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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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