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Broaching the topic of drugs and drug use with your child can feel particularly daunting. With the illegal drug market constantly evolving, it can be difficult to stay up to date with the latest information. How to Talk to Your Child About Drugs is an evidence-based, practical guide from a leading addiction specialist. The book offers clear and accessible guidance for parents on how to have effective conversations with their child about this difficult topic. It provides a summary of both established and newly emerging drugs, how drugs work in the brain, how they cause harm, and why some people are more vulnerable than others to problems, including signs parents should be looking out for. This is a book that all parents will need at some stage. It will help you feel better informed about drugs, more confident in talking to your child, and better equipped to tackle any problems.
There is an emerging evidence base to support the benefit of naltrexone prescription in methamphetamine dependence. This audit assesses prescribing practice and benefit of naltrexone in a specialist NHS drug service based in West London. The process for initiation and monitoring of naltrexone in the service was compared with best practice recommendations.
A patient with methamphetamine dependence can be referred to a psychiatrist in order to consider naltrexone treatment. Naltrexone works by reducing cravings, thereby assisting with abstinence. Liver function is checked and then naltrexone is made available by an FP10 prescription. Follow up is then conducted in order to ascertain whether a continuation of naltrexone is indicated.
Methods
Patients prescribed naltrexone were identified using a hand-written prescription record. Each case file was audited for prescribing metrics, substance misuse pattern, diagnoses, past treatments, efficacy, tolerability and length of prescription. Information was manually collected from the SystmOne case notes and anonymously entered into a spreadsheet under headed topics.
Results
Data was collected from 1st April 2019 to 1st June 2023 which identified 28 patients. All patients had keyworker involvement and physical health checks. GHB/GBL was the most common comorbid substance. 18 of the 28 patients took naltrexone for longer than one week. 16 reported benefit with cravings. 6 were abstinent from methamphetamine and 10 were seen to have a partial response (periods of abstinence/lessened use). 9 of the 18 patients reported one or more side effects, most commonly nausea.
Conclusion
The service meets best practice guidelines with regards to keyworker involvement, physical checks and follow-up reviews. Improvements could be made with regards to accurate diagnostic coding. Given the prevalence of side effects, it would be important to discuss options to mitigate these, as well as the importance of continuation of naltrexone (if tolerated) for at least four weeks. The offer of written information should be recorded. The tolerability and efficacy of naltrexone is in keeping with data from randomised controlled trials, which helps to inform patients and clinicians that naltrexone is an effective, safe treatment for methamphetamine dependence.
Chemsex occurs primarily among gay, bisexual and other men who have sex with men (GBMSM), and there is evidence of a subgroup of users who carry out chemsex-related criminal offences and experience harm. Challenges with chemsex can present to various settings; there are concerns that harm is increasing, including at interfaces between health, social care and criminal justice systems. The UK response to date has lacked a coordinated approach. An expert reference group was convened to share chemsex knowledge, articulate priorities for research and pathway development, and foster collaborative working between agencies. It made three key recommendations: develop and increase training and awareness across all services; implement a coordinated research programme with the development of a common data-set and assessment tool to fully characterise population-level needs; develop a professional network to share information, provide professional support and act as a knowledge hub. There was support for a unified multi-agency strategy incorporating the priorities identified as overarching principles.
Substances with a stimulant effect have been used by successive generations of people. A wide range of substances have been used, notably of course caffeine and nicotine. Psychostimulants can be plant-based substances or can also be of a synthetic nature.
Synthetic cannabinoid receptor agonists (SCRAs), also referred to as synthetic cannabinoids, or synthetic cannabimimetics, are a large group of smokeable drugs initially sold as legal alternatives to cannabis. They have a strong effect on the endocannabinoid system. More than 200 different SCRA compounds were available in Europe at the end of 2020.
There is a large body of evidence on the effectiveness of psychosocial interventions (PSIs) for the management of substance misuse problems, including national guidelines. It is therefore possible to make specific and robust recommendations.
The natural analogue to synthetic cathinones is the active compound in the leaves of the khat plant (Catha edulis), which have been chewed for centuries in parts of Africa and the Arabian Peninsula for their stimulant properties.1 Synthetic cathinones are also prescribed medications, such as bupropion, Wellbutrin®.
New synthetic opioids are an increasing risk for public health across the world. These drugs can be divided into two categories, pharmaceutical and non-pharmaceutical fentanyls, as well as non-fentanyl opioid novel psychoactive substances (NPS). These NPS are easily available on the Internet and are characterised by low price, purity, legality, and lack of detection in laboratory tests. However, most have not been approved or are not recommended for human use.
The evidence on the management of the acute and chronic harms associated with the recreational use of nitrous oxide (N2O) is limited and consists mainly of case reports, with occasional experimental studies into acute effects. There are few findings on acute harms and interventions relating to the use of the drug, but consistent findings on the chronic effects of prolonged nitrous oxide use.
Dissociative drugs distort perceptions of sight and sound and produce feelings of detachment (or dissociation) from the environment and self. Among the dissociative drugs, ketamine and phencyclidine (PCP) are the drugs most commonly used for recreational purposes.
This document provides a new edition and an update to the 2015 NEPTUNE guidance on the clinical management of harms resulting from acute intoxication and from the harmful and dependent use of ‘club drugs’ and ‘novel psychoactive substances’ (NPS).