WHATS NEW? - November 2019

Cocaine and alcohol a 'deadly combination'

Ketamine-like drug for depression could get UK licence within the year

Drug deaths soar to highest level on record

Growing controversy over the benefits of CBD products

UK universities publish guidance on risks of initiation ceremonies

Grading cannabis strength ‘will improve mental health of users’

MDMA treatment for alcoholism could reduce relapse, study suggests

Children as young as seven 'being enslaved by UK drug gangs'

Medical cannabis product approved for epilepsy

Cocaine and alcohol a 'deadly combination'

Mixing cocaine and alcohol together creates a "deadly combination" which can increase violent and impulsive behaviour, the Royal College of Psychiatrists is warning.

At least 13 "self-inflicted" deaths happened in a year in England among people who took the two substances. Coroners have reported seeing a rise in such cases.

The charity Inquest uses the term "self-inflicted" to describe deaths where a person had injured or harmed themselves, resulting in death. Some research in the US even suggests the mixture could increase the risk of suicide by a factor of 16.

Some doctors believe that when you mix the two the liver produces a substance called cocaethylene, which may temporarily enhance the high - but also increases blood pressure, poor judgement and violent thoughts.

Figures show there has been a rise in the number of alcohol-and-cocaine-related deaths over the past two decades, plus an increase in cocaine use.

Professor of addiction psychiatry Julia Sinclair, who is chairwoman of the faculty of addictions at the Royal College of Psychiatrists, explained that alcohol and cocaine were very different pharmacologically.

"Alcohol is a depressant, it increases the levels of Gaba (gamma-aminobutyric acid) in the brain, which is like its handbrake and makes us feel less anxious. You add cocaine into the mix and you have a rocket-fuelled increased impulsivity which gives people the driver to complete an act that they may not otherwise do. It's like crossing a road in front of a car speeding towards you."

There are calls for more research into the combination of alcohol and cocaine and its links with suicide or life-threatening behaviour.

Prof Sinclair said: "People are looking for what the ingredient that makes alcohol and cocaine such a toxic combo. It might be cocaethylene - but we don't know and everyone has a different response."

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Ketamine-like drug for depression could get UK licence within the year

A ketamine-like drug that could be licensed in the UK as soon as December could transform treatment for severe depression, one of the country’s leading psychiatrists has said.

The drug, called esketamine, which is administered through a nasal spray, would be one of the first “rapid acting” drugs for depression and the first drug in decades to target a new brain pathway. Unlike conventional antidepressants, which take weeks or months to take effect, ketamine has been shown in some patients to have enduring effects within hours.

Prof Allan Young, director of the Centre for Affective Disorders at King’s College London, said that for the substantial portion of patients who do not respond to conventional drugs, ketamine-based therapies could offer new hope.

“We haven’t had anything really new for 50 or 60 years. What’s particularly exciting is the arrival of a new type of treatment and that’s ketamine,” he said. “It’s got a different pharmacology. It’s not just the same old steam engine, it seems to work in a different way and it seems to work more quickly.”

However, other experts have raised questions about the overall effectiveness of the drug and say there could be serious safety risks associated with taking ketamine over long time periods.

The European Medicines Agency and the UK health regulator will make a decision in December on licensing the drug, which Johnson & Johnson sells in the US under the brand name Spravato. If approved, esketamine would become available through private clinics. Nice are scheduled to make a decision on whether to approve the drug for NHS use in March next year.

Young believes the drug could prove to be an important alternative for the roughly 2.7 million people in the UK who suffer from chronic depression and have not responded to conventional drugs.

The most commonly used drugs, known as selective serotonin reuptake inhibitors (SSRIs), work by stopping the brain mopping up the chemical serotonin. They typically take six to eight weeks to have an impact on symptoms.

Ketamine appears to act on a different brain chemical called glutamate, and in animal studies has been shown to restore connections between brain cells that are thought to shrink back during prolonged periods of depression.

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Drug deaths soar to highest level on record

Drug deaths rose sharply in England and Wales to reach record numbers last year, official figures show.

A total of 4,359 people died due to drug poisoning last year, the ONS said - a figure which includes accidental overdoses and suicides from medicinal drugs, as well as illicit drug use.

It was also the biggest annual increase in drug deaths since records began in 1993, the statisticians said. There were 2,917 deaths from illicit drugs in 2018, the Office of National Statistics said, a rise of 17%.

