WHATS NEW? - March 2018

‘Chemsex’ and NPS drive dramatic shift in drug use

Stronger cannabis linked to rise in demand for drug treatment programmes

Anxious teenagers ‘buy Xanax on the dark web’

Anti-depressants: Major study finds they work

Global Drug Survey Reveals the Drugs most Likely to Hospitalise

Clinic opens to help teens hooked on illegal pills bought online

Most UK cannabis 'super strength skunk'

Giving alcohol to teens at home fuels binge drinking, parents told

A Potential ‘Cure’ for Cocaine Addiction?

Nasal spray aimed at tackling gambling addiction to be trialled in Finland

‘Chemsex’ and NPS drive dramatic shift in drug use

Former legal highs and “chemsex” drugs are driving a dramatic shift in substance abuse away from alcohol, heroin and crack cocaine, according to a study.

Researchers are urging drug support staff to adapt to the changes they found on the streets where homeless users are shunning injectable drugs like heroin in preference for smoking “Spice”, a powerful synthetic cannabinoid.

The six-month study also discovered that gay men who previously used recreational drugs such as ecstasy have moved on to injecting, or “slamming”, crystal methampetamine and mephedrone. Criminologists from Manchester Metropolitan University conducted interviews with 53 drug users and 31 staff from a range of organisations in the city – including drug and alcohol treatment services, the police, homeless day centres and sexual health services. Dr Rob Ralphs and Dr Paul Gray, who carried out the research, are advising that treatment services need to respond to this “significant shift” to ensure appropriate help is available. Dr Ralphs said one problem was that Spice users viewed drug treatment centres as places for heroin and crack addicts to obtain clean needles while gay men described the stigma of being associated with heroin users.

“Despite complex and often interrelated needs, it was apparent that users of Spice and chemsex substances had a lack of knowledge of existing service provision and, perhaps most concerning, outdated views and perceptions of who treatment services are targeted at and what services could offer,” he said. Dr Gray added: “The stereotypical perceptions and outdated views of users – namely, that drug services are solely places for injecting heroin and crack cocaine users – provides evidence of the need for services to better promote the range of interventions that they offer.”

To help Spice users, the academics recommend targeted street initiatives to provide harm reduction advice, with treatment and advice offered through pop-up services in homeless day centres and supported accommodation. For the the gay community, they urge that physical and mental health services need to be prioritised, with pop-ups in key locations such as gay saunas and fetish clubs. Dr Ralphs said: “Drug users should be treated holistically, requiring substance use services to work more closely with mental health, sexual health, supported housing and homeless services. “A lack of clear referral pathways through other agencies into drug treatment services must be combated, while tackling the outdated perception among some professionals that treatment services are just for heroin and crack users”.

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Stronger cannabis linked to rise in demand for drug treatment programmes

Researchers have found fresh evidence to suggest that more potent strains of cannabis are at least partly to blame for the number of people seeking help from drug treatment programmes.

Scientists at King’s College London drew on data from the Netherlands to show that admissions to specialist treatment centres rose when coffee shops sold increasingly more potent cannabis, but fell again when the cannabis weakened.

The work is the first to investigate how admissions to drug treatment programmes rise and fall in line with the strength of cannabis available to users. It found that changes in demand for treatment typically lagged five to seven years behind changes to cannabis strength.

“This is the first study to provide evidence for an association between changes in potency and health-related outcomes,” said Tom Freeman, an addiction scientist at King’s.

The demand for specialist treatment among cannabis users has risen steadily in recent years, with more people now citing the drug on admission than any other illicit substance. In Europe, the number of first-time referrals for cannabis rose 53% from 2006 to 2014.

Cannabis plants produce more than 100 active compounds called cannabinoids but THC, or delta-9 tetrahydrocannabinol, is largely responsible for the drug-related high. A second compound called CBD, or cannabidiol, appears to reduce some of the mental health risks linked to heavy cannabis use by counterbalancing the effects of THC.

Many countries have seen far stronger cannabis come on to the market in the past few decades. A major survey in the US found that the strength of illicit cannabis rose from an average of 4% THC in 1995 to 12% in 2014. After two years of legal sales in Washington state, cannabis extracts containing nearly 70% THC now make up one fifth of the market, researchers found last year. In Britain, the Home Office has not recorded cannabis strength since 2008 when high-strength skunk, containing 15% THC, accounted for 80% of the market.

