Drugs and alcohol

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.

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

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.

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.