Growing up can be tough - always under pressure from your friends and family to do the right thing - look right, sound right and behave right.

But, as a young person, what is the 'right' when it comes to drugs and alcohol - should you take that MDMA powder or neck that ecstasy pill. What's in it, how will it make you feel, what are the risks?

This page provides you with clear, non-judgemental information about some of the most commonly used legal and illegal substances, including:

• Alcohol
• Amphetamine
• Cannabis
• Cocaine
• Ecstasy
• Ketamine
• Legal Highs
• Mephedrone
• Solvents

The final section is called 'staying safe.' It includes information about mixing drugs and alcohol, feeling unwell, and looking after yourselves and your mates.

Remember, new substances are coming out all the time, make sure you do your research before you make a decision. There are numerous websites and forums out there - some bad, some good. Keep up-to-date, stay informed and stay safe.

Alcohol is a chemical called Ethanol. It is produced by brewing grains or fruits containing sugar, with water and yeast. It comes in various forms such as lager, wine, cider or vodka.

The amount of alcohol in a drink is measured in units. Different drinks have a different number of units. The number of units in a bottle or can of alcohol is printed on the label or packaging.

The effects of alcohol

• Can slow down your brain which, in small amounts, can make you feel relaxed and sociable.
• Can cause slurred speech, blurred vision, confusion, loss of coordination, and heightened emotions, the more you drink.

The problems with alcohol

• Can damage your liver, stomach, kidneys, brain, muscles, skin and bones and causes cancer.
• Can cause impotence (brewer's droop), infertility (shooting blanks), shrink the testicles, and grow breasts, in men.
• May cause loss of periods, infertility (can't have a baby), and fat redistribution, in women.
• Can cause addiction.
• Can result in unconsciousness and sometimes death, if you drink a lot very quickly.

Young people, under 16, should not drink alcohol at all as this can damage developing organs. The best advice is not to drink alcohol until you're 18.

When over 18, men & women should drink no more than 14 units a week, spread evenly across a few days with a couple of alcohol-free days.

Alcohol and the law

If you are under 18 it is against the law for you:

• To sell you alcohol or for an adult to try and buy it on your behalf.
• To buy alcohol, attempt to buy alcohol, or to be sold alcohol.
• To drink alcohol in licensed premises, with one exception - 16 and 17 year-olds accompanied by an adult can drink (but not buy) beer, wine, and cider with a table meal in a pub or restaurant.

Amphetamine sulphate is a stimulant, commonly known as 'speed', which normally comes as a grey, dirty-white or pinkish powder.

The effects of amphetamines

• Can speed up your heartbeat and breathing.
• Can also cause anxiety, paranoia, irritability, twitchiness and insomnia.

The problems with amphetamines

• Can lead to tolerance, meaning you have to take more to get the same effect.
• Excessive use can lead to psychosis (loss of contact with reality), chest pain, heart problems and high blood pressure.
• Can cause something called formication, which is the excessive itching and scratching of the skin, leading to skin infections.
• The purity of some amphetamines can be as low as 5%.

Amphetamines and the law

• Amphetamines are illegal, Class B drugs. 
• Possession of Class B drugs carries a maximum sentence of 5 years' imprisonment and a fine. 
• Supplying (selling or giving away) carries a maximum sentence of 14 years' imprisonment and a fine.

Cannabis comes from a plant called Cannabis Sativa.
Cannabis normally comes in a solid brown lump called hash (the resin scraped from the plant), or the dried flowers of the plant, known as grass, weed or Skunk.

The main chemical in cannabis is called THC (Tetra-Hydro-Cannabinol), which is the bit that makes you feel trippy. Different types of cannabis have different levels of THC.
It is normally smoked, rolled with tobacco in cigarette papers, or in a pipe or bong, but it can also be eaten.

The effects of cannabis

• Cannabis can make you feel relaxed, trippy, talkative and giggly.
• It can make you feel tired, lazy and sleepy.
• Can make colours, music and taste seem more intense.

The problems with Cannabis

• Cannabis can cause paranoia, anxiety and panic attacks.
• In some people, cannabis can bring on mental health problems.
• The earlier you start smoking cannabis, the more likely you are to have problems with it.
• Can cause lung damage if smoked.
• Cannabis become a habit and lead to a lack of motivation and problems concentrating at school or work.

Cannabis and the law

• Cannabis is an illegal, Class B drug.
• It is illegal to have, sell, grow or give away.
• If you are under-18 and caught with cannabis your parents or guardian will be contacted, you could get a reprimand and possibly a referral to a Youth Offending Team.
• If you are over-18, a first-time offence will usually get you a 'cannabis warning,' a second offence will get you an on-the-spot fine, and a third offence will result in prosecution and a criminal record.

There are products which claim to have the same effects as cannabis (Spice, Black Mamba, etc.), but these can also be harmful and are illegal under the Psychoactive Substances Act 2016.

Cocaine is a substance obtained from the leaves of the coca plant.

