WHATS NEW? - October 2018

Doctors can prescribe medical cannabis from November in UK

More student unions set to offer drug-testing kits at universities, NUS says

Cannabis 'more harmful than alcohol' for teen brains

Children caught up in ‘county lines’ drugs gangs being failed by police, says Home Office report

Antidepressant withdrawal 'hits millions'

Nearly 30% of young people in England do not drink, study finds

Newly discharged mental health patients at much higher risk of death

North Wales police boss calls for drug overdose reversing spray to be carried by cops

Alcohol causes one in 20 deaths worldwide, says WHO

Huge rise in ambulance callouts to deal with ‘spice’ users

Ketamine drug trial to treat alcoholism at Exeter University is recruiting

Royal College to review opposition to legalising cannabis despite concerns over mental health risks

Doctors can prescribe medical cannabis from November in UK

Doctors will be able to prescribe cannabis products to patients from 1 November, the Home Secretary Sajid Javid says.

The new regulations apply to England, Wales, Scotland and Northern Ireland. Javid decided to relax the rules on when cannabis products could be given to patients after a review into medicinal cannabis earlier this year.

This followed an outcry over Alfie Dingley and Billy Caldwell being denied access to cannabis oil which contained THC.

The parents of the two young epilepsy sufferers said the product helped to control their seizures. Alfie's mother, Hannah Deacon, welcomed the move, saying: "We urge the medical world to get behind these reforms so they can help the tens of thousands of people who are in urgent need of help.

"I have personally seen how my son's life has changed due to the medical cannabis he is now prescribed."

Professor Mike Barnes, the medical cannabis expert who secured the first long-term licence for its use for Alfie, encouraged doctors to embrace the changes to the laws on prescribing medicinal cannabis.

An initial review by chief medical officer Dame Sally Davies concluded there was evidence medicinal cannabis has therapeutic benefits.

The Advisory Council on the Misuse of Drugs (ACMD), which carried out the second part of the review, then said doctors should be able to prescribe medicinal cannabis provided products met safety standards.

It recommended cannabis-derived medicinal products should be placed in schedule two of the Misuse of Drugs Regulations 2001.

Cannabis has previously been classed as a schedule one drug, meaning it is thought to have no therapeutic value but can be used for the purposes of research with a Home Office licence.

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More student unions set to offer drug-testing kits at universities, NUS says

An increasing number of student unions across the country are seeking to introduce drug-testing kits at universities, the National Union of Students (NUS) has revealed.

The NUS is now looking at whether they can send the kits to unions in bulk to make them “more accessible and cheaper” to meet a rise in demand.

Eva Crossan Jory, the NUS vice-president for welfare, said: “More and more unions are asking about drug-testing kits. So we are trying to make the kits cheaper and more accessible.”

A number of student unions – including Manchester, Newcastle and Sussex – already offer kits so students can test drugs before taking them to determine their toxicity and potency. And more are looking to do the same, but smaller SUs need financial support, Ms Crossan Jory said.

She added: “Student unions are taking it more seriously. And there are a lot more student unions that are looking at ways they can reduce harm and educate their students within the union.”

An NUS survey released earlier this year revealed more than half (56 per cent) of students had tried drugs – and two in five said they currently use drugs.

The findings have prompted more student unions to consider introducing the kits, the NUS says.

“We are definitely trying to gear towards harm reduction. There is a lot more interest in that now. The debate has moved on,” Ms Crossan Jory said.

However one vice-chancellor, Sir Anthony Seldon, of Buckingham University, has taken the opposite approach — reinforcing an attempt to create a drug-free campus by asking students to sign a contract pledging to refrain from ingesting illegal substances.

He said he was aiming to start a "revolution" to make drug-taking "socially unacceptable" – adding that it would be "insane" to allow the harmul consequences of drug-taking to continue.

University leaders risked "colluding in the mass consumption" of drugs on campuses by ignoring the issue, he warned.

