Title:

  Drugs of Abuse: Their Actions & Potential Hazards
 Author:   Samuel Irwin, Ph.D.
Publisher:   Do It Now Foundation

 Publication Date:

  September 2003

 Catalog No:

  203

Chapter 3: Over-the-Counter Drugs

Alcohol

Examples: Wine, beer, whiskey, and spirits.

Actions: Alcohol is a central nervous system (CNS) depressant that alters a variety of activities in the brain. It produces anesthesia, coma, respiratory depression, and death at dosage levels 10 times above the psychoactive dose. Other effects include:

Low Dose: One or two drinks (0.05 percent blood-alcohol level).* Feelings of relaxation and well-being, reduced reflex reactions, impaired driving skills.

Moderate Dose: Two to four drinks (0.10% BAL). Slurred speech, impaired judgment and coordination, reduced inhibitions, decreased emotional control.

High Dose: Large quantities (0.15% BAL). Gross intoxication, clearly-impaired gait, problems in thinking and memory, distorted judgment, emotional instability, aggression.

Alcohol carries a high risk of psychological and physical dependence with regular use. Tolerance develops to its depressant effects, and withdrawal symptoms occur within a few hours of heavy use -- contributing to the hangover symptoms suffered by many drinkers.

Medical Uses: To sedate, promote sleep, and provide a medium for other therapeutic agents (e.g. elixirs, cough syrups, etc.). Alcohol is often self-administered to treat numerous ailments, including head colds, anxiety, and insomnia.

Main Dangers: Short-term hazards arise from impaired judgment, poor coordination, emotional instability, and risk of death by overdose (alcohol alone or in combination with other drugs).

Long-term dangers include irreversible damage to body tissue (brain, liver, pancreas, kidneys), memory problems, and nutritional deficiencies.

The drug also poses high risks of fetal damage -- so much so that by law, alcohol producers must add warning labels to their bottles cautioning women against use during pregnancy.

Withdrawal Symptoms: Alcoholic withdrawal symptoms set in about three hours after the last drink. Early signs include tremors, nausea, anxiety, perspiration, cramps, hallucinations, and hyper-reflex reactions. A second phase, beginning within 24 hours, can involve convulsions.

The most severe form of withdrawal -- delirium tremens ("DT's") -- involves dangerously high fever, rapid heartbeat, hallucinations and delirium. Death can result from cardiac failure.

Alcoholic withdrawal is considered more life-threatening than withdrawal from heroin. Because of the risk of complications, particularly in the DT phase, withdrawal following extensive, long-term use should only be attempted under medical supervision.

Signs of Use: Incoordination, slurring of speech, emotional instability, decreased inhibitions, stupor.

Tobacco

Examples: Examples: Cigarettes, cigars, snuff, smokeless tobacco.

Actions: Tobacco's main active ingredient is nicotine. An average cigarette yields 0.05-2.5mg of the drug; cigars can contain 120mg. Smokeless tobacco products contain 6.9-14.4mg nicotine and produce similar blood-nicotine levels as smoked tobacco. Cigarette smoke also contains 1-5% carbon monoxide, and delivers 0.5-35mg of tar.

Nicotine exerts an immediate stimulant effect on the brain and central nervous system followed by a longer-lasting depressant action on the autonomic nervous system. Nicotine produces constriction of blood vessels, loss of appetite, and a sharp rise in blood pressure and heart rate.

Demographics: Movement away from tobacco has stopped, a reversal of a trend that began with the Surgeon General's first warning of the link between smoking and lung cancer in 1964. Today, 29.5 percent of American adults smoke, down from 43 percent in the mid-1960s, but up from 26 percent in 1994.

That means that more than 56 million Americans still smoke cigarettes, while 7 million more use snuff or smokeless tobacco.

Medical Uses: None. Nicotine is one of the most toxic of all drugs. Just a few drops of pure nicotine are lethal to adults.

Main Dangers: Tobacco is linked with more serious health problems than nearly all other psychoactive drugs, directly causing an estimated 440,000 U.S. deaths in 2002.

Dependence: Researchers -- and ordinary smokers -- have long known that smoking produces a high level of psychological dependence. But a 1988 Surgeon General's report went even further, describing nicotine as one of the most addictive of all drugs, producing true physical dependence in users.

Disease: Chronic smoking is causally linked to cancer (of the lungs, larynx, and mouth), heart disease, and respiratory problems, including bronchitis and pulmonary emphysema. Users of smokeless tobacco face a four times greater risk of cancers of the throat and mouth than nonusers, particularly with long-term use.

Pregnancy Effects: Risks of low birth weight, premature birth, and early fetal death (20-35 percent over nonsmokers). About 66 percent of all crib deaths (Sudden Infant Death Syndrome) in the U.S. may be attributable to tobacco use during pregnancy.

Withdrawal Symptoms: Can include irritability, anxiety, headaches, energy loss, problems in concentrating, drowsiness or insomnia, cramps, hunger, and tremors. While most successful efforts to stop depend largely on will power, nicotine-containing gum (Nicorette®) is helpful in reducing tobacco cravings and relieving withdrawal.

Signs of Use: Discolored fingertips, cough.

Inhalants

There are two main categories of inhalants, volatile solvents (and aerosols) and the nitrites group, which includes amyl and butyl nitrite (and their act-alike chemical cousins) and nitrous oxide.