It normally comes in a white powder form. The purity of cocaine can vary greatly throughout the UK, from between 15-55%.

The effects of cocaine

• Can cause an energy rush, and feelings of exhilaration, confidence and wellbeing.
• Can also cause effects like edginess, paranoia, anxiety and shaking.

The problems with cocaine

• Cocaine is normally snorted through a rolled-up note or straw. The cocaine and the chemicals it is mixed with are acid and can burn or damage your nose.
• The note or straw you use may have been up others peoples' noses and can be covered in snot, viruses and germs.
• The initial effects of cocaine only last between 15 and 30 minutes. Using again and again to achieve the same effect can lead to tolerance, where you have to use more and more to get the same buzz further down the line, addiction.
• Cocaine increase blood pressure, heart rate and body temperature.
• Using cocaine increases the risk of stroke or a heart attack.

Cocaine and the law

• Cocaine is an illegal, Class A drug.
• Possession of Class A drugs carries a maximum sentence of 7 years imprisonment and/a fine.
• Supplying (selling or giving away) carries a maximum sentence of life imprisonment and a fine.

 

MDMA usually comes in tablet form, known as 'ecstasy', or powder, known as 'MDMA powder.'

Tablets come in various shapes and colours. MDMA powder usually comes in white or off-white crystals or powder.

Remember, not all tablets claiming to be ecstasy or powder claiming to be MDMA, actually contain any real MDMA.

The effects of ecstasy

• Can cause an initial rush, jaw clenching, nausea, and nervousness.
• Can increase energy levels and give a warm 'loved-up' huggy feeling.
• Can cause sounds, colours, and feelings to be more intense.

The problems with ecstasy

• Ecstasy can cause you to overheat, particularly if you are jumping up and down (sometimes called dancing!) in a nightclub and don't drink enough liquid, take a break, or get some fresh air.
• Ecstasy causes your body to retain water (you can't pee!) which alters your body's chemical balance.
• If you also drink a lot of water, this can cause your brain to swell.
• Deaths from ecstasy have often been caused by drinking either not enough or too much water.
• Your body needs about a pint of fluid - water, isotonic drink or fruit juice - an hour, to function properly in a hot environment.
• Ecstasy normally takes half an hour to an hour to start working but can take longer. Being impatient and taking more can increase the dangers.
  The comedown from ecstasy can leave you feeling tired and depressed for a few days afterwards.

Ecstasy and the law

• Ecstasy is an illegal, class A drug.
• Possession of Class A drugs carries a maximum sentence of 7 years imprisonment and/or a fine.
• Supplying (selling or giving away) carries a maximum sentence of life imprisonment and a fine.

Ketamine is an anaesthetic that comes in the form of a clear liquid, tablets, or powder ranging in colour from off-white to light brown.

The effects of Ketamine

• The effects of Ketamine vary depending on your environment. In small doses it normally acts as a stimulant, boosting your energy levels, and making you feel high and trippy.
• Larger doses can cause a strange 'out-of-body' effect, with hallucinations, feelings of calm and serenity, distorted reality, panic attacks, unpleasant feelings and fear.
• These feelings can last up to 90 minutes.
• The out-of-body experience is known as being in a 'K hole'.
  Physical effects can include loss of control over your body, loss of coordination, difficulty speaking, moving, hearing and seeing (delirium), numbness and nausea. 

The problems with Ketamine

Obviously, if you are having an out-of-body experience and can't move your arms and legs, then you're particularly at risk, especially in unfamiliar surroundings.

Because Ketamine is an anaesthetic and numbs your body, you can't feel pain as much as you would normally, so you can injure yourself without realising.

• Regularly using a lot of Ketamine can cause serious bladder problems, with severe pain and difficulty peeing.
• Too much Ketamine can affect your breathing, leading to unconsciousness or heart failure.
• Ketamine can be addictive.

Ketamine and the law

• Ketamine is an illegal, Class C drug.
• Possession of Class C drugs carries a maximum sentence of 2 years imprisonment and/or fine.
• Supplying (selling or giving away) carries a maximum sentence of 14 years imprisonment and a fine.

Mephedrone (4-Methylmethcathinone) also known as Meph, Meow Meow, M-Cat, is a synthetic chemical, similar to amphetamines.

Usually an off-white powder. Normally found in tablets or capsules. It can have a sharp chemical or fishy/bleachy smell.

Effects of Mephedrone

• Feelings of wellbeing,
• alertness,
• increased confidence and becoming more talkative.

Adverse effects of Mephedrone

• Increased heart rate.
• Palpitations, heavy sweating.
• Blurred vision.
• Hot flushes.
• Irregular heartbeat.
• Nausea, and muscle tension, especially in the face and jaw.

The main after-effects are tiredness, feeling dizzy and feeling low.

The problem with Mephedrone

• Can be mixed with unknown substances.
• Damage to the nose through snorting.
• Anxiety, panic attacks and agitation.
• Raised blood pressure, which can lead to heart problems and strokes.