Rob Noon, LGBT+ officer at NUS, added: “With our research showing so many students use drugs to deal with poor mental health and stress, it is highly unlikely that punishing them heavily and attempting to create a ‘drug free university’ going to deal with these issues. In fact, it is likely to exacerbate them.”

Gary Jones, senior scientist from charity The Loop, a drug testing and counselling service, has seen a rise in students interested in getting hold of the kits, despite some universities still having punitive policies.

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Cannabis 'more harmful than alcohol' for teen brains

Teenagers using cannabis are causing long-lasting damage to their developing brains, a Canadian study suggests.

It found the impact on thinking skills, memory and behaviour was worse than that of teenage drinking. The researchers, from the University of Montreal, urged teenagers to delay their use of cannabis for as long as they felt able.

The study tracked and tested 3,800 adolescents over four years, starting from around the age of 13.

Drinking alcohol and taking drugs, such as cannabis, at a young age is known to cause problems with cognitive abilities such as learning, attention and decision-making as well as academic performance at school. This study found these problems increased as cannabis use increased - and the effects were lasting, unlike those of alcohol.

The teenagers, from 31 different Canadian schools, gave details of their drug and drinking habits once a year. Their brain skills were also tested every year in school using computer-based cognitive tests.

Although levels of cannabis use in the study were low compared with alcohol use, 28% of the teenagers still admitted to some kind of use. This compared with 75% of the teenagers who said they drank alcohol at least occasionally.

Prof Patricia J Conrod, lead study author, from the department of psychiatry at Montreal, said she had expected alcohol to have had more of an impact on the teenagers' brains.

But, instead, the research detected greater increases in errors in cognitive tests on the teenagers using cannabis - while they were taking the drug and after they had stopped.

These effects were seen in working memory, reasoning and their ability to control their behaviour.

"Their brains are still developing but cannabis is interfering with that," Prof Conrod said, of teenagers. They should delay their use of cannabis as long as they can."

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Children caught up in ‘county lines’ drugs gangs being failed by police, says Home Office report

Children exploited by gangs operating “county lines” drugs rings have been failed by police and agencies unable to operate effectively across regional boundaries, according to a new report.

Officers were not easily able to share intelligence with other forces or even between teams in the same force while local authorities were often unaware of vulnerable children within their areas, the report, commissioned by the Home Office, said.

An understanding of the scale and nature of the problem was variable across and within different areas and organisations, leading to young people being inappropriately criminalised, it said.

One head of children’s services was quoted as saying: “In our county, we have three unitary authorities, two youth offending services, two clinical commissioning partnerships, two public health bodies, one police force, three adult safeguarding teams and three multi-agency safeguarding hubs. Each authority has a different youth offer and its own child sexual exploitation lead.

“The county is so diverse. We’ve got a lot of gang activity in two towns and then rural middle England. Getting the right people around the table can be challenging.”

“County lines” gangs use children to traffic drugs from the inner city areas where they are based to provincial towns, where they are used to sell drugs. They have long presented a challenge to police, who are used to working within specific force areas and who are unable to target the organised criminals higher up the chain who are directing the actions of the children.

The report was published by the St Giles Trust, which works with young people caught up in offending, after sections were leaked to the press at the weekend. The

charity ran a pilot project between September 2017 and March 2018 working with young people involved in lines extending from London to Kent.

Case workers had expected to find most of the young people involved had travelled from London to sell drugs. Instead, they found that 85% of the young people involved were locals. To read the report visit: info@stgilestrust.org.uk

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Antidepressant withdrawal 'hits millions'

Millions of people get bad side-effects trying to cut down on or come off antidepressants, a large review says.

The All Party Parliamentary Group for Prescribed Drug Dependence review suggests half of patients have withdrawal symptoms and for half of these the symptoms will be severe.

Patients should be properly warned, it says. Yet guidance says symptoms are usually mild and clear up in a week. But it's not uncommon for side-effects to last for weeks, months or longer.

