What happens when you call 000 and ask for an ambulance?

When you call 000 and ask for an ambulance what actually happens? What information do they ask for and do the police come?

The Emergency number in Australia is Triple Zero (000). You can call this number 24 hours a day, seven days a week from any landline, pay phone or mobile phone. These calls are always free and, if you're calling on a mobile, you will get through even if you do not have any credit or your phone is locked.

Police do not routinely attend an ambulance call, even if there are illegal drugs involved. If they do attend it is usually because the paramedics attending the emergency have asked them to be there. This is usually due to another crime taking place or the threat of violence. When you call for an ambulance, that's what you get - an ambulance!

When you call 000 it will be answered by a Telstra operator who will ask you which service you want – police, fire brigade or ambulance. Once you have asked for an ambulance they may also ask what state and town you are calling from, particularly if you are calling from a mobile. You will then be connected to an ambulance control centre in your state or territory. A control centre officer will then need to ask for the following information:

• Where are you? They will need to know your exact address, so try to provide as much information as you can. If you know the nearest cross street or any identifying landmarks that are nearby that can also be helpful. The more information you are able to provide, the faster the paramedics will be able to get there
• What number are you calling from? Some young people panic when they are asked for this, worried that the number will be kept and possibly used to trace them at a later date. There is no need to worry though, as the only reason they need this is if you get 'cut-off' or they need to call you back to get extra information
• What is the problem? Tell the ambulance operator what your emergency is, i.e., who is sick or hurt and what has happened to them. They will also sometimes ask how old the person is
• Is the person conscious? Are you able to wake the person up? If you can't it is likely that they will ask you other questions about their breathing

It is important that you try to keep as calm as possible and be clear. Based on your answers, the officer will be able to assess the situation and then respond appropriately. If it is required, an ambulance will be sent immediately. Do not hang-up as you may be asked additional questions to assist the paramedics who are on their way. They may also give you some simple first-aid instructions over the phone if necessary.

After hearing what the emergency is, the officer may decide that sending an ambulance is not required. At that point, depending on where you live, you may be transferred to a nurse for further assistance.

Calling for an ambulance for a friend, or even someone you do not know, can be quite scary. Try to keep as calm as possible, provide all the information you can and hopefully the experience won't be too traumatic ... Most importantly, once again, remember - police do not routinely attend an ambulance call. When you call for an ambulance, that's what you get - an ambulance!

First published: April 2018

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Can snorting cocaine really cause your nose to collapse?

Can snorting cocaine really cause your nose to collapse? Have the photos you see online of people with one nostril been photo-shopped or can that really happen?

Snorting cocaine can irritate and damage the nose. In extreme cases, such as the ones you may have seen online, the wall that separates the left and right nasal passages (the 'septum') can perforate, making a hole. This can lead the appearance that the two nostrils have become one.

Understanding how the nose is constructed and the characteristics of cocaine will help explain why this happens.

The nasal passages are very delicate and blood vessels in this area are extremely close to the surface. This explains why the drug reaches the brain quickly when snorted. When coke is sniffed mucous production increases. This helps to protect the delicate nasal membranes from ‘foreign bodies’ including cocaine. Apart from a runny nose, some users may find it difficult to breathe through their nose properly as it becomes increasingly stuffy, while others may start to experience nosebleeds. This can lead to the nasal septum dividing the nostrils developing a hole and possibly causing the nose to collapse.

Why does cocaine cause this? Medically speaking cocaine is a vasoconstrictor. This means that the blood vessels constrict, leading to the blood supply being reduced and less oxygen delivered to the nasal passages. This process can cause the delicate nasal passages to shrink and perforate. Put simply, the cocaine puts a 'chemical tourniquet' on the blood supply to the septum leading it to become 'weaker' and more susceptible to damage.

This kind of damage is not the norm. Most cocaine users will not experience this problem. That said, it can happen in extreme cases and is just one of the risks associated with snorting any drug, including cocaine.

First published: April 2018

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Why can cannabis be found in a drug test for longer than other drugs?

You've said in a previous post that cannabis can be found in a drug test much longer than other drugs. Why is that?

The time that cannabis (or any other drug) can be detected in the body can vary and is influenced by many factors. It can be different for each person, with the same individual possibly even getting different results each time they are tested. There are no guarantees in this area but it is certainly true that cannabis is likely to be identified in a drug test for much longer than other substances.

One of the main active components in cannabis is THC – that's what gets you stoned. Drug tests measure THC, or to be more specific a THC metabolite that shows your body has broken down THC. These metabolites can stick around in the body for a reasonable amount of time mainly due to the fact that when you use cannabis, unlike other drugs, it is stored in the body’s fatty tissue. It is then, over a period of time, released slowly back into the bloodstream.

Drugs such as amphetamine or cocaine are not stored in fat, leading to them leaving the body relatively quickly through a range of bodily functions such as urinating and sweating.

The length of time cannabis can be detected depends on what method of testing is used and the nature and extent of someone’s cannabis use. The more frequently and heavily cannabis is used the longer it may be detected in the body, especially in urine.  Drug tests in the workplace usually use saliva or urine tests. In Australia, police conduct roadside saliva tests for a range of drugs, including cannabis. Blood tests are expensive and invasive, so are used less frequently.