Stimulants can cause you to overheat, especially if you are bouncing around in a nightclub.

There isn't enough information around at the moment to predict if Mephedrone is addictive or will cause long-term damage to your health.

Mephedrone and the law

• Mephedrone and other cathinone-based substances are illegal to possess, supply or produce.
• It is a class B drug.
• Possession could get you up to 5 years in jail and a fine.
• Supplying (even giving it away) gets up to 14 years in jail and a fine.

New psychoactive substances (NPS) - formely know as legal highs

In 2016 the Government brought in a new law, the Psychoactive Substances Act, which made all drugs formerly known as 'legal highs' illegal to produce, import or supply. Legal highs used to be sold in head shops or from websites and were packaged in shiny colourful bags.

They had names like Spice, Mexxy, Benzo etc. They claimed to be 'legal' things like bath salts, research chemicals or plant food and were claimed to have the same effects of illegal drugs like cannabis, cocaine and ecstasy.

NPS and the law

It is not illegal to possess a psychoactive substance unless you are in custody, a prison or a young offender institution. It is illegal to possess a psychoactive substance if you intend to supply it to others, or if the substance is covered under the Misuse of Drugs Act.

For possession of a psychoactive substance in a custodial institution, the maximum sentence is 2 years. For other offences, such as production and possession with intent to supply, the maximum sentence is 7 years.

Remember, supply can mean giving them to a mate, and importing can mean ordering them from the internet.

Some drugs that started out as legal highs, like Spice, are now illegal under the Misuse of Drugs Act. Spice is a Class B drug, so having it in your possession will get you into trouble. Although maximum sentences are rarely used, possessing Spice can lead to a maximum sentence of five years. If you are convicted of possession with intent to supply, you could add another 9 years on top of that.

The bottom line is - most drugs that are intended to get you high can also get you into bother with the law.

Solvents come in many forms, such as household products like glues, lighter fluid and aerosol sprays, and are normally inhaled.

The effects of solvents

• Can cause intoxication (feeling very drunk), dizziness and drowsiness.
• Can cause sickness and vomiting.
• Can lead to aggressive and risky behaviour.

The problems with solvents

• Can cause your heart to beat irregularly or stop, even on first-time use. This can happen whether they are sniffed from a bag, an aerosol or sprayed into your mouth.
• Can cause loss of consciousness. If you use solvents in a dangerous location or place your head inside a bag, there is the added danger of having an accident or suffocating.
• Can cause burning or a rash around your mouth and nose.

Solvents and the law

• It is illegal to supply solvents to persons under the age of 18 if the supplier knows or suspects the product will be sniffed.

The best way to stay safe and avoid the risks of using drugs and alcohol is not to use them at all, but if you intend to, then the information on this page will help you and your friends have as safe a night out as possible.

Pre-loading

A few drinks with your mate to loosen up as you get ready to go out can turn into a session. You are two and a half times more likely to get into a fight or have an accident than people who only start drinking when they go out.

Mixing drugs and alcohol

Using drugs is risky in itself, but mixing them with alcohol can make the effects of both very unpredictable and dangerous. Alcohol dehydrates you so mixing it with other drugs that do the same, like cocaine, ecstasy or Mephedrone, or some of the legal highs can be very risky.

Pace yourself

It can be tempting, on a night out, to get as hammered as possible, as quickly as possible. This is going to ruin your night! Try to pace yourself. Don't drink on an empty stomach. Have a soft drink or water. You don't have to have an alcoholic drink at every round. Drink lower alcoholic drinks, or drink slower. Sip your drink and then put it down somewhere you can keep an eye on it, holding your drink will mean you drink faster.

Don't take more drugs because you think the ones you have taken are not working. The effects of drugs can vary for lots of reasons, such as the way you feel, where you are, how much you have taken.

Or there may be different amounts of the drug in the substance you have taken. It may even be a completely different substance. Taking more could mean you overdose. Be patient, pace yourself!

Violence

Alcohol and drugs reduce our ability to think straight. If you are someone who loses their temper easily, alcohol and drugs can make things worse. If you are on the receiving end of someone giving you grief, walk away. It can be hard to lose face in front of other people, but it has got to be better than being the victim of a serious assault or being locked up for giving someone else a hiding.

Sex

Alcohol and drugs increase your self-confidence and make it easier to approach someone you fancy, but if you've been using drugs or alcohol, you can end up going further than you intended.

If you intend to have sex, use a condom. Having sex without a condom can leave you open to sexually transmitted infections (STI's) and unplanned pregnancies. If you are worried, you might have an STI, visit your GP, walk-in centre or visit the GUM clinic at your local hospital

Women can get oral emergency contraception from their GP, Walk-in-centre and most pharmacies. This can be taken 72 hours after unprotected sex and is available to anyone over 16 years of age.

Don't flash your valuables

Don't flash your expensive phone around; it could end up stolen. Buy a cheap phone to use when you are going out. Make sure it has credit and is fully charged.

