MJ Bazos MD, Patient Handout
- Are there any herbal products that are
their sale would be controlled by a federal agency. Even preparations that
contain ephedra, a mild stimulant, have never been shown to produce "addiction"
(newer term: dependence).
- What is
This drug (brand name,
Buprenex) is a powerful analgesic. Recently, the Food and Drug Administration
approved it for the treatment of heroin dependence. It is unique because, unlike
methadone, it has an opioid "antagonist" effect, which means that it is less
likely to be abused by heroin addicts in treatment (that is, they are less
likely to get "high" on it during slips in recovery). Its brand name for this
purpose is Suboxone, and it can be given sublingually (under the tongue) for
quick action. Unlike methadone, it can be prescribed by any properly-trained
physician for treating heroin dependent patients.
- Do illegal drugs
have approved therapeutic effects?
Yes, some do. Heroin has none,
since it is totally illegal in the United States. However, it has powerful
pain-relieving properties (but it breaks down in the body to morphine, which is
used instead). Cocaine has an approved use as a local anesthetic for eye
surgery, but possession and use of the drug for other purposes is illegal.
Marijuana (actually, the active ingredient in pill form, THC) is approved for
the treatment of nausea and vomiting, and for its anti-wasting
(appetite-increasing) effect in AIDS patients. All other alleged medical uses of
marijuana (pain relief, anti-asthma, anti-glaucoma) are unapproved.
- What are the
differences between a "sedative", "tranquilizer", "anxiolytic", and
They are all related. The word
"sedative" is a general (older) term for anything that calms people down.
"Tranquilizer" is a more specialized (older) term for a drug that reduces
anxiety ("minor" tranquilizer) or reduces psychotic symptoms ("major"
tranquilizer). These terms have mostly been replaced by "anxiolytics" (anxiety
reducers) and "neuroleptics" (anti-schizophrenic drugs).
- Part of the
variability in response to drugs from person to person is due to "set" and
The "set" is the expectation of
the drug's effect by the user. The "setting" is the environment in which drug is
taken. An example of this is that someone will get higher smoking marijuana when
they have a positive attitude about it than if they were raised to believe that
marijuana is harmful. Also, a person will generally get a better response using
a drug with other people than using it alone.
- Why do some drugs
make us feel better and some drugs make us feel worse?
There is a complex answer
to this, but the probable answer is that drugs affect each person differently,
and, depending upon the situation, some drugs can help people who want to feel
better, and the same drugs work in an opposite way for other people.
- There are an
enormous number of chemicals in the world. Why do people use some to get
Perhaps the normal human desire
is to feel better, and when normal every-day activities fail to satisfy people,
they use drugs to feel better.
- We hear a lot about "methadone maintenance",
which is a controversial treatment for heroin dependence. But what about
"nicotine maintenance", where people stop smoking cigarettes but continue to use
nicotine in the form of patches or gum?
These people believe that
they are reducing their chance of lung cancer or heart disease because they are
no longer exposing themselves to carbon monoxide, tars, and other harmful
effects of cigarette smoke. But nicotine itself is highly toxic, and will likely
have lethal effects with long-term exposure over many years in the person who
cannot stop using nicotine in pure form.
- Nicotine, given to
animals, is extremely toxic. Why can humans smoke nicotine in
Well, when cigarettes are
smoked, much of the nicotine is "vaporized" (broken down), so the toxic effects
are reduced. People smoke because of the calming, or (in some cases) energizing
effects. Doesn't it make sense that people who smoke for such effects are
sacrificing their health? We do the same with food, but the toxic effects of
nicotine are much greater than the toxic effects of food.
- How long does the
effect of Rohypnol (date rape drug)
Although the research
is incomplete, all indications are that the effects of Rohypnol last about 4-6
hours. This is similar to the duration of action of Xanax, another
benzodiazepine that has significant central nervous system anti-anxiety action.
Both drugs have significant dependence liability. But why is one approved by the
FDA, and the other one not approved (Rohypnol is only approved for prescription
use in Mexico)? We need more research on these drugs!
- All of the
inhalants that children use are extremely dangerous.
correction fluid ("white out"), lighter fluid, paint thinner, gasoline, toluene,
spray paint, acetone, marking pens, hair spray, and many other chemicals. These
can damage the heart, liver, respiratory tract, brain, kidneys, and they can
produce a number of diseases. They are poisons and should never be used for
- What is the cause
of death in LSD and marijuana users?
Interestingly, these two
drugs have no known lethal dose in humans. Certainly, if a person took enough
LSD or delta-9-tetrahydrocannabinol (the active ingredient in marijuana), that
person could die. But the amount of drug required to cause death would be
extremely high, and would no doubt differ from person to person, as it does with
other drugs. The cause of death is really only an academic question, since there
are no overdose cases to examine.
- Some people become
dependent on cocaine with the first use of the drug, according to reports of
people undergoing treatment.
In a recent scientific
study, 5-6% of cocaine users became dependent ("addicted") within the first year
of use. Of course, some people who use cocaine never become
- The following drugs are all equally
- heroin, nicotine, cocaine powder, crack cocaine,
morphine, Oxycontin (oxycodone), Demerol (meperidine), Dilaudid (hydromorphone),
- All other opioids (methadone, codeine, Darvon,
Vicodin, etc) are less dependence-producing than the powerful opioids.
- (There are many myths regarding which drugs are
more likely to produce dependence, and which drugs produce more serious
- If a person becomes
tolerant (needs increasing doses) to a drug, does it mean they are
No! "Addiction" (newer term:
dependence) relates to an array of symptoms that are related to "the inability
to stop using the drug without help". Tolerance is only one of the dependence
symptoms. Thus, without the other symptoms, tolerance is not the same as
- With respect to
drugs, what is "dope"?
The word "dope" is a general
term that covers many drugs: narcotics, opiates, sedatives, barbiturates, speed
(amphetamines), hallucinoges, and marijuanna. It is probably most often applied
to marijuana. The term "narcotic" is no longer in vogue, since it was used to
describe (in the 1930's Harrison Narcotic Act) several drugs: opiates, cocaine,
and marijuana - the "natural" drugs obtained from plants. The term literally
means "a drug that causes a state of drowsiness". Cocaine obviously is not a
neurotransmitter(s) does marijuana affect in the brain?
Marijuana has its own
receptor in the brain, called the cannabinoid receptor. Therefore, it may not be
necessary for marijuana to affect other neurotransmitters to produce its
pharmacological effects. There are a few studies suggesting that marijuana may
affect transmitters such as serotonin to produce mood changes, or dopamine to
produce the pleasurable effects of the drug. These studies are very sparse
however, and are not the final answer.
- What is the
This phrase actually has two
1) a personality which exists in young people
that predicts who may be at high risk for "addiction" later in life, and
2) a set of behavioral characteristics that is
common among all "addicts" taking drugs. In the latter case, some people have
suggested that addicts behave in a similar manner under the influence of drugs.
Scientists have never identified the "addictive personality", regardless of
how it is defined.
Alprazolam (Xanax) is a benzodiazepine
anti-anxiety drug that can lead to dependence ("addiction") in individuals with
a susceptibility to dependence. It appears to have a greater ability to produce
dependence than other benzodiazepines. While it can produce a long-lasting
withdrawal that is uncomfortable, the simple phenomenon of withdrawal does not
mean it has produced dependence ("addiction") in that person. Most people who
use Xanax over a long period of time will experience withdrawal, but relatively
few become pathologically dependent as defined by DSM criteria.
- Is phenobarbital
Phenobarbital is an old-time
barbiturate with the least addiction potential. In fact, it is used as a
substitute for benzodiazepines during benzodiazepine withdrawal, since it more
comfortable for patients to withdraw from phenobarbital than from their
benzodiazepine drug of choice. Phenobarbital is also still used for treating
- Should marijuana be
This is a controversial issue
whose answer lies more in the cultural arena than the scientific arena. In the
Netherlands, for example, the Dutch have legalized marijuana and noticed a drop
in marijuana trafficking and crime, without an increase in marijuana addicts,
driving under the influence incidents, or drug-related deaths. Would such a
policy work in the United States? There is no way to know, since only a large
population "study" will provide the long-term answers. The majority of the U.S.
population probably would not agree to legalize the drug because of a
traditional anti-drug bias.
