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Downloads are all free, however licencing restrictions apply. There are no 'hard copies' of the Drugs Wheel - however the files below are scalable and will print at high resolution at any size. Please get in touch if you would like a version of the Drugs Wheel for your language or country, use the contact form to ask for the translation template.

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The Drugs Wheel: a new model for substance awareness

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The Drugs Wheel by Mark Adley is a new model for substance awareness

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"Almost all cannabis seized by police now comprises high-strength varieties, with outdoor-grown herbal strains and hashish barely found," The Guardian reports. The news is based on researchers analysing samples of cannabis seized by 5 police forces in 2015 and 2016.

They found almost all the cannabis (93.6%) was sinsemilla, also known as skunk. This is a potent form of herbal cannabis often grown in the UK in indoor "cannabis farms" which has been specifically bred to have high levels of tetrahydrocannabinol (THC).

THC is the psychoactive chemical in cannabis responsible for many of the pleasurable effects people get when using the drug. THC has also been linked to an increased risk of developing mental health problems, such as psychosis (where a person is unable to tell the difference between reality and their imagination).

Analysis of samples of the drugs showed a wide variation in the levels of THC, with an average level of 14.2% in sinsemilla, compared to 6.3% in resin.

Cannabis resin, which dominated the UK market before 2000, only accounted for 5.8% of the cannabis seized by police. Resin THC levels were higher than those recorded in a similar study in 2005.

Cannabis resin usually contains cannabidiol (CBD), a substance thought to protect against some of the dangerous effects of THC. Sinsemilla does not usually contain CBD.

This matters, because doctors think people who use cannabis with high levels of THC, especially without CBD to counteract it, are more likely to become addicted and develop mental health problems.

Read more about the potential health risks of cannabis use.

Where did the story come from?

The study was carried out by researchers from GW Pharmaceuticals, which produces a range of medical cannabinoid medicines, and from King's College London. GW Pharmaceuticals could be seen to have a conflict of interest in highlighting the dangers of illegal cannabis, as it is currently researching a range of medical treatments based on cannabidiol (CBD).

One of the researchers was funded by the Medical Research Council. The study was published in the peer-reviewed journal Drug Test Analysis.

The study was widely covered in the UK media. Some of the headlines - such as the Mail Online's "Terrifying rise of super-strength 'skunk' cannabis" - ramp up the fear, but by and large the study was accurately reported.

What kind of research was this?

This was a laboratory analysis of samples of drugs seized by police. The study gives a snapshot of the types of cannabis and range of potency of cannabis being sold illegally. However, we don't know how representative the samples are of the types of cannabis being used in the UK, as police may not target all potential cannabis users equally.

What did the research involve?

Researchers contacted 5 police forces which had been involved in previous surveys of cannabis, in 2005 and 2008. The forces were asked to send all seized cannabis samples in their property stores for analysis.

The researchers sorted the cannabis by type, then selected a representative sample to analyse for levels of THC, CBD, and a degraded form of cannabinoid, CBN, which is less potent and is a result of THC breaking down.

Cannabis came from Kent and London Metropolitan districts (in 2015) and Derbyshire, Merseyside and Sussex (in 2016). It was sorted into 3 types:

resin

sinsemilla

natural herbal cannabis (a less-potent type of cannabis, often imported from Morocco)

Researchers analysed about half of the samples of sinsemilla, and all of the samples of resin and natural herbal cannabis, as there were fewer of them. They analysed 250mg from each sample, which they say is a typical amount of cannabis used in 1 joint.

To see whether the time the sample had been held by the police affected the strength, they measured 34 samples where the length of storage was known, and looked at whether CBN levels were linked to time stored.

What were the basic results?

The vast majority of the 995 cannabis samples were sinsemilla:

929 (93.6%) of these were sinsemilla, compared to 708 (84.5%) in 2008 and 247 (50.6%) in 2005

58 (5.8%) were resin, compared to 104 (14.2)% in 2008 and 169 (42.7%) in 2005

6 (0.6%) were traditional herbal cannabis, compared to 14 (1.3%) in 2008 and 39 (6.7%) in 2005

The average THC content of sinsemilla samples was 14.2%, similar to the 13.9% found in 2005. However, the range varied from 1.9% to 22.5%, with most being around 10% to 20%.

Average THC content of resin was much lower, at 6.3%, although this varied from no discernible THC to 29% in 1 sample found in a prison. The average strength was much higher than in 2005, when average THC concentration was 3.7%.

Only 1 of the sinsemilla samples contained CBD, the protective agent. While most resin samples did contain CBD, researchers found the average level had dropped from 4.3% in 2005 to 2.3% in 2015/6.

The analysis found no indication that length of time in police storage affected the strength of cannabis.

How did the researchers interpret the results?

The researchers said: "This trend presents an increased risk of harm to those susceptible to the development of psychotic disorders following cannabis use." They suggest the need for a nationwide survey.

Conclusion

Cannabis has often been dismissed as a relatively harmless street drug, compared to class A drugs such as cocaine and heroin. However, mounting evidence suggests it may have a harmful effect on mental health, particularly for teenagers and adolescents, increasing the chances of problems including panic attacks, anxiety and psychosis.

Although research is still taking place, it seems that stronger sinsemilla cannabis (aka skunk, which contains more THC and little CBD), raises the risk of mental health problems and addiction, compared to cannabis resin, which tends to have less THC and more CBD.

It's concerning that this study suggests sinsemilla is becoming much more common, and that where resin is on sale, it has more THC and less CBD than a decade ago. People who base their ideas about cannabis on the drug they smoked many years ago may not realise the strength and potential harm of the cannabis sold on the street today.

However, the study has some limitations:

It only looked at drugs seized by police. It's possible that police may prioritise arresting and confiscating drugs from people selling sinsemilla, because of its perceived harm. This might mean the proportion of cannabis resin in the study could be artificially low.

It only analysed a proportion of the samples of sinsemilla, and only 250mg from each sample. The overall sample strength might have varied, because the cannabis plant's concentration of THC varies in different parts.

Only 5 police forces were involved, so we don't know if the results would apply equally around the country.

Cannabis doesn't just affect mental health, smoking any form of cannabis can be bad for your health in other ways.

It can also:

damage your lungs

increase your risk of road accidents

damage your fertility and, if smoked when pregnant, damage the unborn baby

Find out more about the effects of cannabis.

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High-strength skunk 'now dominates' UK cannabis market

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"Almost all cannabis seized by police now comprises high-strength varieties, with outdoor-grown herbal strains and hashish barely found," The Guardian reports. The news is based on researchers analysing samples of cannabis seized by 5 police forces in 2015 and 2016. They found almost all the cannabis (93.6%) was sinsemilla, also known as skunk.

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"For me, having cannabis in the evening is the equivalent of having a glass of wine on a Friday night.

"People of my generation see cannabis as safer than drinking and safer than smoking," says Faye, 22.

"The health risks [of drinking and smoking] have been drummed into us."

Faye's comments come as Lord Hague has said he wants to see "decisive change" in the law on cannabis and that the government should consider legalising recreational use of the drug.

Faye (not her real name) says the message at her school was simply: "Under no circumstances must you do drugs." Meanwhile, however, pupils were given much more specific information about the dangers of alcoholism and smoking tobacco.

"We were just taught to say, 'No.' But young people are going to come into contact with drugs at some point in their lives," Faye says.

She believes the education system is struggling to keep up with drug trends and that a message of: "Just say no," does not prepare for youngsters for the realities of a society where drugs are widely available.

"You're told your whole life, 'These drugs are bad for you and they could kill you,' and then when you do these drugs and you're fine and having fun, you reflect on your education and think that maybe everything you've been told is wrong," Faye says.

Negative effects of taking cannabis

It may make you feel faint or sick

It can make you sleepy and lethargic

It can affect your memory

It makes some people feel confused, anxious or paranoid, and some experience panic attacks and hallucinations

It interferes with your ability to drive safely

Source: NHS Choices

In some cases cannabis can increase anxiety and paranoia, lead to confusion and even hallucinations, according to the Royal College of Psychiatrists.

There is also "compelling evidence" that regular cannabis use increases the risk of developing psychotic illnesses, such as schizophrenia, particularly in adolescents, according to Dr Marta Di Forti, from King's College London.

Writing in the Telegraph newspaper, Lord Hague says that as far as cannabis is concerned "any war has been comprehensively and irreversibly lost".

"The idea that the drug can be driven off the streets and out of people's lives by the state is nothing short of deluded," he writes.

"Surveys of young people attest that they find it easier to purchase cannabis than virtually anything else, including fast food, cigarettes and alcohol."

Statistics from NHS Digital have recently found secondary school children in England are more likely to have tried drugs than cigarettes.

The research, published in November, interviewed 12,051 pupils in 177 schools in the autumn term of 2016.

Analysis of the results showed 24% of the 11- to 15-year-olds interviewed said they had tried recreational drugs at least once in their lives - a nine percentage point rise on the last survey conducted in 2014.

'I love the way it makes me feel'

Darren (not his real name), now 24, has been smoking cannabis since he was 13.

"After a busy day at work, you go home and light up and it just relaxes the mind, the body. And, all of a sudden, everything's OK," he says.

"I love the way it makes me feel relaxed."

Darren agrees with Faye that many young people see cannabis as the safer option to drinking alcohol.

"You hear how alcohol can kill, cause liver damage, affect your speech," he says. "People lose limbs and life by doing silly things.

"But you don't hear that so much about weed. So, it sounds like a softer option - 'I'm getting a buzz, but I'm not going to die.'"

Darren admits that smoking cannabis may have had a detrimental affect on his exam grades and general achievement.

"I've done great. But maybe I could have done better? That's the conflict I have daily with smoking weed," he says.

"It's lovely in the moment. But then the guilt kicks in an hour later.

"And it's costly. And it makes me lazy, sometimes."

'More normalised now'

But Darren says that, whatever the positives or negatives of cannabis, the idea of its use being confined to seedy pubs and clubs is far from reality.

"You walk out of work or the shopping centre and there are people who sell weed and they'll have no issue approaching you," he says.

"It's much more normalised now. People think of it as teenagers on the street corner - but it goes far beyond that, I know.

"There are mothers out there smoking it. There are grandparents, police officers, teachers."

Faye adds: "It's not just school kids - it stretches far beyond the people you think would do drugs."

She believes the taboo around the use of cannabis for private recreational use should be challenged.

"I did some ecstasy because they're cheap - but now I do cannabis," Faye says. "It's a treat. It's not something I do regularly.

"I just think we need to stop judging people, at the end of the day."

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Young 'think cannabis safer than alcohol'

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"For me, having cannabis in the evening is the equivalent of having a glass of wine on a Friday night. "People of my generation see cannabis as safer than drinking and safer than smoking," says Faye, 22. "The health risks [of drinking and smoking] have been drummed into us."

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How you take a drug affects how quickly you start to feel its effects and how strong they are. Depending on how the drug enters you, it can damage different parts of the body.

How a drug is taken can influence how likely you are to get addicted to it. Smoking and injecting drugs cause the biggest concentration of chems in the blood in a very short amount of time. This gives the fastest, strongest hit and a greater chance you will become addicted.

Remember:

Know your dealer - always buy your drugs from someone you trust and who knows what they're selling.

Don't be alone - if you overdose or have a bad experience, you'll need help.

Bad batches happen - try a small sample of a new batch first to avoid overdosing.

Have condoms and lube with you - stimulants can make you horny.

Knowing about the specific risks with taking drugs in different ways can help you to keep these as safe as possible:

Find out about different entry methods, and how to keep these as safe as possible:
Next: Swallowing ››
Published: 07/08/2015
Next review: 07/08/2018

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How you take a drug affects how quickly you start to feel its effects and how strong they are. Depending on how the drug enters you, it can damage different parts of the body. How a drug is taken can influence how likely you are to get addicted to it.

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N-ethylpentylone in Montreal, Canada

''Although unadulterated MDMA capsules have been common in eastern Canada since 2017, pure N-ethylpentylone (also called ephylone, or BK-EBDP) has lately made its way into the streets of Montreal and was reported to be sold as MDMA in capsule form. An official warning has yet to be issued as most users are unaware of this designer drug. This compound is far more toxic than MDMA and may cause death at high dosage but still within the range of what heavy MDMA users would ingest.

The appearance of the drug or the subjective user's experience of the drug aren't good indicators of its nature. N-ethylpentylone may look like MDMA and feel similar to MDMA. Marquis drug reagent test is your best ally as it will turn bright yellow if it is N-ethylpentylone instead of purple/black for MDxx.''

Anonymous concerned Montreal citizen.

New Zealand - dangerous drug n-ethylpentylone sold as ecstasy

A new drug masquerading as ecstasy has experts worried after six kilograms were netted in a bust by Wellington police this week.

Wendy Allison, director of free drug testing service Know Your Stuff, says many who believe they're taking ecstasy are actually taking something far more dangerous.

"In our testing this season approximately 25 percent of substances brought us as MDMA have turned out not to be, and of those the majority have been n-ethylpentylone."

N-ethylpentylone is a newcomer to New Zealand, only being detected in the country late in 2017. It's cheap and easy to manufacture, but is also far more toxic if it's taken in the same dosage as ecstasy.

Full article here:

http://www.newshub.co.nz/home/health/2018/03/police-concerned-by-emergence-of-new-drug-n-ethylpentylone-sold-as-ecstasy.html

NB Pentylone and N-ethyl-pentylone turning up in more pills

Please read this excellent article on NB Pentylone and N-ethyl-pentylone detection by The Loop in the UK.

"... with all the valerones being more potent than MDMA, the mis-selling of valerones as ecstasy causes added concern given that an amount that could be considered an â€˜averageâ€™ dose of MDMA would be a very strong dose of any of these impostors."

"NB Pentylone and N-ethyl-pentylone can also both be detected at home with [Marquis] drug reagent tests as they turn bright yellow instead of purple/black for MDMA."

Official Facebook Page for Pill Reports

We've decided to create an official Facebook page for Pill Reports, here's the link: Pill Reports Official.

There are a few imitation Fan Pages on Facebook and we want to avoid any confusion and let you know that they aren't us - nor do they represent what we are about.

We want to make it as easy as possible to stay up to date with the latest information and warnings that are posted on our website and other relevant info that is brought to our attention.

- PR Team

2017 News Update

Hello PR Family,

The turkish section will be removed due to people in that section consistantly breaching our rules/guidelines and its alot harder to maintain due to language barriers.

Pillreports.net will recieve a brand new look / website update in the near future thanks to johnboy.

Bearlove has officially left the team and deserves a huge thank you for everything hes done for the website over the years.

We appreciate everything and hope you will join us again one day,
til then the best wishes to you.

Bornatubby / PR Team

Mix of 25C-NBOMe, 4-FA and MDMA sold as MDMA in Melbourne AUS

tl;dr NBOMe mixtures sold as MDMA are around, donâ€™t snort unknown caps, use test-kits wisely, look after your mates, and get your lab student/worker friends to contact us so we donâ€™t need to rely on labs in Barcelona to access high-quality drug testing in Australia!

On the weekend 15-16 January 2017, there was a spate of poisonings, hospitalisations and deaths that have been associated a batch of capsules that were reportedly sold as MDMA or Ecstasy. Punters at Revolver nightclub and other clubs on Melbourneâ€™s Chapel Street were affected.

The contents of these caps appeared damp, more like a brown sugar consistency than crystals or powder.

We obtained anonymous reports from people who consumed these capsules. The reports describe very strong hallucinogenic symptoms and paranoia. While in most cases, the symptoms resolved without medical intervention, they were very unpleasant, with one person reporting that they â€˜felt like they were going to die or never be the same againâ€™.

