Glossary of Drugs

The Effects of Alcohol

Just the Facts: Alcohol is the most widely used and abused drug in America. Alcoholism is one of the most preventable illnesses; yet 7 out of 10 adults drink alcohol. Of these, one out of seven is an alcoholic.

What is Alcoholism?

Alcoholism is a primary, chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.

Alcoholism is a progressive illness that can be treated. Each alcoholic has a different drinking pattern, but the one thing all alcoholics have in common is an uncontrollable drinking habit.

Alcoholism has three distinct stages:

* Early Stage. A person in the early stage of alcoholism uses alcohol as a coping device to relieve tension or escape from problems. The alcoholic must drink more and more to achieve the same effect and has trouble stopping after one drink. The alcoholic makes promises to quit drinking but never follows through.

* Middle Stage. An alcoholic in the middle stage of alcoholism cannot get through the day without alcohol and may need a drink in the morning to overcome the “shakes.” The middle-stage alcoholic will begin to manipulate others, lie about drinking, and may drink in secret or hide alcohol. It is harder and harder to get the same effects as tolerance increases. Irregular heart beat, hypertension, loss of appetite, irritability and insomnia are physical and psychological problems at this stage. The alcoholic denies that drinking is a problem.

* Late Stage. The alcoholic now lives to drink and avoids and distrusts others. All ambition is lost and the drinker is unable to cope with responsibility and is often absent from work. A late-stage alcoholic may suffer from reverse tolerance: the brain and liver can no longer tolerate a high level of alcohol, so the drinker becomes impaired after even small amounts of alcohol. Malnutrition, nerve dysfunction, loss of memory, mental confusion, impaired vision, hypertension, heart disease and cirrhosis of the liver can occur during this stage. If drinking stops, there severe withdrawal reactions. Late-stage psychological problems include shame, guilt, severe depression, violent behavior, low self-esteem, loss of control of emotions, loss of concentration and learning ability. At this point, the alcoholic “hits bottom.” The alcoholic may continue to drink despite pain or disability. The only viable alternative is to seek treatment. Seeking treatment at an early stage of alcoholism will prevent a loss of many things that are constituted with a bottom.

Long-Term Effects of Alcohol

Frequent and prolonged use of alcohol has many detrimental effects on the body. Heavy drinkers develop a tolerance for alcohol, which means that larger amounts of alcohol are needed to get the desired effect. A drinker is physically dependent if withdrawal symptoms are experienced when alcohol use is discontinued abruptly. Symptoms vary but include delirium tremors (the “DTs”), cramps, vomiting, elevated blood pressure, sweating, dilated pupils, sleep problems, irritability and seizures. Most of these symptoms will subside in two to three days, though irritability and insomnia may last two to three weeks or longer. Psychological dependence occurs when the drinker becomes so preoccupied with alcohol that it is difficult to do without it. Short-term memory loss and blackouts are common among heavy drinkers. A blackout, which is an amnesia-like period often confused with passing out or losing consciousness, results when the drinker appears normal and may function normally; however, the person has no memory of what has taken place. Research indicates that blackouts are associated with alcoholism, and there is a correlation between the extent and duration of alcohol consumption during any given drinking episode and the occurrence of blackouts.

Medical Complications of Heavy Alcohol Use GASTROINTESTINAL SYSTEM

Alcohol acts as an irritant and increases the amount of hydrochloric acid (a digestive juice) that is secreted from the stomach lining. Intoxicating amounts of alcohol cause the digestive process to stop, robbing the body of vital vitamins and minerals. Alcohol in combination with other stomach irritants such as aspirin can cause gastritis, ulcers and severe bleeding.

Liver Disorders

The liver maintains the blood sugar level in the body. This sugar (glucose) is the only source of energy that brain cells can use. When alcohol is consumed, the liver’s attention is diverted from maintaining the sugar level to ridding the body of the alcohol, thus denying the brain the energy it needs to function properly.

Liver disorders associated with heavy alcohol use are:

* Fatty liver, which gets its name from the deposits of fat that build up in normal liver cells. It is caused by the decreased breakdown of fatty acids by the liver and occurs when 30 to 50 percent or more of the drinker’s dietary calories consist of alcohol. Acute fatty liver is reversible it alcohol use is stopped.

