Textbook of Clinical Management of Club Drugs and Novel Psychoactive Substances: NEPTUNE Clinical Guidance PDF
Preview Textbook of Clinical Management of Club Drugs and Novel Psychoactive Substances: NEPTUNE Clinical Guidance
Textbook of Clinical Management of Club Drugs and Novel Psychoactive Substances Published online by Cambridge University Press Published online by Cambridge University Press Textbook of Clinical Management of Club Drugs and Novel Psychoactive Substances NEPTUNE Clinical Guidance Dima Abdulrahim ProgrammeManagerandPrincipalResearcherfortheNEPTUNEProject,CentralandNorthWestLondonNHSFoundationTrust Owen Bowden-Jones ConsultantAddictionPsychiatrist,CentralandNorthWestLondonNHSFoundationTrust Published online by Cambridge University Press UniversityPrintingHouse,CambridgeCB28BS,UnitedKingdom OneLibertyPlaza,20thFloor,NewYork,NY10006,USA 477WilliamstownRoad,PortMelbourne,VIC3207,Australia 314–321,3rdFloor,Plot3,SplendorForum,JasolaDistrictCentre, NewDelhi–110025,India 103PenangRoad,#05–06/07,VisioncrestCommercial,Singapore238467 CambridgeUniversityPressispartoftheUniversityofCambridge. ItfurtherstheUniversity’smissionbydisseminatingknowledgeinthepursuitof education,learning,andresearchatthehighestinternationallevelsofexcellence. www.cambridge.org Informationonthistitle:www.cambridge.org/9781009182133 DOI:10.1017/9781009182126 ©TheRoyalCollegeofPsychiatrists2022 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2022 AcataloguerecordforthispublicationisavailablefromtheBritishLibrary. ISBN978-1-009-18213-3Paperback CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyof URLsforexternalorthird-partyinternetwebsitesreferredtointhispublication anddoesnotguaranteethatanycontentonsuchwebsitesis,orwillremain, accurateorappropriate. ................................................................................................................................................................................................ Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup- to-dateinformationthatisinaccordwithacceptedstandardsandpracticeat thetimeofpublication.Althoughcasehistoriesaredrawnfromactualcases, everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthat theinformationcontainedhereinistotallyfreefromerror,notleastbecause clinicalstandardsareconstantlychangingthroughresearchandregulation. Theauthors,editors,andpublishersthereforedisclaimallliabilityfordirector consequentialdamagesresultingfromtheuseofmaterialcontainedinthis book.Readersarestronglyadvisedtopaycarefulattentiontoinformation providedbythemanufacturerofanydrugsorequipmentthattheyplantouse. Published online by Cambridge University Press Contents Acknowledgements vi Part I Introduction and Background 8B Amphetamine-typeStimulants:An Overview 146 1 AnIntroductiontoClubDrugsandNovel 9 ‘Ecstasy’:MDMA(3,4-Methylenedioxy-N- PsychoactiveSubstances 1 Methylamphetamine),MDMAAnaloguesand 2 PsychosocialInterventionsforClubDrugsand DrugswithSimilarEffects 165 NovelPsychoactiveSubstances 22 10 Methamphetamine 202 11 SyntheticCathinones 240 Part II Drugs with Primarily Depressant ff E ects Part IV Drugs with Primarily 3 Gamma-Hydroxybutyrate(GHB)andGamma- Hallucinogenic Effects Butyrolactone(GBL) 37 12 HallucinogenicDrugs 267 4 NewBenzodiazepineNovelPsychoactive Substances 65 Part V Synthetic Cannabinoid Receptor 5 SyntheticOpioidNovelPsychoactive Substances(Fentanyland Agonists Non-fentanyl) 78 13 SyntheticCannabinoidReceptor 6 KetamineandOtherNovelPsychoactive Agonists 299 SubstanceswithDissociativeEffects 101 7 NitrousOxide(N O) 131 2 Part VI Concluding Remarks Part III Drugs with Primarily Stimulant 14 Conclusion 329 ff E ects 8A IntroductiontoStimulantClubDrugsand NovelPsychoactiveSubstances 143 Index 330 v Published online by Cambridge University Press Acknowledgements The authors would like to express their gratitude to The