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DRUGS: staying safe

DRUGS:
Staying Safe

This big bumper book of drug and alcohol features 10 of the most common substances. It's perfect for anyone who need easy-to-understand harm reduction advice, and accurate information about a range of substances

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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 thing when it comes to drugs and alcohol? should you take that white powder or neck that pill? What’s in it, how will it make you feel, what are the risks?

The only way to avoid the risks of using drugs and alcohol is not to use them at all. If you use drugs and alcohol or are thinking about it, it’s essential to learn as much as you can about the substances you are using.

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
  • Nitrous oxide
  • Mephedrone
  • Solvents

The final section in this booklet is called ‘Staying Safe’. It includes information about mixing drugs and alcohol, feeling unwell, and looking after yourself and your mates.

ALCOHOL

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

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 cause feelings of energy and alertness, suppressing hunger and reducing the need to sleep.
  • 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

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

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.

 

Ecstasy

The active chemical in Ecstasy is MDMA, or to give it its full chemical name, 3,4 methylenedioxymethamphetamine.

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

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

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.

Nitrous oxide

Nitrous oxide is a colourless and mainly odourless gas. It's Common street names include laughing gas, noz or noxy.

It comes in small, silver pressurised containers (bulbs) or large canisters, usually transferred from a canister into a balloon for inhaling.

> The effects of nitrous oxide

Users feel light-headed, dizzy, giggly, and euphoric.

You may experience sound distortions and hallucinations – when you see or hear things that aren’t there. It can also cause confusion, headaches, nausea, and paranoia.

 > The problems with nitrous oxide

Using pressurised gas directly from a canister is dangerous.

Inhaling in an enclosed space or putting your head in a bag of gas can lead to unconsciousness.

Using it in hazardous locations, like high buildings or close to water etc., is risky.

Prolonged and heavy use can result in vitamin B deficiency and nerve damage.

Symptoms of nerve damage can include numbness or pins and needles in the arms and/or legs.

Excessive use can cause breathing difficulties and heart problems.

The law: nitrous oxide is a Class C drug. Supply or possession with the intention of using it to get high is illegal.

Solvents

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.

Staying safe

Taking drugs is risky. 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 this information will help you and your friends stay as safe as possible.

Low and slow

Give drugs time to work - rushing to take more is risky. Effects vary based on how you feel, where you are, and what’s in them, so take it slow.

Synthetic opioids

Be aware that drugs are increasingly being mixed with dangerous synthetic opioids like nitazene and fentanyl, which can cause overdose even in tiny amounts. You won’t be able to see, smell, or taste them - take it slow and be careful.

Avoid using drugs alone

Never use drugs alone - it’s dangerous, as no one can help if things go wrong. Have a friend present who knows what you’ve taken. If someone becomes unresponsive, put them in a recovery position (on their side, top knee and arms bent), check their breathing, call 999 and be honest about what they’ve taken so medics can help properly.

Mixing drugs and alcohol

Using drugs and alcohol together can be unpredictable and dangerous, especially since alcohol dehydrates you. Mixing cocaine, ecstasy, or other substances with alcohol can put you at serious risk.

Pre-loading

Having drinks while getting ready might seem like a good way to start the night, but it makes you more likely to get into trouble later. Take it easy - the night’s just beginning!

Pace yourself

Want to make your night last? Have food first, grab water between drinks, and don’t feel pressured to drink every round. Put your drink down between sips - holding it means you’ll drink faster.

Violence

Keep your cool if someone’s giving you grief - walking away might feel tough, but it’s better than getting hurt or in trouble.

Sex

If you’re planning to hook up, bring protection and use it. Emergency options are available if needed - visit your GP, walk-in centre, or pharmacy within 72 hours.

Don't flash your valuable

Keep your phone and valuables safe - consider bringing a backup phone for nights out. Be careful at ATMs - shield your PIN and stay aware of your surroundings.

Keep an eye on your drink

Never leave your drink unattended or take one from someone you don’t trust.

Looking after yourseleves and your mates

We all need to look out for each other! If you’re heading off with someone new, let your friends know where you’re going. Maybe even send them a quick photo of who you’re leaving with.

If a friend’s feeling unwell, get them somewhere quiet and cool, keep them sitting up, and give them water. If they’re not responding, put them in the recovery position and get help immediately.

Getting home safely

Plan your journey home before you go out - it makes everything easier! Pre-book a taxi if you can, and arrange a meeting point in case you get separated from your friends. If you end up walking, stick to well-lit streets and main roads, no matter how tempting those shortcuts might be.

Remember - the best nights are the ones where everyone gets home safe!

Drugs and the law

What happens if you're caught with drugs, what will the police do, what are the legal options?

Supplying Drugs

Supplying illegal drugs includes possession with intent to supply, or give away for free to friends, and will almost certainly result in a criminal record, severe sanctions and possibly prison time.

Maximum penalties range from 14 years for Class C drugs to life imprisonment for Class A drugs.

Possessing Drugs

It’s illegal to be in possession of drugs and can get you from 2 to 7 years in custody, depending on the class of drug.

Out of court resolutions

If you’re found with a small amount for personal use, some police forces will take a different approach. They might opt to deal with the matter using what’s known as Out of Court Resolutions (OoCRs), with the following aims:

  • Keep you out of the court system
  • Help you address issues around drug use
  • Divert you from repeat offending

Types of OoCRs

Community resolution: the police can make you attend an educational course on drugs and their anti-social effects to try to address the cause of your drug use.

Conditional caution: the police could opt for this if you’re a repeat offender when it’s not in the public interest to prosecute. It can include some kind of intervention to address drug use, such as referring you to a drug and alcohol service or other agency. It goes on your criminal record.

Restorative interventions: the police can consider these alongside a community resolution or conditional caution. You might need to attend drug awareness sessions or do community work and educational programmes.

OoCRs for children and young people

  • Youth community resolution
  • Youth caution
  • Youth conditional caution

Additional things to consider

Failure to complete or engage with OoCRs will land you in court for the original offence.