* Alcoholic hepatitis, which often follows a severe or prolonged bout of heavy drinking. The liver becomes inflamed, damaging many liver cells, and metabolism is seriously disturbed. Symptoms include jaundice (yellowish color of the skin and whites of the eyes), weakness, loss of appetite, nausea, vomiting, low-grade fever, dark urine, and mild weight loss. Alcoholic hepatitis is usually reversible with abstinence from alcohol. In some drinkers, it can be fatal or can become chronic. Alcoholic hepatitis precedes alcoholic cirrhosis in some cases.

* Cirrhosis of the liver, a condition in which there is major destruction of liver cells and
build-up of scar tissue. One in 10 long-term heavy drinkers eventually develops cirrhosis of the liver. Because of the irreversible damage caused, a person with cirrhosis will most likely die within five years.

Heart Disease

Moderate drinking causes a significant rise in blood pressure. Heavy alcohol use is an important factor in causing high blood pressure and an enlarged heart, which increase the risk of heart attack and stroke. As few as two drinks a day can lead to impaired muscle functioning of the heart.

Reproduction and Pregnancy

Effects of heavy alcohol use include missed menstrual periods in women and diminished libido (sexual desire) and possible sterility in men. A woman who drinks alcohol during pregnancy risks the health of her unborn child. Alcohol passes freely through the placenta, creating a level in the fetus almost identical to that in the mother. Babies whose mothers drink frequently or heavily during pregnancy may be born with serious birth defects. These defects are termed Fetal Alcohol Syndrome (FAS), or Fetal Alcohol Effects (FAE), which include babies affected by alcohol but without the full set of FAS characteristics. These characteristics are low birth weight, physical deformities, heart defects, joint and limb deformities, heart defects, and mental retardation. FAE complications include spontaneous abortion, stillbirth delivery, low birth weight, neurobehavioral abnormalities, mental retardation, cerebral palsy and learning disorders.

Treating Alcoholism

The sooner alcoholism is detected, the better the chances of recovery. There are several effective treatment methods for alcoholism, and what works for one person may not work for another. Many options should be explored when seeking help. Local or state health organizations or insurance companies can be contacted to find out what treatment alternatives exist in each community.

The important part of seeking treatment is the motivation and determination of the alcoholic to recover. It is also important for the family of the alcoholic to participate in treatment in order to understand the alcoholic’s problems and how family members also have been affected by alcohol.

What are the effects of benzodiazepines?

The benzodiazepines (BZD’s) are a relatively new family of depressant drugs, discovered in 1957 and introduced throughout the world in the 1960s and 1970s. Although the drugs first found fame for their “anxiolytic” (or anxiety-reducing) effects, they’re also prescribed as muscle relaxants, anticonvulsants, and sleeping pills. In general, though, the drugs are more alike than different. Their main differences involve how quickly they go to work and the length of time they remain active in the body.

What are some common BZD’s?

Although Valium ranked for years as the leading benzodiazepine (and at one time was the best-selling prescription drug in America), it’s been slipping lately, a victim of its own success–and its failure at being trouble- and addiction-free.

Today, the top-selling tranquilizer in the United States is Xanax, and another benzodiazepine, Halcion, is one of the most widely-used prescription sleeping pills. They’re the two biggest slices in the benzodiazepine marketing “pie,” which, according to the American Psychiatric Association, accounts for about 61 million prescriptions a year.

Down but not out, Valium (and its generic equivalent, diazepam) is still widely prescribed and still probably the best-known member of the family. Other common BZD’s include Klonopin®, Ativan®, Serax®, Centrax®, and Tranxene®.

What are their main effects?

The benzodiazepines’ main therapeutic effects–to reduce anxiety and induce sleep–are the same as other depressant drugs, with a difference: BZD’s target receptors in the limbic region of the brain (a system involved in emotional regulation and control) instead of depressing activity throughout the central nervous system that doesn’t mean they’re harmless.

You mean they’re not safe?

Not necessarily. When taken as directed for short periods (no more than two months, in the case of tranquilizers, and two weeks, for sleeping pills), most BZD’s are relatively safe. Still, they’re not safe for everyone, all the time.

