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Recreational drugs.....Part 2

Following on from this month's newsletter, Worse Things Happen at Sea, this is our second blog, taking 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. 

This week we take a look at another selection of drugs you might find out and about…

Psychoactive Drugs
AKA: Monkey Dust, Spice, Black Mamba, Flakka, Annihilation, Clockwork Orange, Plant Food, Magic Crystals.

Formerly known as ‘legal highs’, psychoactive drugs are synthetic substances that have been specifically designed to imitate the effects of other illegal drugs including cocaine, ecstasy/MDMA and certain prescription medications. 

But don’t be fooled, most were never really legal! Those that were made illegal as class A, B or C drugs under the Misuse of Drugs Act, are still covered by that legislation. All other psychoactive substances fall under the Psychoactive Substances Act.

Most psychoactive drugs are smoked with tobacco or other herbs in a joint or bong. 

It’s hard to be specific about effects as they vary widely and depend on the chemical to plant ratio in each batch. But in general they affect the brain, causing changes in awareness, thoughts, mood, and behaviour. Depending on the substance, psychoactive drugs can cause euphoria, increased energy, sleepiness, paranoia, hallucinations, agitation, disorientation, dizziness, motor impairment, tremors, and more.

As with all drugs, there’s no saying what other random substances have been mixed in unless the drug is tested. However psychoactive drugs are normally stronger than cannabis and can be very addictive.

Our Paramedic trainer, Rachel, frequently encounters patients high on psychoactive substances. She told us that different cities tend to see different types of drugs on the streets. For instance, in the UK, Manchester is known for a high level of Spice use and Stoke-on-Trent for Monkey Dust where it’s cheaper to buy than heroin!

Patients can be very volatile and switch from being semi-conscious and docile to extremely agitated and aggressive in the blink of an eye, and they become super strong. This makes it really dangerous for the medic. One big risk for users is the changes in awareness that can lead them to dangerous places like roofs and bridges, where there is a huge risk of falling. 

Word on the street is that Flakka is the new kid on the block in the world of psychoactive drugs. It’s already in the UK (and elsewhere in the world) and anecdotally described by those in the know as ‘100 times worse than Monkey Dust’. 

We genuinely hope you don’t have to deal with anyone on psychoactive drugs, but if you do, remember the D in your DRsABC and look after yourself first and seek professional help as soon as possible! Monitor vital signs if you can, but that can be tricky due to the behaviour of the patient.

For more information about Monkey Dust, there’s a useful short documentary here: https://www.youtube.com/watch?v=fVfVaiqhwIw


MDMA
AKA: Ecstasy, Molly, E, Eve, Hug Drug, Peace, X, XTC.

MDMA is the active ingredient in Ecstasy but in recent years has been extracted as powder or crystals to take on its own. Ecstasy pills are normally bright colours with pressed logos or characters. MDMA powder/crystal is off white or beige but can be white, yellow, grey, purple or brown. The content and strength of either can vary a lot, even within the same batch. 

Pills and powder can be swallowed. The powder can also be dabbed on the gums. Some snort or smoke it. 

MDMA generates feelings of empathy and connection, increased energy, chatty, euphoric and sexually aroused. It causes an increase in heart rate and temperature, dry mouth, dilated pupils, difficulty urinating, jaw tension/clenching, psychedelic effects such as enhanced colour and sound and hallucinations. 

Effects of pills will be within 30-90 minutes, but it’s quicker if the drug is crushed, snorted or smoked. Effects last 3-6 hours, but the comedown can take up to 3 days. Long term use leads to feelings of unease, chronic low mood and difficulty managing anxiety.

Signs of an overdose of MDMA are seizures, overheating (hyperthermia), nausea, vomiting, rapid heart rate, chest pain, heart attack, hallucinations, difficulty breathing, anxiety, fear and panic. Wow… that’s quite a concoction to deal with as a medic isn’t it?