If you’re under 18, the police are likely to inform your parents or carers.

A drug possession conviction can impact your life, such as restricting travel abroad (e.g. the US), or affect job opportunities.


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Mephedrone (4mmc) information and harm-reduction advice

Mephedrone (4mmc): Dosage, Effects, Risks and Safer Use

Learn about mephedrone (4-MMC) dosage, effects, risks and safer use. Trusted harm reduction advice to help you stay informed and reduce harm.

Where mephedrone comes 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 a mild social stimulant. In the UK, possession of the Khat plant itself or its leaves is not illegal, but the chemical it contains, cathinone, is banned.

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

At that time, the quality of cocaine and ecstasy was poor: cocaine purity had dropped from 60% in 1999 to 22% in 2009, and many ecstasy pills contained no MDMA but other substances including mephedrone. The UK drugs market was primed for a new, cheap, and (then) legal alternative.

Mephedrone is part of a family of compounds known as Beta-Ketones, which also includes Methylone and MDPV. As synthetic relatives of cathinone, they weren’t covered by existing laws at the time and were sold as ‘legal highs’.

Much of the mephedrone available in the UK is thought to be manufactured in India or China (though it is now illegal there), bought online and shipped by post. When it was legal in January 2010, one kilo cost £2,500 from China and sold at £10 a gram, making big profits. After it was banned in March 2010, the wholesale price rose to £4,000 per kilo, retail prices doubled, and it was more likely to be cut with other powders (caffeine, glucose, MSG) or mixed with other drugs.

To avoid the risks – don’t take mephedrone!


However, if you are determined to go ahead, limit yourself to small amounts (no more than half a gram per session) and occasional use (no more than once a week).

The more you take, the more likely you are to have problems.

What mephedrone looks like


Mephedrone usually comes as a white powder, making it hard to tell apart from other powders sold as ‘legal highs’.

There’s no way to know for sure what’s in the powder you buy from online suppliers, street dealers or even friends—you have to trust what they tell you. Even ‘mephedrone’ from the same supplier might be different from one week to the next.

Sellers have mixed mephedrone with ketamine and sold it as ‘Kit Kat’, and have also passed off crystal methamphetamine as mephedrone. Be careful and follow the advice below.

Slow & Low

If you're going to use mephedrone, take a small amount and wait.

Don’t take more just because you can’t feel anything after half an hour. It could be a dud or something completely different—but how would you know?

Give it time to start. Taking too much too soon could lead to a bad experience.

Learn to recognise and handle the effects.

How mephedrone works


Stimulant-type drugs like mephedrone cause a sudden release of brain chemicals (neurotransmitters), including noradrenaline (for the rush), dopamine (for euphoria) and serotonin (for loved-up feelings). But as a short-acting drug, it also causes a sharp drop in these chemicals as it wears off.

This quick come-up and come-down often causes users to want to re-dose, leading to a pattern of compulsive use and taking more than intended.

The effects of mephedrone


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

Main effects include feeling alert, calm, excited, energetic, elevated mood, and sociable or talkative.

Common unpleasant side-effects

Dry mouth, teeth grinding, reduced appetite, poor concentration and short-term memory, increased heart rate, increased body temperature, palpitations, anxiety, depression, sweating, and dilated pupils.

How to reduce the harm from mephedrone


Cutting down on the amount and how often you use will reduce unpleasant side-effects and other risks.

Mephedrone can seriously dehydrate you. Keep your fluids up—sip water, fruit juice or isotonic sports drinks to replace salts and minerals lost through sweating.

Mixing mephedrone with other drugs increases risks. Alcohol and mephedrone can cause confusion and aggressive, erratic behaviour. Combining it with other stimulants raises the risk of dehydration and heatstroke, which can be fatal.

The comedown can leave you feeling miserable, tired and drained but unable to sleep, with cravings for more. These feelings can last into the next day. Look after yourself in the week: eat and sleep well, exercise to build stamina. Plan for the comedown—take the next day off, rest, eat and drink (but avoid alcohol!), watch TV, or go for a walk until the bad feelings pass.

Mephedrone has been confirmed as causing or contributing to the deaths of over 40 people. Heatstroke may be a factor, so stay hydrated and keep cool.

Mephedrone and the law


Mephedrone is illegal in the UK and most of Europe. It is a Class B controlled substance under the Misuse of Drugs Act (1971). This means it is illegal to possess (maximum penalty five years in prison) or supply (maximum penalty 14 years in prison).

So why were they called ‘Legal highs’?

Under the Consumer Protection Act it is illegal to sell food, drinks or anything else for human consumption without safety checks. To get around this, suppliers initially described mephedrone as ‘plant food’, often marked ‘NOT FOR HUMAN CONSUMPTION’.

Some products were sold as ‘research chemicals’ or ‘incense’, as with cannabis-like substances such as Spice. Spice and other smoking mixes like Black Mamba and Annihilation are now illegal. Interestingly, just six weeks after mephedrone was banned in March 2010, products sold as NRG1, NRG2 and MDAI were found to contain mephedrone.

What are the risks from the different ways mephedrone is used


Swallowing

The powder can be wrapped in a cigarette paper (‘bombed’) or dissolved in a drink. Capsules or tablets are swallowed.

How much?* Users report around 150 mg orally. Effects start in about 30 minutes and last 2–3 hours. Swallowing is possibly the least harmful way but taking lots risks stomach damage.

Reducing the harm: Drink plenty of water to help dissolve it and flush it through your system.

Snorting

The powder can be snorted but is reported to burn and cause nosebleeds.

How much?* Around 50 mg per line. Effects start in minutes and last about an hour.

Reducing the harm: Snorting damages nasal passages. Rinse your nose with warm water between lines or at the end of a session to reduce damage.

Smoking

Mephedrone melts at around 67 °C, much lower than direct flame heat. Indirect heat is used, typically on foil or in a glass pipe.

How much?* Around 50 mg. Effects come on in seconds but last only about 30 minutes.

