Ketamine, the antidepressant we always knew it to be…

Spravato; the esketamine nasal spray released for use by the public.

https://www.brainfacts.org/diseases-and-disorders/therapies/2019/listening-to-ketamine-041119#

I wanted to share this very interesting article from last year, which talks about the recent race pharmaceutical companies have been in to get the first ketamine based anti depression product into the market, which many BP readers may already know.

Well, in case you missed the fairly quiet news, which is actually big news, but which you could be forgiven for not seeing as it didn’t make much of a splash – especially considering the rather large fact that many of us are still getting locked up on a regular basis in prisons around the world for using our own Kay for our own self medication and self…exploration…But I digress, I want to pass on this news you just might have missed…

Ketamine, or rather, ‘esketamine in the nasal spray formulation called Spravato’ (‘dig the hipster parlance’ as my buddy used to say!) has finally made it out the door first, as a proper polished big pharma product- via the company Janssen Pharmaceuticals (a subsidiary of Johnson and Johnson). Guess we should say thanks or something…

Anyhoo, that has made ketamine “the first novel depression drug to hit the market in more than 50 years.” Now that IS big news isn’t it? Yay Kay! So it was officially approved by the US FDA in March 2019 and it appears everyone has big hopes for it.

In brief, and from what I can gather, the idea is to prescribe it to those suffering severely with depression and suicide ideations – along with a common antidepressant; being dosed nasally a couple of times a week for 4 weeks, and then being reassessed as to whether your prescription should contine. But it’s expensive…of course. Thanks again guys…we think?

And if you are interested in a little more information on dosing, which to be honest, we DO want to know how much the dose is (and yeh, they are super small) along with prescribing information and stuff like that, I have included a couple of links that shed a bit more light on this fascinating subject, that many BP readers will be very interested in, indeed. One more thing to add, there are also a whole heap of intravenous ketamine clinics popping up throughout the USA, giving teeny tiny doses of Kay, IV, as you lie flat out on a trolley bed in a therapists office for an hour or so, before you feel better and they send you on your way with your next appointment in hand. And what results they have had! Really very good readers, though we might suspect as much. The malleability of ketamine makes it an ideal drug to ‘guide’ and I am certain one could address numerous issues and feelings of depression from using it in a…therapeutic kind of way. Anyway, read on, the article is very interesting and the subject well worth a further bit of study, friends. Adiós til next time. EO.

FDA approval and company expectations for the drug.and how it’s used, with some trial info etc

The situation re medicines approval in the EU and UK

Listening to Ketamine, The terrific article below was written by Emily Underwood, April 2019, updated in 2020, from Knowable Magazine.

At 32, Raquel Bennett was looking for a reason to live. She’d struggled with severe depression for more than a decade, trying multiple antidepressants and years of talk therapy. The treatment helped, but not enough to make it seem worth living with a debilitating mental illness, she says. “I was desperate.”

In 2002, following a friend’s suggestion, Bennett received an injection of ketamine, an anesthetic and psychedelic party drug also known as Special K. During her first ketamine trip, Bennett hallucinated that God inserted a giant golden key into her ear, turning on her brain. “It was as if I was living in a dark house and suddenly the lights came on,” she says. “Suddenly everything seemed illuminated.”

The drug lifted Bennett’s depression and dispelled her thoughts of suicide within minutes. The effect lasted for several months, and, she says, the respite saved her life. She was fascinated by the drug’s rapid effects and went on to earn a doctoral degree in psychology, writing her dissertation about ketamine. Today, she works at a clinic in Berkeley, California, that specializes in using ketamine to treat depression. “This medicine works differently and better than any other medication I’ve tried,” she says.

When Bennett experimented with ketamine, the notion of using a psychedelic rave drug for depression was still decidedly fringe. Since the first clinical trials in the early 2000s, however, dozens of studies have shown that a low dose of ketamine delivered via IV can relieve the symptoms of depression, including thoughts of suicide, within hours.

Even a low dose can have intense side effects, such as the sensation of being outside one’s body, vivid hallucinations, confusion, and nausea. The antidepressant effects of ketamine typically don’t last more than a week or two. But the drug appears to work where no others have — in the roughly 30 percent of people with major depression who, like Bennett, don’t respond to other treatments. It also works fast, a major advantage for suicidal patients who can’t wait weeks for traditional antidepressants to kick in.


“When you prescribe Prozac, you have to convince people that it’s worth taking a medication for several weeks,” says John Krystal, a psychiatrist and neuroscientist at Yale University in New Haven, Connecticut. “With ketamine, patients may feel better that day, or by the next morning.”

The buzz around ketamine can drown out just how little is known about the drug. In the April 2017 JAMA Psychiatry, the American Psychiatric Association published an analysis of the evidence for ketamine treatment noting that there are few published data on the safety of repeated use, although studies of ketamine abusers — who typically use much higher doses — show that the drug can cause memory loss and bladder damage.

Most clinical trials of the low dose used for depression have looked at only a single dose, following up on patients for just a week or two, so scientists don’t know if it’s safe to take the drug repeatedly over long periods. But that’s exactly what might be necessary to keep depression at bay.

The analysis also warned about ketamine’s well-established potential for abuse. Used recreationally, large doses of the drug are known to be addictive — there’s some evidence that ketamine can bind to opioid receptors, raising alarms that even low doses could lead to dependence. (BP Ed – that is interesting.)

Bennett has now been receiving regular ketamine injections for 17 years, with few negative side effects, she says. She doesn’t consider herself addicted to ketamine because she feels no desire to take it between scheduled appointments. But she does feel dependent on the drug, in the same way that a person with high blood pressure takes medication for hypertension, she says.