Reagent test kit results were shared by Bernie Maitri: these reports showed the substance was unlikely to be MDMA-like, and could instead contain PM(M)A or 2C-T-X. However these results were inconclusive, so we arranged to send a sample of this drug to Barcelona, where Energy Control conducts an international testing service. Mireia Ventura conducted the tests with GC/MS and LC/MS. The testing confirmed that the contents of the capsules:

- 4-FA (main substance)
- a low amount of MDMA
- 25C-NBOMe

This mixture is consistent with the reports. 25C-NBOMe is highly potent with only microgram doses required to produce strong hallucinogenic effects. 4-FA is an amphetamine-type stimulant which has been described as having an effect somewhere between amphetamine and MDMA. It is concerning that a low amount of MDMA was detected in the mixture, as this may be an indication that the manufacturers were hoping to fool reagent test kits by including enough MDMA to produce a positive result.

PLEASE GO TO BLUELIGHT FOR THE REST OF THIS ARTICLE

http://bluelight.org/vb/content/252-25C-NBOMe-4-FA-and-MDMA-mixture

WARNING! - PMA/PMMA is being sold as MDMA in Victoria Australia

In recent months DanceWize has received a number of reports from our peers in the dance community who use Mecke and Mandelin reagent tests sourced online (or from a limited number of retailers in Melbourne) that substances purchased as MDMA (colloquially referred to as Ecstasy) were in fact other Novel Psychoactive Substances, including methylone, 2CB, 2CI, and 2CE. Further, of more concern, such reagent tests have also indicated with a high degree of certainty that PMA/PMMA is in circulation in Victoria masquerading as MDMA.

The substances tested were described as a clear capsule containing white powder that had a subtle purple hue, and a circular orange pill with a capitalised â€˜Bâ€™ press.

This is extremely concerning due to the dangers associated with PMA/PMMA, which is known to elevate body temperature dramatically and has been linked to deaths around the world from hyperthermia (overheating). When partying, if you or anyone else seems to be experiencing fever-like symptoms please seek urgent medical attention and make every effort to reduce core body temperate (drink water, remove clothing layers, apply ice packs to hot spots, and move to a cooler environment if necessary). Remember emergency services are there to help not judge, so donâ€™t hesitate!

DanceWize encourages partygoers to be aware of this trend and consider pill testing as an advisable harm reduction tool. If you would like additional harm reduction educational information please contact DanceWize via the Harm Reduction Victoria website: http://hrvic.org.au/dancewize/.

from press release dated 5/2/2015

HOW TO RATE REPORTS

***PLEASE NOTE***

When rating a report (thumbs up/thumbs down), you are rating the QUALITY OF THE REPORT - *NOT* THE PILL!!

Thanks!
PR Admin Team & Mods.

Official Facebook Page for Pill Reports

We've decided to create an official Facebook page for Pill Reports, here's the link: Pill Reports Official.

There are a few imitation Fan Pages on Facebook and we want to avoid any confusion and let you know that they aren't us - nor do they represent what we are about.

We want to make it as easy as possible to stay up to date with the latest information and warnings that are posted on our website and other relevant info that is brought to our attention.

- PR Team

We've decided to create an official FB page for Pill Reports. We want to make it

We've decided to create an official Facebook page for Pill Reports, here's the link: Pill Reports Official.

There are a few imitation Fan Pages on Facebook and we want to avoid any confusion and let you know that they aren't us - nor do they represent what we are about.

We want to make it as easy as possible to stay up to date with the latest information and warnings that are posted on our website and other relevant info that is brought to our attention.

- PR Team

Current Staff List - 2016

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Pill Reports - Ecstasy Test Results Database by Enlighten

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N-ethylpentylone in Montreal, Canada ''Although unadulterated MDMA capsules have been common in eastern Canada since 2017, pure N-ethylpentylone (also called ephylone, or BK-EBDP) has lately made its way into the streets of Montreal and was reported to be sold as MDMA in capsule form.

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Around 100 new Novel Psychoactive Substances are synthesised each year, there is considerable uncertainty about the effectiveness of recent legislative changes, and near moral panic in parts of the popular press (I won't mention the 'Z' word here).

We are experiencing fast shifting sands in the world of substance misuse, with a clear current need to pitch some way-markers and determine research and clinical priorities.

What are Novel Psychoactive Substances (NPS)?

Technically, they're any drug consumed for an intoxicant effect but not covered by the 1971 Misuse of Drugs Act. The fact they weren't covered (and thus not banned) by this older legislation led to their popular name 'legal highs'. They are often still inaccurately referred to as such, but following a change in UK law in 2016, synthesis and distribution/sale of all current and any future compounds is prohibited. You'll notice this doesn't cover possession for personal use or consumption: the gap is intentional, with the aim of avoiding criminalising drug consumers, and pushing such emphasis onto those making and selling the drugs.

However, the new legislation opens a couple of curious loopholes. Firstly, one could in theory get in more trouble with the police for possession of, for example, cannabis (which is covered by the older legislation) than for possessing a novel but more potent NPS cannabinoid analogue (a 'spice' variant). Secondly, it also exempts certain specific mind-altering compounds: some not because they're less harmful, but because we're historically used to having them (think alcohol, nicotine, and, less harmfully, caffeine); some because they are medically required (antidepressants and other psychoactive medications). New Scientist magazine provocatively highlighted that semen has been shown to change female behaviour and asked if it was therefore prohibited or exempted: no clear answer has been forthcoming, though I'm not aware of any prosecutions for its synthesis.

NPS also altered the 'traditional' drug-dealing model, with a shift to internet and 'dark-web' purchasing, though of course obtaining them from dealers, friends and so forth is obviously still a major source for most people.

There are over 650 identified NPS, so presumably there are more out there yet to be scientifically described, and this list is growing. This creates an enormous problem in terms of keeping up to date with the field, something that matters if you (or a loved one) consume NPS or you are a clinician or scientist working in this area. There is no universally agreed way to categorise NPS, though colleagues and I recently wrote linked papers for the BMJ (Tracy, Wood & Baumeister 2017a, b) chunking them into four major groups:

1. Stimulants (drugs similar to cocaine, amphetamines, and ecstasy)

2. Cannabinoids (drugs similar to cannabis)

3. Depressants (which can be further broken down into benzodiazepine and opioid sub-groups)

4. Hallucinogens (both psychedelics like LSD, psilocybin, mescaline, and dissociatives like ketamine and phencyclidine (PCP or angel dust)).

The majority of NPS fall into the first two categories, with hundreds in each. However two NPS stimulants may be as different from each other as cocaine is from ecstasy, and as well as 'desired effects', their harmfulness can vary considerably from drug to drug (as well as from drug consumer to consumer). Standard drug screens are proving inadequate, with multiple false positives and negatives: the implications for (emergency) clinical care and legal issues are obvious. Continuing the learning test, many NPS can be consumed in multiple ways (injecting, smoking, swallowing, inhaling/snorting etc.), confounding our perhaps stereotyped ways of how people take certain drug types (e.g. 'smoking cannabis', 'injecting heroin', 'snorting cocaine'). I think the challenge facing us is clear.

NPS-UK Project

The NPS-UK project (Mdege et al, 2017) has set out to address this, with three specific objectives:

1. Summarise and evaluate what is known about NPS use, harms, and responses

2. Develop a dedicated conceptual framework for a public health approach

3. Make recommendations on key evidence gaps and future priorities.

Methods

The authors systematically reviewed the existing literature up to June 2016, and used these findings to produce both the conceptual framework and key recommendations on future priorities. Given the nature of the topic, they included grey literature, with both Google queries and hand-searching of identified relevant websites. The authors rightly concluded that the nascent extant literature is too weak to allow a proper risk of bias assessment, and the team used a pragmatic approach in determining inclusion in the narrative synthesis.

In developing the conceptual framework, they applied these findings to what is already known in parallel evidence-informed but complex multi-sector public health fields such as tobacco, alcohol, and 'traditional' illicit drug use. This allowed a preliminary NPS model to be created.

These two aspects were combined to create the proposed future research recommendations.

Results

995 studies meeting inclusion criteria were identified

Few data were found on social and other risk factors, population-level risk factors, long-term harms, intervention effectiveness, and treatment outcomes

The most robust data were for the NPS stimulant mephedrone, in part as this is one of the 'older' and more established NPS

It is not possible at this time to build good population risk-data on the limited (often case-report) harms data available

The legislative changes seem to have attained some of their targets of reduced access, use, healthcare utilisation, and self-reported toxicity; however, the collection methodology in such studies is very much open to challenge

Following from this, the conceptual framework notes the need for better long-term data on harms and intervention effectiveness, and the wider societal burdens involved.

Conclusions

The authors produced key recommendations, which I have summarised:

1. Evaluate the effectiveness of existing NPS monitoring systems and pharmaco-toxicology in informing this

2. Monitor new drug trends & how behaviour maps onto what is known about alcohol, tobacco and existing illicit drugs

3. Design cohort studies to map determinants of NPS use and harms

4. Develop and evaluate prevention strategies, and further evaluate the impact of legislation

Strengths and limitations

Data on drug use can occupy a peculiar space: randomised controlled trials are few, anecdotal evidence and case reports many. Much sits in a grey-literature space. This has always been the case, but multiply it by 650 new compounds, and you get a sense of the problem. However, it can be argued that this only strengthens the need for work such as this, to make early terrain maps.

A challenge of NIHR 'first-look' work is that not all details are contained within, and I would have liked to see more on the papers found and assimilated; however, that will come with time, and it is not a fair complaint to make when the point of this iteration is to provide rapid open access to all.

Summary

NPS use remains a 'minority' amongst those who consume drugs, but the area is important. Some are being shown to be especially potent, with localised bursts of hospitalisations and deaths; the novel fentanyls seem a particular worry. Even more so than is usually the case, there are some very marginalised and vulnerable people who seem disproportionately involved, notably those who are homeless, in prisons, and forensic psychiatric units. Issues of detectability and cost may be playing a role, but when we think of the social space in which harmful drug use is treated and lives rehabilitated, these may be very difficult people to reach.

Early problems have arisen with the new legislation. Two very recent cases brought by the Crown Prosecution Service against sellers of nitrous oxide (laughing gas) at musical festivals have been dismissed, including after hearing expert testimony from the Government's own witness. It was successfully argued that nitrous oxide is not covered by the 2016 legislation; its anaesthetic properties meant that it was exempted as a medical product "restoring, correcting or modifying a physiological function by exerting a pharmacological, immunological or metabolic action". The fact it remains on sale at Amazon and other online retailers (for culinary purposes; making whipped cream) underscores the confusing headache we face.

In the flurry, and at times panicked, slew of information (often partial, sometimes inaccurate) that has followed the growth of NPS, this work by Mdege et al is an important initial census and State of the Nation. It is timely to set forth prospective goals, rather than seemingly just be reactive to the environment. It is now for others to comment and contribute to the authors' roadmap, and help fill in the gaps and refine it.

Links

Primary paper

Mdege ND, Meader N, Lloyd C, Parrott S, McCambridge J. (2017) The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations (First look draft). NIHR Journals Library, National Institute for Health Research.

Other references

Tracy DK, Wood DM, Baumeister D. (2017a) Novel psychoactive substances: types, mechanisms of action, and effects. BMJ 2017; 356 :i6848

Tracy DK, Wood DM, Baumeister D. (2017b) Novel psychoactive substances: identifying and managing acute and chronic harmful use. BMJ 2017; 356 :i6814

Novel Psychoactive Substances: important information for health professionals

Easton M. (2017) 'Legal high' review after laughing gas cases collapse. BBC News, 31 Aug 2017.

Photo credits

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Novel Psychoactive Substances: bridging the knowledge gap

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Around 100 new Novel Psychoactive Substances are synthesised each year, there is considerable uncertainty about the effectiveness of recent legislative changes, and near moral panic in parts of the popular press (I won't mention the 'Z' word here).

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In previous briefing papers, Mentor looked at the impact of new psychoactive substances on public health and drugs education. Schools and practitioners should also update their drugs policy to take account of New Psychoactive Substances (NPS).

Every school's drugs policy should include new psychoactive substances (NPS), formerly known as "legal highs," as these drugs have had harmful effects on young people and some school communities. Schools have a statutory obligation to protect the welfare of their students, so they must maintain accountability by updating their drugs policy accordingly, particularly considering increasing numbers of school exclusions related to drugs and alcohol.

These briefing papers are part of a series produced by Mentor-ADEPIS on alcohol and drug education and prevention, for teachers and practitioners.
Other resources you may find interesting:

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Updating your drugs policy to include NPS - Mentor-ADEPIS

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In previous briefing papers, Mentor looked at the impact of new psychoactive substances on public health and drugs education. Schools and practitioners should also update their drugs policy to take account of New Psychoactive Substances (NPS). Every school's drugs policy should include new psychoactive substances (NPS), formerly known as "legal ...

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An online, interactive support tool, created buy guys who get chemsex, for guys who have chemsex; or healthcare providers supporting them.

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(Can't see the video? Watch it on Vimeo)

Turning Tina is TIM's harm reduction resource for gay, bi, trans men living with HIV who use crystal meth AKA tina.

Please read no further. The following material may trigger and/or elicit cravings if you have or had an issue with substance use.

It's time to talk about tina. Whether you're a regular user of crystal meth, have dabbled once or twice, or know a mate that is struggling: this HIV + community-developed resource is for you.

People's reasons for trying or using tina are varied. This four-part resource outlines some of the facts about using tina, including what it does to your body and how you get it into your body. We also wanted to talk about some of the warning signs that might signal it's time to take a break or even get some help.

This resource has gathered practical risk reduction strategies and advice based upon survey responses and interviews with former and current tina users. Some information was provided by members of The Institute of Many, and the authors of this resource are very grateful for their honest contributions.

READ TURNING TINA (2MB DOWNLOAD)

The Institute of Many (TIM) does not in any way endorse or encourage the use of illicit drugs and this resource emphasises the fact that the only way to totally avoid any of the risks associated with methamphetamine use is not to use methamphetamines.

The only way to avoid any adverse consequences from illicit and/or recreational drug use is not to use. However, a lot of guys have already made the decision to do so and they are no less deserving of support in seeking to reduce harmful consequences that can arise for themselves and for those who live and love with them.

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(Can't see the video? Watch it on Vimeo) Turning Tina is TIM's harm reduction resource for gay, bi, trans men living with HIV who use crystal meth AKA tina. Please read no further. The following material may trigger and/or elicit cravings if you have or had an issue with substance use.

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The second European Chemsex Forum, recently held in Berlin, highlighted a number of difficulties and harms experienced by chemsex users, including non-consensual sex. "We have heard many stories of men who, during sexual marathons that last for days, pass out on GHB or GBL, while the sex continues to take place," said Leon Knoops of the Dutch harm reduction organisation Mainline. "When they come around, they often have no recollection of what happened.

"Men have spoken from two sides of the coin, and many wonder if this could be considered rape or if it's just a part of the game. This often triggers immense shame and guilt."

Dr Chris Ward of the Manchester Royal Infirmary and the city's chemsex support clinic (Reach at the Hathersage Centre) said that it is already known that male victims of sexual assault or rape often do not report the incident to police or to healthcare professionals. Under-reporting may be linked to concerns about masculinity, the stigma of being a victim of sexual assault, a fear of being not believed, or not being aware that what has happened was a crime.

