Shisha is specially prepared tobacco that can be different flavours. The tobacco is heated to produce smoke that passes through a bowl of water and inhaled. Tobacco contains the stimulant drug nicotine.

Other names for shisha are hookah, narghile and waterpipe.

HOW IS SHISHA USED?

The tobacco is heated with charcoal. The charcoal burns the tobacco, and the smoke is drawn through a water bowl and inhaled through a tube with a mouth piece.

WHAT ARE THE EFFECTS?

The start very quickly but are more intense compared to cigarettes. This is because the hookah pipe enables users to inhale larger amounts and for longer periods. First time users often feel dizzy or sick.

Users will experience an increase in their heart rate and blood pressure. There is also a risk of carbon monoxide poisoning especially if shisha is used in an enclosed setting.

Regular smokers often say it helps them to concentrate, relax, deal with boredom and reduce anxiety. Shisha can suppress the appetite, so people often eat less.

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 IS SHISHA SAFER THAN CIGARETTES?

No, smoking shisha is not safer than smoking cigarettes. Many people think that drawing tobacco smoke through water makes shisha less harmful than cigarettes, but that’s not true. The water in the hookah cools the smoke, but it does not filter out the toxins in the smoke.

In a shisha session (lasting 20-80 minutes) a shisha smoker can inhale the same amount of smoke as a cigarette smoker consuming over 100 cigarettes. (British Heart Foundation)

WHAT ARE THE PROBLEMS WITH SHISHA?

Like cigarettes, shisha smoke is toxic. It contains nicotine, tar, carbon monoxide and heavy metals such as arsenic and lead.

Infectious diseases such as herpes, tuberculosis, hepatitis and respiratory infections can be spread through sharing hookah.

Regular users have a much greater risk of developing lung cancer, heart disease and circulatory problems.

Breathing in second-hand shisha tobacco smoke can increase the risk of heart disease, lung cancer and other lung diseases. It can also worsen asthma and bronchitis. Inhaling second-hand smoke is even more dangerous for children, making them more likely to suffer health problems such as bronchitis, pneumonia and asthma

Shisha during pregnancy can damage an unborn child. It can result in low birth weight and other complications.

Coughs, chest and breathing problems are common among smokers.

STOP SMOKING TIPS FOR SHISHA USERS

1. Pick a quit date that will be stress-free.
2. Write down all the reasons you want to quit. Keep the list handy and read it when the cravings start.
3. Build a support network to give up shisha. Tell your friends and family that you have quit.
4. Exercise even short walks can reduce cravings.
5. Have healthy snacks and drinks to hand so you’re not tempted to smoke or reach for unhealthy treats.
6. Avoid trigger situations should as places and people associated with shisha.
7. Treat yourself with the money you have saved not buying cigarettes.
8. Use stop smoking services – see below.

GETTING HELP TO STOP SMOKING IN WIRRAL

For help with stopping smoking, visit the Wirral Stop Smoking Service website.

SHISHA AND THE LAW

The law classes shisha smoking the same as cigarette smoking. It is illegal to smoke shisha in an enclosed public space or a space that's mostly enclosed. To smoke in any public premises with a roof at least half the wall space must be open.

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Benzodiazepines are sedative and anti-anxiety drugs that are used to treat anxiety, insomnia, muscle spasms and epilepsy.

There are different types of benzodiazepines. Often each type will have a generic and brand name. For example, diazepam is the generic name and Valium the brand name. Likewise, alprazolam (Xanax), temazepam (Restoril) and lorazepam (Ativan).

Most benzodiazepines are prescribed by a doctor. But an increasing number of people are using illegally obtained so-called ‘street benzos’ or ‘street Valium’, which are diverted from legitimate prescriptions or purchased online. 

HOW ARE BENZODIAZEPINES USED?

Most benzodiazepines are tablets and capsules. Some people crush tablets to inject them. This is extremely dangerous and can lead to skin infections and abscesses and potentially, an overdose, which can be fatal.

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WHAT ARE THE PROBLEMS WITH BENZODIAZEPINES?

For people who have been prescribed a benzodiazepine by a doctor, the most common side effect is feeling drowsy. But like many other medicines there are many potential side effects including light-headedness, confusion, dizziness and headaches.

Links have been noted between benzodiazepine use and depression and, in some cases, the emergence of suicidal thoughts.

Evidence suggests that higher benzodiazepine dosages may be associated with an increased risk of depression. Reducing or discontinuing use can help deal with the feelings.

It's possible to get addicted to benzodiazepines. However, you are less likely to get addicted if you take it at the lowest dose that helps your health condition. It is not recommended to use benzodiazepines for longer than 4 weeks.

STREET BENZOS

Illicit or fake benzodiazepines often called ‘street benzos’ or ‘street Diazepam’ are benzodiazepines bought online or obtained without a prescription.