- What is the
difference between powdered cocaine and "crack"?
They are the same drug,
with different potencies and routes of administration. Crack is made from
cocaine freebase, which is an intermediate form of cocaine made by heating
cocaine with sodium bicarbonate and water. Upon further heating with ether and
more sodium bicarbonate, a waxy form of pure cocaine is formed, called "crack",
for the crackling sound it makes when smoked. By the way, there is no evidence
that crack is more "addicting" than cocaine powder.
- Which drugs can
cause death in overdoses?
Most people understand that
people can overdose on heroin (cause = respiratory depression), cocaine (stroke
or heartbeat abnormalities), alcohol (respiratory depression or drowning on
vomit), and amphetamines (convulsions). However, there are two drugs for which
the lethal dose is not known: marijuana and LSD. This does not mean that these
drugs should be legalized, however, for they both have harmful mood-altering
- The term "narcotic"
Formerly used to describe
analgesic opioids, marijuana, and cocaine, the word now seems to be
misunderstood by people who use it. The term narcotic literally means "drugs
that produce sleep or grogginess", but the new, more accurate terms for
sleep-inducers are "sleep aids" and "hypnotics".
- What is
We hear the terms "smoking
dope", "dope fiends", and "using dope". Obviously, "dope" is a pejorative term
for illegal drugs, including marijuana, heroin, and perhaps all other illegal
drugs. The term obviously does not apply to alcohol and nicotine. Reducing the
use of the term "dope" will help to reduce the stigma associated with public
misunderstanding of what these drugs do to the brain.
such a dangerous drug, yet it is legal for people over the age of 21. Since
marijuana is illegal, it must be more dangerous - right?
Not necessarily. Although the acute effects of
marijuana are similar to those of nicotine (mood alteration and physiological
effects), the long-term effects of marijuana are inconclusive. There is some
scientific concern over the effects of marijuana on the immune and hormonal
systems, but there is insufficient research on such long-term effects. It does,
however, have detrimental effects on driving skills. The main reason marijuana
is illegal is that it was included in the Harrison Narcotic Act of the 1920s,
and there has so far been insufficient government interest in making it
- There is a new
"Nico Water" on the market containing small amounts of nicotine. What is the
purpose of this product?
Some smokers who are trying to
quit can use nicotine patches, gum, and low-nicotine devices to try to wean
themselves off nicotine. Nico Water is marketed as a way to help people with
"nicotine cravings" who are trying to quit. The value of such a product is in
question, however, because of the potential use by people (children?) who are
not smokers. No one knows whether such a product could produce nicotine
- How many people who
use marijuana become dependent
According to one recent study,
8% of marijuana users will become dependent over a 10-year period of use. This
compares with 12-13% for alcohol and 15-16% with cocaine. The bad news?
Marijuana is addicting. The good news? Not as many people become addicted to
marijuana as to cocaine or alcohol.
- The term "substance
abuse" is vague, weak, misleading, and inaccurate in many
People often use this term when
they mean "substance dependence", and the vague "substance" term is used as a
catch-all for food, chemicals, and drugs. In many "substance abuse treatment
centers", people are also being treated for sex or gambling addictions, which
are certainly not substances. In addition, "abuse" is rarely treated in
dependence treatment centers, so the term tends to be misleading.
28. What is the
difference in the use of the terms "drug", "chemical", and
A drug (example: aspirin) is a chemical that
produces a pharmacological and a toxicological effect in the body. Most drugs
produce therapeutic or unwanted effects on the body. A chemical (example:
toluene) is an organic or inorganic substance that produces more of a
toxicological (poisonous) effect on the body than a drug. A substance (examples:
gasoline, food) is something that is a catch-all term, but when used with
"abuse" is generally a very vague term. Thus there is overlap among these terms,
but they should not be used synonymously.
29. The following
drugs have low to moderate dependence potential (that is, not as powerful as
heroin, cocaine, or alcohol): methadone, benzodiazepines (such as Xanax,
Librium), marijuana, and codeine.
These drugs, for many pharmacological reasons,
do not produce a powerful effect on nerve transmission in the "dependence area"
of the brain - the medial forebrain bundle (MFB). The MFB is also known as the
mesolimbic dopamine system.
30. The following
drugs are not addicting, according to recent research: caffeine, hallucinogens
(such as LSD), antidepressants, neuroleptics (used to treat schizophrenia), and
lithium (used to treat bipolar disease).
Some scientists feel that the reason they are
not addicting is because they do not produce a strong and specific effect on the
"dependence area" of the brain - the medial forebrain bundle.
percentage of the public is dependent on
These figures vary depending upon the drug, but
here are some rough numbers. Approximately 15-16 % of cocaine users develop
dependence within the first 10 years of use. The number for marijuana is 8%, and
for alcohol 12-13%, according to one recent study. Such information is not known
for other drugs like heroin, nicotine, ecstasy, etc.
32. How do
Blackouts are an apparent result of depression
of activity in the part of the brain known as the hippocampus. The function of
this brain area concerns cognitive learning and memory. It is known to be very
sensitive to the effects of central nervous system depressant drugs such as
alcohol, opioids, anesthetics, and even some stimulants such as cocaine. The
rest of the brain is not as sensitive to such drugs, so that an intoxicated
person may appear fine - until the next day when certain events of "the night
before" are not remembered.
33. Can drugs
other than alcohol cause "blackouts"?
While the alcohol-induced "blackout" is most
well-known, other drugs can cause it. A blackout is nothing more than a brief
period of drug-induced short-term amnesia. Thus, some anesthetics used for
surgery cause blackouts, but the term is not used with this therapeutic use of
drugs, since short-term amnesia of the surgical event is a desired outcome.
Other drugs that cause intense intoxication, such as opioids (powerful
analgesics such as morphine), cocaine, LSD, and ecstasy can also cause
34. What causes
No one really knows, since there has not been a
lot of LSD research performed over the past 20 years. It is clear that
flashbacks (hallucinations occurring months or years after the drug has been
used) are not caused by LSD that is still in the body. Flashbacks probably occur
because of psychological "triggering" (such as an emotional bad memory), due to
cues in the environment. However, this is simply speculation, since research on
flashbacks is inconclusive.
35. Is it true
that marijuana concentrates in the body fat?
Yes, some metabolites (break-down products) of
marijuana concentrate in the body fat, but not much of the active ingredient,
delta-9-tetrahydrocannabinol (delta-9-THC). These metabolites leak out of the
body fat stores slowly, over days or weeks. Thus, urine and blood analyses can
tell us that people have used marijuana, but it is very difficult to tell when
they used it, since the available urinalysis methods measure primarily the
metabolites of marijuana.
36. What is drug
Drug craving is an urge or desire to continue
taking the drug. In the drug research arena, the word "craving" does not have a
solid scientific meaning. It is also difficult to measure. When patients are
asked to describe drug craving, scientists receive widely different answers.
Thus, the words "urge" or "desire" are often more meaningful. Craving is not the
same as drug dependence ("addiction").
37. Which drugs
are most dangerous to the organs of the body?
Collectively, the inhalants (really chemicals,
rather than drugs) are extremely toxic to organs such as the liver, kidney,
brain, and heart. Inhalants include chemicals from correction fluid, to
gasoline, to model airplane glue and paints, to amyl nitrate "poppers", and
propellants in hair sprays etc. These are usually inhaled in dangerous ways as
well (as in plastic bags over the face). These chemicals are so dangerous that
we don't even know if they're "addicting", since people rarely use them long
enough to develop dependence.
38. What do
scientists mean by "CNS stimulants" and "CNS
"CNS" stands for central nervous system, which
includes the brain and spinal cord. Drugs affecting the CNS include morphine
(CNS depressant) and cocaine (CNS stimulant). Some CNS depressant drugs, such as
alcohol, produce "stimulation" in low doses by depressing parts of the brain
that normally put brakes on other parts of the brain. Thus, "releasing the
brake" causes these other parts of the brain to become excited (apparent
39. How do drugs
No one really knows. Craving is a complex
phenomenon that scientists have difficulty describing and measuring. We believe
that craving is one of the causes of, but not the same as, dependence
("addiction"). Craving probably leads to relapse in recovering people. Craving
may arise from brain structures including the medial forebrain bundle (pleasure
pathway), the limbic system, the amygdala, and the cerebral cortex. In other
words, the precise brain areas involved in craving have not yet been fully
40. How do drugs
work on the brain to produce a "high"?
