Harm reduction information

Alcohol and A&E

HARM REDUCTION INFORMATION

This is the same harm reduction information we use in our drug & alcohol leaflets. Please feel free to use it in your own resources or websites. Alternatively, you can buy designed and printed versions of this information from the Substance shop.

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ALCOHOL AND A VISIT TO A&E

A recent report (The report looked at adults seeking emergency care at Bristol Royal Infirmary over a four week period) suggested that one in five patients (20%) said they had drunk alcohol before coming to A&E and 14% felt their injury was related to drink. Of these, around half believed they had been injured by someone who had been drinking, while a similar proportion had consumed more than the maximum recommended weekly units that night. So, what is alcohol and how has it affected you? The information on this page will explain some of the processes which may have resulted in you ending up at A&E, explain what has happened to you during your visit, the treatment you received, and how you can prevent the same thing happening again. WHAT IS ALCOHOL? Alcohol in its many forms has been around for thousands of years and is one of the most widely used drugs in the world. It is very effective at affecting the way you feel and act. The more you drink, the more you feel the changes, and the more impact it has on your body. Alcohol comes in many different forms - beer, vodka, wine, cider, etc., but contained within them all is a chemical called Ethanol, a CNS (central nervous system) depressant that alters the amount of chemicals (neurotransmitters) your brain produces which, in turn, slows everything down. The amount of alcohol in a drink is referred to to as ABV or Alcohol By Volume (percentage). So that you can measure or count the amount of alcohol in a drink the percentage of alcohol is divided into ‘portions’ of alcohol called units. One unit of alcohol is 10 millilitres of alcohol by amount. A standard measure of wine, half a pint of standard beer or larger or a standard size shot of spirits contains one unit of alcohol. WHAT HAPPENS WHEN YOU START DRINKING ALCOHOL? Alcohol enters your bloodstream through your stomach and small intestine and is then circulated around your body. It passes through the liver where the alcohol is processed or ‘broken down’ but - and this is the important part  - your liver can only process alcohol at a steady pace. For the average person this is at the rate of about one unit (half a pint of lager or standard glass of wine or spirits) per hour. This means that if you continue to drink, your blood alcohol level will rise and this will have an increasing effect on your brain and, in turn, the way you behave and feel. HOW DID YOU END UP IN A&E? This question can be answered, in part, by the way alcohol influences your behaviour and plays a part in causing you to act and behave in an unpredictable and erratic manner. Alcohol depresses brain function and the speed at which it processes information, making it difficult to think clearly and make rational decisions. (Think about this next time you decide to have a pop at the 20 stone martial-arts-trained doorperson or put yourself in other risky situations). It does this by changing the balance of chemicals in your brain (remember neurotransmitters from earlier?). The two main chemicals affected are called GABA and Glutamate, which at the correct levels, keep your brain functioning properly and you feeling normal. Alcohol alters the levels of these chemicals and starts to affect your Central Nervous System (CNS), which controls your behaviour and coordinates all the information coming in through your senses, such as your sight and hearing. Part of the CNS controls your heart and breathing, which is slowed down (or depressed) under the influence of alcohol. If you continue to drink, this depression increases and becomes more dangerous, even life threatening. Alcohol affects different parts of the brain in different ways. In small amounts it can help you to relax and improve your sociability, but in larger amounts it causes confusion, erratic behaviour, impaired memory, vomiting, unconsciousness, coma and - possibly - death!  DIFFERENT PARTS OF THE BRAIN HAVE SPECIFIC JOBS TO DO. ALCOHOL AFFECTS THESE IN DIFFERENT WAYS. Cerebral Cortex This is where thought processing and consciousness are found. Alcohol relaxes this area making you feel less inhibited, but it also slows down the processing of information from the senses (eyes, ears and mouth) and inhibits the thought processes, making it difficult to think clearly and make rational decisions. Cerebellum This controls your movement and balance. Alcohol interferes with this, resulting in the staggering, off-balance walk we associate with being drunk. Hypothalamus and pituitary These areas control automatic brain functions and the release of hormones. Alcohol closes down nerve centres in the hypothalamus that control sexual arousal and performance. Although the desire to have sex may increase, for men the ability to maintain an erection will decrease. Medulla This area of the brain looks after your breathing, consciousness and body temperature. By relaxing the medulla, alcohol induces sleepiness, lowers body temperature, and can slow down your breathing to a point where it stops. ALCOHOL & OVERDOSE >Alcohol poisoning (overdose) is dangerous and can kill. More than 35,000 people were admitted to hospital with alcohol poisoning in England in 2010/11 (16,200 men and 19,800 women) – that’s more than 600 every week. 173 people died from accidental alcohol poisoning in England in 2010. Being able to spot the signs of alcohol poisoning, and what you should and shouldn’t do, could save a life. Signs of overdose Confusion Loss of coordination Vomiting Seizures