Reducing the harm: Smoking causes a faster, shorter high, increasing temptation to re-dose. Wait at least half an hour between hits.

* Everyone reacts differently, and there's no way to know how strong any powder or pill really is. These amounts aren’t recommendations. Start low, go slow—take a small amount first, wait, and see how it affects you before taking more.

Long-term harm from using mephedrone


Because it’s relatively new, there are no long-term studies. Many users report strong cravings, suggesting possible psychological addiction, similar to cocaine or crack. It’s too early to say if it is physically addictive.

We also don’t know if it can specifically damage your heart, liver, brain or nervous system. The only guaranteed way to avoid these risks is not to use it at all.

Overdose


Mephedrone, like all stimulant-type drugs, increases heart rate, blood pressure, and body temperature. Taken in excess, it can cause overdose and convulsions.

Early signs of stimulant overdose

  • Sudden rise in body temperature
  • Flushed face
  • Hot, dry skin with no sweating
  • Muscle cramps or stiffness in arms and legs

What to do

  • Reassure them calmly and explain what’s happening.
  • Encourage slow, deep breathing. Count with them. If they hyperventilate, have them breathe into a paper bag carefully.
  • Move them somewhere cool, loosen clothing around the neck (gently to avoid panic) and apply cold/wet towels or ice to the back of their neck.
  • If they stop sweating or collapse, phone an ambulance immediately.

Call for help IMMEDIATELY

  • Lay them gently on their side in the recovery position so they don’t choke if they vomit.
  • Stay with them until help arrives. Tell medics what they took—you won’t get in trouble and it could save their life.

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KETAMINE FAQ

Ketamine FAQs - Harm Reduction Information

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What is ketamine?


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

Does it have any other names?


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?


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?


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?


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?


  • 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.

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Ketamine guide for drug workers

Ketamine harm reduction: a guide for drug workers & services

This ketamine harm reduction guide helps drug workers and services build the knowledge and confidence to engage with and support people who use ketamine

More people are using ketamine


Ketamine use has increased in recent years and is now common across a wide range of social settings. It was once mainly linked to the gay club scene but is now widely used at festivals, in student nightlife, and among people who use multiple drugs. In England and Wales, 3.8% of 16–24-year-olds — approximately 220,000 young adults — reported using ketamine in the past year (2022/23), the highest level recorded to date. Among adults aged 16–59, 0.8% — roughly 300,000 people — reported past-year use (ONS, 2024).

While many people use ketamine recreationally and without significant problems, drug services and outreach workers are reporting growing concerns. Some users are developing more frequent, chaotic, or dependent patterns of use, which can lead to a range of adverse side effects. As ketamine use continues to rise, drug workers and services are encountering more people who may benefit from harm reduction advice and support.

What is ketamine


Ketamine is an anaesthetic drug with dissociative effects. It was first developed in the 1960s and became widely used in surgery during the 1970s and 1980s. These days, it is used less often for routine operations but is still used in trauma cases such as burns or traffic accidents because it helps manage pain while maintaining breathing and blood pressure.

Is ketamine really a horse tranquilliser?

Ketamine is still used in human medicine in certain situations, such as emergency care and paediatrics but it is more commonly used as an anaesthetic in veterinary surgery — probably the source of the popular ‘horse tranquilliser’ misnomer. As a marketing ploy, something that could knock out a horse sounds like a winner for dealers and for media looking for an eye-catching headline. 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 drug and does not slow the heart. At anaesthetic doses, it usually increases heart rate and blood pressure. However, at low doses the subjective effects are often experienced as a slowing down and heaviness of the body — sometimes known as ‘sledging’.

Sought-after mental effects include a trance-like state, disconnection from reality, feelings of floating or flying, and visual (sometimes shared) hallucinations. The ketamine experience is very dependent on the setting in which it is taken. At low doses in clubs or raves, with loud music, lights, and the buzz of the crowd, it can feel stimulating, with increased energy and euphoria.

In quieter, more relaxed settings, such as at home with friends, users report transcendental or spiritual experiences — including apparent travel to other worlds, out-of-body sensations, re-emergence of long-forgotten memories, a sense of insight into existence, time distortion, or the feeling of dying and being reborn. However, panic, unpleasant feelings, and nightmare-like experiences can also occur.

Physical effects can include loss of body control, poor coordination, difficulty speaking, moving, hearing and seeing (delirium), numbness, and nausea. Among users, ketamine has sometimes been described as ‘psychedelic heroin’ or ‘L.A. coke’, highlighting the mixed and complex nature of its effects.

Short-term mental effects of ketamine

  • Short-term mental effects
  • Out-of-body experiences
  • Shifts in perception of reality
  • Confusion or disorientation
  • Pleasant mental and/or body high
  • Increased energy
  • Euphoria
  • Sense of calm and serenity
  • Meaningful or spiritual experiences
  • Enhanced sense of connection with the world (people, beings, objects)
  • Distortion or loss of sensory perceptions (common)
  • Open- and closed-eye visual hallucinations (common)
  • Dissociation of mind from body
  • Significant changes in the perception of time

Short-term physical effects

  • Increased heart rate
  • High blood pressure (hypertension)
  • Respiratory depression (rare with ketamine alone but more likely when mixed with other depressants)
  • Hypersalivation (excess saliva)
  • Nausea
  • Slurred speech
  • Numbness and reduced sensitivity to pain (analgesia)
  • Loss of coordination (ataxia)

What are the problems of using ketamine?


The main immediate risk with ketamine use is physical helplessness. Disconnection from the body, combined with loss of coordination and awareness, can be dangerous — especially in the disorienting environment of a club or rave. This is similar to being extremely drunk in a public place, where accidents are more likely. It can also leave users vulnerable to assault (physical or sexual) and to unprotected sex, increasing the risk of unplanned pregnancy, sexually transmitted infections (STIs) such as gonorrhoea, and blood-borne viruses (BBVs), including hepatitis B, hepatitis C, and HIV.

Fatal overdose from ketamine alone is very rare, as it typically does not cause life-threatening respiratory depression. However, loss of consciousness is dangerous in itself. If someone becomes unconscious after using ketamine, this is an emergency and should be treated as such.

