• Cocaethylene is a toxic chemical which is produced by the liver when you take cocaine and alcohol together.
• Cocaethylene can force your heart rate and blood pressure higher than cocaine on its own would, leading to a higher risk of seizures, heart attacks and strokes, even in perfectly healthy people.
• It is extremely risky for someone with an underlying heart condition to mix cocaine and alcohol.
• Cocaethylene slows down the rate at which your liver can process both cocaine and alcohol. This means the liver has to work harder which can put you at risk of liver damage.
• Cocaethylene is associated with sudden mood changes. It can increase impulsiveness and aggression and potentially lead to physical altercations and personal harm.
• Cocaethylene can interfere with brain chemicals and lead to panic, anxiety and depression.

What is it...

• Alcohol is a depressant drug. This means it slows down the central nervous system – not that it makes you depressed – although alcohol can have a negative effect on your mood and mental health.
• Alcohol is a by-product of the fermentation process, which is the reaction of sugars and yeast. Alcohol can be made from various starch rich foods such as maize, potatoes, barley and wheat.
• Alcohol is the most widely used drug in the world, and the harmful use of alcohol causes a wide range of health, social and economic consequences.
• According to WHO (World Health Organisation) 3 million deaths per year result from the harmful use of alcohol worldwide and it is a casual factor in more than 200 disease and injury conditions.
• Alcohol is addictive and withdrawal from alcohol can be fatal. Read on to find out about withdrawal symptoms and how to get help.

Alcohol withdrawal symptoms include:

• Tremors (‘the shakes')
• Sweating
• A pulse rate of over 100 beats per minute
• Nausea and/or vomiting
• Headaches
• Loss of appetite
• Depression and/or anxiety
• Restlessness
• Difficulty sleeping
• Hallucinations
• Delirium tremens (DT's include severe disorientation, increased heart rate and blood pressure, breathing problems and uncontrollable restless behaviour)
• Seizures

Severe withdrawal from alcohol can be fatal. If you experience any of the above withdrawal symptoms after several hours without a drink do not stop drinking suddenly and seek professional help as soon as possible. It could save your life.

Effects...

• Short term (depending on amount taken and condition of individual) – relaxed, uninhibited, confident, excitable, sociable, outgoing, aggression, slurred speech, uncoordinated, unsteady, staggering, drowsiness, upset stomach, vomiting, blurred vision, headache, lapses in memory, distortion of senses and perception, impaired judgement, hangovers, sleep disruptions, breathing difficulties, unconsciousness, coma, alcohol poisoning, impaired gag reflex (which can lead to choking on vomit and death), unintentional injuries and violence.
• Long term – anxiety, depression, mood swings, sexual problems, infertility, increased family problems, broken relationships, issues with employment, issues with crime, weight gain, malnutrition, gastritis (inflammation of the stomach walls), stomach ulcers, vitamin B1 deficiency, problems with coordination, permanent damage to the brain, nerve damage, inflammation of the liver (alcoholic hepatitis), scarring of the liver (cirrhosis), increased risk of certain cancers, high blood pressure, cravings (potentially dangerous, see above...), pancreatitis, dementia.

Fast Facts

• Your liver can only process about 1 unit of alcohol per hour. That's 1 pub measure of spirits like vodka and gin, about half of a standard glass of wine or about half a bottle of standard strength beer/lager. Could you be driving over the limit the day after a drinking session without realising it?
• Up to 80% of people who are addicted to alcohol develop a thiamine deficiency. This can lead to serious health complications and even death. If this could be you see a health professional.
• Alcohol and pregnancy don't mix! In the UK as many as 1 in 13 babies born to mothers who drink during their pregnancy are affected by FASD (Fetal Alcohol Spectrum Disorder). New research has shown that as many as 1 in 3 children diagnosed with ADHD and 1 in 5 diagnosed with autism may have FASD.
• Alcohol use is responsible for approximately 11,900 cancer cases per year. We know alcohol can cause cancers of the mouth, throat, voice box, oesophagus, liver, bowel, breast. It also may increase the risk of cancers of the pancreas and stomach.
• Once in the bloodstream alcohol is carried to every cell in the body, and effects every major organ including the muscles, skin, liver and brain, where it can cause inflammation.

