Club drugs and the long-term impacts - tips for GPs
Club drugs, novel psychoactive substances (NPS) and 'chemsex' drugs are terms used to describe a confusing menagerie of psychoactive drugs used for recreational purposes. Little is known about them in the general health setting of general practice, hospital medicine, community clinics and general adult psychiatry.
The drugs: explained
- The most commonly used club drugs are cocaine, MDMA (ecstasy), cathinones (mephedrone amongst others) and amphetamines
- Novel psychoactive substances (NPS) include an ever expanding list of synthesised drugs used for their stimulant, sedative, hallucinogenic and cannabinoid effect. 'Spice' is the most common NPS
- The most commonly used 'chemsex' drugs are GHB/GBL, mephedrone and methamphetamines, which are used for their euphoric, sedating, disinhibiting and supposed sex-enhancing effects
Increase in use
There is an unabated increase in the prevalence and use of these kinds of drugs in the last decade; 8.6% of adults have used drugs in the past year, most commonly:
- Cocaine powder
'Hard drugs' such as heroin and crack cocaine, which typically receive the most press, only represent 0.1% of this use.
A minority of drug users may end up seeking help for their use by presenting to drug services. However, the number of individuals seeking help from drug services has still increased from 3,487 in 2011, with current-day figures reaching nearly 7,000. This of course, represents a fraction of the total use and harm, with individuals preferring to obtain information about the effects of drugs from their peers or via online forums.
NPSs have become prominent due to a variety of factors, including the increasing ability to synthesise such substances outside of a laboratory, market availability, internet supply, trends in drug use, price, their legality in the past (despite this no longer being the case) and many other factors.
Effects of stimulating versus sedating drugs
Stimulating drugs can make individuals feel awake, excited, alert, energetic, confident, sociable and even sexually aroused. However, a few hours after taking them, these drugs can result in insomnia, anxiousness, suspiciousness, hypervigilance, tiredness and lethargy.
Sedating drugs can make individuals feel 'floaty', relaxed, stuporous, 'chilled out', dissociated in time, place and person, and, worse still, unrousable and paralysed.
The risks can be even more severe if the drug use has an effect on the cardiovascular system, particularly for people with an underlying heart problem. Drug use can also be especially dangerous when drugs are mixed with other drugs or alcohol. Stimulating and sedating, as well as hallucinogenic, drugs can lead to accidents (falls, road traffic collisions, etc.), dis-inhibition and an increase in sexual risks.
As well as biological effects, drug use also results in psychological and social impacts. Social and psychological effects of drug use can often overshadow the biological risks that we primarily focus on. I continue to see patients who have experienced significant mental health problems with ongoing hallucinations, who are experiencing a distorted reality, and have emotional trauma from a 'bad trip'.
Advice for GPs
Eight areas to enquire about during consultation
During a consultation, it is important to review and consider a range of effects of substance use on your patient, in terms of their impact on:
- Relationships with family and friends
- Problems with studies and work
- Aggression and violence at home
- Trouble with the police
- Effect on children and their safeguarding
Support from loved ones
It is common for individuals using such substances to minimise their use or fail to appreciate the impact on themselves and others around them. A loved one attending the consultation is an invaluable source of collateral in helping us to shift an individual's appreciation of the problems that they are facing. Getting a patient to identify the harm that they are causing, with the help of others, is more powerful and effective in building insight than being told what the risks are. Building rapport, maintaining contact and an ongoing dialogue are therapeutically more important than trying to convince a patient of the harm their drug use is causing, especially when there are time constraints in a consultation.
Harm minimising advice for patients
When individuals take drugs in a club or party environment where their peers are also using drugs, there is a desire for everyone to feel the same effects or be on the 'same plane' at any one time. Of course, the type of drugs that are taken, the purity and individual pharmacodynamics vary from one person to the next.
In an effort to achieve an effect at the same time as others, it's easy to see how an individual in such a situation might end up double dosing ('double drop') resulting in intoxication and serious harm.
This leads us to the practical advice that we can give to our patients. Often, the goal in addiction treatment is one of abstinence, but if this evades us, we must not forget, like in any branch of medicine and health, that harm-minimisation is critical until the patient shifts in the motivational cycle.
We should recommend that our patients:
- Avoid and/or limit alcohol consumption
- Purchase a drug from a known and 'reliable' source
- Stay in a group of trusted peers and have a plan to help to get friends home if needed
- Carry condoms and practice safe sex
- Do not snort drugs off the surface of toilets, keys and other septic sources or share drug paraphernalia
- Avoid the temptation to 'double drop'
- Keep your drink close to you, drink water and juices slowly and steadily over the course of an evening, and rest between dancing
- Do not drive or use machinery when under the influence of alcohol or drugs
- Finally, prior to referring a patient on to an addictions consultant/specialist, it is important to discuss with them the harm that they are causing to their mental health, career and relationships, as well as how their use fits in with their ultimate life goals and aspirations in the coming years. This plants a seed of internal discussion in our patients' minds
Importance of early intervention
To mitigate the long-lasting behavioural, social and psychological impacts of drug use, it is very important that patients see an addictions specialist as early on in their drug use as possible. Outpatient treatment, provided at clinics such as Priory Wellbeing Centre Harley Street, offer fast and easily accessible outpatient appointments to patients.