Antidepressants are one of the most common prescription drugs in the UK and their use has been rising. NHS figures show there were nearly 65 million of these prescriptions given out in England in 2016 - 3.7 million more than in 2006.

The review authors, Dr James Davies, from the University of Roehampton, and Prof John Read, from the University of East London, say about four million people in England may experience symptoms when withdrawing from antidepressants, and about 1.8 million may experience these as severe.

This might include: anxiety, sleep problems and hallucinations

They looked at 24 pieces of research, involving more than 5,000 patients, to reach their conclusions, published in the Journal of Addictive Behaviours.

Dr Davies said: "This new review of the research reveals what many patients have known for years - that withdrawal from antidepressants often causes severe, debilitating symptoms which can last for weeks, months or longer. Existing NICE [National Institute for Clinical Excellence] guidelines fail to acknowledge how common withdrawal is and wrongly suggest that it usually resolves within one week.

"This leads many doctors to misdiagnose withdrawal symptoms, often as relapse, resulting in much unnecessary and harmful long-term prescribing."

Prof Wendy Burn, President of the Royal College of Psychiatrists, said: "Antidepressants are an effective, evidence-based treatment for moderate to severe depression, and are a life-saver for many people. But not enough research has been done into what happens when you stop taking them. As this review shows, for many people the withdrawal effects can be severe, particularly when antidepressants are stopped abruptly.

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Nearly 30% of young people in England do not drink, study finds

A large proportion of young people in England are shunning alcohol completely, a study has suggested.

Researchers said abstaining from alcohol was becoming “more mainstream” among people aged 16 to 24 after the analysis showed a rise in the proportion of non-drinkers.

The research, published in the journal BMC Public Health, found more than 25% of young people classed themselves as “non-drinkers”.

University College London’s researchers said the norms around drinking appeared to be changing. They studied data from the annual health survey for England and found the proportion of 16- to 24-year-olds who do not drink alcohol had increased from 18% in 2005 to 29% in 2015.

Meanwhile, the proportion of “lifetime abstainers” rose from 9% to 17%. The study also appeared to show fewer young people were drinking harmful amounts.

In 2005, 43% said they drank above the recommended limits, but this proportion had fallen to 28% 10 years later.

Binge-drinking rates also dropped from 27% in 2005 to 18% in 2015.

But the increased rates of non-drinking were not observed among smokers, ethnic minorities and those with poor mental health, according to the study, which analysed data on almost 10,000 young people.

Dr Linda Ng Fat, the lead author of the study, said: “Increases in non-drinking among young people were found across a broad range of groups, including those living in

northern or southern regions of England, among the white population, those in full-time education, in employment and across all social classes and healthier groups.

“That the increase in non-drinking was found across many different groups suggests that non-drinking may becoming more mainstream among young people, which could be caused by cultural factors.

“The increase in young people who choose not to drink alcohol suggests that this behaviour maybe becoming more acceptable, whereas risky behaviours such as binge drinking may be becoming less normalised.”

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Newly discharged mental health patients at much higher risk of death

People with mental health problems are at a hugely increased risk of dying from unnatural causes, including suicide, soon after they have been discharged from hospital, new research reveals.

Such patients are 38 times more likely to die of fatal poisoning and 90 times more likely to perish from a drugs overdose than the general population, according to a new study. Experts say the difficulties some people with serious mental illness have in adjusting to life after a spell of inpatient care are likely to explain the higher death rate among that group of vulnerable patients.

They are at greatest risk of dying very soon after their discharge up until three months afterwards, according to new findings by a team led by Prof Roger Webb, an academic in Manchester University’s centre for mental health and safety.

Newly-discharged patients with psychological or psychiatric conditions are also 32 times more likely to kill themselves than people who have not been admitted, they found.

They are also 41 times more likely to die as a result of intentional self-poisoning and 15 times more likely to die any unnatural death.

Samaritans can be contacted on 116 123 or email jo@samaritans.org.