Most deaths were due to opiates such as heroin, but cocaine deaths doubled in three years. A government adviser blamed cuts to treatment programmes, while health officials said they were commissioning an independent review.

Deaths from drug misuse among men aged between 40 and 49 rose "significantly", they added.

The North East had the highest death rate in England, while London had the lowest.

Deaths from new psychoactive substances - known as "legal highs" until they were banned in 2016 - doubled in a year to 125, following a fall the previous year. MDMA deaths rose from 56 to 92.

Professor Alex Stevens from the University of Kent, who serves on the government's advisory council on the misuse of drugs, said there had been a 47% increase in deaths from drug poisoning since 2013.

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Growing controversy over the benefits of CBD products

Sales of the cannabis extract cannabidiol (CBD) have roughly doubled over the past two years in the UK. But some are concerned that CBD products are not all they claim to be.

Alongside reputable sellers, the rapid growth of the industry has attracted "CBD cowboys" - opportunists trying to make a quick profit - according to Mark Reinders, president of the European Hemp Industry Association.

There are two main compounds found in cannabis - CBD and THC (tetrahydrocannabinol). Unlike THC, CBD is legal, doesn't make you high and is easily available on high streets and online.

There are now an estimated quarter of a million regular users in the UK, turning to CBD to support general wellness, ease anxiety, sleep problems and chronic pain among other things. CBD is commonly found in the form of oil to be dropped under the tongue or e-liquids to be vaped.

A recent report by industry body the Centre for Medical Cannabis blind-tested 30 products advertising themselves as CBD, bought on the High Street and online. It found almost half (45%) had measurable levels of THC, making them technically illegal in the UK.

The researchers also found the presence in seven products of the solvent dichloromethane, which can cause wheezing and shortness of breath, at levels above food safety limits.

Some CBD products also contain very little of the advertised ingredient. One sample, bought at a high street pharmacy chain, had no CBD in it at all and was selling for well over £50. Only 38% of the products tested had levels of CBD within 10% of the amount advertised on the bottle.

There is no legal requirement for these products to be tested, though some companies say they have rigorous testing regimes.

Prof Saoirse O'Sullivan, from the University of Nottingham, recommends shoppers look for brands that can provide a certificate of analysis of their products.

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UK universities publish guidance on risks of initiation ceremonies

Students starting university are being warned of the dangers of initiation ceremonies, almost three years after an undergraduate was killed as a result of the “toxic effects” of such events.

Ed Farmer died after excessive drinking at an initiation event run by Newcastle University’s agricultural society in 2016. Karen Dilks, the coroner at the inquest into his death, called on universities to issue more forceful warnings about the dangers of alcohol for first year students.

As part of its response, Newcastle University worked with Universities UK to publish guidance about the potential physical risks of initiation ceremonies and the bullying and coercion that can be involved.

At the time of the inquest, Farmer’s parents expressed frustration at the “inactivity” of the university and its student union over initiation ceremonies.

But in a foreword to the Initiations at UK Universities guidance, Jeremy and Helen Farmer say they hope the document could save lives.

They write: “If students were made aware of the dangers of drinking large volumes of spirits in short periods of time and maybe aware of the signs of someone that is no longer just drunk but in a life-limiting state, and use the example of Ed to give the message some relevance, then possibly just one student might be luckier on a night out than Ed.”

Instead it seeks to raise awareness among students and staff of risky behaviour involved in initiation ceremonies including advertising support available to students.

It claims that a blanket ban would be “unhelpful” because it could encourage initiation ceremonies “into private spaces, such as off-campus accommodation” where they would be more dangerous and difficult to monitor.

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Grading cannabis strength ‘will improve mental health of users’

Standard units for grading the potency of cannabis – similar to those already used for alcohol – would result in significant improvements in the mental health of users, according to addiction experts.

Researchers from the Addiction and Mental Health Group at the University of Bath, working with staff from King’s College London, UCL and the Australian Catholic University in Melbourne, say more needs to be done to make people aware of the levels of THC – the main psychoactive component – in the cannabis they are consuming. Writing in the journal Addiction, the experts suggest a unit level should be set at 5mg of THC – the amount that would typically be found in a small joint. This is enough to induce intoxication but without psychotic symptoms, they say.

Previous research from the team has highlighted how concentrations of THC in cannabis have doubled across Europe in the past decade. But although use of the drug is widespread and there are moves in some countries to legalise it, standard units – which have been commonplace for alcohol for many years – have not been adopted in health guidelines.

