WHATS NEW? - September 2015

Men more likely to suffer from cannabis psychosis

Review begins into benefits for those with alcohol and drug addictions

Smoking could play a direct role in the development of schizophrenia and needs to be investigated, researchers say.

More pupils try 'vaping' than smoking

Ecstasy and LSD use reaches new high among young

Former head shop drug 'Snow Blow' linked to HIV surge in Dublin

New legal chemicals causing internal 'car crash' injuries

Former government drugs adviser Professor David Nutt writes to PM arguing against banning legal highs

Twitter and Facebook 'allow massive illegal and counterfeit drugs market'

Delivering alcohol and drug education: Advice for teachers

Men more likely to suffer from cannabis psychosis

New research by health scientists at the University of York has revealed that a greater proportion of men than women suffer from cannabis psychoses.

There has been much research exploring the nature of the relationship between cannabis -- the most widely used illicit drug in the United Kingdom -- and psychosis, however the role of gender in relation to cannabis psychosis is less well explored and understood.

A new study by researchers in the Department of Health Sciences used large datasets over a period of 11 years to investigate the differences in men and women as they progress from exposure to cannabis through to developing cannabis psychosis. The research is published in the Journal of Advances in Dual Diagnosis.

Trends in cannabis use suggest that twice as many males as females use the drug. This gender ratio is mirrored in rates of psychosis with males outnumbering females by 2:1. But the research team found a significant widening of this ratio for cannabis psychosis, where males outnumber females by four to one.

Ian Hamilton said: "The marked gender difference in rates of cannabis psychosis is puzzling. It is possible that mental health and specialist drug treatment services, which have a disproportionate number of men, are identifying and treating more males with combined mental health and cannabis problems. However it is also possible that women with cannabis psychosis are not being identified and offered treatment for the problems they develop.

"When it comes to cannabis psychosis gender does matter."


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Review begins into benefits for those with alcohol and drug addictions

People with substance addictions could lose their sickness benefits if they refuse treatment under a review now under way.

Medical expert Dame Carol Black is to examine the support given to addicts - and obese people - on sickness benefits to "better support them in work".

David Cameron, who ordered the review, says there is currently no requirement for such groups to undertake treatment and suggested that this could change. But one Tory MP said it was "ethically unacceptable" to coerce people.

The idea of requiring drug users to seek treatment or lose their benefits was first suggested by the last Labour government although it was not adopted following a consultation. During the last Parliament, the Conservatives floated extending the concept of sanctions to those with serious alcohol conditions and the clinically obese but the idea was not pursued by the coalition government.

In February, the prime minister said he would ask Dame Carol to examine the support that the 90,000 drug and alcohol addicts estimated by the government to be on sickness benefits get, a pledge included in the party's election manifesto.

Ministers are calling for evidence to be presented by the end of September.

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Smoking could play a direct role in the development of schizophrenia and needs to be investigated, researchers say.

The team at King's College London say smokers are more likely to develop the disorder and at a younger age.

Published in the Lancet Psychiatry, their analysis of 61 separate studies suggests nicotine in cigarette smoke may be altering the brain.

Experts said it was a "pretty strong case" but needed more research.

Smoking has long been associated with psychosis, but it has often been believed that schizophrenia patients are more likely to smoke because they use cigarettes as a form of self-medication to ease the distress of hearing voices or having hallucinations. The team at King's looked at data involving 14,555 smokers and 273,162 non-smokers.

It indicated:

The argument is that if there is a higher rate of smoking before schizophrenia is diagnosed, then smoking is not simply a case of self-medication.

Dr James MacCabe, from the Institute of Psychiatry, Psychology and Neuroscience at King's, said: "It's very difficult to establish causation [with this style of study], what we're hoping that this does is really open our eyes to the possibility that tobacco could be a causative agent in psychosis, and we hope this will then lead to other research and clinical trials that would help to provide firmer evidence."

Clearly most smokers do not develop schizophrenia, but the researchers believe it is increasing the risk.

The overall incidence of the condition is one in every 100 people normally, which may be increased to two per 100 by smoking.

The researchers said nicotine altered levels of the brain chemical dopamine, which has already been implicated in the psychosis.