authors would like to thank the Health the EU Action Against Drugs and Organised Crime Foundation for supporting the development of the (EU-ACT)(aprojectfundedbytheEuropeanUnion NEPTUNE work through unrestricted educational andimplementedbyFIIAPPInternationalandIbero- grants. AmericanFoundationforAdministrationandPublic The authors would also like to thank the multi- Policy)foranunrestrictedqualityimprovementgrant disciplinarygroupsofexpertsandexpertsbyexperience usedtoproducethispublication. fortheirinvaluablesupportinthedevelopmentofwork. The authors would like to extend particular thanks to Paul Dargan, David Wood, Jonathan Dewhurst, Sarah Finley, Fabrizio Schifano, Christopher Whitely, and LukeMitcheson. vi Published online by Cambridge University Press Introduction and Background PartI Chapter An Introduction to Club Drugs and Novel 1 Psychoactive Substances 1.1 Introduction and Background Novelpsychoactivesubstanceshavebeenfoundin most of Europe and North America, as well as Thisdocumentprovidesaneweditionandanupdate Oceania, Asia and South America, and in a number tothe2015NEPTUNEguidanceontheclinicalman- of African countries. To some extent, however, NPS agement of harms resulting from acute intoxication are primarily a North American and European phe- and from the harmful and dependent use of ‘club nomenon. Although NPS affects all regions of the drugs’and‘novelpsychoactivesubstances’(NPS). world, there are diverse regional patterns, in terms Theguidanceisevidence-basedandisaresponseto of both the type and number of NPS reported by thegapinknowledgeandexperienceinthemanagement individual countries. The NPS situation also differs ofthesedrugs.Thereisevidencethatcliniciansoftenfeel bycountryfromoneyeartothenext.4 poorlyequippedtoassessandmanagetheharmsofNPS andreportthatmoreeducationonemergingdrugsand misuse patterns is needed.1 It has alsobeennoted that 1.2 NEPTUNE Aims and Guidance continued education on NPS is fundamental for the Development provision of improved harm reduction services, which canenhanceoverallcareforNPSserviceusers.2 1.2.1 Objectives of NEPTUNE Patterns of drug use continue to be dynamic. At the time of publication of this second edition, the This document is the 2022 update of the 2015 guid- quantity and range of drugs available to people is anceontheharmsandmanagementofNPSandclub wider than ever. Recreational users typically use drugs, developedby NEPTUNE (Novel Psychoactive awiderepertoireofsubstances: Treatment UK Network). This edition has been (cid:129) ‘Traditional’drugscontinuetobethemostused funded and supported by EU-Action Against Drugs (dependingoncountry,bute.g.cannabis,cocaine, andOrganisedCrime(EU-Act).5 amphetamines). Theaimoftheguidanceistoimproveconfidence, (cid:129) Novelpsychoactivesubstances(NPS)areused competence, and skills of clinicians in the detection, alongwiththesetraditionaldrugs,buthavenot assessment,andmanagementoftheharmsassociated replacedthem. withtheuseofNPS. (cid:129) Increaseofnon-medicaluseofprescriptiondrugs. Specificareasaddressedinclude: Thisdocumentfocusesonthehealth-relatedharmsof (cid:129) Detection/identification.Recognisingthe clubdrugsandNPSandtheirclinicalmanagement. significantpsychological,physical,andsocialrisks The use of substances referred to as ‘club drugs’ whichcanbeassociatedwithclubdrugsandNPS, has been well established for many decades. It andequippingprofessionalstobeableto includes illicit substances, e.g. cocaine and amphet- recogniseproblematicuse,associatedharms,and amine,aswellasNPS. dependence. TheuseofNPSisarelativelymorerecentglobal (cid:129) Assessment.Assessmentoftheproblemsrelated phenomenon, with 120 countries and territories totheuseofclubdrugsandNPS,includingthe from all regions of the world having reported one assessmentofbothdirectandindirectharms. ormoreNPStotheUnitedNationsOfficeonDrugs (cid:129) Management.Clinicalmanagementofacuteand and Crime (UNODC) Early Warning Advisory on chronicharmsrelatedtotheuseofclubdrugsand NewPsychoactiveSubstances.3 NPS–basedonthebestavailableevidence. 