Still, she acknowledges what most clinicians and researchers contend: There simply aren’t enough data to know what the optimal dose for depression is, who is most likely to benefit from ketamine treatment, and what long-term treatment should look like. “There’s a lot that we don’t know about how to use this tool,” Bennett says. “What’s the best dose? What’s the best route of administration? How frequently do you give ketamine treatment? What does maintenance look like? Is it OK to use this in an ongoing way?”Despite the unknowns, pharmaceutical companies have been racing to bring the first ketamine-based antidepressant to market. In March, the U.S. Food and Drug Administration approved a ketamine-derived nasal spray, esketamine, developed by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson.

Only two of Janssen’s five phase III trials had shown a benefit greater than taking a placebo. Still, in February an independent panel recommended FDA approval. That makes ketamine the first novel depression drug to hit the market in more than 50 years, notes Carlos Zarate Jr., a psychiatrist who studies mood disorder therapies at the National Institute of Mental Health.


Although clinicians are hopeful that Janssen Pharmaceutical’s newly approved esketamine nasal spray, Spravato, will expand access to treatment, many also worry about the drug’s potential for abuse.


Thousands of people are already flocking to private clinics like Bennett’s, which provide intravenous ketamine infusions. Because the drug was approved in the 1970s as an anesthetic, physicians can legally provide the drug as an “off-label” depression treatment. Many ketamine clinics have long waiting lists or are so swamped that they aren’t accepting new patients, and Janssen’s nasal spray could rapidly expand access to treatment.

But some researchers worry that the nasal spray won’t solve many of ketamine’s problems and could create new ones. Although the FDA is requiring that the nasal spray be administered only in a certified doctor’s office or clinic, esketamine is “every bit as habit forming as regular ketamine,” and will be difficult to keep out of the hands of abusers, says Scott Thompson, a neuroscientist at the University of Maryland and a coauthor with Zarate of a 2019 review on fast-acting antidepressants in the Annual Review of Pharmacology and Toxicology. A nasal spray can’t deliver as precise a dose as an IV infusion, Thompson notes. “If someone has got a cold, they’re not going to get the same dose.”


Scott Thompson of the University of Maryland discusses how ketamine is changing the landscape of the psychiatric treatment of severe depression.
Video Produced by Hunni Media for Knowable
In Thompson’s view, esketamine holds few advantages over generic ketamine, which costs less than a dollar per dose, although the IV infusions in private clinics often cost hundreds of dollars per visit. Janssen has indicated that each esketamine treatment will range from $590 to $885, not including the costs of administration and observation.

Zarate and others are still thrilled to see big pharma investing in ketamine, after decades of stalled efforts to find new psychiatric drugs. “As esketamine hits the market, venture capitalists will come up with better versions and move the field forward,” Zarate says. Several drug companies are now testing other ketamine-like compounds in hopes of developing drugs that have its potent antidepressant potential without its psychedelic and dissociative side effects.

Some researchers are also testing whether ketamine works for conditions beyond depression, such as obsessive-compulsive disorder, as well as in specific subsets of patients, such as severely depressed teenagers. Other scientists are using ketamine to help untangle one of the biggest mysteries in neuroscience: What causes depression?

Seeking Answers in Neural Wiring.

Thirty years ago, the prevailing thought was that low levels of certain brain chemicals, such as serotonin, caused depression. Boosting those could remove symptoms.

“I felt that depression needed months or weeks of treatment — that the plastic changes involved in the healing process would require weeks to reset themselves,” says Todd Gould, a neuropharmacologist at the University of Maryland and a coauthor of the recent review paper. But ketamine’s speed of action casts doubt on that idea.

Newer evidence suggests that depression is caused by problems in the neural circuits that regulate mood, Gould notes. Much of the evidence for this faulty-wiring hypothesis comes from rodents. Starting in the 1990s, scientists began to discover intriguing abnormalities in the brains of mice and rats that had been exposed to certain stressors, such as bullying by a big, aggressive male.

Stress and trauma are strong predictors of depression in people, but scientists can’t ask rats or mice if they are depressed. Instead, they use behavioral tests for classic depression symptoms such as anhedonia, the inability to take joy in pleasurable activities, Thompson says. Depressed animals “give up easily” in experiments that test their willingness to work for rewards like sugar water, or their interest in the intoxicating scent of a potential mate’s urine. “They can’t be bothered to cross the cage,” he says.

Thompson and others have found that there are fewer connections, or synapses, between neurons that communicate reward signals in the brain in depressed animals. Other labs have found shriveled connections in neuronal circuits key to decision-making, attention, and memory. Brain imaging studies in people with depression have also revealed abnormal activity in neural circuits that regulate emotion, suggesting that the findings in rodents may also apply to humans.

If faulty neural connections are to blame for depression, the next question is, “How do we get atrophied neural pathways to regrow?” Krystal says.

Circuit training
The answer, many scientists now believe, is the brain’s most abundant neurotransmitter, glutamate.

Glutamate is the workhorse of the brain. It relays fleeting thoughts and feelings, and enables the formation of memories by strengthening synaptic connections. Glutamate is the reason you can still ride a bike years after you learned, even if you never practiced.

Not all glutamate activity is good. Too much can cause the equivalent of an electrical storm in the brain — a seizure — and chronically high levels may lead to dementia. Abnormalities in glutamate receptors — specialized proteins on the surface of brain cells where glutamate can dock and bind — are linked to a wide array of psychiatric diseases, including depression and schizophrenia.

To maintain balance, cells called inhibitory interneurons act like brakes, releasing a neurotransmitter called GABA that quiets brain activity. Most mind-altering drugs work by changing the balance between GABA and glutamate — amphetamines and PCP enhance glutamate signaling, for example, while alcohol inhibits glutamate and boosts GABA.

By the 1990s, scientists had discovered that ketamine triggers a gush of glutamate in the brain’s prefrontal cortex. This region governs attention and plays an important role in emotional regulation. The out-of-body sensations that some people experience when they take ketamine may occur because this rapid release of glutamate “excites the heck out of a whole bunch of neurons” in the prefrontal cortex, says Bita Moghaddam, a neuroscientist at Oregon Health & Science University who discovered the drug’s glutamate-revving effect on rats while studying schizophrenia.

