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To investigate veterinarians' experience and perception of the risk of veterinary prescription medication (VPM) misuse and abuse by the public and veterinary professionals and to determine the clinical context in which respondent veterinarians prescribed certain VPMs. Anonymous online voluntary survey. A total of 361 of 7126 veterinarians registered as practicing in the UK, who provided e-mail contact details to the Royal College of Veterinary Surgeons Knowledge for participation in research. Respondents included general practitioners, with or without further qualifications, and European specialists, covering charity, private or academic small, large or mixed animal practice. The anonymous online survey, open from September to December 2021, posed 27 questions regarding personal experience and perception of VPM misuse or abuse, including which VPMs were considered most at risk of abuse by clients or veterinary staff. Thematic analysis was performed on free-text sections. The participation rate was 5% (361/7126), and the completion rate 60% (216/361 respondents). Of these, 88% of respondents somewhat agreed, agreed or strongly agreed that some VPMs were at risk of abuse. A third (29.9%; 107/358) had suspected an owner of taking VPMs, and one fifth (20.1%; 72/358) had suspected veterinary staff. Perceptions regarding the likelihood of public VPM abuse ranged from not suspecting a problem to having first-hand experience. Drugs considered most at risk of owner abuse were opioids, benzodiazepines and gabapentin, and those for veterinary staff were opioids, benzodiazepines and ketamine. Numerous 'red flags' prompting suspicion of VPM abuse were identified alongside ways of mitigating risk. Veterinarians in the UK reported varied experiences with, awareness of, and attitudes towards VPM abuse by the public and veterinary staff. Although not quantified, the UK veterinary industry could be a source of abusable drugs. [ABSTRACT FROM AUTHOR]

Introduction: Linaclotide is approved for adults with moderate-to-severe irritable bowel syndrome (IBS) with constipation (IBS-C). Linaclotide is not indicated for weight loss or for patients with inflammatory bowel disease (IBD); it is contraindicated in patients with mechanical bowel obstruction (MBO). Some patients with obesity or eating disorders (ED) may use linaclotide off-label for weight loss or as a laxative. Objectives: To describe the use of linaclotide in clinical practice, including patients with potential for off-label use or misuse. Methods: Post-authorization safety study conducted in three databases from the linaclotide launch date to 2017: the Clinical Practice Research Datalink in the United Kingdom (UK), the Information System for Research in Primary Care database in Spain and the linked Patient, Prescription and Causes of Death Registries in Sweden. Cohorts of patients were identified as having IBS using diagnostic and treatment codes; IBS subtypes were identified using symptoms and treatment codes; patients with obesity, ED, MBO, and IBD were identified using diagnostic codes or body mass index. Results: There were 1319, 1981, and 5081 linaclotide users from the United Kingdom, Spain, and Sweden with a median age of 45, 57, and 51 years, respectively; most were females. In the United Kingdom, Spain, and Sweden, respectively: 59.0%, 60.3%, and 31.3% of linaclotide users had an IBS diagnosis recorded, and among those, 68.8%, 61.3%, and 92.7% were classified as IBS-C. The proportions of linaclotide users considered at risk for potential off-label use for weight loss or as a laxative were 17.1%, 29.7%, and 1.7%, and the proportions of users considered at risk of misuse due to a history of MBO or IBD were 3.5%, 4.6%, and 5.7% in the United Kingdom, Spain, and Sweden, respectively. Conclusions: Potential linaclotide off-label use and misuse appears limited, as evidenced by the small sizes of the patient subgroups at risk for off-label use and misuse. [ABSTRACT FROM AUTHOR]

Acute toxicity caused by New Psychoactive Substances (NPS) has created a significant burden for Emergency Departments (EDs). Here we report characteristics of people presenting with toxicity after exposure to the synthetic cathinone N-ethylpentylone (NEP). Adults presenting to hospital with severe acute toxicity after suspected NPS use were recruited between March 2015 and October 2020. Clinical features were recorded using consistent methodology and biological samples analysed using liquid chromatography-tandem mass-spectrometry. NEP was detected in at least one sample from 9 of 893 patients recruited during the period of study, all presenting between 2016 and 2019 and 8 presenting in southern England. Commonly reported clinical features included tachycardia (6), agitation (6), confusion (6), mydriasis (5), hallucinations (4), acidosis (3) and elevated creatine kinase (3). Co-used drugs, detected in 6 patients, may have contributed to these features, but agitation and hallucinations were also reported in all 3 patients without analytical evidence of co-use. NEP was detected infrequently in episodes of drug toxicity in the UK between 2016 and 2019, especially in southern England. Clinical characteristics of toxicity are similar to those of other cathinones, although co-use of other drugs is common and may contribute to the features observed. [ABSTRACT FROM AUTHOR]