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Anxious teenagers ‘buy Xanax on the dark web’

A growing number of children are using the anti-anxiety drug Xanax to “self-medicate” against mental health problems, prompting calls from senior Labour MPs for an investigation into the escalating use of the tranquilliser, which is around 20 times stronger than Valium.

Xanax has seen a sharp rise in popularity in the past year, with some experts saying it has become one of the top five drugs used by young people, alongside cannabis and alcohol. Known as alprazolam in its generic form, Xanax can easily be bought from street dealers, online pharmacies or the dark web for as little as £1 a pill.

Shadow health secretary Jonathan Ashworth is joining Labour MP Bambos Charalambous to urge Public Health England to look into the apparent boom in usage after one of Charalambous’s constituents said her daughter had been groomed using Xanax. Ashworth said: “Some of the stories we are hearing about this are shocking. We need to raise awareness and have a proper understanding of the implications of this. I hope that the government … plans for greater research on the impact this is having on many adolescents’ lives.”

Charalambous, who will address a debate on the drug in parliament on Monday night, said: “Some young people are using Xanax to self-medicate to cope with anxiety, while younger teenagers are being groomed and exploited by drug pushers taking advantage of the drug’s ‘zombie-like’ effects. The government needs to research its use and gather clear data, raise public awareness and put support in place for those who have developed a dependency.”

The news comes after a spate of Xanax-related hospitalisations recently, prompting Lewes police in East Sussex to warn people about the dangers of taking Xanax and other prescription drugs. Charity workers believe most teenagers taking Xanax are doing so for recreational use, but significant anecdotal evidence is suggesting that many are trying to manage anxiety and other mental health problems.

Nick Hickmott at the charity Addaction said: “I think the self-medication taps into CAMHS [child and adolescent mental health services] waiting lists and young people not having access to good mental health care.

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Anti-depressants: Major study finds they work

Scientists say they have settled one of medicine's biggest debates after a huge study found that anti-depressants work.

The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.

But it also showed big differences in how effective each drug is. The authors of the report, published in the Lancet, said it showed many more people could benefit from the drugs.

There were 64.7 million prescriptions for the drugs in England in 2016 - more than double the 31 million in 2006 - but there has been a debate about how effective they are, with some trials suggesting they are no better than placebos.

The Royal College of Psychiatrists said the study "finally puts to bed the controversy on anti-depressants".

The so-called meta-analysis, which involved unpublished data in addition to information from the 522 clinical trials involving the short-term treatment of acute depression in adults, found the medications were all more effective than placebos.

However, the study found they ranged from being a third more effective than a placebo to more than twice as effective.

Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: "This study is the final answer to a long-standing controversy about whether anti-depressants work for depression.

"We found the most commonly prescribed anti-depressants work for moderate to severe depression and I think this is very good news for patients and clinicians."

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Global Drug Survey Reveals the Drugs most Likely to Hospitalise

The Global Drug Survey (GDS) of 2017 that covered 50 countries around the world and involved 120,000 people, including 5,900 from the UK, rated recreational drugs. Based on the total number of emergency ward visits, recreational drugs were ranked from safest to most dangerous.

Recreational drugs that have sent the most number of people to the emergency room are methamphetamine or crystal meth, synthetic cannabis, and alcohol that sits at the bottom of the drug safety table, notes a report on the survey by Science Alert.

Magic mushrooms or "shrooms", were responsible for the least emergency hospital visits. Cannabis was placed second safest and surprisingly, Lysergic acid diethylamide (LSD) or acid and cocaine share the third place. Going up the list, amphetamines and MDMA, also known as ecstasy or simply "E", were left in the middle of the scale.

In the survey, it was found that over 10,000 participants used mushrooms but only 0.2% of them needed to go to the hospital because of their trip.

Researchers also pointed out that there is no completely safe recreational drug that is harmless. There is always going to be some consequence related to drug use, even if they do not land the user directly in the hospital. "Combined use [of mushrooms] with alcohol and use within risky or unfamiliar settings increase the risks of harm," the founder of the Global Drug Survey, addiction psychiatrist Adam Winstock said.

The greatest risk with mushrooms is consuming the wrong type and getting unwittingly poisoned as a result, the report adds.

While the number of users of drugs averaged out across genders, women were found to be more at risk than men in most cases.