Scientists aren’t sure yet how ketamine forms stronger neural circuits. But the hypothesis goes roughly like this: When ketamine enters the brain, it causes a short-term burst of neuronal activity that triggers a series of biochemical reactions that create stronger, more plentiful synaptic connections between brain cells.

At first, many researchers thought ketamine’s antidepressant effects relied on a structure located on the surface of neurons, called the NMDA receptor. Like a key that fits into different locks, ketamine can bind to several types of NMDA receptor, making neurons release the excitatory glutamate neurotransmitter.

This hypothesis suffered a blow, however, when several drugs designed to bind to the NMDA receptor (as ketamine does) failed in clinical trials for depression.

Illustration of an NMDA receptor
Central to the controversy over how ketamine works in the brain is the NMDA receptor (illustrated here), which binds to the neurotransmitter glutamate. Some scientists believe ketamine’s antidepressant effects hinge on its ability to block NMDA receptors, but others believe the drug works via other mechanisms. Resolving that mystery is key to developing similar drugs with fewer side effects, scientists say.
Furukawa Lab, CSHL
Esketamine also complicates the story. Ketamine is made up of two molecules that form mirror images of each other, R- and S-ketamine. Esketamine is made up of just the S form and binds roughly four times as effectively as R-ketamine to the NMDA receptor. Despite acting much more powerfully on the NMDA receptor, studies in rodents suggest that S-ketamine is a less potent antidepressant than R-ketamine, although it’s not yet clear whether or not R-ketamine could work better in humans.

Zarate and others now believe ketamine may work through a different receptor that binds glutamate, called AMPA. By pinpointing which receptor ketamine acts on, researchers hope to develop a similar drug with fewer side effects. One hot lead is a compound called hydroxynorketamine (HNK) — a metabolic byproduct of ketamine that does not affect NMDA receptors but still produces rapid antidepressant effects in rodents. The drug appears to lack ketamine’s disorienting side effects, and Zarate and Gould plan to launch the first small clinical trials to establish HNK’s safety in humans this year, likely in around 70 people. “I think we have a very good drug candidate,” Gould says. (Zarate and Gould, among others, have disclosed that they are listed on patents for HNK, so they stand to share in any future royalties received by their employers.)

Plastic synaptic remodelers
To alter how the brain processes mood, scientists believe ketamine must ultimately change synapses. In experiments in rodents, Ron Duman of Yale University has shown that both ketamine and HNK can harness one of the brain’s most important tools for synaptic remodeling: brain-derived neurotrophic factor, or BDNF.

BDNF is a protein intimately involved in shaping synapses during brain development and throughout the lifespan. Healthy brain function depends on having just the right amount of BDNF in the right place at the right time. Many mental illnesses, including depression, are associated with low or abnormal amounts of the protein. For example, samples of brain tissue from people who have died by suicide often contain abnormally low amounts of BDNF.

Duman and colleagues have found that both ketamine and HNK cause a sharp uptick in the amount of BDNF that is released from neurons. This increase is required for the drugs’ antidepressant effects, and for the increase in dendritic spines — the stubby protrusions that form synaptic connections with other neurons. Both ketamine and HNK also seem to reduce inflammation, which has been linked repeatedly to the stress-induced loss of synapses.

Compared with a control, a rat neuron (in red) treated with ketamine has grown more dendritic spines (shown by yellow arrows).
Ketamine strengthens connections between brain cells. Compared with a control (top), a rat neuron (red) treated with ketamine (bottom) has grown more dendritic spines (shown by yellow arrows).
Rong-Jian Liu, George Aghajanian & Ronald S. Duman
Ketamine is not the only compound that can induce rapid synaptic plasticity: Other psychedelics, such as ecstasy (MDMA), acid (LSD), and DMT also trigger similar structural changes in neurons and rapid antidepressant effects in rodents, researchers at the University of California at Davis recently found. The effects don’t hinge on getting high, the team reported in March in ACS Chemical Neuroscience. Even very small doses — too low to cause perceptual distortions — can increase synapse density and lift depression.

Traditional antidepressants such as Prozac also increase BDNF levels in the brain, but not nearly as fast as ketamine does, Duman says. That is why most antidepressants take so long to remodel synapses and relieve depression symptoms, he says.

Dissecting depression
Beyond promising new treatments, Zarate and other researchers see ketamine as a powerful tool for probing depression’s tangled neurobiology. Studies in mice and rats are a good start, but scientists need to study the drug in people to truly understand how ketamine affects the brain. Unlike traditional, slower-acting antidepressants, ketamine lends itself to short-term lab experiments.

Zarate is using neuroimaging tools such as fMRI to study the human brain on ketamine. Past studies have shown that in people with depression, communication among several key brain networks is disrupted. One network, called the default-mode network (DMN), is involved in self-referential thoughts such as ruminating about one’s problems or flaws. This network tends to be hyperactive in people with depression, and less connected to more outwardly attuned brain networks such as the salience network, which helps the brain notice and respond to its surroundings.

Neural activity prior to a ketamine infusion (on the left) and six to nine hours after an infusion (on the right).
Ketamine appears to strengthen connections between neural networks in people with severe depression. In a study comparing neural activity prior to a ketamine infusion (left) and six to nine hours after an infusion (right), a single dose made the brain more responsive to a simple sensory stimulus, the light stroking of a finger.
Carlos Zarate & Jessica Gilbert, Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health (NIMH)
In one recent study, Zarate and his colleagues found that after receiving an IV dose of ketamine, people with depression had more normal activity in the default mode network, and that it was better connected to the salience network. At least temporarily, the drug seems to help people get unstuck from patterns of brain activity associated with repetitive, negative thoughts. Zarate does caution that the study results need to be replicated.

