Reducing the risk

Sabina Dosani talks frankly about how to minimise the risk of taking drugs

Risks associated with taking drugs vary depending on the drug and how it is taken. Swallowing, smoking, or inhaling are safer than injecting, though still not risk free. Once a drug has been ingested, effects can be delayed for 1-2 hours and may be stronger than anticipated. Injecting is riskier because there is a greater chance of overdose, infection (HIV, hepatitis B, and hepatitis C), abscesses, thromboses, septicaemia, gangrene, and death.

Who is taking the drug and where the drug is taken will also influence the chance of an adverse effect occuring. For example, taking drugs with friends is safer than being alone. It is risky to take drugs in isolated places like toilets, derelict buildings, canal banks, and railway lines.

What goes up ...

All drugs-including coffee, cannabis, and cocaine-can lead to dependence. Stimulants or "uppers"-like amphetamine, ecstasy, and cocaine-are particularly dangerous if users have cardiac problems or hypertension. They are also more dangerous in hot or active settings, like a sweaty club.

NIGEL BARKLIE/REX

Your credit card company won't cover you for this...

... must come down

Depressants or "downers"-like heroin, alcohol, and anxiolytics-can be fatal in overdose. Hallucinogens, including LSD and magic mushrooms, change perceptions and emotions. Their effect varies. This makes downers a bad idea for anyone with psychiatric problems. Some drugs combine effects. Ecstasy is partly stimulant and partly hallucinogen. Cannabis can feel like an "upper", but at other times may be experienced as a "downer" or mild hallucinogen.

Cannabis

Most of the risks associated with cannabis are linked to regular heavy use. Smoking cannabis may be more harmful than smoking tobacco as it has higher concentrations of carcinogens. Regular heavy use makes it harder to study and concentrate. Being stoned all the time does not help with exams. Using cannabis often can lower sperm counts and suppress ovulation. Some research has linked cannabis and schizophrenia.¹ People with a family history of psychiatric illness should think carefully before getting stoned.

Ecstasy

About 10 people die in the United Kingdom each year after taking ecstasy.^2,3 Deaths are usually related to dancing non-stop in hot crowded clubs, which leads to overheating and dehydration. Taking a break from dancing, cooling down, and drinking water regularly can prevent this. But drinking too much water can also be dangerous. Sipping no more than a pint of water or sweetened drink-not cola because of the caffeine-each hour to replace lost fluids when dancing is recommended. Good clubs provide an on-site first aid attendant.

Amphetamine

Some users of amphetamines inject, which is extremely dangerous as there is a high chance of accidentally overdosing. Amphetamine raises body temperature. Users risk overheating and should follow the same precautions as for ecstasy.

Cocaine

The more cocaine people use the more they crave and the less effect it has. Users should try to increase the intervals between taking it-less really is more with this drug. Using it at night upsets sleep patterns so users often combine it with temazepam. This can lead to fatal respiratory depression. Some users will develop "cocaine psychosis," becoming paranoid and deluded. Hallucinations are common during withdrawal, with users seeing insects or other creatures. Admission to hospital is recommended if this is prolonged.

SAKKI/REX

Ecstasy

LSD (lysergide)

An LSD trip can last several hours. Panic during a trip can lead to risky behaviour, like running across a busy road. Dangerous incidents are much less likely in a safe room with non-tripping companions. You can help someone through a bad trip by speaking calmly and confidently. Refer to them by name and say who you are. If possible, do not leave them alone. This may mean staying for several hours. Flashbacks are an unpredictable hazard and can plague users many years later. Users may see intense colours or have other hallucinations. Flashbacks can be triggered by other drugs, stress, or fatigue.

Magic mushrooms

Most problems with magic mushrooms occur when people choose the wrong mushrooms and take poisonous ones by mistake.

Heroin

Needle exchanges were introduced to the United Kingdom in 1985 in response to the HIV/AIDS epidemic. Injecting users are given free sterile injecting equipment ("works"). They are also encouraged to return used works in a personal sharps bin for safe disposal, to prevent someone else being injured or infected. People who do inject, even occasionally, should have vaccination against hepatitis B and regular testing for HIV.

SAKKI/REX

Lysergic emanations

Alcohol

Alcohol reduces inhibitions and masks anxiety. People who are drunk may be more likely to take other drugs. Mixing alcohol and other drugs can lead to respiratory depression. An additional risk is that users may choke on their own vomit. Many unplanned overdoses and deaths are due to people mixing drugs and alcohol. Alcohol intoxication can also put users at increased risk of sharing injecting equipment; dangerous incidents; being aggressive, suspicious, or violent; unsafe sex; overdoses; and being a victim of crime. So don’t mix alcohol and drugs.

Test doses

Users should be careful with drugs which look different from what they are used to, when buying from an unknown dealer, or when drugs come from a new source. One way of doing this is to take a test of less than the usual amount.

1. Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 2002;325:1199.
2. Office for National Statistics. Deaths related to drug poisoning: England and Wales, 1993-2000. Health Stat Q 2002. (Spring.)
3. Office for National Statistics. Deaths related to drug poisoning: England and Wales, 1997-2001. Health Stat Q 2003;17. (Spring.)