SUMMARY: Nitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Background: Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower.Aim: To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies.Design and Setting: A semi-structured qualitative interview study of GPs working in general practices across England.Method: Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis.Results: The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR.Conclusion: When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies. [ABSTRACT FROM AUTHOR]

Background: Over the last ten years, there has been a worldwide expansion of research on drug use among university students. However, this trend has been less noticeable in the United Kingdom (UK). The aim of the current study is to add to the existing research base by investigating some of the characteristics and correlates of drug use among university students in the UK. Methods: Seven of the nine universities in Wales collaborated in a national survey of drug use among students during the academic year 2015–2016. The online questionnaire was identical for each university and covered a range of topics including: tobacco and e-cigarette use, traditional drug use, use of new psychoactive substances and illicit use of prescription drugs. Results: All students from seven universities in Wales were individually emailed an online questionnaire. In total 7,855 students returned the questionnaire. The most commonly used drugs, after alcohol and cigarettes, were cannabis, ecstasy, nitrous oxide and powder cocaine. There was significant variation across universities in the prevalence of drug use. Conclusions: Several prevention and treatment programmes have been implemented by universities in the United States (US) to reduce drug use among students. These include university-based education and information programmes, social norm approaches, and brief motivational interventions. Such programmes should be trialled in UK universities to test their effectiveness based on rigorous methods of evaluation. [ABSTRACT FROM AUTHOR]

Aims: The aim of the research was to identify the types of drugs currently being used by university students, their involvement in multiple drug misuse and drug combinations, and the consequences of drug misuse in terms of associated harms. Methods: The research was based on an email survey of all first- and second-year students registered as undergraduates at a university in south Wales during October 2012. Results: The results of the research showed that drug misuse on the university campus studied was widespread in terms of the types and patterns of drug misuse. The most troublesome findings concern the high levels of multiple drug use, the use of some of the most dangerous drugs (including crack and powder cocaine and heroin, as well as ketamine), and the list of recorded harms experienced as a result of drug misuse. Conclusions: The article concludes that little attention has been paid outside of the United States to drug use among university students or to interventions designed to prevent it. However, there are signs that government policy in the United Kingdom is beginning to pay attention to the specific problems of drug misuse among university students. [ABSTRACT FROM AUTHOR]

For the most part the 2003 Criminal Justice Act, which came into effect in England and Wales in April 2005, was accepted by the probation service with relatively little opposition. Given the enormity of its impact acquiescence to this degree of change ought to come as something of a surprise. The 2003 Act changed fundamentally the nature of community supervision, it brought to an end the traditional range of non-custodial penalties and replaced them with a single community order to which sentencers could add any of 12 possible requirements. This article considers the impact of the 2003 legislation on one particular offender group – drug misusers. Drug misusing offenders have the potential to pose serious difficulties for probation officers; the habitual nature of drug addiction and a tendency towards an irregular lifestyle make drug misusers particularly susceptible to breach. Under the new legislation courts have significantly fewer options available to them when responding to incidents of offender non-compliance. This article argues that many of the provisions of the 2003 Act together with developments elsewhere in the UK are likely to have impacted disproportionately on those groups whose lifestyles are chaotic and whose routines are incompatible with the terms and conditions of modern day probation practice. It concludes that greater flexibility towards non-compliance, supported by regular and consistent judicial review, would encourage improved rates of compliance and retention in treatment and improved outcomes for offenders. [ABSTRACT FROM AUTHOR]