The team has also used brain imaging to study how ketamine affects suicidal thoughts. About four hours after an infusion of ketamine, a chunk of the prefrontal cortex that is hyperactive in people with depression had calmed down, researchers found, which correlated with people reporting fewer thoughts of suicide.

Ketamine also seems to tune other brain regions that are key to effective treatment. Last year, scientists published a study in mice showing that ketamine quiets abnormal activity in the lateral habenula, a small nodule wedged deep under the cortex. Some researchers have described the lateral habenula as the brain’s “disappointment center.” The region is responsible for learning from negative experiences, and is hyperactive in people with depression, as if “broadcasting negative feelings and thoughts,” Thompson says.

Such studies remain exploratory. As to why ketamine works — and just as important, why its effects are transient — scientists are still speculating. “I think ketamine is resetting neural circuits in a way that improves the symptoms of depression, but the risk factors — whether genetic, environmental, or other risk factors — are still present,” Gould says. “It seems to help reset things temporarily, but the underlying cause is not necessarily resolved.”

Helen Mayberg, a neurologist at Mount Sinai Hospital in New York who specializes in using an experimental procedure called deep brain stimulation to treat depression, suggests that ketamine may be like using a defibrillator on someone experiencing cardiac arrhythmia. “I am not addressing the fact that you have underlying heart disease, but now that your arrhythmia is gone, I can concentrate on other treatments.”

It’s important to put the potential risks of ketamine into perspective, particularly for people contemplating suicide, researchers emphasize. Most people are willing to tolerate severe side effects for other life-saving treatments, such as cancer drugs, Mayberg points out. “If you can interrupt an extreme suicidal plan and ideation, I’ll take that.”

Ketamine in teens?
For Krystal, weighing ketamine’s still largely uncharted risks and potential rewards ultimately comes down to a deeply personal question: “What would we want for ourselves? For our families? Do we want them to have to go through several failed trials over several months, or even a year, before taking a medication that might make their depression better in 24 hours?”

Some of the hardest decisions are likely to involve children and adolescents. Hospitalization for youth suicide attempts and ideation nearly doubled between 2008 and 2015, leaving many clinicians — and parents — desperate for more effective and rapid treatments. Left untreated, depression is “really bad for the brain” and can cause serious, long-term cognitive and developmental problems when it starts young, Zarate says. “The question is, is that going to be better than the long-term side effects of ketamine?”

Untreated depression is really bad for the brain, especially in the young. The question is, is that going to be better than the long-term side effects of ketamine?

Scientists don’t yet know. Ketamine has been deemed safe to use as an anesthetic in children, but there aren’t yet sufficient clinical data to show how low, repeated doses of ketamine used for depression could affect the developing brain.

On a more fundamental level, scientists don’t fully understand the neurobiology of adolescent depression, notes psychiatrist Kathryn Cullen of the University of Minnesota. It may involve abnormalities in brain development, such as the way the prefrontal cortex connects to brain regions that process emotion, but “we don’t know if the brain connection abnormalities emerge because of toxic stress induced by depression, or if these abnormalities predispose people to develop depression, or if depression itself reflects abnormal development,” Cullen says. “It’s critical to figure out how to alleviate the biological changes that are associated with [teen] depression so that the brain can get back on a healthy trajectory.”

Two recent clinical trials — one at Yale and another at Minnesota run by Cullen — have found that ketamine can lower symptoms in severely depressed teenagers, but neither study was set up to follow the teenagers long-term, says Cullen. Janssen is currently running a trial of its esketamine nasal spray with 145 youths who are suicidal, but the results of that study have not been published yet. Cullen thinks ketamine has potential for use in teens, particularly to avoid suicide, but “there are still a lot of unknowns.”

Not just a quick fix
Worldwide, depression afflicts more than 300 million people, making it the leading global cause of disability. When contemplating such overwhelming misery, the vision of a world in which depression can be cured with a single injection or squirt of nasal spray holds obvious appeal.

But — despite the hype — that is not what ketamine offers, Bennett says. Based on her own experience as a patient, and her clinical work, she is troubled by the framing of ketamine as a “rapid” depression treatment if that precludes the slower, more effortful process of psychotherapy. Without psychotherapy, she says, “you’re not giving patients any tools to help themselves, just making them dependent on a molecule that has temporary effects. When the effect wears off, they have to go back for more medicine. This is going to be lucrative for the pharmaceutical company but probably not in the patient’s best interest.”

In Bennett’s clinic, ketamine is administered only alongside talk therapy, which she uses to prepare patients before they take ketamine, and afterward to help them process the experience. “I think this is the only ethical way” to administer a drug that can trigger disorienting psychedelic experiences, she says. “This isn’t a ‘take two and call me in the morning’ situation.”

There’s growing scientific interest in whether ketamine can enhance the effectiveness of therapy by increasing the brain’s ability to remodel circuits through experience, Krystal notes. And in 2017 a small Yale study found that providing cognitive behavioral therapy in tandem with ketamine can extend the drug’s antidepressant effects.

Unlike some researchers and pharmaceutical companies, which consider ketamine’s and esketamine’s hallucinogenic side effects inherently negative, Bennett thinks that for some people the visions can be positive — particularly in the context of therapy. There’s scant scientific evidence to support the idea that such hallucinations are therapeutic, and they can be deeply disturbing for some people. (If people who experience hallucinations do better, it may simply be because they have received a higher dose of ketamine, Krystal points out.)

Still, Bennett thinks researchers and clinicians need to stay open-minded about why ketamine is helping people — and be more attentive to the settings in which ketamine and esketamine are administered. “People consistently report that they experience the presence of God, or their own sacredness,” she says. “When someone comes to my office wanting to kill themselves, ready to die — and then they have a transformational moment where they believe their life is sacred — it’s indescribable how exciting that is as a clinician.”

