Here is the list of major drugs of abuse according to the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA):
- Bath Salts (Synthetic Cathinones)
- Club Drugs
- K2/Spice (“Synthetic Marijuana”)
- MDMA (Ecstasy/Molly)
- Prescription Drugs & Cold Medicines (Stimulants like Ritalin, Adderall; Opioids like Oxycontin, Vicodin, methadone; Sedatives like benzodiazepines Valium, Xanax, Klonopin, Ativan)
- Steroids (Anabolic)
Our government classifies abusable drugs into five categories they call Schedules.
Schedule 1 drugs are the most dangerous and most likely to be abused and according to the government have no medicinal value. Schedule 5 is the least likely to be abused and may have medicinal value. This list is according to the government, not reality.
Schedule 1 drugs: heroin, LSD, marijuana, ecstasy (MDMA), peyote.
Schedule 2 drugs: hydrocodone (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid) meperidine (Demerol), oxycodone (OyContin), Dexedrine, fentanyl, Adderall, Ritalin.
Schedule 3 drugs: less than 90mg codeine per dosage (Tylenol with codeine), ketamine, anabolic steroids, testosterone.
Schedule 4 drugs: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Ambien, Tramadol
Schedule 5 drugs: cough preparations with less than 200mg of codeine per 100ml (Robitussin AC), Lomotil, Lyrica.
Alcohol is legal but is the most used abusable drug in the United States and the third largest cause of death after heart disease and cancer. Ethanol is the name of the kind of alcohol that can be consumed. It is a central nervous system depressant formed from fermentation of yeast, sugars, and starches. It isn’t digested. It’s absorbed right from the stomach and small intestine into the bloodstream. Even though it’s a depressant, you will have patients who use it as a stimulant. You must ask your patients what benefit they derive from using alcohol. Does it allow them to feel more comfortable in social situations? Then that person is missing the stimulatory neurotransmitters like dopamine and in addition to alcohol they are going to be using methamphetamine or cocaine or chocolate or coffee or Coca Cola/Pepsi/Mountain Dew.
Or does alcohol allow them to check out from stressful emotions or situations? If so they are going to also be using numbing comforts like heroin or OxyContin or sugar or bread.
Alcohol withdrawal can be dangerous
We aren’t talking about what you buy at Bed Bath and Beyond. It’s a family of “designer” synthetic stimulant drugs. Some of the popular names are Bliss, Vanilla Sky, and various colors of Wave, like Purple. They’re also called plant food, jewelry cleaner, or phone screen cleaner, according to several websites. They are used because they are stimulants but people can end up in the emergency room with paranoia, hallucinations, and chest pain among other scary symptoms, including kidney failure. They’re injected, swallowed, or inhaled or snorted and are an assorted mixture of various chemicals, often including mephedrone, MDPV, and methylone but the designers of these drugs are always a few steps ahead of law enforcement and legislators.
A group of chemical agents that change brain chemistry and are most often used by young people when out in groups such as in bars, nightclubs, concerts, or parties.
GHB is a form of GABA, which is our brain’s major calming neurotransmitter. GHB is a depressant drug used for narcolepsy. Withdrawal symptoms include anxiety, tremors, sweating, and insomnia.
Rohypnol is a sedative in the family of benzodiazepines like Valium or Xanax. It is therefore addictive if used frequently. Both GHB and Rohypnol are colorless and odorless and can be slipped into a date’s drink without the person realizing it, leading to “date rape” since the person is so drugged she cannot say no. With Rohypnol there is amnesia so the person can’t recall being raped.
Ketamine is legally used by veterinarians as anesthesia for animal surgery. At clubs the drug is snorted or injected. What’s fun to users is the dreamy reaction and hallucinations.
Since these drugs are depressants people can have breathing difficulties.