For an occasional light user, cannabis may be detected in the urine for 1 to 5 days following use. For frequent heavy users such as those people who use most days, cannabis may be detected up to 2 months or even longer. Most other drugs, even when used frequently or heavily, are only detectable in the urine for 1 to 3 days.

Cannabis can usually be detected in saliva for up to 6 hours, depending on the test procedure and the person. Government road safety guidelines in Australia state that cannabis can be detected for up to 12 hours in a saliva test. Some people have claimed that cannabis has been detected in their saliva beyond the 12-hour period, in some cases days and weeks after having used the drug.

Cannabis can usually be detected in blood for 24 to 36 hours after use.

First published: April 2018

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What is fentanyl and why is it so dangerous?

I read that fentanyl was the drug that killed Prince. What is fentanyl and why is it so dangerous?

Fentanyl was first manufactured in 1960 and has become one of the world's most important and frequently used painkillers. It is a synthetic (or man-made) opioid. Opioids, such as heroin, are derived from a substance produced by the opium poppy, morphine. Other opioids include prescribed medications like codeine and oxycodone.

The drug hit the international headlines when it was established that Prince died as a result of a fentanyl overdose. In the US, fentanyl is one of the drugs blamed for the recent increase in drug overdose deaths. Fentanyl-related deaths have been reported in many parts of the world, including the UK. In Australia, 498 deaths were linked to the drug between 2010 and 2015.

Fentanyl is a short-acting opioid that is similar to, but much more powerful than morphine or heroin. As with heroin, in addition to its pain relief properties, fentanyl use can lead to drowsiness, shutting down of the respiratory system, coma and death. There are also many compounds that are similar in structure (referred to as fentanyl analogues) that vary in strength, effects and toxicity. Some of these are far more dangerous and have received a great deal of media attention, e.g., carfentanil.

Pharmaceutical fentanyl is used for managing acute or chronic pain and is available as lozenges, tablets and nasal sprays, patches placed on the skin and an injectable medicine. These prescribed medications can be misused by people for whom it was not intended. Fentanyl is also illicitly manufactured for use in the illegal drug market. In some parts of the world, fentanyl has been reported as being used as a low-cost additive to increase the potency of street heroin.

What makes fentanyl so dangerous? Quite simply, it is all to do with the strength or potency of the drug. A fatal overdose can be caused by a tiny amount of the drug. Fentanyl is reported to be 50-100 times more potent than heroin and carfentanil is 100 times more powerful than fentanyl. This means that a fatal dose of fentanyl may be equivalent to just 4-6 grains of table salt and a fatal dose of carfentanil may be equivalent to a speck of dust so small it may be very hard to see!

It is no surprise that fentanyl has received a great deal of media attention in recent times. It is a powerful painkiller that, when used as prescribed, can make a huge difference to people's lives. Unfortunately, when misused it can lead to people becoming dependent and, as we have seen in the Prince case, overdose and death.

First published: March 2018

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Is drinking 'straight' spirits more or less dangerous than drinking 'mixed' spirits?

I was wondering if it is better off to drink straight spirits or mixed drinks? For example, in the long-term is drinking vodka more dangerous or damaging on the liver than drinking mixed alcohol? I'm aware that vodka can be consumed faster making it more dangerous but say I was to have the same number of standard drinks over the same amount of time, would straight or mixed alcohol be better health wise?

Is drinking 'straight' spirits more or less dangerous than drinking 'mixed' spirits? Well, it depends ... 

To help drinkers understand the relative strengths of alcoholic products, a 'standard drink' is used as measure of alcohol. In Australia, one standard drink contains roughly 10 grams of pure alcohol. This means that one standard 30ml serving of vodka (a 'shot') is roughly equivalent to a 285ml serving of full-strength beer and a 100ml serving of wine. Therefore, one standard drink of vodka is exactly the same as the equivalent standard drink of beer and wine.

Spirits aren't necessarily any more harmful than other types of alcohol if you drink them at 'safe levels'. Unfortunately, as you have stated in your question, you are able to consume a lot more alcohol by drinking a smaller amount when you drink products like vodka, whiskey or rum. For example, two shots of vodka (60mls) could be consumed in under a minute, whereas for most people it would usually take much longer to drink the equivalent amount of beer (two 285ml glasses). Shots are particularly problematic as they are designed to be drunk in one go.

The speed and ease of drinking spirits increases the risk of a range of acute problems including alcohol poisoning or overdose and, potentially, long-term health problems including liver damage.

Recent studies in Australia have shown that the risk of young people being admitted to hospital with alcohol-related liver disease has risen more than tenfold over five years. The most worrying increase in alcoholic cirrhosis has occurred in those aged 20 to 29, many of whom would have begun drinking in their early teens. Researchers have suggested that this increase could be due to the increase in the consumption of products with high alcohol content, such as spirits. Young women could potentially be at greater risk due to their livers developing at a later age.

