drug

Alcohol is a depressant drug consisting mainly of water and ethanol, produced by the fermentation of fruits, vegetables or grain.

Alcohol use among young adults has fallen over the last twenty years in England. The reasons include changing social, cultural and religious attitudes towards alcohol and socialising.

What are the effects of alcohol?

A small amount of alcohol can produce feelings of relaxation and confidence.

Alcohol is absorbed into the bloodstream and starts to have an effect within 5 - 10 minutes.

The effect alcohol has depends on the amount and strength of the drink, how quick quickly it is drunk, whether there is food in the stomach and the mood of the drinker. The effects last several hours depending how much is consumed.

What are units?

The amount of alcohol in a drink is measured in units. Different drinks have different number of units. The number of units in a bottle or a can of alcohol is printed on the label or packaging.

Units are a simple way of explaining the quantity of alcohol in a drink. The number of units in a drink is based on the size of the drink as well as its alcohol strength. For example, some cans of superstrength lager contain 4 units of alcohol, whereas the same amount of standard lager contains 2 units of alcohol.

What are the problems with alcohol

Alcohol affects different people in different ways. How much you drink; when and where you drink, who you are with, and how you feel at the time will all play a part in how alcohol affects you.

Drinking too much can lead to a loss of control, dizziness, vomiting and even loss of consciousness. One of the other big problems with alcohol is that it can make you do things that you wouldn’t normally do.

Young people who drink frequently or drink heavily are more likely to be involved in fights and get hurt, commit violent offences and get into trouble with the police.

Too much alcohol on a single occasion can lead to alcohol poisoning, which can result in the person going into a coma or even death.

Young people who drink frequently or drink heavily are more likely to be involved in fights and get hurt, commit violent offences and get into trouble with the police.

Heavy drinking in young people can affect how the brain functions, self-confidence and how you make decisions.

Reducing risks

Avoid drinking on an empty stomach. Doing so can make you feel drunk and sick.

Make sure you know what you are drinking and how strong it is. Knowing your units will help you stay in control of your drinking keep health risks from alcohol to a low level.

Men and women are advised not to drink more than 14 units a week on a regular basis and spread their drinking over 3 or more days during the week. If you want to cut down, try to have several drink-free days each week.

14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of lower-strength wine.

Drink lower strength drinks. Avoid high strength ciders and lagers and especially spirits such as vodka. It is very easy to drink more than you had planned to do.

Drink slowly - do not gulp of alcohol. Have a soft drink or water between alcoholic drinks.

Make sure you have a plan for getting home safely. Stay with friends and have taxi Apps on your phone.

Coffee, cold showers, being sick or exercise will not sober you up. These things don’t work and could be dangerous. The only thing that will sober you up is time.

Alcohol and the law

Across the UK, it can be an offence to be drunk in a public place – for example if you’re causing a disturbance, or unable to look after yourself. Police have powers to issue fines or make an arrest depending on the severity of the offence.

You can be stopped, fined or arrested by police if you’re under 18 and drinking alcohol in public.

For more detailed information about the law, visit the Release website.

Benzodiazepines are sedative and anti-anxiety drugs that are used to treat anxiety, insomnia, muscle spasms and epilepsy.

There are different types of benzodiazepines. Often each type will have a generic and brand name. For example, diazepam is the generic name and Valium the brand name. Likewise, alprazolam (Xanax), temazepam (Restoril) and lorazepam (Ativan).

Most benzodiazepines are prescribed by a doctor. But an increasing number of people are using illegally obtained so-called ‘street benzos’ or ‘street Valium’, which are diverted from legitimate prescriptions or purchased online. 

How are benzodiazepines used?

Most benzodiazepines are tablets and capsules. Some people crush tablets to inject them. This is extremely dangerous and can lead to skin infections and abscesses and potentially, an overdose, which can be fatal.

What are the effects of benzodiazepines?

Benzodiazepines will stay in your body for different lengths of time. Generally, short-acting benzodiazepines are used as sleeping pills and long-acting benzodiazepines are used for anxiety and muscle spasms. For example, temazepam effects last for 7-8 hours and is used to treat sleeping problems while diazepam effects last for 12 hours or more and is used to treat anxiety.

The different brands of benzodiazepines are usually of different strengths. For example, temazepam 10mg is approximately equivalent to diazepam 5mg.

What are the problems with benzodiazepines?

For people who have been prescribed a benzodiazepine by a doctor, the most common side effect is feeling drowsy. But like many other medicines there are many potential side effects including light-headedness, confusion, dizziness and headaches.

Links have been noted between benzodiazepine use and depression and, in some cases, the emergence of suicidal thoughts.