A stimulant made from the coca leaf native to Peru and Bolivia, cocaine is frequently used as a powder, usually snorted up the nose or dissolved in water and injected. You may hear it called blow, or snow, or coke, or flake. It’s the reason coca cola is called coca cola. In 1885 when the drink was first created it was sold as a medicine containing two active ingredients, coca leaf extract and kola nut. It certainly must have relieved fatigue back in the day. According to Snopes.com in 1902 there was only 1/400th of a grain of cocaine per ounce of syrup and by 1929 Coca Cola was totally cocaine free. However in 1988 a New York Times story revealed the drink still uses coca leaves (minus the cocaine) for flavoring. The cocaine is extracted and sold to a pharmaceutical company that is licensed to purify it for medicinal uses.
The form of cocaine called crack or rock is no longer a powder but has been transformed into a crystal that makes a cracking sound as it is heated, producing vapors that are inhaled. It is changed from a salt into a base through the heating process and in this form is called “free base” or one may say one has “free-based” the cocaine by inhaling the fumes or smoking the residue that remains.
While snorting cocaine creates a high that may last up to a half hour, smoking cocaine results in a high lasting probably no more than 10 minutes. As expected, if the high is that short people are going to go after it again and again. But, since the high comes from a rousing blast of dopamine in levels unknown in the natural flow of neurochemicals, there is a price to pay.
It increases heart rate and blood pressure while constricting blood vessels. People die from heart attacks because of cocaine use. It also causes gastrointestinal pain, nausea, and malnourishment, which is the common experience of stimulant users because stimulants reduce appetite and are therefore diet drugs. This is literally true with another stimulant, methamphetamine. In addition the user can hallucinate bugs crawling under the skin.
Cocaine stops the reuptake of dopamine that’s left in the synapse into the receptor site that normally recycles it. The brain is saturated with the drug but the user craves more of it and feels let down after the initial rush. It causes people addicted to cocaine to chase after the first high. Cocaine does work as a pain reliever but topically, as is clearly indicated by various advertisements of the late 1800s. For 15 cents you were promised immediate relief for toothaches with cocaine drops. In 2010 in the Journal of Pain Palliative Care Pharmacotherapy two authors described the immediate relief in pain achieved by patients with cancerous lesions of the mouth. http://www.ncbi.nlm.nih.gov/pubmed/20504138
Addicts are adept at manipulating their biochemistry to offset the effects of one drug with another. And so they take heroin with cocaine, called a speedball, that reduces the negative feelings that result from cocaine alone but too often this combination leads to fatal overdoses.
Ecstasy is a stimulant type drug that has been used by some psychiatrists as a part of treatment. In fact it is still being studied for PTSD, among other uses. It produces feelings of empathy and connection in a way that mimics the hallucinogenic peyote cactus button mescaline. It can also increase heart rate, cause sweating, chills, and dehydration. It comes as a tablet or capsule and effects can last 3 to 6 hours. Because it causes a dramatic increase in serotonin, it can also cause a dramatic emptiness of serotonin in the nervous system after taking the drug. However negative effects might be caused by the use of other drugs simultaneously or by unpure MDMA.
Miley Cyrus shared her love of Ecstasy in a song called “We Can’t Stop” (which should teach her fans something right there!) but calls it Molly, which teens believe is pure MDMA and therefore safe to use. In fact, according to the Drug Enforcement Agency, only 13% of Molly has MDMA in it. Instead it more resembled the chemical combo called bath salts along with a mishmash of other drugs like PCP, ketamine, methamphetamine, or even heroin. Results can be chest pain, paranoia, hallucinations, even kidney failure or death. That is from the cocktail of other drugs, not pure MDMA/Ecstasy. But pure MDMA can still contribute to sweats, chills, increased heart rate, and dehydration.
