Emergency Info

Guidelines on when to call the Emergency Services 999 for unwell recreational drug users

Call 999 if ANY one of the following is present:

Unconsciousness – if the patient does not respond to vocal commands, requires painful stimulus (e.g. pressure across the fingernails) to respond or does not respond at all.

Significant agitation (e.g. pacing around the room) or aggression not settling within 15 minutes.

Seizures (e.g. a convulsion similar to an epileptic fit)

Breathing difficulties such as fast breathing rate which does not settle within 15 minutes.

Heart rate over 140 beats per minute not settling within 5 minutes.

Temperature over 38.5 not settling after about 5 minutes of rest, or if very flushed and feels very hot if no thermometer is available.

Blood pressure – Systolic (“upper pressure”) over 180mmHg, or Diastolic (“lower pressure”) over 110mmHg on two repeated blood pressure measurements.

Other concerns – if there are any other concerns (e.g. severe headache, chest pain).


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The distribution of recreational drugs

Last month (27 February 2020) marked the publication of perhaps the most important drug-related report of the current century. The first phase of Dame Carol Black’s Review of Drugs provides a detailed and rigorous analysis of the complex and overlapping markets for illegal drugs.

The report is accompanied by 125 pages of detailed evidence, most of it presented in easy to understand charts and infographics. The material covers drug-related harms, drugs production and trafficking, drug-related violence and much else. In this blog post, we focus on Dame Carol’s analysis of the distribution of recreational drugs in the UK.

Dame Carol provides a detailed overview of domestic drug distribution, helpfully summarised in a number of infographics.

The first of these shows the drug distribution pyramid with the four main levels: importer, national wholesaler, local wholesaler and retailer.

Dame Carol goes on to show that a large majority (70%) of Organised Crime Groups tend to supply multiple drugs. Recreational drugs (ecstasy, cannabis, and powder cocaine) and problematic drugs (heroin and crack) tend to be supplied together because they have similar customer bases.

The report shows that Albanian OCGs dominates the UK cocaine market, with their supply network stretching from source country all the way to UK towns and cities. They act as the main wholesaler to powder cocaine retail operations, including those converting it to crack. However, some British OCGs also operate at the wholesale level.

Four main methods of distribution

The Black Review is careful to differentiate the distribution of heroin and crack (generally supplied by street dealers) and recreational drugs which are supplied in a number of different ways. She lists four main methods:

Social supply

Many recreational drug users obtain drugs for free through their social networks, rather than buying from a dealer. The latest Drug Misuse Statistics from the Home Office suggest that roughly half of recreational drug users obtain drugs through social supply on the last occasion they used drugs.

The dark web

The dark web is a small but growing part of the recreational drug market, particular for new psychoactive substances. The proportion recreational drug users who reported obtaining drugs from the darkwave increase from 12% in 2014 to 29% last year (data from the Global Drug Survey).

Social media

There is increasing anecdotal evidence that young people are sourcing recreational drugs via social media. Recent research by Volteface found that one in four young people led seen illicit drugs advertised for sale on social media cocaine was the drug most commonly seen advertised in this way, followed by ecstasy and Xanax.

County lines

The Black Review also suggest that some county lines drug runners are starting to sell cannabis or powder cocaine as a “sideline”. Data on powder cocaine use in particular appears to show a County lines pattern, with increased use in rural areas.

Increased cocaine production

Dame Carol also analysed in detail the surge in cocaine production which has produced a highly competitive UK market, with significant increases in purity clear evidence that supply is outstripping demand. There now appears to be a two tier user market – a standard, cheaper product in a purer, more expensive one. The sharp increase in purity levels indicates a possible shift in the market to the upper tier product.

We know that police forces are only able to intercept a very small amount of illegal drugs in this country. Indeed, the number of ecstasy seizures has declined slightly in recent years despite substantial increases in usage among young people. There was, however, a sharp increase in the quantity of ecstasy seized in 2018/19 which Dame Carol sees as been linked to the increasing quantity of powder cocaine sees, given that these drugs are often distributed by the same Organised Crime Groups.


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