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Cannabis aware

  • Article Introduction: Cannabis awareness and advice for young people, including the physical and mental health impact of cannabis use.

Cannabis Aware - Harm Reduction information

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WHAT IS CANNABIS?

Cannabis, also known as marijuana, generally refers to the dried flowers (Grass) or resin (Hash) of the female Marijuana plant (Cannabis Sativa/Indica). It comes in the form of resin, normally extracted from the flowers of the plant, the dried flowers themselves, or very rarely as cannabis oil.

Cannabis contains many chemicals, some of which are known as cannabinoids.

The cannabinoid which give you the feeling of being high or stoned is called THC (tetrahydrocannabinol).

HOW IS IT USED?


Smoked as a joint

Cannabis is usually smoked in a cigarette called a ‘joint’, normally rolled with tobacco.

Smoked using a bong or pipe

Smoked in a pipe or a water ‘bong’ (a pipe which passes the smoke through water to cool and filter it). When smoked, cannabis usually affects you quite quickly.

Vaporisers

Vaporisers (about £50 to buy) are less risky - they get just hot enough to release the THC (Tetrahydrocannabinol, the bit that gets you stoned) but not the tar.

Eating

Sometime people will eat cannabis, mixed with other ingredients, eg. in biscuits (cookies) or cakes.

  • If it is eaten, the effects take much longer to be felt but can build up and get stronger over a longer time.
  • It is much harder for someone to control the dose of the drug when cannabis is eaten.

How will cannabis make you feel?

Cannabis affects people in different ways. It depends on how you feel, how much you smoke and where and who you are with, but generally, when smoked, the effects are felt quite quickly.

They can range from feeling relaxed, happy and laid back to feeling wired and paranoid.

Other effects can include eating large amounts of biscuits, pot burns in your favourite clothes and sitting on your bum all day.

PROBLEMS


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 were 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.

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.

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.

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. Don’t smoke cannabis if you are going to drive or operate machinery.

REDUCE THE RISKS


The only risk-free drug use is no drug use, 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 has been proven to cause cancer and heart disease.

Don’t hold  the cannabis 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 too many papers 

Three skinners will do – or you’ll breathe in too much burnt paper.

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 you or someone you are with is having a bad time while using cannabis, the information below will help you stay in control:

  • If one of your friends is having a bad time sit them somewhere quiet and comfortable, away from others. Stay calm and keep them calm, take their mind off things by talking to them. Tell them the bad feelings will wear off soon.
  • 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, if only for a short time. Give your mind and your body a break.
  • If you use it every day, have a couple of days off each week. Smoke fewer spliffs a day, or put a bit less in them.
  • If you are trying to cut down, avoid places, people or events that remind you of cannabis.
  • Don’t buy extra, thinking you will save some for tomorrow – you probably won’t.

CANNABIS AND THE LAW


Cannabis is illegal. It is a class B drug. It’s against the law to possess cannabis, sell it or give it away, grow it or let your place be used for smoking it.

The maximum penalty for possession of a Class B drug can be up to five years in prison and an unlimited fine.

The maximum penalty for supplying a Class B drug can be 14 years’ imprisonment and an unlimited fine.

In reality, if you are caught in possession of cannabis an ‘escalation’ penalty system may be used.

  • First offence:

    Verbal ‘cannabis warning’ from the police.

  • Second offence:

    Penalty Notice for Disorder (PND), resulting in an on-the-spot £80 fine.

  • Third offence:

    Arrest, conditional caution or prosecution.

If you are under 18

Anyone under 18 years of age found in possession of cannabis will be taken to a police station where they may receive a reprimand, final warning or charge, depending on the seriousness of the offence. This must be administered in the presence of an appropriate adult.

If you are caught with cannabis in Scotland you’ll be arrested and reported to the Procurater Fiscal, who will decide if criminal proceedings should be taken or not.

A criminal record can be a real problem at home, college or work, and in later life.


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Clubbing & Drugs: the essential Clubber’s guide to drugs & staying safe

  • Article Introduction: Health-related information and advice for people who use alcohol and drugs in a nightclub environment.