Irregular or slow breathing (less than eight breaths a minute) Blue-tinged or pale skin Low body temperature (hypothermia) Stupor – when someone is conscious but unresponsive Unconsciousness – passing out There are lots of dangerous myths about how to deal with people who are dangerously drunk. Sometimes it is just as important to know what NOT to do. DON’T: Leave someone alone to just sleep it off. The level of alcohol in someone’s blood can still rise to dangerous levels after they have stopped drinking. Give them coffee. Alcohol dehydrates - giving them coffee will dehydrate them even more and can cause brain damage. Make them vomit. Their gag reflex won’t be working properly and they could easily choke on their vomit. Pick them up and walk them around. Alcohol suppresses brain function; they could easily slip over and injure themselves. Give them a cold shower. Alcohol lowers body temperature. A cold shower will make them colder and possibly cause hypothermia. Give them more alcohol. Their alcohol levels are already dangerously high. Any more alcohol could tip them over the edge. DO: Try to keep them awake and sitting up. If they are able to drink, give them some water. If they pass out, lie them on their side in the recovery position, and check they’re breathing properly. Keep them warm. Stay with them and monitor their symptoms. Don’t mix alcohol & drugs Mixing alcohol with some drugs will exaggerate the effects of both. some will interact and produce other toxic substances and alcohol will stop some medicines from working.  Alcohol and drugs are both processed through your liver. As it struggles to cope with both substances it can lead to elevated and dangerous levels of both substances. If you are mixing alcohol with illegal drugs, how do you know what is in the drug you are taking? What is the white powder, or the pill you have taken? Was it the same as last time or something completely different? All very unpredictable and dangerous! Let’s run through some of the most common substances Stimulants Cocaine/Speed/Ecstasy/Mephedrone Alcohol is a depressant, which means it slows down your breathing and heart rate. Cocaine, speed and ecstasy are stimulants. The depressant alcohol tries to slow down your system, whilst the stimulants try to speed it up, putting your brain and heart under a lot of pressure. In addition, combining alcohol and cocaine produces a third toxic chemical called cocaethylene, which puts additional strain on you body and can cause heart-attacks and strokes. If you have an underlying heart condition there is an increased risk. Most deaths from stimulant drugs are related to overheating and dehydration. Combined with the dehydrating effects of alcohol, the risk is increased. Depressants GHB & GBL/Heroin & methadone/tranquilisers Combining one depressant with another is doubling the risk of respiratory failure - you stop breathing!. GHB & GBL has a sedative effect, dulling your inhibitions and making you sleepy. By itself, it can cause unconsciousness, coma or death, so mixing it with alcohol is particularly dangerous. Heroin, methadone and tranquilisers (valium, librium, etc. are powerful sedatives and if you mix them with alcohol then you have a much higher risk of overdosing. Even a moderate amount of alcohol can lower the level of heroin that leads to a fatal overdose. Around three-quarters of people who die from heroin overdoses have also drunk alcohol. Prescription medicines You should always check the instructions on the pack and consult your doctor about the risks of using alcohol with prescribed medication. Antidepressants Drinking alcohol can make your depression worse, slow you down and make you feel drowsy, which is dangerous in situations where you need to be alert, such as driving, or at work. Antidepressants work by increasing the activity of neurotransmitters in the brain (the same chemicals that are affected by alcohol) and can increase the effects of both alcohol and the medication. Alcohol can  also make the side effects of your medication much worse . Monoamine oxidase inhibitor (MAOI) type antidepressants, such as phenelzine and isocarboxazid, can be very dangerous mixed with alcohol, and can cause a dangerous rise in blood pressure, causing a stroke. Tranquilisers Any tranquiliser, e.g., Valium (Diazepam), Librium, Temazepam, Nitrazepam, Lorazepam, etc., and alcohol do not mix. Both tranquilisers and alcohol are depressant drugs, so the effects are the same - slowed heart rate and breathing, low blood pressure and drowsiness. The combined effects of both can often result in overdose and can be fatal. Signs of an overdose The signs of overdose can vary, depending on the types, combinations and amounts of drugs consumed and if alcohol is involved. Someone who has overdosed may show one or more of the following symptoms.  Irregular or slow breathing (less than eight breaths a minute, or 10 seconds between each breath) Unconsciousness (can’t be woken up even if their name is called or they are shaken vigorously) Faint and irregular pulse Blue-tinged or pale skin Loss of coordination Vomiting Seizures Muscle spasm Extremes of body temperature (either very hot, but not sweating, or very cold) CALL AN AMBULANCE! If they are not responding or getting any better, don’t delay, dial 999 for an ambulance immediately! If they are unconscious place them in the recovery position (see below) so that if they vomit it will drain away and not choke them. Stay with them until the ambulance arrives, and tell the medics how much alcohol they have had, and what else they have taken. Don’t worry, you won’t get into trouble and this could save their life. If the person is conscious and panicking or hyperactive, reassure them that they will be alright if they relax and calm down. Explain what’s happening to them and what you are going to do. A&E