In the context of chemsex, many men feel that their drug use or being in a highly sexualised environment blurs the line around consent. Overdosing means that men might drift in and out of consciousness or may cycle between pleasure and distress while having sex.

Nonetheless, under UK law, a person who is incapacitated through drink or drugs, or is unconscious, cannot give their consent to a sexual act.

Chris Ward said that the way chemsex users are asked about the issue is important. When his clinic asked about being raped or being forced into sex (the same language used with women), it was under-reported. Men involved in chemsex tend to describe their experiences in different terms.

"The presentation is much more subtle," he said. "When we learnt how to ask the question properly, over a third of people in our chemsex clinic reported being a victim of a sexual offence."

He and his colleagues now have a conversation about unwanted sexual attention, negotiation and coercion, with questions such as:
"Have you ever received any unwanted sexual attention at parties?" "Have you ever been made to feel like you have to have sex?" "Have you ever had sex you weren't aware of at the time?" "Do you feel like you can say 'no' to sex at parties?"
Previously, when men were asked about rape or being forced into sex, 5 of 30 men disclosed non-consensual sex. Since the new questions have been used, 23 of 60 men attending the chemsex clinic have disclosed non-consensual sex. Most of these cases involved men being penetrated while they were unconscious; only eight of the men were previously aware that it was a crime.

In addition, nine men said that they had had sex that they didn't want to have but didn't feel able to refuse because they were at a chemsex party. Three men had been assaulted more than once, two men believed that they had been the victim of a planned assault (for example, being deliberately overdosed) and one man reported being filmed and injected while he was unconscious.

Only two of these men decided to take the incident to the police.

Two men attending the clinic came to realise that they had been the perpetrator of non-consensual sex. Ward said that these were particularly challenging situations for clinical staff to work with.

Rebecca Evans, a nurse at the clinic, said that one reason why asking about non-consensual sex could be difficult for staff was because it might not be clear what they would do with the information. As sexual health clinicians, they would not be providing ongoing therapy or support. However, they could help men identify a way to move forward - having a robust referral network to organisations such as SurvivorsUK and the LGBT Foundation was important.

Fred Bladou of AIDES in Paris commented that it was important to draw attention to power relations within this environment. He was particularly concerned about young people, migrants and sex workers who are often particularly vulnerable, for example attending a party on the understanding that their drugs would be provided and paid for. "The chemsex community is not always very friendly and we have to think about the most vulnerable people in the community," he said.

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Non-consensual sex is a recurrent problem in the chemsex environment

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The second European Chemsex Forum, recently held in Berlin, highlighted a number of difficulties and harms experienced by chemsex users, including non-consensual sex. "We have heard many stories of men who, during sexual marathons that last for days, pass out on GHB or GBL, while the sex continues to take place," said Leon Knoops of the Dutch harm reduction organisation Mainline.

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Resources from Chemsex Forum: presentations, audios etc..

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Resources from Chemsex Forum: presentations, audios etc..

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Dean Street is a friendly, convenient and free NHS sexual health clinic in the heart of London. The service - based in Soho - also offers full outpatient HIV clinic services.

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The focus of the forum was on chemsex that has become problematic. There are many gay men who use drugs without having difficulties, but the meeting was not about these 'happy users', Knoops said.

The forum opened with a minute of silence for those men who have died of drug overdoses and drug-related suicides. Many of the activists present had got involved in this work because of these cases. "In the eighties and nineties I saw too many gay men dying of AIDS and I don't want to see this happen again," said Arnd Bächler of the counselling organisation Schwulenberatung Berlin.

Leon Knoops said that Mainline's peer support meetings on chemsex are often attended by men who seem to have lost control. "They often participate in sex marathons which go on for days. They experience physical issues like sleeping problems, losing weight, dental problems and dehydration.

"Mental issues such as depression, psychotic episodes and suicidal tendencies are also frequently occurring problems," he said. "Men have shared stories about losing jobs, houses and partners due to their drug use."

The response to problematic chemsex should come from within the gay scene itself, but will require gay men to acknowledge the issue. Jan Großer of Schwulenberatung Berlin said that gay men had a long history of defending their sexual culture and shared sexual spaces. As gay sex tends to be seen as an "uninhibited, horny, fun party where everyone looks hot", it can be difficult to accept that people are coming to harm in these sexual spaces, he said.

We need to create new narratives of gay sexuality which encourage men to accept and express their emotions as they arise, he suggested. Many men use drugs to overcome their inhibitions, but many of these inhibitions relate to very 'normal' concerns such as having a less than perfect body. "At the moment it feels like a lot of gay men feel obliged to censor and suppress some of their emotions in order to have sex," he said.

Gay men should change their sexual culture so as to have better sex, with richer emotional experiences and deeper personal connections. "Sleazy pigs can be emotionally aware too," he said.

Adam Schultz, an activist from London, said that when he withdrew from chemsex, he had to reconstruct his entire social network and social life. An important part of his recovery was to find 'safe spaces' where he could reconnect with gay men on a social, rather than sexual level. He joined running clubs, pole dancing classes and social groups. He particularly appreciated the frank discussions he could have at the open mic night 'Let's Talk About Gay Sex and Drugs'. He needed a safe space to think about and talk about his experience: "I finally gave meaning to what happened to me."

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Loneliness and community are key to chemsex

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The second European Chemsex Forum, recently held in Berlin, highlighted how the perspectives of activists and health professionals working on the issue have changed. When the first forum took place two years ago in London, most of the discussion was about the drugs that gay men were taking, the impact of potent drug combinations on the body and the brain, and whether a harm reduction approach is even possible when the drug is crystal meth.

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When I open the Grindr app on my smartphone, I see there's a 26-year-old man with tanned abs just 200 feet away. He's called "looking4now," and his profile explains that he wants sex at his place as soon as possible.

Scrolling down, I find 100 similar profiles within a one-mile radius of my apartment in Boston. I can filter them by body type, sexual position (top, bottom, or versatile), and HIV status.

As a gay psychiatrist who studies gender and sexuality, I'm thrilled with the huge strides we've made over the past decade to bring gay relationships into the mainstream. The Supreme Court ruled that same-sex marriage is a constitutional right. Today in Boston, two men can walk down the street holding hands without consequence.

But I'm worried by the rise of the underground digital bathhouse. Apps like Grindr, with 3 million daily active users, and others like Scruff and Jack'd, are designed to help gay men solicit sex, often anonymously, online. I am all for sexual liberation, but I can't stop wondering if these apps also have a negative effect on gay men's mental health.

Since there's little published research on the men using Grindr, I decided to conduct an informal survey and ask men why they're on the app so much and how it's affecting their relationships and mental health. I created a profile identifying myself as a medical writer looking to talk to men about their experiences. I received about 50 responses (including propositions).

It's a small sample size, but enough to give us some clues about how Grindr is affecting gay men. And it doesn't look good.

Apps like Grindr are designed to make finding sex easy. And that can make them hard to stop using.

The most common reason users gave for going on the app is that sex feels great and Grindr makes it accessible, right at your fingertips. The screen full of half-naked men excites users. With a few clicks, there's a possibility of meeting a sexual partner within the hour.

Neuroscientists have shown that orgasm causes activation of pleasure areas of the brain like the ventral tegmental area while deactivating areas involved with self-control. And these patterns of activationin men are strikingly similar to what researchers see in the brain of individuals using heroin or cocaine. So when a neutral action (clicking on Grindr) is paired with a pleasurable response in the brain (orgasm), humans learn to do that action over and over again.

This can be a normal pleasure response or it could be a setup for addiction, depending on the situation and individual.

Grindr, intentionally or not, also leverages a psychological concept called variable ratio reinforcement, in which rewards for clicking come at unpredictable intervals. You may find a hookup immediately, or you may be on your phone for hours before you find one.

Variable ratio reinforcement is one of the most effective ways to reinforce behavior, and it makes stopping that behavior extremely difficult. Slot machines are a classic example. Because gamblers never know when the next payout will come, they can't stop pulling the handle. They hold out hope that the next pull will give them the pleasurable sound of coins clanking against a metal bin, and they end up pulling for hours.

Now imagine a slot machine that rewards you with an orgasm at unpredictable intervals. This is potentially a powerful recipe for addiction and may explain why one user I spoke with stays on Grindr for up to 10 hours at a time, hoping to find the perfect partner for casual sex.

The phrase "addiction" continues to be controversial when it comes to sex and technology, But as John Pachankis, an LGBTQ mental health expert at the Yale School of Public Health, described the impact of Grindr to me: "I don't know if it's an 'addiction,' but I know it causes a lot of distress."

For now, it's hard to know just how many Grindr users feel their use of the app is problematic. Early research on app use and health has focused only on sexually transmitted infections, for instance, rates of HIV among Grindr users, using Grindr to get people tested for STIs, etc.

Just last week, Grindr announced that it will start sending users HIV testing reminders and the addresses of local testing sites (on an opt-in basis). In less pleasant news, BuzzFeed revealed on Monday that Grindr has also been sharing the HIV status of its users with third-party companies. (The company later said it would stop sharing the information.)

Though there is this new attention to sexual health, both Grindr and the research community have been silent on mental health. Yet since 2007, more gay men have died from suicide than from HIV.

This suggests it's time we start thinking about Grindr's health effects more broadly. Other dating apps, like Tinder, for example, are now the subject of early research looking at mental health implications. It's time to do the same for gay hookup apps.

Grindr may provide men with some relief from their anxiety and depression. But it's temporary.

For some users I talked to, the allure of Grindr was not just the rush to feel good. It was to stop feeling bad. Users told me they log on when they feel sad, anxious, or lonely. Grindr can make those feelings go away. The attention and potential for sex distract from painful emotions.

A staggering number of gay men suffer from depression, with some estimates as high as 50 percent. Because gay men's anxiety and depression often stem from childhood rejection for being gay, messages of affirmation from other gay men are particularly appealing. Unfortunately, these messages are typically only skin-deep: "Hey man, cute pic. Looking to ****?"

A recent survey of 200,000 iPhone users by Time Well Spent, a nonprofit focused on the digital attention crisis, showed that 77 percent of Grindr users felt regret after using the app.

The users I interviewed told me that when they closed their phones and reflected on the shallow conversations and sexually explicit pictures they sent, they felt more depressed, more anxious, and even more isolated. Some experience overwhelming guilt following a sexual encounter in which no words are spoken. After the orgasm, the partner may walk out the door with little more than a "thanks."

And yet they keep coming back for that temporary emotional relief. One user told me that he feels so bad after a hookup that he jumps right back on the app, continuing the cycle until he is so tired he falls asleep. Every once in a while, he deletes the app, but he finds himself downloading it the next time he feels rejected or alone.

"We see patients like this almost every day," Pachankis told me. "Apps like Grindr are often both a cause and a consequence of gay and bisexual men's disproportionally poorer mental health. It's a truly vicious cycle."

Not all Grindr users are addicted and depressed, of course. Some users I interacted with seem to use Grindr in a healthy, positive way. One man I interviewed met his fiancé there; they are excitedly planning their wedding. Some I spoke with said they use the app for sex but haven't suffered any negative consequences and have control over their use.

Using Grindr may keep men from finding lasting relationships

Why do so many of these men turn to Grindr to begin with? Perhaps Grindr's popularity is a sign we haven't made as much social progress as we think for same-sex relationships. The general population seems comfortable with the idea of gay marriage, but it's still difficult for a gay man to find a partner.

One 23-year-old user told me that the only places he can find gay men are clubs and Grindr, and both are hypersexualized. The cultures of both intimidate him. According to Pachankis, gay culture is often "status-focused, competitive, hierarchical, and exclusionary." He explains that these traits are common among men generally, but in the gay community, they become amplified in a group that "both socializes and sexualizes together."

The 23-year-old is afraid of rejection, and Grindr shields him from the pain of in-person turndowns. "My framework now is sex first. I don't know how to date people in person."

His relationships, he says, start with casual sex on Grindr. They first meet at 2 am for a hookup. He'll try to schedule the next sex date a little earlier, maybe 11 pm. Then the next step may be drinks.

But this sex-first approach hasn't led to lasting relationships for the men I interviewed and is affecting their self-worth and identity. "My self-esteem now is all about my sexual ability," the 23-year-old said. "I don't feel confident about myself as a partner in any other way."

Another user told me he downloaded the app hoping to find a husband. Now he says that when he and a boyfriend (he's gone through several) fight, his natural response is to open Grindr to "find an alternative" instead of working through problems. He can't maintain a monogamous relationship because he is constantly cheating.

There may be ways to treat men with problematic Grindr use

The mental health professionals I spoke to are seeing problematic Grindr use in their clinics. And there is little published guidance on how to help those who are struggling.

Doctors I spoke to say the best available tools for treating problematic Grindr use are the ones they use in general sex addiction treatment. Citalopram, a common antidepressant, was shown in one small study to be helpful with sex addiction in gay men. Naltrexone, a drug commonly used for other compulsive behaviors, may work as well.

For more extreme cases, patients could request hormonal implants that turn off testosterone signaling, making sexual cravings less intense. However, even these treatments have modest empirical support at best, and none have been studied for hookup app use specifically.

Dr. Shane Kraus, the director of the behavioral addictions clinic at Bedford Veterans Hospital and an assistant professor of psychiatry at the University of Massachusetts Medical School, says the most promising treatment for problematic Grindr use is likely talk therapy techniques like cognitive behavioral therapy (CBT). CBT can teach patients to engage in other behaviors that are more productive (though often more difficult and time-consuming than Grindr) to help them feel loved or supported.

Another psychotherapeutic technique known as acceptance and commitment therapy (ACT) can help teach patients how to better tolerate the feeling of being alone without logging on to Grindr.

The dynamics of Grindr, though, are complicated, and it can take time to work through all the angles. Are you self-soothing anxiety? Are you addicted to sex? Have you lost interest in your monogamous relationship? Do you think you can't attain love, so you're settling for hookups? Did your parents tell you being gay is wrong and you're searching for acceptance? Ultimately, Kraus explains that therapy can help clarify these kinds of thoughts and feelings, and lead to insights that bring about a healthy change.

He also believes it's only a matter of time before states and the federal government sponsor research exploring Grindr use and mental health. Grindr did not respond to our request for comment on this piece. But if future data supports what I suspect about the link between Grindr and mental health problems, even small interventions like advertising mental health resources on the app may help to address these users' suffering.

As we continue to fight to bring gay relationships into the mainstream, we need to keep an eye on Grindr and how it both reflects and affects gay culture. The bathhouse is still around. It's now open 24/7, accessible from your living room.
Jack Turban is a physician and medical writer at Harvard Medical School, where he researches gender and sexuality. His writing has appeared in t he New York Times, Scientific American, and Psychology Today, among other publication s. Find him on Twitter at .

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We need to talk about how Grindr is affecting gay men's mental health

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When I open the Grindr app on my smartphone, I see there's a 26-year-old man with tanned abs just 200 feet away. He's called "looking4now," and his profile explains that he wants sex at his place as soon as possible. Scrolling down, I find 100 similar profiles within a one-mile radius of my apartment in Boston.

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British students are using Xanax in growing numbers. It's 10 times stronger than Valium, relatively easy to get hold of, but has been linked to at least two recent student suicides.

Xanax is addictive, dangerous, and we don't encourage or endorse taking it. But, burying your head in the sand about drugs isn't going to help anyone. So here's what you need to know about Xanax.

If you've come across those little white bars, that's probably Xanax

You've probably seen those little white bars by now, the ones with the little lines pressed into them. Those are Xanax.

It's a tranquiliser, part of the benzodiazepine (benzo) family. Xanax is the brand name for the drug Alprazolam.