Editor’s note: This story was updated March 29, 2019, to correct the affiliation of neuroscientist Bita Moghaddam. She is a professor at Oregon Health & Science University.

ABOUT THE AUTHOR
Emily Underwood
Emily Underwood

Emily Underwood is a freelance science writer and contributing correspondent for Science magazine. She is based in Coloma, California.

CONTENT PROVIDED BY
Knowable Magazine
Knowable Magazine

Knowable Magazine is an independent journalistic endeavor from Annual Reviews.

Are you a drug user and a diabetic?

Hi everyone –

Long time no chat -I apologise, I will not let next year be as slow as this one for blogging, my apologies friends. Today, however, I wanted to let you all know about a really great booklet we have discovered that is free to download and it’s really useful, non-hysterical info for people who are or who know drug users who are also diabetics. Its about managing diabetes when you are an active drug user – something that must actually be very difficult when you consider needing to take meds, needing to eat/avoid certain foods, trying to look after your health when you might not feel like it – or can’t manage it coz you might have other things on your mind, etc.

I really think any diabetic will appreciate this booklet -its full of really interesting information and things I didn’t know anything about. I added a final note at the end of this blog -I felt inspired to do so, so check it out if you fancy it.

(Here is a link to the booklet -repeated at the end of this blog)

Drugs-and-diabetes-A5-dimensions-Final-draft-web

person holding blood suger pen

Here are a few quotes direct from the booklet and above and below are the links to download the booklet.

The intro goes like this….“Managing diabetes can be difficult to balance with a busy lifestyle or partying. All drug use carries risk. We know that there are people who are diabetic who will choose to take drugs. So we want to highlight some things that can help you to reduce the risk if you do.  This information was written by Dr Disorderly – PhD Neuroscience and Immunology. We also collaborated with people who have diabetes and experience of taking drugs.”

Here are some of the tips inside the booklet….

“Eat a meal of long acting carbohydrates before going out.
These include: bread, potatoes, high fibre cereal, oats.
If you are going out for the day remember to eat regular meals – if
food is missed there is a greater chance of a hypo (hypoglycaemic
episode*)

“….Alcohol may cause blood sugars to rise in the short term but                                        will increase the risk of a hypo after the party…”

“….If you are going to a rave or long festival, make sure you
stock up on plenty of sugary drinks and fast acting
carbohydrates to keep in your locker, bag, car or tent…”

“…Never miss insulin doses, however, be extra careful
with taking insulin at the end of the night or just before
going to bed as you are already at risk of having a
hypo from dancing/drinking.  In this circumstance, many
people with diabetes will take a reduced dose of
insulin before consuming food and only take a
correction dose if sugar levels are very high, in which
case, they only take a small dose. Ensure that there is a
glucagon kit in the house and that people know how/when
to use it …”

“…Cannabis can lower your blood sugar levels suddenly so make                                       sure you have some fast acting carbohydrates nearby.

And on depressants…. “Avoid eating sugar /carbs to combat lethargy while taking depressant drugs – it could just be the effects of these drugs. Drugs like valium/xanax and can affect your judgement and you might forget to take insulin. Again, set alarms to check your levels and avoid falling asleep without eating carbs. Be aware of taking depressants – it may be difficult for you to recognise the symptoms of a hypo or for others to realise you are experiencing a hypo…”

And even about ketamine, God bless ’em! “The effects of ketamine can mask the signs of a hypo and reduce your ability to treat yourself. If you choose to take ketamine it is essential to check your sugar levels first – especially if it is a big
dose. Set alarms to remind you to check throughout the time you are
taking it as the effects of ketamine could make you forget…”

This is a handy booklet to know about – for drug workers, GPs, drug users, friends and lovers of diabetics and, of course drug using diabetics -especially for those who know little about managing their condition in drug using situations. That must get hard and is worth spending some time really thinking about and researching though I imagine this may be the ONLY booklet out there on this very issue of drug using and diabetes.

Well done to the guys who produced it –  Crew: mind altering  (also known as Crew2000 and Crew25). These dudes have been around in the UK for a LONG time now and have always produced good information and have lots of great stuff on psychedelics and stimulants. Well worth a visit.

Heres how you can download their booklet: Click here.

One last word on the subject of our health as active drug users: It’s really important to learn about your own body and how it reacts to taking illicit drugs; ie -do certain drugs make you forget to medicate, do certain foods work better at keeping your levels correct (ie like for how long etc, remember this to list it as a food to take before partying, for example). Like people who have seizures, keeping a diary and noting down what has been really good at keeping you well, while also noting what you did when it goes wrong for you -did you miss sleep, what drugs did you take, what foods did you eat and when etc. Take your control back and learn how to live with your illness like a pro. Tell us about your experiences of being a diabetic and a drug user. We think this booklet is great -we need more thinking like this -looking at our health even though we are active drug users. Because WE want to know! We do care about our health (despite how it might look to some) and we want to stay safe when we use our drugs! I know because of all the thousands of enquiries this website gets each month – the top 3 looked at topics looked at every single month year on year are ALWAYS; drug-related seizures, overdoses and abscesses -and, ok, there is how to freebase coke as well that is always rolling about in the top 3 or 4 as well! Well, we are drug users! Yet even that is saying – how do we get the shit out of our cocaine and make it purer. That tells me more of the same -we want to learn how to make better choices whenever we can. We might not always manage it -or even want to -but our good intentions are there and knowledge is power -the more we learn, the more able we become to make those choices as soon as the opportunity arises. Sleep well comrades, stay safe.

 

Micro-dosing LSD / Modafinal

Hi peeps,

Again, apologies for the long absence on the site -I have been involved with some other activism, mainly on the European front, as part of the new EuroNPUD, the European Network of People who Use Drugs, whose aim is to represent the interests of drug users in the EU.

