5

Title: Drugs of Abuse: Their Actions & Potential Hazards
Author: Samuel Irwin, Ph.D.
Publisher: Do It Now Foundation
Publication Date: September 2003
Catalog Number: 203

Chapter 5:
Street Drugs

Stimulants & Cocaine

Examples:
Methamphetamine
(Desoxyn®), amphetamine (Dexedrine®, Benzedrine®),
phentermine (Ionamin®), phenmetrazine HCL (Preludin®),
methylphenidate (Ritalin®), cocaine, caffeine (in coffee,
tea, and soft drinks), ephedrine, phenylpropanolamine or PPA
(found in nonprescription diet products).

Demographics: Stimulant use has risen
sharply since the mid-1970s, starting with widespread use of
nonprescription “lookalike” tablets and capsules and
continuing with a nationwide resurgence of amphetamine use in
the 1990s. While laws now restrict sales of lookalike drugs,
over-the-counter stimulants are still widely used.

Methamphetamine
(“crystal”) has staged a huge comeback in recent years,
but cocaine still ranks as the most commonly-used stimulant in
America. According to the National Institute on Drug Abuse, 22.1
million Americans have tried cocaine, and 8.7 percent of the
high-school class of 2002 say they’ve used it at least once.

Smokable cocaine
— freebase, “crack,” or “rock” — fueled
the explosion in cocaine use, and these forms of the drug are
now generally considered to be among the most dependence-producing
drugs known.

Actions: Cocaine, amphetamine,
and amphetamine-like drugs are CNS stimulants which elevate basic
body processes — speeding up breathing and heart rate and raising
blood pressure. Low doses produce increased alertness and talkativeness,
feelings of power and energy, and decrease appetite and desire
for sleep. Larger doses cause impaired judgment, insomnia, irritability,
anxiety, and transient psychotic episodes and paranoia.

Since stimulant
use is so reinforcing–and the drugs themselves so dangerous
— continued use poses serious hazards to users, including:

Behavior:
Regular
or heavy users may become suspicious, hostile, and paranoid.
High doses may trigger full-blown psychotic episodes, characterized
by aggression and violence, hallucinations, and delusions.

Overdose: Coma and death can occur
from cardiac arrest following high doses of amphetamine and methamphetamine.
Cocaine overdose can occur at lower dosage levels, triggering
sudden heart attack in otherwise-healthy users.

Depression: Stimulant withdrawal
involves deep depression and strong cravings for the drugs. Suicide
rates are high among dependent individuals.

Dependence:
All stimulants
carry high psychological dependence potential. Tolerance develops
quickly to the drugs.

Medical Uses:
To reduce appetite and overcome chronic fatigue, although on
a much reduced scale from 20 years ago. Hyperactive children
and adults with attention-deficit disorder may be prescribed
Ritalin or Dexedrine to improve concentration. Cocaine was once
widely used in dental surgery, while caffeine and PPA are ingredients
in many nonprescription diet aids, “stay-awake” pills,
and cold and allergy medications.

Main Dangers:
Long-term
amphetamine use can permanently damage teeth, bones, lungs, liver,
and kidneys, and deplete body stores of vitamins and minerals.
Heavy cocaine use carries risk of overdose and dependence. Cocaine
sniffing can damage nasal tissue and weaken the heart muscle,
while freebase use is linked with chronic lung irritation.

Many users turn
to CNS depressants to counter the hyperstimulation of constant
amphetamine use. Stimulant-depressant combination use can result
in multiple addiction.

Withdrawal
Symptoms:

Severe depression, anxiety, and exhaustion. Intense psychological
craving for the drugs can persist for months following cessation
of use.

Symptoms of
Use:
Dilated
pupils, loss of appetite, compulsive behavior, belligerence,
suspicion, confusion, insomnia.

Marijuana

Examples: Marijuana (Cannabis
sativa, Cannabis indica), hashish, hashish oil.

The principle
psychoactive ingredient is -9 tetrahydrocannabinol (THC), which
varies in concentration in different strains of the plant. Average
potency of street marijuana in 1997 was 3.61 percent (up from
2.38 percent in the early 1970s) and 7.57 percent for high-powered
strains (sinsemilla).