If one should choose to take these drugs, the researchers say that it is vital that people know what they are getting into. There is no room for complacency, says GDS, even with what can be termed safe drugs. LSD, for example will affect the body for up to 12 hours, but cannabis will last only for a few hours.

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Clinic opens to help teens hooked on illegal pills bought online

The psychological impact of drugs like these, bought online, has prompted Bowden-Jones to open the Addiction to Online Medicine (Atom) service in London: a free, easy-to-access clinic run by Central and North West London NHS foundation trust.

He is opening what is thought to be the country’s first facility aimed at people experiencing problems resulting from medication they have sourced online. The service launches on Monday amid growing concern about addiction to such drugs: last week the government ordered Public Health England to examine why one in 11 patients was prescribed an addictive medicine last year, including benzodiazepines and opiods.

“The internet has really transformed the patterns of people’s drug use. It sanitises the buying of drugs,” says Bowden-Jones, a consultant psychiatrist, as he settles into one of the chairs in the group therapy room.

“There is something about the ability of the internet to deliver products to you in a timely, safe and predictable way that seems to have now extended to include prescription medicines.”

The growth of an online marketplace is changing the landscape of drug-taking in Britain. For many, getting hold of drugs no longer involves waiting for dealers on street corners or seeing a doctor for a prescription. Now people are buying them online in a matter of minutes. The phenomenon has seen a rapid increase over the past year, bringing with it new risks and obstacles to recovery.

“What we want to do is try to develop some expertise about this,” says Bowden-Jones. “There is a whole set of extra complications around online purchasing. The sort of age group that we see in the clinic spends a lot of time on their phones, so what you can’t do is tell them you can’t use the internet.”

A growing number of teenagers appear to be using the benzodiazepine Xanax, a potent anti-anxiety drug, for recreational use as well as a means to self-medicate. Earlier this month, the danger posed by the misuse of Xanax was raised in parliament after an MP’s constituent claimed her daughter was groomed through her need for the drug.

Experts say they are seeing people experiencing problems after taking other anti-anxiety drugs and painkillers, also bought online. Bowden-Jones says: “We’re beginning to see students taking cognitive enhancers, and people

with anxiety disorders taking illicit benzodiazepines. There’s an issue with people in custodial settings taking [anti-anxiety drug] pregabalin, and people with chronic pain purchasing illicit analgesics.”

These groups often feel they cannot get help through existing addiction services. “They look at traditional drug and alcohol services and feel that those are for people using heroin or crack cocaine or alcohol,” Bowden-Jones says. “So they don’t really know where to go or where they fit in.”

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Most UK cannabis 'super strength skunk'

Most cannabis being sold illegally in the UK is super-strength skunk linked to a higher risk of psychotic mental health episodes, an analysis of 995 samples seized by the police suggests.

In 2016, 94% of police seizures were high-potency marijuana, compared to 85% in 2008 and 51% in 2005. The drug contains more of the psychoactive ingredient THC than some other types of cannabis, such as hash.

Researchers from King's College London say users should be warned of this.

There are three main types of street cannabis - hash (hashish or resin), herbal cannabis (weed, grass or marijuana) and high-potency cannabis or skunk.

Hash is made from the resin of the plant, while herbal cannabis is made from the dried leaves and flowering parts of pollinated cannabis plants.

Skunk is made from from unpollinated cannabis plants which naturally contain higher levels of THC - the substance that gives recreational users the 'stoned' feelings they seek from the drug, but can also cause nasty side effects, including paranoia and hallucinations.

Hash and herbal cannabis are considered to be milder than skunk. That's because they contain higher levels of a substance called CBD (cannabidiol) which experts say works as an anti-psychotic and counteracts some of the negative effects of THC (tetrahydrocannabinol).

It's argued that cannabis with high levels of THC and no or very low CBD can lead to people developing psychiatric issues.

The skunk examined by the researchers from King's College London was high potency - about 14% THC. Previous work by the same team, based on a study of 780 people, suggests the risk of psychosis is three times higher for users of potent "skunk-like" cannabis than for non-users.

The use of hash, a milder form of the drug, was not associated with increased risk of psychosis.

According to the Royal College of Psychiatrists, there is sufficient evidence to show that people who use cannabis, particularly at a younger age, such as around the age of 15, have a higher than average risk of developing a psychotic illness, including schizophrenia or bipolar disorder.

