Liam Watson (MSc, BSc (Hons.), PGDip.)

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
'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)
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.’
Kratom (natural)
Salvia (natural)
Hallucinogenic mushrooms (natural)
MDAI (synthetic)
MXE (synthetic)
Benzo Fury/ 6-APB (synthetic)
Dimethocaine (synthetic)
JWH-122/250 (synthetic cannabinoids)
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).
‘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
Severe mood swings, insomnia, paranoia,
palpitations, psychosis.
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
‘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.’
Forensic Analysis of ‘legal highs’
22% contained some Class B
cathinone derivitives. Some pure
18% contained some quantity of
Class B cannabinoids
22% contained some quantity of class
c piperazines.
(SOCA, 2011)
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
Methoxetamine (MXE) first ‘legal high’ to
be subject to ‘temporary ban’.
Max penalties for supply/import: 6 months
and £5,000 fine.
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
Phenyletheylamines I Have Known and
Loved’ (1991)
 ‘Tryptamines I Have Known and Loved’
 (1997) Dosage, chemical structure and user
experiences of 55 psychedelic compounds.
Internet user forums
And hundreds more…..
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’
Mephedrone (4-methylmethcathinone)
Synthetic stimulant – cathinone/ephedrine
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).
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%
“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
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.
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.
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
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.
MM-Cat: harm reduction tips
 Don’t use if history of depression/ anxiety.
(both are triple neurotransmitter reuptake
 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
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.
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.
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.
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
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.
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.
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.
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’)
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
Enjoy the more ‘trippy’ side of the drug.
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.
‘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
Source: Bristol Urological Institute, 2010
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.
Daniel, 21, DJ, Brighton:
Told he has ‘the bladder of an 80-yearold’, 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"
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
User is less sensitive to pain need to be
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
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.
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
Most popular ‘legal high’ in UK at the
Can be purchased for as little as 20p a
Research has found direct causal link with
brain damage, heart disease, cancer and
mental health problems such as
Slang names include ‘booze.’
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