Actions: Marijuana raises heart
rate and lowers blood pressure, and causes reddening of the eyes.
Low to moderate dose effects last from two to three hours and
can range from euphoria and hilarity to mild lethargy, perceptual
changes, and feelings of heightened sensitivity. High dose effects
can simulate the perceptual and cognitive changes associated
with more potent hallucinogens.

Since the drug’s
effects on performance — particularly on tracking ability and
reaction speed–can last hours after intoxicating effects fade,
pot use can pose significant safety risks. In addition, marijuana
may cause problems in learning and social development for adolescent
users.

Health problems
tied to smoking marijuana include:

Lungs: Marijuana irritates lung
tissues. One study found that it delivers three times the tar
and five times the carbon monoxide of a tobacco cigarette, raising
the risk of lung damage in long-term users.

Immune System: Studies suggest the
drug may lower the body’s natural defenses against disease.

Nervous System:
THC and
other ingredients disrupt the production and flow of neurotransmitters
in the brain and central nervous system. Researchers suspect
these changes may contribute to impaired memory and concentration
and reduced motivation in chronic smokers.

Hormonal Effects: Marijuana reduces normal
levels of hormones which regulate growth and sexual development.
Such irregularities may change growth patterns in adolescents
or affect fertility.

Pregnancy
Effects:
Studies
tie maternal use of marijuana to higher levels of miscarriage,
stillbirths, and low birth-weight babies, as well as problems
in nervous system development.

Marijuana can
cause psychological dependence and some tolerance. While it does
not appear to produce serious physical dependence, a withdrawal
syndrome — which can include irritability, depression, and insomnia
— is reported following abrupt cessation of use.

Medical Uses:
Marijuana
has a long history of use as a medicinal agent. Today, research
on the drug’s possible therapeutic value focuses on its use in
treating glaucoma, reducing muscle spasms and seizures, relieving
the nausea and vomiting caused by cancer chemotherapy, and reducing
the “wasting syndrome” associated with AIDS.

Main Dangers:
High
dose or chronic use can trigger panic and anxiety episodes in
some users. Regular use interferes with learning and concentration
and contributes to low motivation and psychological dependence
on the drug.

Withdrawal
Symptoms:
A
slight withdrawal syndrome can follow long-term or heavy use
(e.g. irritability, sleep disturbances, decreased appetite),
but symptoms are mostly transient and disappear within a few
weeks.

Symptoms of
Use:

Intoxication, euphoria, impairment of judgment and coordination,
memory lapses, reduced attention span, and fatigue. Possession
of marijuana paraphernalia (pipes, rolling papers, etc.). Reddening
of the eyes.

Hallucinogens

Examples:
Naturally-occurring:
mescaline (peyote), psilocybin (mushroom), nutmeg, jimson weed.
Synthetic: Lysergic acid diethylamide (LSD), dimethyltryptamine
(DMT), methylenedioxyamphetamine (MDA, MDMA, “ecstasy”),
and related compounds.

Actions: The hallucinogens act
on the central nervous system by altering the production and
processing of chemical neurotransmitters in the brain. Effects
can last anywhere from four to 12 hours (MDA, LSD) or as long
as 24 hours (TMA, jimson weed).

Hallucinogens
trigger profound perceptual and thought changes, which vary according
to the individual, situation, and drug used. Other effects can
include intense and unpredictable emotions, a sense of detachment
from self, and feelings of great insight. In addition, most users
are highly suggestible under the influence of hallucinogens,
which can further alter the experience.

Physically, hallucinogens
increase blood pressure and body temperature, produce dilation
of the pupils, and speed up heart and reflex rate. The compounds
are also linked to tremors, weakness, profuse sweating, and dizziness.

Hallucinogens
can profoundly impair judgment, coordination, and thought, so
that driving or other complex activities can be risky, indeed.
The drugs carry a slight potential for psychological dependence,
but do not produce physical dependence. Some hallucinogens are
derived from amphetamine (MDA, MDMA, TMA) and can cause overdose.
Tolerance builds quickly and almost completely within a few days.

Medical Uses:
LSD,
mescaline, MDA, and MDMA have been tested in treatment of a range
of psychological disorders and emotional problems, including
alcoholism, autism, depression, and psychosis, although the drugs
have no currently-accepted medical use.