When taken for longer periods or at high doses they can be particularly risky. They can also be dangerous when used with alcohol–even small amounts of alcohol. And certain BZD’s–particularly Halcion and Xanax–are being linked to a number of serious side effects, including depression, hallucinations, amnesia, and violence. In fact, one study by the U.S. Food and Drug Administration ranked Halcion and Xanax first and second in episodes of violence traced to 329 different prescription drugs. Experts are unsure why the drugs cause such problems

Are other risks linked to BZD’s?

As a matter of fact, there are. Probably the most obvious –and most likely, for most users–is the risk of dependence that comes with the drugs. Dependence is a risk factor so often because the drugs block the experience of anxiety so well that many users forget they can (and should) try to live without their daily ration of Valium or Xanax or Tranxene. And they should try for the simple reason that benzodiazepines are addictive, and putting your life back together after a bout with BZD dependence can be an agonizing experience.

What makes getting off so tricky?

For one thing, users often don’t realize they’re getting hooked until they are hooked. They just know they have to have a hit of Valium or Tranxene or something every few hours to hold things together–not even to get high, since most BZD users don’t take the drugs to get high, but merely to cope. It’s only when the drug stops working, when tolerance builds and they have to step up the dosage just to avoid freaking out (often in the most mundane situations), that most people begin to suspect they have a problem. Unfortunately, most suspect their problem is anxiety or insomnia or whatever they started taking tranquilizers to deal with in the first place–not benzodiazepine dependency.

Is addiction serious?

Yes–and unpleasant, too. But how serious and how unpleasant depends on the drug involved and other factors. With the short-acting benzodiazepines withdrawal symptoms appear almost immediately and are difficult from the start. With longer-acting drugs (like Valium or Centrax), symptoms build gradually and may not reach a peak for several days. Still, no matter how long they take to arrive, benzodiazepine withdrawal symptoms are similar, regardless of the drug involved. Main symptoms include high (even intense) levels of anxiety, insomnia, tension, tremors, and fatigue. The main factor that determines the course of withdrawal is the pattern of use involved.

Dependency resulting from short-term, high-dose use follows much the same course as withdrawal from other downer drugs. Symptoms start and peak fast, usually within one to four days, and begin to wind down within two to three weeks.

Long-term, low-dose use is more typical for more users, though, and presents a different situation altogether. Symptoms may not be as immediately intense, for example, but may hang around a whole lot longer.

Is withdrawal really that bad?

Not if you do it right–and get professional help. But it can miserable, if you do it wrong. The fact is that benzodiazepine withdrawal can be a soul-wrenching experience simply because it unmasks so many emotional and psychological symptoms. What’s worse is that many users don’t recognize withdrawal symptoms for what they are–signs of chemical dependency–but see them instead as personal inadequacy or a recurrence of the original problem that gave rise to the dependency. One frequent result is that they think of themselves as defective and use that belief as a reason to stay addicted.

On top of that, potentially serious physical problems–particularly seizures–can also develop during withdrawal, especially following a long-term period of high-dose use. That’s why it’s usually wise to seek professional help during withdrawal. Doctors can help reduce the risk of convulsions and the severity of other symptoms by gradually reducing dosage or switching from a fast-acting drug to a slow-acting one, then reducing dosage. But with help or without, getting off benzodiazepines takes a lot longer than getting on them does.

How long does it take to get off?

Typically, the full range of withdrawal symptoms last about six weeks and run a two-phased course. This means that symptoms may seem to ease during the second week, only to get worse again during the third week of withdrawal. In addition, different symptoms can emerge at different times: Physical symptoms usually occur during the first phase of withdrawal, while psychological symptoms can hang on for weeks or months. But regardless of which problems occur (and when they kick in), withdrawal from BZD’s is a difficult process and one that some recovering addicts say can take months to complete. In fact, some long-term ex-users report not feeling completely on top of their dependence–and fully in charge of their lives again–for up to a year after they stop using.

Alternative: Action

One of the biggest dangers of the benzodiazepines is their ability to reinforce what psychologists call “learned helplessness”–the tendency on the part of stressed-out people to throw up their hands and simply do nothing, believing that nothing they do will make much of a difference, anyway. The problem with that thinking is that we all need to learn the exact opposite–to be powerful to the degree that we can be to take charge of the events and circumstances of our lives.