Mixing ketamine with other drugs


Nowadays, many people use multiple drugs together, and ketamine is no exception. On a night out, people who use ketamine often combine it with substances such as alcohol (which increases risks), cocaine, and a range of newer compounds known as novel psychoactive substances (NPS).

There is also the added risk that ketamine may be contaminated with other substances — including potent opioids such as nitazenes — without the user’s knowledge. Contamination is an increasing concern in some drug markets, including ketamine.

Mixing drugs greatly increases risks, as the effects are unpredictable and harder to manage.

Is ketamine addictive?


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.

Distressing psychological effects of using ketamine


Persistent use of ketamine has been linked to a range of distressing psychological effects, including:
  • Anxiety and panic attacks
  • Depression and suicidal thoughts
  • Insomnia and sleep disturbances (including nightmares)
  • Flashbacks and persistent perceptual changes
  • Feelings of unreality or detachment from the world (depersonalisation, derealisation)
  • Paranoia
In some cases, frequent use may exacerbate pre-existing mental health conditions (such as PTSD) or lead to unusual thoughts, such as grandiosity or identity disturbances, particularly in vulnerable individuals.
 
Occasional use (once or twice a month) is not generally linked to long-term psychological harm, though sensitivity varies between individuals.

Bladder damage from ketamine use


There is clear evidence that heavy ketamine use can cause serious physical damage to the bladder and urinary tract. Some users develop a condition known as ulcerative cystitis, with symptoms such as:

  • a frequent and urgent need to urinate
  • pain or burning during urination
  • blood in the urine
  • urinary incontinence

These symptoms are linked to scarring and shrinking of the bladder. If ketamine use continues, the damage can become irreversible and may also lead to kidney problems.

For more on bladder-related complications, see our page on Ketamine bladder symptoms, k cramps & what to do about them.

What are K-cramps?

K-cramps (also called K-pains) refer to severe abdominal pain experienced by many people who use ketamine heavily. The exact cause is not fully understood, but is believed to involve irritation or damage to the gastrointestinal tract and gallbladder, and may also be linked to bladder-related complications.

K-cramps are most commonly reported by people taking high doses (such as more than a gram a day) or using ketamine daily. However, some people experience symptoms with frequent or prolonged use even at lower doses.

Is ketamine illegal?


Ketamine is illegal. Under the Misuse of Drugs Act (1971) it is a Class B drug. The maximum penalty for possession is five 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.

If you support people who use ketamine this is 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.

This content is provided for harm reduction and educational purposes and is not a substitute for professional medical advice.

Please share this guide with people who use ketamine, their friends and families, and other professionals who may find it helpful.

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Alcohol Aware: alcohol harm-reduction information

Alcohol awareness, harm reduction & safety guide

This guide provides clear alcohol awareness advice, harm reduction strategies, and practical tips for safer drinking. Learn about the health effects of alcohol, ways to reduce risks, and how to make informed choices about drinking.

Alcohol is one of the most commonly-used drugs in the UK.

It affects individuals differently, depending on when and where you drink, who you’re  with, and how you feel.

This information will help you identify the risks associated with alcohol and give advice on how to stay safe.

Alcohol awareness: what is alcohol?


What we usually refer to as alcohol is a chemical called ethanol, which is made through a process called fermentation.

During fermentation, yeast is combined with fruits or grains in order to convert the sugars into alcohol. 

Spirits, such as vodka, rum, gin, and whiskey, are fermented and then filtered/distilled to separate the ethanol from water.

How alcohol works in the body


Your body absorbs alcohol into the bloodstream through the stomach and intestines. It’s broken down by the liver and expelled as urine at the speed of about one unit an hour.

While your liver works to break down the alcohol it can manage, the rest is circulated into your body and sent to your brain, where it depresses your heart rate and breathing and affects your brain's ability to control what your body does. 

Initially, one or two drinks generally produce feelings of relaxation and cheerfulness, but any more can lead to blurred vision and coordination problems.

Drinking even more alcohol can lead to a loss of control, blurred/double vision, dizziness, wobbly legs, vomiting and even loss of consciousness.

The effects start within 15-20 minutes of drinking and can last a few hours, depending on how much you drink. 

Stronger drinks (like spirits) and fizzy drinks (like alcopops) are absorbed quicker into the bloodstream and will affect you sooner.

How alcohol makes you feel depends on lots of things:

How quickly you drink it 

Your liver processes alcohol at a steady rate no matter how quickly you drink. Drinking quickly increases the levels of alcohol in your bloodstream, making you drunker, faster.

How recently you’ve eaten 

Food helps slow down the speed that alcohol is released into your system.

Your body weight 

In general, the less you weigh, the more you’ll be affected by a given amount of alcohol.

Your mood before drinking 

If you feel a bit down before drinking, it may make you feel even more depressed. If you feel angry, it can make you aggressive.

Sex

Women's bodies contain less water than men's, so alcohol is less diluted, meaning women feel the effects more than men. This is particularly true either just before or during a period.

Alcohol units and government guidelines


This section contains advice on units, the term used to describe the amount of alcohol, and therefore the strength of your drink.

A unit is defined as 10ml by volume, or 8gm by weight, of pure alcohol. Units are normally displayed on alcoholic packaging in a similar style to the label below

Government Guidelines

Government recommended safe drinking limits.

Unit guidelines are the same for men and women. Both are advised not to regularly drink more than 14 units a week.

Working out the units for yourself: Multiply the ABV by the total liquid (ml) and divide by 1000 12 x 750 ÷ 1000 =

Alcohol units in popular drinks

  • Can of lager

    2 units

    500ml (Normal strength)
  • Bottle of strong lager

    2 units

    330ml
  • Bottle of alcopops

    1.4 units

    275ml
  • Pint of lager

    2 units

    568ml (Normal strength)
  • Shot (Tequila, Sambuca etc)

    1.3 units

    35ml
  • Bottle of wine

    9 units

    750ml
  • Glass of Wine

    1.5 units

    125ml
  • Spirits (Vodka Whiskey etc.)