The authors believe that a standard unit system would also yield benefits for countries where cannabis use is illegal, such as the UK.

“Where the unit system for alcohol has helped consumers to better manage their alcohol intake, so, too, this could have important implications for cannabis users,” said senior author Dr Tom Freeman from the University of Bath. “This should give clear guidance about the dose of THC people are consuming. Our hope is that the introduction of a system in locations where the drug is legalised will have knock-on effects to countries where it is not, providing users and clinicians with an important toolkit to guide safer use.”

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MDMA treatment for alcoholism could reduce relapse, study suggests

The first study looking into the use of MDMA to treat alcohol addiction has shown the treatment is safe and early results show encouraging outcomes from the approach, scientists have said.

Doctors in Bristol are testing whether a few doses of the drug, in conjunction with psychotherapy, could help patients overcome alcoholism more effectively than conventional treatments. Those who have completed the study have so far reported almost no relapse and no physical or psychological problems.

In comparison, eight in 10 alcoholics in England relapse within three years after current treatment approaches. Dr Ben Sessa, an addiction psychiatrist and senior research fellow at Imperial College London, and who led the trial, said: “With the very best that medical science can work with, 80% of people are drinking within three years post alcohol detox.”

Eleven people have so far completed the safety and tolerability study, which involves nine months of follow-ups. “We’ve got one person who has completely relapsed, back to previous drinking levels, we have five people who are completely dry and we have four or five who have had one or two drinks but wouldn’t reach the diagnosis of alcohol use disorder,” Sessa said.

Most addiction is based on underlying trauma, often from childhood, explained Sessa. “MDMA selectively impairs the fear response,” he said. “It allows recall of painful memories without being overwhelmed.

“MDMA psychotherapy gives you the opportunity to tackle rigidly held personal narratives that are based on early trauma. It’s the perfect drug for trauma-focused psychotherapy.”

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Children as young as seven 'being enslaved by UK drug gangs'

Children as young as seven are being targeted for grooming, violence and exploitation by drug gangs enslaving them into criminality, says a report from the Children’s Society.

The charity says the main age bracket for criminal exploitation of children is 14 to 17, but warns the age at which youngsters are being targeted for grooming is getting younger. “There is evidence that primary school age children – as young as seven – are targeted,” states the report.

There can be a lack of recognition of criminal exploitation of younger children and so opportunities to protect under-10s can be missed, it added.

The report focuses on the criminal exploitation of children, best known via the ‘county lines’ tactic whereby drug gangs use children to break into new markets.

Children routinely suffer violence and threats of harm to themselves or loved ones, and sexual exploitation, to enforce compliance. Grooming involves physical and emotional exploitation of children from all backgrounds, mostly deprived or troubled, and including some from private schools, the report says.

Criminals change their tactics as police and the authorities become aware of their operations, the report says, for example by introducing “shift work” for the children under their control so they are missing for less time and less likely to arouse suspicion.

The Children’s Society is calling for changes in law and policy and more resources to counter the threat, saying all children caught up in activities such as county lines operations should not be criminalised and should be treated as victims.

The report is based on the charity’s own case studies, and freedom of information requests to police and local councils, which reveal inadequate information about the scale of the exploitation of children as well as drastically varying levels of awareness and resources in different areas.

The report says: “The vast majority of police forces and local authorities across England and Wales were not able to share figures of the number of children affected by criminal exploitation in their area.”

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Medical cannabis product approved for epilepsy

The EU has approved for the first time the use of a medicinal cannabis product aimed at patients with two rare, but severe, forms of childhood epilepsy.

Doctors can prescribe Epidyolex - an oral solution of cannabidiol, which comes from the cannabis plant - if they think it will help sufferers. It has been approved for use in the UK and other European countries, but the NHS does not currently recommend it.

Epidyolex does not contain any of the psycho-active component of cannabis, a compound called tetrahydrocannabinol (THC).

Some parents, who have travelled to the Netherlands to buy cannabis medicines, feel the treatment will not help many children because it does not contain THC, which they argue has helped their children.

Epidyolex has been approved as a treatment option for children as young as two with Lennox-Gastaut syndrome or Dravet syndrome - difficult-to-treat conditions that can cause multiple seizures a day.

The medication, developed by GW Pharmaceuticals, will be used in combination with another epilepsy medication called clobazam.

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