Evidence suggests that higher benzodiazepine dosages may be associated with an increased risk of depression. Reducing or discontinuing use can help deal with the feelings.

It's possible to get addicted to benzodiazepines. However, you are less likely to get addicted if you take it at the lowest dose that helps your health condition. It is not recommended to use benzodiazepines for longer than 4 weeks.

Street benzos

Illicit or fake benzodiazepines often called ‘street benzos’ or ‘street Diazepam’ are benzodiazepines bought online or obtained without a prescription.

Among street drug users, benzodiazepines have long been part of the drug ‘mix’ along with heroin, crack and alcohol. However, in recent years, a range of illicitly produced benzodiazepines have become widely available across the UK.

The content and potency of street benzodiazepines are unpredictable. Street benzos can include unknown substances or substances that are dangerously stronger than that displayed on the packaging. The unpredictable content and potency make street benzodiazepines particularly dangerous and are causing an increase in overdose, hospitalisation and deaths.

Reducing risks

• Do not use benzodiazepines for longer than 4 weeks.
• If you take benzodiazepines and feel sleepy, do not drive, cycle or use tools or machines.
• Do not drink alcohol while taking benzodiazepine. It can make you sleep very deeply. You may have breathing problems, difficulty waking up and depending on the amount of alcohol and benzodiazepinestaken a fatal overdose.
• It's possible to get addicted to benzodiazepines, but you're less likely to get addicted if you take it at the lowest dose that helps your symptoms, for up to 4 weeks.
• If you have used benzodiazepines for more that 4 weeks on a daily basis, you should not stop using them suddenly.
• Cutting down or stopping suddenly can cause unpleasant and dangerous withdrawal symptoms. Always reduce your use gradually and seek advice from your doctor, drug worker or other health professionals.
• Avoid buying benzodiazepines online. 
• Counterfeit benzodiazepines and other drugs, such as illicit oxycodone and synthetic cannabis (spice), are increasingly mixed with synthetic opioids like fentanyl and nitazenes. These substances significantly increase the risk of overdose. If using benzodiazepines, start with a small amount before taking more, and avoid using drugs alone so someone can help if something goes wrong.

Benzodiazepines and the law

If you have a prescription for benzodiazepines and have obtained them from a pharmacist, you have nothing to worry about.  But if you have bought them from the internet, been given them, or sold them to another person, they become a Class C drug and they are unlawful to possess.
Unlawful possession of benzodiazepines is a Class C drug. It is illegal to possess, produce or supply the drug.
Possessing benzodiazepines is punishable by up to two years imprisonment and an unlimited fine. 
 
Supplying benzodiazepines (including giving some to a friend) is punishable by up to 14 years imprisonment and an unlimited fine.
 
For more detailed information about the law, visit the Release website. 

There are different types of cannabis. The most common types are grass and hash. 

Grass (weed) is made from the dried leaves and flowering parts of the cannabis plant. Skunk is a strong strain of grass. Hash is made from the resin of the cannabis plant and can be black, brown and soft or hard in appearance.

Cannabis contains many chemicals, including THC (tetrahydrocannabinol), which makes you feel high or stoned.

Synthetic cannabinoids are solids or oils, which are added to dried herbs, vegetable matter or plant cuttings to make a smoking mixture. A well-known synthetic cannabinoid is Spice. More recently, synthetic cannabis edibles that look like gummies, lollipops and other sweets have emerged.

Synthetic cannabinoids are especially dangerous because it is impossible to know how strong they are and how it will affect people. Even tiny amounts of the drug can be very potent. 

How is cannabis used? 

Cannabis is usually smoked in a cigarette called a ‘joint’ and normally rolled with tobacco. Cannabis is also smoked in a pipe or a water ‘bong’ (a pipe which passes the smoke through water to cool it).

Cannabis can also be vaped. Vaporisers get hot enough to release the THC - which is the part of the plant that gets people stoned - whilst reducing the level of toxins.

When cannabis is smoked or vaporised the effects are usually noticeable quickly.

Cannabis can also be mixed with other ingredients and eaten in biscuits (cookies) or cakes. The effects take longer to come on when cannabis is eaten making it harder to control the dose.

What are the effects of cannabis?

Cannabis affects people in different ways. It depends on how you’re already feeling, how much you smoke and where and who you are with. But, if you smoke it, you’ll feel the effects quickly.

The effects range from feeling relaxed, happy, giggly and laid back to feeling sleepy, confused, anxious and paranoid.

What are the problems with cannabis?

PHYSICAL HEALTH

Cannabis is usually smoked with tobacco which is known to cause serious health problems including cancer and heart disease. The nicotine in tobacco is very addictive and damaging to your health.

Your lungs are not meant to take in hot, noxious gases, so smoking cannabis, even on its own, is not good for your lungs.