Clubbing & Drugs: Essential Harm Reduction Tips for a safer night out

Our clubbing resource offers practical harm reduction advice for using alcohol and other drugs in club environments. Learn to recognise risks and apply simple strategies, ensuring a more enjoyable and safer clubbing experience.

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Clubbing and drugs

The UK has a vibrant nightlife scene attracting a diverse range of clubbers using an increasing range of illegal drugs.

With new and different drugs popping up all the time, it’s essential to be extra careful. Drugs can affect you differently depending on what they are, where you are, and how you’re feeling. Some speed you up, some slow you down, and some get you as far off your head as possible. However, there are risks involved in using any drug.

This booklet will help guide you through some of the  potential risks of a night or weekend clubbing and provide tips on reducing the risks and staying as safe as possible.


DRUGS

This section contains information on the most commonly used club drugs, split into three categories based on their effects – uppers, spaced and downers.

But remember, the effects of drugs can vary depending on how much you have taken, what is actually in the drugs, and any other drugs you may have taken.

Pill testing kits

Pill testing kits should be viewed with caution. Although they can detect certain chemicals, they cannot tell you how much of the chemical is in the pill (dose), or what other drugs may be in there. Just because a pill tests positive for the chemical you were hoping for, it does not make it safe.

Snort it or eat it?

Snorting drugs will cause the effects to start within a very short time and with a higher intensity, but wear off relatively quickly. Eating your drugs, pills or powder, means the effects will come on much slower and steadier, but last for a longer period with much less of a crash at the end.

Passing around notes or straws for snorting drugs can pass around germs like hepatitis and other blood-borne viruses. Keep your nostrils healthy by flushing out your nose with clean water at the end of each session.

UPPERS


Ecstasy - MDMA

  • Type

    Stimulant/Psychedelic
  • Effects

    Feelings of empathy, closeness to other people, extra energy and a loved-up feeling
  • Problems

    Anxiety, depression, insomnia, dehydration, loss of appetite
  • Form

    Tablet, capsule and powder
  • Law

    Illegal Class A drug
  • Caution

    Ecstasy raises body temperature to dangerous levels. Stay hydrated and take breaks

Ecstasy strength

The strength of ecstasy can vary widely. Some pills have been tested that contain three times as much MDMA as previously. This is not a good thing! Most of the hospitalisations - and even deaths - have been caused by these super-strong tablets. If you are determined to take a tablet, start with a quarter or a half and wait for an hour or so to see how strong it is

Cocaine

  • Type

    Stimulant
  • Effects

    Quick and euphoric rush, increased confidence, extra alertness.
  • Problems

    Anxiety, depression, insomnia, paranoia. Prolonged use can lead to dependence and snorting can damage the lining of your nose
  • Form

    Powder
  • Law

    Illegal Class A drug.

Speed (Amphetamine)

  • Type

    Stimulant
  • Effects

    Euphoric rush. Increased alertness and extra energy
  • Problems

    Headaches, itchy skin (known as formication), anxiety, psychosis, loss of appetite
  • Form

    Powder
  • Law

    Illegal Class B drug

Methamphetamine

  • Type

    Stimulant
  • Effects

    Intense euphoria, increased energy and alertness, decreased appetite, increased sociability and sex drive.
  • Problems

    Increased heart rate and blood pressure, risking stroke and heart attack. Psychological addiction, paranoia, hallucinations, and aggressive behaviour.
  • Form

    It comes in several forms – powder, crystals, or occasional pills.
  • Law

    Methamphetamine is classified as an illegal class A drug.

SPACED


Cannabis

  • Type

    Psychedelic
  • Effects

    Euphoria, relaxation, changes in perception, enhancement of senses
  • Problems

    Damage to airways and lungs if smoked, anxiety and sometimes panic, paranoia
  • Form

    Dried herbs or solid block of resin
  • Law

    Illegal Class B drug

Mushrooms

  • Type

    Psychedelic
  • Effects

    Visual, audio and time distortions, euphoria, spiritual experiences
  • Problems

    Nausea, anxiety and sometimes panic, paranoia
  • Form

    Fresh or dried mushrooms
  • Law

    Illegal Class A drug

Ketamine

  • Type

    Psychedelic
  • Effects

    Visual, audio and time distortions, increased energy, feelings of spirituality, increased heart rate, out of body experiences
  • Problems