Warnings...

• Alcohol withdrawal symptoms can increase in severity each time a person stops drinking. This is called kindling.
• Long term Alcohol misuse can weaken the immune system, making you more vulnerable to infections. It can also weaken the bones.
• Alcohol is a toxin that kills cells such as microorganisms, which is why we use it to preserve food and sterilise skin/needles etc. It has the same effect on human cells. Not as ‘safe' as a lot of people believe...

What are they...

• Benzos (or benzodiazepines) are a group of highly addictive depressant drugs. This means they slow down the central nervous system – not that they make you depressed – although benzos can have a negative effect on your mood and mental health.
• Diazepam (Valium) is the most widely used benzo in the UK. In Scotland many ‘street benzos' contain a NPS benzodiazepine like Etizolam or Bromazolam. NPS benzodiazepines can be more potent than diazepam, increasing the risk of accidental overdose.
• Of the 1330 drug deaths recorded in Scotland in 2021, benzos were implicated in 918 (69%). Mixing drugs (polydrug use) was responsible for 93% of drug related deaths.
• Benzos sometimes cause ‘paradoxical' effects which are the opposite of what the medication is meant to do. This can include aggression, agitation, anxiety, depression, irritability, rage and suicidal thoughts or behaviour.
• Benzos are synthetic chemicals which means they are made by humans. The first benzodiazepine (Librium) was synthesized in 1955 by a chemist called Leo Sternbach at the Swiss drug firm Hoffmann-La Roche.
• Protracted withdrawal from Benzos refers to withdrawal symptoms that last for months, and even years in some cases, after stopping use. Symptoms include anxiety, insomnia, depression, sensory symptoms (pain, tingling, burning, numbness), weakness, tremors, gastrointestinal issues, and clouded thinking or ‘brain fog'.
• It is extremely dangerous to mix benzos with other drugs, especially other depressants/downers such as alcohol, GHB, opioids (like heroin, buprenorphine and methadone) and gabapentin/pregabalin. All of these drugs depress breathing resulting in a serious risk of death if mixed.
• Benzodiazepines can also react with other types of prescribed medication and cause more side effects such as extra tiredness or low blood pressure. These include:
  • Antidepressants
  • Antipsychotic medication
  • Antihistamines
  • Beta-blockers
  For safety, carry out research on interactions between benzos and prescribed medication before mixing, or preferably talk to your doctor.
• Effects from benzos begin in around 30 minutes and can last up to approximately 6 hours although this varies depending on the type of benzo you have taken.
• The half-life (this is how long it takes for half of the dose to be metabolized and eliminated from the bloodstream) of benzodiazepines can vary significantly. For example, diazepam has a half-life of 20 to 100 hours and etizolam has a half-life of 3.4 to 12 hours (depending on the rate of metabolism). Because of the long half-lives of some of these drugs, it's possible to mix drugs without realising you're doing so, which can be very dangerous.
• Withdrawal from benzos can be fatal. If you have been using benzos regularly for more than 2-3 weeks and you want to stop, you should seek help to do so. Stopping suddenly can be very risky. Read on to find out about withdrawal symptoms and how to get help.

There is a wide range of potential benzodiazepine withdrawal symptoms. These can include:

• Stomach cramps
• Stiffness
• Anxiety and/or depression
• Visual problems
• Difficulty with concentration and memory
• Weakness
• Dizziness
• Eye, face and neck pain
• Flu-like symptoms
• Headaches
• Increased sensitivity to light/noise/touch/smell
• Loss of libido
• Problems with appetite
• Nausea/vomiting
• Nightmares
• Restlessness
• Insomnia
• Sore tongue and metallic taste
• Tinnitus (ringing in ears)
• Pins and needles
• Unsteadiness
• Weight loss

Some people experience more severe withdrawal symptoms including burning sensations in the skin, hallucinations, delusions, depersonalisation (feeling detached from your surroundings), derealisation (feeling out of touch with reality), memory loss, muscle twitching and paranoia.