MENTAL HEALTH

If you feel down, cannabis will probably make you feel worse. You may feel sick, confused and worried – but these feeling will normally wear off as the cannabis does.

Be aware of how you feel when you smoke cannabis. If you start to feel anxious, paranoid or stressed out, you should think about cutting down or stopping altogether. Some research suggests that if you have an underlying mental health problem or one that you may not know about, using cannabis may bring it on.

DEPENDENCY

Using cannabis can become a habit. Regular users may find it hard to stop. If you smoke cannabis with tobacco, you may find it even more difficult to give up cigarettes.

MOTIVATION

When you use cannabis, you may keep forgetting what you’re doing and find it hard to concentrate. You might find you can’t work or study properly. You may still feel spaced out the next day.

ACCIDENTS

Cannabis can make you clumsy and slow to react. Never smoke cannabis if you are going to drive or operate machinery.

Reducing risks

The best way to avoid the risk associated with drugs is not to use drugs. But if you are using, or considering using cannabis the advice below will help minimise the risks to your health.

Don’t mix it with tobacco. Tobacco is addictive and is proven to cause cancer and heart disease.

Don’t hold smoke in your lungs. You won’t get more stoned. It just means more tar and other nasty chemicals will stick to your lungs.

Don’t use a cigarette filter for a roach. You will inhale more tar. Use plain card, loosely rolled up, for a roach. This lets the smoke flow easily.

Don’t use plastic bottles, rubber hoses, PVC, foil and aluminium. These give off toxic fumes when hot. Glass, steel or brass pipes are safer.

Maybe you like to get high, but not everyone does. Show some respect. Don’t smoke near people who don’t use cannabis – especially children and people with breathing problems.

In control

If one of your friends is having a bad time, sit them somewhere quiet and comfortably, away from others. Stay calm and keep them calm, take their mind off things by talking to them.

Cannabis lowers blood-sugar levels. You will feel better if you have something sweet to eat or drink.

If you feel bad when stoned, you should think about stopping.  Give your mind and your body a break.

If you are trying to cut down, avoid places, people or events that remind you of cannabis.

Cannabis and the law

Cannabis is a Class B drug. It is illegal to possess, produce or supply the drug.

Possessing cannabis is punishable by up to five years imprisonment and an unlimited fine. Supplying cannabis (including giving some to a friend) is punishable by up to life imprisonment and an unlimited fine.

You can be arrested for drug-driving, lose your licence, or go to prison. The police can test for drugs on a roadside stop check.

For more detailed information about the law, visit the Release website.

Cocaine is a stimulant drug produced from the leaves of the coca plant. The leaves are mashed together with various solvents and other substances to extract the cocaine. This is turned into a white crystalline powder.

What else is in cocaine?

Cocaine is often mixed with other chemicals such as lidocaine, caffeine and sugars, which are used to bulk out the cocaine and mimic some of its effects. The purity of ‘street-level’ cocaine can vary enormously.

How is cocaine used? 

Cocaine is usually sniffed up the nose through a small tube such as a straw or rolled-up bank note. In clubs, users might dip the end of a key into the bag of cocaine and sniff a small amount from the tip.

What are the effects of cocaine?

Cocaine speeds up your heart rate, breathing and brain activity causing enlarged pupils, raised blood pressure and body temperature. It can make you feel confident, exhilarated, excited and alert. But cocaine can also make you feel paranoid, edgy and anxious.

When cocaine is sniffed the effects start within a few minutes and will last approximately 40- 60 minutes, depending on how much you use, your mood, your size and how often you have used cocaine.

What are the problems with cocaine?

Physical health

Cocaine increases your heart rate and can cause it to beat erratically, constrict blood vessels, increase body temperature and increase the risk of a seizure or fit.

When cocaine is absorbed into the bloodstream through the lining of your nose, the drug shrinks the blood vessels and damages the lining of your nose. Symptoms include sneezing, runny nose, nasal congestion and nosebleeds.

Unlike alcohol or heroin, you can’t become physically addicted to cocaine. But, with regular use, you can develop a serious psychological addiction, which can be just as damaging to both your financial and mental health.

Mental health

When the effects of cocaine wear off, you can feel depressed, anxious and paranoid. The more you use, the more you are likely to experience bad feelings. If you stop using, these feelings normally go away.

Money problems

Building up a tolerance to cocaine can mean you use more to get the same effect. Spending increasing amounts of money on cocaine can leave you seriously in debt.

Mixing drugs

Taking more than one drug at the same time can cause unpredictable and potentially dangerous effects. For example, cocaine and alcohol when used together produce a substance called cocaethylene, which is more toxic than either substance alone.