    Nausea, confusion, anxiety, sometimes panic, paranoia, loss of coordination, accidents, unconsciousness
  • Form

    Powder, sometimes in tablets
  • Law

    Illegal Class B drug

Caution:

  • Ketamine can further damage the liver of anyone using protease inhibitors to treat HIV or Hepatitis.
  • Ketamine has been linked to bladder problems. Symptoms include an increased need to urinate, pain when doing so and passing blood.
  • Long-term users can suffer from abdominal pain know as ‘K-Cramps.

Downers

Alcohol

  • Type

    Depressant
  • Effects

    elaxation, talkative, increased confidence and sociability
  • Problems

    Dizziness, loss of coordination, confusion, aggression and violence, poisoning, addiction, accidents, anti-social behaviour, increased risk of sexually transmitted infections or unplanned pregnancies.
  • Form

    Liquid
  • Law

    Illegal to drive while under the influence

Benzodiazepines

(Valium, Mogadon, Librium, etc.)

  • Type

    Depressant
  • Effects

    Relaxation, reduced stress and anxiety, drowsiness and sleep
  • Problems

    Drowsiness, forgetfulness and confusion. Strong risk of dependence with regular use
  • Form

    Tablets
  • Law

    Illegal Class C drugs without a prescription

GHB & GBL

  • Type

    Depressant/ Psychedelic
  • Effects

    At low doses similar to alcohol, relaxation,increased sociability, dizzines
  • Problems

    The wrong dose, which can happen by only increasing what you use by a small amount, can cause vomiting, muscle spasms and unconsciousness
  • Form

    Liquid
  • Law

    Illegal Class C drug

Caution

  • Those on HIV or hepatitis meds should seek specialist advice before using GHB or GBL.
  • Never swallow GBL undiluted, it will burn your mouth/throat.

New Psychoactive Substances

Mephedrone (and all Cathinone derivatives)

  • Type

    Stimulant
  • Effects

    Euphoric rush, increased alertness and extra energy
  • Problems

    Headaches, anxiety, psychosis, loss of appetite. Long-term health effects are unknown. Excessive or long-term use can lead to depression.
  • Form

    Powder
  • Law

    Illegal Class B drug

Mexxy

  • Type

    Psychedelic
  • Effects

    Similar to Ketamine
  • Problems

    Nausea, confusion, anxiety, sometimes panic, paranoia, loss of coordination, accidents, unconsciousness
  • Form

    Usually in white powder form, but may be found in tablets
  • Law

    Illegal Class B drug

MDPV, NRG1 (and Pyrovalerone derivatives)

  • Type

    Stimulant
  • Effects

    Euphoric rush. Increased alertness and extra energy.
  • Problems

    Headaches, anxiety, psychosis, loss of appetite. Long-term health effects are unknown. Excessive or long-term use can lead to depression.
  • Form

    Powder
  • Law

    Illegal Class B drug

SYNTHETIC CANNABINOIDS (Spice)

  • Type

    Psychedelic
  • Effects

    Euphoria, relaxation, changes in perception, enhancement of senses
  • Problems

    Damage to airways and lungs if smoked, anxiety and sometimes panic, paranoia.
  • Form

    Organic matter sprayed with synthetic cannabinoids, to mimic the effects and appearance of skunk type substances.
  • Law

    Synthetic cannabinoids, are illegal class B drugs, like cannabis.

NITROUS OXIDE (Noz, noxy)

  • Type

    Inhalant
  • Effects

    Users feel light-headed, dizzy, giggly and euphoric.
  • Problems

    Confusion, headaches and nausea. Direct inhalation from a canister is risky. Inhaling in enclosed spaces or from a bag may cause unconsciousness. Heavy, prolonged use can cause numbness or tingling in limbs, and breathing and heart issues.
  • Form

    Colourless gas usually found in small metal canisters (whippits) or larger tanks typically used in medical or commercial use.
  • Law

    Class C drug. Supply or possession to get high is illegal.

