The Pharmaceutical Journal Vol 267 No 7162 p258
25 August 2001

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The changing world of drug misuse

Every day, pharmacists come into contact with people who misuse drugs. Clare Bellingham investigates recent trends in substance misuse

Drug misuse is dynamic. Use of one drug rises while another falls. New entities are discovered, and sometimes, like MDMA (3,4-methylenedioxymethamphetamine, ecstasy), become widely used.

The strongest trend in the past few years has been an increase in cocaine use. New drugs are few, and although a small number of ecstasy-type derivatives have been discovered, none are used to any great extent.

Cannabis is the most widely used illicit drug in the European Union, according to the most recent annual report of the drugs problem in the EU (October, 2000), compiled by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Next most used are amphetamines and MDMA. Cocaine and LSD (lysergic acid) are less commonly used, with heroin being used the least.

Cocaine

Use of cocaine is spreading to a broader population, the EMCDDA report reveals. In particular, higher levels of use are found among socially outgoing, employed young adults in urban centres.

This observation of a trend for increasing cocaine use is supported by last year’s annual report of DrugScope. This is an organisation that is the United Kingdom’s focal point for collating information on drugs and part of the EMCDDA monitoring network.

“Cocaine has got cheaper, trendier and there is more of it about,” said a spokesman for DrugScope. Cocaine is traditionally seen as an expensive drug used by people with money. Despite retaining this image, its price has fallen. Seven years ago, a gram of cocaine (which can make between 10 and 20 lines for snorting) cost £70 in south east England compared with £40 today.

Cocaine use has also increased because of a change in the pattern of drug use in the “dance scene”. MDMA use has fallen and there has been a switch to cocaine, he said.

Use of crack, the freebase form of cocaine that is smoked or injected, has increased in some inner city areas but has not become as significant a problem as was feared some years ago. Crack is much more of a problem in America.

Cannabis

Use of cannabis increased substantially throughout the 1990s, the EMCDDA report finds. Young people use cannabis the most and 18 per cent of Europeans aged between 15 and 64 years have tried the drug at least once. In the UK, 25 per cent of all adults have tried cannabis and 44 per cent of 16- to 24-year-olds have used the drug.

Heroin use has remained stable, DrugScope says, but use of methadone has increased.

MDMA and amphetamines

Use of MDMA and amphetamines has levelled off, the DrugScope report finds. In people aged below 20 years, there are indications that use of these drugs is falling. The UK situation reflects the pattern of use in Europe where MDMA use appears to be stabilising following increases in the 1990s, while use of amphetamines is either stable or rising. The EMCDDA report says that between 1 and 5 per cent of 16- to 34-year olds in the EU have tried amphetamines or MDMA or both, but that up to 10 per cent of all adults in the UK have tried amphetamines, the highest figure in the EU.

There have been few “new drugs” produced recently that have become widely used. The newest drugs available are derivatives of MDMA but use of these substances is not widespread.

MBDB (N-methyl-1-[1,3-benzodioxol-5-yl]-2-butanamine) is an ethyl homologue of MDMA. Its effects are similar to those of ecstasy but it tends to be less potent. MBDB is often sold as ecstasy and many users are unaware that they have taken it rather then MDMA. The EMCDDA estimates that the proportion of ecstasy pills that contain MBDB is up to 5 per cent and typically between 1 and 2 per cent.

Another new ecstasy-type drug is 4-MTA (4-methylthioamphetamine). It appears to carry a higher risk of acute effects than MDMA, including adverse reactions and overdose.

Other new synthetic drugs include hallucinogenic substances that give similar effects to LSD, for example, a short-acting substance, DMT (dimethyltriptamine), which has effects that last for two hours.

Ketamine and GHB

The anaesthetic drug ketamine has been used as a recreational drug since 1992. It alters perception and gives an “out of body” feeling of detachment. Ketamine is sometimes known as “super K”, “special K” and “KitKat”. There have also been reports of it being mixed with cocaine and called “special CK” (in reference to the fashion designer Calvin Klein).

Ketamine is usually supplied in powder form to be snorted or as liquid for injection although it has also been found in tablet form, leading to some confusion for MDMA users who have inadvertently taken ketamine.

Ketamine is not controlled in the UK under the Misuse of Drugs Act so its possession is not an offence; this is an attraction for people using the drug. However, people can be prosecuted for supplying it under the Medicines Act. A spokesman for DrugScope said that ketamine’s legal position was under review and that it would be controlled within the next five years.

In March this year, the EMCDDA called for Europe-wide monitoring of use, health consequences, manufacture and trafficking of ketamine following rising concerns over its use. At the same time, it called for monitoring of another anaesthetic drug, gamma-hydoxybutyric acid (GHB).

GHB is supplied in a liquid or powder formulation and its street names include “liquid ecstasy”, “GBH”, “easy lay” and “cherry meth”. GHB causes euphoria, relaxation and loss of inhibitions. In larger doses, it causes sedation and has been associated with use in sexual assaults, particularly since it is tasteless when put into drinks.

Like ketamine, GHB is controlled under the Medicines Act and its use may soon fall under the Misuse of Drugs Act.

Other drugs

Herbal drugs that mimic the effects of illegal drugs have been produced. The spokesman for DrugScope said that these were commonly sold at festivals and on the internet. “They are marketed as a safe alternative to drugs but they are just as dangerous. They are not clinically tested and control of their sales is very loose,” he said.

Herbal ecstasy often contains salvia, yohimbine or ephedrine (from the herb Ma Huang). It is also sold in the UK under names such as “Herbal Highs”, “Cloud 9”, “Eclipse” and “Nirvana Plus”.

Finally, polydrug use has become more popular in the past 10 years than it was before, the DrugScope spokesman said. Apart from combinations of drugs mentioned above, the newest addition to polydrug use is sildenafil (Viagra). Sildenafil is being used particularly in combination with recreational drugs that cause erectile dysfunction.

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Clare Bellingham is on the staff of The Pharmaceutical Journal