TREATMENT  The treatment you receive during your stay at A&E varies depending on how serious your condition is and if you have just used alcohol, or alcohol in combination with other substances. When you come into A&E we assess  your condition before we make decisions regarding your treatment. This is known as ‘triage’ and help us decide if you need treating immediately or can wait. The length of your wait will depend on your condition and how busy the A&E is at the time. The kind of treatment an individual receives is decided on a case-by-case basis. In general, if your blood alcohol concentration (BAC) is at a dangerous level, we would normally attach you to a saline drip to counteract the dehydrating effects of the alcohol and to get fluids back into your system and we would also attach a monitor to check the oxygen levels in your bloodstream, in case the alcohol has slowed your breathing and heartbeat to a rate that could be life threatening. Mainly, it is just a question of time. As mentioned earlier, your liver can only breakdown alcohol at a steady rate. Once any necessary medical interventions have been carried out, we put you in the recovery position and let you sleep it off before sending you home. YOUR NEXT DRINK What’s going to happen when you have your next drink? Your visit to hospital has cost approximately £700.00 and has taken up the time and resources of ambulance staff, A&E doctors, nurses and other hospital staff. But, did it really need to happen? It’s obvious but the only way to stop this happening (apart from never drinking again) is to reduce the amount and change the way you drink. The following suggestions can help you take control of your drinking and avoid another trip to A&E. Start drinking later Delay the time you start drinking. Go to the pub an hour later than normal or, if you are having a drink at home, occupy yourself by reading a book, playing with the kids for a bit longer, or replacing your alcoholic drink with soft or low alcohol ones. The same for less Check the label on the bottle or have a look for the alcohol by volume (ABV) number on the pump. The higher the number the more alcohol the drink contains. Some continental and designer-type drinks can have high percentages of alcohol. Try to stick to standard or lower-alcohol drinks. Size does matter In the battle for your custom, pubs and clubs are trying to tempt you with more and more offer and measures are getting larger, so be careful when ordering your drink - always check what the standard measure is The difference between a small glass of wine, 125mls (1 unit), and a large glass of wine, 250ml (3 units) is considerable. One minute I was OK - then the next...! Knocking back shot after shot, getting involved in drinking games, or trying to down a pint as fast as you can, means your liver will struggle to cope with the amount of alcohol you are sending it. Your alcohol level will rapidly build up, delivering a massive dose of alcohol to your brain, knocking you for six  - one minute you were OK, and then the next... Don't forget the ‘eat’ part of ‘eat drink and be merry’ Eat something before you drink. The food in your stomach will help absorb the alcohol and release it at a steadier rate. Drinking on an empty stomach can mean you take the knock, as alcohol levels build up quickly and your system struggles to cope. Large amounts of alcohol on an empty stomach can also irritate the stomach lining, causing you to vomit. Miss a round You don’t have to have an alcoholic drink every time someone goes to the bar. Try a shandy or a soft drink. Or, as an alternative to rounds, why not have a kitty instead. Agree on the number of drinks and the amount you are going to spend - and stick to it! YOUR ALCOHOL USE Was this a one-off, or has alcohol caused you problems before? People react in different ways to alcohol. For some people alcohol can help them relax and enjoy social occasions; for others, it will damage their health and personal life. Consider the questions below about your alcohol use. Could you be developing an unhealthy relationship with alcohol? Do you find it difficult to stop drinking once you’ve started? Have you neglected work, college or school because of alcohol? Do people close to you worry about the amount you drink? Do you take risks when you’ve had a drink, such as driving a car or getting into fights? Do you drink more than five days a week and regularly drink more than nine units at each session? Do you regularly think about when you can have your next drink? Have you found it difficult to enjoy yourself or relax without alcohol? Have you ever been involved in violence when you have been drinking? If any of the above apply to you then you should consider cutting down. If you can answer ‘yes’ to a couple of these points, it might be worth your while getting a bit more help and advice. Contact any of the organisations on the back page of this booklet, or have a look at the ‘help in your area’ in this pack. It lists services and organisations in your area that can help you. Further Help and Support We hope you have found this alcohol information useful. If you feel you need extra support, consider talking to someone. Maybe a close friend, partner or a local support service. Below are some organisations that can also help you: Drinkware Drinkaware aims to increase awareness and understanding of the role of alcohol in society, enabling individuals to make informed choices about their drinking. www.drinkaware.co.uk Live well - NHS alcohol support Alcohol advice, tips and tools to help you make the best choices about your health and wellbeing nhs.uk/live-well/alcohol-support/ Talk to frank National drugs awareness site for young people and parents/carers. 24 hrs a day, seven days a week. Call 0800 77 66 00 (calls are free and confidential) www.talktofrank.com  