To assess the state of maternity services for pregnant drug misusers, a postal questionnaire-based survey was carried out in England and Wales in 2005. A total of 222 questionnaires were sent with a response rate of 80.63%, reporting a total of 5,324 births to drug-misusers. Data were collated and analysed using Microsoft Excel 2003. Despite improvement in the services provided to the pregnant drug-misusers, there is wide regional variation. Hepatitis-C screening is particularly under-offered. Pre-birth meetings appear to be the way forward to optimise overall outcome. Maternity-unit staff need appropriate training for providing sufficient knowledge of drug use and its consequences for the pregnancy. [ABSTRACT FROM AUTHOR]

A recent trend of escalating use of cocaine/crack cocaine was observed in the UK. The number of mentions on death certificates; last year use of cocaine; treatment demand, number of drug offenders, seizures, prices and average purity levels were the indicators used for this descriptive and correlational study. Figures (1990-2004) were taken from official UK sources. A total of 1022 cocaine/crack cocaine death mentions (i.e. deaths from any cause where the presence of cocaine/crack cocaine was also detected) were identified, with cocaine/crack cocaine being the sole drug mentioned in 36% of cases. The number of cocaine/crack cocaine death mentions showed a year-on-year increase and correlated positively with the following cocaine (powder) figures: last year use (p < 0.001); number of offenders (p < 0.001) and number of seizures (p < 0.001), but correlated negatively with price (p < 0.001). Furthermore, the number of cocaine/crack cocaine death mentions correlated positively with the number of crack offenders (p < 0.001) and seizures (p < 0.001), but correlated negatively with both crack purity ( p < 0.001) and price (p < 0.05). With conditions of increasing drug availability having been met in the UK, decrease in cocaine prices were associated with higher consumption levels and this, in turn, contributed to the increase in number of cocaine-related fatalities. There are limitations with the information collected, since no distinction is usually made on medical death certificates between cocaine and crack cocaine. The present study being an ecological one, it proved difficult to address the role of confounding variables that may well explain some of the associations observed. [ABSTRACT FROM AUTHOR]

This paper presents a case study of a Criminal Justice Intervention Programme (DIP) for drug-using offenders in the UK. Of 180 offenders offered the scheme, 103 (57%) successfully engaged and 59 (32%) stayed six weeks or more. The majority of referrals (94%) were for heroin misuse and 45% also reported crack use. Less than a third (27%) of all referrals reported injecting. Those who engaged initially were more likely to be injectors (70% compared to 30% of those who did not engage), females, polydrug users, and older clients. But those who stayed in treatment for at least six weeks were more likely to be non-injectors (60% stayed in treatment compared to 40% who did not), male and ethnic minority groups. Qualitative analysis of 40 semi-structured interviews with clients emphasized the benefits of fast access and friendly helpful staff. However, clients believed that drug use itself was interlinked with social, economic and psychological problems and identified a need for comprehensive 'wrap-around services' and help with housing and employment. The complexity of the relationship between drug use and crime was seen as reflecting the complexity of these underlying problems. The opportunities and limitations of combining individual treatment and public safety objectives are discussed. [ABSTRACT FROM AUTHOR]

The last 10 years have seen considerable government focus on effective initial assessment processes in the UK. This has been given added impetus by research that found that more than 97% of referrals are closed without allocation for long-term work. Yet there is little research on referrals that are closed and no British study of patterns of re-referral for such children. The current study looks at 400 consecutive referrals to three local authority Social Services Departments in London that were closed rather than being allocated for long-term work. It investigates how many children were re-referred in the 27 months after closure and identifies factors statistically associated with re-referrals. The study found that a third of closed cases were re-referred (36.5%), with most re-referrals happening relatively rapidly. A small proportion of families accounted for most re-referrals: 8.5% of families had 52% of subsequent referrals. There was very wide variation between local authorities in the number of referrals and re-referrals received. Other factors associated with increased likelihood of a re-referral were: previous referrals, neglect, parental capacity issues (particularly drug misuse) and parent/child relationship problems. The implications of the findings for practitioners, policy-makers and researchers are discussed. [ABSTRACT FROM AUTHOR]