So, would it be better to drink 'straight' or 'mixed' spirits? If you were to drink the same number of 'standard drinks' over the same period of time, as you have stated, it should not make a great deal of difference. Drinking spirits 'straight' is not necessarily more dangerous than mixing them with other drinks. But realistically, many people (but certainly not all) would be likely to drink a mixed drink faster than they would a straight spirit, increasing the risk to some degree …

First published: April 2018

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Why are some drugs legal and others that aren't as dangerous illegal?

Why are some drugs legal (like alcohol) and other drugs that aren't as dangerous (like cannabis) illegal?

Firstly, it is important to acknowledge that different drugs affect different people in different ways. Even though some people can use cannabis and not experience any major issues, there are others who will have great problems with this drug. Comparing one drug to another is problematic – all drug use, whether it be legal, illegal or pharmaceutical entails some degree of risk …

With that out of the way, back to your question …

A range of different substances have been consumed for medical, religious and recreational reasons for thousands of years. Western society started to make non-medical drug use illegal in the late 19th and early 20th centuries and when this began to happen, a range of factors determined whether a drug was to be controlled by the full force of law or through taxation and regulations such as age restrictions.

The health or social harm of a drug is not the only the reason why some substances are illegal and others are not. If it were, alcohol and tobacco would surely be made illegal and some illegal drugs may even have some legal restrictions relaxed. Societal attitudes, often reinforced by the news media, moral panics, racism and powerful commercial interests have been proven to play a major part in why we have the drug laws we do …

If we look at some specific examples across time, it may help to illustrate that many of the laws in this area were not originally passed due to concern about health or social harm related to a particular drug.

In the United States, the first drug law was passed in 1875 banning Chinese opium-smoking dens in San Francisco. The reason cited was that women and young girls, as well as "young men of respectable family", were being induced to smoke opium. No action was taken against the producers of opium-based 'cure-all' medicines, which were widely taken by white Americans. The first Australian laws in this area also restricted the smoking of opium whilst allowing the sale and consumption of opiate medicines. Historians have asserted that the primary purpose of the laws was clearly to discourage the entry of Chinese people to Australia, rather than to restrict the importation of opium itself.

In 1937, once again in the US, moral campaigners were able to make cannabis an illegal drug with the introduction of the Marijuana Tax Act. They were able to do this with the help of newspapers that successfully created great fear and concern amongst the general community about the impact of cannabis on American youth, including stories of cannabis smoking Mexican immigrants seducing white women. The ensuing public anxiety led to the drug being banned. Around this time, cannabis was not consumed on a large scale in Australia, although it was available for sale as cigarettes called 'Cigares de Joy' until the 1920s. Partly to comply with international pressure, cannabis use and importation was prohibited in 1926.

The United Nations drafted the Single Convention on Narcotic Drugs in 1961, effectively criminalising drug production, cultivation, possession and supply across the globe, even though few countries actually experienced domestic drug problems at this time. In the late 1960s and early 1970s many countries including Australia passed laws to enforce the UN Convention.

Unfortunately there is no simple reason to explain why some drugs are legal and others are not. It is quite clear, however, that the legal nature of a particular substance is not always related to the harms associated with the drug. When you closely examine the original reasons behind the introduction of specific laws, they often have to do with a range of historical factors, whether they be based on moral panic, racism or greed. Over time, as we have learned more about the harms associated with a particular substance, the reasons behind laws may actually make more sense in some cases, while in others the decisions may be difficult to justify.

First published: April 2018

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Are you at risk of unlocking mental health problems from passive smoking of cannabis?

Can you experience the effects of cannabis by second-hand inhalation (like the risk of second-hand smoking with tobacco)? For instance I'm mainly worried about the possibility of developing schizophrenia. Can any of those effects be experienced or just general lung stuff?

You have raised lots of issues here. Firstly, it is important to note that the dangers linked to second-hand inhalation of tobacco (passive smoking), such as the development of some cancers, along with heart and lung conditions are usually due to exposure over a long period of time. Even though it can be pretty unpleasant if you're a non-smoker, you're not going to develop these problems simply hanging out with tobacco smokers from time to time. It's really long-term exposure that is the problem. So having lived in a home where both parents (and other family members) smoked cigarettes regularly could be an issue.

We have no evidence of similar problems for cannabis smoke exposure because no research has really been conducted in the area. Given cannabis smoke contains more carcinogens (i.e., compounds that are known to be associated with an increased risk of developing cancers) than tobacco smoke, it is reasonable to suggest that being around cannabis smokers frequently over a period of time could cause some health problems. This is particularly true for babies and children, at a time where the brain is undergoing rapid development.

You sound as though you are more concerned with the impact of passive cannabis exposure on your mental health. It is possible to experience mild intoxication from inhaling the cannabis smoke of others if you are in a very confined space that is not well-ventilated. This is more likely when the newer, stronger strains are being smoked as they contain higher levels of THC (the chemical that produces the high) in side-stream and exhaled smoke. THC has been found in non-smokers' oral fluid and blood up to 3 hours after being exposed to cannabis smoke and reported the same kinds of intoxication effects as smokers depending on their level of exposure (i.e., whether or not the room was ventilated).