CAUTION:

Caution: Use drugs cautiously: start with low doses and increase slowly because everyone’s tolerance is different. Pills or powders may not be what you think they are. Wait for the drug to take effect before taking more to prevent overdose.

Remember: you can’t be certain of the content, strength and purity of illegal drugs, even from trusted sources. Do your homework and research any new drugs before taking them.

New, and updated resources

BEFORE THE CLUB

Pre-club drinks

Mixing alcohol with drugs is dangerous. If you must drink, try and stick to drinks with a low percentage of alcohol. Avoid the high-strength lagers, shots and spirits. Alternate your drinks with soft drinks, fruit juice or lemonade.

Drugs and the law

Under a new law, all psychoactive substances (i.e. drugs) are illegal - apart from alcohol, tobacco, and caffeine. So if it doesn’t look like booze, fags, or coffee, the police can pull you. So is picking up drugs for yourself and your mates to share. If you are stopped by the police and tell them the drugs are for you and your mates, that would be considered possession with intent to supply, a very serious offence.

If you are in a car in which the police find drugs and no one claims ownership, everyone in the car could be charged with possession or supply.

On the door

Many clubs insist on a search. You can refuse, but the club also has the right to refuse you entry.

Only the outside of clothes, pockets and bags can be searched. The search must be conducted by a member of staff of the same sex. They cannot search inside clothes without your permission and can never conduct intimate searches, such as inside underwear or strip-searches.

Necking all your drugs at once to get around the search is dangerous, you could also still be standing in the queue when your drugs start to come up. Make sure you bring some warm clothes for waiting in the queue and for going home.

Don’t buy drugs in the club. You can’t be sure what you are buying in a dark club if you are off your face.

IN THE CLUB

Look after each other

Know what drugs your mates have taken so you can tell the medical staff if they are taken ill. If anyone starts to have a bad trip, take them somewhere quiet and reassure them it’s just the effects of the drugs and the feelings will wear off.

Don’t let a friend leave with strangers. Try to find out who they are and where they are going first.

Getting caught with drugs in the club

Any club that allows its premises to be used for the consumption of drugs can be closed down. So it’s unsurprising they keep a close eye on what’s happening inside. Openly snorting powders and necking tablets aren’t good looks.

If you are lucky, you will only have your drugs confiscated and have a very long wait outside the club for your mates to come out, rather than being reported to the police and ending up with a criminal record.

Uppers and heatstroke (Hyperthermia)

Uppers can raise your body temperature and decrease the release of heat by constricting blood vessels near the skin, combined with physical exertion it can cause your body to overheat. If it reaches extreme levels it can permanently damage your organs or prove fatal.

Signs of heatstroke are:

  • Headaches
  • Dizziness
  • Hot dry skin
  • Nausea (this can also be caused by your drugs starting to kick in)

If you start to feel ill stop what you are doing, get some fluids and take some time out. Go to the chillout area and try and get some fresh air. If the symptoms don’t improve, get medical help straight away.

Water Intoxication (hyponatraemia)

While it is important not to become dehydrated when out clubbing, taking on too much fluid can also cause its own problems. It can upset the balance of sodium in your body and cause your brain to swell, which is extremely dangerous.

You should try to sip about a pint of fluid an hour. Try to include some fruit juice or Isotonic sports drinks.

Mixing drugs

Mixing drugs is dangerous as the effects of the two drugs together are unpredictable. Your body can only process so much at once. Putting extra pressure on it by asking it to do too much can lead to a dangerous build-up of drug levels in your body which could have serious consequences. If you drink alcohol and take cocaine, your body produces a third substance called Cocaethylene. This is highly toxic and can cause heart problems.

Mixing alcohol or prescription drugs with illegal drugs is asking for trouble.

Those on HIV or hepatitis meds should seek specialist advice before using GHB/GBL or Ketamine. They can cause serious interactions with prescribed medication.

AFTER THE CLUB

Driving home

It’s simple – DON’T DRIVE IF YOU HAVE BEEN TAKING DRUGS! They affect your vision, coordination, concentration, perception and spatial awareness, and reaction times. You will be affected for a long time after you have taken drugs.