1 Published online by Cambridge University Press Introduction and Background PartI Chapter An Introduction to Club Drugs and Novel 1 Psychoactive Substances 1.1 Introduction and Background Novelpsychoactivesubstanceshavebeenfoundin most of Europe and North America, as well as Thisdocumentprovidesaneweditionandanupdate Oceania, Asia and South America, and in a number tothe2015NEPTUNEguidanceontheclinicalman- of African countries. To some extent, however, NPS agement of harms resulting from acute intoxication are primarily a North American and European phe- and from the harmful and dependent use of ‘club nomenon. Although NPS affects all regions of the drugs’and‘novelpsychoactivesubstances’(NPS). world, there are diverse regional patterns, in terms Theguidanceisevidence-basedandisaresponseto of both the type and number of NPS reported by thegapinknowledgeandexperienceinthemanagement individual countries. The NPS situation also differs ofthesedrugs.Thereisevidencethatcliniciansoftenfeel bycountryfromoneyeartothenext.4 poorlyequippedtoassessandmanagetheharmsofNPS andreportthatmoreeducationonemergingdrugsand misuse patterns is needed.1 It has alsobeennoted that 1.2 NEPTUNE Aims and Guidance continued education on NPS is fundamental for the Development provision of improved harm reduction services, which canenhanceoverallcareforNPSserviceusers.2 1.2.1 Objectives of NEPTUNE Patterns of drug use continue to be dynamic. At the time of publication of this second edition, the This document is the 2022 update of the 2015 guid- quantity and range of drugs available to people is anceontheharmsandmanagementofNPSandclub wider than ever. Recreational users typically use drugs, developedby NEPTUNE (Novel Psychoactive awiderepertoireofsubstances: Treatment UK Network). This edition has been (cid:129) ‘Traditional’drugscontinuetobethemostused funded and supported by EU-Action Against Drugs (dependingoncountry,bute.g.cannabis,cocaine, andOrganisedCrime(EU-Act).5 amphetamines). Theaimoftheguidanceistoimproveconfidence, (cid:129) Novelpsychoactivesubstances(NPS)areused competence, and skills of clinicians in the detection, alongwiththesetraditionaldrugs,buthavenot assessment,andmanagementoftheharmsassociated replacedthem. withtheuseofNPS. (cid:129) Increaseofnon-medicaluseofprescriptiondrugs. Specificareasaddressedinclude: Thisdocumentfocusesonthehealth-relatedharmsof (cid:129) Detection/identification.Recognisingthe clubdrugsandNPSandtheirclinicalmanagement. significantpsychological,physical,andsocialrisks The use of substances referred to as ‘club drugs’ whichcanbeassociatedwithclubdrugsandNPS, has been well established for many decades. It andequippingprofessionalstobeableto includes illicit substances, e.g. cocaine and amphet- recogniseproblematicuse,associatedharms,and amine,aswellasNPS. dependence. TheuseofNPSisarelativelymorerecentglobal (cid:129) Assessment.Assessmentoftheproblemsrelated phenomenon, with 120 countries and territories totheuseofclubdrugsandNPS,includingthe from all regions of the world having reported one assessmentofbothdirectandindirectharms. ormoreNPStotheUnitedNationsOfficeonDrugs (cid:129) Management.Clinicalmanagementofacuteand and Crime (UNODC) Early Warning Advisory on chronicharmsrelatedtotheuseofclubdrugsand NewPsychoactiveSubstances.3 NPS–basedonthebestavailableevidence. 