Inhalants is a general word for solvents, aerosols, gases, and other substances administered by “huffing” or inhaling them. When you are after a high you use what’s available. When you’re a preteen, what is available is around the house. So you sniff glue, cleaning fluid, lighter fluid, correction fluid, shoe polish, spray paint, or markers. Whipped cream aerosol cans are used so much they have a nickname: whippets. If you’re 16 or 17 you may choose nitrous oxide instead. And if you’re an adult you may have access to nitrites like amyl nitrite, also called a “popper.” I know someone who loves to breathe deeply when filling her car with gasoline. These substances do have an effect on the brain. While poppers are used to improve lovemaking by dilating blood vessels, the rest of the inhalants slow down the central nervous system and you get a giddy kid with slurred speech, awkward movements, and dizziness. That’s the fun part. These are chemicals that are toxic to liver and kidney, nerve fibers and brain cells.
Popular in high school as an alternative to marijuana, K2 or Spice or Skunk or Moon Rocks or Yucatan Fire or other herbal products under the K2 label are sold in head shops and online as legal natural herbs to be smoked (most often) or drunk as a tea with the goal of altering consciousness. The government has studied the ingredients and found synthetic cannabinoids. As soon as the government declares an ingredient a Schedule 1 controlled substance which means it’s illegal to buy, sell, or even possess, manufacturers substitute another. Twice as many boys in high school use Spice as girls, but this form of drug is the second most popular illegal drug used in high school after marijuana.
d-lysergic acid diethylamide) was actually discovered in 1938 from the grain fungus called ergot. It is sold as tablets, capsules, liquid, added to colorful paper, or back in the 60’s as I do recall even though I was there, on sugar cubes. When the experience is positive it can take the user into a pleasant visual and auditory trip through altered reality with crossing over of the visual, auditory, and sensate fields. It isn’t addictive. When it’s a negative experience, however, those changes in reality can become terrifying like the worst imaginable nightmare. Positive or negative, the hallucinogenic experience can last as long as 12 hours.
There was a jar of marijuana seeds in the pharmacy at my acupuncture college. It is a medicinal plant no matter what the government declares. It is the same species as hemp. Both are Cannabis sativa, but are different varieties that have quite different chemical properties. Marijuana is psychoactive Hemp isn’t. Marijuana as a recreational drug uses the flowering tops and leaves of plants grown specifically to enhance their delta-9 tetrahydrocannabinol or THC content. It also contains CBS, cannabidiol, but of low percent compared to THC. Cannabidiol reduces the psychoactivity of the THC. Meanwhile, hemp has low THC and is used for its seeds, oil, and fiber.
While alcohol is still the most used drug in the US, marijuana is the most used illegal drug here. It is smoked in hand-rolled cigarettes called joints or thicker cigar paper called blunts, or inhaled in pipes or water pipes (bongs), or inhaled through an intermediary device called a vaporizer that separates the vapor from the smoke. It is also brewed as a tea and eaten by being mixed into foods like the famous Hashish Fudge made of spices, nuts, fruit, and Cannabis found in the Alice B. Toklas Cook Book published in 1954. More recently people have been smoking marijuana resins, unfortunately using butane at home to prepare them and as some found out, butane, being lighter fluid, is highly flammable. Using the resins is often called dabbing.
According to the Potency Monitoring Program at the University of Mississippi the amount of THC in marijuana has risen from four times to as much as ten times what it was in 1993, from 3.4% THC in 1993 to from 12.3% to as high as 36% as of 2014.
Not only is the pot more powerful, with the increasing popularity of buying ready-made edibles infused with marijuana the customer doesn’t know how much of the THC is really in the product. The Denver Post studied the ingredients of products sold in Colorado and found many with less THC than advertised on the label but some with nearly 50% higher levels than advertised.
THC enters the bloodstream whether quickly from the lungs or slowly from the stomach and is carried to the brain and elsewhere. If it is eaten it takes up to an hour for the drug to have an effect. Our body has cannabinoid receptors which are turned on by the drug in levels much higher than normally found in the brain. Hallucinations may result. Often the senses are enhanced. Colors are brighter. Music is more intense. There is a strong craving to eat. That may be positive or negative. Certainly potheads are not the emaciated malnourished figures easily picked out in a treatment class as stimulant users. But pot users have lower sperm counts than nonpot users and can have a decrease in motivation. Depending on the amount smoked teens may experience changes in thinking ability and memory. Their IQ may even suffer, something that doesn’t seem to happen to people who start using pot as adults.