It’s illegal to drive if either:

  • you’re unfit to do so because you’re on legal or illegal drugs
  • you have certain levels of illegal drugs in your blood (even if they haven’t affected your driving)

The police can stop you and use a roadside drug kit if they think you’ve been using drugs. If convicted, the penalties are:

  • a minimum 1-year driving ban
  • an unlimited fine
  • up to 6 months in prison
  • a criminal record

Your driving licence will also show you’ve been convicted of drug driving. This will last for 11 years

Sex and ED (erectile dysfunction) Drugs

Some drugs give you a loved-up feeling and increase sexual desire, but they can also make it difficult to get an erection. Some of you may consider using ED drugs to try and overcome this. But combining uppers (ecstasy, speed or cocaine) with ED drugs can have an increased effect on body temperature, blood pressure and heart rate. Using Poppers with ED drugs can also compromise your immune system, increasing the risk of sexually transmitted infections. Poppers are dangerous for anyone with chest or heart problems, anaemia or glaucoma.

ED drug’s ability to prolong sex increases the risk of breaks in the skin, increasing the risk of passing on sexually transmitted infections. Always carry condoms and use them.

Handling the come-down

The best way to ensure a bad come-down is to take more drugs or drink alcohol. You won’t get any higher, but you will regret it later on. Taking downers to ease the landing will only put off the inevitable for a few hours.

When you get back from the club, try to resist the temptation to keep the party going by taking more drugs. Treat it as a different part of the experience. This is the best time of the night. Relax. Change into fresh, loose-fitting clothes. Turn the lights down low. Put on some chilled tunes. Get a cup of tea - the best come-down drug there is! Crash on the sofa and chat with your friends. Chill out.

Look after yourself

If you enjoy clubbing and want to continue doing it, be good to yourself. Don’t drink or do drugs throughout the week. Get plenty of rest and sleep. Eat well. A healthy, balanced diet throughout the week is like putting money in the bank to spend at the weekend. Stay fit. Working out, walking, swimming, or any sport will strengthen your heart and lungs and improve your mental wellbeing.

Keep clubbing as a special weekend treat; don’t let it take over your life. The more varied social life you have outside the club nights will make those sessions all the more enjoyable. Clubbing can be fun, but it’s not the top and bottom of everything. Enjoy life. The more you have going on in your life, the more special your night’s clubbing will become.

OVERDOSE

Using any drug carries risk. These risks increase if you are mixing drugs or combining them with alcohol, and can result in an overdose. This can still happen even sometime after you have taken the drugs.

The symptoms for people who are overdosing on uppers or downers are different but some people can display symptoms of both.

OVERDOSE SYMPTOMS CAN INCLUDE
  • Uppers - Chest pain or tightness, shortness of breath, hot to the touch and red in the face, sudden collapse.
  • Downers - Looks pale, blue lips, shortness of breath, sudden collapse, not waking in response to stimuli, snoring deeply (this is a sign of difficulty breathing, not deep sleep).

If this happens in a club, take them to a cool quiet place and get help straight away, most clubs will have a designated first aider who will help them until an ambulance arrives.

If it happens away from the club, put them in the recovery position and call an ambulance, you do not have to give your name, and the police have a policy of not attending overdose calls, unless there is any danger to the medical staff, a death, or child safety issues.

Always tell the medical staff who attend what drugs they have taken, and if possible give samples to the medical staff this could save someone's life.


You can buy printed versions of this information in the Substance shop

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These organisations and websites can provide further drug information and advice.

Talk to Frank

National drugs awareness site for young people and parents/carers.
www.talktofrank.com

Helpline 0800 77 66 00

talktofrank.com

RELEASE

Release is the national centre of expertise on drugs and drugs law - providing free and confidential specialist advice to the public and professionals.

www.release.org.uk

WEDINOS

WEDINOS is a harm reduction project, providing an anonymous drug-checking service,

wedinos.org

The Loop

The Loop develops and delivers innovative health interventions through its drug checking services and related harm reduction advice and support.

wearetheloop.org

 

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Cocaethylene: cocaine and alcohol

  • Article Introduction: Cocaethylene awareness and harm reduction advice for anyone who uses alcohol and cocaine together.