    1.4 units

    35ml

Know your limits and recommended units


Guidelines for both men and women recommend drinking no more than 14 units a week to reduce the risk to your health.

The more you drink, the more your risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases.

If you drink up to 14 units a week, spread them over a few days and include drink-free days.

There are no safe limits for young people: not drinking is the healthiest option.

Positive effects of drinking at ‘recommended’ levels

  • Increased relaxation
  • Increased sociability
  • Possible reduced risk of heart failure*

*New evidence shows fewer heart health benefits than previously thought (primarily for women over 55 at around five units a week or less irrespective of the type of alcoholic drink).

Risks of drinking too much alcohol

Drinking over limits: short-term negative effects

  • Low energy
  • Accidents
  • Injuries or violence
  • Unplanned sexual encounters
  • Problems with friends and families

 Drinking over limits: long-term negative effects

  • Alcohol dependence
  • High blood pressure
  • Liver disease
  • Cancer

Warning signs of alcohol misuse


Different people react in different ways to alcohol. For some people, alcohol helps them relax and enjoy social occasions; for others, it might damage their health and personal life.

Signs that you’re developing an unhealthy relationship with alcohol: 

  • Finding it difficult to stop drinking once you've started.
  • Neglecting work, college or school.
  • People close to you worrying about the amount you drink.
  • You’re taking risks when you've had a drink, such as driving a car or getting into fights.
  • Drinking more than five days a week and more than nine units each time.
  • You’re regularly thinking about when you can have your next drink.
  • Being unable to enjoy yourself or relax without alcohol
  • Getting involved in violence

If any of the above apply to you, you should consider cutting down. If a few of these apply to you, contact your GP for help and advice, or contact any of the organisations on the back page of this booklet.

The risks of alcohol and overdose


Getting hooked on alcohol

Regular use of alcohol can lead to tolerance: having to drink more and more to get the same effect. This can lead to physical dependence.

Mixing alcohol and other drugs

Mixing alcohol with other drugs, particularly depressants like sleeping tablets or heroin, is risky. The combination produces effects which are difficult to predict and can lead to an increased risk of passing out or death.

Overdose

Alcohol slows down breathing and heart rate. In large enough quantities, it can lead to loss of consciousness and even death.

Signs of alcohol overdose:

  • Slow, shallow, or irregular breathing
  • Confusion
  • Difficulty awakening the person
  • No reaction from painful stimuli (such as pinching)
  • Unconsciousness (passing out)
  • Blue-tinged skin or pale skin
  • Seizures

If a person displays any of these symptoms, lie them on their side so they don't choke if they're sick, and call 999.

Alcohol and sex


Alcohol can affect your judgement and make you feel confused. You’re more likely to have unplanned sex when drinking, or sleep with someone you wouldn't have done had you been sober. 

You’re also at risk of rape, sexually transmitted infections (STIs) and pregnancy.

Always use a condom during sex.

Alcohol and violence


Alcohol lowers your inhibitions, causing you to overreact in certain situations, which can lead to aggressive behaviour. It's not much fun waking up in a police cell with a hangover and a criminal record.

It might also lead to problems with your friends and family. Being drunk isn't much of an excuse if you say something that you regret the next day.

Being drunk makes you an easy target for robbery and assault. So don't flash your mobile phone, or any other valuables, around. Be aware of your surroundings.

Drink Driving


Driving while drunk or being in a car with a drunk driver is very dangerous both for you and other people in the car. You, your friends or a pedestrian could be seriously hurt or killed.

Staying safe when drinking


Passing out

As already mentioned, it’s possible to overdose on alcohol which can be fatal. If someone you’re with passes out, turn them onto their side so they can't choke on their vomit and ring an ambulance or find someone to help you.

Space your drinks out

Use soft drinks or water between alcoholic drinks. Your night will last longer, and it will stop you from getting dehydrated and reduce the effects of a hangover.

Don’t drink on an empty stomach

Food slows the release of alcohol into your system and helps to limit how quickly the alcohol affects you. Eating a meal before you go out or a snack while you drink is a good idea. You’ll have more energy to enjoy yourself!

Have smaller drinks

Some measures in pubs and clubs can be very large and have 2 or 3 units in each drink. Where possible, choose a smaller glass.

Have the day off

Give your liver a chance to 'detox' by having at least two alcohol-free days a week – this way, it has time to recover and repair itself.

Drinking before you go out

Drinking alcohol before you go out means you could already be drunk before you start your night out. 

You’re more likely to be involved in accidents and violence, or be refused more alcohol at the bar.

Try to stick to one type of drink

Avoid mixing your drinks. This’ll help you keep track of how many units you've had and avoid mixing different strength drinks.

Mixing drugs and alcohol

Mixing alcohol with drugs, particularly depressant drugs, can increase the chances of an overdose and can make the effects of the individual drugs unpredictable and dangerous.

Getting help and support


If you feel your drinking is getting out of hand, consider talking to someone. Maybe a close friend, parent, teacher or a local advice centre.

Here are some organisations that can also help you:

Talk to Frank

National drugs awareness site for young people and parents/carers.
0800 77 66 00
www.talktofrank.com

Childline

Calls are free and confidential.
www.childline.org.uk
0800 1111

Addaction

UK - wide treatment agency, helping individuals, families and communities to manage the effects of drug and alcohol misuse.
www.addaction.org.uk

Brook

Free, confidential advice on sex for young people.
Call 0800 185 023 or
visit www.brook.org.uk


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Binge drinking: a night on the town

  • Article Introduction: Practical harm reduction information and advice about reducing the problems caused by harmful drinking habits.

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BINGE DRINKING

This alcohol harm reduction resource will help drinkers of any age understand the risks associated with binge drinking. It provides practical and sensible information and advice about reducing the harm caused by harmful drinking habits.

Latest resources

For most people having a drink can be a positive experience. Having a night out and a laugh with your mates after a long week's work or study helps you to relax and wind down.