In fact, the ultimate lesson that an anxious person, whether a BZD user or not, can learn is the ancient prayer: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Those are the key ingredients, simple as they sound, to beating anxiety and overcoming addiction: resisting it and learning to change the areas of our lives that contribute to it. It may sound easy, but it isn’t. But, come to think of it, it’s a lot easier than living life as a nervous wreck–or as a Valium or Xanax addict.

The Effects of Club Drugs

Ecstasy, Herbal Ecstasy, Rohypnol, GHB, and Ketamine are among the drugs used by teens and young adults who are part of a nightclub, bar, rave, or trance scene. Raves and trance events are generally night-long dances, often held in warehouses. Many who attend raves and trances do not use drugs, but those who do may be attracted to the generally low cost, seemingly increased stamina, and intoxicating highs that are said to deepen the rave or trance experience. Recent hard science, however, is showing serious damage to several parts of the brain from use of these drugs.

Many users tend to experiment with a variety of club drugs in combination. Also, combinations of any of these drugs with alcohol can lead to unexpected adverse reactions and death. Club drugs are an increasing challenge for treatment programs. Many teens and young adults enter treatment with a number of these drugs and alcohol, rather than a single drug, as their primary problem.

Club drug use appears to be increasing in many cities around the country,* with Atlanta, Seattle, Chicago, Detroit, Miami, and Newark reporting widespread use at rave and club scenes. A recently completed survey in the Seattle area found that 20 percent of young, gay men reported using Ecstasy. GHB is the drug of choice among white, gay males in New Orleans’ French Quarter and is popular among high school and college students. Ecstasy MDMA, called “Adam,” “Ecstasy,” or “XTC,” on the street, is a synthetic, psychoactive drug with hallucinogenic and amphetamine-like properties.

Many problems MDMA users encounter are similar to those found with the use of amphetamines and cocaine. Psychological difficulties can include confusion, depression, sleep problems, severe anxiety, and paranoia. Physical problems can include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Use of the drug has also been associated with increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease. Recent research also links Ecstasy use to long-term damage to those parts of the brain critical to thought, memory, and pleasure.

Rohypnol, GHB, and Ketamine

Rohypnol, GHB, and Ketamine are predominantly central nervous system depressants. Because they are often colorless, tasteless, and odorless, they can be easily added to beverages and ingested unknowingly. These drugs have emerged as the so called “date rape” drugs.

Because of concern about these abused sedative-hypnotics, Congress passed the “Drug-Induced Rape Prevention and Punishment Act of 1996” in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault.

Rohypnol

Rohypnol, a trade name for flunitrazepam, has been of particular concern for the last few years because of its abuse in date rape. When mixed with alcohol, Rohypnol can incapacitate a victim and prevent them from resisting sexual assault. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants.

In addition to sedative-hypnotic effects including muscle relaxation and amnesia, Rohypnol can produce physical and psychological dependence. In Miami – one of the earliest sites of Rohypnol abuse – poison control centers report an increase in withdrawal seizures among people addicted to Rohypnol. Rohypnol is not approved for use in the United States and its importation is banned. Illicit use of Rohypnol began in Europe in the 1970s and started appearing in the United States in the early 1990s, where it became known as “rophies,” “roofies,” “roach,” and “rope.” Another very similar drug is now being sold as “roofies” in Miami, Minnesota, and Texas. This is clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril. It is sometimes abused to enhance the effects of heroin and other opiates. Based on emergency room admission information, Boston, San Francisco, Phoenix, and Seattle appear to have the highest use rates of clonazepam.

GHB

Since about 1990, GHB (gamma hydroxy-butyrate) has been abused in the U.S. for euphoric, sedative, and anabolic (body building) effects. It is a central nervous system depressant that was widely available over-the-counter in health food stores during the 1980s, purchased largely by body builders to aid fat reduction and muscle building. As with Rohypnol and clonazepam, GHB has been associated with sexual assault in cities throughout the country.