I will try and post more frequently however as BP is very close to my heart and we still have tens of thousands of people accessing the site every month, so thanks for coming back -we need information updated on the site and we have had someone connect with us offering to put the back issues up in PDF format, which would be fabulous as this is yet to be done in full so we will look forward to that.

Anyway, what propelled me to post today was coming across a neat 10min BBC video on the trend of DIY microdosing on acid or mushrooms. In the video they speak with a handful of very interesting people such as Ayelet Waldman who used acid in microdoses to combat her own deep depression, with ‘earth shaking’ results -and she has written about it in a book called A Really Good Day. And the very interesting James Fadiman, who has been researching psychedelics since the 1960’s and now has a website where he discusses microdosing in detail as well as collecting data on those who do it. His website says “This website has information on microdosing, including a protocol many people have used to microdose safely. What we offer is information on safe and effective microdose use. We do that by enrolling people in studies, then recording and analyzing their reports. We then share the results. We also advise and support other research projects related to microdosing“.

 

So, the piece was interesting, especially in the light of an increase in people microdosing -As James says, “If people are feeling the slightest bit high, then we tell them there dose needs to be reduced”. So it really is about microdosing your dose. We would love to hear from anyone that has done this and what they think about it.

Modafinal -How Smart is a Smart Drug?

Shortly after this video, getting sucked into YouTube (as you do), I came across another one on Modafinal. We really don’t hear a lot about Modafinal these days but it is still out there and this is quite an interesting piece. The young journo actually takes some Modafinal on camera and has tests at a clinic to see if it really improved his cognitive functioning. It did. By 10%. Not a lot but he certainly looked like he was buzzing a bit. But as he says, it wasn’t all plain sailing.  Although this film was made before the UK’s crazy Psychoactive Bill, and Modafinal is still legal to buy as long as you don’t sell it, it still gives a rather interesting look at what is a pretty interesting drug…Not quite like a speedball but, hey ho it is still a stimulant. BP would love to hear from you if you have taken Modafinal and let us know what you thought.

 

 

So, that’s it for today, I will get back on the case and keep BP updated. In the mean time for those in the EU, have a look at the EuroNPUD website -or indeed the international drug user network INPUD

Apologies for the recent quiet.

Hi everyone,

I just wanted to thank so many of you for hanging with us over the months that we have not been posting. The website is way over due for a makeover which will get done this year, and more updates are needed with our information as the drugs discourse and health, changes over time etc.

Just a word to say we are still here, personal circumstances have made attention to the blog/site difficult but we are back and have read all your comments, and when we update our pages we will incorporate the most commonly asked questions into our write-ups.

Thanks again for hanging around, we are here and will start attending to your comments over the coming weeks.

In solidarity,

The (very small) BP Crew

Drug Consumption Rooms

Here is a video I just wanted to share with you all, it was made in the UK by one of our treasured harm reduction /drug workers Phillipe Bonnet in Birmingham and he presents a very honest (and difficult to watch at times) account of why we need drug consumption rooms all across the world – particularly in the UK today. We have yet to open such a facility in the UK -it makes no sense to shy away from such a simple, straightforward solution. Our pal Neil Hunt talks about cost and why DCR’s are not that expensive and that they could hook onto needle exchanges as they already appear. Why not? How much longer can we look the other way when we have the solution in our very hands -solutions with the evidence base to back it up. As Dr Judith Yates in the film says “A simple intervention like this early on, can prevent all this damage later on”.

A word from the film-makers – Published on 23 Oct 2012

This Documentary invites the audience to see the harsh reality of ‘street injecting’ drug users in the UK’s second city Birmingham. The presenter Philippe Bonnet explores this subject by interviewing outreach workers, health care professionals and current and ex drug-users. The film shows how other countries around the world have found a solution to this and as a result have reduced harms and costs associated with this phenomenon and ultimately helped drug users access treatment and begin their recovery.

 

Recovery In The Bin – 18 Principles

Readers, check out these folk at ‘Recovery In The Bin’ and their ’18 Key Principles’ Manifesto, agreed and adopted by group members on 6th February 2015. I think the community of people in treatment could take a lot from this -when we make our own manifesto against…let’s see…I know! Against the ‘Trafficking of People who Use Drugs inside and outside the Drug and Alcohol Treatment Sector’! 

Take it away comrades in arms; 

We oppose the ways in which the concept of ‘recovery’ has been colonised by mental health services, commissioners and policy makers.