Even so, could passive inhalation of cannabis lead to developing a serious mental illness? There are no reported cases of anyone attributing their exposure to second-hand cannabis smoke as the cause of their schizophrenia or other mental health issue. While the risk is extremely small, however, if you have any concerns about your mental health or know you have a family history of the condition, it is best to avoid any exposure to cannabis.

First published: April 2018

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What's the drug that kills more people than any other?

What's the drug that kills more people than any other? We had a debate in class and we couldn't agree on which one it was. I think it's tobacco but others thought it was illegal drugs like ice and heroin.

Well, you were right - across the world, tobacco kills more people than any other drug. In countries like Australia, alcohol is the second largest cause of drug-related deaths, followed by prescription medications and illicit drugs.

Before we look at the actual numbers, it is important to understand what we mean by a 'drug death'.

In Australia, deaths are considered 'drug-induced' if directly attributable to drug use. For example, when an alcohol or drug overdose occurs. Drugs can also contribute to 'drug-related deaths' as a result factors such as violence, driving while drunk or intoxicated or when an underlying health condition exists. For example, a stimulant drug may cause death in a vulnerable individual with an undiagnosed heart problem.

It is often the case that a death occurs as a result of the combined effect of alcohol and illicit drugs making it difficult to attribute the death to one specific substance. Sometimes deaths may occur as a result of ill health caused by alcohol or drug use many years ago and there are instances when doctors may not record drugs on a death certificate even where drugs might be involved. Despite these difficulties there are estimates of the number of deaths associated with different tobacco, alcohol and drugs.

When you look at the statistics, smoking is by far the leading cause of preventable death. Worldwide, tobacco use causes nearly 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030. Around 15,000 people die every year in Australia due to smoking – that's about 40 each day!

According to the World Health Organisation, in 2012, there were around 3.3 million deaths attributable to alcohol consumption. That accounts for around one in 20 of all global deaths. The number of Australians that die due to alcohol can vary each year from between 3,500 up to more than 5,000. That means up to 15 alcohol-related deaths per day.

There are many prescription drugs that can cause death and in recent years it is the painkillers such as oxycodone, morphine and codeine and benzodiazepines, a range of drugs used to treat anxiety or sleep problems, which lead to many accidental and intentional fatal overdoses. Using drugs in combination (or 'polydrug' use) is often the cause of death. For example, the latest statistics show that in 2016 over 96% of benzodiazepine deaths in Australia involved other drugs including alcohol.

In 2014, there were an estimated 207,400 illicit drug-related deaths worldwide. Overdose deaths account for almost half of these worldwide, and in most cases the drugs involved were opioids (i.e., drugs like heroin). According to the latest Australian statistics, in 2016 the total number of prescription and illicit drug-related deaths was 1,808 – the highest number in 20 years. Stimulant drugs including methamphetamine (speed or ice) and MDMA (ecstasy), as well as heroin accounted for 724 of these deaths.

Using any drug involves risk. Using alcohol, prescribed or illicit drugs at the same time massively increases the risk of illness and death.

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Could one try of cannabis have affected my school grades?

Having read your answer to "can smoking weed once have a lasting effect" I was wondering how obvious, after having smoked once, any negative long-term effects would be. If I can't say for certain that there are long- term effects does that mean that there aren't any or just that they are too subtle to perceive? Basically, I smoked cannabis once and since then I have noticed school grades going down (like from 100s to 95s), is this probably just in my head?

Some people who experiment with an illegal drug, whether it be cannabis, ecstasy or whatever, do not necessarily have the experience they were expecting. As a result, many will choose never to use the drug again. In some cases, particularly if their experience was unpleasant, people are tempted to 'over-analyse' what happened and start to stress about what impact the drug had on them and could potentially have on them in the future.

Realistically, the most likely negative effect of smoking cannabis just once is having an accident when intoxicated or making a fool of yourself in front of your friends. Some people who have used only once, but perhaps smoked too much or unknowingly used a high THC product, may have extremely unpleasant effects. They could feel faint as the drug causes a drop in blood pressure, become paranoid, anxious or nauseous. In extreme cases, some first time users may even vomit. In these cases, it becomes obvious to the person experimenting with cannabis that it is not a 'harmless' drug (i.e., things can go wrong) and, as a result, they'll choose to never use the drug again.

You ask specifically about long-term effects that are "too subtle to perceive" and highlight how your experience could have affected your school grades. Could that 'one try' have resulted in an effect on your school performance? Most probably not ...

You have obviously been performing at an extremely high level and any drop, no matter how small, is noticeable but this change has much more likely explanations. Focus on the reason you decided to smoke cannabis in the first place and whether it was associated with other new activities or challenges that were happening around the time you decided to experiment. It could be one of these, or even a combination of all of them, that could explain the slight change in school marks.

You are obviously concerned about your grades and that is the first step to maintaining or even improving them. You might like to talk with your school counsellor about anything else that might be concerning you and causing you to worry about your once-only cannabis use.

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What effect does alcohol have on antidepressants and anti-anxiety medications?

