. • Strong chemical/solvent smell when you sniff in packet but no odour when smoked. • Users report ‘skunk – like’ qualities but its more likely to cause severe hallucinations. • Reports include breathing problems, vomiting, ‘loss of control’ over some parts of the body.

34. Salvia Divinorum • Used traditionally in spiritual ceremonies. • Active ingredient is ‘Salvinorin A’. • Main form is dried leaves for smoking. • Also sold as ‘herbal ecstasy’ in capsules. • Very hallucinatory compared to other ‘legal highs’ • Sold in varying strengths e.g. ‘Salvia x20’ (50 mg of Salvinorin A extract per gram) which is 20 times stronger than normal salvia leaf.

35. Methoxetamine (‘MXE’) • Methoxetamine is a near chemical analog of ketamine and PCP. Its use was first publicly reported in 2010. • The drug is often referred to as MXE, Mexxy or ‘legal K’. • A number of online accounts describe compulsive redosing and unintentional consumption of more than initially planned. The drug acts as a dissociative sedative.

37. Ketamine – medical/veterinary use • Synthetic drug first developed in 1962. • Sold as Ketaset or Ketalar. • First given to US soldiers in Vietnam war (still used on battlefields). • As it suppresses breathing less than other anaesthetics used in emergency medicine such as traffic accidents. • Used in some countries to treat migraine • Used by vets to manage pain.

38. Ketamine (K, Ket, special K) • Disassociate anaesthetic. • Complex drug with unusual mixture of stimulant and hallucinogenic properties. • Most illicit K brought from India in liquid form then dried in to powder. • Very dose specific. • Can be snorted or swallowed in liquid form. • Snorted – 10/15 minutes to peak then lasts about hour. • Smaller doses = mild stimulant effect (bit trippy). • Increased doses = more sedating with significant psychedelic effects. (‘K hole’)

39. Why Ketamine? • Numbers using have tripled in last ten years. Estimated 110,000 users. • Its cheaper than cocaine (only £20 a gram) and, as the purity of cocaine has fallen, gives a more reliable high. • Believe it is a ‘safe’ and ‘clean’ risk free drug. • Enjoy the more ‘trippy’ side of the drug.

40. Changing patterns of ketamine use • Recreational users may use ‘bump’ of K (10 – 30mg) for euphoria, ‘wonkey donkeys’ and some visuals. • ‘K – hole’ initially reached by 100mg+. • Tolerance can increase very rapidly. Some users taking 3 -5g a day. • Prices now as low as £10 a gram. Led to younger users.

41. ‘Ketamine Bladder’ in UK • In 1/3 cases, the patients' symptoms improved when they stopped using K. • BUT in 2/3 of cases the symptoms either stayed the same or got worse - even after the patients stopped using the drug. • If patients continued using k, their symptoms became ‘very difficult to control’. • Source: Bristol Urological Institute, 2010

42. K – bladder problems • Bristol Urological Institute - ‘Worrying link’ between heavy use and urological problems inc. incontinence, pain when urinating, blood in urine. • Causes bladder to shrink and harden = holds less urine. • Toxic effect of K strips away lining of bladder = blood in urine. • Some have bladders removed and have catheters inserted to hold the urine. • 1/3 users will develop bladder problems.

43. Daniel, 21, DJ, Brighton: • Told he has ‘the bladder of an 80-year-old’, can have it surgically stretched, but can’t stop using. • "I've got a fixation with ‘K’, I think every time ‘just one more line – then I’ll quit.' I'll go for a piss it will be a tablespoon's worth. I'll piss out slugs of blood, like congealed jelly and the pain is horrific. It feels like a ball with loads of spikes just bouncing on your bladder. On a bad day I’ll go to the toilet every five minutes. I’ve basically stopped going out"

45. Ketamine – harm reduction • Avoid if prone to mental health problems. Don’t use if depressed or anxious. • Can make people very disorientated and unstable so use in ‘safe’ place. (Most of 23 k related deaths over last decade due to accidents.) • User is less sensitive to pain need to be careful.

46. Ketamine – harm reduction • Be careful over dosage. ‘Normal’ dose is 60 – 100mg but some taking 5g a day. Stronger than the same amount of coke or speed. • Avoid injecting brings additional risks – damage to veins, infections, viruses. • Risk of nausea and vomiting. Don’t use with alcohol or opiates. Put user in recovery position if nauseous.

47. Future trends in drug use • Increasing range of new psychoactive chemical componds available. (many will be ‘legal’) • More diversion of pharmaceutical/prescription drugs. • Increased ‘local production’ of drugs. • Widespread testing will ‘expose’ more drug users. • Increased poly-drug use amongst young people.

48. C2H5OH • Most popular ‘legal high’ in UK at the moment. • Can be purchased for as little as 20p a dose. • Research has found direct causal link with brain damage, heart disease, cancer and mental health problems such as depression. • Slang names include ‘booze.’