If you are drawing cash from a machine, be aware of who is around and don't let anyone distract you, shield your pin and put your money away quickly. Use a machine in a well-lit public area.

Keep an eye on your drink

Never accept drinks from a stranger or someone you don't trust. These could be spiked.

Looking after yourself and your mates

If you are going to leave the club or pub with someone you have just met, make sure your friends know what you are doing and where you are going, maybe you could take a pic of your new friend and text it to your friends. If a friend is telling you where they are going and who with, listen to what they are saying.

Feeling unwell

If someone goes too far and starts to feel unwell, take them somewhere quiet and cool. Keep them sitting up and awake, give them water if they're able to drink. If you are unable to wake them and their breathing is erratic, lie them on their side in the recovery position and get medical help.

Getting home safely

Have a plan of how you are going to get home after a night out.

Try to pre-book and pay for a taxi to take you home from a pre-arranged location. Use this location as a meeting point if you get split up from your friends.

If you do end up walking home alone, be aware of your surroundings, stay on well-lit public roads, don't be tempted to take the short-cut across the dark, deserted park because you can't wait to crash into bed.

You can buy printed versions of this information, and other drug and alcohol resources in the Substance shop

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methylmethcathinone - 4-MMC - 4-methylephedrone - Meeow! Meeow!

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If you are using, or thinking of trying, mephedrone this guide will help you understand what is known (so far) about it, describe how it is used, the effects and potential risks, and highlight harm reduction advice.

Mephedrone is known by many names. Its chemical names are 4-methylmethcathinone (sometimes shortened to 4-MMC) and 4-methylephedrone, hence the shortened version ‘mephedrone’. Over the past few years it has been sold by the names M-CAT, Bubble, Magic, Plant Food, amongst a long list of product names.

Usually a white powder commonly sold in gram bags, it is a short-acting, stimulant-type drug with effects similar to cocaine and amphetamines, so any problems attached to its use will be similar too.

After “killer drug” style headlines in 2009 it was made illegal in 2010. Despite this, mephedrone is now established as one of the most popular illegal drugs, on a par with ecstasy and cocaine. But mephedrone is only the tip of the iceberg. Underground chemists have hundreds of new compounds lined up for manufacture and new drugs are being identified at the rate of one a week.

WHERE DID IT COME FROM?

Mephedrone is a synthetic (man-made) chemical modelled on the natural stimulant drug cathinone, which is found in the plant ‘Khat’. 

The leaves of the Khat plant have been chewed by people in East Africa (mainly Somalia and Ethiopia) for centuries. Chewing Khat leaves has a similar effect to caffeine (coffee) and is used as mild social stimulant. In the UK, possession of the Khat plant itself or its leaves is not illegal, you can buy it in some African food shops, but the chemical it contains, cathinone, is banned.

The first European synthesis of mephedrone was recorded in 1929, but it remained an obscure chemical compound up until 2003 when it was rediscovered by an underground chemist and publicised on the internet. From these early and enthusiastic postings on discussion forums, interest in mephedrone grew and it eventually became available to buy over the internet in 2007.

At that time the quality of both cocaine and ecstasy was dubious, to say the least: cocaine purity had dropped from 60% in 1999 to 22% in 2009; and almost all the ecstasy pills tested in 2010 contained no active ingredient, MDMA, but were made up of other substances including mephedrone. Consequently, the UK drugs market was primed for a new, cheap and, most importantly, legal alternative.

Mephedrone is one of a family of compounds known as Beta-Ketones that also include Methylone and Methylenedioxypyrovalerone (MDPV). As these are synthetic relatives of cathinone they weren’t covered by existing laws at the time so they were sold as so called ‘legal highs’.

It is thought that much of the mephedrone available in the UK today is manufactured in India or China (although it is now illegal there), bought from internet sites and shipped by post. When it was legal, in January 2010, one kilo of mephedrone from China cost £2,500 which, when sold for £10 a gram, made a profit of £7,500. When it was made illegal in the UK in March 2010 the wholesale price jumped to £4,000 a kilo, retail prices for a gram doubled, and it was more likely to be cut with other powders (caffeine, glucose, monosodium glutamate, etc.) or mixed with other drugs. 

WHAT IT LOOKS LIKE

As mephedrone usually comes in the form of a white powder, it is difficult to tell it apart from other ‘white powders’ sold as legal highs. 

And here’s the problem - there is no way of knowing for sure what is in the white powder bought from online suppliers, street dealers or even friends - you’ve got to believe what they tell you! There is also no way of telling that the ‘mephedrone’ bought from a trusted supplier last week is the same product on offer this week.

In South Wales in 2012 a mixture of mephedrone and ketamine was being sold as a cocktail called ‘kit-kat’, whilst in other areas of the UK it has been reported that crystal methamphetamine is being passed off as mephedrone. it is a case of ‘you pays your money and you takes your chance’ because there really is no way of knowing what it is!

