Global Drug Survey have made some of Dr Adam Winstock’s most recent academic articles available here
We have included the abstract and a link to full PDFs. This section will be updated as new articles are published.
New Recreational Drugs and the Primary Care Approach to Patients Who Use Them (2012)
In recent years, hundreds of new drugs have appeared on the recreational drugs market in Europe. 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.
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 inevitably limited, we have based this article on case series, observational studies, consensus guidelines, our own clinical experiences, and those of our colleagues.
Mitcheson, L; Winstock, A.R (2012)‘New recreational drugs and the primary care approach to patients who use them’. British Medical Journal 344:e288
Assessment and Management of Cannabis Use Disorders In Primary Care (2010)
Summary of points:
- Cannabis use is common, especially among young people.
- The greatest risk of harm from cannabis use is in young people and those who are pregnant or have serious mental illness.
- A tenth of cannabis users develop dependence, with three quarters of them experiencing withdrawal symptoms on cessation.
- Most dependent users have concurrent dependence on tobacco, which increases the health risks and worsens outcomes for cannabis treatment.
- Brief interventions and advice on harm reduction can improve outcomes.
- Psychoeducation (for a better understanding of dependence), sleep hygiene, nicotine replacement therapy (where indicated), and brief symptomatic relief form the mainstay of withdrawal management.
- Dependent users may present with symptoms suggestive of depression, but diagnosis and treatment should be deferred until two to four weeks after withdrawal to improve diagnostic accuracy.
Ford, C; Winstock, A.R; Witton, J. (2010) ‘Assessment & management of cannabis use disorders in primary care’ British Medical Journal, 340:c1571.