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As I'm sure most people who read this site will know Mephedrone has been around for a few years now and it is one of the wide range of new and emerging drugs, some legal, some not that people are experimenting with, using recreationally or in some cases developing a dependency on. One of the questions and fears that has been around has been which of these, if any, will people inject and what will be the consequences and risks if they do.
 
In the early months of 2012 me and my colleagues who work in the NSP began to hear from service users who had previously mainly injected heroin that they had begun to inject Mephedrone, known variously locally as MCat or Mdog. Within a matter of weeks we had people accessing the NSP whose use of MCat had escalated rapidly and who were injecting large amounts of the drug on a daily basis with little or no awareness about what it was that they were using apart from a vague idea that it was some kind of 'plant food.'
 
The speed with which long term heroin users adopted this new drug took them and us by surprise. As harm reduction workers we are faced with the challenge of firstly finding any relevant harm reduction information around the IV use of M Cat to pass onto service users (there is very little of this), of educating people who were injecting about possible risks and consequences and of learning from them about the issues that they were beginning to encounter.
 
Much of the Harm reduction advice that we as workers can offer around the use of Mephedrone is similar to other stimulant type drugs that we have worked with but we also began to hear alarming reports from our service users about the impact that their use was having on themselves and people around them.
 
Many reported an increase in incidents of violence and aggression amongst the using community, as one long term heroin injector said to me, 'people do more for this than they ever did for heroin'. Stories of assaults and robbery of other people who use drugs became common place. Many people reported that they felt aggressive when using and that they and others were resorting to violence to settle disputes and differences far more quickly than they would have done in the past. As workers we saw a marked change in the way in which people were behaving in and around the project with individuals acting in erratic and aggressive ways towards staff and other service users.
 
This aggressive behaviour came alongside a reported increase in paranoia and anxiety, particularly after using for several days. Stories of people feeling that they were being watched or followed, strangers in vans, voices from the TV etc are commonplace amongst people injecting large quantities of the drug . One woman who was using about 5 Grams daily at that point remarked to me that 'its wrecking everyone's heads..'
 
A visible effect of injecting M Cat has been the rapid and significant weight loss that people are experiencing. Most people I have spoken with have been concerned by this but there have been a few female injectors who have identified this as a positive side effect.
 
One of the most concerning side effects that users have discussed has been the slow healing process of wounds. As with other stimulants people under the influence of M Cat may pick at their skin. These spots do not seem to be healing and are then picked at again , slowing the healing process. People have told me that other cuts and wounds on their body are also healing very slowly or not at all. This would appear to be related to a vasoconstriction effect where the blood in the veins is flowing far more slowly but I can find little solid information or research to support this particular reported side effect of Mephedrone.
 
There have also been several reports from people who have suffered fits after injecting, this has generally occurred after extended use of larger amounts, in the region of 3 Grams or more over the course of a session and would appear to be a stimulant type overdose.
 
It appears that the rise in tolerance that people experience with Mephedrone is rapid. It is not uncommon for people to be injecting in the region of 3 – 5 G on a daily basis. There have also been reports of almost compulsive injecting episodes. I spoke to one person , a long term heroin user who claimed that he had injected approximately 40 times in a 24 hour period, he based this on the number of used filters that he counted afterwards. The potential vein damage and trauma associated with this number of injections is clear and he himself was deeply concerned about how much Mephedrone he was using and the compulsive nature of his binges.
 
What is puzzling is why so many in the heroin using community have adopted Mephedrone as their main drug of choice, in some cases ceasing to use heroin completely. I have spoken with people about their motivations for using Mephedrone and there have been a few different explanations that have been offered.
 
For some older heroin users the buzz and rush of injecting could only be likened to one thing, that of early 90's ecstasy. 'its like old school pills' has been enthusiastically stated on several occasions. Many people have also stated that while they enjoy the initial rush it is the come down afterwards that they really enjoy, describing it as being opiate like and 'better than the gear that's around.'
 
The most common explanation offered is based on the fact that the quality of heroin and Crack has been steadily decreasing and Mephedrone is seen by users as being a cleaner, higher quality drug. Up until a few months ago there were people selling Mephedrone in the original 'plant food' packaging that it was sold in when legal. This has changed over the last few weeks and there are now complaints that the quality has declined and people who are using claim that it is now being cut with a wide range of substances including salt, sugar or amphetamine. People who are using back this up with their descriptions of the drug which has changed from being rice sized crystals to a more powder form. There has been a recent Police seizure in the area where a large amount of crystal type Mephedrone was discovered ( 9 Kilogram's) alongside 24 Kilos of Monosodium glutamate (MSG) a flavoring used in Chinese cooking which the police stated was to be used as a cutting agent.
 
The above is really only a snapshot of some of the issues that people injecting Mephedrone have discussed with workers. None of these people have injected it for any longer than 6 months. What the consequences of longer term IV use will be is hard to say and this is the message that we are giving to our service users. What is clear is that as workers we need to listen to everything that they are reporting to us and work with them to develop effective and relevant strategies to reduce the harm of a drug that one person likened to 'A nightmare, this drug has got a hold of me quicker than any other.'
 
OmnicansOmnicans is the nom de plume of a very experianced harm reduction worker based in the UK. Currently his main focus at work is ensuring that the issue of legal highs and research chemicals is firmly on the agenda and keeping up to date with the rapidly changing nature of substance use.