Overdose

Signs of overdose can include heavy sweating tremors, confusion, hyperactivity, seizures, stroke, and irregular heartbeats. Risk of overdose increases if cocaine is mixed with other drugs including alcohol.

Reducing risks

The best way to avoid the risk associated with drugs is not to use drugs. But if you are using, or considering using cocaine, the advice below will help minimise the risks to your health.

Sharing straws or notes for snorting is risky. Viruses like hepatitis and herpes can be transmitted in snot and blood from the inside of the nose. If your nose is bleeding, take a break.

Don’t mix cocaine with other drugs, particularly alcohol. This can lead to dependence on several drugs and increase your risk of overdose.

Only buy what you are going to use during a session. Don’t buy ‘some for later’ as ‘later’ will only become ‘now’.

Find something to keep you busy that doesn’t remind you of cocaine. This could mean changing where you socialise or visiting friends that don’t use cocaine.

Cocaine will reduce your need to sleep or eat, which in turn can affect your physical and mental health. Try to eat a healthy diet and get enough sleep.

Cocaine and other drugs, such as illicit oxycodone, Xanax, and synthetic cannabis (spice), are increasingly mixed with synthetic opioids like fentanyl and nitazenes. These substances significantly increase the risk of overdose. If using cocaine, start with a small amount before taking more, and avoid using drugs alone so someone can help if something goes wrong.

CRACK COCAINE

What is crack cocaine?

Reducing risks

Cocaine and the law

Cocaine is a Class A drug. It is illegal to possess, produce or supply the drug.

Possessing cocaine is punishable by up to seven years imprisonment and an unlimited fine.

Supplying cocaine (including giving some to a friend) is punishable by up to life imprisonment and an unlimited fine.

You can be arrested for drug driving and lose your licence or even go to prison. Police can test for drugs on a roadside stop check.

For more detailed information about the law, visit the Release website.

E-cigarettes are battery-operated devices that heats a liquid that produces vapour when inhaled. This is commonly known as vaping. They come in many shapes and sizes, and usually contain nicotine.

Invented in 2003, e-cigarettes started to become widely used in the early 2010s as a harm reduction and stop smoking aid. Also known as vapes or e-cigs, are less harmful than cigarettes, and can help people cut down and quit smoking. Increasingly, e-cigarettes have been used recreationally by non-cigarette users.

The main substance in an e-cigarette is nicotine. It’s mixed with other chemicals, including propylene glycol, vegetable glycerine and flavourings. Different devices contain varying amounts of nicotine.

There are different types of e-cigarettes, including refillable and disposable devises. E-cigarettes often come in bright colours. They are also available in flavours that tend to appeal to young people, like fruit and sweet.

How are they used?

An e-cigarette comprises a heating devise that holds a nicotine cartridge containing liquid nicotine. When heated, the liquid nicotine changes into a vapour. The nicotine and other ingredients such as and flavourings are inhaled into the body.

What are the effects of e-cigarettes?

Nicotine is a stimulant drug. It increases the heart rate and blood pressure and makes users feel alert and stimulated.

What are the problems with e-cigarettes?

Vaping is less harmful than smoking. E-cigarettes don’t contain the cancer-causing tobacco, and most of the toxic chemicals found in normal cigarettes. But this does not mean vaping is harmless.

Most vapes contain nicotine, which is an addictive substance that is difficult to give up.

Some people who use vapes may experience headaches, dizziness, light-headedness, coughing, nausea, a dry mouth and throat and shortness of breath.

Nicotine is dangerous for pregnant women and their developing babies.

There are concerns that some flavourings in vapes may be harmful. This is especially the case with illegal vapes that do not conform to the UK regulations.

Emerging research has raised the possibility that long term use of e-cigarettes may cause health problems, but the risks are likely to be less than smoking.

Illegal Vapes

Since 2016, the UK Government has regulated e-cigarettes including the maximum strength of the products and rules about advertising them.

Some disposable vapes on sale are illegal and do not meet UK safety regulations. They can contain high levels of harmful substances.

Some people using illegal vapes have needed urgent medical attention after using devices with very high levels of nicotine or illegal drugs such as synthetic cannabinoids. It is difficult to know what it is that you are using.

Illegal vapes often look like legal e-cigarettes. Vapes with many more puffs or a greater amount of vaping liquid compared to may be a giveaway that they are not regulated.

THC Vapes

1. What Are THC vapes?

THC vapes contain THC oil, which is heated and inhaled. THC (Tetrahydrocannabinol) is the main psychoactive compound found in cannabis that causes the ‘high’. These vapes come in reusable and disposable forms and have gained popularity because they’re discreet, easy to use, and produce quick effects, and don’t involve traditional smoking.

