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Recreational drugs......Part 1

Following on from this month's newsletter, Worse Things Happen at Sea, we thought we’d take a closer look at some of the recreational drugs that you might encounter, the short and long term effects, and what you should do as a medic if you think someone has taken drugs onboard, or even overdosed. 

It’s important to acknowledge that effects of any drug will depend on the type of product, how it’s been taken, how the individual is feeling and what the environment is like. Effects will also vary depending on whether there is alcohol involved, or if drugs are being mixed. 

Remember, it’s impossible to calculate the toxic dose or judge the overdose level of a recreational drug as they aren’t regulated. Every mix or purchase is different, and even buying from a different dealer could prove fatal. 

Over the next 2 weeks, we’ll take a brief look at some of the most common drugs around to give you some background. 

Cannabis
AKA: weed, marujana, pot, dope, grass, doobie, ganja, hashish, hash, bhang.

A cannabinoid drug that binds to cannabinoid receptors in the body to create an effect. It’s important to note that cannabis today is much stronger (4-5 times stronger) than that used in the 1960s. This means both the short and long term effects are greater and not always in a good way.

It can be smoked, vaped or taken as an edible. If it’s inhaled, the full effects are felt in a few minutes and last about an hour with after effects lasting several hours. As an edible, it takes an hour or so to feel effects which can be more psychedelic and physical than inhaling. 

Too much cannabis can cause dizziness, sickness, dry mouth, red eyes, and changes to blood pressure, blood sugar and an increased heart rate. It’s known as a ‘whitey’. 

Cannabis can make you feel happy, giggly and calm. Some people feel more creative and introspective, more aroused and connected to the people they’re with. It can lower inhibitions.

Cannabis can cause a lack of motivation and feeling anxious, paranoid, hungry, sleepy and withdrawn. Carrying out tasks requiring concentration when stoned can result in accidents and injuries and if you smoke it, you increase the risk of smoking related issues. 

If cannabis is used a lot, or over a long period of time, or when you’re young and the brain is still forming, it can cause significant mental health problems and can become addictive, especially when combined with nicotine addiction.

Treatment: Monitor the patient’s vital signs while the effects wear off.

Cocaine
AKA: Coke, blow, crack, dust, flake, line, snow, speedball.

Cocaine stimulates your central nervous system which increases your heart rate and breathing. 

Cocaine is normally snorted up the nose but can be dabbed under the tongue or rubbed into the gums. Crack and cocaine powder can be injected but it’s very risky. 

Snorting cocaine takes a few minutes to feel effects and it wears off after 30-60 minutes. When it wears off there is usually a craving to take more. Withdrawal symptoms can occur and it’s normal to feel very low when you stop taking cocaine short and long term. 

It can make you feel happy, confident and alert, with an initial ‘rush’, followed by a short-lived high and a strong urge to take more. It can make people feel like they are less anxious, increase focus and sex drive and reduce the desire to eat or sleep.

But it increases restlessness, aggression, paranoia, arrogance and over-confidence. People who take cocaine have also reported it to be a factor in losing jobs and driving licenses, relationship breakdowns, gambling and drug related debt. 

Cocaine damages the heart. It increases the heart rate and blood pressure, thickens the heart muscle and causes the blood vessels to stiffen and constrict making it harder for blood to circulate properly. This can lead to a heart attack and cardiac arrest. It can be fatal even in the healthiest people. 

Treatment: 
If the patient is conscious, monitor vital signs and pay particular attention to their temperature and heart rhythm and rate. 

If the patient is unconscious, you may want to use an OPA or NPA to maintain a patent airway. Put them into the recovery position and monitor their vital signs, particularly their breathing. You should have a Bag Valve Mask (BVM) and oxygen to hand, with your resuscitation kit, in case they are needed.

Heroin
AKA: Smack, gear, H, horse, skag.

Heroin is part of the opiate family and looks like a fine, brown powder. It can cause euphoria and relaxation, with feelings of being calm, relaxed, safe and warm, but can also cause constipation, nausea and vomiting. 