It's big in the US, but now British students are getting into it

Some use Xanax's anti-anxiety effects to self medicate, while others do it to get a buzz, or to help them get to sleep after a big night.

Whilst it's a prescription drug in the US, it's less widely available in the UK. Legitimately, it's only available on a private prescription. Yet its ready availability on the deep web, or casually through friends - most students we recently surveyed get it from someone they know - means Xanax culture and usage is spreading among British students.

Stories about Xanax range from wavy nights out to the pub, to the struggles of addicted students we've spoken too. These can have tragic outcomes. In December, University of Brighton student Georgia Jackson took her life two days after an "out of character rage" whilst on Xanax. Raven Hunt, a UWE student, took her own life last April after suffering from Xanax withdrawal.

Fake Xanax is out there, and easier to make than you might think

Although legitimate pills can be obtained through private prescription, buying Alprazolam in bulk off the dark web and pressing it into pills is a common method for making the Xanax you might come across in the UK. There are two pitfalls with this.

Anybody (with £88 and a will to press some Xannies) can get hold of a Xanax "candy" pill press.

And then, who knows what they're pressing? Not to get all "you don't know what you're putting in your body", but really, you don't know what you're putting in your body.

Finding out whether what you've got is really Xanax is hard - plenty of benzo testing kits specifically say they don't actually pick it up. As a result, you're often relying on trust that it's actually Alprazolam in your bar, and not something else. Even then, you've no way of knowing how strong they are, which makes controlling your dosage problematic.

Beyond its addictive nature, these supply issues are one of the things which make Xanax so hazardous, with Vice reporting on the UK's fake Xanax epidemic.

"Even if you're taking 1mg or 0.5mg, it may not have the desired effect that you would have from a credible source," says Dr Mateen Durrani, a pyschiatrist from UK Addiction Addiction Treatment Centres, who specialises in substance misuse psychiatry.

It gets you waved

The effects of taking Xanax run from the mildly wavy to the completely incapacitating. One student we've spoken to, James, describes the effects of Xanax as: "It makes people feel like they are living in a dream-like state not understanding the reality around them. It makes you lose touch with yourself and the people around you."

For insomnia, or getting to sleep, Xanax isn't the best choice. Although it can be useful as a one-off, the quick tolerance build-up means increased doses are needed. There are more effective treatments for a sleep disorder, says Dr Durrani: "If you've got a chronic problem you should go and see a doctor, and look at alternatives like antidepressants, SSRIs and others that have a better and more lasting effect on insomnia."

Xanax come in different varieties, with their strength in mg usually pressed onto them, such as the '2' on the typical white bar. Again, unless this is prescribed, it's difficult to know if this is accurate.

"Usually people take 0.25mg or 0.5mg or 1mg and that gives the desired effect," says Dr Durrani, however the effect varies based on age, weight, dosage, and what else you've taken alongside it, as well as the quality of the Xanax.

Go slowly when taking it

Alongside the more obvious not knowing what you're taking, there are other reasons to be cautious with how much Xanax you take.

The first is that the effects take hold fast. Xanax is one of the more potent benzodiazepines, and kicks in quickly. "Because of that high potency, and because of that short half-life, it has an immediate effect, like you would have with alcohol or opiates," says Dr Durrani.

Second is that a bigger dose, taken frequently, can lead to an addiction that happens quicker and more severely. With an increased dose, says Dr Durrani, "the potential for harm is more, but the potential for dependence is also increased."

Avoid mixing it with alcohol or other drugs

Combining Xanax with alcohol is common and produces more of wave. However, mixing the two can be dangerous.

Whilst there is an increased effect, this combination "can also lead to serious physical complications including death from overdose," says Dr Durrani.

Taking any benzo on its own reduces the risk, and Dr Durrani says that "it's very rare, even in overdose, to see somebody dying from it."

Yet mixing is dangerous, and "if taken in combination with alcohol or with opiates, the potential for it to cause respiratory arrest or cardiac arrest, or for that matter death, multiplies manyfold. When you see a death from alcohol or benzodiazepine overdose, when you look at it they've usually taken other drugs with it."

Signs of Xanax overdose include blurred vision, slurred speech, weakness, respiratory depression, and coma.

Addiction and withdrawal happen quicker than you expect

Xanax withdrawal doesn't just affect those with a fully-fledged addiction. "Inter-dose withdrawal" can happen when a dose wears off, bringing back heightened anxiety symptoms.

An addiction can build up quickly, says Dr Durrani: "You may develop a dependence when using a small dose for a few weeks, but with a higher dose you can develop the withdrawal symptoms much quicker."

These symptoms are notoriously unpleasant. One Reddit user, wunderbez, recounts his experiences: "Withdrawals were horrible. My teeth felt like they were turning in their sockets, sensitive to smell, touch, taste etc. Manic thoughts. Suicidal thoughts. Addictive behaviour. (obsessing over empty xanax bottles and counting valiums religiously.) Plus lots of other problems."

This range of symptoms extends up to more extreme, and dangerous, seizures. "If you stop suddenly or the supply suddenly dries up, then you have serious risk of going into withdrawal seizures," says Dr Durrani, warning that these seizures can be fatal.
If you or someone you know is struggling with drug addiction you can find out more about UKAT's services

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So, you're taking Xanax for the first time. This is what you need to know

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British students are using Xanax in growing numbers. It's 10 times stronger than Valium, relatively easy to get hold of, but has been linked to at least two recent student suicides. Xanax is addictive, dangerous, and we don't encourage or endorse taking it. But, burying your head in the sand about drugs isn't going to help anyone.

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'It reduces people to zombies': UK readers on Xanax misuse

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After warnings of an 'emerging crisis' in the drug's use by young Britons, you shared your stories

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ChemSex support - for Professionals - Counselling and sexual health support for gay men who use recreational drugs for sex. ChemSex.

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A dangerous interaction is possible between ritonavir or cobicistat and several recreational drugs:

Crystal methamphetamine (crystal, tina, meth)

MDMA (ecstasy, X, mandy)

Mephedrone (miaw miaw, plant food, bath salts)

Ketamine (K, vitamin K, special K)

Erectile dysfunction drugs (Viagra, Cialis, Levitra)

Benzodiazepines (benzos, Valium, Xanax)

The interaction may increase the intensity of the effect of the recreational drug, sometimes to unpleasant or dangerous levels.

Experts judge the potential for interactions with the first three drugs listed to be 'moderate' and with the last three to be 'high'. There have been a handful of documented cases of deaths and serious side-effects in people taking ritonavir alongside crystal meth, MDMA or ketamine.

Heavy use of ketamine can lead to damage to the liver and bile ducts. Overdoses of erectile dysfunction drugs are dangerous for the heart. An overdose of benzodiazepines could result in the person passing out.

Poppers may also interact with erectile dysfunction drugs, causing a potentially dangerous drop in blood pressure. This may be more likely if you are also taking ritonavir or cobicistat.

For GHB (gamma-hydroxybutyrate) and GBL (gamma-butyrolactone), the risk of interactions is unknown.

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Factsheet Interactions between HIV treatment and recreational drugs

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A dangerous interaction is possible between ritonavir or cobicistat and several recreational drugs: Crystal methamphetamine (crystal, tina, meth) MDMA (ecstasy, X, mandy) Mephedrone (miaw miaw, plant food, bath salts) Ketamine (K, vitamin K, special K) Erectile dysfunction drugs (Viagra, Cialis, Levitra) Benzodiazepines (benzos, Valium, Xanax) The interaction may increase the intensity of the effect of the recreational drug, sometimes to unpleasant or dangerous levels.

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Slamming drugs can be more dangerous in comparison to other methods of taking chems. We're here to reduce the harm injecting could potentially have. Keep yourself informed and come in and speak to us for a judgement-free consultation. We can offer you clean needles and guidance on how to take drugs safely.

Important:

Never inject below your waist

Avoid injecting into your hands or feet

Never inject deeper than 5mm or you may hit an artery or a nerve. Arteries are deeper and harder to pierce than veins, the blood is brighter and it will spurt rather than ooze

Never inject into a site that is sore, swollen or tender

Don't inject into the same spot two times in a row. Vary your injecting sites to give the vein a break and to recover

Don't bend your elbow to stop the bleeding - apply pressure and hold the bleeding site

Safer injecting practices

If you are injecting it is safer to do it yourself if you can, you then have power over of the situation. You can practice safer injecting practices like being hygiene aware and can stop if you feel something is wrong.

Never use alone. Having someone else there is important if your body reacts in a way you did not expect

Wash your hands with warm soapy water before and after injecting

Never let a used fit come into contact with a group mix. No matter how well it has been cleaned everyone must have their own fit, water, spoon and filter

Stock up on equipment so you don't run out, always get more than you think you will need

Always mix up on a clean space (wipe with a clean cloth and soapy water or use new swabs)

Clean your spoon before mixing up (wipe once with a new swab)

If you can't wash your hands use single wipes with new swabs. Remember - rubbing swabs backwards and forwards spreads the dirt and bacteria around

Stop the flow of blood after injecting with clean cotton wool, tissues or clean toilet paper

Have your own tourniquet and don't share it, wash it regularly to remove blood

Rinse your fit with clean, cold tap water straight after your hit to help remove traces of blood

If you keep your own fit, mark it and keep it somewhere safe

Always dispose of injecting equipment in a disposal container or a puncture-proof container with a child-proof lid. If possible return the container to your local needle and syringe exchange programme

Don't re-use swabs, filters or open water ampoules as they can become contaminated once opened. Dispose of them with your fits or inside two plastic bags

Be aware of blood on sleeves and clothes - if you get blood on your clothes, tourniquet or other washable items wash them immediately

If someone is helping you inject, make sure they wash their hands before and after

Injecting over a long period of time can result in:

Blocked blood vessels (caused by things mixed or cut with the drugs)

Inflamed blood vessels and abscesses

Damage to vital organs such as the liver, heart or lungs

Injecting may also increase the risk of becoming dependent on the drug thereby exposing you to serious mental health problems

Crystal meth is a strong, highly addictive amphetamine stimulant which is usually snorted, smoked, mixed with water and injected (slamming), or injected inside the anus (booty bumping). It releases the brain's stress hormone norepinephrine and 'feel good' chemicals dopamine and serotonin which makes people feel high, full of energy, confident, invincible, impulsive, less likely to feel pain and very horny with fewer inhibitions. It also increases the appetite and energy levels, so people taking Crystal can go for days without eating or sleeping. It is often used during non-stop sex sessions and on the clubbing scene.

Sex on Crystal Meth
Crystal can make people feel extremely sexually aroused for long periods. People using this drug may do things they wouldn't normally do, including risking picking up or passing on HIV. It often makes it difficult for men to get an erection or ejaculate (known as 'crystal dick'). It can become hard to think of having sex without being on meth and - like G and mephedrone - it can have a big impact on your ability to have sex sober.

Health risks of Crystal Meth

Long or rougher crystal-fuelled sex sessions can cause the genitals, mouth or anus to become irritated, sore or bleed. This may not be noticed at the time, but it can increase the risk of HIV, Hepatitis C and other sexually transmitted infections being passed on.

Due to increasing the body temperature, heart beat and blood pressure, it can increase the risk of heart attack, stroke, coma or death

Comedowns can leave a person exhausted, aggressive and paranoid, in some cases even suicidal.

People can develop stomach problems such as acid reflux or gastritis due to not eating for a long period of time.

With long-term use, crystal meth can damage the lungs, nose and mouth and lead to lasting mental health problems, even after quitting the drug. It can also interact dangerously with other recreational and prescription drugs

People may find quitting crystal very difficult and its effects on the brain can last long after giving the drug up.

Useful to know

Injecting is best avoided. It's the quickest way to getting addicted and runs the risk of serious health problems (skin abscesses, collapsed veins, blood poisoning and heart infections).

Sharing injecting equipment puts you at high risk of getting or passing on HIV, Hepatitis C and other infections.

Using hot pipes might injure your mouth and if you share them it risks passing on infections like hepatitis C and HIV.

Condoms are more likely to break after about half an hour of use. So during long sex sessions it makes sense to check condoms regularly and put a fresh one on after 30 minutes.

Although Mephedrone (Meph) is now illegal, it developed popularity in 2009 along with other so called "Legal Highs". It is a stimulant that causes speediness and euphoric effects.

Psychological dependance is common with Mephedrone. If you're worried this applies to you come and see us.

Mephedrone is most often a powder and can be snorted, mixed with a drink, "bombed" (wrapped in paper or put in a capsule and swallowed), booty-bumped (syringed up the anus) or injected.

Meph is very irritant and commonly causes inflammation.

Snorting the drugs can cause nose bleeds. Swallowing it mixed with a drink can cause a sore throat.. It is particularly damaging to your veins. The best harm reduction advice (besides not doing it at all) would be to "bomb" it in a paper wrap or capsule, to avoid the aggravation to nostrils, veins and throat.

Side effects include heart palpitations, anxiety, sleeplessness, temperature fluctuations and in some cases hallucinations and fainting.

GHB/GBL causes a feeling of euphoria and reduced inhibitions, but when used carelessly it can also be very dangerous.

There are many common dangers with GHB/GBL including accidental overdose, "going under" on a dance-floor, date-rapes in saunas, or visits to A&E. People using the drug frequently can physically dependent (addicted) to the drug. They may find themselves forced to dose hourly to avoid difficult and dangerous withdrawal symptoms.

Dependent use means that stopping GHB/GBL without medical supervision poses dangerous health risks, to clear your system you will require an in-patient detox.