2. Effects of THC vapes

THC can make you feel happy, giggly, or sleepy, but it can also make you feel confused, paranoid, anxious, hungry, and cause withdrawal symptoms. Effects typically begin within minutes and last about an hour, though some after-effects may linger, though it depends on the individual and the dose.

3. Are THC vapes Legal?

THC vapes are illegal in the UK. THC is a psychoactive compound found in cannabis and a Class B drug, making it illegal to possess, sell, or supply. In contrast, CBD is legal in the UK, as it relaxes the nervous system without causing a high.

4. Why Do People Use THC vapes?

• Easy to use: vapes are less smelly than smoking cannabis, require no flame, and need minimal preparation.
• Potentially less harmful: compared to smoking cannabis joints, vapes release fewer chemicals and usually don’t contain tobacco or nicotine. However, the long-term health effects are still unclear due to limited research.

5. Risks of THC vapes

• Mental effects: THC can impair judgment, coordination, and decision-making.
• Addiction: THC is addictive and regular use can lead to dependence and related health and social issues.
• Synthetic cannabinoids: some vapes may contain lab-made cannabinoids, which can have unpredictable and more harmful effects.
• Mental health: high or frequent doses, or mixing drugs, can increase the risk of mental health problems.
• Health risks: contaminated vape juice has caused lung injuries among UK users.
• Legal penalties: possessing or using a THC vape can result in fines, prison, or both.

Harm reduction

•  If you are going to use, start with a low dose to avoid overwhelming effects.

For further harm reduction advice on THC, go to the cannabis page.

6. Getting Support

• Ages 13-19 (Up to 25 with SEND): contact Response at 0151 666 4123.
• Adults (18+): contact Wirral Ways at 0151 556 1335.
• General support: your GP can help all ages.

Reducing risks

The best way to avoid the risk associated with e-cigarettes and normal cigarettes is not to use them. But if you smoke cigarettes, vaping is safer but if you don’t smoke, don’t vape.

Ensure that your e-cigarette complies with Government regulations. The vape must have a tank size of no more than 2ml, which this roughly translates to round 600 puffs. Vape products should also come with a nicotine health warning on the front and back of the packaging. 

E-cigarettes, particularly disposable vapes pose an environmental threat. They introduce a waste, including plastic, metals, lead, mercury and flammable lithium-batteries into the environment.

E-cigarettes, vaping and the law

In the UK, it is against the law to sell nicotine vaping products to under-18s or for adults to buy them on their behalf.

Getting help to stop smoking

For help with stopping smoking, visit the Wirral Stop Smoking Service website.

What is heroin?

Heroin is an opiate drug made by chemically altering morphine, which comes from opium poppies. Street names for heroin include H, brown, gear and smack. It usually comes as a fine powder ranging from an off-white to brown colour.

How is heroin used?

Snorting

The drug dissolves slowly through the lining of the nostrils and enters the bloodstream.

Smoking

The powder is usually heated on foil and the fumes inhaled. It gets into your body via the lungs and affects you almost immediately.

Injecting

Heroin that's injected has been dissolved in citric or ascorbic acid. Injecting is a quick way to get a lot of it into your bloodstream and up to your brain, producing what you might call a ‘rush’. It’s also the most dangerous way to take it.

What are the effects of heroin?

Heroin is a downer and makes you feel calm, relaxed, safe, and warm. It can also constipate you and make you feel sick – particularly the first few times you use it.

What are the problems with heroin?

Physical dependence

You can become physically dependent after regular, repeated use. That means you’ll experience withdrawal symptoms when you stop using.

Overdose

Heroin slows down your breathing and heart rate. It can be fatal to use more heroin than you’re used to or from a more potent batch than usual.

If you haven't used heroin for a while and your tolerance levels have dropped, using the same amount as you were used to can be particularly risky.

Mixing heroin with other downer drugs, such as methadone, alcohol, and benzodiazepines, like diazepam (Valium) and temazepam, is dangerous and increases the risk of overdose.

Signs of an overdose including the following:

• confusion
• unconsciousness (unable to wake someone up when you shout or shake them)
• severe nausea and vomiting
• having a fit
• difficulty breathing
• snoring or raspy breathing
• blue/pale tingeing of knees, hands, and lips
• slow or erratic pulse (heartbeat)
• pale, cold, and clammy skin

If you think somebody is overdosing, put them in the recovery position (on their side) and call an ambulance as soon as you can. A 999 operator can also talk you through giving naloxone.

New synthetic opioids

Heroin and other drugs like illicit oxycodone, Xanax, and synthetic cannabis (spice) are increasingly mixed with new synthetic opioids like fentanyl and nitazenes.