This "high", technically known as "euphoria", is
an exciting sense of well-being. Some drugs produce a blockbuster euphoria
(cocaine, heroin), while others cause a mild euphoria (anti-anxiety
benzodiazepines, nicotine, caffeine). This effect seems to be produced through
the release of a chemical called dopamine in the pleasure pathway (medial
forebrain bundle) of the brain. Euphoria, by the way, is not a cause of chemical
dependency. Euphoria is merely the reason for why people use drugs
41. What are the
effects of smoking cigarettes?
People who smoke report that cigarettes make
them more relaxed, or sometimes more energized. Beyond that, there are no
beneficial effects of smoking. The detrimental effects of smoking far outweigh
the few beneficial effects.
The detrimental effects of smoking include:
- greatly increased risk of lung cancer and heart
- increased incidence of other cancers
- halitosis (bad breath),
- early signs of aging (wrinkled skin, etc.), and
- side-stream (second-hand) smoke effects on those
around the smoker, which can be particularly detrimental to young children.
Smoking is the leading cause of
Three factors are traditionally cited as being
important reasons for beginning to smoke:
- peer pressure (acceptance),
- poor education about the negative effects of
Thus, teen-age women are the
fastest-growing segment of the American population of new smokers. Of these, up
to 40% will become dependent (addicted) to nicotine, and will be unable to stop
without help: some sort of smoking cessation program will be
A rave (almost the same as a dance party) is a
large get-together, mostly of young people. At raves, disc jockeys and
synchronized light shows are featured, and drug use is condoned. Drugs used at
raves include the so-called club drugs (ecstasy, LSD, methamphetamine, rohypnol,
ketamine, and GHB). These are either used alone or in combination with alcohol.
Most raves are well-attended (generally 100-500 people), and are advertised on
the Internet, in music stores (posters), and by word-of-mouth. While illegal
drugs are bought and used at raves, authorities are usually outnumbered at such
places, so the number of arrests is relatively small. Research is needed to find
out what to do with such parties.
44. What is a
"Speedball" is a street name for a drug
combination of a central nervous system (CNS) stimulant and a CNS depressant.
One of the most popular speedballs is a combination of cocaine and heroin.
Another (not usually called a speedball) is amphetamine and alcohol.
People take these for one of the following
- to increase the euphoric effect (sense of
well-being) over that achieved with either drug alone (both depressants and
stimulants produce a type of euphoria),
- using the second drug to stop the first drug's
actions (for example, an amphetamine can "perk up" a person who is drowsy from
- producing a unique euphoric effect that cannot be
achieved with either drug alone.
In general, mixing such drugs
is dangerous, for the effects are not always predictable and the side effects
can be additive.
45. Is there a
difference between sedatives, hypnotics, and
Technically, a sedative is an agent that calms a
person, and it may or may not cause drowsiness. An hypnotic is a drug that
increases the probability of sleep. A tranquilizer (often thought to be the same
as a sedative) is a drug that specifically reduces anxiety, or (formerly)
overcomes schizophrenic symptoms. Today, the terms "anxiolytics",
"sedative-hypnotics", and "antipsychotics" are more descriptive of the use of
these drugs. All of these drugs can be abused, but only anxiolytics and
sedative-hypnotics are capable of producing dependence.
46. We often hear
the term "compliance to treatment". How does this relate to addiction treatment?
"Compliance" has to do with the regularity with
which people continue treatment over time. It is a common medical problem for
patients to become less compliant with treatment when they feel better, or when
treatment is difficult to obtain. However, recent research suggests that
alcoholics and other drug addicts are as compliant with their treatment as are
people with more popular diseases such as diabetes, high blood pressure, or
47. Vaccines are
now being developed for the treatment of several drug dependencies: cocaine,
nicotine, and methamphetamine.
These "polyclonal" and "monoclonal" antibodies
have been developed to bind with the parent drug to either prevent the drug from
reaching the brain, or from attaching to the brain receptor that produces the
drug effect. Thus, an animal or person who is given one of these vaccines will
not feel the effects of the drug. Will these be highly useful in addiction
treatment? We must wait for the clinical trials to be completed.
48. Some drugs are
incapable of producing dependence ("addiction")
- because they do not have a significant effect
on the addiction area of the brain, the medial forebrain bundle (also known as
the pleasure pathway, or mesolimbic dopamine system). Drugs such as caffeine,
hallucinogens (e.g., LSD), lithium, antidepressant drugs, and antipsychotic
drugs have so fare not been shown to have a major effect on the medial forebrain
bundle. If someone insists that caffeine or Prozac (an antidepressant drug) are
addicting, they are using an old definition of addiction. The new definition is
embodied in the term "dependence", as defined by accepted psychiatric assessment
49. The old-time
barbiturates were notorious for their addictive
They were particularly dangerous when mixed with
alcohol. Thus, people who became drunk, who were so excited that they couldn't
sleep, and who knew they had to be "fresh" the next day, often took a
barbiturate to help them sleep. The problem is, they often didn't wake up the
next day. Several former movie stars accidentally overdosed in this manner. Even
though barbiturates have been replaced by the less dangerous benzodiazepines
these days, barbiturates are still available on the street.
50. What are the
effects of marijuana on driving behavior?
While we would expect that the intoxicating
effects of marijuana would negatively affect driving behavior (altered
perception, altered judgment, etc.), this subject has been incompletely studied.
Limited studies even suggest that marijuana can cause more careful (!) driving.
This is very characteristic of marijuana research. Opposing studies often cancel
one another out, or there is a perception of research bias. Only an
extraordinary emphasis on a large number of excellent studies on marijuana
pharmacology and toxicology will help us out of this "marijuana facts vacuum".
51. How do drugs
Even though research is lacking, some scientists
believe that drugs such as LSD cause a malfunction of the "filtering mechanism"
for stimuli coming into areas at the base of the brain, called the "reticular
formation". When this filtering mechanism (however it works) is blocked, all
environmental stimuli entering the brain via sight, hearing, touch, smell, etc.
are allowed to flood the brain, causing hallucinations (probably in the
conscious cortex). This makes sense, but it is old information since not much
new research has been performed on how hallucinating drugs produce their
52. Not all drugs
that make us feel good are addicting.
One of the most controversial is caffeine. Most
scientific studies indicate that caffeine is mildly addicting at best, but even
this is not completely established. Since addicting drugs probably affect the
mesolimbic dopamine system of the brain to produce "addiction", scientists must
show that caffeine has a major action on this system. This has not yet been
done. In addition, it is not clear that caffeine has the ability to satisfy the
necessary dependence criteria of the DSM-IV.
52. What drugs
have the greatest addiction potential?
As of this writing, the most addicting drugs are
heroin, cocaine/crack, and nicotine. There is a large amount of research to
support this, but more research might change this conclusion. Right behind these
four drugs are alcohol and amphetamines. Other drugs have significant addiction
potential, but not as great as these.
53. Why don't we
legalize heroin for the treatment of
First of all, heroin is a highly potent, illegal
drug with high addiction potential, sold on the street with an enormous black
market following. Thus it has a terrible "reputation". Legalizing it will not
change its reputation among the public. Pharmacologically, it's broken down
(metabolized) to morphine, so there is really no advantage to legalizing heroin.
The same effect can be achieved by increasing the dose of morphine.
54. The term
"substance abuse" is a poor term
- when applied to treatment centers and some
government agencies. When talking about a "substance abuse treatment center",
this is now inaccurate according to the new definition of "addiction" (which is
beginning to be replaced by the DSM word "dependence"). Thus a better term is
"dependence treatment centers" (this is especially true when sex and gambling
disorders are treated, which are not "substances"). Also, the Center for
Substance Abuse Treatment (CSAT) sends the wrong message to the public. This
agency actually is more involved in supporting programs on dependence treatment.
It is important that institutions accurately reflect what they do through the
use of accurate and up-to-date nomenclature.