Slow & Low

If your going to use Mephedrone take a small amount and wait. 

Don’t take more because you can’t feel anything happening after half an hour or so. Yes, it could be some blag white powder, or even a completely different substance, but how do

you know? 

Give it time to start. Taking too much too soon could put you on a bad one. 

Learn to recognise, and handle, the effects

HOW IT WORKS

Stimulant-type drugs like mephedrone cause a sudden release of brain chemicals (neurotransmitters). 

These include noradrenaline (which gives you the rush), dopamine (which gives you the euphoria) and serotonin (which gives you the loved-up feelings). However, as mephedrone is a short-acting drug, it also causes a sharp decrease in these chemicals and the effects wear off quickly.

As it comes on fast but wears off quickly this causes the urge to take more, or re-dose, that many users describe. This, in turn, sets up a pattern of compulsive use that may lead you to take more than you originally intended.

EFFECTS

Users report a definite feeling of ‘coming up’ or ‘rushes’, as the drug starts to work. 

The main effects include alert, a sense of calm wellbeing, excitement, energy, elevated mood and feeling sociable and talkative.

Common unpleasant side-effects

Unwanted effects include dry mouth, teeth grinding, reduced appetite, poor concentration and short-term memory, increased heart rate, increased body temperature, palpitations of the heart, anxiety, depression, sweating, and pupil dilation.

REDUCE THE HARM

Cutting down on the amount you take and cutting back on the times you take it will help reduce unpleasant side-effects and other risks.

Mephedrone can seriously dehydrate you. Make sure you keep your fluids topped up - sip water, fruit juice or, better still, isotonic sports drinks as these help replace the vital salts and minerals lost through sweating.

Mixing mephedrone with other drugs also increases the risks. Drinking alcohol and taking mephedrone can cause confusion and aggressive, erratic behaviour. Taking other stimulant-type drugs at the same time as mephedrone can increase the risks of dehydration and heatstroke, which could prove fatal.

The comedown can leave you feeling miserable, tired and drained but unable to sleep, and wanting to take more. These feelings can last well into the next day. So look after yourself through the week, eat and sleep well, get plenty of exercise to build stamina and resilience. Plan for the comedown, take the next day off, stay in bed, eat & drink (but no alcohol!), watch TV, just slob out or go for a refreshing walk and the bad feelings will soon be gone.

Mephedrone has been confirmed as causing or contributing to the deaths of 42 people (so far). So it’s clear that mephedrone can kill. Heatstroke may be a contributing factor, so stay hydrated and keep cool.

SWALLOWING

The powder could be wrapped in a cigarette paper and swallowed (bombed), or dissolved into a drink. Capsules or tablets are usually swallowed.

How much?

Users say an effective oral dose is around 150mg, it comes on within about half an hour and lasts for 2-3 hours. Swallowing is possibly the least harmful way to take it, but if you take lots of it you risk damaging your stomach.

Reducing the harm

Drink plenty of water to dissolve it fully and help flush it through your system.

SNORTING

The powder can be snorted but it is reported to be very unpleasant, causing a burning sensation and nosebleeds.

How much?

Users say an effective snorting dose is around 50mgs, it comes on within a few minutes and lasts about an hour.

Reducing the harm

Mephedrone can damage the skin in the nose and nasal passages, causing inflammation, pain and nosebleeds. Washing your nose out with warm water between lines, or at least at the end of a session, will help reduce the damage.

SMOKING

Mephedrone melts at around 670c which is much lower than the direct heat generated by a match, lighter or joint. 

To release the vapour without burning the drug, indirect heat needs to be applied, usually on tinfoil or in a glass pipe.

How much?

Users say an effective dose is around 50mgs, it comes on within seconds but only lasts about half an hour.

Reducing the harm

The more you smoke the faster it comes on and wears off and you will want to take more to keep the buzz going. So have a look at the time when you take it and don’t have another hit for half an hour.

LONG-TERM HARM

As it is such a recent addition to the drug scene no long-term studies have been conducted. 

Many users report a strong desire to continue taking it (craving) so it is possible that mephedrone could be psychologically addictive, on a par with cocaine and crack. 

It may be too early to say whether it is physically addictive or not.  

We don’t know if mephedrone can cause specific damage to your heart, liver, brain or central nervous system.

Basically, it’s not yet known what long-term harm might be caused by mephedrone. The only way to avoid the potential risks is not to use mephedrone.

 

FURTHER HELP AND SUPPORT

FRANK

www.talktofrank.com
Helpline 0800 77 66 00

Call 24 hours a day, 365 days a year, FRANK is around to give you FREE info on drugs

RELEASE www.release.org.uk
Helpline 0845 4500 215

Release is the national centre of expertise on drugs and drugs law – providing free and confidential specialist advice to the public and professionals.

EROWID

www.erowid.org

Erowid is a member-supported organization providing access to reliable, non-judgmental information about psychoactive plants, chemicals, and related issues.

URBAN 75

www.urban75.com

A resource for people who want  to access drug  information and make their own, informed decisions.  