GHB has not been sold over-the-counter in the U.S. since 1992. However products containing gamma butyrolactone (GBL), a chemical that is converted by the body into GHB, are used in a number of dietary supplements in health food stores and gymnasiums.

Reports from Detroit indicate liquid GHB is being used in nightclubs for effects similar to those of Rohypnol. It is also common in the club scene in Phoenix, Honolulu, and Texas, where it is known as “liquid ecstacy,” “somatomax,” “scoop,” “Georgia Home Boy,” or “grievous bodily harm.” In Miami, poison control center calls have reflected problems associated with increased GHB use, including loss of consciousness. In New York City, there have been reports of GHB use among those in the fashion industry. GHB is one of the most popular manufactured drugs in Atlanta. It is available in some gyms and reputed to be widely accessible at some gay male party venues. A Poison Control Center in Denver reports that in 1998, 33 calls involved GHB, and almost half of these cases were considered life threatening. GHB accounts for an increasing number of sexual assault cases in Los Angeles and overdose deaths involving drug combinations. Coma and seizures can occur following abuse of GHB and, when combined with methamphetamine, there appears to be an increased risk of seizure. Combining use with other drugs such as alcohol can result in nausea and difficulty breathing. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating.

Ketamine

Ketamine is another central nervous system depressant abused as a “date rape” drug. Ketamine, or “Special K,” is a rapid-acting general anaesthetic. It has sedative-hypnotic, analgesic, and hallucinogenic properties. It is marketed in the U.S. and a number of foreign countries for use as a general anesthetic in both human and veterinary medical practice. It is similar to phencyclidine (PCP), although ketamine has a more rapid onset and is less potent. Depending on the dose, ketamine induces everything from feelings of pleasant weightlessness to full-fledged out-of-body or near-death experiences. Ketamine is reportedly used as an alternative to cocaine and is generally snorted. Ketamine abuse has been reported in many cities around the country. It has been reportedly stolen from veterinary supply sources in Minnesota, Louisiana, and Michigan. In Miami, ketamine has been diverted from shipments intended for other countries. Ketamine is widely available in New York City where it sells for about $20 a dosage unit. A small but stable market for ketamine has been established in suburban areas outside Baltimore. Three ketamine deaths were reported in New Orleans in 1998, and the Detroit Poison Control Center reported six ketamine contacts in early 1999

Cocaine and Crack-Cocaine–Effects of Cocaine Use

It is profoundly unwise to take crack-cocaine. The brain has evolved a truly vicious set of negative feedback mechanisms. Their functional effect is to stop us from being really happy for long. The initial short-lived euphoria of a reinforcer as powerful as crack will be followed by a “crash”. This involves anxiety, depression, irritability, extreme fatigue and possibly paranoia. Physical health may deteriorate. An intense craving for more cocaine develops. In heavy users, stereotyped compulsive and repetitive patterns of behaviour may occur. So may tactile hallucinations of insects crawling underneath the skin (“formication”). Severe depressive conditions may follow; agitated delirium; and also a syndrome sometimes known as toxic paranoid psychosis.

The social consequences of heavy cocaine use can be equally unpleasant. Users are likely eventually to alienate family and friends. They tend to become isolated and suspicious. Most of their money and time is spent thinking about how to get more of the drug. The compulsion may become utterly obsessive. The illusion of free-will is likely to disappear. During a “mission”, essentially a 3-4 day crack-binge, users may consume up to 50 rocks a day. Whereas “empathogens” such as ecstasy – which trigger the release of far more serotonin than dopamine – will typically promote empathy, trust, compassionate love and sociability, mainly dopaminergic drugs, if taken on their own and to excess, can easily have the reverse effect. Simplistically, cocaine tends to be a “selfish” drug.

Commonly Asked Questions about the Effects of Heroin

What is it?

Heroin is a highly addictive drug derived from morphine, which is obtained from the opium poppy. It is a “downer” that affects the brain’s pleasure systems and interferes with the brain’s ability to perceive pain.

What are its short-term effects?

The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, users report feeling a surge of euphoria (?rush?) accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes ?on the nod,? an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Other effects included slowed and slurred speech, slow gait, constricted pupils, droopy eyelids, impaired night vision, vomiting, and constipation.

