Research Article Open Access

O’Neill and McElrath, J Addict Res Ther 2012, S9 DOI: 10.4172/2155-6105.S9-001

ISSN:2155-6105 JART, an open access journal J Addict Res Ther Synthetic Cathinone Abuse

Simultaneous use of Mephedrone and Alcohol: A Qualitative Study of Users’ ExperiencesChristina O’Neill and Karen McElrath*School of Sociology, Social Policy and Social Work, Queen’s University, Belfast BT7 1NN, Northern Ireland, UK

Keywords: Mephedrone; Polydrug use; Alcohol; Synthetic cathinones

IntroductionNew synthetic stimulants have gained popularity in “recreational”

drug scenes in New Zealand [1], Australia [2], several European countries [3], and the United States [4]. These stimulants often include cathinone derivatives [5], e.g., MDPV (3,4-methylenedioxypyrovalerone) and mephedrone (4-methylmeth-cathinone), which are intended to mirror the effects of cathinone, a compound found in the Khat plant. Although few studies have investigated users’ experiences with MDPV, a growing number of European and Australian studies have explored the use of mephedrone [2,6-13], a substance that emerged as a legal psychoactive substance in several European countries beginning in 2007-2008 [14].

Prior to its control in Europe, mephedrone was available through street-based head shops, other retail outlets, internet-based suppliers, friends/acquaintances, and/or street dealers [7,10,11,15]. Despite its now illegal status in several European countries, the use of mephedrone has continued [16] and the supply of the drug has tended to shift to street-based dealers following legislative bans [7,12]. Online provision has continued and the number of internet-based “shops” that supply new psychoactive substances has increased since 2011, with some speculation that the rise is due in part to an increase in internet suppliers in the United States [3]. In Europe and Australia, user preferences for mephedrone have been linked to wider drug market changes, e.g., higher price, reduced purity and decreased availability of ecstasy or cocaine [2,6,8,9]. National probability studies have shown ever using mephedrone ranged from 4.4% among persons aged 15-24 in England and Wales [17] to 5.7% in Northern Ireland [18]. Higher lifetime prevalence (i.e., 41.3%; 21% respectively) has been reported among individuals connected to the dance/music scene [11] and among frequent users of ecstasy [2].

In this paper, we explore the simultaneous use of mephedrone and alcohol among individuals who used mephedrone following the UK legislative ban in 2010. Commonly described as a form of “polydrug use”, simultaneous drug use refers to the consumption of two or more psychoactive substances at approximately the same time or during the same drug episode [19-22]. Simultaneous drug use can enhance the effects of one or more psychoactive drugs, extend the drug experience or ease the “comedown” effects associated with particular drugs [23-26]. Unplanned simultaneous polydrug use is more often associated with negative drug outcomes [23,25]. Simultaneous polydrug use often

includes the use of alcohol which users have been known to consume with ecstasy [27-29], cocaine [30], “club drugs” [24], benzodiazepine [31], opioids [32], and prescription drugs [21,33]. Biochemical interactions between alcohol and other drugs have been linked to adverse health effects [34-36], thus it is important to understand users’ reasons for consuming alcohol and mephedrone simultaneously.

Materials and MethodsSemi-structured interview data were drawn from two separate

studies. The first study included 23 individuals from Northern Ireland who had used mephedrone during the six months prior to interview [7]. Twenty-one of 23 respondents had used mephedrone following the 2010 legislative ban. The interviews focused on a number of issues relating to users’ experiences with mephedrone; data pertaining to the simultaneous use of mephedrone and alcohol are the focus of this paper. Interviews were completed within two hours and were conducted by the authors. Respondents were recruited through personal contacts of the authors, chain referral and a social networking website. Respondents’ ages ranged from 19 to 51 years, and 13 were aged 20 to 29 years. Approximately half the respondents were female (12 of 23). All respondents were white, similar to population demographics of Northern Ireland. Respondents were from working- or middle-class backgrounds and the majority (19 of 23) were employed, largely in occupations affiliated with business, trades, service industry and civil service.

