Club Drugs and Legal Highs: New drugs, new harms new users

Club Drugs and

Legal Highs: New drugs, new harms new users

Dr Owen Bowden-Jones Consultant Psychiatrist

10th December 2013

CLUB DRUGS

1 Day Training

Course

Trainer:

XXXXXXXX

History

of club

drugs

Synthesis, War and Flapping…

• 1912 MDMA first synthesised

• 1914 Cocaine use in WW1

• 1919Methamphetamine synthesised

• 1920s Flapper parties

• 1920 Cocaine banned in UK

Lightening war?

• 1929 Mephedrone first synthesised, then forgotten until 2003

• 1932 Amphetamine sold as Benzedrine

• 1939 -45 Both sides use amphetamine and methamphetamine

Post War partying…

• 1953 US Army use MDMA

• 1954 Japanese meth epidemic

• 1960s Mods & Rockers

• 1965 Ketamine developed

• 1966 The first ‘Head Shop’ opens (NY)

Northern Soul & Punk…

• 1967 IV Meth use in Soho, London

• 1970’s Punk and Northern Soul scenes fuelled by ‘speed’

• 1971 UK’s first ‘Head Shop’

Back to the 80’s…

• 1980s Meth production moves to Mexican cartels in USA

• GHB sold in health food stores

• 1988 – 89 ‘The Second Summer of Love’, Acid House and Ecstasy

The Naughty Nineties… • 1990s ‘Homemade’

meth becomes easier & more popular

• 1991 PiHKAL: A Chemical Love Story by Dr. Alexander Shulgin

• 1992 Ecstasy on the terraces

The Web, Media and Politics…

• Mid 90s Internet ‘Head Shops’ and legal high selling begins

• 1995 Leah Betts dies

• Ecstasy purity down, cocaine use increases

• Ibiza & Ayia Napa

• Late 90s UK Crystal Meth use begins

The Naughtier Noughties? • 2003 From GHB to

GBL

• Cocaine decreases in purity (avg 22%), increase in legal highs

• 2004 Mephedrone rediscovered

• 2009 Mephedrone increases… Media / political attention?...

0

10

20

30

40

50

60

70

80

2009 2010 2011 2012

24

41

49

73

Source: EMCDDA

New psychoactive substances across EU

EMCDDA 2011

314

690

0

100

200

300

400

500

600

700

800

2010 2011

Online sites selling NPS across EU

EMCDDA Annual Report 2012

New generation, new access

Who are using these new substances ?

Depends where you are in the UK

• Clubbers and students - Major cities, University towns

• MSM- London, Manchester

• Employed - avoiding detection, legal use

• Existing drug users – trying out something new

– Heroin users moving to mephedrone injecting - Yorkshire, Lancashire, Nottingham, South Wales

– Squats and alternative communities - ‘Kit-kat’

– ‘Bubble’ – generic white powder

Students and clubbers • 300,000 mephedrone

• 116,000 ketamine

Where are the patients ?

Club Drug Users are NOT your typical drug users

• More likely to be in work, often highly functioning

• Good social networks

• Psychologically minded

• Less likely to define their problems around drug use

• Do not consider themselves ‘drug addicts’

• Do not want to go to drug services

Attendees at Club Drug Clinic

• Average age 35 years (20-62)

• 90% White British/White other

• 55% employed (lawyers, nurses, teachers, managers)

• 3/4 first drug treatment episode

So why would people in work be attracted to club drugs/legal highs?

• Potent (but often seen as safe)

• Variety of effects- stimulant, hallucinogenic, sedative

• Cheap (£10/gm)

• Readily available

• Easy to use – snort, swallow, dissolve, ‘dab’

• LEGAL !!!

• Undetectable on most company urine drug screens

How can clinicians deal with new trends?

Stimulants Dissociatives Sedatives

Hallucinogens Synthetic

cannabinoids Other?

When working with different club drugs

think of the drug family and drugs you might have

more experience with such as

knowledge with Crack being utilised

for working with Crystal Meth

If you are not sure about a particular drug, try and work out if

it is…. • Stimulant

• Sedative/depressant

• Other (dissociative, hallucinogen)

Drug Harms ACUTE CHRONIC

KETAMINE Collapse, Accidental injury

Ulcerative cystitis ‘K cramps’ Cognitive impairment Dependence

MEPHEDRONE Psychosis Chronic psychosis Depression & Anxiety Cognitive impairment Dependence

GHB/GBL Overdose Acute withdrawal

Severe dependence

METHAMPHETAMINE Psychosis High risk sex CVA, MI (injecting)

Dependence Depression & Anxiety HIV Hepatitis

Key messages

Drug Treatment HARM REDUCTION TREATMENT

KETAMINE Bladder monitoring Using in safe place Dose timing Start small Don’t use alone

MI/RP/social Pain management Detoxification Co-morbidity

MEPHEDRONE Own straws Using in safe place Dose timing Start small Don’t use alone

MI/RP/social Antipsychotics Co-morbidity

GHB/GBL Measuring and time doses Avoid mixing with other sedatives Overdose letter Using in safe place Dose timing Start small Don’t use alone

MI/RP/social Detoxification – benzodiazepines & baclofen Co-morbidity

METHAMPHETAMINE Own injecting equipment Safe sexual practices Using in safe place Dose timing Start small Don’t use alone

MI/RP/social Sexual identity/intimacy 12 step Co-morbidity

Drug Service

LGBT

Sexual Health

Urology

Sexual Health Services

Acute Medicine

Urology

Mental Health

General Practice

Drug Services

Neurology

• Novel psychoactive substances present a challenge for prison health

• Available, cheap, potent and undetectable

• Cause very significant harms

• Clinicians must go back to basics. Work out drug class and follow that protocol

• Project NEPTUNE (early 2014 !)

• [email protected]

• [email protected]

• www.clubdrugclinic.com

• @ClubDrugClinic