What are its long-term effects?

Long-term effects of heroin appear after repeated use for some period of time. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulites, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heron?s depressing effects on respiration. In addition to the effects of the drug itself, street heroin may have additives that do not really dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.
With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (?cold turkey?), kicking movements (?kicking the habit?), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.

Commonly Asked Questions About Marijuana

Q: How long does marijuana stay in the user’s body?
A: THC in marijuana is strongly absorbed by fatty tissues in various organs. Generally, traces (metabolites) of THC can be detected by standard urine testing methods several days after a smoking session. However, in heavy chronic users, traces can sometimes be detected for weeks after they have stopped using marijuana.

Q: What are the short-term effects of marijuana use?
A: The short-term effects of marijuana include:

  • problems with memory and learning
  • distorted perception (sights, sounds, time, touch)
  • trouble with thinking and problem-solving
  • loss of coordination
  • increased heart rate, anxiety

These effects are even greater when other drugs are mixed with the marijuana; and users do not always know what drugs are given to them.

Q: Does marijuana affect work, school, sports, or other activities?
A: It can. Marijuana affects memory, judgment and perception. The drug can make you mess up in work, school, or in sports. If you’re high on marijuana, you are more likely to make stupid mistakes that could hurt yourself or othres. If you use marijuana a lot, you could start to lose interest in your appearance and how you’re doing at school or work. Athletes could find their performance is off; timing, movements, and coordination are all affected by THC.

Q: What are the long-term effects of marijuana use?
A: Findings so far show that regular use of marijuana or THC may play a role in some kinds of cancer and in problems with the respiratory, immune, and reproductive systems.

Cancer
It is known that marijuana contains some of the same, and sometimes even more, of the cancer-causing chemicals found in tobacco smoke. Studies show that someone who smokes five joints per week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.

Lungs and airways
People who smoke marijuana often develop the same kinds of breathing problems that cigarette smokers have: coughing and wheezing. They tend to have more chest colds than nonusers. They are also at greater risk of getting lung infections like pneumonia.

Immune system
Animal studies have found that THC can damage the cells and tissues in the body that help protect people from disease. When the immune cells are weakened, you are more likely to get sick.

Q: Does marijuana lead to the use of other drugs?
A: It could. Long-term studies of drug use show that very few people use other illegal drugs without first trying marijuana. For example, the risk of using cocaine is 104 times greater for those who have tried marijuana than for those who have never tried it. Using marijuana puts children and teens in contact with people who are users and sellers of other drugs. So there is more of a risk that a marijuana user will be exposed to and urged to try more drugs.
To better determine this risk, scientists are examining the possibility that long-term marijuana use may create changes in the brain that make a person more at risk of becoming addicted to other drugs, such as alcohol or cocaine. While not all people who use marijuana go on to use other drugs, further research is needed to predict who will be at greatest risk.

Q: How does marijuana affect driving?
A: Marijuana has serious harmful effects on the skills required to drive safely: alertness, the ability to concentrate, coordination, and the ability to react quickly. These effects can last up to 24 hours after smoking marijuana. Marijuana use can make it difficult to judge distances and react to signals and sounds on the road.
Marijuana may play a role in car accidents. In one study conducted in Memphis, TN, researchers found that, of 150 reckless drivers who were tested for drugs at the arrest scene, 33 percent tested positive for marijuana, and 12 percent tested positive for both marijuana and cocaine. Data have also shown that while smoking marijuana, people show the same lack of coordination on standard “drunk driver” tests as do people who have had too much to drink..

Q: What does marijuana do to the brain?
A: Some studies show that when people have smoked large amounts of marijuana for years, the drug takes its toll on mental functions. Heavy or daily use of marijuana affects the parts of the brain that control memory, attention, and learning. A working short-term memory is needed to learn and perform tasks that call for more than one or two steps.
Smoking marijuana causes some changes in the brain that are like those caused by cocaine, heroin, and alcohol. Some researchers believe that these changes may put a person more at risk of becoming addicted to other drugs, such as cocaine or heroin. Scientists are still learning about the many ways that marijuana could affect the brain.