Alcohol can help you chill out, make you less shy, and give you extra confidence.

But hammering it every weekend and sometimes during the week can lead to serious short- and long-term health issues.

This booklet will help you think about your drinking and offer practical and sensible information and advice about reducing the harm caused by alcohol.

ALCOHOL


Alcohol is a depressant drug. It's absorbed through the intestines and stomach into your blood and then sent to your brain. It slows down your central nervous system and alters your mood, perception, movement, vision and hearing.

Your body flushes out most of the alcohol through your liver and small amounts in your sweat and breath. A breathalyser measures the amount of alcohol in your system through your breath.

Short-term effects of alcohol

  • Short-term effects of alcohol
  • Relaxation
  • Increased confidence
  • Talkativeness
  • Anxiety
  • Sexual difficulties such as impotence
  • Bad judgement, leading to accidents and injuries
  • Alcohol poisoning. This could lead to a loss of consciousness and could be fatal

Long-term effects of alcohol

  • Cirrhosis of the liver
  • Inflamed stomach or pancreas
  • Certain cancers such as throat cancer
  • High blood pressure

People’s reaction to alcohol can vary and depends on things like

  • Age
  • Gender
  • Body height and weight
  • If you have eaten
  • How quickly you drink
  • If you have used any legal or illegal drugs

BINGE DRINKING


Binge drinking means different things to different people, but generally, it means drinking lots of alcohol over a short period to get hammered. 

RISKS AND PROBLEMS


Accidents and violence

Alcohol can make you reckless and impulsive. Binge drinking can lead to an increased chance of falls, car accidents and becoming the perpetrator or victim of violence. 

Physical health

Consuming large quantities of alcohol over a short time means your body cannot process the alcohol quickly enough. Alcohol can build up to dangerous levels, and the extra stress on your body's organs can increase the risk of high blood pressure, heart disease and certain cancers.

Alcohol poisoning

Alcohol depresses the nerves that control your breathing and gag reflex (which prevents choking). A fatal dose of alcohol can stop these functions. You could choke to death if you vomit while not conscious because of alcohol.

HOW MUCH DO YOU DRINK?


Alcohol is measured in units. You can calculate the  the amount you drink by knowing how many units of alcohol are in your drink.

What is a unit?

A unit is 10ml by amount or 8gm by weight of pure alcohol (Ethanol).

To work out the number of units in a drink, multiply the volume (in millilitres) by %ABV, then divide the result by 1000.

What is  %ABV?

ABV means Alcohol By Volume. A 750ml (75cl) bottle of wine with 12% ABV on the label shows that 12% of the liquid in the bottle is alcohol. A 700ml (70cl) bottle of vodka with an ABV of 37/38% on the bottle would contain almost three times the amount of alcohol/units for roughly the same amount of liquid.

Alcohol limits

The suggested alcohol limit for males and females is the same: Don’t regularly drink more than 14 units per week (6 pints of 4% beer, or 6 glasses of 13% wine). These limits will help reduce potential health problems.

If you drink up to 14 units a week, spread these across a few days and have at least two drink-free days a week.

  • Can of lager 440ml
    2 units
    (Normal strength)

  • Small glass of wine
    125ml
    1.5 units

  • Bottle of strong lager
    330ml
    2 units

  • Bottle of wine
    750ml
    10 units

  • Shot 35ml
    1.3 units
    (Tequila, Sambuca etc)

  • Bottle of strong cider
    1000ml
    9 units

  • Standard size bottle of spirits
    750ml
    26-28 units

  • Single pubmeasure ofspirit
    25ml
    1.3 units

STAYING SAFE


The information in this section will help make your night out as enjoyable and safe 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. You are more likely to be refused entry to a club or pub if you are drunk.

ALCOHOL AND THE LAW


Drunk and disorderly

It is illegal to be drunk and disorderly in public. If you've had a skinful try not to attract attention by acting like an idiot. If the police arrest you, once you are fit to be dealt with, you will typically either be cautioned, be issued with a Penalty Notice for Disorder (PND - £80 fine in ticket form) or, depending on the offence, end up in court.

Drink spiking

Spiking drinks is illegal, even if the person affected is not attacked or assaulted. It can result in a prison sentence of up to 10 years for anyone guilty of doing this.

Drinking outside

It isn't illegal to drink in public, but many areas, such as city centres, have alcohol-free zones, where drinking outside is not allowed. Under-18s can have their alcohol confiscated if they drink outside, no matter where they are.

Entering the pub or club

It is illegal for a pub or club to sell alcohol to someone drunk or conducting themselves in a 'disorderly manner'. It is unlawful for you to refuse to leave licensed premises when asked by the police, the licensee or someone acting on their behalf, such as the door staff.

Pubs or clubs have the right to search anyone entering their premises. If you agree (you have the right to refuse), the search can only be on the outside of the clothes, pockets and inside bags.

MIXING DRUGS AND ALCOHOL


Using drugs or alcohol can make the effects of both very unpredictable. Your body will struggle to cope if you use too many substances, which can rise to dangerous levels.

Alcohol and cocaine used together produce a third toxic substance called cocaethylene, which can increase the chance of seizures, heart attacks and strokes, even in healthy young people. Cocaine will also increase the risk of violent, impulsive, and reckless behaviour.

Alcohol dehydrates you, so mixing it with other drugs that do the same, like cocaine, ecstasy or mephedrone, or some of the newer drugs (formerly legal highs), can be very risky.

VIOLENCE


Alcohol affects the brain and reduces our ability to think straight.

It makes us more likely to misread the signs; someone bumping into you or the 'dirty look' can be seen as an act of aggression when you usually wouldn't even notice it.

The more you drink, the more frustrated you can become; trying to get to the bar or queue to use the toilet can become a flashpoint.

If you lose your temper quickly, try not to get too drunk. Drink in pubs and clubs that are not so busy and avoid trouble hot spots where you know there are always kick-offs.

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 increases your self confidence and makes it easier to approach someone you fancy, but if you’re too drunk you can end up going further than you intended.