It is also a respiratory depressant, causing slow and shallow breathing, and a reduced heart rate which can quickly lead to respiratory failure and death. 

Heroin is normally snorted, inhaled, heated on foil and smoked, sometimes injected into a vein. Regular users may display ‘track marks’ on their arms, legs and sometimes feet, as they search for a vein. Abscesses, often in the groin, can form due to poor hygiene when injecting and easily become infected.

If smoking or injecting heroin, the effects are pretty much immediate, but take a few minutes if smoked or snorted. Effects normally last for about an hour but it can be longer and very intense. Heroin is highly addictive and it’s easy to become dependent on it. 

Our Paramedic trainer Rachel has attended plenty of heroin overdose jobs, most of which can be dealt with relatively easily by the ambulance service. But she does recall this particular https://www.stokesentinel.co.uk/news/stoke-on-trent-news/dad-two-died-after-taking-4679307 where the patient had taken a single dose of heroin, his first, possibly alongside other drugs and with alcohol. Sadly that one use was all it took to kill him. 

Treatment: 
If the patient is conscious, carefully remove any paraphernalia and be aware there might be sharps around. Monitor vital signs and pay attention to their breathing. 

If the patient is unconscious, you may want to use an OPA or NPA to maintain a patent airway. Put them into the recovery position and monitor their vital signs, particularly their breathing. You should have your resuscitation kit, a Bag Valve Mask (BVM) and oxygen to hand in case they start to go into respiratory failure. The BVM can be used to supplement breaths if they drop to 8 per minute or below. If you’re onboard, we’d recommend advice from your shoreside support. 

Remember, if you carry Morphine Sulphate in your medical kit on board, you should also be carrying Naloxone. Naloxone (or Narcan) is a ‘reversal drug’ that can literally reverse the respiratory depressant effects of opiate drugs. In an emergency where heroin (or other opiates) use is suspected, your shoreside support may suggest using the Naloxone, which is an IM injection. 

Nitrous Oxide
AKA: Nitrous, NOS, balloons, laughing gas, gas, N2O.

If you’ve ever spotted small silver canisters lying around in city centres, you know Nitrous Oxide is being used locally. It’s classed as one of the ‘psychoactive substances’ which used to be known as ‘legal highs’, but don’t be fooled, they were never legal!

The gas is dispensed into party balloons and inhaled through the mouth. It’s cold and under high pressure, so the balloon is needed to avoid damage to the mouth, throat and lungs. It works quickly, but wears off within a couple of minutes. Users feel relaxed and often giggly, but can experience sound distortions and feel paranoid, anxious and dizzy. It can make users lose consciousness or suffocate.

It is legal for medical (and dental) use, and its function during labour is legendary - let's face it, millions of pregnant women can’t be wrong! 

But regular use leads to reduced levels of vitamin D and B12. If B12 levels drop, it can lead to serious health issues such as permanent nerve damage. We’ve certainly been made aware of cases where young people have ended up with permanent pain, pins and needles, reduced mobility and memory problems as a result of their Nitrous Oxide use. 

There’s also the environmental issue of the canisters and balloons to consider, as neither can be recycled normally.

Treatment: 
Stopping inhaling Nitrous Oxide means that the effects will wear off within a couple of minutes and the patient should return to normal. If the patient is unconscious, put them in the recovery position and monitor vital signs until they come round.

If you do suspect or discover drug use onboard, and that includes prescription drugs that haven't been declared, you’ll need to follow your vessel's protocol for reporting the incident. 


We found a couple of really useful websites during our research:

https://www.crew.scot and https://www.talktofrank.com, both of which give honest information about a host of drugs, how to use safely, how to help in an emergency, or help if you want to stop taking drugs.


We hope you’ve found this week’s blog interesting and we’d love to hear your (confidential) stories if you are able to share. Staying safe at sea is everyone’s responsibility and reducing the risks from drug use is one way that we can all help.


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