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North Wales police boss calls for drug overdose reversing spray to be carried by cops

The 25-year-old singer and actor Demi Lovato, a star of X Factor USA, collapsed after a suspected overdose at her Hollywood home in July and was revived by a paramedic using a naloxone spray.

Now North Wales Police and Crime Commissioner Arfon Jones has joined the campaign to have all police officers equipped with naloxone which is used as an antidote to overdoses from fentanyl, prescription painkillers and heroin.

He said: “Police officers are in the business of helping people and by allowing our officers in North Wales and elsewhere in the UK to carry naloxone we would be saving lives in a country where far too many are lost to overdoses.

“In the past delivering an antidote to a heroin overdose involved giving an injection and I can understand the reluctance of police officers to administering what is a medical procedure. But naloxone can be given on the scene of a suspected opiate overdose with a simple nasal spray and in a country where there are well over 1,000 deaths a year from this kind of overdose it makes sense."

Mr Jones, a former police inspector with North Wales Police, is backing the campaign by Derbyshire Police and Crime Commissioner Hardyal Dhindsa, the Association of PCC’s Alcohol and Substance Misuse Lead.

She said: “The increased threat of super-strength opiates such as Fentanyl and Carfentanyl, which can cause an accidental overdose even for those with a higher opioid resistance, further highlights how providing an effective first response to these overdoses is only going to get more important in the coming years.

“A key tool to preventing these deaths from overdose is the opioid-suppressant naloxone. This drug is used to inhibit the effects of opiates, such as heroin and morphine, and can stop an overdose in its tracks, providing a crucial window for getting medical assistance to the patient.”

Naloxone acts by preventing opiates, which affect the brain’s control of respiration, from slowing or even shutting down breathing, the most common cause of drug-related death.

It can be given with a simple nasal spray and has been listed by the World Health Organisation as an essential medicine. and is recommended by health experts at the Advisory Council for the Misuse of Drugs and Public Health England on the basis of the difference it has made and the lives it has saved both at home and abroad.

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Alcohol causes one in 20 deaths worldwide, says WHO

Report finds that 13.5% of deaths among people in their 20s are linked to alcohol.

Alcohol is responsible for more than 5% of all deaths worldwide, or around 3 million a year, new figures have revealed. The data, part of a report from the World Health Organization, shows that about 2.3 million of those deaths in 2016 were of men, and that almost 29% of all alcohol-caused deaths were down to injuries – including traffic accidents and suicide.

The report, which comes out every four years, reveals the continued impact of alcohol on public health around the world, and highlights that the young bear the brunt: 13.5% of deaths among people in their 20s are linked to booze, with alcohol responsible for 7.2% of premature deaths overall.

It also stresses that harm from drinking is greater among poorer consumers than wealthier ones.

While the proportion of deaths worldwide that have been linked to alcohol has fallen to 5.3% since 2012, when the figure was at 5.9%, experts say the findings make for sobering reading.

A WHO alcohol-control expert, Dr Vladimir Poznyak, who was involved in the report, said the health burden of alcohol was “unacceptably large”.

“Unfortunately, the implementation of the most effective policy options is lagging behind the magnitude of the problems,” he said, adding that projections suggested both worldwide alcohol consumption and the related harms were set to rise in the coming years.

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Huge rise in ambulance callouts to deal with ‘spice’ users

There has been a dramatic increase in ambulances being called to deal with people who have taken the dangerous synthetic cannabinoid spice, with paramedics in some areas of England dealing with six times as many affected people compared with last year.

The figures have prompted concern from paramedics and police that some areas may be engulfed by the substance, which has become a persistent problem among homeless communities.

The warnings come despite it being reclassified as a class B drug more than a year ago. Anyone found to be in possession of it could face up to five years’ imprisonment.

Data from West Midlands ambulance service showed a surge in call-outs linked to spice and black mamba (another name for the drug). Numbers went up from 2,890 call-outs between January and July 2017, to 3,233 in the same period a year later.