COCAETHYLENE

Effects & toxicity explained


Learn about cocaethylene: what it is, how it forms when alcohol & cocaine are used together, the risks to your heart and liver, and simple steps to reduce harm.

What is Cocaethylene?


Cocaine and alcohol are increasingly being used together as a 'straightener' to keep the night going, allowing people to drink more alcohol and lessen the 'comedown' from cocaine. When you use these substances together, your liver automatically creates a third drug called cocaethylene. This new compound affects your body differently than cocaine or alcohol alone, creating both stronger effects and greater risks. The information in this guide will help you understand and minimise these risks.

Cocaethylene Effects


Cocaethylene increases both the duration and intensity of cocaine's effects. It stays active in your body 3–5 times longer than cocaine alone, creating a more powerful high. But the downside (yes, there always is one!) is that cocaethylene is also more toxic than cocaine by itself, causing both short-term and long-term physical and mental health problems.

Cocaethylene Risks


Health

Cocaethylene causes more severe increases in heart rate and blood pressure than cocaine alone. Even for perfectly healthy people, this increases the chance of seizures, heart attacks and strokes. For anyone with an underlying heart condition, this is extremely risky. Cocaethylene is more toxic than cocaine and stays in your system much longer, putting greater strain on your liver and other organs. Over time, this can cause serious damage.

Violence

Alcohol reduces your inhibitions, cocaine increases confidence, and cocaethylene amplifies both effects. This combination significantly increases the risk of impulsive or reckless behaviour, including violence.

Sex

The combined effect of cocaine and alcohol can significantly impact sexual performance. It increases sexual desire but makes it harder to achieve an erection and lubrication, and more difficult to reach orgasm. Prolonged attempts to climax can cause physical damage and increase the risk of sexually transmitted infections (STIs).

Important: Using sexual stimulants like Viagra with cocaine and alcohol puts massive strain on your heart and is not recommended.

Warning Signs


Cocaethylene itself doesn't increase addiction risk beyond what cocaine and alcohol carry individually. However, you can become accustomed to using both substances together, so that using one triggers cravings for the other. This can lead to dependency on both substances.

Some warning signs include:

  • Using larger amounts of alcohol and cocaine to get the same effect, or to cancel out the negative effects of either substance
  • Spending time thinking about when you are going to use next
  • Having problems at home, work or university because of your behaviour or neglecting responsibilities
  • Getting involved in violence or injuring yourself or others after a session

Taking Control


If you want to cut down or stop using alcohol and cocaine, the following advice may help:

  • Use smaller amounts at each session and give yourself more time to recover between sessions
  • Think about the negatives – financial problems, feeling rough all the time, relationship issues. Remind yourself of these when you feel the urge to use
  • Avoid triggers like places or people you use with
  • Take a break from certain friends, avoid specific pubs and clubs, and find alternative activities
  • Tell someone what you're doing or ask a friend to support you. Having someone to talk to during difficult moments can make all the difference
  • Don't give up. Breaking the habit is possible. If you don't succeed the first time, don't be hard on yourself – you've taken the first step. Try again!

Additional Cocaethylene Information


The information above is from our cocaethylene harm-reduction leaflet. It includes everything people need to reduce the risks of using cocaine and alcohol together.

The additional information below comes from questions we receive from clients and searches made on our website and takes a deeper dive into the science of cocaethylene.

How much stronger is cocaethylene than cocaine?

Cocaethylene isn't exactly "stronger" than cocaine, but it does affect you more intensely and lasts longer. When you use cocaine and alcohol together, your liver creates cocaethylene – and this new compound behaves very differently in your body.

Why it feels more intense:

  • Lasts 3–5 times longer: While cocaine leaves your system quickly, cocaethylene sticks around longer
  • Affects the brain more powerfully: It blocks dopamine more effectively than cocaine alone, creating a more intense high
  • Builds up over time: Because it breaks down slowly, it accumulates if you keep using both substances

Key takeaway: While people might find the cocaine-alcohol combination more appealing because of these enhanced effects, the longer duration and increased potency make it a very different experience than cocaine alone.

How toxic is cocaethylene compared to cocaine?