Hi Paul, you recently talked at my school about the effects of alcohol and how long it takes to get out of your system. I was wondering what are the effects of alcohol on antidepressants and anti-anxiety medications? Does using these types of medication cause alcohol to stay in your system any longer and do they amplify the effects of alcohol?

Anti-anxiety and antidepressant medications should only be taken when prescribed by a doctor. Using either medication on their own can cause a range of problems including, in extreme situations, death by overdose. When you drink alcohol at the same time this dramatically increases the risk of something going wrong.

Anti-anxiety and anti-depressant medications do not cause alcohol to stay in your system any longer. Understanding the interaction between the types of medications and alcohol is important.

Anti-anxiety and anti-depressant medications affect the body in different ways.

The most commonly prescribed anti-anxiety medications in Australia are benzodiazepines (also known as minor tranquillisers or 'benzos') and are classified as 'depressants' (i.e., drugs that 'slow down' the central nervous system). Examples include diazepam, temazepam, nitrazepam and oxazepam. These are prescribed to help people with anxiety or sleep problems. The effects may last from a few hours to 12 hours or even longer, depending on the dose and type of drug taken. Using benzodiazepines at the same time as other depressants - such as alcohol, GHB, heroin and methadone - is extremely dangerous. It can cause loss of consciousness, breathing problems, coma and death.

The situation with anti-depressant medications and alcohol is more complex due to the availability of different types of anti-depressants. Drinking alcohol while taking these medications, however, is generally not advised. Even in small amounts, alcohol can affect concentration and coordination, cause drowsiness and dizziness and lead to injuries and road traffic accidents. It is also important to note that drinking alcohol and taking anti-depressants at the same time can also make depression worse.

Combining alcohol with monoamine-oxidase inhibitor (MAOI) anti-depressants is especially risky. This is because a substance called tyramine, often found in alcoholic drinks, can cause serious side-effects if taken with MAOIs, including a sudden and dangerous rise in blood pressure.  Speak to your GP or pharmacist if you're not sure what type of anti-depressant you're taking and don't know whether you should avoid alcohol.

It is always a good idea to ask your GP or pharmacist about how alcohol interacts with prescribed and over the counter medications. If the doctor has known you for a long time, they may not even think about the possibility of you drinking and prescribe you something that could be particularly risky. If you want to continue to drink and need to take medication, your GP may be able to find a safer alternative.

There are some people who try to push the boundaries to see what will happen if they intentionally combine medications with alcohol or, as you say in your question, to 'amplify the effects of alcohol'. This is extremely dangerous. There is no effective advice that can be provided to reduce risks other than 'please don't do it'.

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Would snorting or sniffing a drug cause an irritation under the nose?

Would snorting or sniffing a drug cause an irritation under the nose? If so, why does this happen and could this cause any long-term problems?

Understanding how the nose is constructed, and how delicate the inside is, will help to answer the question. The septum is the wall that separates the left and right nasal passages. This can be pinched between your fingers. A thin protective layer called the mucous membrane covers the nasal passages. The centre part of the nose is made from bone and cartilage.

The nasal passages are very delicate and the blood is extremely close to the surface. This explains why the drug reaches the brain quickly when snorted or sniffed and why this method of use can lead to problems. The mucous membrane acts as a filter to protect against foreign bodies such as dust, pollen and drugs. When these things enter the nose the production of mucous increases, which protects the delicate nasal membranes. This can often result in regular 'snorters' having a runny nose, causing them to sniff regularly. The extra mucous can also make snorting the drug more difficult.

Regular snorting or sniffing can, at the very least, irritate, and at worst, damage the nasal passages. Apart from a runny nose, some users may find it difficult to breathe through their nose properly as it becomes increasingly stuffy, while others may start to experience regular nose bleeds. In extreme cases, regular snorters can experience a nasal septum perforation. This is when the septum dividing the nostrils develops a hole.

Snorting powder or crystal drugs like cocaine or amphetamine is unlikely to cause irritation under the nose. Most of the damage would be inside the nasal passages where the more sensitive skin is being affected. If there is irritation, it is likely to be caused by the regular wiping of the area due to the user having a runny or stuffed nose.

Inhaling products like amyl nitrite ('Jungle Juice') can also cause irritation to the nose. This is because amyl can be extremely abrasive if it comes into contact with the skin. Residue liquid on the bottle can easily touch and damage the nose and other parts of the face. Consequently, some regular users report a range of skin problems on the face, mouth and nose including redness, infections and outbreaks of small sores.

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Why do ecstasy users 'connect' with other people when they use the drug?

How come human beings bond while 'rolling' on MDMA? I was with some friends a few weeks back and while rolling, I connected deeply with someone I usually don't talk to. It's a strange feeling to have such a connection after a trip.

A deep connection with someone when taking MDMA (ecstasy) is not unusual. Users of the drug often describe a combination of feeling energetic and yet calm, as well as an enhanced sense of closeness with other people. The usual social defences are weakened and communicating with strangers is no longer taboo. These effects have been recognised for a long time – both on the dance floor and in therapeutic settings.