Figures from South Western ambulance service NHS foundation trust (SWASFT) painted a similar picture. Between August 2016 and July 2017, 157 calls were about the synthetic cannabinoid, compared with 960 from August 2017 and July 2018.

SWASFT said it had seen a “significant rise” in the number of patients experiencing symptoms from taking spice, but incidents remained a small proportion of the 900,000 annual calls they get.

A West Midlands ambulance service spokesman said users were “putting their lives at risk every time they take [these substances]”.

“The effect on the patient can vary considerably; our staff often treat legal high users who have suffered seizures, heart attacks and strokes. Some patients are left with long-term illnesses whilst others never wake up,” he said. Police and charities have also warned that use of the psychoactive substance is a big problem.

“Walk to any city centre and you can see the effect [of spice] going up, and also rough sleeping in city centres is going up – the two are absolutely inextricably linked,” says Lee Ball, the Salvation Army’s centre manager in Cardiff.

“The reason spice use has gone up is that we have lots of people who are very hurt and not enough resources and time out there to understand what we are working with.”

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Ketamine drug trial to treat alcoholism at Exeter University is recruiting

Low doses of the drug Ketamine are being used to treat alcoholism in a trial being run by Exeter University - and places are still available for people who want to join the study.

The KARE study, funded by the Medical Research Council, follows up on previous research that suggested ketamine could produce brain changes that make it easier to make new connections and learn new things.

This could make the sessions of psychological therapy that are given as part of the trial more effective. There is also some evidence in humans, from a study of alcoholics in Russia, that ketamine alongside psychological therapy can cut the numbers of people who return to drinking following detoxification by nearly 40%.

Ketamine has recently been shown to alleviate depressive symptoms – a common feature of alcoholic relapse. Scientists are testing whether a low dose of the drug ketamine, along with therapy and regular monitoring of participants’ alcohol levels, can help prevent relapse to alcoholism.

For more information about the trial please contact KARE on: Email: kare@exeter.ac.uk

Exeter site telephone: +44 (0)1392 724070

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Royal College to review opposition to legalising cannabis despite concerns over mental health risks

The Royal College of Psychiatrists is to review its opposition to the legalisation of cannabis despite its concerns over the risks the drug poses to users’ mental health.

It is setting up a panel to consider decriminalisation in the wake of more countries legalising the drug and the government’s decision to make medical cannabis available on prescription.

The move is critical as much of the research the government has used to keep cannabis as an illegal drug has been conducted by leading researchers from the College.

Its members also hold key positions advising ministers on mental health including the chairman of the advisory council on the misuse of drugs Dr Owen Bowden-Jones, an expert on addiction, although he is not on the panel.

He said he remained deeply concerned over the risks of psychosis from new high-strength strains of cannabis but accepted there were arguments legalisation could pave the way for regulations to limit the strengths, generate tax income and reduce the numbers criminalised by taking it.

“We need to look at it in more detail to get more evidence. One of the arguments for legalising cannabis has been that you will get purer forms of it and you can tax it so governments benefit,” said Dr James, who as registrar is head of policy at the College.

“As a forensic psychiatrist, the strongest argument is decriminalising behaviour that is widespread and avoiding people getting caught up in the criminal justice system and ending up on a conveyor belt. If you can decriminalise it as an activity, you prevent that and the stigma associated with it.”

Although the college believed drug policy worldwide needed to be reviewed on the basis it “had not worked”, he said there was evidence that even in states where it was legal, high-strength cannabis still “proliferated.” Ex-Tory leader William Hague joined some police leaders in backing decriminalisation, saying the current law on cannabis was “inappropriate, ineffective and utterly out of date.”

The Royal College of Physicians, British Medical Journal, British Medical Association and Royal Society for Public Health have also called for reform to the laws up to and including legalisation.

Dr Adrian James, the Royal College of Psychiatrists’ registrar who will chair the panel, said they would start with an “open mind” and review the medical evidence and the research from US states, Uruguay, Canada and Portugal where it has been decriminalised.

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