If you are using GHB or GBL dependently (multiple times daily, for more than 2 weeks), then it is advisable that you are assessed for a medically supervised detox. A GHB/GBL detox is not a service that 56 Dean Street can provide; you would need to contact your local borough drug & alcohol service. Below is a list of the London services that provide GHB/GBL detoxes; if your own borough is not there, or if you have no formal connections to a London borough (eg, residence, GP, hostel) then come to see us at 56 Dean Street Chemsex support and we will explore options for you.
TRI BOROUGH (WESTMINSTER - KENSINGTON&CHELSEA - HAMMERSMITH & FULHAM)
CLUB DRUG CLINIC
http://clubdrugclinic.cnwl.nhs.uk/ BARKING & DAGENHAM
RED LION SERVICE
https://www.changegrowlive.org/content/red-lion-service-barking-dagenham BARNET
WPD - BARNET RECOVERY CENTRE
http://www.wdp.org.uk/find-us/london/barnet-0 BEXLEY
THE PIER ROAD PROJECT
https://www.bexley.gov.uk/services/public-health/drug-and-alcohol-services BRENT
WPD - BRENT RECOVERY & WELLBEING SERVICE
http://www.wdp.org.uk/find-us/brent BROMLEY
BDAS - BROMLEY DRUG AND ALCOHOL SERVICE
https://www.changegrowlive.org/content/bromley-drug-alcohol-service-bdas CAMDEN AND ISLINGTON
GRIP CLUB DRUGS SERVICE
https://www.candi.nhs.uk/services/grip-club-drugs-service CITY OF LONDON
WDP
http://www.wdp.org.uk/get-help/club-drugs CROYDON
CROYDON RECOVERY NETWORK
http://www.turning-point.co.uk/croydon-recovery-network.aspx EALING
CGL - EALING RISE
http://www.ealingrise.org.uk/ ENFIELD
ENABLE - ENFIELD DRUG AND ALCOHOL SERVICE
http://www.beh-mht.nhs.uk/mental-health-service/mh-services/enable-enfield-alcohol-and-drug-service.htm GREENWICH
CGL - ASPIRE GREENWICH
https://www.changegrowlive.org/content/greenwich-aspire HACKNEY
HACKNEY RECOVERY SERVICE
http://hackneyrecoveryservices.org.uk/ HARINGEY
THE GROVE
http://www.beh-mht.nhs.uk/mental-health-service/mh-services/the_grove_drug_treatment_service_haringey.htm HARROW
WPD - HARROW RECOVERY SERVICE
http://www.wdp.org.uk/find-us/london/harrow-0 HAVERING
WPD - HAVERING
http://www.wdp.org.uk/find-us/london/havering HILLINGDON
WPD - ARCH
http://www.wdp.org.uk/find-us/london/hillingdon HONSLOW
iHEAR PARTNERSHIP
http://www.ihearpartnership.org/ KINGSTON
KINGSTON WELLBEING SERVICE
https://www.kingstonwellbeingservice.org/ LAMBETH
CHEMCLINIC
http://www.slam.nhs.uk/our-services/service-finder-details?CODE=SU0995 LEWISHAM
CGL - LEWISHAM
https://www.changegrowlive.org/content/new-direction-lewisham MERTON
WDP - MERTON
http://www.wdp.org.uk/find-us/london/merton NEWHAM
CGL - NEWHAM RISE
https://www.changegrowlive.org/content/cgl-newham-rise REDBRIDGE
WDP - REDBRIDGE
http://www.wdp.org.uk/find-us/london/redbridge RICHMOND
RICHMOND INTEGRATED RECOVERY SERVICE
https://www.changegrowlive.org/content/richmond-integrated-recovery-service SOUTHWARK
CGL
https://www.changegrowlive.org/content/cgl-southwark TOWER HAMLETS
RESET
https://www.elft.nhs.uk/service/362/Reset-Tower-Hamlets-Drug-and-Alcohol-Service WALTHAM FOREST
CGL - WALTHAM FOREST

https://wwWER HAMLETS w.changegrowlive.org/content/cgl-waltham-forest-chingford
WANDSWORTH
WANDSWORTH COMMUNITY DRUG AND ALCOHOL SERVICE
https://www.addaction.org.uk/services/wandsworth-community-drug-and-alcohol-service

Recreational Use

Always be responsible for your own dosing. Always.

Avoid mixing GHB/GBL with alcohol and ketamine as this increases your chance of 'going under' or having fits and coma

Take appropriate doses at appropriate time intervals. A commonly used dose would be between 0.5ml and 1ml. Never dose again within the same 3 hour period

Stick to your own doses and times. Don't accept GHB/GBL from friends just because it's being offered

Use a measured dropper bottle or syringe to measure your doses. Never just pour it casually into a cup and never drink from the bottle or from someone else's drink

Dependence

If you use GHB/GBL regularly for a long weekend you might find yourself feeling anxious, sweaty and shaky the week after or unable to sleep. These are the first signs of dependence (addiction). Even though a shot of GHB/GBL would alleviate these symptoms, resist the urge to take GHB/GBL and try to ride out these early signs with rest and stress free activities.

If you have become dependent on GHB/GBL, your withdrawals will be shakes, sweats, sleeplessness and extreme anxiety. In this case, you should continue taking your GHB/GBL in regular amounts at regular time intervals. Then you can seek medical advice from a drugs advisor at 56 Dean Street, Antidote, your local borough drug service, or GP

Keep a record of your doses and times, to stabilise your use and reduce chaotic ups and downs.

If you're experiencing withdrawals and have no GHB/GBL you should go to A&E and be honest about your situation. This is the safest course of action as withdrawals can be dangerous.

Try not to panic, help is available

NOTE:

GHB and GBL are not the same thing; GHB is the chemical produced in the body when we drink GBL. (The liver converts the GBL to GHB after ingestion.) And sometimes, though less commonly, GHB is a different form of the drug that can come as a powder or liquid, different from GBL. In regard to the effects on the body, they are essentially the same; but when it comes to dosing, it is important to understand the difference.

GBL is the most commonly used form of the drug, and the one you are most likely to find available on the internet, often sold as a liquid cleaning solvent. Concentrations of GBL when bought on the internet rarely vary enough to cause concern in regard to dosing. Take appropriate doses at appropriate time intervals. A commonly used dose of GBL might be between 0.5ml and 1ml. Never dose again within the same 3 hour period. If unsure or inexperienced, always start with the lowest dose, and if it doesn't work after 45 minutes, you might increment up; in this case, make sure your second dose is never more than half of your first dose.

is less commonly available than G BL; sometimes sold as a powder to be mixed with water (never sniffed, never injected), and sometimes already mixed and in liquid form (liquid GHB). This would be more likely to have been sold to you by a dealer or on the dark web, than via traditional internet shopping. G HB in liquid form (not G BL) is perhaps the most dangerous way to ingest the drug, as the concentration can vary enormously. Some samples of liquid GHB in Holland measured between 350 and 550 mg/ml; but without testing your sample, there is really no way of knowing the concentration of your liquid GHB, so be extremely careful. Don't assume anything. Carefully check the concentration with your source before calculating your dosage. 2.5ml of liquid GHB might be a safe dose to start with - but again, there are no guarantees, and be sure that it is GHB and not GBL you are using, as a 2.5ml dose of GBL could be fatal.

Always start with a low dose to determine if it works for you, and if there is no effect after 45 minutes, increment up gently with a second dose; this second dose should never be more than half of your first dose.

Whether it is GHB or GBL you are using, appropriate dosing vary person to person, depending on body weight, how much sleep you've had, when you ate last, other drugs you might have taken, and other factors. Alcohol and Ketamine are especially dangerous in this regard, and should never be used with GHB/GBL.

Both GHB and GBL are drugs that can develop into a physical dependence, and if this kind of addiction develops, you should not consider stopping "cold turkey" without advice from a doctor or drugs worker, as these withdrawal symptoms can be dangerous, and sometimes fatal. Sexual assaults, poor choices around safer sex, and overdsoses (sometimes fatal) are commonly reported consequences of GHB and GBL.

More GHB/GBL harm reduction tips from our friends at Drugs.ie can be found here.

If a new pair of gloves is used with each sexual partner you can cut the risk of most infections, you can pick up gloves as well as lube and condoms from 56 Dean Street.

There is a risk of HIV transmission from fisting if the fister (the guy doing the fisting) has cuts or sores on his hand or wrist

It is easy to damage the lining of the rectum when fisting, so if fisting is followed by condomless anal sex the risk of transmission of HIV and Hepatitis C to either partner is much higher.

Using oil-based lube (such as Crisco) for fisting can cause problems if you have anal sex afterwards. This is because the oil damages the rubber that's used in most condoms. Either use a water-based lubricant or switch to non-latex condoms which are not affected.

If more than one person is being fisted, HIV or Hepatitis C could be passed from one fistee to another via anal mucus or blood carried on the fist

It's best to have your own pot of lube. Sharing lube can also lead to the transmission of HIV and other STIs, as the pot can become contaminated with others blood or anal mucus

Hepatitis A and gut infections like salmonella and shigella (causing fever, diarrhoea with blood and mucus) can get passed on if anything gets passed to the mouth

Urine carries no risk of HIV transmission. There is little risk of passing on any infections.

Shared dildos and butt plugs can pass on infections. Wash sex toys thoroughly after use, using warm soapy water or a sterilising fluid designed for baby bottles.

Alternatively use a condom on it and change it between partners.

Using sex toys may cause microscopic damage inside. You may not notice anything but it may increase the chance of HIV transmission if followed by condomless sex.

Shared penile toys such as Fleshlights can also pass on infections As with dildos, you should wash them thoroughly after use, using warm soapy water or a sterilising fluid designed for baby bottles.

Using other household objects can be very dangerous. If you do, avoid anything with sharp edges or anything that may break inside you. If it doesn't have a base, be careful not to let it go too deep inside you. If you lose anything inside go to A&E.

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Slamming drugs can be more dangerous in comparison to other methods of taking chems. We're here to reduce the harm injecting could potentially have. Keep yourself informed and come in and speak to us for a judgement-free consultation. We can offer you clean needles and guidance on how to take drugs safely.

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Gay and bisexual men who reported engaging in chemsex (the use of specific drugs to enhance or facilitate sex) were five times more likely to be newly diagnosed with HIV, nine times more likely to be diagnosed with hepatitis C and four times more likely to be diagnosed with a sexually transmitted infection (STI) during a 13-month follow-up period, according to London data published this week in HIV Medicine.

"This is the first published study to demonstrate a significant association between chemsex disclosure and new HIV diagnosis," said Dr Mark Pakianathan and colleagues at St George's University Hospital, London. Clinicians and public health officials should use the findings to identify a population particularly vulnerable to HIV acquisition who could be targeted for pre-exposure prophylaxis (PrEP) and other prevention interventions, they say.

During routine appointments for sexual health care at St George's between June 2014 and July 2015, 1840 gay and bisexual men were asked questions about mental health, substance use and chemsex. (A previous aidsmap.com article reported on harms associated with chemsex.) Their ages ranged from 14 to 82 years, but the median was 34. Just under a third were born outside the UK and the cohort was ethnically diverse.

Currently engaging in chemsex was reported by 286 men (16.5% of all men).

Drugs most commonly used for chemsex were mephedrone (198 men), GHB/GBL (152 men), crystal methamphetamine (126 men), cocaine (54 men), other amphetamines (36 men) and ketamine (22 men). Of note, the St George's researchers used a wider definition of chemsex than some other groups, who define it as only the use of the first three drugs in a sexual context.

Men often used more than one drug at the same time. Injecting drug use was reported by 74 men.

Whereas 1.8% of men who did not report chemsex had a new HIV diagnosis during 2014 or 2015, this was the case for 8.6% of men who were involved in chemsex. In multivariate analysis (which took into account a range of other factors which influence HIV infection), chemsex was associated with a fivefold increase in the risk of HIV infection (adjusted odds ratio 5.1, 95% confidence interval 2.6-10.1).

The researchers comment that chemsex sessions may last several days and involve mucosally traumatic sex with multiple partners. Given the high incidence of HIV in this population, sexual partners who met at chemsex parties may be men who have very recently acquired HIV, have not been diagnosed and have an extremely high viral load.

A new diagnosis of hepatitis C occurred in 0.2% of men who did not report chemsex and 2.8% of men who did (eleven men in total). In multivariate analysis, this amounts to a ninefold increase in risk (adjusted odds ratio 9.2, 95% confidence interval 2.3-36.3).

Similarly, diagnoses of STIs were elevated in men involved in chemsex. This was true for all STIs (adjusted odds ratio 3.5), rectal STIs (4.5) and acute bacterial STIs (3.9).

Gay and bisexual men attending sexual health services should be assessed for chemsex participation, the researchers say. "Disclosure should prompt health promotion, harm minimization and wellbeing interventions."

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Gay men having chemsex are five times more likely to have a new HIV diagnosis than other gay men

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Gay and bisexual men who reported engaging in chemsex (the use of specific drugs to enhance or facilitate sex) were five times more likely to be newly diagnosed with HIV, nine times more likely to be diagnosed with hepatitis C and four times more likely to be diagnosed with a sexually transmitted infection (STI) during a 13-month follow-up period, according to London data published this week in HIV Medicine.

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Health warnings as image culture drives usage of performance-enhancing drugs

Up to 1 million people in the UK are taking anabolic steroids and other image- and performance-enhancing drugs (IPEDs) to change the way they look, public health experts and doctors have said.

This ranges from teenagers seeking the perfect physique to elderly men hoping to hang on to youthful looks.

Research suggests that appearance rather than sporting performance is the reason for a majority of those now using anabolic steroids and other IPEDs.

Q&A
Are anabolic steroids illegal?
Show Hide

Anabolic steroids are class C substances under the Misuse of Drugs Act 1971. There is no possession offence but it is illegal to manufacture, supply or possess/import/export steroids with the intent to supply, without a licence to do so. The maximum penalty is 14 years in prison and/or a heavy fine.
What are the most common IPEDs?

Methandrostenolone (Dianabol or D-Bol) is taken orally.

Testosterone enanthate (Test E) is injected.
Who are the users?
Why do people take IPEDs?
What the possible complications?

Human growth hormones are commonly taken.

The most common age to begin is between 20 and 24, but users range from 13 to mid-70s. The vast majority are male and in work or fulltime studies.

More than half say they want to change their body shape for image or cosmetic reasons. Some take them to increase chances in bodybuilding competitions, as hormone replacement therapy, to retain youthfulness or increase confidence.
Do users take other drugs and drink alcohol?
Testicular atrophy, change in sex drive, sleep difficulties, aggression, mood swings, acne, injection site pain, depression, hair loss.

Long-term effects may include disease and dysfunction of the liver and both acute and chronic cardiovascular pathologies.

Users are not believed to become physically dependent, but may become hooked on the way the drugs make them look and feel.

75% wait for side effects to go away on their own. 15% of users say they have shared vials, which increases the chances of passing around blood-borne viruses.

75% say they consume alcohol and almost half recreational drugs including cannabis, cocaine and ecstasy.

Photograph: Dimitris Legakis/Athena Picture Agency Ltd

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Thank you for your feedback.

There is growing concern that the desire to conform to a "ripped" male image beloved of people featured in lifestyle magazines and reality television shows is causing tens of thousands of young men to put their long-term health at risk by taking ever more complex cocktails of IPEDs. Many also face complications by mixing steroids with alcohol and drugs such as cocaine.

Police forces and border officials are seeing an increase in the number of underground laboratories "cooking" steroids in the UK and consignments of drugs being imported to the UK from countries where IPEDs can be bought over the counter. The rise of social media has made it easier to swap both information and products.

Josie Smith, the head of the substance misuse programme at Public Health Wales, said there had been extraordinary changes in both the profile of people using IPEDs and the availability of the substances.

Drug use Venn diagram

In Wales, which has long been seen as a hotspot for steroid use, boys as young as 13 were known to be using IPEDs. "It has become normal and acceptable," she said. "From a public health perspective there are genuine and very real concerns."

Just over half of people who use Welsh needle exchanges - where safe drugs equipment is handed out - are steroid users and in some of the southern valleys the proportion is 75%.

Frank Atherton, the chief medical officer for Wales, said steroid use was a significant issue. "It's something we're monitoring carefully. It's a cultural thing. Among some young men there's a desire to be perceived as bulky and muscly. It's the message we see from GQ and other magazines."

Police forces are promising to clamp down on dealers. Commander Simon Bray, the National Police Chiefs' Council lead for drugs, said: "While the possession of anabolic steroids is not a criminal offence, the sale or distribution of them is and there are significant risks to the health of young people who misuse steroids for non-medical reasons.

Other drug use diagram

Drug use motivation diagram

"There is also a growing problem of counterfeit and illicit steroids which poses further health risks as they are often produced in environments unfit for the preparation of goods destined for human consumption and without the same safety testing."

Public Health Wales estimates there are about 350,000 male users aged 16-64 who visit needle exchanges across England, Wales and Scotland. But it points out there are many more who do not use exchanges as well as those who take steroids orally. It also adds that the figure excludes women as well as very young and older IPED users.

Age of first drug use diagram

Source of IPEDs diagram

The national IPED info report is considered the most in-depth study of usage. Joe Kean, who is the lead recruiter of steroid users for the report, said he was confident there were about 900,000 users in the UK. Kean, who is based in Yorkshire, said users he had worked with included an imam and that members of the emergency services and military were a subgroup that more research needed to be done on.