Our advice would be to seek help as soon as possible, because they could deteriorate. Manage seizures in the normal way and keep them safe, give oxygen if it’s available (SCMG p16-17) put them into the recovery position once the seizure stops. If they’re too hot (SCMG p 50) keep them cool and if they can, drink plenty of fluids. Reassurance will be key and monitor vital signs regularly.

Ketamine
AKA: Ket, K, special K.

So, Ketamine started life as a horse tranquiliser… can you see where we’re going with this? As one of our medics responded at a festival when asked “my friend’s having a bad trip on Ket, what do you recommend?” the answer was categorically, DON’T TAKE KETAMINE!

Ketamine is an off white grainy powder or clear odourless liquid. It’s snorted, taken as an IM injection or swallowed (bombed) wrapped in a cigarette paper. As with all illegal drugs, there’s no way of judging how strong it is or what it’s been mixed with. 

Effects are felt 20-30 minutes after taking and last for about an hour. But mood can be affected for several days afterwards.

Ketamine can slow reactions and make you feel dreamy and detached from your surroundings. Low doses can be stimulating, increase energy and give a pleasant high, even spiritual and calming. But how do you know how much has been taken? 

It can cause confusion, altered perception, hallucinations, and stop you feeling pain which means the risk of injury is high. 

High doses create what’s called a K-hole. An out of body experience affecting balance and coordination, resulting in obvious dangers and the scary feeling of your mind and body being detached, but being unable to do anything about it. Regular use can cause agitation, anxiety, panic attacks, depression, damage to the long and short term memory and the bladder.

If you suspect someone is high on Ketamine, monitor vital signs and seek medical help.

Benzodiazepines
AKA: Benzos, Downers, Valium, Diazepam, Xanax.

Benzodiazepines are sedatives and often prescribed for insomnia and anxiety, but also used illegally to get a psychoactive effect or to balance the comedown from another drug. They come as tablets or capsules in a variety of shapes, sizes and colours, are normally swallowed and take around 30 minutes to have an effect.

Benzos can make you feel drowsy and dizzy, they slow down your heart rate and breathing. Users describe a floating, warm, calm and relaxed feeling. But Benzos can also cause depressed breathing, loss of coordination, short term memory loss, reduced levels of alertness, slow speech and increase the risk of suicidal thoughts. While a reduction in anxiety could be seen as a good thing, it can reduce to a level that makes people care less, lose inhibitions and this results in risk-taking behaviour. 

It’s really dangerous to take Benzos with any other drugs that affect the central nervous system, including alcohol. You might have heard of Rohypnol, the ‘date rape’ drug. Rohypnol is a Benzo and there are concerns about drink spiking, leading to the victim being unaware of or unable to stop a sexual assault. 

If you suspect Benzo use or overdose, keep the patient safe and use the recovery position if needed. Monitor vital signs and seek further help.

Scopolamine
AKA: Devil’s Breath, Truth Drug, Burundanga

Finally, we thought we’d introduce you to Scopolamine. This is not a well known drug but could be a good one to be aware of, especially in the Superyacht industry or for anyone travelling.

Evidence is building to suggest that Scopolamine use is increasing around the world, in particular with tourists, the wealthy and the elderly in South America and France being targeted. While available under prescription in some countries as a remedy for seasickness (as a transdermal patch), illegal use is reported to be growing.

Scopolamine comes as a powder or liquid and the results are dramatic. Within just a few minutes it leads to a zombie-like state, removing their free will, where the user (or victim) is unable to control their actions or verbal responses and simply comes around a few hours later with no recollection of what’s happened. Some describe it as a child-like state where the victim will do whatever they are told to do. This leaves them at risk of robbery, sexual assault and worse. 

Side effects can include a dry mouth, blurred vision, headache, urinary retention and dizziness. For higher doses it can lead to a dangerously fast heart rate, dilated pupils, toxic psychosis, confusion, vivid hallucinations, seizures and coma. Combined with alcohol or other central nervous system depressants, it can cause confusion, disorientation, excitability and amnesia. 