Supplemental data were included from a second study that used ethnographic methods (interview and observational data) and focused on patterns of “recreational” drug use over time [37]. A total of 45 individuals from Northern Ireland who were aged 18 or older

AbstractMephedrone (4-methylmethcathinone) gained popularity across “recreational” drug scenes in the United Kingdom

and Ireland during 2009. Although mephedrone was banned in both jurisdictions in 2010, the drug was subsequently sourced through street dealers. This qualitative study explores the simultaneous use of mephedrone and alcohol, among study participants who used mephedrone following legislative controls. Data were collected through semi-structured interviews with male and female respondents. The results suggest a three-tier classification system that describes users’ experiences with simultaneous use of mephedrone and alcohol. Most participants engaged in “heavy” alcohol use immediately prior to consuming mephedrone, and then reduced alcohol consumption as the effects of mephedrone were experienced during the drug episode. Spontaneous use of mephedrone often was associated with larger amounts of alcohol being consumed just prior to the mephedrone episode. The findings have the potential for informing socio-epidemiological surveys as well as peer interventions to reduce harm associated with simultaneous drug use.

*Corresponding author: Karen McElrath, School of Sociology, Social Policy and Social Work, Queen’s University, Belfast BT7 1NN, Northern Ireland, UK, Tel: +44 28 90 973551; Fax: +44 28 90 973943; E-mail: k.mcelrath@qub.ac.uk

Received July 29, 2012; Accepted August 28, 2012; Published August 30, 2012

Citation: O’Neill C, McElrath K (2012) Simultaneous use of Mephedrone and Alcohol: A Qualitative Study of Users’ Experiences. J Addict Res Ther S9:001. doi:10.4172/2155-6105.S9-001

Copyright: © 2012 O’Neill C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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ISSN: 2155-6105

Citation: O’Neill C, McElrath K (2012) Simultaneous use of Mephedrone and Alcohol: A Qualitative Study of Users’ Experiences. J Addict Res Ther S9:001. doi:10.4172/2155-6105.S9-001

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ISSN:2155-6105 JART, an open access journal J Addict Res Ther Synthetic Cathinone Abuse

participated in the study, and considerable rapport had developed between the interviewer and respondents. Data were collected during 2010 and 2011, and respondents were recruited from the first author’s personal and professional contacts, as well as chain referral. Thirty-four of 45 respondents in the second study had consumed mephedrone following legislative controls over the substance. Nine of these individuals were included in the first study (described above), and data from 25 other respondents were reviewed here. These 25 mephedrone users were aged 19 to 49, with the majority aged 20 to 29. Females comprised 42% of this sample. Similar to the first sample, respondents were white and the majority were employed. Respondents in both studies had a history of psychoactive drug use (e.g., cannabis, ecstasy, cocaine) prior to initiating mephedrone use. Analysing the data from the two studies served to increase the sample size and strengthened the validity of data interpretation.

Respondents were interviewed in university offices, private residences of respondents or their acquaintances, and to a lesser extent, semi-public spaces such as cars parked in retail area car parks. Confidentiality was assured and respondents provided informed consent prior to the collection of data. The studies were granted ethical approval from the Research Ethics Committee, School of Sociology, Social Policy & Social Work, Queen’s University, Belfast.

The analytical approach commenced with several reads of the interview transcripts, noting emerging themes and categories, and developing coding schemes. Preliminary patterns in the data were analysed, followed by a system of corroboration and comparison with other cases. In general, we followed the rules of analytic induction.

Results The vast majority of respondents (42 of 48) were described as

“current users” who had used mephedrone on several occasions and planned to use again. Respondents reported consuming dosages of between one and two grams of mephedrone, most often taken at various stages of an evening. Additionally, several respondents recalled mephedrone binges whereby upwards of seven to eight grams were ingested among a few people over a 24-hour period.