Alexander Shulgin, an American research chemist, experimented with MDMA in the 1960s and found it produced 'emotional openness' and empathy and made those using the drug feel in tune with each other and facilitated communication. As a result, a handful of psychotherapists used the drug in couple's therapy and as a means to help address post-traumatic stress disorders during the 1970s in the US. During the last decade, research into how MDMA and its unique effects could potentially be used therapeutically has been renewed. Clinically-controlled studies in the US and Switzerland continue to be carried out, particularly in relation to the treatment of PTSD.

So how does MDMA cause this effect?

There is no straightforward answer but most experts agree that MDMA works by increasing levels of dopamine and oxytocin in the brain, which affect emotions, empathy and pleasure. At the same time, MDMA 'tricks' the brain into releasing serotonin (the 'feel-good' neurotransmitter) and then also prevents it from being re-absorbed. As a result, the level of serotonin in the synapse – a part of the brain that allows information from one neuron to flow to another neuron - increases, producing the 'loved-up' euphoria associated with MDMA.

Some experts, however, are sceptical about serotonin explaining this unique effect. Other drugs, including pharmaceutical products, cause a big release of serotonin but they don't cause anything like the euphoric effect of MDMA. We still have a lot to learn about this drug.

Please remember, using MDMA does involve risk. The main reasons why it can cause problems or even deaths are as follows:

• adulterants – drugs sold as ecstasy may contain little or no MDMA. Ecstasy may contain other substances some of which may be more harmful than MDMA
• heatstroke – using the drug in a hot environment (like a nightclub) can cause body temperature to dangerous levels, which can result in death
• water intoxication – MDMA affects the kidneys, preventing the body from getting rid of fluids. Water is retained in the body and the pressure can lead to coma and death  
• heart failure – the stimulant effects of MDMA have caused death in vulnerable users, particularly those with undiagnosed heart problems
• MDMA overdose – the increase in the strength of ecstasy may have caused fatal overdoses among some users i.e., the 'dose' taken is 'over' the safe amount

All drugs, whether they be legal, illegal or pharmaceutical, are potentially dangerous. Things can, and do, go wrong - no matter what the substance. Although taking MDMA can lead to some positive effects for many users (such as the feelings of being 'connected' to others), there are risks those people thinking about taking the drug also need to consider. 

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Can I be affected (or get stoned) if someone around me is smoking cannabis?

Every time I believe someone is using cannabis near me, I become anxious and fearful that I may experience the same effects of the drug, as has the user. Is this fear irrational? Furthermore, can the effects of being merely exposed to the smoke of cannabis cause noticeable or even negligible effects to the developing brain?

It sounds as though you are someone who has never used a drug like cannabis and you have no intention of ever doing so. If that is the case, it is no surprise that being around those using the drug could worry you. In most parts of the world cannabis is still an illegal drug and being around people who are breaking the law can often result in problems for you, even if you're not actually involved. But as far as the risk of being affected by cannabis due to exposure to the drug by others smoking around you ('passive cannabis smoking'), from what we know from current research it should not be a major concern.

Just being in a room where people are smoking and the smell of cannabis is in the air is not sufficient to cause effects and you should not be worried about such levels of exposure. If you are in a very confined space that is not well ventilated, it is possible, however, to experience mild intoxication from inhaling the smoke of others. Even then, the effect would be at much lower levels. An effect is more likely to be experienced when the newer, stronger strains of cannabis are smoked as they contain higher levels of THC (the chemical that produces the high) that can be found in side-stream and exhaled smoke. Realistically, however, this is a situation that can, and should be, avoided.

The simplest thing to do if you suspect someone is smoking or vaping cannabis near you and that you may be exposed to smoke or vapour is to move away, or excuse yourself politely if you know the person. If you don't feel comfortable about being honest with them and telling them about your concerns, say that you are allergic to the smoke/vapour or you're worried about the smell of the smoke getting onto your clothes or into your hair. Alternatively, simply make an excuse to leave the room when they're using the drug. Even though the risk of being affected by the drug is low, if being around someone who is smoking the drug causes you to become anxious, avoid the situation when you can - it's just not worth the worry!

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What is 'greening out' and an it have long-term effects?

"I was reading one of your articles online about 'greening out' or what happens when you smoke too much weed. I am overseas and have no health coverage and don't know how I can get this question answered. Long story short I had never smoked weed and decided to try it. I took two hits of a bong and greened out. Experienced nausea, anxiety, cotton mouth and a loss of time. Things such as looking around became strange as well and my body felt light and different. Safe to say it was the first and last time. That was three months ago. I do have this fear that I have 'destroyed' my brain as a result of this or caused some sort of permanent damage. Is that a known side effect? It really is giving me great anxiety ..."

To be honest it sounds as though you simply experienced a cannabis 'high' rather than actually 'greening out'! Many people who experiment with any drug, but particularly cannabis, are not completely prepared for the experience and when the drug starts to have an effect it is not as they expected. They then try to fight the feeling and this results in anxiety and panic. That's what this sounds like ... This is why so many people try cannabis once, find out that it doesn't agree with them and choose to never use it again.