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Alcohol aware

Harm Reduction information

This is the same harm reduction information we use in our drug & alcohol leaflets. Please feel free to use it in your own resources or websites. Alternatively, you can buy designed and printed versions of this information from the Substance shop.

View all harm reduction information

Free to use

Just a few things to remember:

Only use for non-commercial purposes

Link to, or credit the Substance website

Let us know where you used the information

MSJ/DIAZEPAM GUIDE

MSJ (DIAZEPAM) INFORMATION The misuse of benzodiazepines (benzos/minor tranquillisers/sleeping tablets) has been steadily growing. Known as MSJs or blues, they are valium that can be obtained via the internet and distributed locally. The reason for their current popularity may have something to do with the recent heroin and ketamine droughts and the poor quality of other drugs, but probably has more to do with availability. Our sources tell us that heroin and crack users are taking benzos orally (not much injecting – yet!) but, more surprisingly, they are becoming popular amongst a whole new group - alcohol users are now supplementing booze with a fistful of blues. Although benzos have been around for decades, this new generation of users may not be fully aware of the very real problems that these drugs can bring. So we’ve decided to put together some information and harm reduction advice to warn of the risks involved. Brand Name: MSJ Diazepam
Active compound: Diazepam
10mgManufacturer: J.L. Morison Son & Jones (Ceylon) PLC is a Sri Lanka-based company. The Company, together with its subsidiaries, MSJ Industries, is engaged in the manufacture of pharmaceuticals and toiletry products, and the import and distribution of finished pharmaceuticals, toiletries, agro chemicals, medical aid, milk foods, household insecticides, shoe care, hair care products, diagnostics reagent and equipments, and other consumer products.Distributor: State Pharmaceuticals Corporation (SPC)
 What are MSJ? MSJ Diazepam: valium (MSJs, vallies, blues) Small (6mm x 1.5mm), professionally made (hard and well defined), blue pills with MSJ stamped on one side and a fracture line on the other. Available from pharmaceutical manufacturers on the internet; importers on the internet; internet user forums. Manufacturers in Sri Lanka, India, China, Thailand, South Africa, Sweden, etc. Effects Diazepam is a prescription-only medicine called a benzodiazepine. Used for their sedative, anxiety-relieving and muscle-relaxing effects. Only suitable for short-term treatment of insomnia and anxiety as it has a high potential for dependence and addiction. Diazepam is a long-acting benzodiazepine - remains active in the body for many hours, drowsiness may also last into the next day. Causes drowsiness and muscle weakness and impairs concentration and alertness. These effects may continue into the following day and are made worse by drinking alcohol. If affected avoid potentially hazardous tasks such as driving or operating machinery. Avoid alcohol. Only suitable for short-term use. If used for long periods or in high doses, tolerance and dependence may develop, and withdrawal symptoms may occur if treatment is stopped suddenly. Treatment with this medicine should be stopped gradually, following instructions given by a doctor, in order to avoid withdrawal symptoms. (from Netdoctor.co.uk) Side effects Drowsiness. Drowsiness and lightheadedness the next day. Confusion. Shaky movements and unsteady walk (ataxia). Loss of memory (amnesia). Unexpected increase in aggression (paradoxical aggression). Muscle weakness. Dizziness. Headache. Slurred speech. Tremor. Skin rashes. Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain. Difficulty in passing urine (urinary retention). Urinary incontinence. Visual disturbances such as blurred vision. Changes in sex drive. Low blood pressure (hypotension). Blood disorders Jaundice. (The side-effects listed above may not include all of the side-effects reported by the medicine's manufacturer).