  • We believe the growing development of this form of the ‘Recovery Model’ is a symptom of neoliberalism, and capitalism is the crisis! Many of us will never be able to ‘recover’ living under these intolerable social and economic conditions, due to the effects of social and economic circumstances such as poor housing, poverty, stigma, racism, sexism, unreasonable work expectations, and countless other barriers.
  • We believe “UnRecovered” is a valid and legitimate self-definition, and we emphasise its political and social contrast to “Recovered”. This doesn’t mean we want to remain ‘unwell’ or ‘ill’, but that we reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by market forces, humiliating treatment techniques and atomising outcome measurements.
  • We are critical of tools such as “Recovery Stars” as a means of measuring ‘progress’ as they represent a narrow & judgemental view of wellness and self-definition. We do not believe outcome measures are a helpful way to steer policy, techniques or services towards helping people cope with mental distress
  • We believe that mental health services are using ‘recovery’ ideology to mask greater coercion. For example, the claim that Community Treatment Orders are imposed as a “step towards recovery”.
  • We demand that no one is put under unnecessary pressure or unreasonable expectations to ‘recover’ by mental health services. For example, being discharged too soon or being pushed into inappropriate employment.
  • We object to therapeutic techniques like ‘mindfulness’ and “positive thinking” being used to pacify patients and stifle collective dissent.
  • We propose to spread awareness of how neoliberalism and market forces shape the way mental health ‘recovery’ is planned and delivered by services, including those within the voluntary sector.
  • We want a robust ‘Social Model of Madness & Distress’, from the left of politics, placing mental health within the context of the wider class struggle. We know from experience and evidence that capitalism and social inequality can be bad for your mental health.
  • We demand an immediate halt to the erosion of the welfare state, an end to benefits cuts, delays and sanctions, and the abolishment of ‘Work Capability Assessments’ & ‘Workfare’, which are both unfit for purpose. As a consequence of austerity, people are killing themselves, and policy-makers must be held to account.
  • We want genuine non-medicalised alternatives, like Open Dialogue and Soteria type houses to be given far greater credence, and sufficient funding, in order to be planned & delivered effectively. (No half measures, redistribution of resources from traditional MH services if necessary).
  • We demand the immediate fair redistribution of the country’s wealth, and that all capital for military/nuclear purposes is redirected to progressive User-Led Community/Social Care mental health services.
  • We need a broader range of Survivor narratives to be recognised, honoured, respected and promoted that include an understanding of the difficulties and struggles that people face every day when unable to ‘recover’, not just ‘successful recovery’ type stories.
  • We oppose how ‘Peer Support Workers’ are now expected to have acceptable ‘recovery stories’ that entail gratuitous self-exploration, and versions of ‘successful recovery’ fulfilling expectations, yet no such job requirements are expected of other workers in the mental health sector.
  • We refuse to feel compelled to tell our ‘stories’, in order to be validated, whether as Peer Support Workers, Activists, Campaigners and/or Academics. We believe being made to feel like you have to tell your ‘story’ to justify your experience is a form of disempowerment, under the guise of empowerment.
  • We are opposed to “Recovery Colleges” and their establishment, as a cheap alternative to more effective services. Their course contents fall short of being ‘evidence based’, and fail to lead to academic accreditation, recognised by employers.
  • We believe that there are core principles of ‘recovery’ that are worth saving, and that the colonisation of ‘recovery’ undermines those principles, which have hitherto championed autonomy and self-determination. These principles cannot be found in a one size fits all technique, or calibrated by an outcome measure. We also believe that autonomy and self-determination, as we are social beings, can only be attained through collective struggle rather than through individualistic striving and aspiration.
  • We demand that an independent enquiry is commissioned into the so-called ‘Recovery Model’ and associated ideology that it stems from
  • We call for our fellow mental health Survivors and allies to adopt our principles, and join us in campaigning against this new ‘recovery’ ideology by non-violent protest. We know our views about ‘recovery’ will be controversial, and used by supporters of the ideologies behind ‘recovery’ colonisation to try to divide us. However, we seek to balance the protection of existing services valued by Survivors with agitation for fundamental change.

recovery in the bin.org

Source: 18 Principles

Junkie Literature

BP is starting a new segment on our site -something we think you will enjoy. The good ol’ internet has thrown up some real gems in the world of the arts; old videos and films we all thought lost forever, wonderful artistic surprises we never believed we would even see let alone to be able to keep a copy safe on our own laptops. For this new BP segment, we hope to collect writers /poets and authors from our own drug culture in the best format possible, and preferably recorded reading their work, in their own voice. What a treat! The chance to share some of our old favourites and inform a new generation of listeners, or just to warm the fuzzy hearts of us oldies.

The first 2 we have for you are pretty special, whether you are a fan or not; both ground-breakers for the invention of the stream of consciousness style of writing, the subject matter raw, real and like nothing before it, they both managed to put  their pens straight onto the pulse of a new generation.

And finally, these guys discussed drugs and philosophy with such relish, such passion, such singularity -it managed to expel upon an era of incredible conservatism,  a spiky new vocabulary for an entire generation, fortunately somewhat protected by the elite position of the untouchable befalling the avante-garde. These guys could take drugs, write books, and tell the world to fuck off and still be considered an artist. It should shame us today; when our society is now so quick to judge, to exclude, to label, to diminish those who seek an alternative road. When one’s art forces one to take the big risks in the search of furthering answers, in search of surfaces real and unreal looming to carry you on ahead, despite the deep fissues always risking to drive apart the roads you thought would lead you back home…
Why must we denigrate those who don’t / can’t choose ‘this life’ this lie we all know is on offer to the democratic masses? We all smell a rat, don’t we?

So, back to our 1st two contenders…

William Burroughs reads his first novel, Junky, to you

 

Jack Kerouac On the Road – The complete audiobook

When the book was originally released, The New York Times hailed it as “the most beautifully executed, the clearest and the most important utterance yet made by the generation Kerouac himself named years ago as ‘beat,’ and whose principal avatar he is.”[1] In 1998, the Modern Library ranked On the Road 55th on its list of the 100 best English-language novels of the 20th century. The novel was chosen by Time magazine as one of the 100 best English-language novels from 1923 to 2005. That’s quite something, is it not? Pick your spot, sit back and get ready -for you are finally going on the road with Jack…

Click here for the rest…

Cocaine -How Do You Take Yours?

This was no. 2 in our series; How Do You Take Yours? We looked at Cocaine, and asked the people that used it, how they preferred taking it and why, and gave some useful harm reduction tips for everyone!

This BP article was brought to you by A&E Lifestyles, a BP partnership in drug taking & drug investigating!

While the BP ‘knowledge’ tends to come from hundreds of combined years of experience of opiate, coca use and loads of pharmaceuticals (and that’s just the crew!), these days, drug taking for the enthusiast is changing. It’s broadening out, it’s becoming consumer savvy, it’s becoming mainstream. Nowadays, we aren’t so attached to one drug anymore, it’s a pill for this, then a smoke for that, then a whole pharmacopoeia of drugs for the come downs. We are learning how to use our drugs, we want to know more about them and what they do and what are the safest ways of taking them. The West has created a pill culture – and drugs are out there by the bucket load. This issue, BP looks at cocaine – and A&E are asking you “How do you take your coke?”