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

DRD Co-ordinator (Aberdeenshire)

Life+

What is ketamine?

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Ketamine is a general anaesthetic normally used on animals as a painkiller, but which also has hallucinogenic qualities.

Does it have any other names?

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Common street names for ketamine include ‘K’ and ‘Ket’, but you might know it as something else depending on where you live.

What does it look like?

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Medical-use ketamine comes in liquid form, but the stuff that’s used illegally has been dried out and typically comes as white or off-white powder. In this form, it can look a bit like cocaine. Occasionally, you can get it as a tablet.

How is it used?

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As a liquid (usually for medical use), it’s injected. The powder is snorted or wrapped in cigarette papers and swallowed (bombed).

What’s the law on Ketamine?

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In the UK, ketamine is a Class B drug. A sentence for possession comes with a maximum of five years in prison, an unlimited fine, or both. Supply or production of the drug can result in a maximum of 14 years in prison, an unlimited fine, or both. However, local police forces will have their own approach to dealing with personal possession. Medical use is legal with a prescription. 

How does it make you feel?

---

As with all drugs, its effects depend on how much you’ve taken, how you’re feeling at the time, if you’ve taken any other drugs, etc.

When snorted, the effects will start within five to ten minutes with a speedy rush-like feeling, and last between one and two hours. With small amounts, people report feeling dreamy, as if they’re having an out-of-body experience. With larger amounts, the effects become stronger and can turn into a full-blown hallucinogenic trip, sometimes known as a K-hole. You might find it difficult to move your arms and legs, patterns may look like they’re moving, colours might shift and change and you might have a synesthetic experience where you feel like you ‘see’ music. Some users feel spiritually uplifted, others find it quite scary. Ketamine’s trippy effects can be more full-on than LSD or magic mushrooms.

What are the risks?

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• Larger amounts of ketamine can leave you so out of it that your coordination goes and you can’t move. That’s not a good way to be in the middle of a club as it makes you vulnerable. Bring a friend along who can keep an eye on you when you’re using ketamine.
• Ketamine is an anesthetic, which means you’re less likely to feel any pain and may not know if you’ve injured yourself.
• The effects of ketamine are unpredictable and are particularly dangerous when mixed with other drugs, including alcohol.
• There’s increasing evidence that ketamine can damage the bladder. If you experience an increased need to urinate, find you’re passing blood in your urine (wee, piss), are leaking urine or are in pain when you urinate, consult your GP and let them know you use ketamine.
• You can quickly build up a tolerance to ketamine, which means you need to take more to get the same effects. That makes it very habit-forming and can have a very bad effect on your wallet, body and mind.

You can buy printed versions of this information in the Substance shop

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Engaging with problem Ketamine users

The use of ketamine has been on the increase in the past few years, particularly on the gay clubbing scene. Although not included in the British Crime Survey (BCS) until 2006/7, when it was made illegal, the proportion of 16-24 year-olds reporting using it ever in their lifetime has gone from 1.3% in 2006 to 2% in 2009/10. Although this may not sound a lot statistically, it equates to around 113,000 persons having used it at some time.

Although most use it for recreational purposes (occasionally, in the context of a night out clubbing) with few problems, anecdotal evidence from outreach workers in several areas is emerging which does give cause for concern. Some ketamine users have developed more chaotic, daily, even dependent patterns of consumption with a range of negative and unwanted side-effects.

What is ketamine

Ketamine is an anaesthetic drug with dissociative properties. First developed in the1960s, it was routinely used in surgery up until the 1980s. Because of its speed of action and safety (unlike traditional anaesthetics it does not affect breathing) it was recommended for use on the very young and the elderly.

Ketamine seems to have the unusual capacity to disconnect the physical being from the psychic self, which some describe as an ‘out-of-body’ experience. This was often interpreted as a near-death experience, although patients were in no physical danger as overdose is very rare. Because of this, ketamine is more commonly used in severe trauma cases, such as burns or traffic accidents.

Although ketamine is not used as a primary anaesthetic in humans it is more widely used in veterinary surgery, which is probably where the popular ‘horse tranquilliser’ misnomer has arisen. As a marketing ploy, something that could knock out a horse sounds like a winner for dealers. Even though it is mainly used on a wide range of small animals, ‘hamster tranquilliser’ just doesn’t have the same ring to it.

Non-medical use of ketamine

The non-medical use of ketamine became popular in the UK in the early 1990s rave scene, often sold in tablet form as ecstasy. These days ketamine is usually sold as ketamine and comes as a white powder that can be snorted (most common), swallowed (less common as it takes too long to work and acts as a laxative!), smoked (rare, as it tastes awful and wears off too quickly) or injected (very rare and not recommended).

When snorted, the effects begin within a few minutes and last around 30-45 minutes, depending on how much is taken. A common method in a club would be to dip the end of a key into the bag of powder and sniff a small amount (around 200mg) from the tip, known as ‘keying’. This short duration of action leads to re-dosing at regular intervals throughout the night. If swallowed, the effects begin around 15-30 minutes and last for 1-3 hours.