If you stop taking benzos suddenly you may experience serious withdrawal symptoms including confusion, psychosis, seizures, a rapid heartbeat, sweating, high blood pressure, tremors (shaking) and hallucinations.

Severe withdrawal from benzodiazepines can be fatal. If you experience any of the above withdrawal symptoms after several hours to several days of stopping use, seek professional help as soon as possible. It could save your life.

If you are addicted to benzos the safest way to stop is by gradually reducing the dose with support from a professional.

Effects...

• Short term (depending on dose, duration and type of benzo) – relaxed, sedated, calm, feeling of warmth, sensation of ‘floating', drowsiness, sleepiness, slowed heart rate and breathing, reduced anxiety/increased anxiety, aggression, mood changes, problems with movement and balance, dizziness, slurred speech, reduced mental alertness, memory issues and black outs, impaired judgement, risky behaviours, disturbances of consciousness.
• Long term – Tolerance (the reduced reaction to a drug following its repeated use so more of the drug is needed over time to achieve the same effects), anxiety, depression, insomnia, memory impairment, difficulty concentrating, cognitive decline, confusion, disinhibition, sexual disfunction, sleep problems, learning problems, overdoses, psychosis, brain damage, suicidal thoughts and behaviour, dependence (this can develop quickly so it is recommended by doctors that you avoid using benzos regularly for longer than 2-4 weeks).

What is it...

• Cocaine is a popular party drug. It's a stimulant which means it speeds up the central nervous system to increase brain activity. It comes from the leaves of the coca plant.
• The coca plant leaves are ground down and processed with other chemicals to eventually bring you the white powdery substance you know as cocaine.
• Street cocaine can range in purity from approximately 40% to 70%.

Some of the chemicals involved in the production of cocaine include:

• Kerosene/paraffin (*toxic to inhale or ingest* - commonly used to power jet engines)
• Sulfuric acid (*toxic/destructive to the skin, eyes, teeth and lungs* - often found in household cleaners including drain unblockers because of its corrosive qualities – no wonder coke can damage your nose...)
• Ammonia (*toxic/corrosive/damaging to the brain and spinal cord* - can be used as a household cleaner – can cause breathing difficulties if used in a confined space)
• Diethyl ether (*toxic/irritating to the eyes, respiratory system and skin* - often used to make plastics)
• Acetone (*irritant/can cause throat, nose and lung irritation* - can be used as nail polish remover).

How is it taken...?

• Cocaine is usually snorted using a straw or a rolled-up bank note, but it may be dabbed on gums or swallowed in a cigarette paper. Crack cocaine is the smokable form of the drug. Crack comes in crystals known as rocks or stones. Cocaine can also be injected but this method carries more risk to users and is strongly discouraged.

Effects...

• Short term – euphoria, increased confidence increased energy and alertness, reduced appetite, reduced need to sleep, talkativeness, abdominal pain, anxiety, increased sensitivity to sounds, sights and touch, irritability, nausea, paranoia, restlessness, tremors, volatile or violent behaviour, increased sex drive (cocaine is known to be a factor at times in situations of drug-fuelled sexual assault and violence).
• Long term – anxiety, mood swings, malnutrition (due to supressed appetite), depression, difficulties with concentration, difficulties in feeling pleasure, fatigue, irritability, slower thinking or movement than usual, paranoia, issues with sleep, cravings (these can be intense...), impotence, damage to the nose (caused by snorting the drug), damage to the heart, damage to the lips, mouth and lungs (caused by smoking cocaine), needle related injuries and, in extreme cases, amputation of limbs (due to damage caused by injecting).
• Be aware!! Even after one use cocaine can potentially cause dangerous medical complications including: coma, heart attack, irregular heartbeats or changes to your heart rhythms, seizures or stroke.

