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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 !)
• www.clubdrugclinic.com
• @ClubDrugClinic