What are the effects of ketamine?

Despite what many users feel, ketamine is not a depressant-type drug and does not slow the heart. In fact, at anaesthetic doses it is a powerful stimulant that increases heart rate. However, at low doses the subjective effects of ketamine are experienced as a slowing down and heaviness of the body, what used to be known as ‘sledging’.

Sought after mental effects include a trance-like state, disconnection from the reality, feelings of floating or flying, and visual (sometimes shared) hallucinations. The ketamine experience is very dependent on the environment within which it is taken. Taken at low doses in a club or rave where there is loud music, lighting effects and the buzz of the crowd, it can be stimulating with increased energy and euphoria.

Consumed in a quiet, relaxed setting, at home with friends, users say it can provide a transcendental, spiritual experience, with apparent travel to other worlds and places (the ‘out-of-body’ experience), a welling up of long-forgotten (or suppressed) memories, apparent insight into the nature of existence, distortion of time, and the belief that one has died and been re-born. There can also be panic and very unpleasant feelings and nightmare-like experiences.

Physical effects can include loss of control over the body, loss of coordination, difficulty speaking, moving, hearing and seeing (delirium), numbness, and nausea. Ketamine has been described as ‘psychedelic heroin’ and ‘L.A. coke’, emphasising the mixed and complex nature of the effects.

Short-term side-effects of Ketamine

• Increase in heart rate
• Slurred speech
• Confusion, disorientation
• Out-of-body experience
• Shifts in perception of reality
• Nausea
• Cardiovascular effects, including hypertension and tachycardia
• Respiratory depression
• Hypersalivation
• Pleasant mental and/or body high
• Increase in energy
• Euphoria
• Sense of calm and serenity
• Meaningful spiritual experiences
• Enhanced sense of connection with the world (beings or objects)
• Distortion or loss of sensory perceptions (common)
• Open- and closed-eye visual hallucinations (common)
• Dissociation of mind from body
• Analgesia, numbness
• Ataxia (loss of motor coordination)
• Significant change in perception of time

What are the problems?

The main problem associated with ketamine is physical helplessness as disconnection from the body can be dangerous, especially in the disorienting environment of a club or rave. This is similar, in many ways, to being extremely drunk in a public place where accidents are more likely. This can leave the user vulnerable to assault (both physical and sexual) and having unprotected sex, increasing the risk of unplanned pregnancy, sexually transmitted infections (STIs) like gonorrhoea, and blood-borne viruses (BBVs) such as hepatitis and HIV.

Fatal overdose is extremely rare as the upper limit for safe use in medicine is very high. What is more likely is that the user would pass out before reaching a fatal dose, which is dangerous in itself. Unconsciousness is an emergency situation and should be treated as such.

Mixing ketamine with other 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. There is also the added risk that ketamine is contaminated with other substances (such as nitazenes) without the users knowledge. Most illegal drugs these days are contaminated with other substances. Obviously, mixing drugs increases the risks and should be avoided as the outcome is difficult to predict.

Addiction to ketamine

Although not considered physically addictive, tolerance to ketamine builds up very quickly and higher doses are needed to achieve the desired effects. As mentioned earlier, some users are getting into patterns of compulsive binges. This can lead to problems with memory, word/name recall, reduced attention span, damage to relationships, loss of productivity, isolation, and neglecting other interests. Despite evidence of harm the compulsive user often finds it difficult to cut down, all the hallmarks of dependence.

Long-term use of ketamine

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, post-traumatic stress disorder, persistent perceptual changes, mania, depression, suicidal thoughts, insomnia, nightmares, night terrors, an unpleasant feeling of being unreal or that the world is unreal, paranoia, grandiose delusions, and fragmentation of the personality.

Ketamine bladder

There is evidence of some physical damage caused by excessive use, particularly to the bladder and urinary tract. One study linked urinary tract disease with ketamine as users reported a range of symptoms associated with ulcerative cystitis, including an increased need to urinate, passing blood in urine, leakage of urine and pain on urination. It is thought that these may be associated with scarring and shrinking of the bladder which, if use continues, could go on to cause irreversible damage and harm the kidneys.

Another, more commonly reported symptom 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.

Ketamine is illegal. Under the Misuse of Drugs Act (1971) it is a Class C drug. The maximum penalty for possession is two years in jail plus an unlimited fine. The maximum penalty for supplying to another person (dealing or giving away) is 14 years imprisonment plus an unlimited fine.

 

How you can help

The law

Let’s take that last point first. Ketamine is illegal. If the client wants to avoid the risk of arrest, prosecution, fine, jail or a criminal record – don’t go near ketamine. Simple. All ketamine users should be made aware of the legal risks they run.