Sexually Transmitted Infections (STI’s)

If you intend to have sex, use a condom. Having sex without a condom can open you to sexually transmitted infections (STIs) and unplanned pregnancies.

Women can get oral emergency contraception from their GP, Brook, or NHS Walk in-centre. It can be taken 72 hours after unprotected sex and is available to anyone over 16.

Brewers droop

Alcohol affects the part of the brain that sends messages that helps with sexual arousal; alcohol suppresses the signals and can lead to brewers droop.

DON’T FLASH YOUR VALUABLES


Don’t flash your expensive phone around, it could end up being stolen. Buy a cheap phone to use when you are going out. 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. Where possible, use a machine in a well lit public area.

DRINK SPIKING


Spiking a drink means putting alcohol or drugs into someone's drink without their knowledge or permission. Following these tips will help you reduce the risks:

  • Buy your own drink and watch it being poured if possible.
  • Don't accept drinks from strangers
  • Never leave your drink unattended
  • Don't drink or taste anyone else's drink
  • Throw your drink away if you think it tastes odd
  • If you think your drink may have been spiked, you should get help from a friend you trust or the venue management.

LOOKING AFTER YOURSELF AND YOUR MATES


If you or one of your friends are going to leave the club or pub with someone you have just met, make sure your friends know what you are up to 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 calm. Keep them sitting up and awake, and give them water if they can drink. If you can't 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 will 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 end up walking home alone, be aware of your surroundings, stay on well-lit public roads, and don't be tempted to take the shortcut across the dark, deserted park because you can't wait to crash into bed.

CUT DOWN


How often do you say, 'I am never getting that drunk again?' These tips will help you keep that promise during your next night out.

  • Set yourself a limit

    Decide how much you will drink and only carry enough money for that number of drinks and your taxi or bus fare home.

  • Eat something before you go out

    Having some food in your stomach before you start drinking will help your body release the alcohol at a steadier pace. While you are out, have some bar snacks or maybe eat the kebab halfway through the night rather than at the end.

  • Mix your drinks 

    Mix your drinks with soft drinks. Have a shandy or mix your wine with soda or lemonade. Or alternate between alcoholic and soft drinks.

  • Miss a round

    You don't have to get a drink in every round; when it's your turn to get the drinks, miss yourself out. Or say no and stick to it.

  • Go for lower alcoholic drinks

    Some premium lagers, beers and ciders can have almost twice the alcohol content as the normal alternatives.

  • Drink slower

    Sip your drink, put it on a table and do something else. Standing with your glass in your hand means you will end up drinking it quicker.

LONG TERM CHANGE


Regular heavy drinking sessions can become a habit. If you need to make long term changes the following advice will help.

Are you drinking too much?

Have a look at this list and see if any of the warning signs apply to you.

  • Drinking larger amounts to get the same effect.
  • Drinking more than nine units in one session, that’s roughly equivalent to five pints or 9 shorts or nearly a full bottle of wine.
  • Have you started doing things you normally wouldn’t do (e.g. missing work or college, letting people down)?
  • Do friends and family have a go at you about the amount you drink?
  • Have you got into bother, or injured yourself or others after drinking?

If one of these applies to you then you might want to cut-down your drinking. If three or more of these apply to you then you may need help or support before you start to cut down or stop drinking. You can find more help on the back page of this booklet.

Think about how will you benefit from cutting down on drinking

There are lots of benefits to cutting back on the drinking sessions and for everyone they will be different.
Some benefits might be:

  • Feeling less tired
  • Losing weight
  •  Having more money to spend on other things
  •  Better relationships with friends and family
  •  Healthier and less likely to develop serious health issues

Plan ahead and set your goals

Are you going to cut-down slowly or stop straight away? Think about how and when you are going to start.

You could make a decision to book your taxi home earlier than normal. Maybe just go to the local rather than going clubbing. Or choose a couple of days to be completely alcohol free.

Think about difficult situations and how to deal with them

Think of the situations you are in last time you got smashed, who were you with, where were you, how did you feel, what where you doing at the time? Situations that could trigger your drinking could be:

  • The end of a stressful day
  • After work
  • Celebrating at a party or a club
  •  Needing to relax
  • Feeling down

Dealing with difficult situation

Stay active

Plan activities for the times you used to spend drinking. If you are getting bored, stressed, or craving a drink, do something, the feelings will pass. 

Do something new

Start a new hobby or enrol on a course. It will occupy your mind, stop you getting bored and fill the time you used to spend drinking.

Look after yourself
Stick to a healthy diet, try to get as much sleep as you can, drink plenty of water and try to get some exercise, this will help make you feel better.

Avoid your friends who drink heavily for a while
Some of your drinking friends can act as a trigger to your drinking sessions.

 

Clear your home of any alcohol
No need to keep temptation within arms length.

Tell your friends or family what you are about to do

Having support and someone to talk to will make it easier to achieve your goals. You can also get help and support from your local GP, nurse or support service. There are some contact details on the back page.

Keep going

Don’t worry if you don’t succeed the first time you try. Don’t beat yourself up if this happens, you haven’t failed, you have just taken the first step. Try again - it will probably be a bit easier next time.


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Alcohol poisoning: learn to spot the signs of alcohol overdose

  • Article Introduction: When does drinking become an emergency? What’s the journey from a few drinks to a hospital casualty department?

Alcohol poisoning: signs, overdose and help

Drinking too much alcohol too quickly can lead to alcohol poisoning or overdose. This page will help you recognise the signs, know when to get help, and learn what to do to keep someone safe.

Recognising alcohol poisoning and overdose


Alcohol poisoning happens when you drink more alcohol than your body can process. It can be life-threatening and requires urgent help.

Alcohol overdose is a severe form of poisoning that can lead to unconsciousness, breathing problems, seizures or death. It is a medical emergency.

What is alcohol poisoning?

Alcohol poisoning is when drinking large amounts quickly overwhelms your body’s ability to process it, leading to dangerous levels in your bloodstream.