1 https://doi.org/10.1017/9781009182126.001 Published online by Cambridge University Press AnIntroductiontoClubDrugsandNovelPsychoactiveSubstances (cid:129) Harmreduction.Interventionsaimedatpreventing (cid:129) Newpopulationsintreatment(includingnew morbidityandmortalityamongindividuals patternsofdruguseandcontextsofharm); presentingtoclinicalsettings,includingmeasuresto (cid:129) New harms (some club drugs are associated reducetheharmsofclubdrugsandNPSfor with harms not previously linked to illicit individualsandcommunitiesandtohelppatients drug use, e.g. ketamine-related ulcerative achieveandsustainrecoveryandwell-being. cystitis); Thisdocumentprovidesguidance,notguidelines.The (cid:129) Newmanifestationofdrug-relatedharmswhich implementationofNEPTUNEatnationallevelsmust arefamiliartoclinicians(e.g.dependenceand takeplacewithintheprinciplesofnationalandinter- withdrawalassociatedwithgamma- national guidelines, national and local protocols, as hydroxybutyrate(GHB). wellastheinternationalstandardsandbroadprinciples NEPTUNE therefore aims to improve clinicians’ forthetreatmentofsubstancemisusedisorders.6,7 knowledge of the specific issues relating to NPS and The implementation of NEPTUNE learning into to support evidence-based practice at local levels. It clinical practice must adapt the learning to take into also aims to help improve clinicians’ confidence in accountfactorsspecifictotheregion,countryorsector working with patients who use NPS, by providing where they are implemented. This includes the needs, thefollowing: priorities, legislation, policies, systems of healthcare (cid:129) ‘Technical’knowledge(whatthedrugsareand delivery and resources of the various countries. howtheywork); Adaptationshouldbecarriedoutwithoutundermining (cid:129) ‘Cultural’knowledge(whoisusingthem,andhow); the validity of the evidence-based training. Local and (cid:129) ‘Clinical’knowledge(howtoclinicallymanage national protocols, including prescribing protocols, bothacuteandchronicpresentations). shouldbeused. For up-to-date information, it is also recom- 1.3 Target Audience for the Guidance mended that clinicians contact the Poisons Centres intheirregion,whereavailable.Thesearespecialised units that advise on, and assist with, the prevention, 1.3.1 Primary Audience diagnosis,andmanagementofpoisoning.Theirstruc- Thisguidanceisaimedprimarilyataclinicalaudience ture and function varies around the world; however, andmostspecificallyclinicianswhomanagephysicaland at a minimum, a poisons centre is an information mentalhealthproblemsassociatedwithharmfulor/and service. Some centres may also include a toxicology dependent drug use and ensuing acute or chronic laboratoryand/oraclinicaltreatmentunit.8 problems. These will include clinicians working in spe- 1.2.2 Why Produce Guidance on Club cialist drug treatment and recovery services, as Drugs and Novel Psychoactive Substances? well as in emergency departments. The document is also relevant to professionals working with The underlying principles of good clinical practice in populations at risk of drug-related harms and relationtotheusersofclubdrugsandNPSarethesame associated poorer treatment outcomes, such as asforharmfulanddependentdrugmisuseingeneral. Clinicians’existingexperienceofthetreatmentof mental health services, prison health services, pri- mary care, sexual health services, HIV treatment, othercommonlyuseddrugs(suchasheroin,alcohol hepatology and others. orcannabisforexample)isveryrelevanttothetreat- mentofclubdrugsandNPS. 1.3.2 Other Audiences However,goodassessmentandmanagementofthe harms of club drugs and NPS must also consider the Although not directly aimed at them, this docu- particularchallengesposedbynoveldrugsandaddress ment is also a resource for funders/commissioners themdirectly.Theseincludechallengesposedby: and policy-makers in developing local, national or (cid:129) Newdrugs(rapidlychangingprofileandever- regional services. It also provides patients and increasingnumbersofsubstances,withpoorly carers with information on what interventions understoodharms); should be available. 2 https://doi.org/10.1017/9781009182126.001 Published online by Cambridge University Press
The list of books you might like