55. We often hear
of "substance abuse" rather than "drug abuse". Why do people continue to use the
It is imprecise, and not as scientific as the
words "drug" or "chemical". Although it is impossible to determine the reason
why people use the word "substance", it appears that it is an attempt at being
"all-inclusive" - to include not only therapeutic drugs, illegal drugs, alcohol
(many people still call alcohol a food), nicotine, chemicals that are inhaled
("inhalants"), foods (to which some people can become "addicted"), and certain
plant products (including marijuana and herbs).
happened to meprobamate (Miltown,
Like the barbiturates, meprobamate has pretty
much been replaced by the safer benzodiazepines. Meprobamate is characterized by
its low potency (many milligrams needed to produce an effect), its hangover, and
its addiction potential. One drug similar to meprobamate that still gives us
trouble is Soma (carisoprodol), used to produce muscle relaxation.
Unfortunately, some individuals are abusing Soma, because of its sedative
happened to the barbiturates?
Actually, the good ol' barbiturates are still
around. Not as many, and they're not used as much as they used to be, but some
of them are still used. One problem is that a few of them are abused by people
who want to get "high". These include mephobarbital (Mebaral) and pentobarbital
(Nembutal). Thiopental (Pentothal) is still sometimes used intravenously as a
pre-anesthetic medication, and phenobarbital (a long-acting, not-very-potent
barbiturate) is still used as a sedative and in detoxification of
benzodiazepine-dependent individuals. The reduced use of barbiturates is due to
their high addiction potential and the fact that benzodiazepines are not as
prone to produce overdose.
58. Shall we
treat, or punish, drug addicts?
Always treat, sometimes punish, if they have
committed a crime. Treatment should take place either inside or outside the
prison system, depending upon the seriousness of the infraction. If no
infraction has occurred other than drug use (even illegal drug use), then
punishment is inappropriate. However, addicts should always be held responsible
for what they do under the influence. Punishment alone does not overcome the
brain chemistry problem leading to impaired control over drug use.
59. When people
relapse after being clean and sober for a period of time after treatment, it's
called treatment "failure".
When people regain symptoms of any other disease
after treatment, it's called non-compliance or disease progression (for example,
diabetes, hypertension, asthma). Why the difference? Stigma!
amphetamines such as Ritalin and Adderall lead to addiction when used for
reducing the symptoms of Attention Deficit Hyperactivity Disorder
Present evidence indicates that the therapeutic
use of these drugs is highly effective in controlling symptoms of this disorder.
Furthermore, the benefit of these drugs far outweighs their danger in producing
dependence. (Remember that drugs do not cause dependence, it is the person's
susceptibility to addiction that leads to the disease.) Clinicians also think
that untreated ADHD may lead to increased drug use later in life as the person
tries to "self-medicate" the symptoms.
61. Marijuana is a
difficult drug to study in the laboratory.
There are several problems: a) standard joints
cannot easily be smoked in a standard way by laboratory volunteers, b) animals
exposed to marijuana smoke often stop breathing, so this is not a good way to
give them the drug, c) the active ingredient in marijuana is THC, which is not
water soluble. Thus solutions must be made with alcohol, which confounds the
findings of the experiments. Finally, marijuana, being a controlled substance,
is difficult to obtain by scientists, since a lot of paperwork and experimental
controls are needed. For all these reasons, research on understanding the
effects of marijuana on the body is very slow.
62. Do drugs
destroy brain cells?
The only two drugs for which there is solid
evidence are ecstasy and alcohol. Alcohol destroys brain cells ("neurotoxicity")
only in large, prolonged doses. But with ecstasy (MDMA), the ends of the
serotonin nerve cells are simply gone (as seen in animal studies). Not only is
the serotonin, gone, but all the other cell components of the nerve terminal
have disappeared. Small doses of MDMA apparently produce little or no damage,
moderate doses produce damage but some of the serotonin system is still
functional, and large doses can completely destroy the nerve terminals.
("Small", moderate", and "large" doses are relative terms; these vary from
person to person.)
63. Marijuana is
an illegal drug, whereas alcohol and nicotine are legal
Since marijuana is a mood-altering drug, it has
detrimental effects on driving skills and operation of dangerous machinery.
Furthermore, like alcohol and nicotine, it produces dependence (addiction) in
susceptible individuals. There are no short- or long-term beneficial effects of
using marijuana in normal individuals that cannot be achieved with other drugs
or activities. The medicinal effects of marijuana are anecdotal (but strong), so
it makes sense that people who are very sick should be allowed to use the drug.
However, the lack of public and professional agreement about the risks and
benefits of marijuana means that the value of this drug will continue to be
debated until scientists accumulate an overwhelming amount of research about its
pharmacology and toxicology.
64. Marijuana is a
safe drug pharmacologically.
It has no known lethal dose in humans, it
apparently produces no significant toxicity on organ systems other than the
lungs, and it has much less organ toxicity in high doses than alcohol. The
long-term effects of high doses of marijuana on body physiology and organs is
65. There are
several ways by which opiates may be administered.
These are a) orally (morphine is
relatively ineffective when taken orally, but methadone is very effective), b)
pulmonary (opium smoking began in China, but is not used much these days), c)
insufflation ("snorting" - opium itself is not well absorbed by this route, but
heroin can be taken this way), and d) injection (probably the most effective -
intravenously, intramuscularly, or subcutaneously). "Intravenous" means into a
vein, "intramuscular" means into a muscle, and "subcutaneous" means between the
layers of the skin. Injection methods are the most dangerous if the needles are
dirty, leading to transmission of hepatitis and HIV from user to user.
66. One of the
most potent drugs is LSD, yet it is not toxic to organs in the
Potency has to do with the number of molecules
of the drug that will produce a pharmacologic action. With LSD, only micrograms
(millionths of a gram) of the drug are needed to produce hallucinations (most
drugs work in milligram doses - thousandths of a gram). There is no known lethal
dose for LSD in humans, and LSD is rarely used often enough or long enough by
people to tell us which body organ the drug might most adversely affect.
67. According to
the National Institute on Drug Abuse, these two barbiturates are still abused in
the U.S.: mephobarbital (Mebaral) and pentobarbital (Nembutal).
These drugs fall into the sedative-hypnotic
category, and have been replaced in therapeutic practice by benzodiazepines such
as diazepam (Valium). Other barbiturates still available include secobarbital
(Seconal) and phenobarbital (which is a long-acting barbiturate that has low
dependence potential). This class of drugs is dangerous because of the high
dependence potential and lethal outcomes when combined with alcohol.
68. The amount of
nicotine in a typical cigarette is about one milligram, enough to make a person
sick if taken in the form of a tablet.
However, when smoked, most of a cigarette's
nicotine is lost in exhaled or uninhaled smoke. A plug of snuff kept in the
mouth for 30 minutes delivers a dose of 3-5 milligrams, but because the
absorption is slower than cigarette smoke-nicotine through the lungs, both
routes of delivery produce similar peak blood nicotine levels.
69. Drugs that
directly affect the pleasure pathway of the brain have the potential to produce
Drugs that have little or no effect on the
brain's pleasure pathway are incapable of producing dependence. However,
physical withdrawal (also known as physiological dependence, a confusing term)
can occur with any drug that is used in high doses over a long period of time.
Withdrawal symptoms seen when drug use ceases does not mean that a person is
70. Lots of drugs
- alcohol, caffeine, nicotine, marijuana,
benzodiazepines (like Valium), Vicodin, Ritalin, Prozac, LSD, aspirin (and
similar pain killers), ecstasy, GHB, and many others. But not all drugs produce
dependence (are "addicting"). Some drugs that affect the nervous systems do not
produce dependence (or have not yet been proven to be addicting): caffeine,
Prozac, LSD, aspirin, anti-parkinson drugs (such as L-dopa), anti-schizophrenic
drugs (such as Risperdal), and anti-epileptic drugs (such Depakote or
71. Addiction is
not a "too much. Too often, withdrawal disease", it's an "I can't stop without
In other words, one cannot diagnose addiction by
looking at the amount and frequency of drug use. Professional assessment of the
individual by qualified diagnosticians is necessary for proper diagnosis.
72. Is caffeine
addicting or not?