"None of them see themselves as drug users," Kean said. "The first thing they say when they arrive at a needle exchange is: 'I'm not a smackhead.' If you start mentioning bloodborne viruses and HIV rates they look at you as though you're an alien that has just landed.

"The evidence is emerging that steroid use will cost the NHS millions. Lads are taking steroids, drinking and taking a bit of coke and they go out feeling hard and manly. Steroids, alcohol and cocaine are the holy trinity for heart issues."

The Guardian has spoken to several doctors who work closely with users and said they believed there were a million users in the UK.

IPED effects diagram

IPED effects diagram

Dr Aneil Malhotra, a cardiology doctor based at St George's, University of London and a spokesman for the British Cardiovascular Society, said young people who used steroids could suffer conditions in later life such as high blood pressure, cardiovascular disease and strokes.

He said: "We may well see teenagers and twentysomethings who have repeatedly used steroids presenting with problems in their late 30s, 40s and 50s.

"We need to make people aware of the dangers of steroids. If we don't it is going to cause extra pressure on the NHS. We need to get out the information so people can make an informed choice."

Some claim the risks are exaggerated. Tom Maw, a steroid user and trainer who advises on the use of IPEDs, said he believed the media sensationalised their impact and called for more information to be published about how to use them safely.

* This article was amended on 23 January 2018 to clarify that Dr Aneil Malhotra is based at St George's, University of London, not St George's hospital.

Topics

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Up to a million Britons use steroids for looks not sport

# data[].attributes.attachment_link.description
Health warnings as image culture drives usage of performance-enhancing drugs Up to 1 million people in the UK are taking anabolic steroids and other image- and performance-enhancing drugs (IPEDs) to change the way they look, public health experts and doctors have said.

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The videos here seek to address the uncomfortable and unglamorous public health issue, and gay community issue, of ChemSex. ChemSex is the Zeitgeist intersec...

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The Public Health Consequences of Performance-Enhancing Substances

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The nonmedical use of performance-enhancing substances, particularly androgens and related drugs, has been a global public health problem for several decades.1,2 A meta-analysis of 271 studies published between 1970 and 2013 estimated lifetime prevalence rates of 6.4% among males and 1.6% among...

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Study Puts Smart Drugs Back in Spotlight

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This Medical News article explores the nonmedical and medical uses of cognition enhancing drugs.

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A quarter of finalists have taken the study drug du jour

* A FIFTH of UK students have tried the fad study drug
* 26% of current undergraduate finalists have used it
* Students at Oxford use it more than any other

One in five students at UK universities have admitted to taking the study drug modafinil in our survey.

The drug can dramatically enhance concentration for long revision periods.

It is usually prescribed to treat narcolepsy and has been used in the past by the US Air Force to keep helicopter pilots alert during long distance flights.

But in recent years, students have used the drug to help them concentrate on their work in the build-up to exams and deadlines.

The pressures of being at the country's top uni must be getting to Oxford students - 26% of Oxonians have used it - more than any other uni.

Newcastle students fill the runner-up spot with 25% trying the drug, while Leeds, whose students take the most recreational drugs, are third.

Students who took the drug reported side effects such as "needing to go to the loo more" and "inability to sleep" while "reduced appetite" was the most common.

Of those who admit taking it, 20% of the students say they swallow the pill on a daily basis.

Kingston University prof Andrea Petroczi worries that people might think it makes them cleverer. "It's not a magic pill" she says, "it doesn't work without putting the work in. It helps you to put more work in."

Buying prescription drugs isn't a crime in the UK, but supplying them is. This is currently being reviewed by the Advisory Council on the Misuse of Drugs.

Tab Editor-in-chief Jack Rivlin said: "Obviously there is a self-selection bias - people who take modafinil are much more likely to answer the survey - but it still shows massive growth for a drug most students hadn't heard of three years ago.

"Modafinil is not a wonder drug - it doesn't make you reach a higher limit of achievement than people who haven't taken it. But it can massive improve your efficiency, so it's a big boost to lazy people to force themselves to work.

"I don't think anyone ever became cleverer because of modafinil, but it has allowed people to live up to their ability."

You can watch him on BBC News throughout the day talking about our survey and his experiences of the drug.
Find out what modafinil is like in our feature.

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One in five students have used modafinil: study drug survey results

# data[].attributes.attachment_link.description
A quarter of finalists have taken the study drug du jour * A FIFTH of UK students have tried the fad study drug * 26% of current undergraduate finalists have used it * Students at Oxford use it more than any other One in five students at UK universities have admitted to taking the study drug modafinil in our survey.

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The use of so-called smart drugs is growing in popularity. But do they work?

It was a normal Tuesday morning when my friend first told me about "smart drugs".

"Everyone does it. They're just pills that make you concentrate," she explained. She was taking them to deal with her "big day" ahead.

Many so-called smart drugs have conventional uses - a popular one, modafinil, is used to treat excessive need for sleep caused by narcolepsy or shift work. But they are also being taken, in growing numbers, by people looking to work more effectively.

Modafinil was dubbed the "world's first safe smart drug" by researchers at Harvard and Oxford universities who suggested its effects were "low risk" when taken in the short term. But side effects can include insomnia, headaches and potentially dangerous skin rashes, and there is a lack of long-term data.

Nevertheless, having read such positive reviews online - some claiming smart drugs had drastically improved their university grades - I decided to take it as an experiment.

While it is illegal to sell modafinil in the UK without a prescription, it is not illegal to buy. There are many websites, often based in India, which make it available to purchase - though the UK's Medicines and Healthcare Products Regulatory Agency warn this can be unsafe.

When the package arrived less than a week later, the drugs looked similar to paracetamol tablets.

After consulting a doctor - who said, being young and healthy, it was unlikely I'd have severe side effects - I decided to go ahead.

I took the first pill at the University of Cambridge as part of a cognitive test, where they examined my visual sustained attention, spatial working memory, executive function and episodic memory before and after taking the drug.

Prof Barbara Sahakian was confident the pill would have an effect: "We've done a number of studies that show an increase in cognitive ability when taken - from doctors doing night shifts to healthy people in a controlled testing environment."

Before the pills, my attention was in the top 15-20% of people my age. After, it was in the top 5-10%.

I had certainly begun to feel more awake, and a bit less prone to frustration having taken the drug. But there were a number of other factors that could have affected the results.

Find out more

Watch Benjamin Zand's full film on smart drugs on the Victoria Derbyshire programme website.

My mind, however, stayed alert as the day went on. As I took the four-hour journey back home to Liverpool, I didn't feel a bit of the tiredness I usually would.

But this was the last time I would experience any positivity about taking modafinil.

The following day, a train journey presented what I expected to be a perfect opportunity to get some work done with the aid of a smart pill. I was wrong.

I became distracted - more so than normal. While the drug made me focus, it was on the wrong things - such as playing video games on my smartphone.

As the time passed, I began to develop a very bad headache, I lost my appetite and I needed to use the bathroom - constantly. While my brain wasn't working any faster, my bladder certainly was.

That evening, I began to feel the effects of modafinil's "wakefulness promoting agent". When I tried to get to sleep, I found myself unable to switch off until the early hours of the morning.

I also found an itchy lump on the back of my leg - one on my arm appeared too the following day.

My experiences seemed a far cry from those of others. Jason Auld - an athlete and entrepreneur from Edinburgh - says he feels like he can achieve virtually anything on modafinil.

"It just makes you feel as if you're operating at 100%, you're putting in all you can put in. Usually you don't think that's possible, but modafinil allows me to do it."

Apart from the initial burst of energy and the increased focus I experienced first time around, however, I ended up feeling far from my best.

The third and final time I took modafinil it was also disappointing. With a day of film editing ahead of me, the headaches returned.

I became more and more dehydrated and, once again, I wasn't hungry.

Even worse was the constant reminder from friends at how bad my skin was becoming. As modafinil was preventing me from sleeping, I looked terrible.

Eventually, as the day continued, I stopped procrastinating and the drugs seemed to be having the intended effect. This, though, occurred at about 8pm - when I did not want them to kick in.

I worked endlessly until around 11pm in the office - editing, filming, writing - doing things I didn't even know I needed to do. I felt like I had to continue working, as opposed to wanting to do so.

Overall, the negative aspects of taking the drugs far outweighed the positives - which could have been for a number of reasons.

People's bodies react differently to chemicals and tablets, and - after speaking to my doctor - I was told my liver had released an enzyme aimed at flushing the modafinil out of my system.

Having purchased them on the internet, I could also have been taking dud pills - though Jason told me he had used the same supplier before.

In a way, I was disappointed not to have had the chance to feel the positive effects of modafinil I had heard about - but also felt a sense of relief knowing I had not been missing out.

The side effects and lack of productivity meant it was no wonder drug, and I would definitely not be tempted to try them again.

More from the Magazine

British survivalists - known as "preppers" - are fixated on the need to survive in the event of a catastrophe. What motivates them, asks Benjamin Zand.
The British people preparing for the end of the world (October 2015) The Subscribe to the BBC News Magazine's email newsletter to get articles sent to your inbox. Victoria Derbyshire programme is broadcast on weekdays between 09:15 and 11:00 on BBC Two and the BBC News channel. Follow the programme on Facebook and Twitter, and find all our content online.

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The use of so-called smart drugs is growing in popularity. But do they work? It was a normal Tuesday morning when my friend first told me about "smart drugs". "Everyone does it. They're just pills that make you concentrate," she explained. She was taking them to deal with her "big day" ahead.

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The use of drugs by people hoping to boost mental performance is rising worldwide, finds the largest ever study of the trend. In a survey of tens of thousands of people, 14% reported using stimulants at least once in the preceding 12 months in 2017, up from 5% in 2015.

The non-medical use of substances - often dubbed smart drugs - to increase memory or concentration is known as pharmacological cognitive enhancement (PCE), and it rose in all 15 nations included in the survey. The study looked at prescription medications such as Adderall and Ritalin - prescribed medically to treat attention deficit hyperactivity disorder (ADHD) - as well as the sleep-disorder medication modafinil and illegal stimulants such as cocaine.

The work, published in the International Journal of Drug Policy in June, is based on the Global Drug Survey - an annual, anonymous online questionnaire about drug use worldwide. The survey had 79,640 respondents in 2015 and 29,758 in 2017.

US respondents reported the highest rate of use: in 2017, nearly 30% said they had used drugs for PCE at least once in the preceding 12 months, up from 20% in 2015.

But the largest increases were in Europe: use in France rose from 3% in 2015 to 16% in 2017; and from 5% to 23% in the United Kingdom (see 'Quest for cognitive enhancement'). An informal reader survey by Nature in 2008 found that one in five respondents had used drugs to boost concentration or memory.

The latest analysis is impressive in its size, says Barbara Sahakian, a neuroscientist at the University of Cambridge, UK, who was not involved in the work. There is an increasing 'lifestyle use' of cognitive-enhancing drugs by healthy people, which raises ethical concerns, she says.

Cultural factors, the prevalence of ADHD diagnoses and availability all influence which drugs are used for PCE and the rate of use, says Larissa Maier, a psychologist at the University of California, San Francisco, who led the study.

In the United States, where ADHD diagnoses are high and medication is a common treatment, 22% of respondents said they had used amphetamine-combination drugs such as Adderall for PCE. Those drugs are not approved in the European Union, where methylphenidate - sold under various trade names, including Ritalin - is more commonly used.

The study suggests that the spread of US-style practices in ADHD treatment is driving the trend and making drugs more available: countries with higher rates of ADHD diagnoses, such as the United States, Canada and Australia, have higher rates of non-medical prescription-drug use for cognitive enhancement.

"The increased diagnoses of ADHD and their prescription drug use is creating a substantial population of young pharmacologically medicated persons whose underlying problems may very likely be located in their social world," says Steven Rose, a neuroscientist at the Open University in Milton Keynes, UK.

Nearly half (48%) of people said they obtained the drugs through friends; 10% bought them from a dealer or over the Internet; 6% obtained them from a family member; and 4% said that they had their own prescriptions.

Debate continues over whether the non-medical use of prescription drugs boosts brain performance. Data suggest that some people benefit from certain drugs in specific situations, - for example, surgeons using modafinil - but larger population-wide studies report lesser gains, and conflicting results.

Maier notes that respondents to the Global Drug Survey are more likely than the general population to be interested in drug use, which could bias results. But she says that similar rates of non-medical use of smart drugs are seen in studies of the general population, suggesting that the findings are robust.
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The use of drugs by people hoping to boost mental performance is rising worldwide, finds the largest ever study of the trend. In a survey of tens of thousands of people, 14% reported using stimulants at least once in the preceding 12 months in 2017, up from 5% in 2015.

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1 smart drug nootropic supplement; modafinil provigil; main vault index;

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Erowid Modafinil Vault (Provigil, Modavigil, Armodafinl, Nuvigil)

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Information about Modafinil (Provigil) including basics, effects, dosage, history, legal status, photos, research, media coverage, and links to other resources.

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Info on smart drugs, nootropics and nutraceuticals

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Diazepam (Valium), vallies, blues Alprazolam (Xanax) Temazepam, jellies, eggs Flunitrazepam (rohypnol), roofies, R2 Phenazepam, kronic, bonsai Nitrazepam, Oxazepam, Chlordiazepoxide (Librium), Lorprazolam
What are Benzodiazepines?

Benzodiazepines are the most commonly prescribed sedative drugs. They may be short or long acting. Short acting forms such as temazepam and Rohypnol are used as sleeping tablets ( hypnotics) while longer acting forms, such as lorazepam and diazepam, are used in the management of anxiety ( anxiolytics).

Since these drugs begin to work within 30-90 minutes they are useful for the quick relief of severe anxiety symptoms.

Other medical uses for benzodiazepines include as a muscle relaxant, as a pre-operative relaxant, for epilepsy and mania, and in treating alcohol and opiate withdrawal.

Valium is the most widely used benzodiazepine in the UK. In addition to prescribed medical use, benzodiazepines are also used recreationally in the UK.

How they work

Benzodiazepines increase the levels of a brain neurotransmitter called GABA (Gabba Amino Butyric Acid). GABA has a calming effect on the brain.

History

Tranquillisers were first manufactured in the 1960s as non addictive drugs which could be used to treat anxiety and insomnia. They were developed as a safer alternative to barbiturates which had proven to be addictive and could be highly dangerous in overdose.

Although many people, particularly women, suffered side effects and dependence, the prescribing of tranquillisers continued to grow for over 20 years. It was not until the late 1970s that these problems were openly acknowledged. Prescriptions for tranquillisers fell from just over 30 million in 1979 to around 11 million in 2012 (see prevalence section below).

Benzodiazepines have a long history of recreational use. They are taken for their relaxing and sedating properties.

Effects/risks

Tranquillisers are depressant drugs which slow down people's reactions and can make them feel drowsy, lethargic and forgetful. They can also lead to problems concentrating, headaches, vertigo and a loss of libido.

Benzodiazepines relieve anxiety and tension and can make people feel more calm and relaxed. Effects begin around 30 minutes after taking and can last for up to 6 hours.
"It's like a dream state. It gets you away from it all. It cushions you so you don't worry or care anymore. You don't really know what is going on".
Doctors now recommend that patients should not be on benzodiazepines for longer than four weeks as the drugs can become addictive and tolerance can develop so that increasing amounts are needed to get the same effect.