Problems

to benzodiazepines (Diazepam) develops quickly.

low on their own, high when mixed with alcohol or other depressant drugs.

potential very high.

very long and uncomfortable.

can cause insomnia, panic, anxiety, confusion, sweating, tremor, irritability, convulsions.

risk of BBV transmission, tissue damage, vein collapse, thrombosis, etc., etc., etc.

Advice Do not take large amounts. But if you do, start low and slow. Do not use on your own. But if you do, let someone know and ask them to check on you. Do not use regularly/daily. Leave it for a week, give yourself a break to get over it. Otherwise you will get addicted. Do not use during pregnancy or breastfeeding. But if you do, tell your doctor. Do not drive or operate machinery - if you do, you will have an accident. Do not take the day before your driving test/go to work/school – leave it for Saturday night. Do not mix with alcohol or other sedative drugs - JUST DON’T! But if you do, look after each other. Do not inject - JUST DON’T! But if you do: don’t share, take care! Do not stop abruptly. But if you do, be prepared for withdrawals.

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MSJ/DIAZEPAM GUIDE

MSJ/DIAZEPAM GUIDE

MSJ (Diazepam) Information & Advice

September 2011

Over the past couple of years, the misuse of benzodiazepines (benzos/minor tranquillisers/sleeping tablets) has been steadily growing across the country. This is a very serious concern.

Known as MSJs or blues, they are valium that can be obtained via the internet and distributed locally. The reason for their current popularity may have something to do with the recent heroin and ketamine droughts and the poor quality of other drugs, but probably has more to do with availability.

Our sources tell us that heroin and crack users are taking benzos orally (not much injecting – yet!) but, more surprisingly, they are becoming popular amongst a whole new group - alcohol users are now supplementing booze with a fistful of blues. Although benzos have been around for decades, this new generation of users may not be fully aware of the very real problems that these drugs can bring.

So we’ve decided to put together some information and harm reduction advice to warn of the risks involved.

Brand Name: MSJ Diazepam

Active compound: Diazepam
10mg
Manufacturer: J.L. Morison Son & Jones (Ceylon) PLC is a Sri Lanka-based company.

The Company, together with its subsidiaries, MSJ Industries, is engaged in the manufacture of pharmaceuticals and toiletry products, and the import and distribution of finished pharmaceuticals, toiletries, agro chemicals, medical aid, milk foods, household insecticides, shoe care, hair care products, diagnostics reagent and equipments, and other consumer products.
Distributor: State Pharmaceuticals Corporation (SPC)


What are MSJs?
MSJ Diazepam: valium (MSJs, vallies, blues)
Small (6mm x 1.5mm), professionally made (hard and well defined), blue pills with MSJ stamped on one side and a fracture line on the other.
Selling for £1 per tablet, discounts on bulk orders.
Available from pharmaceutical manufacturers on the internet; importers on the internet; internet user forums.
Manufacturers in Sri Lanka, India, China, Thailand, South Africa, Sweden, etc.