Prof Michael Owen, the director of the Institute of Psychological Medicine at Cardiff University, said the researchers had made a "pretty strong case" that smoking may increase the risk of schizophrenia.

"The fact is that it is very hard to prove causation without a randomised trial, but there are plenty of good reasons already for targeting public health measures very energetically at the mentally ill."

The charity Rethink Mental Illness said: "We know that 42% of all cigarettes smoked in England are by people with mental health problems, and so any new findings about the link between smoking and psychosis is a potential worry.

"However, longer-term studies are needed to fully understand this potential link."

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More pupils try 'vaping' than smoking

More pupils in England aged between 11 and 15 have tried electronic cigarettes than have tried smoking, according to official figures.

The Health and Social Care Information Centre showed the lowest levels of smoking or drinking ever recorded. It asked pupils about e-cigs for the first time and found that more than one in five had tried them.

The figures, based on a survey of 6,173 pupils in 210 schools, showed only 3% had tried legal highs. There have been consistent falls in the number of children taking up smoking. In 2003, 42% of pupils had tried cigarettes at least once, but that figure now stands at 18% - the lowest since records began in 1982.

Crucially, the new Children and Families Act will make it an offence to sell e-cigarettes to children.The pupil survey, which was conducted by the NatCen Social Research and the National Foundation for Educational Research, shows the popularity of e-cigs in 2014. The figures showed 22% had vaped at least once.

But the figures were far higher among smokers, with 89% of them trying e-cigs. The figure is just 11% for those who have never smoked.

Elizabeth Fuller, the research director at NatCen Social Research: "We see that young people are more likely to have tried an e-cigarette than a traditional cigarette. We can't be certain why this is so, but there are likely to be a number of reasons, including the novelty element, price, and the fact there are currently no restrictions on children under the age of 18 buying e-cigarettes."

However, the report said there was "little evidence of frequent use of e-cigarettes". Only 3% reported occasional use and just 1% vaped at least once a week.

Prof Kevin Fenton, the director of health and wellbeing at Public Health England, said: "The continuing decline in under-18s smoking, drinking and drug use is encouraging. It is reassuring that regular use of e-cigarettes remains low at 1%, and almost entirely among young people who have previously smoked tobacco.

Deborah Arnott, the chief executive of the anti-smoking charity ASH, said: "These results do not support the idea that experimentation with electronic cigarettes is a gateway into smoking as the number of young people trying smoking continues to decline year on year."

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Ecstasy and LSD use reaches new high among young

The use of ecstasy and LSD among young adults has spiked over the past two years, with survey results indicating the numbers taking the drugs in the past 12 months up 84% and 175% respectively.

An estimated 157,000 more people aged 16-24 took ecstasy over the past year compared to two years ago, according to figures released on Thursday. About 49,000 more used the hallucinogen LSD over the same period.

An estimated one in 20 young people have used ecstasy in the past 12 months, according to the latest data. Use of LSD is still much lower, with around 0.4% of young people – about one in 200 – using it.

Both drugs saw year-on-year increases in consumption by the young of around 40%.

The figures will be a serious blow to the government's hardline strategy on drug use. In an effort to combat an increase in the numbers of new designer drugs, a recent bill was introduced that would ban all new psychoactive substances.

But even as overall drug use remained flat, the statistics from the Crime Survey of England and Wales show a sharp rise in the use of the two class-A drugs, which are among the drug war's major targets.

Among most of the population – those aged 16-59 – use of ecstasy in the past year has risen an estimated 37% since 2012/13, while use of LSD is up 117%. The reasons for the surge in the popularity of LSD are unclear, but one expert said the rise in ecstasy use could be explained by an increase in the availability of relatively pure MDMA – that drug's active ingredient.

The figures also illustrate how young adults remain the most likely age group to take drugs: they indicated 19% of 16-19 year-olds and 20% of 20-24 year-olds took any drug within the past year. By contrast, only 2% of 55 to 59 year-olds did so.

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Former head shop drug 'Snow Blow' linked to HIV surge in Dublin

The Director of Public Health in Dublin has set up a team of experts to examine the recent increase in HIV cases among injecting drug users in the city, and to look at a likely link with the former head shop drug known as 'Snow Blow'.