Smoking anything isn’t great for the lungs, and marijuana is no different. It is said to raise the heart rate and possibly influence a child’s ability to focus, problem-solve, and maintain a sharp memory if exposed in utero. For most people marijuana isn’t addictive in the same way as heroin or other drugs (NIDA says just 9% of those exposed to marijuana will become addicted to it) but it can be addictive for those 9%. Withdrawal symptoms include anxiety, cravings, sleeplessness, and grouchiness. Heavy use exacts a serious toll in terms of higher likelihood of dropping out of school, car accidents, and injuries. Other negative experiences include panic attacks, impaired coordination, and nausea.
When someone stops using marijuana drug tests can still register the drug for many days afterwards. The test measures a metabolite of the THC that the liver must break down and each person’s liver works at its own rate depending on the level of use and other factors. TCH is lipotropic, meaning it loves fat cells and sticks around quite a while. A person may still register THC in a urine test after anywhere from 1-3 days from the last use for an occasional user to 7-10 days for a frequent user but it’s also common to test positive up to a month after stopping use and one person who used cannabis daily for 10 years was still testing positive after 67 days.
A powerful central nervous system stimulant, meth allows users to stay up for days and eat little. Many women are prescribed a similar drug, amphetamine, as a weight loss aid by well meaning physicians. Because it often feels like bugs are crawling under their skin they will pick at their skin until they cause lesions. They may develop hallucinations and paranoia from the lack of sleep.
After some time they also develop “meth mouth” which is severe deterioration of the gums and teeth. Some research by NPR found meth mouth similar to what is seen with soda pop mouth. (http://www.npr.org/sections/thesalt/2013/05/29/187050058/soda-mouth-can-look-a-lot-like-meth-mouth)
Meth is smoked, snorted, swallowed, or injected in water or alcohol. It slams the dopamine system into overdrive, making meth users jittery, talkative, and hyperactive. And when they stop using they crash into the opposite. So why do doctors prescribe amphetamines called Ritalin or Adderall for hyperactive kids? What drives someone to want to use methamphetamine is a reduced level of stimulant chemicals in his body. Trying to build the feeling of stimulation a person will do risky things like gamble on the horses, jump with a parachute, hang glide, race motorcycles, obsessively drink Pepsi or Mountain Dew or Coca Cola, move and talk without rest, and generally live like they have the Energizer Bunny inside.
There has been much discussion in Washington whether it was worth the cost to treat meth users. Why throw money after fried brains? However, though it takes a good year or more to recover, people who used meth extensively have been found to recover and get back to ordinary life even if there may be some problems with memory and thinking.
Although most meth is produced in commercial labs run by big drug cartels there are homegrown labs using products purchased at local hardware stores and pharmacies and these labs have created a whole level of danger to the children of those producing the drug and their neighbors. Labs have blown up. The chemicals used in these labs are, in the best of circumstances, toxic to the environment around the property after the police shut it down. In an attempt to control production pharmacies are not allowed to sell some of the ingredients beyond a limited amount to any one person any one day.
This is my discussion of illegal drugs so we are focusing on heroin and opium right now, though codeine, morphine, methadone, and oxycodone are opiate/opioids that are prescribed and also abused. An opiate is from nature. An opioid is from a lab. We will use the term opiate to cover both of them.
Opiate receptors are located in many areas of the body and brain, including the brain stem, which controls breathing. Thus overdosing an opiate can lead to stopping breathing.
Opiates start with the poppy flower native to the Mediterranean, Southeast Europe, and Western Asia. Opium is a creamy sap or latex inside the poppy (papaver somniferum) plant. It is released by scratching the plant pod, allowing the sap to dry, scraping it off and dehydrating it. 5,000 years ago the Sumerians called it the joy plant.