Freebase Cocaine

freebase -not the same as crack…

Cocaine is used by such a diverse group of people, probably because it lends itself to being snorted, smoked, injected, freebased, chased,  chipped, drunk, or blown up an orifice somewhere,  and as such, many of us will have a preference of our own. A (of A&E Lifestyles prefers to have it via injection and mixed with brown in a speedball, while E prefers to have the coke first, then the brown!). The emergence of crack has added more dimensions to what the phrase ‘using coke’ actually means. But as anyone who’s had a coke habit will tell you, no matter which way you take it, consistent, regular use of coke/crack can lead to a whole host of problems – the combo of no food, sleep, come down drugs and paranoia  can lead to some serious shit , compounded by the potential health problems due to the method by which it’s administered. A&E spoke to a few coke fiends to get their views on using it their way and have collected some good harm reduction tips to remember – whichever way you use it.  (This focuses on cocaine in all its guises except crack -although we do look at freebase and smoking tips -crack kinda needs its own article these days!

To see the rest of the article, click here…

Dealer’s Discuss

Articles from BP’s back catalogue….

Here’s a chat with a few of the people doing the biz, day in and day out, they haggle and hassle (and we cough up and complain)…But by and large, dealer’s are just like us, most are just trying to keep their own habits going without resorting to ‘other methods’. Can’t blame them. Dealer’s don’t sit out the front of schools tempting kiddies, they rarely want to sell to a newbie. In today’s world of prohibition and drug habits, dealing to keep your own head above water, is a way of managing day to day. It is the result of drug laws that leave all our drugs to the influences of the black-market. Some dealer’s are a nightmare, some violent, some a complete rip-off. BP says; if you are going to deal drugs -have compassion, take pride, do your best to give a clean product and treat your customers with respect. It shouldn’t have to get down and dirty. See our ‘Dealers Certificate’ and sign up to it. Let’s make the best of it and treat each other well; we are all struggling out there.

 

Martin (does heroin & crack):

“I wouldn’t call myself a dealer personally, and this very important to me; whether it’s the profiteering aspect or the pushy aspect, to me it makes a difference. I feel I am providing a service – most of my clients are middle class,  I see them twice a day, the same faces; My employers you could call business men or drug dealers, but again, its supply and demand. We don’t push drugs onto other people, we don’t go looking for new converts.

I guess I do it out of choice – it suits my lifestyle,  I’m paid a salary – I see the guy at the end of the day and get paid up. It doesn’t work on a commission basis like some setups. I use drugs myself so naturally it keeps my habit looked after. I look at it as a proper job, one has to be professional, it entails a hell of a lot from you and the law aspect is also on your mind. Yet sometimes one reaps the benefits and hits the highs, and meets some amazing people along the way. The myth of the user / dealer’s relationship is complex – discovering all the layers within each customer as you get to see them day after day in all manner of situations…It can be tough job.”

To see the rest of the article click here….

Drug Induced Seizures -an Update

health-logo

(from BP Issue 9 but now with new updates as of Nov 2015)

Many BP readers will have already witnessed the distressing sight of someone having a seizure, or you may have even experienced one yourself. It can be frightening to watch, exhausting to go through and unfortunately, people can often make the situation worse by not knowing how to deal with seizures properly, leaving everyone concerned thoroughly freaked out.

Most people associate seizures with having epilepsy and while it is certainly true to say that seizures (there are over 40 different types) are a symptom of having epilepsy, you don’t have to have epilepsy, to have a seizure. Anyone who has seen someone have a cocaine or alcohol induced seizure can attest to that.

Drug Induced:

For those of us who use drugs, particularly those of us who binge use or use to excess, seizures are known to occur for a few reasons. Sometimes they happen just before or as someone is overdosing, (i.e a seizure occurring just in the minutes before someone actually lapses into an overdose) or through withdrawing from a drug/s (i.e benzos, alcohol) or, they are a (rather intense) way of telling us that we have been pushing our bodies too hard for too long (i.e cocaine/stimulant related) and we can have a seizure which although is not an overdose -it is an overdose in the sense that you have reached the threshold in what your body can tolerate -and it is telling you -“Enough! My body has now gone into toxic overload!”. Basically, seizures occur when our systems have reached this point of toxicity or overload, even if the culprit drug is ecstasy, acid or heroin -when we tend to think of the most common culprits as stimulants and alcohol and benzodiazepines and barbituates.

 Know Your Limit

Everyone however, has what is called a ‘seizure threshold’, a certain sensitivity to seizures which means that anyone can experience one given the right conditions – such as excess use of alcohol, drug withdrawal, toxicity, dramatic metabolism changes etc. With 1 in 20 people having experienced a seizure at some stage in their lives, amongst drug users that rate increases rather dramatically, so its important that we learn something about seizures, their ‘triggers’ as well as their treatment.

It can be all too common to put the odd re-occurring seizure down to ‘the drugs I’m taking’ or to find that our medical investigations have not been followed up due to the pressures of everyday life and the difficulty embarking on consistent/stable medical care when you have other things on your mind like survival. But it’s important to remember that seizures can be very serious, they are hard work for the body and the brain in particular and, depending on where you are when you have your seizure, or if you end up having multiple seizures, you can be left in a dangerous or vulnerable situation.

If you are affected by seizures, if you have had more than 2 at once or 2 or more during the last year, or if it takes you more than a day to recover, or if your seizures start to occur regularly, it is essential you seek medical advice – at least to rule out any underlying causes such as infection, virus’s, tumors etc. You might have developed epilepsy in which you need medication, or there may be an underlying medical condition that has nothing to do with your drug use. You need to know these answers so you can take the right action.

To read the rest of this interesting and updated article, click here. Comments always welcome

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