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Giving alcohol to teens at home fuels binge drinking, parents told

Children given alcohol by parents in the belief it will foster responsible drinking are more likely to become binge drinkers, a major new study has found.

The six-year analysis of nearly 2,000 12 to 18-year-olds revealed there were “no benefits” to introducing alcohol to teenagers at home and that doing so only encouraged them to seek it elsewhere.

Writing in The Lancet, the researchers say that despite a widespread folk belief that a parentally-supplied glass of wine over Sunday lunch or a quiet beer in the evening promotes a stable attitude to drinking, there is in fact no reliable evidence to back this up.

Instead, they show that the chances of binge drinking, alcohol-related harm or displaying symptoms of alcohol use disorder are all higher in children provided alcohol by parents. Experts have said the study’s findings “strongly refute” the current wisdom.

“While governments focus on prevention through school-based education and enforcement of legislation on legal age for buying and drinking alcohol, parents go largely unnoticed,” said professor Richard Mattick, from the University of New South Wales, who led the research.

“Parents, policy makers, and clinicians need to be made aware that parental provision of alcohol is associated with risk, not with protection.

“We advise that parents should avoid supplying alcohol to their teenagers if they wish to reduce their risk of alcohol-related harms.”

The analysis found that, on average, 62 per cent of teenagers who were not given alcohol by their parents went on to binge drink - described as four or more drinks in one session - compared to 81 per cent who were.

Meanwhile teenagers supplied with alcohol by only their parents one year were twice as likely to access alcohol from other sources the next year.

Previous studies have shown that in the UK middle class children were those most likely to have tried alcohol before they reached their teenage years, with 35 per cent of those with professional parents having had a drink compared to around 18 per cent across all economic groups.

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A Potential ‘Cure’ for Cocaine Addiction?

Scientists have found that they can decrease appetite for cocaine by neutralising a protein molecule which is found in the blood and brain at higher levels in repeat cocaine users.

This raises the prospect for a safe medication for cocaine addiction by using existing treatments to tackle this biological system driving drug-taking behaviour.

The protein molecule, G-CSF, affects the reward centres of the brain and could become the first medication to help people beat cocaine addiction according to doctors, from Mont Sinai Medical Centre in New York.

“The results of this study are exciting because outside of 12-step programmes and psychotherapy, no medication-assisted therapy exists to treat cocaine addiction,” according to lead researcher Dr Drew Kiraly, assistant professor of psychiatry at Icahn School of Medicine at Mount Sinai.

The team found that injecting this G-CSF molecule directly into the brain’s reward centres, a region called the “nucleus acumbens”, led to a significant increase in the cocaine seeking and consumption behaviours in mice.

In trials mice treated with G-CSF worked much harder to seek out more cocaine as the strength of each dose was gradually lowered.

This finding is important, according to Dr Kiraly, because there are safe treatments already on the market which target this molecule in humans, primarily for kick-starting production of infection fighting cells after chemotherapy.

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Nasal spray aimed at tackling gambling addiction to be trialled in Finland

A group of Finnish researchers are launching a study to find out whether gambling addiction be treated with a nasal spray?

The fast-working spray contains naloxone, which is commonly used as an emergency treatment for overdoses of opiates such as heroin, opium and morphine. It blocks the production of dopamine, a neurotransmitter linked to pleasure with a central role in addictions.

“The spray goes to the brain in a few minutes so it’s very useful for a gambler … if you crave gambling, just take the spray,” Hannu Alho, professor of addiction medicine at the Helsinki-based national institute for health and welfare, explained.

The researchers are looking for up to 130 volunteers to take part in the experiment, which Alho says is “the first of its kind globally to use nasal spray.” Half will use the treatment for three months, while the other half will be given a placebo.

2.7% of Finns aged 15-74 suffer from some level of gambling problem, while the UK Gambling Commission found that two million Britons were either problem gamblers or at risk of addiction.

Alho said a previous attempt to treat gambling addiction with a pill containing a substance similar to naloxone had shown benefits, but was inefficient as the pill takes at least one hour before it is absorbed.

“Gambling is a very impulsive behaviour … the need to gamble starts right away,” Alho said. “For this reason we are seeking a medication with a quick effect … the nasal spray acts in just a few minutes.”

The experiment is to be launched in April and is expected to last for a year.

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