Cocaethylene is more toxic than cocaine alone and carries a higher risk of overdose. Research studies consistently show that combining cocaine and alcohol increases the risk of fatal complications compared to using cocaine by itself.

What "more toxic" means:

  • Affects the heart more severely: It causes more dangerous changes to blood pressure and heart rhythm than cocaine alone
  • Impacts multiple organ systems: It's more damaging to the liver, lungs, and immune system compared to cocaine by itself
  • Higher overdose risk: The combination creates unpredictable effects that increase the likelihood of medical emergencies
  • Fatal cardiac events: Heart arrhythmias or cardiac arrest can occur without warning and can be fatal, even on first use

Research findings: Multiple studies have found that people who use cocaine and alcohol together face substantially higher risks of serious medical complications and fatal outcomes compared to those who use cocaine alone, though the exact level of increased risk varies between studies.

How is cocaethylene made in the body?

Cocaethylene forms automatically in your liver when you use cocaine and alcohol together through a chemical process that creates an entirely new drug.

How cocaethylene forms:

  • Normal cocaine breakdown: When you use cocaine by itself, your liver breaks it down into two inactive waste products: benzoylecgonine and ecgonine methyl ester. These don't produce drug effects and get filtered out by your kidneys and eliminated from your body through urine.
  • What changes when alcohol is present: When someone drinks alcohol and uses cocaine at the same time, something different happens in the liver. Instead of just breaking down the cocaine normally, some of the cocaine combines with the alcohol inside the liver to create a completely new active drug called cocaethylene. This process happens automatically – you don't control it.
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Benzodiazepines: MSJ/Diazepam guide

  • Article Introduction: Street benzos like MSJs and other non-prescribed pills are behind a rise in overdose deaths. This guide shares practical, non-judgemental advice to help people stay safer and understand the risks.

Benzodiazepines: MSJ/Diazepam guide

Street benzos like MSJs and other non-prescribed pills are behind a rise in overdose deaths. This guide shares practical, non-judgemental advice to help people stay safer and understand the risks.

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What are street benzos?


Street benzos—also called MSJs, blues, vallies, scoobies, and street Valium—refer to benzodiazepines bought online or obtained without a prescription. They can be real, fake, or novel drugs that imitate legitimate medicines.

They’re usually cheap, easy to get, and may be sold in blister packs or pill containers designed to look safe and official. Common markings include ‘DAN 5620’, ‘10’, ‘T-20’, ‘TEM 20’, ‘Bensedin’, and ‘MSJ’.

Street benzos are unpredictable in both content and strength. Some contain novel psychoactive substances (NPS) like etizolam, flualprazolam, or phenazepam, which are not licensed in the UK and can be much stronger than diazepam.

In 2024, the UK classified 15 more novel benzodiazepines as Class C drugs. Some of these, like bromazolam, have been found in tablets marked ‘MSJ’ or sold as diazepam. These substances may be stronger than expected and increase the risk of overdose—especially when mixed with alcohol, opioids or GHB. Read more on GOV.UK.

What are MSJs?


MSJs are blue diazepam tablets stamped with 'MSJ' on one side and a break line on the other. They're produced by MSJ Industries, a subsidiary of Sri Lankan manufacturer J.L. Morison Son & Jones (Ceylon) PLC. Though legitimate, they're being diverted into the illicit market.

  • Small, blue, professionally pressed pills (approx. 6mm x 1.5mm)
  • Often referred to as MSJs, vallies, blues
  • Available online through unauthorised sources
  • Illicitly sourced from manufacturers in Sri Lanka, India, China, Thailand, and elsewhere

Due to illicit production and lack of quality control, MSJ tablets sold on the street can contain anywhere from 8mg to 30mg of diazepam despite being marketed as 10mg, making dosing unpredictable and dangerous.

Types of benzodiazepines


Different benzodiazepines vary in strength, duration and effect. Common types include:

  • Diazepam (Valium)
  • Temazepam (Restoril)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Chlordiazepoxide (Librium)
  • Flubromazolam
  • Flurazepam (Dalmane)
  • Phenazepam

Not all benzos are equal—10mg of one type may not be equivalent to 10mg of another.