Synthetic opioids are made in labs and mimic the effects of natural opioids such as heroin. They're much stronger than heroin – even hundreds of times stronger – and at least as potent as fentanyl. A growing number of overdoses and deaths across the country have been caused by heroin and other drugs that have been mixed with nitazenes.

You won't know if your drug has been contaminated with nitazenes because it'll look no different. But the risk of overdosing has significantly increased.

Infection

Sharing equipment, including needles, filters, containers, spoons, and water, can spread infections and blood-borne viruses like hepatitis C and HIV.

Skin damage

Repeated injections, particularly in the same spot, can cause damage to your skin and veins, leading to ulcers, abscesses, and collapsed veins.

Reduce the risks

Carry naloxone

Always carry naloxone because you can use it to reverse an opioid overdose temporarily.

You can still use naloxone even if you're unsure whether opioids are involve because it won't cause harm.

Naloxone is only a temporary fix. The person overdosing still needs immediate medical help.

If synthetic opioids are involved in the overdose, you may need to give them more than one dose of naloxone. You only need to restore breathing; they don't need to regain consciousness.

Naloxone is available from all drug and alcohol services. Make sure you find out where you can get it locally.

Don't use alone

Avoid taking drugs alone. If you do, tell someone what you're taking, how much, and when, so they can check on you.

Take it easy

Start low, go slow! Start with a small test dose to feel the effects.

Test your drugs

Fentanyl test strips can confirm the presence of fentanyl. These are available online or you can contact your local drug and alcohol service. Nitazene test strips are available from CGL Wirral Ways.

Don't mix drugs

Avoid mixing drugs, including alcohol and medicines.

Safer injecting

Use new equipment each time, including filters and sterile water. Never reuse or share anything. Filter your solution properly to remove harmful particles.

Clean the site with an alcohol swab and rotate where you inject to protect your veins. Avoid infected areas. Injecting produces the quickest effect, but it's also the riskiest way to use. Get help if you notice any signs of infection like redness, swelling, or heat.

Sterile supplies are available from needle exchanges or you can buy them online. Use colour-coded equipment so you know which kit is yours and get tested regularly for blood-borne viruses.

Stay hydrated

Smoking heroin dries out your mouth. Use lip balm, drink small sips of water regularly, and brush your teeth twice daily.

Avoid getting drawn in by dealers

A dealer might offer you more drugs than you asked for. This can be a deliberate ploy to get you indebted to them, which gives them a hold over you. Only buy what you can afford.

The law

Heroin is an illegal Class A drug.

Penalties for possession are up to 7 years in prison and an unlimited fine. Penalties for supply are up to life in prison and an unlimited fine.

For more detailed information about the law, visit the Release website.

Ketamine is a complex drug. It has anaesthetic, stimulant and psychedelic properties. Often people describe feeling ‘disassociated’ from their environment, as if they’re not part of it.

In the UK, the drug is licensed for use in human and animal medicine.

The non-medical use of ketamine became popular in the UK in the early 1990s’ rave scene, when the drug was sold as a tablet known as ecstasy. Nowadays, the street form of ketamine usually comes as white crystals or powder.

How is ketamine used?

You usually sniff ketamine up the nose through a small tube such as a straw or rolled-up bank note. In clubs, users often dip the end of a key into the ketamine bag and sniff a small amount from the tip.

What are the effects of ketamine?

Like all drugs, the ketamine experience can vary depending on several things, including the strength of the drug, how much you take, how you’re feeling and where you are.

Generally, in small doses, ketamine acts as a stimulant, making you feel high. In larger doses, you can have an out-of-body experience (known as a K-hole), hallucinations, a sense of calm and a distorted notion of time. But ketamine can also make you feel panicky, have unpleasant feelings and nightmare-like experiences.

When you snort it, the effects begin within a few minutes and last around 30 to 45 minutes, depending on how much you take.

What are the problems with ketamine?

PERSONAL SAFETY

The effects of ketamine can leave users in a confused state and vulnerable to assault, traffic accidents, drowning and burns. Ketamine is a very powerful anaesthetic, so you might hurt seriously injure yourself without realising.

PHYSICAL HEALTH

Bladder problems

Prolonged and frequent ketamine use can cause serious long-term and irreversible harm to the bladder (known as Ketamine Bladder Syndrome) and can cause kidney and liver-related problems.

Typical signs and symptoms of harm to the bladder include a greater need to pee (urinate), an inability to hold it, passing blood when you do, and being in pain when you pee because of ulceration, shrinkage or scarring of the bladder. The damage can sometimes be so severe that surgery is needed and the bladder might even need to be removed.

Doctors at the NHS London service called Club Drug Clinic are more likely to see serious ketamine bladder symptoms in people who are using most days for several months. Occasionally, some people with lower use also develop symptoms – possibly because of existing medical conditions or vulnerability.