Initiation into mephedrone occurred between May 2009 and January 2010 when mephedrone was legal in the UK. Thirty-one respondents were asked about the use of alcohol during mephedrone initiation, and 26 of these respondents recalled using alcohol just prior to or during mephedrone initiation. None of the respondents voiced concerns about mixing alcohol with a psychoactive substance about which they had little knowledge and had never experienced:

“The first time…We had quite a few [drinks]...we had two bottles of wine probably and then her boyfriend, he was like, ‘Do you want some mephedrone?’ So like we just took it after the wine…before we went to the club. We had actually taken it in like a wee capsule sort of thing and then snorted some of it as well.” (Female, early 20s)

A male reported consuming several pints of beer just before mephedrone initiation:

“I was at a friend’s house – maybe five or six people there. There was somebody over from England, visiting his cousin, a policeman. He had it [mephedrone]. I wasn’t sure what it was - never heard it before. He said, ‘It’s legal’. I bombed it [swallowed] – used for hours and hours the first time – was on Es [ecstasy/MDMA] as well.” (Male, early 20s)

Subsequent use of mephedrone and alcohol mixing:

All respondents had consumed alcohol during the most recent

mephedrone episode, however, the amount and timing of alcohol use varied across respondents and social contexts. We identified three general patterns of mephedrone/alcohol mixing: 1) Party folk consumed alcohol (e.g., numerous vodka drinks and glasses of wine; several pints of beer), particularly just prior to the mephedrone episode, 2) Sippers consumed one or two drinks over the entire mephedrone episode, and 3) Remedy makers restricted alcohol intake to one or two drinks during the morning or day after the mephedrone episode in order to ease the comedown or to induce relaxation or sleep.

Party folk

The majority of respondents were characterized as Party folk who recalled heavy drinking sessions or alcohol intoxication just prior to mephedrone use. For some respondents, this sequence reflected their usual pattern of mephedrone use whereby the effects of heavy alcohol use led to the desire to extend, enhance or otherwise further alter consciousness:

“If I was on the rip [consuming large amounts of alcohol], I’d maybe take two or three grams [of mephedrone] in a night. If I wasn’t on the rip, I’d maybe take two or three lines…If I was sober I wouldn’t even think about it [mephedrone] – no definitely not. It’s only when I’m drunk I want something to give me a different buzz.” (Male, late 20s)

“Coke would be my daytime drug. E’s and meph [mephedrone] for [going]

out and ketamine or grass at an after party. And then drinking [alcohol] the whole way through.” (Male, mid 20s)

Mephedrone use was sometimes unplanned and occurred in the context of drinking alcohol, when one or more group members suggested that they locate and access a supply of mephedrone. A female respondent reported never planning to take mephedrone; rather, consumption occurred because of what she described as “alcohol-fuelled courage” as well as the opportunity to use. She recalled that negative stories about mephedrone in the media affected her during periods of sobriety:

“When I’m sober, yeah. No doubt about it, I’d be adamant I was never doing it again – until the next night of drinking where it [mephedrone]

became available.” (Female, late 20s)

A few males also recalled how the effects of alcohol contributed to their interest in using mephedrone:

“I had just finished a shift in work and I walked up and we went back to the house and I tried a bit…Next thing it was being called meph and you started to find out more about it and it started putting a wee bit of fear in you. But when you had a few drinks, that fear soon left you. You just forgot what the newspapers said when you had a few drinks in you…I’d never touch that [mephedrone] sober like, never.” [Male, early 30s]

Party Folk who did not plan for a particular mephedrone episode often consumed more alcohol than Party Folk who had organized mephedrone episodes well before the episode began. During his most recent experience with mephedrone, a male respondent recalled consuming between 10 and 12 beers before he ingested mephedrone that evening because “the mephedrone didn’t arrive until [late]”. Using alcohol and mephedrone during the same session was not generally viewed by Party folk as “mixing drugs”. For example, a respondent recalled her most recent use of mephedrone which occurred during the week before the interview:

Citation: O’Neill C, McElrath K (2012) Simultaneous use of Mephedrone and Alcohol: A Qualitative Study of Users’ Experiences. J Addict Res Ther S9:001. doi:10.4172/2155-6105.S9-001