Engagement

It is quite likely that mainstream drug services will not see ketamine users presenting for help. This is due, in part, to services being set up to deal with other drugs and are not geared towards the needs of ketamine users. This will also be the perception of ketamine users who don’t see themselves in the same league as heroin or crack users and may feel unwilling to attend such a service.

Contact is more likely to be made through advertising, in the appropriate places, your agency as a more broad-based service, ready and willing to support all forms of drug user. It is not the drug that is important but the behaviour. If you can get this across you may attract a more diverse clientele.

Even more effective will be outreach workers who can get to know ketamine users on their own terms. This approach has proved useful in many areas and helps to provide a bridge into mainstream provision. Outreach workers can also act as an early warning system, picking up on new trends developing in the community before individuals arrive on your doorstep needing help.

If you don’t currently have an outreach team, get one.

Education

Making ketamine users aware of the potential risks, particularly when mixed with other drugs, and ways of reducing harm is vital. How this information is put across will also determine the uptake of the service. Unrealistic, scaremongering will put people off, whereas honest, non-sensational, culturally attuned awareness raising will engage more effectively.

But, to be effective, it’s the credibility of the sender rather than the message itself that is often more important. If your agency has a user-friendly, non-punitive reputation in the community then individuals will feel more comfortable about coming forward. This is where outreach, again, can prove useful. Outreach workers can gain the trust of clients and explain what your service has to offer, as well as providing advice and information at the point of contact.

Vulnerability

Friends shouldn’t need reminding that, on a night out, they must look after each other. Even so, it’s worth reinforcing the message that if someone is really out of it they are vulnerable to all kinds of danger.

So make a plan before going out – stick together, agree meeting places if you get separated, before you go out order a taxi to pick you all up afterwards, make sure everyone has got each other’s phone numbers, try to keep tabs on who has taken what and how much. If someone is really out of it they should never be left alone or put in a taxi to be taken home on their own. They may not be in a fit state to make rational decisions, so they should not go off with their new ‘best friends’.

This may sound improbable, and boring, but if it’s not discussed no-one will think about it.

Collapse and unconsciousness

All drug users need to know how to react if someone collapses and this is important knowledge that you can pass on. Because of the ‘sledging’ effects of ketamine, this may prove very important.

Simple First Aid techniques (recovery position, stay with them + call an ambulance), applied at the point of need, saves a lot of bother. If you don’t currently teach First Aid to your clients, see about setting something up.

Compulsive use

Remember, it’s the behaviour not the drug. Some ketamine users find the escape from reality is a relief from feelings or memories they can’t control, in the same way that users of heroin, for example, find solace in the numbness that drug brings. Clients who feel they can’t control their ketamine use are no different from the alcohol or heroin user who feels they can’t control their use either. An experienced worker will know where to use a brief intervention, how to assess need, or when to suggest more in-depth interventions such as CBT or MI.

Brief interventions, such as quantifying consumption, exploring the pros and cons of using or keeping a diary of use, has been shown to be very effective in reducing alcohol consumption. It has been used successfully with other drugs, so why not ketamine? Helping a client to define their frequency and level of use, and the gains to be made by cutting down, can help to break up patterns of consumption.

Cognitive Behavioural Therapy (CBT) has been used successfully in helping clients understand their motivation to use other drugs and could be equally applied to ketamine. Understanding how patterns of behaviour develop, identifying cues and triggers that stimulate the desire to use, and devising strategies to cope with high-risk situations can all help to bring about change.

And change is the goal. If a client is concerned enough about some aspects of their ketamine use, a Motivational Interviewing (MI) approach can help to identify how change can be incorporated into behaviour. Maintaining that change over time will help move the client through the process and into a less harmful situation.

Mental health

Ketamine has profound psychological effects. It can take the user to some very strange places inside their own head. If they do have unpleasant or suppressed memories, or do have an underlying or overt mental health issue then ketamine could exacerbate these. If the client does have a bad experience they should stop using ketamine immediately. If something has come to the surface that won’t go away, they should seek help from their GP.

Most people who have a bad, transitory ketamine experience will return to normal and will have learned an important lesson - Ketamine is an interesting place to visit, but you wouldn’t want to live there. For many, this will help them re-evaluate the desire for a trip to the dark side and possibly deter them in future.

Physical health

Most of the physical problems associated with ketamine are due to accidents whilst under the influence. At high doses, numbness in the extremities (mainly fingers and toes) is not unusual, but this might mask a broken bone that does not become apparent until the ketamine wears off. Looking after each other when on a night out is good advice, but if everyone’s in the K-hole it’s not much use. In the event of an accident or fall, making others (bar staff, security, First Aiders, etc.) aware that ketamine has been used could help avoid major injuries going unnoticed.

As stated above, some heavy users of ketamine have developed bladder problems. If any of the symptoms outlined above are experienced, it makes good sense to stop using ketamine altogether and seek medical advice. As for K-cramps, even though the exact cause is unclear it has been suggested that Tyrosine, used only under medical supervision, can help alleviate the pain.

The bottom line is this – If you want to avoid harm don’t do ketamine.