UK drug service is ill equipped to deal with new “legal highs” taken by clubbers

Dozens of new drugs known as “legal highs” are being taken by
nightclubbers in London, in ignorance of their dangers and potential
long term effects, a conference on public health and cities was told
on Monday 22 October.

Although use of heroin and cocaine was falling, especially among young
adults,1 their place was being taken by a multitude of new drugs, said
Owen Bowden-Jones of Central North West London NHS Foundation Trust.
He is a founder of the Club Drug Clinic at Chelsea and Westminster
Hospital, which opened its doors 18 months ago and which is now
“overwhelmed” with people seeking help—not only from London but from
all over England and even from mainland Europe.2

He told the City Health 2012 conference at the Guildhall in the City
of London that 24 new substances had been detected in 2009, 41 in
2010, and 49 in 2011 and that he expected the total this year to reach
60. Most were easily obtained over the internet, and “they pop through
your letterbox the next day.” The number of online sites selling club
drugs had risen from 314 in 2010 to 690 in 2011, Bowden-Jones said.
“It’s a big business.”

Traditional drug services, set up to deal chiefly with addiction to
heroin and crack cocaine, were ill equipped to manage the shifting
pattern of club drug use, he said.

The range of club drugs had been assessed in a pooled urine
collection, in which a urinal had been set up in central London and
all the urine that was collected over one night was analysed. Together
with alcohol, caffeine, and other predictable metabolites, the
exercise produced traces of dozens of other drugs.

Some of these presented serious health problems. Ketamine, for
example, produces a feeling of euphoria but also causes a thickening
of the bladder wall, leading to ulcerative cystitis. The bladder
shrinks and becomes painful. Users can get into a cycle from which it
is very difficult to escape, Bowden-Jones said: because ketamine is
also an analgesic, using it dulls the pain. Coming off it makes the
pain worse, making it harder for users to stop.

The clinic found that three quarters of people who used ketamine were
in pain after bladder damage, and these cases became so common that
the clinic now employs its own urologist. Clients using mephedrone
reported depression and psychosis, while users of GBL (γ
butyrolactone) showed high levels of dependence and difficult
withdrawal symptoms. A survey published in Addiction had shown that
66% of clubbers had used ketamine and 41% mephedrone.3

Yet data from the national drug treatment monitoring system, which is
run at the University of Manchester on behalf of the NHS National
Treatment Agency for Substance Misuse, had shown only a small rise in
the number of people who took club drugs presenting for treatment.
“What we are dealing with here is a new drug demographic that the
treatment system has not kept pace with,” said Bowden-Jones.

He said, “Since we opened the doors of the Club Drug Clinic we have
demonstrated that club drug users who are turned off by traditional
heroin and crack services will engage with a service specifically
oriented to their needs.”

A survey of the clinic’s clients showed that they were not teenagers
but an older group with an average age in the early 30s and with a
high proportion of gay men. Most were in full-time employment. A
quarter were found to be injecting, a particularly alarming statistic.
The commonest drugs were GBL, crystal meth, ketamine, mephedrone, and
cocaine.

Bowden-Jones said that new models of treatment were needed to engage
with this group of users, together with a better understanding of the
short and long term harms of club drugs and research into effective
treatments.