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ISSN:2155-6105 JART, an open access journal J Addict Res Ther Synthetic Cathinone Abuse

“…We were getting ready for the concert. It was a real turning point for me because I would never mix it [mephedrone] with anything, but three of us had got ten E’s, four grams of mephedrone and poppers.” (Female, early 20s)

Earlier in the interview, she had described how she and a few female friends had begun to drink vodka and wine in the afternoon – “Maybe three or four [drinks] each” – as they prepared for the concert. However, the ritual of drinking prior to a “big event” was not perceived as “drug mixing,” even when mephedrone use was planned. Rather, Party folk tended to mix the two substances because alcohol use was viewed as normalized behavior in the pursuit of mind-altering leisure.

Despite several Party folk reporting that they had consumed relatively large amounts of alcohol during a mephedrone episode, “heavy” use of alcohol often temporarily subsided once the effects of mephedrone were experienced. Importantly, mephedrone was viewed favorably by several Party folk because they perceived that it helped them control the effects of alcohol and in turn extend the party:

“See a vodka and coke? You can sip it for hours. And if I’m pissed [alcohol intoxicated], meph keeps me up.” (Female, late teens)

“Meph cancels out all alcohol influence like…You can drink away like and the drink doesn’t take control. You’re not all over the place.” (Male, mid-20s)

These respondents reported that their alcohol use tended to subside after they began to feel the effects of mephedrone. Later in the evening, however, alcohol consumption increased among some Party folk, particularly when mephedrone supplies had dwindled and the effects of mephedrone began to subside:

“We were boozing before and then we took that [mephedrone] later on, mainly to keep you boozing, as we do…You can drink more, but at the same time that empty glass of mine can sit there for an hour and a half. It [mephedrone] doesn’t make me want to drink anymore like, but if I do, the drink won’t get me in a state [bad way]…When it comes to the end of a party, I’ll drink [a lot of alcohol] then.” (Male, mid-twenties)

A few Party folk noted their ability to ingest alcohol differently when using mephedrone, and suggested that heavy alcohol use enhances the effects of mephedrone:

“If I drink a lot, the meph has more of an effect. Must be something to do with the mix…and I can drink pure vodka, no problem. See normally, the vodka would sting and I couldn’t drink pure vodka. On meph I can drink it right down.” (Female, late teens)

Sippers and remedy makers

Very few respondents were identified as Sippers (n=4) or Remedy makers (n=2). Sippers preferred to ingest small amounts of alcohol while using mephedrone and rarely engaged in “heavy” alcohol use just prior to the mephedrone episode. Similar to Party folk, sippers did not generally view the combined use of alcohol and mephedrone as “mixing drugs”:

R: “You can’t drink as much alcohol. I might have a drink or two but it takes forever [to finish a drink]. Then sometimes you get drunk all of a sudden. Don’t know what that’s about. Maybe the meph’s worn off and the alcohol’s still in your system. And it just hits you – bam – ‘cause the meph’s out of your system.”

I: “Have you ever used mephedrone without using alcohol?”

R: “No, I suppose I should try that sometime. Funny, alcohol’s a big part of the drug scene. Seems I always have a drink when I’ve a night out. I really don’t think about the drink much, or maybe I just don’t think of going out without a drink in me.” (Male, late 30s)

Sippers tended to be more interested in experiencing what they perceived to be the full effects of mephedrone rather than the confounding effects of mephedrone and alcohol. Remedy makers tended to drink small amounts of alcohol but only towards the very end of the mephedrone episode – generally to ease the next-day comedown or to induce sleep:

“You can’t really drink on it [mephedrone]. I might have a couple glasses of wine the next day but not on the night I’m using it [mephedrone]…The comedown is not so brilliant…problems with the comedown. Next day I’m like a vegetable, and it’s a waste of a day really. Sunday night I finally go to sleep. Monday, I’m fine.” (Female, early 30s)

Remedy makers used alcohol as a remedy for recovery from the mephedrone episode – an antidote to some extent. Next-day use of alcohol did not necessarily prevent difficult comedowns, although Remedy makers perceived that alcohol was important for managing comedowns. Remedy makers and sippers tended to be older than Party folk, and age may have contributed to respondents’ use of alcohol during mephedrone episodes. However, although Party folk tended to be younger than sippers and remedy makers, the vast majority of respondents in all three categories were employed in full- or part-time work.