People who’ve taken ketamine frequently have reported abdominal pain, sometimes called K-cramps.

Snorting Ketamine

Snorting Ketamine can cause damage to the nasal passageways. Long-term use can lead to sinus inflammation/infection, septum perforation, damage to the structure of the nose and impaired smell.

Injecting Ketamine

Injecting ketamine can increase the risk of transmitting blood-borne viruses, damage to the site of injection and an increased risk of overdose.

MENTAL HEALTH

Ketamine use can result in unwanted psychological effects such as anxiety, panic attacks, flashbacks, insomnia, nightmares, paranoia, delusions and hallucinations. Some of which can become long term.

MIXING DRUGS

Few people use one drug on its own, and ketamine is no exception. Ketamine is often used on a night out alongside a range of substances, including alcohol. Mixing drugs increases risks, so you should avoid doing it as the outcome is difficult to predict. 

Synthetic opioids

Some drugs have been contaminated with the synthetic opioids fentanyl and nitazenes, increasing the chance of overdose.

DEPENDENCY

Ketamine isn’t considered to be physically addictive, but you can build up a tolerance quickly, and so higher doses are needed to achieve the desired effects.

Reducing risks

The best way to avoid the risks associated with drugs is not to use drugs. But if you are using, or considering using ketamine, the advice below will help minimise the risks to your health.

If you need to pee more often than usual, and/or pass blood when you do, and/or experience pain when peeing, stop using ketamine and consult your GP and let them know you use ketamine.

When you’re using, do it in a safe place where you and a friend can keep an eye on each other.

Start low and slow: take a small amount and wait. Don’t take more because you can’t feel anything yet. It could be a different substance or a different strength than last time. Be patient and give it time to work.

Don’t mix ketamine with other drugs, especially depressants like alcohol and GHB/GBL. These will slow your breathing down to dangerous levels. This can lead to dependence on several drugs and increase your risk of overdose. Mixing ketamine with alcohol increases the risk of unconsciousness, vomiting, choking and overdose. Mixing it with cocaine increases the risk of potentially fatal cardiovascular complications.

Ketamine and other drugs, such as illicit oxycodone, Xanax, and synthetic cannabis (spice), are increasingly mixed with synthetic opioids like fentanyl and nitazenes. These substances significantly increase the risk of overdose. If using ketamine, start with a small amount before taking more, and avoid using drugs alone so someone can help if something goes wrong.

IN CONTROL

Only buy what you’re going to use during a session. Don’t buy ‘some for later’, as later has a habit of becoming now.

Don’t use alone so you can look after each other.

Stay hydrated, drinking water before and after use.

Eat healthily and get enough sleep, as drugs can put a strain on your body and affect your physical and mental health.

If you start to feel agitated, confused or anxious, stop using, go and chill out somewhere quiet and take a friend to keep an eye on you.

Avoid taking baths if you’ve recently used ketamine and want to soothe related cramps as there’s a risk of being unable to get out, and an increased risk of falling asleep and drowning.

Don’t share drug paraphernalia such as straws, notes and injecting equipment.

Wash your nose out with water after snorting ketamine, to prevent nasal damage from the chemicals.

Don’t use it every day. Repeated ketamine use reduces the ‘high’ you felt when first used it. You might end up using more to chase that high, leading to a damaging habit.

If someone’s breathing is slow and shallow and they don’t respond when you talk to them, it’s best to be cautious and put them in the recovery position. Lie them on their side, so they don’t choke if they vomit. Call an ambulance.

Ketamine and the law

Ketamine is a Class B drug. It is illegal to possess, produce or supply the drug.

Possessing ketamine is punishable by up to five years imprisonment and an unlimited fine.

Supplying ketamine (including giving some to a friend) is punishable by up to life imprisonment and an unlimited fine.

For more detailed information, visit the Release website

Shisha is specially prepared tobacco that can be different flavours. The tobacco is heated to produce smoke that passes through a bowl of water and inhaled. Tobacco contains the stimulant drug nicotine.

Other names for shisha are hookah, narghile and waterpipe.

How is shisa used?

The tobacco is heated with charcoal. The charcoal burns the tobacco, and the smoke is drawn through a water bowl and inhaled through a tube with a mouth piece.

What are the effects?

The start very quickly but are more intense compared to cigarettes. This is because the hookah pipe enables users to inhale larger amounts and for longer periods. First time users often feel dizzy or sick.

Users will experience an increase in their heart rate and blood pressure. There is also a risk of carbon monoxide poisoning especially if shisha is used in an enclosed setting.