Warnings...

• Cocaine causes your blood pressure, heart rate, temperature and respiration to increase while depressing your appetite.
• Cocaine is highly addictive. Regular users can develop tolerance meaning they need to take higher doses more frequently to achieve the same level of pleasure they got from their first hit. Withdrawal symptoms include depressed mood, anxiety, irritability, fatigue, difficulties with focus and concentration, memory problems, cravings, hunger, dehydration, sleep problems (including nightmares) and suicidal thoughts. ! If you ever experience thoughts of suicide, please seek help urgently – more info on the homepage!

What is it...

• Heroin is a highly addictive drug derived from the seed pod of certain varieties of poppy plants.
• Heroin is classed as an opioid. Other opioid drugs include codeine (including Co-Codamol), Tramadol, Fentanyl, Morphine and Oxycodone.
• Heroin is sometimes mixed with Fentanyl which increases the risk of accidental overdose. Depending on the purity of the drugs, Fentanyl can be 25 – 50 times stronger than heroin.
• The word ‘opioid' comes from the Greek work for ‘stupor' and originally referred to a variety of substances that dulled the senses and relived pain.
• Pure heroin is a white powder. Street heroin is most often seen as a brown/white powder because it is diluted or ‘cut' with impurities, meaning each dose is different.
• In 2021 there were 1330 drug deaths recorded in Scotland. Opioids were implicated in 1119 of these deaths (84%). Most of these deaths (9/10) were caused by people mixing heroin or other opioids with other drugs such as benzodiazepines, methadone, cocaine, or alcohol.
• Mixing different kinds of drugs is called polydrug use. It is very dangerous to mix drugs. Of the 1330 drug deaths in 2021 in Scotland, more than one drug was present in 93% of cases.
• As with a lot of painkillers, the human body starts to adjust to the intake of heroin so more and more is needed over time to achieve the same effect. This is called tolerance.

Important!

• Physical dependency to heroin can develop very quickly. This means you will experience physical withdrawal symptoms if you try to stop using the drug. It can happen after a few days or within a few weeks of daily use. There is more information about withdrawal from heroin below...

How is it taken...?

• Heroin can be heated on foil and smoked/inhaled or injected. Sometimes people also snort heroin. Heroin is commonly injected in Scotland but, as this is the riskiest way of taking drugs, it is strongly discouraged. It's worth knowing that a smaller dose is required when injecting as opposed to smoking or snorting to achieve the intended effect.

Effects...

• Short term – a ‘rush', euphoria, relaxation, warm flushing of skin, reduced sensation to pain, sedation, lethargy, dry mouth, heaviness in the arms and legs, nausea, vomiting, itching, drowsiness, cloudy head, confusion, constricted pupils, light sensitivity, low body temperature, reduced mental function, heart function slows, breathing slows, cyanosis (bluish hands, feet, lips etc.), possibility of coma, permanent brain damage or death.

The pleasurable feelings related to the ‘rush' are likely to only be felt for a few minutes, with feelings of sedation lasting a few hours.

• Long term – Tolerance (the reduced reaction to a drug following its repeated use so more of the drug is needed over time to achieve the same effects) – higher doses of the drug increases the risk of overdose, dental health problems, cuts and scabs on the skin due to scratching, constipation (this can be severe), poor appetite and nutrition, weight loss, weakened immune system, sleep problems, decreased sexual functioning, changes in the brain, addiction.

When injecting the drug - scarred and collapsed veins, blood borne viruses (hepatitis B/hepatitis C/HIV) if needles are being shared, bacterial infections, abscesses, sepsis, endocarditis (infection of the inner lining of the heart), gangrene, amputation of limbs.

• Be aware!! If you choose to inject, use new sterile equipment every time. Find your nearest injecting equipment provider at http://www.needleexchange.scot
• Be aware!! If you would like to be tested for BBV's (Blood borne viruses) you can find more information at https://www.waverleycare.org/find-a-service/testing/

What is it...