The latest diagnostic manual (DSM-IV) does not
list caffeine as producing dependence (now interchangeable with "addiction"),
and most scientific reviews indicate that there is insufficient evidence to
classify caffeine as addicting. Yes, withdrawal from caffeine does occur, but
withdrawal is only one of several criteria required to classify a drug as
73. Many, but not
all, abused drugs are "receptor agonists".
An "agonist" (such as heroin) activates a
receptor in the brain to produce its effects. An "antagonist" (such as naloxone,
Narcan) occupies a receptor site and prevents an agonist from activating the
receptor. Thus, when a person overdoses on heroin, Narcan (in sufficient doses)
is capable of taking the place of heroin at the receptor and reversing heroin's
effects. This is why Narcan is a life-saving drug in heroin overdose situations.
Because Narcan does not activate the opioid receptors, it is not
popularly-abused drug is "Oxycontin". What is this
This is the brand name for oxycodone, an
orally-active sustained-release opioid drug used for pain control. Its effects
are designed to last about 12 hours. Like other opioids (heroin is an opioid),
this drug can be abused and is capable of producing dependence ("addiction") in
75. A basic
pharmacological concept is that drug effects are determined, in part, by the
area of the brain that is most affected by a drug.
The drugs act on receptors, and these receptors
vary in concentration throughout the brain. If there are drug receptors, for
example, in the pleasure areas of the brain, then the drug will produce feelings
of pleasure. The same drug working at the same receptors in a different area of
the brain (for example, the motor areas) might produce a "side effect" of
changes in motor activity (movement).
76. A basic
pharmacological concept is that addicting drugs act on portions of nerve cells
to exert their actions.
One major cellular site of action is the
receptors where the drugs "bind" to cause electrical and chemical changes to
occur in the cell. These changes are the beginning of a cascade of electrical
and chemical events that make the next nerve cell more likely to carry the
message ("excitation"), or less likely to carry the message ("inhibition").
77. LSD is a very
interesting drug because:
- of its high potency (only a few micrograms are
needed to produce hallucinations),
- and because there are no known instances of
deaths cased by toxic overdoses. Certainly people have died because of the risks
they took while intoxicated, but LSD is a pretty safe drug otherwise.
- Scientists do not fully understand how it acts on
the brain to produce
Causes of death due to overdose with the following drugs
- cocaine (hypertensive stroke or cardiac
arrhythmia a.k.a. as irregular beating),
- heroin (depression of the respiratory
center in the brainstem),
- ecstasy (hyperthermia and seizures),
- alcohol (same as heroin, or drowning on
- amphetamines (seizures),
- benzodiazepines (very high doses, same as
- inhalants (heart, brain, kidney, and liver
marijuana or LSD are rare, unless mixed with other drugs.
79. There are
several neurotransmitters (cell-communicating chemicals) in the brain that
appear to be related to chemical dependence
These are dopamine, serotonin, endorphins, GABA,
glutamate, and acetylcholine. It appears that dysregulation of one or more of
these chemicals in the brain's pleasure pathway determines the primary drug upon
which a person becomes dependent. For example, we might assume that cocaine
dependence is related to dopamine dysregulation. Another match-up includes
heroin and endorphins. Finally, nicotine dependence might be related to
dysregulation of nicotine receptors (acetylcholine system). More research is
required to confirm such relationships, however.
80. All drugs
affecting the brain have a common general mechanism of
That is, they all affect nerve cells (neurons)
in some way. Some brain-affecting drugs reduce nerve cell function, while others
increase nerve cell function. But it isn't that simple. When a person falls
asleep, some parts of the brain continue to function and are refreshed by the
reduced activity of the body. In a similar manner, some brain areas are
"disinhibited" when a depressant drug such as heroin is working. The result is
an energized feeling.
- blunts are hollowed-out cigars packed with
- Colas are buds of the cannabis plant,
which are preferred by marijuana users because of their higher content of
delta-9-tetrahydrocannabinol (THC), the active ingredient in
- Hashish (hash) is the resin of the
cannabis plant, when it is separated from the plant material.
The big challenge in developing medications to treat chemical dependency is to
obtain high potency, great specificity, and no significant side
This means that new medications must be
effective in low doses (e.g., in the 1-4 mg/dose range), they must target only
the brain areas involved in dependence (e.g., various parts of the medial
forebrain bundle, where addiction occurs), and their effects must not "spill
over" into other areas where side effects would be produced.
83. There is a category
of abused drugs called "Inhalants":
- nitrites (e.g. amyl nitrite "poppers" that
have the same basic effects as nitroglycerin used by angina patients),
- nitrous oxide and other gas anesthetics
("anesthesia outside of the operating room"), and
- solvents (a broad category of highly toxic
chemicals found in gasoline, glues, paints, and sprays).
These are most often used by
young people or desperate individuals who cannot afford or cannot obtain other
drugs such as alcohol.
84. The term "drugs"
includes alcohol, nicotine, illegal drugs, prescription drugs, and chemicals
that produce a pharmacological action when
Sometimes the word "drug" has a narrow meaning
to some people (such as only "illegal" drugs). Sometimes there is a
misunderstanding about what drugs are (alcohol is a drug, not a food; nitrous
oxide is a drug, but also a chemical). Generally, foods, vitamins, and minerals
are not drugs.
85. Most drugs act at
receptor sites in the brain to exert their pharmacological
Receptors are specialized proteins or enzymes
that are the "lock" in the "lock and key" concept of receptor activation. A drug
actually attaches (or binds) to its specific receptor, which creates a change in
the receptor shape or activity. The final result of this activation is increased
or decreased firing of the nerve cell. When many cells are affected in this way
by a drug, the result is called the pharmacological action of the drug, which
might be a behavioral change or a therapeutic action.
86. People "abuse" many
A few that we're hearing about these days
- Ritalin (see below fact 87),
- Vicodin (often used by health
professionals and people who begin using it for rational therapeutic reasons
such as back pain),
- Club drugs (GHB, rohypnol, ketamine, and
others that are taken because of peer group acceptance),
- Ultram (tramadol, a non-traditional
opioid-like analgesic that is abused by health professionals), and
- Codeine (a mild opioid antitussive, or
drugs and codeine, especially, have been taken with other drugs such as alcohol,
which makes the complications of their abuse even more problematic. Some of
these drugs have a large addiction potential, while some have a low addiction
(Ritalin) is now an abused drug.
Patients with Attention Deficit Hyperactivity
Disorder (ADHD, also known as ADD) are selling their Ritalin prescriptions to
other people who use the drug for increasing alertness and getting high. This
even happens with children's prescriptions. Ritalin is an amphetamine-like drug,
so it can be just as dependence-producing as methamphetamine in recreational
users. Ritalin is also available on the black market. Likely, this will lead to
increased restrictions on the availability of the drug for prescription use.
88. Beware of drug
dealers (or even non-qualified professionals) telling you what they know about
Only drug experts (unbiased addiction
scientists, pharmacologists, addiction medicine specialists, and drug educators)
can tell you what drugs really do. For example, it is not true that smokable
heroin is non-addicting, or that LSD causes mental illness. Drug myths cause
many of the problems with drugs that we have in this country.
89. Some psychoactive
drugs are associated with powerful dependence (e.g., cocaine) and some are
associated with minor dependence production (e.g.,
This is because their ability to affect the
pleasure pathway of the brain varies, for reasons that are incompletely
understood. One possible explanation for this variation is the ability of the
drugs' receptors to adapt to the presence of the drug to produce sensitization,
which is one of the component causes of dependence.
90. Not all
psychoactive drugs are associated with dependence
Drugs that produce addiction as a side effect
must have a major action on the pleasure pathway (medial forebrain bundle, MFB))
of the limbic system. Drugs such as fluoxetine (Prozac) are non-addicting,
because they do not have a major action on the MFB.
91. Caffeine is the
least potent of the central nervous system stimulants:
- and is mainly found in coffee, cola
drinks, and other beverages. It is used for its anti-fatigue effects, and
excessive use of caffeine leads to headache, stomach upset, and drowsiness upon
withdrawal. In spite of such withdrawal, caffeine does not cause significant
drug dependence, according to established criteria. The neurochemical mechanism
of caffeine on the brain is incompletely understood.