There are reports that Scopolamine can be administered by blowing powder in the face, handing someone paper or a business card that has been soaked in it, as well as giving it in a clandestine manner in food or drinks. However some experts suggest that the idea of someone becoming zombified after powder being blown into their face is pretty far fetched. 

So, whether these reports are accurate or embellished with a bit of myth, it raises some important travel points:
  • Don’t leave food or drinks unattended when travelling.
  • Don’t accept food or drinks from strangers or new acquaintances.
  • Travel in a group if you can.
  • Don’t leave a venue with a stranger.
  • Check crime and safety warnings before travelling.
  • Seek medical assistance straight away if you think you or someone else has been drugged.
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 second 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.

by Rachel Smith 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
by Rachel Smith 24 Apr, 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.
by Rachel Smith 03 Apr, 2024
You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!
by Rachel Smith 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.
by Rachel Smith 21 Feb, 2024
Well, we’ve made it to February! How are your goals for the year going so far? As you’ll know, we do love a bit of goal setting at Red Square Medical HQ. But, we also understand the importance of Reflective Practice too. Especially in relation to setting goals. Want to know more? Please read on…
by Rachel Smith 07 Feb, 2024
Today we start the first in a series of blogs in conjunction with our friends at the Maritime Skills Academy, and kicking it all off is a Guest Blog from MSAs Head of Training, Sam Kelly. Sam is 37 and lives in southeast Kent, in the quaint seaside town of Deal with with his wife, two children and a ‘Golden Doodle’ called Pringle. He has lived in the area ever since his father, a serving Royal Marine at the Deal Depot, and mother decided this was the place to raise their family. And it is, quite frankly, an excellent place to live. Here is his story… I’m the Head of Training for the Maritime Skills Academy, based in our head office in Dover. I oversee a team of Maritime Safety Instructors who deliver all STCW training for seafarers. Outside the Dover base, we have MSA Gibraltar. This location is operated in partnership with the University of Gibraltar and delivers Basic Safety Training and most recently Operational Firefighting, We are actually in the process of building a state-of-the-art Fire Training Module on ‘the Rock’.
by Rachel Smith 17 Jan, 2024
So Christmas seems like years ago, and we’re all well into the New Year now. Did you make any resolutions? Some love to, some don’t. At Red Square Medical HQ, we love a goal or two and think the turn of the years can be a good prompt to make some positive changes. But, it’s well known that New Year resolutions don’t last. Forbes magazine tells us that 21% don’t make their resolution stick for even a month. While 34% state that it lasted for between one and three months. Is that a failure though? Or could it be all it takes to make some small changes that have a lasting impact? We thought it would be good to take a closer look at one of the most popular resolutions… Dry January! Now, let’s get one thing straight, the Red Square Medical team are not averse to a tipple or two! But as medics, we’re very aware of the short and long term benefits of giving our livers a little breather every so often. Of course, everyone responds differently to stopping drinking for a month, so the timeline below is just a guide. But it might help you to decide whether it’s a good idea to give the booze a break for a while, or work towards reducing your intake - we know it’s easy for it to creep up over time!
by Rachel Smith 03 Jan, 2024
What I miss most about the Ambulance Service… It’s been 12 months since I left the Ambulance service after 8 years of working frontline, and to be honest it’s flown by. A few weeks ago the team at Red Square Medical HQ were chatting about how life has changed in that time and what, if anything, I was missing from my former life! The list might just surprise you… Most of all, I miss my old colleagues and I definitely miss the patient contact. And driving on blue lights… that was one of the best parts of the job! Working in the ambulance service with regular partners who you get on well with really does create friendships for life. Or even doing a tricky job with someone you don’t know well provides a common bond forever. Every day you’re facing stressful situations and sometimes split second, life changing decisions. You rely on each other totally and make sure you keep each other safe in some difficult and challenging situations. I worked with 3 very different partners most of the time for my last few years and I miss them all. Happily though, I have some great new colleagues at Red Square Medical and Outreach Rescue, the other company that I work for.
by Rachel Smith 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!
by Rachel Smith 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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