Clinical Review

New recreational drugs and the primary care approach to patients who use them

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e288 (Published 15 February 2012) Cite this as: BMJ 2012;344:e288
  1. Adam R Winstock, consultant addiction psychiatrist and honorary senior lecturer1,
  2. Luke Mitcheson, consultant clinical psychologist2
  1. 1South London and Maudsley NHS Trust, Institute of Psychiatry King’s College London, Blackfriars Road Community Drug and Alcohol Team, London SE1 8EL, UK
  2. 2South London and Maudsley NHS Trust, London
  1. Correspondence to: A R Winstock adam.winstock{at}slam.nhs.uk

Summary points

  • New drugs of misuse, including ketamine, γ-hydroxybutyrate (GHB), and a range of synthetic stimulants, have become part of global recreational drug culture

  • Use in combination with other substances (especially alcohol) is common and increases the associated health risks

  • These drugs are associated with non-specific risks of intoxication and substance specific toxicological harms

  • Assessment and feedback using a motivational approach and provision of information about harm reduction are useful interventions that can be delivered in primary care

  • Referral to specialist services might be needed to manage complex withdrawal or specific harms

In recent years, hundreds of new drugs have appeared on the recreational drugs market in Europe.1 Some of these substances, such as ketamine and γ-hydroxybutyrate (GHB), have legitimate medical purposes. These compounds have been joined by many novel psychoactive substances that, combined with their online marketing, pose a challenge for policy makers and health providers.2

The origins of these new drugs vary from synthetic compounds (such as 4-methylmethcathinone, or mephedrone) to traditional herbal products (such as salvia divinorum and kratom). The synthetic compounds are often designed and promoted to avoid contravening drug, medicine, and consumer protection laws. Although mephedrone, other cathinones, and various other synthetic compounds (including several cannabinoids) were classified in the United Kingdom as class B drugs in April 2010, many other new substances with psychoactive potential remain legally available. Rapid changes in legislation, combined with diverse branding and poor quality control, have led to a marked variation in the composition of these products, making it difficult for users and clinicians to identify exactly what is being consumed.

We review some common examples of these new drugs, and provide a framework for conducting an interview in the primary care setting with people who may have problems with their use. Since evidence relating to these substances is …

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