Regular smokers often say it helps them to concentrate, relax, deal with boredom and reduce anxiety. Shisha can suppress the appetite, so people often eat less.

Is shisha safer than cigarettes?

No, smoking shisha is not safer than smoking cigarettes. Many people think that drawing tobacco smoke through water makes shisha less harmful than cigarettes, but that’s not true. The water in the hookah cools the smoke, but it does not filter out the toxins in the smoke.

In a shisha session (lasting 20-80 minutes) a shisha smoker can inhale the same amount of smoke as a cigarette smoker consuming over 100 cigarettes. (British Heart Foundation)

What are the problems with shisha?

Like cigarettes, shisha smoke is toxic. It contains nicotine, tar, carbon monoxide and heavy metals such as arsenic and lead.

Infectious diseases such as herpes, tuberculosis, hepatitis and respiratory infections can be spread through sharing hookah.

Regular users have a much greater risk of developing lung cancer, heart disease and circulatory problems.

Breathing in second-hand shisha tobacco smoke can increase the risk of heart disease, lung cancer and other lung diseases. It can also worsen asthma and bronchitis. Inhaling second-hand smoke is even more dangerous for children, making them more likely to suffer health problems such as bronchitis, pneumonia and asthma

Shisha during pregnancy can damage an unborn child. It can result in low birth weight and other complications.

Coughs, chest and breathing problems are common among smokers.

Stop smoking tips for shisha users

1. Pick a quit date that will be stress-free.
2. Write down all the reasons you want to quit. Keep the list handy and read it when the cravings start.
3. Build a support network to give up shisha. Tell your friends and family that you have quit.
4. Exercise even short walks can reduce cravings.
5. Have healthy snacks and drinks to hand so you’re not tempted to smoke or reach for unhealthy treats.
6. Avoid trigger situations should as places and people associated with shisha.
7. Treat yourself with the money you have saved not buying cigarettes.
8. Use stop smoking services – see below.

Getting help to stop smoking

For help with stopping smoking, visit the Wirral Stop Smoking Service website.

Shisha and the law

The law classes shisha smoking the same as cigarette smoking. It is illegal to smoke shisha in an enclosed public space or a space that's mostly enclosed. To smoke in any public premises with a roof at least half the wall space must be open.

Tobacco is made from the dried leaves of the tobacco plant. It can be made into cigarettes, cigars, pipe tobacco, snuff, chewing tobacco and shisha. Tobacco contains the stimulant drug nicotine.

What are the effects?

The effects start very quickly and can continue for up to 30 minutes from one cigarette.

First time users often feel dizzy or sick. Regular smokers often say it helps them to concentrate, relax combat boredom and reduce anxiety. Smoking can suppress the appetite, so people often eat less.

What are the problems with cigarettes?

Although some people smoke occasionally, most people become dependent and smoke regularly. If they don't smoke regularly, they may feel restless, irritable and depressed.

Cigarettes are toxic. It contains nicotine, tar, carbon monoxide and heavy metals such as arsenic and lead.

Tobacco kills up to half of its users. It is estimated that there are 74,600 deaths attributable to smoking in the UK (2019). Since 2011, the largest fall in smoking prevalence has been among 18-34 year olds in the UK.

Long term users have a much greater risk of developing lung cancer, heart disease and circulatory problems.

Smoking during pregnancy can damage an unborn child. It can result in low birth weight and other complications.

Breathing in a second-hand smoke causes about 10,000 deaths each year in the UK. Babies, children and anyone with existing health problems are especially susceptible health problems.

Coughs, chest and breathing problems are common among smokers.

Smoking is expensive. 20 cigarettes a day costs about £112 per week.

Stop smoking tips

1. Pick a quit date that will be stress-free.
2. Write down all the reasons you want to quit. Keep the list handy and read it when the cravings start.
3. Build a support network to give up smoking. Tell your friends and family that you have quit.
4. Remove any reminders - get rid of ashtrays, lighters and matches and any remaining cigarettes.
5. Exercise even short walks can reduce cravings.
6. Have healthy snacks and drinks to hand so you’re not tempted to smoke or reach for unhealthy treats.
7. Avoid trigger situations
8. Treat yourself with the money you have saved not buying cigarettes.
9. Try nicotine replacement therapy
10. Use stop smoking services – see below. 

Getting help tp stop smoking

For help with stopping smoking, visit the Wirral Stop Smoking Service website.

Cigarettes and the law

You must be over 18 years to buy cigarettes in the UK. If you are under 16 the police have the right to confiscate your cigarettes.

It is illegal for shops to sell nicotine products including cigarettes and e-cigarettes to persons under 18.

Smoking has been prohibited by law in virtually all enclosed and substantially enclosed workplaces and public places throughout the United Kingdom since July 2007.