A surge in HIV cases in the capital came to light earlier this year. Data from the Health Protection Surveillance Centre has now revealed the full extent of the problem with 16 cases of newly-acquired HIV infection among Dublin drug users since June 2014.

The public health team dispatched to investigate the issue includes HIV physicians, GPs providing services for the homeless and drug users, addiction clinicians and a clinical virologist. An investigation looking at the pattern of the disease is also under way – and the HSE and other organisations have launched an intensified awareness campaign to highlight the risks posed by unsafe injecting and unsafe sex.

Experts who work with habitual drug users in Dublin believe the rise in the availability of Snow Blow is leading to an increase in the frequency of injections. According to the HPSC:

"Clinicians from the drug services are concerned that the increase is linked to injection of a synthetic cathinone PVP, street name Snow Blow, with consequent more frequent injecting, and unsafe sexual and needle sharing practices. This has mainly been seen in chaotic drug users, who report polydrug use, and are often homeless."

Drugs like Mephedrone and MDPV are also being sold as Snow Blow in the capital – and Tony Duffin of the Any Liffey Drug Project says his team first noticed an increase in the availability of the substance in September of last year.

"In our experience at Ana Liffey, people injecting stimulants typically inject more often than those injecting heroin," Duffin said.

As more injections take place, the risk of HIV and other blood-borne diseases increases. According to Duffin:

"Unfortunately, there are no simple solutions – this is a complex problem. People injecting drugs can be hard to reach, can have a combination of problems like mental health difficulties and homelessness, and can often find it difficult to access mainstream services. It can be difficult to motivate people to get tested and treated, due to the chaos of their lifestyle and due to the understandable fear of being diagnosed with an illness like HIV."

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New legal chemicals causing internal 'car crash' injuries

Users of new psychoactive drugs are being admitted to hospital with injuries normally suffered by car crash victims, a senior doctor has warned.

Professor James Ferguson, a consultant in the emergency department at Aberdeen Royal Infirmary, said that medics doctors were becoming increasingly concerned about the long-term effects of the substances on patients.

Four men in their 30s were admitted to the hospital over the past few weeks with muscle breakdown which could cause tissue to move into the bloodstream, leading to liver or kidney failure and potentially death. The medical condition is more commonly seen in survivors of road accidents or patients who have been crushed during the collapse of a building.

Prof Ferguson said tests have been carried out on patients admitted to the hospital after taking legal highs.

Enzyme test results of 300 or under would be expected from patients with healthy muscle - but one man returned a result of 167,000 after taking psychoactive substances.

He said: "We are seeing some really ridiculously high levels. If you are using these legal highs again and again, you have to know what the long-term effects are going to be. This is a significant workload for us just now and it is a regular workload. Obviously I am worried about the people who we see at the hospital. But I am also worried about those who use legal highs who we don't see."

The surgeon said new psychoactive substances (NPS) – were often taken by people with a history of using illegal drugs. Medics have even been treating patients in their 50s coming into the hospital suffering from the effects of taking unregulated legal highs.

Prof Ferguson said legal high users were being admitted to hospital with varying conditions, including the potentially fatal serotonin syndrome where excessive nerve cell activity can cause confusion, agitation and heart problems.

Some of these patients end up in intensive care and while others are given fluids and observed for a few hours before they are released. The consultant said he fears that people believe the substances are safe to take because they appear on the shelves in "professional" packets, but do not know how their body will react because they are unregulated.

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Former government drugs adviser Professor David Nutt writes to PM arguing against banning legal highs

David Nutt, a former government adviser on drugs, has written an open letter to Prime Minister David Cameron calling on the Government to reconsider planned legislation that will ban all 'legal highs'.

The proposed Psychoactive Substances Bill has already been criticised by the advisory council on the misuse of drugs (ACMD), a body Professor Nutt chaired until 2009, which fears the blanket ban is unworkable. Professor Nutt has often been outspoken over government policy on drugs. He is among more than 40 academics, campaigners and professionals to have signed the letter, reproduced below:

Dear Prime Minister,

We the undersigned request that HM Government immediately reconsiders the proposed Psychoactive Substances Bill (2015).