92. Benzodiazepines are
effective in reducing anxiety ("anxiolytics") and in promoting sleep
Anxiolytic benzodiazepines include:
- Alprazolam (Xanax),
- Chlordiazepoxide (Librium), and
- Diazepam (Valium).
- Flurazepam (Dalmane),
- Triazolam (Halcion), and
- Temazepam (Restoril).
These drugs are thought to
increase the function of gamma-amino butyric acid (GABA) in the brain. Since the
GABA system is an inhibitory system in the brain, increasing its function will
tend to suppress overactivity symptoms, two of which are anxiety and insomnia.
93. There is a nicotine
vaccine being tested in animals, as of this date.
Like the cocaine vaccine, it is designed to keep
the drug from acting on the brain. "Vaccines" are antibodies to the drug
molecule that complex with the drug and make the drug less likely to fit its
receptor. Such vaccines are designed to treat chemical dependency and/or act as
an antidote in overdose situations.
94. How is genetics
involved in addiction?
Abnormal genes, passed from one generation to
another, may cause dysregulation of neurotransmitter function in the "pleasure
pathway" of the brain. This neurochemical dysregulation probably causes a
potential addict to "connect" with certain drugs in a special way, so that the
drug fills a "need" that the individual interprets as "pathological craving"
directed toward the drug's pharmacological actions.
95. Is addiction a
Yes, with qualifications. Although the genetics
research in this area is still under development, most scientists believe that
the tendency to become addicted is inherited. In other words, addiction is under
the control of both genetics and environment, much like other diseases that have
a genetic component.
96. All drugs associated
with dependence (for example, cocaine, nicotine, heroin) produce withdrawal in
many people when they stop after (generally) high drug use over a long period of
There are two types of withdrawal:
- physical hyperexcitability (the most common) as
seen in withdrawal from central nervous system depressants such as heroin, and
- mental "hyper-depression" that follows withdrawal
from central nervous system stimulants such as cocaine.
A person does not have to be
dependent ("addicted") to a drug to have withdrawal. Likewise, not every
drug-dependent individual has withdrawal when they stop using.
(pharmaceutical treatment) of chemical
- falls into two general categories:
a) those that reduce withdrawal severity and
b) those that reduce craving leading to drug
Examples of products that fall into the first
category are nicotine patches and gum (smoking) and clonidine (heroin).
Examples of products that fall into the second
category are bupropion (smoking) and naltrexone (alcohol).
Gamma-vinyl GABA is a derivative of the
inhibitory neurotransmitter GABA. Because there is some rationale for the
involvement of GABA in the actions of cocaine on the brain, GVG might be useful
for the treatment of cocaine dependence. No one knows exactly how it works, but
it is a good example of the types of drugs currently being tested for reducing
the craving associated with cocaine use.
99. What is
This is a powerful analgesic of the opioid class
of drugs, that also seems to reduce the craving for heroin. Unlike methadone,
which is a pure "agonist" (receptor activator), buprenorphine has a mixture of
agonist and antagonist (receptor blocker) activity. Thus it is difficult to
increase the dose of the drug to get a better "high", since at high doses the
antagonist effect apparently kicks in and reduces the rewarding effects of the
This is an antidepressant drug that has recently
been approved for the treatment of nicotine dependence. Better known as Zyban,
it supposedly reduces the withdrawal symptom severity produced when people stop
smoking. It might also reduce the craving for nicotine.
101. Is the new
smokable heroin addicting?
Of course! Changing the way a drug is ingested
does not change its ability to produce addiction. Remember: addiction
(dependence) is not caused by the drug, otherwise everyone who uses heroin and
other drugs would become addicted. Whether or not a person becomes addicted is
dependent upon the person's susceptibility to addiction. This susceptibility is
determined by genetics, brain sensitivity, and other factors.
102. Are there any
drugs that affect the brain and are not addicting?
Yes, there are many of them. According
to the latest definition of "addiction" (dependence as defined by Diagnostic and
Statistical Manual, Edition IV criteria), there is insufficient evidence to
demonstrate that caffeine and LSD produce addiction. (This surprises a lot of
people.) Also, not all mood-altering drugs produce dependence: antidepressants,
presumably because they do not have a direct effect on the pleasure pathway of
the brain (the site of dependence production). Other drugs that do not produce
dependence are: naltrexone and naloxone (opioid antagonists), chlorpromazine (an
anti-schizophrenic drug), lithium (a drug used to treat bipolar disorder), and
anti-epileptic drugs such as phenytoin.
103. Does everyone who
uses cocaine, heroin, and marijuana become
Absolutely not. Our best estimates are that 18%
of people who use cocaine/crack become addicted. Weak evidence indicates that
40% and 4% of people who use heroin and marijuana, respectively, become
addicted. However, these are the results of preliminary household surveys, and
require more research to come up with more accurate numbers.
104. Which drugs
produce the worst Fetal Syndrome when the mother uses them during
Alcohol, by far, is the worst drug. It produces
the permanent teratologic effects caused by alcohol: abnormal facial
characteristics, organ developmental defects, including brain underdevelopment.
All other recreational drugs (legal or illegal) produce marked, but temporary,
effects on the fetus. However, more research would be helpful in identifying the
precise effects of recreational drugs on the fetus.
105. What do we know
LSD is the classic hallucinogen (produces mostly
visual hallucinations). It is used by "acid-heads" who want to have new
experiences and insight. It allegedly allows a person to see everything
differently, while they are in a state of "high suggestibility". This is why it
is difficult to overdose on LSD. While there is no documented human lethal dose
of LSD, the drug supposedly can trigger psychotic episodes and people often
experience "bad trips" (scary hallucinations). Thus, a "bad trip" is not
physiologically dangerous, and the person can be "talked down" from the
experience through suggestive statements.
106. How does
Methamphetamine is a "psychostimulant" that
causes a euphoric response almost as intense as cocaine. It acts longer than
cocaine (in single doses), but has a slower onset of action. Methamphetamine has
therapeutic uses in the treatment of narcolepsy (a sleep disorder), and as an
adjunct to obesity control, when prescribed. It appears to increase the release
of dopamine from brain cells, which leads to an overall generalized stimulation
of the brain.
107. What are "club
These are mood- and consciousness-altering drugs
that can be dangerous, and are often used at "rave parties".
- methamphetamine (meth, crank, ice),
- rohypnol (roofies),
- phencyclidine (PCP, angel dust),
- LSD (acid),
- MDMA (ecstasy, X), and
- ketamine (Special K, vitamin K).
Most of these drugs are not
new. Some of them are in general use in veterinary medicine due to their severe
side effects in humans. Some of them have therapeutic uses but are actually more
dangerous when used recreationally than when used therapeutically.
108. Heroin and
methadone are called "opioid agonists"
- they cause activation of the opioid receptor,
which leads to analgesia, euphoria, and (in some people) dependence on these
drugs. Newer drugs are being developed to treat heroin dependence. One
interesting drug, buprenorphine, is an "agonist-antagonist", which means that it
both activates and blocks the opioid receptor. This mixed action has been shown
to be effective in helping heroin addicts break free of their dependence on
109. The use of
methadone to treat heroin dependence is highly effective,
- the drug reduces the craving for heroin,
- it "stabilizes" the neurotransmitter
dysregulation in the brain associated with heroin craving, and
- it gets the person out of the crime-related
activities associated with the acquisition of heroin.
However, many people mistakenly
think that methadone treatment is only "replacing one addicting drug with
another". People who believe in abstinence-based treatment disagree with the
effectiveness of methadone. However, methadone treatment saves lives.
110. Abused drugs are
- the Drug Enforcement Administration through
categories listed in the Controlled Substances Act of 1970. Schedule I drugs
include those that have no accepted therapeutic use (examples: marijuana,
heroin, ecstasy). Schedule II includes those drugs that are used therapeutically
but which have high potential for abuse, such as cocaine, amphetamines, and
potent opioids such as morphine. Schedule III drugs have "some" abuse potential
(less than those in Schedule II), such as certain drugs used to treat obesity.
Schedule IV drugs have "low" potential for abuse and includes anti-anxiety drugs
such as Valium and Xanax. Schedule V drugs are subject to state and local
regulation and include low-potency opioid compounds used to treat diarrhea,
111. Marijuana has no
federally-approved therapeutic use.