'Greening out' (also known as 'whiting out') is often described as a 'cannabis overdose' and is a term used to describe a situation where a person feels sick after smoking cannabis. They go pale (turning 'green' or 'white') and start to sweat; they feel dizzy and nauseous, and may even start vomiting. The experience can be quite frightening and users can become very anxious and start to panic. In extreme cases, the person may experience prolonged vomiting and even hallucinations. Cannabis users often report that the only way they can alleviate these symptoms is to lie down.

Greening out is much more likely to occur if the user has been drinking alcohol before they start smoking. Research evidence shows that because there is alcohol in the bloodstream, the THC (the part of cannabis that gets you stoned) is absorbed much faster. This can result in a much stronger and often far more unpleasant effect than usual. First-time cannabis users can often report similar experiences, although not quite so extreme (but still feeling very unpleasant nevertheless) - they just weren't prepared for the effects of the drug.

This can be a traumatic experience, whether you were on your own or if it happened at a party or gathering with other people around, and it can take some time for a person to recover. Have you 'destroyed' your brain or caused some permanent damage as a result of this 'one-time' experimentation? That is highly unlikely. As I said in a previous posting 'Can smoking weed once have a lasting effect?' - you would have to be incredibly unlucky for this to happen as it appears to be regular use that causes the greatest problems. That said, a one-time use can lead to a terrifying experience, usually associated with anxiety or a panic attack, and it may be something you never forget!

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Why didn't my ecstasy work? Could taking medications have an effect?

I recently took ecstasy but felt no effects whatsoever. Is this normal or is this a dangerous sign of some kind? Could it have affected me without me being aware of it? I also take 150mg of Zoloft everyday for depression, could this have something to do with me not having any effect.

There are really two issues that need to be covered here - firstly, why would someone who has taken ecstasy not get the effect they were expecting, and secondly, a discussion on using drugs like ecstasy if you are on medications, particularly those used to treat mental health conditions.

There are a number of things to remember when taking an illegal drug that could result in someone not experiencing the desired effect:

• There may not have been any active substance in your pill or capsule. Analysis of pills, capsules and powders sold as ecstasy shows that some contain no active substance at all and may in fact contain household products like Epsom salts and bicarbonate of soda! Sometimes they just contain caffeine. As much as we warn about poisonous substances being in ecstasy (and that may certainly be the case), sometimes there's nothing in them!
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• If others with you took a pill from the same batch and they got an effect remember that different people will be affected differently by exactly the same drug. Just because someone had a very strong effect after taking a pill, it doesn't necessarily mean that others will too. This is why one person may die or get extremely sick after taking a pill, while all the others around them who took exactly the same thing had no problems at all – this is called 'individual difference' and is incredibly important to remember in regards to drugs!
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• There are many other things that could impact on the effect the drug has on the user – what you ate beforehand, how much you ate, your mood when you took the drug and who you were with and so many others. Would this account for getting no effect whatsoever? Most probably not but sometimes people's expectations of what a drug experience is going to be like may exceed what actually happens …

Most importantly, you have been diagnosed with depression and are being treated … taking a drug like ecstasy when you're on medication for a mental health issue is simply not a good idea and can possibly make your condition even worse. There is a great little article on mixing ecstasy with Zoloft at the following link: http://ift.tt/2axljVE- take a look at it and think very carefully about ever using the drug again. Although many people regard ecstasy as a 'low-risk' drug, things can still go wrong - your mental health is so important and when you have a pre-existing condition, using a drug like ecstasy that plays around with your brain chemistry could be even more dangerous.

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How do I know when I can safely put a drunk person to bed?

I have a question that I have thought of about taking care of a drunk friend. One of the things I recall you saying is to try to make sure they don't fall unconscious and try to keep them awake if you possibly can. Some of the people I have looked after have wanted to go to bed, so I was wondering when is it a safe time for a drunk person to be put to bed and go to sleep without me watching them anymore?

The practice of putting someone to bed to 'sleep it off' has been around for as long as alcohol has been consumed and most times the worst thing that happens is that the person wakes up the next morning feeling a little worse for wear or covered in their own vomit. That is not always the case, however, with some drunk people being sick through the night and ending up choking on their own vomit, or others simply stopping breathing due to the depressant effects of alcohol.

The reality is that many drunk people will want to go to bed, particularly if they have been feeling unwell for a while. There are three simple tests that a person looking after a drunk friend can use to see whether you are able to put them to bed and be reasonably sure that they will be safe:

• Can the person walk? Just a few steps, not a marathon - if they can't walk, they still need to be monitored closely. Putting them to bed at this time is not advised

• Can they talk? They don't need to have a quality conversation but you need to know that can speak and let you know where they are, preferably in a language you can understand!

• Can they answer a question? The best question to ask them is something like "What is your full name?" If they don't know what their name is, once again, it is not a good idea to put them to bed!

If they can pass these simple tests, you should be able to put them to bed. It is important, however, that you make sure you put them into bed in the recovery position (you can look at this YouTube video from St John Ambulance if you don't know how to do this), and then put a folded pillow behind their back to ensure that they don't roll back over through the night. Once you have, it is still important to monitor them for at least 30mins to an hour, ensuring that they are breathing steadily, that they haven't vomited or rolled over onto their back.