It is estimated that around 40% of people taking these drugs for more than 6 weeks will become addicted. Withdrawal can lead to symptoms such as intense anxiety, nausea, insomnia, irritability, dizziness and headaches. Sudden withdrawal from high doses can be very dangerous and result in confusion, hallucinations and convulsions. Many people find it very difficult to give up tranquillisers and may need a gradually reduced dosage to do so.
"Temazepam took over my life. It creeps up on you and is very addictive. I started using to bring me down from acid trips to make me feel normal. I liked them and started to use more and more. And that's when the problems really started because I couldn't leave them alone".
Rohypnol (flunitrazepam) is often used in helping sleep disorders. It is sometimes referred to as the date rape drug. This is due to its use being implicated in sex crimes where a victim's drink is spiked with the drug, making them very drowsy or knocking them out so they're either unaware of or unable to prevent a sexual assault.

There have been reports of people fatally overdosing on tranquillisers, especially when also drinking alcohol. People with renal impairment have an increased sensitivity to benzodiazepines. There is a risk of neonatal withdrawal symptoms if benzodiazepines are used during pregnancy.

Harm reduction

The effect of slowing reactions and making people drowsy can make accidents more likely. It can be dangerous to drive while on tranquillisers.

As with all drugs it is best to take benzodiazepines with people you trust rather than on your own and to start with a small dose and wait.

Alcohol can interact with benzodiazepines so is best avoided, as is using different types of benzodiazepines together.

Crushing down tranquillisers in a solution is very dangerous as the tablets often contain chalk which can lead to collapsed veins.

It is best not to take benzodiazepines for more than 4 weeks due to the tolerance and dependence that can develop.

Benzodiazepines should never be stopped suddenly. Always reduce their use gradually with your doctor's supervision.

The law

All benzodiazepines are Prescription Only Medicines under the Medicines Act. This means they can only be legally supplied by a pharmacist in accordance with a doctor's prescription.

They are also controlled as a class C drug under the Misuse of Drugs Act. The maximum sentence for possessing is 2 years imprisonment. The maximum sentence for supplying to someone else and for production is fourteen years and a fine.

In practice maximum sentences are rarely used, for more information please see the sentencing page on the Release website.

Prevalence
Prescribing trends
PHE's analysis published in September 2019 shows that 1.4 million (3%) of people received a prescription for a benzodiazepine.
Prevalence of recreational use
According to a study from November 2014 published in the British Journal of Psychiatry, of 1500 respondents 7.7% ( n = 116) had misused one or more benzodiazepines. Almost 15% of those misusing at least one of these drugs did so once weekly or more often. The main reasons reported for their use were to help sleep (66.4%), to cope with stress (37.1%) and/or to get high (31.0%). A total of 31% obtained the medications from multiple sources; healthcare professionals (55.2%) and friends/family (39.7%) most commonly.

Among street drug users, benzodiazepines have long been part of the drug 'mix' along with heroin, crack, alcohol and more recently synthetic cannabinoids generally know as spice. Traditionally, the sources of benzodiazepines on the street have derived from diverted medical prescriptions or simply prescriptions prescribed to users themselves.

However, in recent years, a range of illicitly produced benzodiazepines have become widely available across the UK. Not all these variants are controlled under the Misuse of Drugs Act and they often contain dangerous levels of the drug. For more information see Novel Benzodiazepines: A review of the evidence of use and harms of Novel Benzodiazepines, (PDF) ACMD, 2020. In July 2020, MHRA issued an alert on Evidence of harm from illicit or fake benzodiazepines. This alert advised on the availability and harm from illicit drugs sold as benzodiazepines, particularly when used in conjunction with alcohol and other drugs with a respiratory depressant effect, including gabapentinoids and opioids.

Read more...
DrugWatch Information Sheet: Etizolam BENZOS Guide by CREW - This guide covers usage, effects, safety and help (PDF) - Published November 2020

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Diazepam (Valium), vallies, blues Alprazolam (Xanax) Temazepam, jellies, eggs Flunitrazepam (rohypnol), roofies, R2 Phenazepam, kronic, bonsai Nitrazepam, Oxazepam, Chlordiazepoxide (Librium), Lorprazolam What are Benzodiazepines? Benzodiazepines are the most commonly prescribed sedative drugs. They may be short or long acting.

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Last Update June 22, 2017 Modafinil is an incredible drug - one that continues to fascinate and prove useful to me as time goes by. This post is a collection of thoughts on modafinil - mainly observations of its effects, some additional suggestions for best use, and modafinil pros and cons.
You can buy Modafinil online from a safe and reliable source at AfinilExpress.com
Much of this was written while on modafinil (heh) and it's a bit of a follow up to this post: Seven Tips to Get the Most from Modafinil
Important disclaimer: Modafinil is a scheduled substance in certain countries, and may require a prescription to obtain. Please be sure to understand the legalities in your country before ordering anything online.
Generally I think the variation that is possible inside human consciousness is fascinating and I am always interested in learning about and comparing between different people's experiences. So a post like this is my way of contributing to that ongoing discussion.

Modafinil is incredible, it's powerful as fuck, it will make your best and most productive 'normal' work days look like your worst work days...

But it's definitely not all sunshine and rainbows either - there are some definite potential downsides (what you might call 'side-effects') which we'll get into in a minute.

Side effects are, in my opinion at least, well worth the benefits though - which is why I continue to use the stuff.

Here we go:

Modafinil feels like it permanently makes you smarter

It feels like taking modafinil has permanently changed my brain and made me smarter. Now whether modafinil really does this or not - I don't know - but it is the way it feels to me.

During the day I take modafinil there is a massive change in mental state, but often for one or even two days after it still feels like my brain is working faster - I am mentally sharper and more 'on it'.

What's more, in the time between now and when I first took modafinil over two years ago, it feels like my day-to-day brain state has become (only very slightly) more similar to the modafinil brain state.

I can think of a few possible explanations for this:

1) Modafinil, when used repeatedly over time and independent of what you do while you're on it, does cause permanent changes the brain.

2) The above is partially true - but it depends what you do while you're on it.

Let's say you often do activity X while on modafinil - writing for example - and this reinforces certain associations in your brain between the activity of writing and the mind state of modafinil.

The more you take modafinil and write, the more you reinforce these neural pathways and the more accessible and ingrained in your brain they become.

So now when you perform this activity in a normal conscious state, it feels a bit more like the modafinil brain state.

3) There is no real difference in my thinking or my brain and it's all just my imagination.

4) My brain has changed since I started taking modafinil, but for reasons completely unrelated to the drug. Correlation here does not mean causation.

All of these are possible, but number 2 seems most likely to me. This is, however, based on my subjective experience and I have a very limited understanding of how the human brain works. Many of you reading probably understand it much better than I do (post a comment, if you do).

Number 4 seems second most likely - if I'm not mistaken, the brain doesn't stop developing until we're 25, so it would make sense to be getting smarter during this time. I think this is especially true if you engage in activities that are intellectually stimulating.

So this is interesting to consider, for me at least. And as far as I can tell, as of yet there is no way to know which is the right answer.

And again, very importantly, I am not making any claims about modafinil actually changing your brain. That's just the way it feels to me.

Modafinil compromises the immune system

This is an unpleasant side effect - one that I haven't heard people talk about much but that is undoubtedly true for me.

Modafinil runs your system VERY HARD and it does so for 16+ hours - in my experience this can have a noticeably taxing effect on the immune system.

Often after being awake for 18-20 hours straight I'll start to feel like I'm getting a cold - usually this goes away after sleeping but the effects are certainly there.

The human body is not really meant to be under the influence of heavy stimulants for long hours - and undeniably modafinil puts everything into overdrive (which is why it's so effective) but it can also take its toll.

Now it may not be just the drug itself, but rather the lessened amount of sleep you tend to get on it - or it may be a combination of the two.

This is certainly a downside and what you might consider a "negative side effect" of modafinil.

This is why I recommend not taking modafinil multiple days in a row, and not more than a few times a month or at most once a week.

This also depends on the individual - people are prescribed modafinil and take it every day and they are fine - so you just have to find what works for you.

Modafinil makes it easy to get 'focused' on something that's not actually important

You often hear about the benefit of "increased focus" - modafinil does provide this, and increased focus is a massive benefit - but of course it does depend what you're focused on.

Most of the time I can stay on task, and this is not a major thing. But I've noticed that when I take modafinil sometimes there's a tendency to get distracted (very intensely distracted) by things that are only remotely related to what I'm supposed to be doing.

This is especially true when you have the entire internet right in front you - but it can be easy to go down a deep rabbit hole of information without actually doing anything useful.

I remember one time I was meant to be working but somehow ended up becoming intensely interested in the Wikipedia page for Magic Johnson. I read through at least half the page before realizing what I was doing, and I don't even like basketball.

This is because on modafinil, things that would otherwise not be interesting or only mildly interesting have the potential to suddenly become fascinating.

Plus you're also able to consume and digest information much more quickly than usual and this makes it a lot more fun.

So.. plan out your day, check yourself to stay on task - and don't get lost in some corner of the internet, over-researching or over-reading when you should be doing your work!

If you're young [18 or under] you do not need to take Modafinil

People might say:

What do you mean "young"?

You're young.

And while that's true.. I've received questions from guys 18 or even younger asking about modafinil.

So - I do understand. Life as a teenager is often kind of shitty and it can seem like a lot to juggle and manage at the time.

You want to get things moving - moving faster - and it makes sense to look for ways to make that happen.

You want freedom AND the responsibility that comes with it - but most people around you, and society more generally - doesn't want to give it to you yet.

This is frustrating, because you're willing to put the work in but you haven't even had the chance yet.

In many ways, simply not enough TIME has passed for you to accomplish the things you want.

So, you want to speed things up.

I get it.

I turned 20 less than 4 years ago - I still remember pretty well.

(And things do get better as time goes by, trust me)

But I do not think you should take modafinil if you are under 18.

It's not so much that there might be harmful physical side effects - although there might be.

It's for any (and all) of these reasons:

1) If you're under 18 you do not need modafinil

2) If you use modafinil at a young age, you risk becoming dependent on it to work hard

3) If you don't develop a good work ethic first (before using external substances) you will always lose to people who do

Now some of you will disregard this and use modafinil anyway - obviously in the end you can do whatever you like.

But I really do think it is worthwhile to convince you of this - so hear me out first:

If you are under 18 you do not need modafinil

If you are not even in university/college yet, there is no reason at all to take modafinil.

The truth is that high school - even combined with all the other things you have going on in life - is just not that hard. It may seem that way now, but it is most definitely NOT difficult compared to what you will be doing later. This is especially true if you are ambitious.

High school is ultimately designed so that everyone can pass - it is the 'bare minimum' to be a functioning member of society.

Even if you are trying to get high, high grades and get into a top university, you can still accomplish this with hard work alone and without any prescription drugs.

This is even more true if you know you are 'smart' - but you're still struggling to do as well as you could, or think you should, in high school. If this is you... then my tough-love advice is that you just need to work harder.

You may have been coasting on your natural intelligence up to this point, and are just now realizing that it won't be enough to excel when grades really start to matter.

This is fine and probably actually a good thing - but the best time to learn how to work hard is NOW.

Which brings us to point #2:

It's not worth the risk of becoming dependent on modafinil (or anything else) to work hard

It is certainly possible to use modafinil to get things done in the short-term, but in doing so you risk developing a dependency in the long term.

One thing you definitely DO NOT want to do at a young age is develop a dependency on anything - this is a surefire way to screw over your 'future self'. Because eventually, at some point later down the line, you will have to deal with that dependency ("fix it") and it's much better to just not develop it in the first place.

Ultimately when you put in the work to handle your life (without external tools - just you) you will build the character virtues that make you successful later - and this is far more valuable than any immediate result you get from taking a pill.

Pretty much everything good in my life so far ( good grades, good body, freedom to travel, online income - even getting laid to a large extent) has come from developing a good work ethic. It's one of the most important things you can do and will help improve every area of your life.

(I really mean it - I understood this pretty early on, but the earlier you realize it the better)

It's way more important than the short-term effects of any nootropic or substance - no matter what you read online or how tempting it may be.

While drugs are a good (and often great) tool to supplement your work ethic, they do not (and actually cannot) replace the real thing

Which leads us to point 3:

If you rely on external substances rather than personality and character traits - you will always lose to people who do have those traits and have access to the same substances you do.

While study drugs undoubtedly give you an edge, you are not the only person in the world with access to these substances.

Far from it - and once you get to college or university, depending on how competitive your school is, significant numbers of students will be taking this stuff too.

I would go so far as to say that many students - and certainly the ones who are serious about their grades - will be using some form of nootropic.

It's like the top levels of the Olympics - everyone is on the same PEDs, and they all cancel each other out. Drugs are no longer a real factor in the competition.

(What's more, as an aside - guys in highly competitive work environments will say the exact same things about college as I've said here about high school. Namely that it is extremely easy compared to what you'll do later. So if you know you're going into a difficult field (finance, law, etc.) then keep that in mind too.)

Anyway the point is this:

A person with highly developed discipline, knowledge of self, good work habits and time management skills PLUS nootropics will ALWAYS beat a person who hasn't developed these areas - no matter how much modafinil, caffeine, adderall, or any other substance they take.

I don't even really consider myself a "competitive type" or like competition that much - I prefer to just do my own thing. But the truth is that in school, business, and likely your career - you will be competing against everyone else who also wants to succeed. That's just the reality of the systems we live in.

So to recap, I do NOT think you should take modafinil if you are 18 or under for these 3 reasons:
2) You want to avoid developing a dependency on anything external to work hard 3) If you want to be competitive, develop a good work ethic first and then supplement it with external substances. If you don't do this, you will lose to people who do.
1) You don't need it yet (Save it for harder stuff later on)

Modafinil Effects (What does it actually feel like?)

In discussing the effects of modafinil, you often hear things like "increased focus and concentration" "better productivity" or "increased mental alertness and wakefulness".
So what does it actually feel like?
I often say these things too - they are accurate and true - but they're also kind of vague.

It's easier to get things done
On modafinil the 'pull' of distraction is almost completely nonexistent.
Normally when you work there is an occasional (or frequent) "pull" of distraction - the urge or impulse to do something else. Usually this pull is towards some fun activity that is not work, or some compulsive behaviour like checking email or social media.

It is literally like something is forcing you, from the inside, to do the things that you know you need to do. Almost like the feelings you have towards your tasks and priorities has been re-arranged - what you know you need to do intellectually becomes 100% aligned with what you feel you need to do emotionally and physically.

You feel 'switched on'

The term 'alertness' is best described as imagining that your brain is 'switched on'. Imagine your normal brain is a like moderately well-light room - taking some modafinil is like flipping the switch for an intense surge of power and lighting this room up like a football stadium at night.

This is great and a supercharged system provides you all kinds of benefits - but you also cannot turn the electricity off. Not until the drug wears off, 16+ hours later. So it feels like your brain and nervous system is on full "GO mode" this entire time, which can sometimes start to feel taxing or draining.

This is the best analogy I can think of - imagine lots and lots of power being shot through a machine - that's what your body and brain is like when you take modafinil.

Heightened mental and physical awareness

You know when you go to the movies and the previews are playing, and then when it's time for the real movie to start the curtains widen to reveal the full screen? That's what it feels like with both your mental and physical awareness when you take modafinil.

Driving on modafinil is a bit weird because you are finely tuned in to everything happening on the road and around you as you pass by.

Workouts tend to be very, very good with a strong mind-muscle connection - provided you remember to stay hydrated throughout the day. You tire less quickly and it's possible to have workouts that are both more intense and longer lasting than usual.

Mental pattern recognition is heightened - you will see connections between things that you wouldn't normally. You will also get more random ideas than usual - and you may come up with solutions to problems that seem incredibly simple but that you wouldn't have thought of otherwise. (I wouldn't really say that modafinil encourages 'creativity' in the traditional sense, however.)

