Drink and Drugs News DDN November 2018 - Page 16

Drug trenDs On the right tra We can all contribute to understanding new drug health harms and developing treatment responses more quickly, says Laura Pechey D id you know that you can get the latest intelligence on new psychoactive substances (NPS) and other drug health harms, and guidance to support you in responding to them, in one handy document? Or that you can quickly report to PHE any unusual adverse reactions to NPS and other drugs that you encounter in your service using a simple online form? I’d like to tell you why we’ve developed a system that does just this and how it can support your work. Over the last 15 years, a host of new drugs have entered the UK market that were completely unknown before, such as mephedrone or the many different synthetic cannabinoid receptor agonists (SCRAs), sometimes called ‘Spice’ or ‘Mamba’. We have also seen an increase in the misuse of drugs previously only used as medicines. New substances and new patterns of use can bring new health risks that aren’t known to users or clinicians. Recent examples of this include retinal damage caused by new compositions of poppers – ‘poppers maculopathy’, and bladder complaints in heavy ketamine users – ‘ketamine bladder’. Stories of bladder damage caused by ketamine began to emerge on online forums in 2007, when ketamine users were increasingly presenting to A&E with bladder complaints. Regular ketamine users were needing to urinate more often and more urgently, experiencing pelvic, bladder and urethral pain, and seeing blood in their urine. However, many health professionals were initially unaware that these urological problems were associated with ketamine use or how best to treat them. CASE STUDY: THE RIGHT DIAGNOSIS In his own clinical practice, Dr Bowden- Jones recently encountered a case of ketamine bladder at his Club Drug Clinic in London. Katie,* a 30-year old woman, was working as a PA in a large company when she presented to the clinic. During her early twenties, she typically used ketamine and MDMA monthly and cocaine three to four times a year, and binged on alcohol once a week. Ketamine was Katie’s main drug of choice as she liked the feelings of relaxation and disconnection it gave her. While her 16 | drinkanddrugsnews | November 2018 Working with the MHRA, PHE launched the Reporting Illicit Drug Reactions (RIDR) system in March 2017. The system is intended to be used by health professionals who work in emergency departments, general practice, alcohol and drug treatment, sexual health, mental health and other settings where staff come into contact with people presenting with acute or chronic problems with NPS and other drugs. While stopping ketamine use can reverse damage in most instances, delays in identifying the cause of the condition were leading some people to experience irreversible damage and, in extreme cases, to undergo radical surgery to remove their bladders. As clinicians began to share information via their networks and through published case reports, the pattern of harm and the need for swift joint work between drug services and urological departments became clear. other drug use fizzled out when she started working, Katie continued to use ketamine. A new relationship with another ketamine user led to Katie using more ketamine, more often, and increasingly at work. The batches that the couple were purchasing online often looked very different from each other and had differing effects; some batches were stimulating, while others had more sedative effects. Katie came into treatment after using a batch she described as being greenish and crystalline. Katie and her partner experienced nausea, dizziness, vomiting and visual distortions within minutes of using and these symptoms lasted for six hours. In treatment, Katie was diagnosed with an underlying anxiety disorder and ‘ketamine bladder.’ She had previously seen a GP about painful, frequent urination but had been mistakenly diagnosed with a urinary tract infection (UTI) and prescribed a course of antibiotics. Dr Bowden-Jones and his team were able to support Katie to understand the extent to which ketamine was causing her physical symptoms and the risks of continuing to use. For ketamine bladder sufferers like Katie, an end to the pain and discomfort that they are experienc - ing, and avoiding any irreversible damage, can be powerful reasons to reduce or stop their ketamine use. *Names have been changed. ‘Ketamine was Katie’s main drug of choice as she liked the feel ings of relaxation and disconnection...’ www.drinkanddrugsnews.com