The active ingredient,
delta-9-tetrahydrocannabinol or THC, is approved in tablet form (dronabinol or
Marinol) for the treatment of nausea and vomiting associated with cancer
chemotherapy, and for the treatment of wasting syndrome in AIDS. However, some
people think marijuana is more effective in joint form than in tablet form,
which has never been proven scientifically. They would also like to see the drug
approved for other uses; for example, the treatment of pain, glaucoma, asthma,
112. Addicting drugs act
at the cellular (nerve cell) level by activating "receptors" that help to
propagate certain types of signals from cell to
When a drug enters the brain, it floods the
nerve cells and eventually reaches the "synaptic area" (spaces between nerve
cells) where the cells "talk to each other" by way of chemicals. Receptors for
drugs and neurochemicals are very specific, being sensitive to only one or a few
chemicals. "Activation" means causing an initial change in the receptor which
leads to other chemical and enzymatic changes at the micro level. These cause
the next nerve cell to become excited or to become less excited. Millions of
receptors all doing their own thing can thus easily become disrupted when an
addicting drug affects these receptors, especially over a long period of
113. "Club drugs" are
drugs taken presumably to enhance people's experiences during dance parties and
These drugs include the older drugs MDMA
(ecstasy), LSD, and methamphetamine, plus some newer drugs: GHB
(gamma-hydroxybutyrate, Liquid ecstasy), rohypnol ("roofies"), and ketamine
(special K, vitamin K). In spite of common belief, all these drugs are dangerous
and can trigger addiction. These drugs have effects on neurotransmitters in the
brain, and most are lethal when mixed with alcohol.
114. The only common
property of inhalant drugs is that they are inhaled.
The category includes nitrites, anesthetics,
solvents, paints, sprays, and fuels. Serious solvent intoxication with these
compounds is like that of alcohol, but with greatly increased risk for
short-term organ toxicity. The risk of a lethal overdose with solvents is
significant, with death occurring because the heart rhythm is disrupted. Other
risks include reduced oxygen exchange, accidents, and suicide. A large number of
first-time users die from the use of inhalants.
115. There is relatively
little research on marijuana, compared to the amount on cocaine, alcohol, and
Marijuana is difficult to study, for several
reasons. Marijuana joints on the street cannot easily be duplicated in the
laboratory, since the content of the active ingredient
(delta-9-tetrahydrocannabinol, THC) varies greatly in street products. Animals
cannot easily be exposed to the smoke, and the native form of THC is not water
soluble; therefore, it is difficult to administer the compound to animals.
Finally, the effects of marijuana on humans varies greatly from one person to
another because of expectations of the user ("set") and the type of environment
in which it is used ("setting").
116. The receptor for
tetrahydrocannabinol (THC, the active ingredient in marijuana) has been
identified in the mammalian nervous
This receptor has been extensively studied and
has been found to be activated by anandamide, a naturally-occurring chemical in
the brain. Antagonists (blockers) of anandamide have been used to study
withdrawal from marijuana in animals, and may provide a tool to prevent the
effects of marijuana in the body.
117. A voucher system is
being used to treat cocaine addicts.
The vouchers, worth money that can be used to
buy anything except drugs, are rewards for having regularly clean urine tests.
The vouchers are very effective in helping cocaine-dependent patients remain
abstinent during counseling or abstinence-based twelve-step therapy.
118. Vaccines are being
developed to treat cocaine and PCP overdose, and perhaps reduce abuse and aid
treatment of dependence on these drugs.
The vaccines are monoclonal antibodies that
attach to drug receptors and prevent their action at receptor sites throughout
the brain. This can greatly reduce overdose effects and perhaps save lives.
119. It is generally
assumed that addicting drugs do not cause nerve cell death, except in high
A few rat/mouse studies have shown that MDMA
("ecstasy") can kill brain cells in the serotonin system of the brain, although
this is difficult to observe, of course, in human brains. It is also possible,
based upon newer research, that certain drugs such as ketamine ("Special K") and
phencyclidine (PCP, "angel dust") might enhance apoptosis, or programmed cell
death. If this is the case, then such drugs are much more toxic to the brain
than previously believed.
120. What are
Endorphins are naturally-occurring
"morphine-like" substances in the brain and spinal cord that are involved in
affecting pain sensitivity in individuals. They are also released in the brain
during exercise, certain types of stress, relaxation, and perhaps when people
take drugs such as heroin and alcohol. Endorphins work by activating opioid
receptors - the same receptors that are affected by opiate pain killers (strong
121. What are
Neurotransmitters are chemicals released at the
end of nerve cells (neurons) that help signals pass from cell to cell, thereby
making the brain capable of producing behavior, thought, and emotions. There are
over 40 specially-identified neurotransmitters in the brain, and probably
hundreds more that are only now being discovered.
122. Drug effects on
brain cells are generally associated with specific actions on certain
message-carrying chemicals called neurotransmitters.
For example, scientists believe that heroin's
effects are exerted through chemicals called endorphins; cocaine, through
dopamine, and benzodiazepines (such as Xanax) through gamma-amino butyric acid
123. "Crack" should not
be confused with "crank".
These street names refer to smokable cocaine and
amphetamine, respectively. Street names for illegal drugs arise from the
strangest places. For example, "crack" is apparently named for the crackling
sound of burning processed free-base cocaine. "Roofies" is one of the street
names for the date rape drug rohypnol, which apparently was used extensively by
roofers repairing homes after a hurricane in Florida.
124. What is the "medial
This anatomical structure in the brain is the
probable site of most drugs' action in producing "euphoria" (sense of
well-being, or "high"). It is known as the "pleasure pathway" of the brain, and
drugs work on one or several of its four main parts (moving from the center to
the front of the brain): ventral tegmental area, lateral hypothalamus, nucleus
accumbens, frontal cortex. It is also possible that "craving" for drugs arises
in this pathway, as well as the addicts' perceived "need" for drugs (although
these last two drug qualities have not been proven to arise
125. MDMA (ecstasy, or
- is chemically related to amphetamines, but it
has different effects on brain chemistry. The main pharmacological action of
amphetamines is to increase the release of dopamine (and some norepinephrine and
serotonin) from brain cells, to produce increased euphoria and alertness. The
action of amphetamines is mainly on the cerebral cortex of the brain. MDMA, on
the other hand, causes nerve cells to release serotonin into the synapse,
thereby producing continual nerve stimulation. The main site of action of MDMA
is probably the limbic system, where mood and emotions are regulated. The amount
of high-quality research on MDMA is low; therefore, scientists do not know much
about the effects of this "rave" drug.
126. Which drugs produce
the greatest tolerance and withdrawal?
Heroin and some other opioid (pain killing)
drugs generally produce the greatest tolerance. The usual pain-killing dose of
an opioid is in the 5-20 milligram range, but addicts often use 3-4 grams
(thousands of milligrams) when they become tolerant. LSD produces very rapid
tolerance (known as tachyphylaxis), which occurs when sequential doses produce
dramatically reduced effects within a very short period of time. Alcohol and the
old-time barbiturates can produce powerful withdrawal, characterized by
life-threatening seizures and other problems. Heroin's withdrawal is also quite
uncomfortable, but not life-threatening.
127. What is physical
Physical dependence occurs when a person uses a
drug on a regular basis over time. Gradually, the person's body adapts to the
presence of the drug, so that without the drug, the person cannot function
normally. When drug use is abruptly stopped in a physically dependent
individual, the person goes through "withdrawal", where signs and symptoms
opposite to the drug's general effects on the body are seen. Physical withdrawal
is not the same as addiction.
128. What is drug
Tolerance is a reduced response to a drug's
action. It can be inborn, in which an individual initially fails to respond to
usual doses of a drug, or it can be acquired as a person uses a drug. Most drugs
produce some degree of tolerance, which produces a need for higher and higher
doses of the drug to produce the same effect as initially. Tolerance occurs in
the liver (where enzymes become more active in breaking down the drug), or in
the target tissues (where the tissues somehow become less sensitive to the
129. The legality of
dangerous drugs such as alcohol and nicotine, and the illegality of marijuana,
have been established through cultural and historical traditions over the
In fact, many drugs were legal in the United
States until the Harrison Narcotic Act of 1914, which made opioids, marijuana,
and cocaine illegal for use outside of medicine. Thus, the term "narcotic"
(which literally means "a drug that produces sleep or drowsiness") is actually a
useless misnomer. Opioid drugs such as morphine, opium, and codeine have
traditionally been called "narcotics", but today the use of the word is
declining due to confusion and its lack of scientific accuracy.