Parliament is responsible for protecting citizens against the harms of drugs. However, the enactment of the Psychoactive Substances Bill would be deleterious to the freedoms, well-being and ultimate safety of UK citizens. The UN Drug Conventions were established under the assumption that prohibition would reduce drug use and therefore minimise drug-related harms. Instead, global drug use has increased significantly in the decades since these policies were incorporated into law. Many countries have witnessed the unintended and damaging consequences related to the dangers of an unregulated criminal market and the criminalisation of a large number of otherwise law-abiding citizens.

If enacted, the Psychoactive Substances Bill would be unlikely to reduce the market for new psychoactive substances (NPS), which are mostly sold "not for human consumption". The law will place the market in the hands of unregulated criminal organisations; increasing the likelihood of violence between competitors over market control as well as driving market focus on products that are higher in price and potency. Unregulated illegal markets have no incentive to comply with quality assurance protocols and accurate labelling of products, resulting in increased health risks for users and a greater strain on the already overburdened National Health Service.

Medical science will suffer from the proposed legislation, just as it continues to suffer from the over rigid regulation of other controlled psychoactive substances. Scheduling psychoactive agents in a blanket ban will impede the development of novel psychiatric medicines and prevent vulnerable members of society from potentially benefiting from new treatments.

Furthermore, any legislation that prohibits the sale of all psychoactive compounds without proper consideration of their relative harms and benefits presents an unwarranted threat to the long-standing freedoms of UK citizens. It is not possible to legislate against all psychoactive agents without criminalising the sale of dozens of harmless, everyday products that produce changes in mood and behaviour, from fresh flowers and herbs to spices and incense.

If the Government is genuinely serious about reducing drug-related harms, it should ensure that policy-makers focus their attention on public health campaigns, wide-ranging educational initiatives, effective drug treatment strategies, and the adequate funding of relevant medical and scientific research.

Despite these concerns we welcome the fact that the Psychoactive Substances Bill does not target NPS possession for personal use and would strongly encourage the extension of this approach to the regulation of other psychoactive drugs. In general, however, we believe the bill to be very poorly drafted, unethical in principle, unenforceable in practice, and likely to constitute a real danger to the health and well-being of our nation's citizens.

Yours sincerely,

Prof. David Nutt
Edmond J Safra Chair in Neuropsychopharmacology
Imperial College, London

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Twitter and Facebook 'allow massive illegal and counterfeit drugs market'

Social media websites including Facebook and Twitter have allowed the proliferation of a massive illegal and counterfeit drugs market, authorities have warned. Regulators criticised the sites for letting anonymous users advertise unlicensed products as they announced that more than £15million of illegal medicines and devices have been seized in the UK.

The haul is the biggest recorded to date and includes huge quantities of illegally-supplied and potentially-harmful slimming pills, erectile dysfunction tablets, anaemia pills and narcolepsy tablets. Unlicensed foreign medicines and fake condoms were also among the items seized following the operation by the Medicines and Healthcare products Regulatory Agency (MHRA).

It resulted in 1,380 websites being shut down and Mark Jackon, the MHRA's head of intelligence, said criminals are increasingly using social media to sell their illegal wares.

He said: "If you put something like, for example, Kamagra (Viagra) into Twitter, you will find tweets with embedded links to websites within it, so even though there's a limit to 140 characters, the criminal can still put - and fairly anonymously - put their link to their shop.

"There is no doubt social media provides fantastic span if you're trying to sell a product, whether legitimately or illegitimately, and equally it provides a great deal of anonymity if you are doing something illegal."

He said the MHRA was working with a range of different social media companies including Facebook, Twitter and YouTube.

Asked if terror groups could be involved, Alastair Jeffrey, head of enforcement at the MHRA, said there was evidence of this happening elsewhere in the world.

"We've seen recently some indications that there may be terrorist groups involved," he said. "It's not something that the UK is concerned about at the moment."

But he added: "Everything's on our radar. We are beginning to see more established criminal groups entering this space," he said. "Risk is low and the profits are very high. That's why we really need to concentrate it and raise awareness of the dangers."

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Delivering alcohol and drug education: Advice for teachers

What are the underlying principles of alcohol and drug education? And what are the best teaching methods to use when delivering alcohol and drug education in your classroom?

This briefing paper provides advice and tips for teachers and educators responsible for delivering alcohol and drug education.

Find out more about ADEPIS free resources: http://mentor-adepis.org/resources/adepis/

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