Main Dangers: Hazards are mostly psychological,
and include:

Panic Attacks:
The intensity
of emotional reactions can trigger anxiety, depression, and confusion,
along with an inability to distinguish between reality and the
drug’s effects.

Psychotic
Reactions:
Some
users experience long-lasting psychological distress, including
full-blown psychotic states.

Flashbacks:
Unexpected,
short-lived recurrences of drug-like effects days or weeks after
use of an hallucinogenic compound. LSD flashbacks are psychological
in origin and may involve a conditioned response to situational
cues associated with previous panic attacks.

New research
indicates that MDA and MDMA may disrupt production of the neurotransmitter
serotonin. Other dangers derive from the sheer unpredictability
of hallucinogens.

Some types (TMA,
jimson weed) produce more intense and long-lasting effects than
others. Yet because of the illegality of the drugs and a lack
of controls associated with their distribution, users can’t even
be certain which drug they’ve consumed, much less factor in such
considerations as dosage or quality.

Withdrawal
Symptoms:
None.

Symptoms of
Use:
Dilated
pupils, emotional swings, nausea, impaired coordination, inability
to carry on a conversation.

Phencyclidine
(PCP) and Ketamine

Examples: 1-(1-phenylcyclohexyl)
piperidine (PCP), also known as “angel dust,” “embalming
fluid,” “tic,” “THC,” and other pseudonyms.
Sold in pill, powder, and liquid form, or sprinkled on marijuana
or tobacco cigarettes (“sherms”). Ketamine is commonly
known as “K” or “Special K.”

Demographics:
Although
PCP is much less prevalent today than in the 1980s, ketamine
has become a fixture of the 1990s urban dance-club scene, due
to its more-manageable effects.

Actions: Both PCP and ketamine
were developed as surgical anesthetics, and are classified as
“deliriants” or “psychedelic anesthetics.”
Their effects are dose-dependent and can resemble stimulants,
depressants, anesthetics, and hallucinogens, depending on the
amount consumed. The drugs interact with receptors throughout
the brain and central nervous system.

Easily the most
unpredictable of all psychoactive drugs, PCP effects vary widely
depending on the user and the dose:

Low Dose:
At low
doses (1-5mg), it produces stimulation, euphoria, numbness, and
reduced inhibitions along with flushing, sweating, impaired coordination
and judgment, and slurred speech.

Moderate Dose: At higher levels (5-10mg),
the drug’s primary action is CNS depression, accompanied by an
excited, confused intoxication. Body image distortion and reduced
sensitivity to pain also occur.

High Dose:
With
larger doses (over 10mg), PCP causes agitation, increased aggression,
paranoia, auditory and visual hallucinations, delusions, and
near-complete insensitivity to pain. A sharp drop in blood pressure
may occur, with muscular rigidity and convulsions, leading to
coma and possible death.

Both drugs cause
moderate psychological and physical dependence. The drugs’ depressant
effects are intensified by alcohol and other depressants. Breakdown
products are fat-soluble and are stored — at full psychoactive
potential — in the fatty tissues of the body, producing increased
risks of overdose and physiologically-based flashbacks.

Medical Uses: Veterinary anesthetic
(PCP). Human surgical anesthetic (ketamine).

Main Dangers: PCP is often sold as
an additive to (or substitute for) more scarce drugs, such as
LSD, cocaine, heroin, and mescaline, posing serious risks to
users who do not realize they are taking PCP. But whether taken
accidentally or intentionally, the drug carries a range of risks:

Accidents:
PCP reduces
sensitivity to pain, heightens aggression, and powerfully impairs
judgment and coordination, producing high risk of injury or death
by falls, drowning, etc.

Panic Attacks:
“Bad
trips” on PCP can involve confusion, mood swings, delusions
and hallucinations. The attacks are difficult to treat and can
lead to long-term emotional problems.

Psychosis:
In some
users, PCP can “unmask” underlying emotional and behavioral
problems, and trigger psychotic states.

Withdrawal
Symptoms:

None.

Symptoms of
Use:
Intoxication,
poor coordination, inability to carry on a conversation, bizarre
behavior. Sweating, flushing, muscular rigidity, and occasional
rhythmic rotation of the eyeballs (nystagmus) may occur. High-dose
symptoms resemble schizophrenia.


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Chapter
6:
Measuring
Risk


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