Chemicals in the first group are most often used by young adolescents and those with limited access to other substances, while young adults are more likely to use nitrous oxide or the nitrites.

Volatile Solvents & Aerosols

Examples: Solvents: glue (toluene), typewriter correction fluid, gasoline, butane, paint thinner, lighter fluid, nail polish remover. Aerosols: spray paint, cooking sprays.

Actions: Volatile solvents and aerosols are CNS depressants that cause an alcohol-like intoxication. Effects last from 15 minutes to a few hours, and can include dizziness and exhilaration and sensations of floating.

Perceptual changes are often accompanied by reckless or aggressive behavior, a breakdown of inhibitions, and feelings of heightened power. Visual and sensory hallucinations may also occur.

Demographics: Solvents are used primarily by younger children and teens, typically from about age seven to 15. One 2002 national survey found that while only 4.5 percent of high-school seniors admitted using the chemicals during the previous year, 7.7 percent of 8th-graders did.

Aerosol use is much less prevalent today than in the past due to regulations mandating replacement of intoxicating (and environmental-destructive) propellants with nonintoxicating gases such as nitrogen and carbon dioxide.

Medical Uses: The solvents are generally too toxic for medical use, although ether and chloroform have been used as surgical anesthetics.

Main Dangers: Solvents and aerosols cause moderate psychological dependence, and mild withdrawal symptoms -- including nausea, depression, insomnia and loss of appetite -- may occur. Tolerance can develop after a few weeks of continuous use.

Solvent use poses a range of immediate and long-term hazards, including:

Accidents: Impaired judgment, memory, and thinking create high risks of harm or accidental death by falls, drownings, or in other potentially-hazardous situations.

Tissue Damage: High concentrations of toluene and other solvents can permanently damage the brain, bone marrow, liver, and kidneys. The chemicals may also produce nervous system damage and lingering problems in memory and thinking.

Sudden Sniffing Death: Can follow sudden heart failure during physical activity or stress following a heavy dose of volatile hydrocarbons.

Suffocation: Plastic bags (used to concentrate solvent vapors) pose obvious hazards, and inhalation of aerosols, such as cooking sprays, can coat air passages in the lungs and cause suffocation.

Signs of Use: Strong odor of glue or other chemicals; plastic bags containing glue or other chemicals; alcohol-like intoxication: euphoria, poor coordination, slurred speech.

Nitrites & Nitrous Oxide

Examples: Amyl nitrite ("poppers," "snappers,"); butyl nitrite, isopropyl nitrite (Rush™, Locker Room™); nitrous oxide ("laughing gas," aka "whippets").

Actions: Nitrites are short-acting heart stimulants and vasodilators -- chemicals that dilate arteries and blood vessels. Nitrous oxide is an anesthetic gas that relieves anxiety and reduces sensitivity to pain.

Both are sniffed for their brief, intoxicating properties. Nitrites lower blood pressure and increase heartbeat, and reduce oxygen flow to the inner brain. Users report sudden, intense weakness and a dizzy sensation lasting 30-60 seconds. Sweating, flushing, and nausea can also occur.

While occasional use may pose few immediate risks to health -- other than headaches and blackouts -- excessive use is tied to serious health problems, including:

Glaucoma: Nitrites elevate blood pressure in the eyes, which researchers believe may contribute to this potentially blinding eye disorder.

Blood Cell Damage: The chemicals damage oxygen-carrying red blood cells and, when swallowed, can trigger an acute, often-fatal anemic condition (methemoglobinemia), in which blood cells can no longer transport oxygen.

AIDS: Researchers have linked nitrites to impaired immune system response, which may contribute to a rare form of cancer (Kaposi's sarcoma) seen in AIDS patients.

Unlike nitrites, which pose their greatest dangers with long-term use, nitrous oxide hazards center on improper use. Sniffing nitrous oxide from pressurized tanks or masks can cause blackout, brain injury, and suffocation from lack of oxygen.

Cold temperatures used to store the gas can freeze the lips and throat when inhaled, while high-pressure tanks may rupture the lungs and cause collapse. Other problems include nausea, vomiting, and disorientation.

Some tolerance may develop to the nitrites, which also carry a moderate potential for psychological dependence. Only nitrous oxide shows evidence of producing physical dependence.

Medical Uses: Amyl nitrite is available by prescription for short-term relief of angina pectoris and asthma. Nitrous oxide is used in minor dental surgery. Butyl nitrite and act-alike nitrite products have never been used medically, but found widespread acceptance in the 1970s and 1980s, primarily as a sexual stimulant.

Once legally-available over the counter as a so-called "liquid incense" or "room odorizer" in an attempt by marketers to avoid U.S. Food & Drug Administration jurisdiction and control, butyl and isobutyl nitrite are much less visible today due to a federal ban on the products in 1989. Since then, most distributors of the products have switched to isopropyl nitrite and cyclohexyl nitrite, which is now marketed euphemistically as a "head cleaner."

Main Dangers: Suffocation or injury from blackout while sniffing nitrites or nitrous oxide. Severe, potentially fatal anemia related to swallowing nitrite compounds.

Withdrawal Symptoms: None.

Signs of Use: Sudden dizziness, flushing, sweating, odor of chemicals.


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