Effects

Diazepam is a prescription-only medicine called a benzodiazepine. Used for their sedative, anxiety-relieving and muscle-relaxing effects.
Only suitable for short-term treatment of insomnia and anxiety as it has a high potential for dependence and addiction.
Diazepam is a long-acting benzodiazepine - remains active in the body for many hours, drowsiness may also last into the next day.
Causes drowsiness and muscle weakness and impairs concentration and alertness. These effects may continue into the following day and are made worse by drinking alcohol. If affected avoid potentially hazardous tasks such as driving or operating machinery. Avoid alcohol.
Only suitable for short-term use. If used for long periods or in high doses, tolerance and dependence may develop, and withdrawal symptoms may occur if treatment is stopped suddenly.
Treatment with this medicine should be stopped gradually, following instructions given by a doctor, in order to avoid withdrawal symptoms.
(from Netdoctor.co.uk)

Side effects

Drowsiness.
Drowsiness and lightheadedness the next day.
Confusion.
Shaky movements and unsteady walk (ataxia).
Loss of memory (amnesia).
Unexpected increase in aggression (paradoxical aggression).
Muscle weakness.
Dizziness.
Headache.
Slurred speech.
Tremor.
Skin rashes.
Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
Difficulty in passing urine (urinary retention).
Urinary incontinence.
Visual disturbances such as blurred vision.
Changes in sex drive.
Low blood pressure (hypotension).
Blood disorders
Jaundice.
(The side-effects listed above may not include all of the side-effects reported by the medicine's manufacturer).

Problems

Tolerance: to benzodiazepines (Diazepam) develops quickly.
Overdose potential: low on their own, high when mixed with alcohol or other depressant drugs.
Dependence: potential very high.
Withdrawal: very long and uncomfortable.
Sudden withdrawal: can cause insomnia, panic, anxiety, confusion, sweating, tremor, irritability, convulsions.
Injection: risk of BBV transmission, tissue damage, vein collapse, thrombosis, etc., etc., etc.

Advice

Do not take large amounts. But if you do, start low and slow.

Do not use on your own. But if you do, let someone know and ask them to check on you.

Do not use regularly/daily. Leave it for a week, give yourself a break to get over it. Otherwise you will get addicted.

Do not use during pregnancy or breastfeeding. But if you do, tell your doctor.

Do not drive or operate machinery - if you do, you will have an accident.

Do not take the day before your driving test/go to work/school – leave it for Saturday night.

Do not mix with alcohol or other sedative drugs - JUST DON’T! But if you do, look after each other.

Do not inject - JUST DON’T! But if you do: don’t share, take care!

Do not stop abruptly. But if you do, be prepared for withdrawals.

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MDPV

WHAT IS MDPV?
MDPV (Methylenedioxypyrovalerone), is produced using a chemical called Pyrovalerone, an illegal Class C drug, developed in the 1960s as an appetite suppressant and to combat fatigue. Pyrovalerone has been chemically altered to produce MDPV which was sold online as a research chemical before it was made illegal in July, 2010.

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COCAINE A FEW LINES

Harm Reduction information

This is the same harm reduction information we use in our drug & alcohol leaflets. Please feel free to use it in your own resources or websites. Alternatively, you can buy designed and printed versions of this information from the Substance shop.

View all harm reduction information

Free to use

Just a few things to remember:

Only use for non-commercial purposes

Link to, or credit the Substance website

Let us know where you used the information

COCAINE ADVICE - A FEW LINES

COCAINE Cocaine (Cocaine Hydrochloride) is a white powder, extracted from the leaves of the coca plant. How is cocaine used? Cocaine is normally sniffed through the nose (snorted), although it can be injected or smoked, when turned into ‘freebase’ or ‘crack cocaine’. Cocaine and the law Cocaine is categorised as Class A drug under the Misuse of Drugs Act and is illegal to have, give away or sell. Possession can get you up to seven years in jail. Supplying someone else, including your friends, can get you life and an unlimited fine. The physical effects of cocaine Cocaine makes you feel confident, exhilarated, excited and alert on the way up and can make you feel paranoid, aggressive and anxious on the way down. Physical effects include increased heartbeat and breathing faster, raised blood pressure and body temperature. The effects, when snorted, start within a few minutes and will last approximately 60 to 90 minutes The effects can depend on lots of things such as how much you use, your mood, your size, how often you have used cocaine before and what other drugs you have taken. How cocaine affects your health Cocaine increases blood pressure damaging the blood vessels close to your heart which can narrow or close down. This is not good! Cocaine can cause overheating especially if you are mixing it with other stimulant drugs, risking seizure or fit. Snorting cocaine damages the inside of your nose causing inflammation and bleeds. This can allow the passing of viruses such as Hepatitis and HIV from shared straws or bank notes, or any other snorting devices, more likely. Cocaine screws up the chemicals in your brain which affect your mood. The more you use the more you are likely to experience anxiety, depression and paranoia. Stay safe Don’t share straws or notes, this can lead to the spread of infections Make the powder as fine as possible before snorting Place your straw high up the nostril Alternate nostrils to lessen damage to one side If your nose is bleeding, take a break Take general care of the nose and use nasal spray to clean out the nose after a session. Stay in control Use less cocaine in each line and space out the time between lines Only buy what you are going to use during a session. Don’t buy ‘some for later’, ‘later’ will only become ‘now’. When you have finished a session, find something to keep you busy, that doesn’t remind you of cocaine. This could mean a different place or visiting friends that don’t use cocaine. Cocaine will reduce your need to sleep or eat, which in turn can affect your physical and mental health, try to eat a healthy diet and get enough sleep, it will make you feel better. Don’t mix cocaine with other drugs, including alcohol. This can lead to dependence on several drugs and increase your risk of overdose.

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COCAINE AWARE

WHAT IS COCAINE ?
Cocaine is stimulant drug produced from the leaves of the coca plant (Erythroxylum Coca), The majority of coca cultivation and cocaine production takes place in Columbia, Bolivia and Peru.
The leaves are mashed together with various solvents and other substances to extract the cocaine. This is turned into a white crystalline powder, the most common form of cocaine found in the UK.

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KETAMINE AWARENESS

Harm Reduction information

This is the same harm reduction information we use in our drug & alcohol leaflets. Please feel free to use it in your own resources or websites. Alternatively, you can buy designed and printed versions of this information from the Substance shop.

View all harm reduction information

Free to use

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Only use for non-commercial purposes

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KETAMINE Aware

WHAT IS KETAMINE?  Ketamine is an anaesthetic licensed for use in human and animal medicine.  The non-medical use of ketamine became popular in the UK in the early 1990s rave scene, often sold in tablet form as ecstasy.  The illicit form of ketamine normally comes as white crystals or powder. 