Q: Can people become addicted to marijuana?
A: Yes. While not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent or addicted to the drug. In 1995, 165,000 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they need help to stop using the drug.
According to one study, marijuana use by teenagers who have prior serious antisocial problems can quickly lead to dependence on the drug.
Some frequent, heavy users of marijuana develop a tolerance for it. “Tolerance” means that the user needs larger doses of the drug to get the same desired results that he or she used to get from smaller amounts.

Q: What if a person wants to quit using the drug?
A: Up until a few years ago, it was hard to find treatment programs specifically for marijuana users.
Now researchers are testing different ways to help marijuana users abstain from drug use. There are currently no medications for treating marijuana addiction. Treatment programs focus on counseling and group support systems. There are also a number of programs designed especially to help teenagers who are abusers. Family doctors are also a good source for information and help in dealing with adolescent marijuana problems.

The Effects of Methamphetamine

Methamphetamines are synthetic amphetamines or stimulants that are produced and sold illegally in pill form, capsules, powder, and chunks. Methamphetamines stimulate the central nervous system, and the effects may last anywhere from 8 to 24 hours.

Short Term Effects

  • increased alertness
  • sense of well-being
  • paranoia
  • intense high
  • hallucinations
  • aggressive behavior
  • increased heart rate
  • convulsions
  • extreme rise in body temperature (as high as 108 degrees which can cause brain damage and death)
  • uncontrollable movements (twitching, jerking, etc…)
  • violent behavior
  • insomnia
  • impaired speech
  • dry, itchy skin
  • loss of appetite
  • acne, sores
  • numbness

Effects on the Mind

  • disturbed sleep
  • excessive excitation
  • excessive talking
  • panic
  • anxiousness
  • nervousness
  • moodiness and irritability
  • false sense of confidence and power
  • delusions of grandeur leading to aggressive behavior
  • uninterested in friends, sex, or food
  • aggressive and violent behavior
  • severe depression

Long Term Affects

  • fatal kidney and lung disorders
  • possible brain damage
  • depression
  • hallucinations
  • disorganized lifestyle
  • permanent psychological problems
  • violent and aggressive behavior
  • weight loss
  • insomnia
  • behavior resembling paranoid schizophrenia
  • decreased social life
  • malnutrition
  • poor coping abilities
  • disturbance of personality development
  • lowered resistance to illnesses
  • liver damage
  • stroke
  • death

Methamphetamines cause a severe crash after the effects wear off. The crash, or low feeling is more intense and longer lasting than cocaine. The effects are not only long lasting, but continue to cause damage to the user long after use has stopped. Methamphetamine abuse can also lead to legal, financial, and social problems.

Addiction to methamphetamine can be very strong; therefore withdrawal symptoms are likely when use of the drug is discontinued.

Withdrawal Symptoms

  • severe craving
  • insomnia
  • restlessness
  • mental confusion
  • depression

Although a person addicted to methamphetamines experience withdrawal symptoms for a short time, the benefits to a person who stops using the drug greatly outweigh an addiction to methamphetamines. These benefits include a longer, healthier life and greater enjoyment of everyday activities.

Effects on Society

  • car crashes
  • crimes
  • fires due to explosions from the illegal manufacture of methamphetamines
  • hazardous waste

Pregnancy and Methamphetamine
If methamphetamines are used during pregnancy, babies tend to be:

  • asocial
  • incapable of bonding
  • have tremors
  • have birth defects
  • cry for 24 hours without stopping

There is also an increased risk of child abuse and neglect of children born to parents who use methamphetamines.

BUPRENORPHINE
(Trade Names: Buprenex, Suboxone, Subutex)

Introduction:
Buprenorphine was first marketed in the United States in 1985 as a schedule V narcotic analgesic. Until recently, the only available buprenorphine product in the United States has been a low-dose (0.3 mg/ml) injectable formulation under the brand name, Buprenex. Diversion, trafficking and abuse of other buprenorphine products have occurred in Europe and other areas of the world.