Time distortion

There is quite noticeable time distortion on modafinil. For ordinary, everyday activities time feels like it's going much slower than usual. But when I'm working or in a 'flow' state - time feels like it's going much faster.

You're fast - while the rest of the world is slow

On modafinil you really feel like you're in the "fast lane" of life while everyone else is in the slow one.

This mainly applies to mental processes here, but it can carry over into what you're doing physically. You are just sped up in everything you do and it can often seem like the surrounding world is moving at a snail's pace.

You are working faster than everyone, thinking faster than everyone, you are being jetted ahead by an external (internal) force, where as everyone else is just meandering along at a regular speed.

I've particularly noticed that this affects conversations with people -

You may experience this to some degree already - when you have conversations with people you are kind of just waiting for the other person to say what they're going to say, because you already have a pretty good idea of what that's going to be.

When you take modafinil this is amplified X1000 because your brain is making connections so much more quickly - and it can feel like you're waiting for ages and ages for someone to get to the point during conversation.

For this reason (and many others) when I take modafinil I usually avoid talking to people - even more than usual.

Good mood with occasional euphoria

Stimulants have a mood-enhancing effect on most people - on modafinil my mood is generally very good. Occasionally I will get awash with a euphoric feeling - hyped up on life in general with incredibly positive projections for the present and into the future. The fact that I am usually getting a ton of high quality work done definitely contributes to this as well.

The degree of mood enhancement and/or euphoria you experience will likely by down to your individual disposition - personally I tend to respond very well to stimulants. So if caffeine makes you feel good - modafinil likely will too.

Impatience/Easily Annoyed/Let's Goooooooo

This may seem contradictory to the above but it's only in certain specific situations -

In 'normal waking consciousness' I usually find certain things mildly irritating:

I can be patient if I need to be... but usually I'd prefer not.

And while I don't like these things ordinarily, on modafinil they drive me absolutely fucking crazy.

Anything that involve waiting... waiting for something or someone else in order to do what you need to do. On modafinil the annoyance is multiplied X1000 and you really want to work at your own (fast) pace.

So I would highly advise that you take modafinil on days where you are not beholden to other people's schedules very much or at all if possible.

And don't take it if you know you are going to be waiting for something - waiting in line, waiting for an appointment, etc. The time will feel like it's inching along at a snail's pace and you will have a hard time not going mad.

Mindfulness is a lot harder than usual

Being 'mindful' refers to a state where you are engaged with your present, physical experience rather than the voice in your head.

That voice, for me on modafinil, is much louder and more intense than usual.

This isn't as bad as it might be, because the thoughts are almost always positive with very few negative thoughts - but it's still quite a noticeable difference.

The 'mind' voice - like everything else - has been amplified and turned up a notch so it's much more difficult to stay present and aware of the fact that 'you' are not that voice. You could also say that modafinil makes you more egotistical, because the ego is a product of the mind.

This is generally OK because it's worth it for the other benefits - but by the end you may begin to feel tired of being hammered by your own accelerated and intense thoughts.

Regarding 'wakefulness' - you may not behave differently but you do feel different

Keeping with the 'lights in a room' analogy from above - after being awake long enough on modafinil, you will want to fall asleep, but there is some mechanism in your brain keeping the lights on - and you literally cannot turn them off.

This is the 'wakefulness' aspect of the drug, and it is very powerful. In one study fighter pilots were given modafinil in 100mg doses and showed very little drop in performance after being awake for 37 hours straight.

This is absolutely incredible, and it certainly says something about the effectiveness of the drug. But while those pilots may not have behaved very differently to the outside observer - they most certainly felt different on the inside.

The study goes on to say, "One potential drawback of modafinil was that, at least at the 100-mg dose level, the drug's effects were not subjectively salient." So while the pilots were still performing to a high standard from the outside, they could not tell this from the inside, i.e. they probably felt like shit.

I've taken modafinil with very little sleep and definitely felt it - even if I may not have behaved any differently. So you can use modafinil to get effectiveness in the outside world with little/no sleep.. but you will still feel it on the inside. In these cases and at a certain point - it sort of just becomes a matter of what you're willing to put yourself through.
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13 Thoughts on Modafinil (Pros & Cons of the Magic Pill)

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Last Update June 22, 2017 Modafinil is an incredible drug - one that continues to fascinate and prove useful to me as time goes by. This post is a collection of thoughts on modafinil - mainly observations of its effects, some additional suggestions for best use, and modafinil pros and cons.

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3 pharmaceutical drug medicine prescription chemical; benzodiazepine sedative anxiolytic; alprazolam xanax niravam; main vault index;

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Information about Alprazolam (Xanax) including basics, effects, dosage, history, legal status, photos, research, media coverage, and links to other resources.

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psychoactive drug chemical; cannabinoid; spice smoking blend; main vault index;

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Erowid Spice Product Vault (Spice, K2, Black Magic, Smoke, JWH-018, JWH-073, etc)

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Information about the smoking blend named Spice (and other similar products) including basics, effects, dosage, history, legal status, photos, research, media coverage, and links to other resources.

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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, told The Independent: "More and more unions are asking about drug-testing kits. So we are trying to make the kits cheaper and more accessible."

Already, a number of student unions - including Manchester, Newcastle and Sussex - offer kits so students can test drugs before taking them to determine their toxicity. 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 often-tragic 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.

He told The Independent: "I think there are quite a lot of senior students who are thinking 'How can we keep new freshers to the university safe? How can we provide resources that engage them and how can we get them interested in reading the leaflets on drug education?'

"[The number of students asking about kits] is definitely growing. I think one of the important things is that people are waking up to the idea that testing is a thing."

In July, t he Home Office said "would not stand in the way" of drug testing at clubs and festivals. It followed calls from experts and campaigners for music events to provide the service after two people died and 13 others were taken to hospital from Hampshire's Mutiny festival.

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

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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.

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Scientists have discovered that regular use of the party drug GHB, and especially unconsciousness following GHB use, is associated with brain changes including negative effects on long-term memory, working memory, IQ, and higher levels of stress and anxiety. This work is presented at the ECNP conference in Barcelona, following partial peer-review publication*.

GHB (gamma-hydroxybutyrate), also known as 'G', 'liquid ecstasy' (etc), is a central nervous system depressant. It is used extensively in clubs, but also in private house parties. It produces an initial feeling of euphoria in users, but it can also cause sleepiness, and users easily tip into a coma. Some regular recreational users will often fall into a coma, which can require hospital treatment: it is not unusual that regular GHB users have experienced more than 50 GHB-induced comas. Despite its limited recreational use, GHB overdose and coma is the third** most common drug-related cause for emergency medical attendance in Europe, after heroin and cocaine, and this trend is increasing.

To understand the effects of GHB on the brain, a team of scientists from the Amsterdam UMC, recruited 27 GHB users who had experienced multiple GHB-induced comas (with a minimum of 4 comas), 27 GHB users who had never had a coma, and 27 volunteers who had used drug combinations (polydrug), but had never used GHB. Each person was asked to complete an adult reading test as proxy for IQ, anxiety, depression and stress questionnaires and they performed different neurocognitive tasks while undergoing a brain scan (fMRI, functional Magnetic Resonance Imaging).

There were two main findings. Firstly, GHB use, even in those who did not undergo a coma, was associated with alterations in identification of negative emotions. Secondly, the presence of GHB-induced comas, but not the use of GHB per se, was associated with lower IQ (despite similar educational level), and altered brain processes during verbal long-term memory and working memory. Additional analyses showed that these findings could not be attributed to group differences in the use of drugs other than GHB.

Lead researcher, Filipa Raposo Pereira, said "Surprisingly little is known about the effects of GHB in humans, and as far as we know, these are the first functional MRI scans to gauge the effect of the regular GHB use and multiple GHB-induced comas. Our results indicate that there may be risks involved in regular GHB use. This is particularly relevant to regular users with multiple GHB-induced comas; we found that these users show differences in cognition to either those who don't fall into a coma, or drug users who have never used GHB.

In an as yet unpublished study, we show that those with multiple GHB-induced comas also have 63% more stress and 23% more anxiety, and alterations in long-term memory. MRI scans also show that there are changes to the brain, with some areas showing altered brain activity and connectivity between memory-related cerebral pathways. These results show that there are brain and cognitive changes associated with multiple GHB-induced comas. Most users experience only the feeling of elation followed by drowsiness or sleep, so they don't see that there might be any negative effects. This work indicates that might not be the case".

Commenting, Professor David Nutt (Imperial College, London) said: "This research is interesting and recreational users should be made aware of these findings. They probably reflect periods of hypoxia due to excessive GHB concentrations in brain. When GHB is used in a regulated fashion as a medicine-for example, for narcolepsy-there doesn't appear to be a similar risk, so patients on this medicine should not worry".

More information: Conference Abstract P718: The influence of GHB-use and GHB-induced coma on affect and the affective network

*This work includes new material, not presented elsewhere. It includes research from the peer-reviewed papers: Adverse effects of GHB-induced coma on long-term memory and related brain function, Filipa Raposo Pereira et al (published in Drug and Alcohol Dependence, Sept 2018) doi.org/10.1016/j.drugalcdep.2018.05.019 and Effect of GHB-use and GHB-induced comas on dorsolateral prefrontal cortex functioning in humans, Filipa Raposo Pereira et al (published in Neuroimage:Clinical, Sept 2018) doi.org/10.1016/j.nicl.2018.09.022 Other parts of the work have not yet been published.

**See European Drug Report, 2017, www.emcdda.europa.eu/system/fi ... 541/TDAT17001ENN.pdf Figure 3.8. Background information on GHB (from the European Monitoring Centre for Drugs and Drug Addiction, 2008) can be found at: www.emcdda.europa.eu/system/fi ... B_and_GBL_107300.pdf

Provided by: European College of Neuropsychopharmacology

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Research shows club drug GHB associated with brain and cognitive changes

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Scientists have discovered that regular use of the party drug GHB, and especially unconsciousness following GHB use, is associated with brain changes including negative effects on long-term memory, working memory, IQ, and higher levels of stress and anxiety. This work is presented at the ECNP conference in Barcelona, following partial peer-review publication*.

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Study Drugs:100 Pills A Day, Students On The Edge - BBC Three

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A student uses so-called "study drugs" believing it makes him smarter.

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We collate information here about the reported effects of new psychoactive substances (NPS) and other drugs. Information comes from a range of intelligence sources (including RIDR) to support frontline practitioners, service providers and other stakeholders in responding to new and emerging health harms.

You can find the most up-to-date information on reported emerging drug trends via the RIDR dashboard here: August 2019.
Download Latest Report

To see how reported trends have changed since RIDR launched, you can review the previous RIDR dashboards below:

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We collate information here about the reported effects of new psychoactive substances (NPS) and other drugs. Information comes from a range of intelligence sources (including RIDR) to support frontline practitioners, service providers and other stakeholders in responding to new and emerging health harms. You can find the most up-to-date information on reported emerging drug trends via the RIDR dashboard here: August 2019.

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The Juice Bar is a free and confidential service to provide accurate information, about the issues around taking Image and Performance Enhancing Drugs (IPEDs).

As a part of the East Riding Partnership, which is run by the Alcohol and Drug Service and Humber Teaching NHS Foundation Trust, individuals can seek advice on a range of substances, including steroids and a needle exchange.

IPEDs are readily available online and circulate in some gyms. They are increasingly popular amongst young males in particular looking for a healthier, bigger and 'better' appearance. But as a charity, we believe this is a public health time bomb.

Paul Martindale manages The Juice Bar project and appeared in the media recently. He said:

"People don't take IPEDs for an immediate euphoria, instead it's the desire to change image and improve performance that drives use. The downside is that users often become fixated on their appearance and feel bigger is never enough."

"Many individuals believe these drugs are supporting a healthy lifestyle and with little official help and support, turn to the Internet for advice which does not always prove to be accurate. So, at The Juice Bar we provide confidential and expert advice aimed at keeping people as safe as possible and ensuring they can make informed decisions about the choices they make."

"The aim of our service is to meet people where they are at with their use of steroids and other IPEDs. We are able to offer support with a range of interventions if users want to continue their use of IPEDs, but we can also offer support if they wish to stop their use of these substances."

"The effects of using IPEDs can be anything from skin conditions such as acne to severe paranoia and physiological issues including; liver and heart failure and in some cases blood born virus contracted from sharing needles and other injecting equipment."

"It can be difficult for users of IPEDS to access services so we have developed tools to reach out including; Live Chat, which is seemingly the first of its kind in the country, allowing people to ask questions anonymously. Two nights each week, we are available online to take live enquiries."

"Whilst engaging online we encourage people to visit our needle exchange and offer blood pressure monitoring as well as a range of other interventions that can help them to realise some of the potential risks to their health, which can impact their future decisions about taking these substances."

Within all areas of The Drug and Alcohol Service across the East Riding and Doncaster, a critical part of the recovery process is the support by peer mentors who have first-hand experience of the benefits of the service and want to help others in their recovery.

Jacks Story

Jack, aged 23 used steroids for three years and says many people become obsessed with their appearance and feel the associated risks to health are worth taking. He says:

"I started taking steroids when I was age 17. I wanted to get bigger and thought steroids were the answer. They were easy to get hold of and users around me gave me advice. I just saw steroids as a supplement which would improve my physique."

"At the time, I didn't realise this was feeding my obsession, I set goals to achieve a certain size and when I achieved it, it wasn't enough, I wanted to be bigger every time."

"I used for approximately three years and experienced severe mood swings and loss of my libido. It wasn't until my Grandparents talked to me and said that I wasn't myself. They were worried about my moods and thought that my physique was a concern - but in my head I was looking good!"

"After trying a soft approach, my family pleaded with me to get help. I absolutely didn't want to but went along to my Doctor to appease them. My Doctor acknowledged that I had an issue with the drugs I was taking and recommended counselling."

"I began meeting the team at The Juice Bar for weekly sessions and unlimited telephone support. I had over a year of counselling and even after this time, I still wanted to use because I hated getting smaller. The psychological pull of steroids is very strong, I was mentally and emotionally addicted, all because of my appearance."

"I am so grateful to the team for their support. They have helped to turn my life around. I have continued with my gym training throughout my recovery and although my size has reduced, I feel fitter and healthier than ever before."

"To anyone using, I want to say that steroids and other IPEDs are damaging your health, no matter what you think at the time, they can cause serious problems which not only affect you but the people around you, who love you. It is important to know that the journey to recovery is not a lonely track, you will get support from the team at The Juice Bar they are there when you need them, without judgement."

"The mental battle with appearance is the main reason I have become a peer mentor for ADS - I want to help people like me, who are trapped. There is so much more to enjoy in life - family, friends, work, relationships! All things no young man should forgo because they want to be able to lift the heaviest weights in the gym. Make that call today, it will be the best thing you ever do."

The Juice Bar offers free, confidential and accurate advice. For more details please contact 01482 336675 or visit. www.ads-uk.org/thejuicebar

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Appearance fixation creating increase in the use of Image and Performance Enhancing Drugs (IPEDs) - ADS

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The Juice Bar is a free and confidential service to provide accurate information, about the issues around taking Image and Performance Enhancing Drugs (IPEDs). As a part of the East Riding Partnership, which is run by the Alcohol and Drug Service and Humber Teaching NHS Foundation Trust, individuals can seek advice on a range of substances, including steroids and a needle exchange.

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New psychoactive substances: new service provider challenges

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Drug and Alcohol Findings Effectiveness Bank analysis titled: New psychoactive substances: new service provider challenges