Depending on your disposition, club drugs – ecstasy, speed, cocaine, MDMA, mephedrone – can either be great night-extenders or tragic night-obliterators. Usually, it's as black and white as that – you do some, you dance around a bit, you go to bed, you wake up feeling shit. Sometimes, though, the drugs become a problem; you start to rely on them for a good time, and then you start to rely on them to get you through the day.
A couple of years ago we spoke to Dr Owen Bowden-Jones, founder of London's Club Drug Clinic – a centre dedicated to helping people with their club drug problems – about what he was up against. Back then, the main drugs the clinic was dealing with were GBL, crystal meth, ketamine and mephedrone, with a number of users injecting those last two. I caught up with Owen recently to see what's changed since then.
VICE: Hi Owen. How has club drug culture changed since you spoke to us in 2013?
Dr Owen Bowden-Jones: Well, I can only speak for people I've seen at the clinic, but we're seeing a much more diverse group of people, including clubbers, students, psychonauts, men who have sex with men, people who've been in prison or in custody and vulnerable groups, such as homeless populations. It seems that more diverse groups are trying these drugs and experiencing problems.
Why do you think that is?
I think it will be a range of factors. The drugs themselves remain easily available, cheap, potent and, for a number of the non-psychoactive drugs, legal, and so they appeal to a variety of different groups for different reasons. Some users say they like the drugs because they don't show up on urine drug screening. If you are being regularly drug tested, that can be a real attraction. Some of our psychonauts say they enjoy trying lots of different chemicals to experience new effects, and some of our clubbers say they're just interested in trying the latest thing.
MDMA and ecstasy usage has gone up, and the purity's gone up. Do you think it's a positive thing that people are experimenting with purer drugs?
It's difficult to say because, as with any commercial market, people want value for money, so they want to get the effect they're seeking for the best price possible, for the least harm. Some of the newer drugs may cause greater harm than MDMA, but it's complicated because plenty of MDMA is cut with other drugs. If you don't really know what you're taking, it's hard to know the risks. Without meaning to sound patronising, taking any psychoactive drug involves some risk.
There was a problem a couple of years ago with dealers selling PMA as MDMA, which caused a number of deaths. Is that still an issue?
Yeah, there were a few cases of users who thought they were taking MDMA, didn't really feel any effects after about half an hour and, being experienced MDMA users, said, "Well, it's obviously not very good quality, so let's take some more." What they didn't realise was they'd actually been taking PMA, which takes a lot longer to work – typically around an hour. So they essentially double-dosed themselves with PMA. Some users died because of the toxic effects of PMA in the amount they took. This is a pattern we often see at the clinic, with people taking a drug, expecting a particular effect and then being surprised when they get something they didn't bargain for.
Have any drugs become particularly popular in the last year?
From about 2008, the big new drug was mephedrone, and that very rapidly gained a new market share. It probably made big inroads into the drug market because the quality of other drugs wasn't so good. At the time it was relatively pure and relatively cheap. What we haven't seen is a sort of son of mephedrone; there isn't another drug that's come along in the same way and taken a big slice of the market. That may happen, but it hasn't happened yet.
Of all the various club drugs, how badly does mephedrone rate in terms of how many issues people have when they come in?
Thinking about drug harm is complicated, because you need to think about the drug itself, then you need to think about the way the drug was taken, and then you need to think about the individual characteristics of the person using the drug. Mephedrone is a synthetic stimulant drug that can cause psychosis, severe agitation and dependence.
Now, it's much more likely to do that if you take it by injection rather than taking it as powder. Some people are more susceptible to psychosis than others, and it's the same with addiction; some people are predisposed. What people want to think about is what their own individual risk might be. Do they have a family history of psychotic illness? Do they have a history of addiction? Have they got addicted to other drugs in the past?
The last time we spoke to you there was a lot of emphasis on ketamine, but since then there's been a bit of a K drought. How has that affected your day-to-day?
Two years ago we were seeing huge numbers of ketamine users, often experiencing very significant "ketamine bladder", some of them experiencing dependence. As ketamine has apparently disappeared off the streets, we have seen a big reduction in people coming to the clinic with ketamine problems. For the moment, it seems to have almost disappeared as a problem drug for us.
Have synthetic cannabinoids been a big problem for you?
We do see quite a number of people who are trying some synthetic cannabis products – things like Spice – and some of the problems have been surprisingly severe. We've seen people with psychosis and very disturbing paranoia. We've seen people get very agitated and being very impulsive and sometimes injuring themselves after smoking synthetic cannabinoids. One of the messages that seems to be emerging is that the synthetic cannabinoids appear to be much stronger and more harmful than regular cannabis.
Has anyone expressed why they decide to go for the synthetic cannabis over regular cannabis?
Again, it's about bang for your buck, because some of the synthetic cannabinoids are very strong and still relatively cheap, and so I think some people just think they're getting a lot of drugs for their money. The problem is, they're also getting a lot of harm for their money – we're seeing increasing numbers of people coming to the clinic with problems around synthetic cannabinoids.
How has work changed for you personally since we last spoke?
What we've had to do over the last couple of years is learn a lot more about the different groups who are using these drugs, because it seems that more and more different groups are trying out club drugs to see what they're like, and we're seeing more people with harms. We're also seeing more people injecting their club drugs and we're seeing greater harms, so the sort of harms we now see related to club drugs are similar to the ones that we see in our traditional drug clinics.
Dependence, withdrawal, psychosis, depression and anxiety are the problems we regularly see. The other thing we've done is we've got a group of experts together, including people who use these drugs, to help us write a set of clinical guidance, which is called Project Neptune. Many doctors and nurses still have very little idea about these drugs and the problems they cause. We're trying to make sure that health professionals in settings like A&E know enough about these drugs to be able to help.
It sounds like club drugs have gone from a bit of a flight of fancy to being more akin to things like heroin or crack cocaine.
Heroin and crack cocaine remain the most harmful drugs you can use, but these other drugs used to be called recreational drugs. What's clear is that some people are experiencing harms that are a long way from recreational. They're experiencing the sort of harms we'd expect to see with more traditional drugs.
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