DiscussionThe aim of this qualitative study was to explore users’ perspectives

and experiences as they relate to the simultaneous use of mephedrone and alcohol.

Three main findings emerged from the data. First, most respondents who had used mephedrone had consumed it with alcohol, and some reported that they always drank alcohol while using mephedrone. Unfortunately, we did not collect self-report data on the amount of alcohol consumed during mephedrone sessions or during episodes when alcohol was consumed alone. Nor did we collect data on “usual” drinking patterns over the lifetime. Although data on alcohol use during mephedrone initiation were limited, some respondents reported consuming large amounts of alcohol immediately prior to using mephedrone for the first time. The short- and long-term effects of mephedrone are not well known, and the content of products sold as mephedrone varied considerably when the substance was available legally [38,39]. Still, study participants willingly combined mephedrone with alcohol, despite having little knowledge about the novel substance.

Second, some of the party folk believed that mephedrone “cancels out” the effects of alcohol, and the ability to drink alcohol without experiencing its full effects was perceived as beneficial. The health implications of mixing mephedrone and alcohol need further investigation. Although the subjective effects of alcohol might be minimized during mephedrone sessions, the alcohol still needs to be metabolized. The interaction between mephedrone and alcohol is not well understood, but has the potential to negatively affect how both substances are metabolized. Additionally, medical case reports have suggested that mephedrone combined with alcohol can increase the risk for cardiac dysrrythmias [40].

Third, the findings suggest the behavioral diversity of simultaneous use of mephedrone and alcohol. The data revealed three broad categories of users, whom we described as party folk, sippers, and

Citation: O’Neill C, McElrath K (2012) Simultaneous use of Mephedrone and Alcohol: A Qualitative Study of Users’ Experiences. J Addict Res Ther S9:001. doi:10.4172/2155-6105.S9-001

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remedy makers. Our combined sample was comprised largely of party folk who often consumed large amounts of alcohol immediately prior to using mephedrone. Some party folk continued using alcohol during the mephedrone episode, whereas others reduced their alcohol use in order to experience the effects of mephedrone more fully. Alcohol use preceded planned as well as spontaneous use of mephedrone. “Pre-loading” with alcohol prior to the planned use of other drugs has been described elsewhere [41]. Spontaneous or unplanned use of mephedrone often followed heavy alcohol use, thus escalating the potential for adverse health effects. Some Party folk perceived that alcohol effects provided them with the “courage” to use mephedrone. The effects of alcohol can alter judgement about “safe” consumption of other drugs [32]. Moreover, heavy alcohol use has been described as “normative behavior” in some cultures [42]; in the present study, study participants rarely described alcohol as a drug.

Combined use of alcohol and synthetic cathinones in other cultures and sub-cultures may differ from that described in this study. For example, the simultaneous use of alcohol and ecstasy has featured highly in some cultures (e.g., cities in Australia) [27], and substantially less so in others (southeast United States; San Francisco area) [23,25]. These differences might be influenced by cultural and sub-cultural norms involving alcohol use, informal social control that shapes behavior within drug scenes, as well as macro-level factors that characterize local drug markets, e.g., availability and purity of ecstasy and other illicit drugs. Still, the findings presented here suggest the importance of developing peer-led interventions to reduce harms associated with drug taking, and simultaneous polydrug use involving novel psychoactive substances. Additionally, socio-epidemiological surveys that investigate new synthetic substances and simultaneous polydrug use should consider how alcohol use can shape drug experiences and self-reporting.

Acknowledgement

We thank the individuals who participated in the studies and shared their experiences with us.

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Thisarticlewasoriginallypublishedinaspecialissue,Synthetic Cathinone Abuse handledbyEditor(s).Dr.M.FosterOlive,ArizonaStateUniversity,USA