Effects of diazepam


Diazepam is a long-acting benzodiazepine used for anxiety, muscle spasms, and insomnia. Its effects can include:

  • Drowsiness and sedation
  • Muscle relaxation
  • Confusion and memory loss
  • Dizziness and impaired coordination

Effects may last into the next day, especially when combined with alcohol. Long-term use increases the risk of dependence and withdrawal.

Side effects


Common side effects:

  • Drowsiness, confusion, dizziness
  • Light-headedness, blurred vision
  • Muscle weakness, slurred speech

Less common side effects:

  • Skin rashes, tremors, headaches
  • Sexual dysfunction
  • Low blood pressure, digestive problems
  • Difficulty urinating or incontinence

Rarely, paradoxical effects like aggression or disinhibition may occur—especially when mixed with alcohol or other drugs.

Mixing benzodiazepines with other drugs


Combining benzos with other depressant drugs increases overdose risk:

  • Alcohol: Increases sedation and impairs judgement. Risk of blackout and poor decision-making.
  • Opioids (heroin, methadone): Strongly suppresses breathing—leading cause of overdose deaths.
  • GHB/GBL: Even hours apart, the combined sedative effects can be fatal.
  • Gabapentinoids (pregabalin, gabapentin): Reduce opiate tolerance, increasing overdose potential.

⚠️ Warning: Some fake benzos contain fentanyl or nitazenes

There have been reports of fake benzodiazepines contaminated with strong synthetic opioids like fentanyl or nitazenes. These can cause sudden overdose, even in small amounts. There's no way to see or taste these substances, so the risk of taking them unknowingly is real.

If you’re using benzos—especially street pills—go slow, don't use alone, and carry naloxone if you can. It won't reverse a benzo-only overdose, but it can save a life if someone's taken drugs containing fentanyl or nitazenes.

Overdose and withdrawal


Overdose signs

  • Unconsciousness
  • Slow or irregular breathing
  • Pale lips or skin, vomiting
  • Cold, clammy skin

If someone has also taken opioids, use naloxone if available—but call 999 in all cases.

Withdrawal symptoms

Stopping suddenly can cause:

  • Severe anxiety and panic
  • Shaking, sweating, confusion
  • Seizures and hallucinations

Withdrawal should be medically supervised. Symptoms can start within hours and last several days.

How are illicit benzodiazepines supplied?


Most legal benzos are prescribed and dispensed by pharmacists. Street benzos may be:

  • Diverted from legal prescriptions
  • Bought online, including the dark web
  • Distributed via social media apps (Snapchat, WhatsApp, Telegram, etc.)

Some are made to look legitimate, but contain unknown or highly potent substances. Public Health England has warned about pills with markings like ‘DAN 5620’, ‘10’, ‘T-20’, ‘MSJ’, and ‘TEM 20’ due to hospitalisations and deaths.

Reducing risk: harm reduction advice


  • Start low, go slow – dosage varies.
  • Don’t mix with alcohol or other sedatives.
  • Don’t use alone – have someone nearby.
  • Avoid daily use to reduce dependence.
  • Don’t inject. If you do, don’t share or reuse.
  • Never stop abruptly—seek medical advice to taper safely.
  • Don’t drive or operate machinery while affected.

In the UK, benzodiazepines without a prescription are Class C drugs.

  • Possession: Up to 2 years in prison, a fine, or both
  • Supply: Up to 14 years in prison, a fine, or both

If prescribed, you can legally possess and use them—but selling or sharing your supply is still illegal.

Share this information


Raising awareness and sharing accurate information is one of the best ways to reduce harm. Services can order our benzodiazepine information and awareness booklet here, or use this guide to support people who use benzos—or anyone who needs to understand the risks and effects more clearly.

Help and support


For more information, advice, or support with benzodiazepine use, visit:

  • Talk to Frank – 24/7 national drug information
  • Release – Legal advice for people who use drugs
  • GOV.UK: take‑home naloxone – Guidance on naloxone supply and overdose prevention
  • WEDINOS – UK-wide drug‑checking data, including benzodiazepine substitutions
  • Mind – Mental health support during withdrawal or medication use
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