December 2011 |
drinkanddrugsnews
| 19
Review of the year |
Post-its
www.drinkanddrugsnews.com
mephedrone use now equal those of
powder cocaine among 16-24 year
olds, despite its 2010 ban.
AUGUST
Alcohol Concern launches a broadside
against the drinks industry’s use of
social networking and video sharing
sites in its
Newmedia, new problem?
report, which calls for far tougher action
in the light of ‘inadequate’ internet age
verification mechanisms. Alex Boyt’s
article on 12-step launches an ongoing
debate on the
DDN
letters pages that’s
still running three months later.
SEPTEMBER
The Liberal Democrats pass a motion
at their autumn conference calling for
an independent panel to review
British drug laws, which, they say, are
costly and ineffective and
disproportionately affect the ‘poor
and marginalised’. The UK Recovery
Federation’s (UKRF) conference and
recovery walk in Cardiff is further
evidence of how fast the recovery
movement is developing in the UK,
while Ivory Wave becomes the latest
‘legal high’ to face a ban.
OCTOBER
The ACMD recommends that
government tackle the ‘legal highs’
issue head-on by introducing an
American-style system of ‘analogue
legislation’ to automatically make all
substances bearing a chemical or
pharmacological similarity to
controlled drugs illegal, although the
UKDPC warns that it would save
politicians from pressure to ‘do
something’ rather than solving the
real problem.
NOVEMBER
The EMCDDA’s annual report
highlights falling rates of cocaine use
across Europe as austerity continues
to bite, while synthetic drug
manufacturers continue to play ‘cat
and mouse’ with the authorities – the
agency says 39 new substances have
been reported so far this year,
bringing the total to 80 in two years.
Meanwhile, the Scottish Government
formally launches its second attempt
to introduce a minimum unit price
with its
Alcohol (Minimum Pricing) Bill
,
although lawyers warn of a very long
road, leading ultimately to the
European Court of Justice.
DECEMBER
US recovery guru WilliamWhite urges
DDN
readers to seize the moment to
create ‘a world in which recovery can
flourish’. Meanwhile, it’s full steam
ahead in preparing for next year’s
service user conference – the event is
growing so much that we’ve now got
a new venue, the Birmingham NEC.
See you there in February! DDN
THER
ND KEEPING IT TOGETHER
I first met 21-year-old Seb a few weeks ago
. He
had walked into my room rather sheepishly,
obviously in discomfort, and asked to be signed
off from work for a week. He said he thought he
had eaten something which had given him severe
abdominal cramps and he hadn’t slept.
I agreed but asked if he would answer a few
questions. I started with smoking and drinking –
Seb didn’t smoke but admitted to occasionally
drinking too much. I moved on to drugs,
specifically asking about ketamine because of his
abdominal pain. He went pale and blurted out
that he thought his pain may be related to ketamine use. I responded, ‘you
mean k cramps?’ He answered yes, and asked me how I knew – he seemed to
relax, and then burst into tears of relief.
He told me how his ketamine use had started as an occasional treat but
he was now using it three or four times a week. The previous weekend had
been an enormous binge, and he now felt suicidal. He had experienced
occasional cystitis and cramps, but never as bad as this. He felt lost, had
never talked to a professional about it before, and didn’t know what to do.
He had a good job as a manager in a high street store and until the last six
months had had an exemplary record. Now he had taken odd days off and
was beginning to get into debt.
We know that increasing numbers of people – especially younger people –
are using ketamine recreationally throughout the UK. Many users who run
into problems are seeking help from their GPs but may not always disclose
their ketamine use – perhaps partly because they don’t link their symptoms
to the drug, or perhaps because they fear, like Seb, the GP’s reaction.
Many people who use ketamine increase their use from ‘a little bump’
recreationally to a drug of daily and habitual use, with elements of loss of
control, compulsion and a move from social to solitary use. Then, on
stopping, there is a psychological withdrawal syndrome with severe anxiety
and abdominal cramps, and increasing urinary tract pain may occur. Users of
1-15 grams per day can experience even more side effects, including
cognitive impairment, lack of energy and increasing isolation and
vulnerability.
Ketamine-associated ulcerative cystitis is the worst side effect and may
require hospitalisation. It is imperative to cut down or stop use once such
symptoms have developed. Why ketamine does this is not fully understood,
but includes inflammation and ulceration of the bladder and scarring of the
ureter, all probably from toxic metabolites.
Seb used his week off to have a long hard look at his use, his life and
where he wanted to go in his work. He had joined a support group and
started individual therapy, and came back yesterday to say ‘thank you for
asking and… I’ve told a few friends’. Another day I feel happy and privileged
to be a GP.
Dr Chris Ford is a GP at Lonsdale Medical Centre, clinical director for IDHDP
and a member of the board of SMMGP.
For more details see ‘Association of ketamine, with unexplained bladder
and abdominal symptoms’ by Rachel Ayres, Fergus Law and Angela Cottrell in
Network 27 (October 2009).
To become a member of SMMGP visit the website www.smmgp.org.uk and
receive bi-monthly clinical and policy update and be consulted on important
topics in the field.
Post-its from Practice
Ketamine crisis
It’s vital to ask about all drugs,
says Dr Chris Ford