This paper presents the initial findings of a research project that is seeking to understand the bereavement experiences of people such as parents, grandparents and siblings, who are close to those who die through illicit drug use. It is argued that the deaths of these individuals are qualitatively different from those related to other substances such as alcohol or nicotine, for example. The reasons for this include the often unexpected nature of the deaths and the young age at which they tend to occur. These deaths result from an activity that is illegal and is regarded as deviant or carries social censure. The deaths under consideration occur in a context that might be poorly understood by those close to the user. The death itself might reveal a relative or friend as drug user for the first time. Drug users also have a 'spoiled identity' that can be attached to the bereaved. There are, moreover, few guides to the practitioner as to the difficulties that the bereaved may experience. [ABSTRACT FROM AUTHOR]

Background We report detailed Endings of the first systematic validation of a Regional Drug Misuse Database (RDMD); such databases constitute the main investment in routine drug statistics in the UK by the Department of Health. [ABSTRACT FROM PUBLISHER]

Objective: To understand how the emerging public health issue of chemsex relates to broader patterns of sexualised drug use (SDU) among men who have sex with men (MSM), which has been understudied., Methods: Potential participants were invited to take part in an anonymous, cross-sectional online survey through Facebook advertising and community organisations' social media posts (April-June 2018). Multivariable logistic regression was used to compare MSM who engaged in recent SDU (past 12 months) with those who did not, and those who engaged in chemsex (γ-hydroxybutyrate/γ-butyrolactone, crystal methamphetamine, mephedrone, ketamine) with those who engaged in other SDU (eg, poppers, cocaine, cannabis)., Results: Of the 1648 MSM included, 41% reported recent SDU; 15% of these (6% of total, n=99) reported chemsex. Factors associated with SDU were recent STI diagnosis (aOR=2.44, 95% CI 1.58 to 3.76), sexual health clinic attendance (aOR=2.46, 95% CI 1.90 to 3.20), image and performance-enhancing drug use (aOR=3.82, 95% CI 1.87 to 7.82), greater number of condomless anal male partners, lower satisfaction with life and greater sexual satisfaction. Predictors of chemsex compared with other SDU were not being UK-born (aOR=2.02, 95% CI 1.05 to 3.86), living in a densely populated area (aOR=2.69, 95% CI 1.26 to 5.74), low sexual self-efficacy (aOR=4.52, 95% CI 2.18 to 9.40) and greater number of condomless anal male partners. Living with HIV, taking pre-exposure prophylaxis (PrEP), and experiencing or being unsure of experiencing sexual contact without consent were significantly associated with SDU and chemsex in bivariate analyses but not in the multivariable., Conclusion: Health and behavioural differences were observed between MSM engaging in chemsex, those engaging in SDU and those engaging in neither. While some MSM engaging in chemsex and SDU appeared content with these behaviours, the association with life satisfaction and sexual self-efficacy indicates psychosocial support is needed for some. The association with sexual risk and sexual consent also indicates the importance of promoting harm reduction among this population (eg, condoms, PrEP, drug knowledge)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of the article is to determine the approximate prevalence of drug and alcohol-related crime among university students in seven universities in the United Kingdom and to assess whether there are differences between substance users who offend and substance users who do not offend. In total, 7,855 students submitted a questionnaire. The results of the study show that 10% of students who used drugs and about the same percentage who used alcohol had committed substance-related crimes in the current academic year. The most prolific offenders in relation to both drug and alcohol-related offending were males, those who frequently went out to socialise, frequent users of nightclubs off campus, and those in poor physical or mental health. The article proposes that preventative interventions should be used to address alcohol and drug-related crime and its consequences.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, restates the requirements of the principle of double effect that seeks to ensure that patients in intractable pain receive the analgesia they require to manage it.

Objectives: Sexualised substance use, 'chemsex', is being increasingly reported by gay, bisexual and other men who have sex with men (GBMSM) in sexual health clinics. We aim to describe the evidence base and practical ways in which clinicians can assess and advise patients disclosing chemsex., Methods: We review published literature on chemsex, discuss vulnerability to substance use, highlight the importance of clinical communication and discuss a management approach., Results: GBMSM are vulnerable to substance use problems, which interplay with mental, physical and sexual health. Knowledge on sexualised drug use and related communication skills are essential to facilitating disclosure. Identifying sexual health and other consequences of harmful drug use may motivate patients to seek change., Conclusions: Sexual health clinicians are well placed to make more holistic assessments of GBMSM accessing their services to promote broader sexual health and well-being beyond the management of HIV and sexually transmitted infections (STIs) alone., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)