The major issue with looking after drunk people is that you can never be sure when they actually had their last drink, so you can't know with any certainty that this is as 'drunk' as they'll get. With that in mind, if you are considering put a drunk friend to bed, another good trick is to quickly take their pulse and then wait 10-15 minutes and take it again, making sure that it is now either steady or getting stronger (faster). If it is dropping that means there is still alcohol making its ways to the brain and putting them to bed is potentially very dangerous.

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What is 'Special K' and what is the 'K hole'?

Some of my friends have started using something called 'Special K'. It's a white powder and they snort it. What is it and what is the 'K hole' that they keep talking about?

'Special K' is a street term for ketamine, a powerful anaesthetic used in both human and veterinary surgery.  It is a dissociative drug, which means that when used, the mind leaves the body causing the user to experience quite intense hallucinations. Ketamine was first used extensively during the Vietnam War during battlefield surgery.  When soldiers returned home, those who had been given the drug talked about the experiences that they had had whilst under the effect of the drug and not surprisingly it started to be used recreationally. Its popularity increased quite dramatically in the 1990s, this time amongst the nightclub scene, with people reporting that the drug enhanced the clubbing experience (e.g., the music sounded different and the lights were more intense). 

Doctors and vets use ketamine in an injectable liquid form but 'Special K' users buy the drug in a fine crystal or powder form that is then snorted. Use too much of the drug and users can find themselves in a dissociated state, or as it is now called a 'k-hole'.  As a result, smaller, measured doses (called 'bumps') are taken, increasing the chance of having a more 'pleasurable' experience with the drug. So what exactly is a 'k-hole' and is it dangerous?

A 'k-hole' is difficult to define as it appears to mean different things to different people, but essentially there appears to be two types of 'k-holes'. Some users regard it as the state of dissociation (i.e., when your mind leaves your body) and in these cases it is definitely regarded as a 'positive' experience. Often the initial events may feel like they are happening at a high speed, with people reporting feeling as though they are zooming through tunnels or computer networks, traveling on rollercoasters or being swept through a sewer. However, there is another place you can go when you have one 'bump' too many – a black place which many users believe they will never return from. Some compare this to a 'near-death experience' (NDE) and see it as a dark and frightening place and somewhere that they never want to go to again! There is a real sense that what is being experienced is real and that one is actually dead or dying, and that what is happening is inexpressible in words.

We really don't know very much about the long-term use of ketamine as most of the research conducted in the area has been looking at its use by medical professionals for surgery. There is certainly growing evidence that regular use of ketamine can cause serious bladder and urinary tract problems. This can lead to difficulty urinating and there have now been documented cases of regular users of 'Special K' needing to have surgery in an attempt to fix these problems. It also needs to be remembered that the potential for ketamine users to do harm to themselves while in the 'k-hole' is great and there are many stories of users burning or cutting themselves unknowingly whilst using the drug. 

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How long does it take for someone to sober up?

You've said in a previous post that time is the only thing that can sober someone up. If that's the case, how long does it take for someone to sober up?

This is a really tough one and you may as well be asking 'how long is a piece of string?' because there are so many different variables to consider and everyone will be different each time they drink alcohol. It would be great if there was a simple calculator that you could use where you entered some simple details about you and your drinking behaviour on a particular occasion and it would then pump out a time to let you know exactly when you will be sober again (there are online examples of these (e.g., http://ift.tt/1IdMBOo) but even these make it clear to users of the site that these are estimates only and they don't accept responsibility for the results). 

We usually say that it takes an average adult healthy liver approximately one hour to get rid of one standard drink (i.e., 10 grams of alcohol, e.g., one 30 ml shot of spirits). Many people use this guide and assume that if they have 8 drinks in a session then they will be sober in 8 hours. This 'formula' is often used by people who are considering driving and want to know when they can drive again safely without being over the limit on a breath test. It is important to note that many people who do get busted for drink driving were following this guide - it is not a 'rule', it is simply a guide and one that gets a lot of people into trouble.

The main organ responsible for getting rid of alcohol in the body is the liver. Gender can play a role here, particularly in young people. The most important thing to remember here is that men and women finish developing their livers at different ages. A young man's liver is fully developed at around 18-19 years of age, whereas young women take longer and don't have the ability to process alcohol as effectively until around 21-22 years. Even when fully developed women usually have smaller livers, on average, than men and that could also affect the time it takes for alcohol to be metabolised.

Studies have shown that the time it takes for alcohol to be eliminated from the body (and therefore how long it will take you to sober up) can vary as much as 3-fold from person to person. There is no way of knowing exactly how long it will take but some things that could affect the time period are your gender, your age, whether you're on medication, your health status (particularly your liver health) and how much body fat you're carrying. How fast you sober up is also affected by the type of alcohol you consumed, how fast you drank and how much food you have in your stomach before you started drinking and if you ate while you drank. 

So, put simply, there is no way of knowing how long it will take for someone to sober up after drinking alcohol. As much as people love simple answers to complex questions there usually aren't any! If you're going to drink alcohol, particularly if you are going to drink to excess, you need to remember that it's going to take some time to recover and there is absolutely no way of knowing exactly how long that process is going to take!

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