In October 2002, the Food and Drug Administration (FDA) approved two buprenorphine products (Suboxone and Subutex) for the treatment of narcotic addiction. Both products are high dose (2 mg and 8 mg) sublingual (under the tongue) tablets: Subutex is a single entity buprenorphine product and Suboxone is a combination product with buprenorphine and naloxone in a 4:1 ratio, respectively. After reviewing all the available data and receiving a schedule III recommendation from the Department of Health and Human Services (DHHS), the DEA placed buprenorphine and all products containing buprenorphine into schedule III in 2002. Since 2003, diversion, trafficking and abuse of buprenorphine have become more common in the United States.

Licit Uses:
Buprenorphine is intended for the treatment of pain (Buprenex) and opioid addiction (Suboxone and Subutex). In 2001, 2005, and 2006, the Narcotic Addict Treatment Act was amended to allow qualified physicians, under certification of the DHHS, to prescribe schedule III-V narcotic drugs (FDA approved for the indication of narcotic treatment) for narcotic addiction, up to 30 patients per physician at any time, outside the context of clinic-based narcotic treatment programs (Pub. L. 106-310). This limit was increased to 100 patients per physician, for physicians who meet the specified criteria, under the Office of National Drug Control Policy Reauthorization Act (P.L. 69-469, ONDCPRA), which became effective on December 29, 2006.

Suboxone and Subutex are the only treatment drugs that meet the requirement of this exemption. Currently, there are nearly 15,700 physicians who have been approved by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the DEA for office-based narcotic buprenorphine treatment. Of those physicians, approximately 13,150 were approved to treat up to 30 patients per provider and about 2,500 were approved to treat up to 100 patients. More than 3,000 physicians have submitted their intention to treat up to 100 patients per provider. IMS Health National Prescription Audit Plus data indicate that 3.54 million buprenorphine prescriptions were dispensed in the US in 2008, compared to 2.12 million prescriptions in 2007.

Chemistry/Pharmacology:
Buprenorphine has a unique pharmacological profile. It produces the effects typical of both pure mu agonists (e.g., morphine) and partial agonists (e.g., pentazocine) depending on dose, pattern of use and population taking the drug. It is about 20-30 times more potent than morphine as an analgesic; and like morphine it produces dose-related euphoria, drug liking, pupillary constriction, respiratory depression and sedation. However, acute, high doses of buprenorphine have been shown to have a blunting effect on both physiological and psychological effects due to its partial opioid activity.

Buprenorphine is a long-acting (24-72 hours) opioid that produces less respiratory depression at high doses than other narcotic treatment drugs. However, severe respiratory depression can occur when buprenorphine is combined with other central nervous system depressants, especially benzodiazepines. Deaths have resulted from this combination. The addition of naloxone in the Suboxone product is intended to block the euphoric high resulting from the injection of this drug by non-buprenorphine maintained narcotic abusers.

User Population:
In countries where buprenorphine has gained popularity as a drug of abuse, it is sought by a wide variety of narcotic abusers: young naive individuals, non-addicted opioid abusers, heroin addicts and buprenorphine treatment clients.

Illicit Uses:
Like other opioids commonly abused, buprenorphine is capable of producing significant euphoria. Data from other countries indicate that buprenorphine has been abused by various routes of administration (sublingual, intranasal and injection) and has gained popularity as a heroin substitute and as a primary drug of abuse. Large percentages of the drug abusing populations in some areas of France, Ireland, Scotland, India, Nepal, Bangladesh, Pakistan, and New Zealand have reported abusing buprenorphine by injection and in combination with a benzodiazepine.

According to the National Forensic Laboratory Information System (NFLIS), drug items/exhibits submitted and identified as buprenorphine in state and local laboratories increased from 229 in 2004 to 4,245 in 2008. DEA laboratories identified 5 buprenorphine items/exhibits in 2004 and 49 in 2008. Buprenorphine now ranks among the top 25 most frequently identified substances analyzed in federal, state, and local laboratories according to NFLIS. According to the 2006 Drug Abuse Warning Network (New DAWN ED) survey, an estimated 4,440 emergency room visits were associated with buprenorphine misuse.

Control Status:
Buprenorphine and all products containing buprenorphine are controlled in Schedule III of the Controlled Substances Act.

Comments and additional information are welcomed by the Office of Diversion Control, Drug and Chemical Evaluation Section. Fax 202-353-1263, telephone 202-307-7183, or Email ODE@usdoj.gov.

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