Among street drug users, benzodiazepines have long been part of the drug ‘mix’ along with heroin, crack and alcohol. However, in recent years, a range of illicitly produced benzodiazepines have become widely available across the UK.

The content and potency of street benzodiazepines are unpredictable. Street benzos can include unknown substances or substances that are dangerously stronger than that displayed on the packaging. The unpredictable content and potency make street benzodiazepines particularly dangerous and are causing an increase in overdose, hospitalisation and deaths.

REDUCING RISKS

• Do not use benzodiazepines for longer than 4 weeks.
• If you take benzodiazepines and feel sleepy, do not drive, cycle or use tools or machines.
• Do not drink alcohol while taking benzodiazepine. It can make you sleep very deeply. You may have breathing problems, difficulty waking up and depending on the amount of alcohol and benzodiazepinestaken a fatal overdose.
• It's possible to get addicted to benzodiazepines, but you're less likely to get addicted if you take it at the lowest dose that helps your symptoms, for up to 4 weeks.
• If you have used benzodiazepines for more that 4 weeks on a daily basis, you should not stop using them suddenly.
• Cutting down or stopping suddenly can cause unpleasant and dangerous withdrawal symptoms. Always reduce your use gradually and seek advice from your doctor, drug worker or other health professionals.
• Avoid buying benzodiazepines online. 

BENZODIAZEPINES AND THE LAW

If you have a prescription for benzodiazepines and have obtained them from a pharmacist, you have nothing to worry about.  But if you have bought them from the internet, been given them, or sold them to another person, they become a Class C drug and they are unlawful to possess.
Unlawful possession of benzodiazepines is a Class C drug. It is illegal to possess, produce or supply the drug.
Possessing benzodiazepines is punishable by up to two years imprisonment and an unlimited fine. 
 
Supplying benzodiazepines (including giving some to a friend) is punishable by up to 14 years imprisonment and an unlimited fine.
 
In practice maximum sentences are rarely used. For more detailed information, visit the Release website.
 

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Ketamine is a complex drug. It has anaesthetic, stimulant and psychedelic properties. Often it is described as a dissociative drug meaning that people feel detached from their environment.

 In the UK, the drug is licensed for use in human and animal medicine.

The non-medical use of ketamine became popular in the UK in the early 1990s when the drug was sold in tablet form as ecstasy. Nowadays, the street form of ketamine normally comes as white crystals or powder.

HOW IS KETAMINE USED?

Ketamine is usually sniffed up the nose through a small tube such as a straw or rolled-up bank note. In clubs, users might dip the end of a key into the bag of ketamine and sniff a small amount from the tip.

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WHAT ARE THE EFFECTS OF KETAMINE?

The ketamine experience can vary depending on several things, including how strong the drug is, how much you take, how you’re feeling and where you are.

Generally, in small doses, ketamine acts as a stimulant, making you feel high. In larger doses, you can have an out-of-body experience (known as a K-hole), hallucinations, a sense of calm and a distorted notion of time. But ketamine can also make you feel panicky, have unpleasant feelings and nightmare-like experiences.

When snorted, the effects begin within a few minutes and last around 30-45 minutes, depending on how much is taken.

WHAT ARE THE PROBLEMS WITH KETAMINE?

PERSONAL SAFETY

The effects of ketamine can leave users in a confused state and vulnerable to assault, traffic accidents, drowning and burns and unaware of any serious physical injury. Ketamine is a very powerful anaesthetic, you might hurt yourself without realising.

PHYSICAL HEALTH

Prolonged and frequent ketamine use can cause serious bladder and kidney-related problems such as an increased need to urinate, passing blood when you pee, and pain on urination due to scarring and shrinkage of the bladder.

At the Club Drug Clinic in London, doctors tend to see serious ketamine bladder symptoms in people who are using most days for several months. Occasionally, some people with lower use develop symptoms – possibly because of existing medical conditions or vulnerability.

Abdominal pain, sometimes called ‘K cramps’, have been reported by people who have taken ketamine frequently.  

MENTAL HEALTH

Unwanted psychological effects after using can include anxiety, panic attacks, flashbacks, insomnia, nightmares, paranoia, delusions and hallucinations. Long-term psychological effects can include anxiety, panic attacks, depression, paranoia and delusions.

MIXING DRUGS

Few people use one drug on its own, and ketamine is no exception. Ketamine is often used on a night out alongside a range of substances, including alcohol. Mixing drugs increases the risks and should be avoided as the outcome is difficult to predict.

DEPENDENCY

Although not considered physically addictive, tolerance to ketamine builds up very quickly and higher doses are needed to achieve the desired effects.

REDUCING RISKS

The best way to avoid the risks associated with drugs is not to use drugs. But if you are using, or considering using ketamine, the advice below will help minimise the risks to your health.