What is an alcohol overdose?

An alcohol overdose is a critical stage of poisoning where vital functions like breathing, heart rate and consciousness are seriously affected.

Key differences between poisoning and overdose

Alcohol poisoning and overdose are part of the same process but overdose describes the most severe, life-threatening effects needing urgent medical care.

How alcohol affects your brain and behaviour


When you drink, alcohol goes into your bloodstream and heads straight for your brain, changing how you feel and behave. It affects neurotransmitters like dopamine and serotonin, which make you feel good and encourage more drinking. It also affects GABA and glutamate, which regulate brain activity and keep you safe.

How alcohol changes your brain

Quick drinking causes levels to rise fast, increasing the risk of overdose. Women often experience effects more quickly due to body size and metabolism differences.

Common behaviour changes when drinking

Violence: Alcohol affects judgment and restraint, making aggression more likely.

Slurred speech: Impaired muscle control leads to slurring and slower reaction times.

Trips and falls: Alcohol slows coordination and balance, increasing injury risk.

Risky sex: Lower inhibitions and poor judgment can increase unsafe sex or difficulty with consent.

Sleepiness: Alcohol is a central nervous system depressant, making you sleepy but disrupting sleep quality.

Blackouts: Drinking heavily can block memory formation in the hippocampus, causing gaps or total amnesia.

Signs and symptoms of alcohol poisoning


Alcohol poisoning is a medical emergency. If someone shows these symptoms, call 999 immediately even if they don’t have all of them.

Early warning signs

  • Mental confusion or difficulty staying awake
  • Vomiting
  • Clammy skin
  • Slow heart rate

Serious symptoms needing medical help

  • Seizures
  • Slow breathing (fewer than eight breaths per minute)
  • Irregular breathing (more than 10 seconds between breaths)
  • Extremely low body temperature
  • Bluish or pale skin. On black or brown skin, this may be easier to see inside the lips, on the gums or under the fingernails.

Not sure what to do? Call NHS 111 if you need medical help but are unsure what to do.

When to go to hospital for alcohol poisoning


If someone displays alcohol poisoning symptoms, don’t wait—call 999 immediately. Even if they don’t show every sign, it’s safer to get help quickly.

When to call 999

Call 999 if someone is unconscious, not waking up, has slow or irregular breathing, seizures or blue or pale skin.

When to call NHS 111

If you’re worried but unsure if it’s an emergency, call NHS 111 for professional advice on what to do next.

How to help someone with alcohol poisoning


Knowing what to do can save someone’s life.

What to do

  • Stay with them. They could choke or stop breathing.
  • Sit them up if they’re awake, preferably on the floor to prevent falling.
  • Lie them down in the recovery position if unconscious. Roll them onto their side with an ear towards the ground.
  • Check they’re breathing.
  • If they can swallow, give them small sips of water.
  • Keep them warm with a jacket or blanket.

What not to do

  • Don’t let them drink more alcohol.
  • Don’t give them coffee or caffeinated drinks – these dehydrate.
  • Don’t walk them around – they could fall.
  • Don’t put them in a cold shower or bath – risk of shock, falls or losing consciousness in water.
  • Don’t try to make them vomit – they could choke.

What to expect in hospital


If you arrive at A&E after drinking, medical staff will follow a set procedure. It may vary between hospitals, but generally includes the steps below.

Triage assessment

A nurse or healthcare professional assesses urgency. You’ll be prioritised for care if it’s serious or life-threatening.

Medical assessment

A doctor will assess your condition, perform tests if needed and decide on treatment.

Monitoring and treatment

Your vital signs like heart rate and breathing will be watched carefully. You may get fluids, medication or support for alcohol withdrawal.

Support and advice

You’ll be given guidance on drinking risks, safer habits and where to get help.

Referral or discharge

Depending on your condition, you may be kept for observation or sent home with instructions. Extra support or referrals may be arranged.

Mixing alcohol with other drugs


Mixing alcohol with drugs is dangerous. Both pass through the liver, increasing harmful effects and creating toxic substances. It also increases overdose risk.

Stimulants

Cocaine, speed, ecstasy, mephedrone: These speed up heart rate while alcohol slows it down. Mixing them puts your heart and brain under extreme pressure. Alcohol with cocaine produces cocaethylene, which increases heart attack or stroke risk.

Depressants

GHB, GBL: Both cause sleepiness and loss of consciousness. Combined with alcohol, the risk of coma or death rises sharply.

Heroin, opioids: Powerful sedatives. Mixing even small amounts with alcohol can lead to fatal overdose.

Spice/synthetic cannabinoids: Very potent, unpredictable depressants. Mixing with alcohol increases overdose risk.

Prescription medicines

Antidepressants: Alcohol can worsen side effects and make you feel more depressed. With MAOIs it can dangerously raise blood pressure.

Tranquilisers: Medicines like diazepam, temazepam and lorazepam slow breathing and heart rate. Mixing with alcohol can be deadly.

Safer drinking tips


These tips can help reduce the chances of drinking leading to an emergency.

Before you go out

Eat beforehand to help absorb alcohol. Set a limit on how much you’ll drink.

While you’re drinking

Alternate with water or soft drinks to stay hydrated. Avoid rounds to control your intake. Miss a round or choose low-alcohol options.

Know your drink’s strength

Check ABV and units. Your body can only process about one unit per hour. Drinking quickly means levels build up to dangerous levels.

Further help and support


NHS alcohol support

www.nhs.uk/live-well/alcohol-advice

Drinkline

Free, confidential helpline: 0300 123 1110 (weekdays 9am–8pm, weekends 11am–4pm)

www.drinkaware.co.uk/alcohol-support-services

Talk to Frank

National drug advice for young people and parents. 24 hours. Call 0800 77 66 00. www.talktofrank.com

NHS 111

For urgent medical advice when you’re not sure what to do. www.111.nhs.uk

Buy the Alcohol Emergency booklet in the Substance shop

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The resources are really good. Very user-friendly and packed with relevant information. They’re great.

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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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