The British wanted tea and other goods from China and for financial reasons demanded the Chinese accept Indian opium. It’s a story in history that is sordid and devilish, with the British going to war twice against the Chinese and by winning forcing them against their government’s will into receiving opium into their society. Britain itself was deep into the troubles of opium in those years. In fact both the British and the Americans were using opium in the 19th century to the point of deepening social despair.
And that led to the use of morphine as a “cure.” Authorities were told morphine was less addictive and would solve the opium problem. Morphine, extracted starting in 1803 from the latex of the poppy, is to this day one of the most effective legal pain relievers in medicine but unfortunately it was actually more addictive than opium and didn’t solve the problem. So in 1898 Bayer Pharmaceutical of Germany announced it had something less addictive that would solve the morphine problem: heroin. They synthesized it from morphine and named it after the German word for powerful and heroic, heroisch. They marketed it for respiratory problems as well as pain relief and a cure for morphinism and handed it out for free to physicians.
Lo and behold heroin was more addictive than morphine being three times more powerful and didn’t solve the problem. Bayer, by 1913, stopped producing heroin and switched to their other popular product, aspirin. But, heroin has been with us ever since, sold as a white powder that is injected, inhaled, snorted, or smoked. Heroin users who inject the drug may “nod out” in class. Their mental function shuts down and they are half awake, half asleep. They are, for a few minutes after use, very very happy. And then 3-5 hours later the delicious effects wear off. And if they don’t feed their body’s addiction they go through some awful withdrawal that includes severe abdominal cramping, vomiting, diarrhea, muscle pain, chills, teeth chattering, shaking, sweating, runny nose, agitation, and insomnia.
Fact is, as awful as the withdrawal is, heroin isn’t itself toxic, but people die from overdosing. I talked about tolerance to drugs building up over time. A person who is a longtime user of heroin might be able to handle 1800 mg of heroin, but a person who has never used it or only used it a brief time may die injecting 200 mg. This is what happens to people who relapse. They remember what they used to take before they went through withdrawal and after getting clean they use the same old amount again and it kills them. Remember how excessive levels of the drug stops the breathing mechanism?
Our culture is ever eager to find a drug to cure drug addiction, so in the 1940s a drug to stop heroin addiction was released commercially that had been developed by yet another German pharmaceutical manufacturer. It went through many names starting with dolophine for the Latin word dolor meaning pain and fin meaning ending but finally was called methadone. Guess what. I’m sure by now you can guess. Methadone is more addictive than heroin. But it is legal! It is prescribed by physicians in specialized treatment programs that chain the clients to them by handing out the doses daily. Why should they get their clients off this legal drug if their business model is to distribute it?
Instead of making heroin withdrawal programs easy to get into, affordable, and an integral part of the healthcare system using the NADA protocol twice a day and shifting the clients’ pH to alkaline in a protocol discovered to work well by some Berkeley physicians back in the 1970s using calcium carbonate, sodium bicarbonate, and potassium bicarbonate, the government has switched the client from a politically unacceptable drug to another drug that is by consensus acceptable. The client is still addicted to a drug. The upside is the client isn’t selling her body, stealing his mother’s jewelry, and so on. People go to work. They maintain their homes. They get pregnant and eat normally and deliver babies of normal weight on time who are healthy though addicted to methadone and need to be detoxed.
Even if a clinic does successfully wean clients off opiates there are plenty of other clients needing their services.. In 2006 in the USA consumers spent 0.8 billion dollars on Oxycontin. In 2010 we spent 3.1 billion. Here’s another way to look at it. From 1991 to 2013 the population of the US rose by 25%. During the same period the number of prescriptions for opiate pain relievers rose 172%. We are apparently a nation in pain.
PCP (Angel Dust)
(Slide 206)PCP started out as an anesthetic but it so dramatically distorts reality it didn’t work to calm people into a state suitable for surgery and recovery. People under the influence of PCP feel invincible and I remember hearing situations where police have had to tackle them with ferocious force to take them in. It can cause paranoia, anxiety, and hallucinogenic delusions leading to violence. The drug is addictive.