• Cannabis is the most commonly used illegal drug in the UK.
• Cannabis is a drug which is derived from the cannabis plant. The common cannabis plant types are Cannabis Sativa and Cannabis Indica. Cannabis Ruderalis is a lesser known strain.
• Each strain is thought to have different properties. For example, the Sativa type is known for its energetic effects while Indica is associated with calming effects.
• Each cannabis strain has a different concentration of the cannabinoids tetrahydrocannabinol (THC), cannabidiol (CBD), as well as other compounds.
• There are more than 100 cannabinoids in the cannabis plant.
• The THC is what gets people high.
• The drug cannabis comes in many forms including resin or hash (a sticky substance made from the resin glands of the plant), Herbal cannabis (the dried leaves and flowers of the plant), Edibles (foods or drinks infused with cannabis) and cannabis oil (a liquid extract from the plant).

Important!

• It's important to be aware that when eaten the effects from cannabis may take longer to be felt, may be felt more strongly, and may last longer, so a lower dose may be required to minimise the risk of unpleasant reactions.

How is it taken...?

• Cannabis is usually smoked or inhaled but it can be eaten (edibles) or taken as a capsule/absorbed under the tongue in oil form.

Effects...

• Short term – euphoria, relaxation, detachment, altered perception of time and space, intensified experiences, laughter (the giggles), talkativeness, decreased anxiety, decreased alertness, creativity, sexual arousal, hunger (the munchies), depression, anxiety, slurred speech, short term memory impairment, dizziness and sickness (a whitey) – especially when used with alcohol, paranoia, sleepiness, withdrawn (not feeling like socialising or talking), low motivation, hallucinations, depersonalisation (feeling outside of your own body), delusion. It can also cause a dry mouth, red eyes, changes in blood pressure and blood sugar levels and increase the heart rate.

• Long term – tolerance (the reduced reaction to a drug following its repeated use so more of the drug is needed over time to achieve the same effects), poorer educational outcomes/employment issues, impaired thinking and ability to learn and complete complex tasks, lower life satisfaction, relationship problems, financial difficulties, chronic cough and other respiratory difficulties, issues with sleep, severe cyclic nausea and vomiting (cannabinoid hyperemesis syndrome), brain development issues (if used while the brain is still developing), psychiatric disorders (schizophrenia, anxiety, depression), dependence.

• Be aware!! Cannabis can be addictive. About 1 in 10 regular cannabis users become dependent on the drug. You are more at risk if you started using it in your teens or if you use it daily.
• Be aware!! If you smoke cannabis in a joint with tobacco you may become addicted to nicotine.

Cannabis withdrawal symptoms

• Irritability
• Cravings
• Sleep problems
• Lack of motivation
• Finding it difficult to enjoy life
• Loss of appetite
• Nausea
• Weight loss
• Restlessness
• Mood swings
• Headaches

Coping with cannabis withdrawal

• Get some exercise – this can help with mood and sleep issues.
• Talk to someone – this could be a friend or family member you can talk openly to about what you're dealing with. Or get support from a professional. Speaking to someone may help you to get through the discomfort.
• Consider a nicotine patch – research has shown that using a nicotine patch seems to help reduce the symptoms of cannabis withdrawal in people who have used cannabis 5 times per week for a year or longer, even if they didn't use tobacco products.

Warnings...

• Cannabis can make some existing mental health issues worse and has been linked with the possible development of mental health issues. You're more at risk if you have an underlying vulnerability to mental health issues such as family history, you use cannabis heavily from a young age or over a long period of time, or you use high potency cannabis.
• The potency of cannabis has increased over the last few decades. This is due to evolved growing and testing techniques. Higher potency means more exposure to THC. Experts still do not know the long-term consequences of high concentrations of THC on the brain and body and there are concerns that the consequences of cannabis use today could be worse than it has been in the past.