If you need to urinate (pee) more often than usual, pass blood when peeing or experience pain when you pee, consult your GP and let them know you use ketamine.

Do it somewhere safe where you and a friend can keep an eye on each other.

Take a small amount and wait. Don’t take more because you can’t feel anything. The substance could be a different strength or a different drug than last time. Be patient and give it time to work.

Don’t mix ketamine with other drugs, especially depressants like alcohol and GHB/GBL. These will slow your breathing down to dangerous levels. This can lead to dependence on several drugs and increase your risk of overdose.

IN CONTROL

Only buy what you’re going to use during a session. Don’t buy ‘some for later’, as later has a habit of becoming now.

Eat healthily and get enough sleep, as drugs can put a strain on your body and affect your physical and mental health.

If you start to feel agitated, confused or anxious, stop using, go and chill out somewhere quiet and take a friend to keep an eye on you.

If someone’s breathing is slow and shallow and they don’t respond when you talk to them, it’s best to be cautious and put them in the recovery position. Lie them on their side, so they don’t choke if they vomit. Call an ambulance.

KETAMINE AND THE LAW

Ketamine is a Class B drug. It is illegal to possess, produce or supply the drug.

Possessing ketamine is punishable by up to five years imprisonment and an unlimited fine.

Supplying cocaine (including giving some to a friend) is punishable by up to life imprisonment and an unlimited fine.

In practice maximum sentences are rarely used. For more detailed information, visit the Release website

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E-cigarettes are battery-operated devices that heats a liquid that produces vapour when inhaled. This is commonly known as vaping. They come in many shapes and sizes, and usually contain nicotine.

Invented in 2003, e-cigarettes started to become widely used in the early 2010s as a harm reduction and stop smoking aid. Also known as vapes or e-cigs, are less harmful than cigarettes, and can help people cut down and quit smoking. Increasingly, e-cigarettes have been used recreationally by non-cigarette users.

The main substance in an e-cigarette is nicotine. It’s mixed with other chemicals, including propylene glycol, vegetable glycerine and flavourings. Different devices contain varying amounts of nicotine.

There are different types of e-cigarettes, including refillable and disposable devises. E-cigarettes often come in bright colours. They are also available in flavours that tend to appeal to young people, like fruit and sweet.

HOW ARE THEY USED?

An e-cigarette comprises a heating devise that holds a nicotine cartridge containing liquid nicotine. When heated, the liquid nicotine changes into a vapour. The nicotine and other ingredients such as and flavourings are inhaled into the body.

WHAT ARE THE EFFECTS OF E-CICARETTES?

Nicotine is a stimulant drug. It increases the heart rate and blood pressure and makes users feel alert and stimulated.

WHAT ARE THE PROBLEMS WITH E-CICARETTES?

Vaping is less harmful than smoking. E-cigarettes don’t contain the cancer-causing tobacco, and most of the toxic chemicals found in normal cigarettes. But this does not mean vaping is harmless.

Most vapes contain nicotine, which is an addictive substance that is difficult to give up.

Some people who use vapes may experience headaches, dizziness, light-headedness, coughing, nausea, a dry mouth and throat and shortness of breath.

Nicotine is dangerous for pregnant women and their developing babies.

There are concerns that some flavourings in vapes may be harmful. This is especially the case with illegal vapes that do not conform to the UK regulations.

Emerging research has raised the possibility that long term use of e-cigarettes may cause health problems, but the risks are likely to less than smoking.

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ILLEGAL VAPES

Since 2016, the UK Government has regulated e-cigarettes including the maximum strength of the products and rules about advertising them.

Some disposable vapes on sale are illegal and do not meet UK safety regulations. They can contain high levels of harmful substances.

Some people using illegal vapes have needed urgent medical attention after using devices with very high levels of nicotine or illegal drugs such as synthetic cannabinoids. It is difficult to know what it is that you are using.

Illegal vapes often look like legal e-cigarettes. Vapes with many more puffs or a greater amount of vaping liquid compared to may be a giveaway that they are not regulated.

REDUCING RISKS

The best way to avoid the risk associated with e-cigarettes and normal cigarettes is not to use them. But if you smoke cigarettes, vaping is safer but if you don’t smoke, don’t vape.

Ensure that your e-cigarette complies with Government regulations. The vape must have a tank size of no more than 2ml, which this roughly translates to round 600 puffs. Vape products should also come with a nicotine health warning on the front and back of the packaging. 

E-cigarettes, particularly disposable vapes pose an environmental threat. They introduce a waste, including plastic, metals, lead, mercury and flammable lithium-batteries into the environment.

E-CIGARETTES, VAPING AND THE LAW

In the UK, it is against the law to sell nicotine vaping products to under-18s or for adults to buy them on their behalf.

GETTING HELP TO STOP SMOKING IN WIRRAL

For help with stopping smoking, visit the Wirral Stop Smoking Service website.

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