HOW IS KETAMINE USED? Snorted A common method in a club environment would be to dip the end of a key into the bag of powder and sniff a small amount from the tip, known as ‘keying’.  Alternatively it is chopped up into lines and snorted. Swallowed Although less common, as it takes too long to work and acts as a laxative, ketamine is sometimes wrapped in paper or tissue and swallowed, known as ‘bombing or ‘parachuting’. Smoked  This is a rare way to use ketamine as it tastes awful and wears off quickly. Injecting Usually injected into a muscle. Injecting ketamine increases the risk of overdose and the infection problems related to injecting. WHAT ARE THE PROBLEMS WITH KETAMINE The ketamine experience can vary depending on your environment, but generally, in small doses ketamine acts as a stimulant, boosting your energy levels, and making you feel high and trippy. At larger doses it can provide a mystical out-of-body-experience where you can experience hallucinations (sometimes shared), a sense of calm and serenity, distortions of time, panic, unpleasant feelings and nightmare-like experiences.  The out-of-body experience is known as being in a ‘K hole’. These feelings can last up to 90 minutes. Physical effects can include loss of control over the body, loss of coordination, difficulty speaking, moving, hearing and seeing (delirium), numbness, and nausea.  When snorted, the effects begin within a few minutes and last around 30-45 minutes, depending on how much is taken. If swallowed, the effects begin around 15-30 minutes and last for 1-3 hours. Personal safety The main problem associated with ketamine is physical helplessness experienced at high doses. Disconnection from the body can be dangerous, especially in the disorienting environment of a club or rave. This can leave the user vulnerable to accidents and assault (both physical and sexual) and having unprotected sex, increasing the risk of unplanned pregnancy and sexually transmitted infections. Physical health Bladder problems Prolonged and regular ketamine use can damage your bladder and kidneys, sometimes permanently. If you experience an increased need to urinate, passing blood, leakage of urine and pain on urination, consult your GP and let them know you use ketamine.  K-Cramps A commonly reported symptom of ketamine use is K-pains or K-cramps. The cause of these abdominal pains are, as yet, unclear, but seem to be linked to high dose use of more than a gram a day. Mental health Occasional use of ketamine (once or twice a month) is not thought to cause any long-term or irreversible damage. Persistent use, however, has been linked with a wide range of distressing psychological effects, including anxiety, panic attacks, flashbacks, persistent perceptual changes, mania, depression, insomnia, nightmares, an unpleasant feeling of being unreal or that the world is unreal, paranoia and delusions. Dependency Although not considered physically addictive, tolerance to ketamine builds up very quickly and higher doses are needed to achieve the desired effects. This can lead to problems with memory, word/name recall, reduced attention span, damage to relationships, loss of productivity, isolation, and neglecting other interests. Mixing drugs Nowadays, very few people use one drug on its own, and ketamine is no exception. Ketamine is often used, on a night out, in combination with a range of substances including alcohol (avoid!), cocaine (CK1), and the plethora of new and emerging compounds (“legal highs”) that are becoming more readily available. Obviously, mixing drugs increases the risks and should be avoided as the outcome is difficult to predict. REDUCE THE RISKS FROM USING KETAMINE The best way to avoid the risk associated with drugs is not to use drugs. But if you are considering using ketamine, the following advice will help minimise the risks to your health: Don’t take ketamine on your own. Only do it somewhere you feel safe and where you can keep an eye on each other.  Chopping the crystals/powder as fine as possible before snorting will help reduce the damage to your nose Start low and slow, take a small amount and wait. Don’t take more because you can’t feel anything when you expect it to. It could be a different substance or a different strength than last time. Be patient, give it time to work. Don’t overload yourself with different substances, learn to recognise and handle the effects.  Don’t mix ketamine with other drugs, especially depressant like alcohol, GHB/GBL, these will slow your breathing down to dangerous levels. This can lead to dependence on several drugs, and increase your risk of overdose. Don’t spark up or slip into a nice relaxing warm bath just before you are about to lose the use of your limbs. It can only end in tears  IN CONTROL If you are using ketamine follow these tips to stay in control: Only buy what you are going to use during a session. Don’t buy ‘some for later’, ‘later’ will only become ‘now’. Using any drugs can put a strain on your body and affect your physical and mental health, so try to eat a healthy diet and get enough sleep, it will make you feel better. If you start to feel agitated, confused or anxious, stop using, go and chill out somewhere quiet and take a friend to keep an eye on you Repeated ketamine use reduces the effects you feel when you first use it. You may use more to ‘chase the high’, leading to a damaging habit. Don’t use every day and space out the sessions. All drug users need to know how to react if someone overdoses. Because of the ‘sledging’ effects of ketamine, this may prove very important to know how to react. It can be difficult to be sure, with someone who has used ketamine, if they are in difficulty. But if someone’s breathing is slow and shallow and they do not respond when you try to talk to them, it is probably better to be cautious and put them in the recovery position, which is lying them on their side, so they don’t choke if they vomit, before you get help and call an ambulance. Tell the medical staff everything they have taken. It may save a life. KETAMINE and The Law At the time of publication (March 2014) in the UK, Ketamine is a class C Drug and is therefore illegal to possess or supply to others. Maximum of two years imprisonment for possession and 14 years for possession with intent to supply. Both carry the potential for an unlimited fine. 

GETTING HELP

If you feel your ketamine use is getting out of hand, the organisations below may be able to help.

0800 77 66 00. www.talktofrank.com

Helpline 0845 4500 215

If you're an organisation that engages with people who use drugs and alcohol, you can buy designed and printed versions of this information in the Substance shop.

Go to Ketamine Aware in the substance shop

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