130. People are confused
by the legal availability of alcohol and nicotine, two highly toxic drugs when
used in excess, and the illegality of drugs such as
In addition, some drugs (hallucinogens) can be
used legally by some native Americans in religious ceremonies, and some
potentially dangerous drugs (opium, coca leaves) are legal in some parts of the
world. No drugs, however, are legal for Americans under the age of 18, except
"medicines" prescribed by physicians. These "medicines", on the other hand,
include abuseable drug categories such as amphetamines, opioid analgesics, and
the anti-anxiety and sleep-inducing benzodiazepines.
131. "Social use" of
drugs is more difficult to define with nicotine and illegal drugs than it is
Technically, any drug can be used "socially",
indicating that people can congregate in groups and use drugs as an aid to
socializing. Individuals who use marijuana socially perhaps best fit into this
category. However, the toxicity (nicotine) and illegality (heroin, marijuana) of
the use of such drugs precludes benign social use of such chemicals. On the
other hand, alcohol can be legally used in social situations that benefit the
individuals and some groups that depend on restrained use of the drug (as in
132. People often wonder
how nicotine can be a legal, socially-accepted drug, while other drugs are
illegal to possess, sell, or use.
Recently an anti-smoking sentiment has arisen
among the general public, based primarily upon new research on the addictive and
harmful effects of nicotine. Legalization, or at least decriminalization, has
been proposed by some as a solution to the high crime rate caused by drug
trafficking in the U.S. Tradition and past history play a major role in the
acceptance of drugs in society, and only more sociological research on the
effectiveness of changing drug availability will help to answer the question. In
the meantime, such an issue is primarily political.
134. Illegal drugs (as
well as nicotine) are administered into the body by different routes:
- orally (by mouth),
- smoking (to the lungs via the trachea from the
- the nasal membranes ("snorting"),
- by vein (intravenously),
- under the skin (subcutaneously),
- into a muscle (intramuscularly),
- by artery (injection into a major neck artery,
- into the rectum (rectally, as by suppository),
- under the tongue (sublingually).
Addicts have tried every site
of administration imaginable. Sometimes the act of preparing and administering
the drug is more exciting than the drug itself (often seen with cocaine use).
135. "Crack babies" are
They are misnamed because mothers who produce
"crack babies" have been found to use more than just crack or cocaine during
pregnancy. In fact, it is difficult to find a pregnant woman who only uses this
drug during pregnancy. Most also use other drugs, such as alcohol, marijuana,
cigarettes (nicotine), heroin, etc. These women are also poorly nourished and
have poor prenatal care. Thus the "crack baby" (a pejorative term) is actually
the product of multiple environmental insults, and is best labeled "a baby with
multiple birth defects".
136. New anti-craving
medications are becoming available for the treatment of chemical
Some of these are older drugs being used for
this purpose; others are new drugs designed specifically as abstinence-enhancing
drugs, with the intent that they will supplement existing behavioral treatments
("talk therapy"). These pharmacotherapies include bupropion (Zyban, nicotine
dependence), naltrexone (ReVia, alcohol dependence), and methadone (Dolophine,
heroin dependence). To date, there are no effective pharmacotherapies for
treating dependence associated with cocaine, marijuana, benzodiazepine,
amphetamine, and miscellaneous drugs (PCP, ketamine, rohypnol).
137. There are two major
drug problems in the world, based upon new diagnostic
The first is drug abuse: - which is
intentional drug overuse or misuse such as seen in the inner cities, or in other
cases with poor judgment about using chemicals too much, too often. The main
characteristic of drug abuse is that people will moderate or stop using when
they decide that the adverse consequences are worse than the desirable effects
The second problem is pathological drug
dependence, the disease of "addiction". - This is a brain-chemistry disease
characterized by the inability to consistently stop using, even under adverse
138. LSD is one of the
most potent drugs in existence.
The amount required to produce hallucinations is
in the microgram range (compared to alcohol, which requires doses in the gram
range to produce euphoria). LSD is also quite non-toxic to organs in the body,
and is generally considered to be non-addictive, as defined by new diagnostic
criteria for drug dependence.
A drug is any chemical that produces a
therapeutic or non-therapeutic pharmacological action (effect) in the body.
Chemicals, on the other hand, are a broad class of substances (including drugs)
that may or may not produce noticeable effects in the body. Many chemicals (such
as tin, lead, gold) have mainly toxicological (harmful) effects on the body,
especially in high doses. Most foods are not drugs. Alcohol is a drug, not a
food (in spite of the calories it provides). Nicotine is a chemical that is also
a drug. The group of "illegal" drugs includes dangerous chemicals that have only
toxic actions (e.g., inhalants).
140. Opioids are drugs
that are powerful analgesics (pain killers).
This class of drugs includes naturally-occurring
opiates such as opium, synthetic opiates such as methadone, and
naturally-occurring brain substances such as endorphins. The major side effects
of the opioids include dependence (addiction), depression of respiration (in
high doses), tolerance (reduction of effect with prolonged use), nausea,
constipation, and reduced pupil size in the eyes. Pharmaceutical companies
continue to search for new powerful analgesics with few side effects,
141. Benzodiazepines are
drugs that reduce anxiety, enhance sleep, and reduce
Examples of this drug class
- Xanax, and
These drugs are thought to work
by enhancing or mimicking the effects of gamma-amino butyric acid (GABA), an
inhibitory neurotransmitter, in certain parts of the limbic system. The limbic
system is the part of the brain where emotions and "mood" are thought to arise.
142. Nicotine is one of
the most toxic drugs available.
It is readily absorbed through skin and mucous
membranes. Much of the nicotine in cigars and cigarettes is vaporized during
burning, but enough still remains to cause significant toxicity in the lungs and
in organs affected by nicotine in the blood. Nicotine is also highly addictive
(as addictive as heroin and alcohol, measured by the number of smokers who
become dependent and by the difficulty in stopping the use of the drug).
143. Caffeine is a mild
(compared to cocaine and amphetamines) stimulant of the central nervous
In moderate doses (e.g., 2-3 cups of coffee, but
it varies among individuals), caffeine can: increase alertness, alter sleep
patterns, reduce fatigue, and cause headaches, nervousness, dizziness, and heart
palpitations. According to the new understanding about drug dependency, caffeine
does not cause "addiction" (impaired control over consumption).
144. Marijuana is less
toxic to the body than alcohol.
Some people have interpreted the relative safety
and lack of toxicity of marijuana to mean that the drug should be legalized,
like alcohol. However, there is a relative lack of research on marijuana's
effects, compared to the large number of studies on alcohol pharmacology and
toxicology. Both drugs produce dependence in vulnerable individuals, leading to
a pattern of chronic compulsive drug-taking behavior that requires treatment.
145. Two dangerous
illicit drugs used by risk-takers are phencyclidine (PCP, "angel dust") and
ketamine ("Special K", vitamin K").
These are "dissociative anesthetics", that are
sometimes used in humans but more often used in animals. Their pharmacologic
category describes a state of anesthesia in which the subject cannot feel pain
but appears to be awake (eyes open, etc.). The drugs apparently produce an usual
dreamy state when taken recreationally.
146. Drugs are generally
categorized as medicinal (pharmaceutical, therapeutic), legal (licit), or
Examples of each of these categories are
aspirin, nicotine, and heroin. Sometimes a drug can fall into more than one
category depending upon how it is used; for example, cocaine is therapeutic and
licit when used as an anesthetic for eye surgery, but is illicit when used to
147. Marijuana is the
general term used to describe several varieties of the plant (or any part of it)
known as Cannabis (indicia, sativa, etc.).
Cannabis contains delta-9-tetrahydrocannabinol
(THC), which is psychoactive.
148. Heroin is called an
"opioid agonist", because:
- it is a synthetic compound similar in
structure to morphine and activates the opioid receptors in the brain to produce
several pharmacological effects.
149. The following drugs
are the most highly addicting, according to present-day
- cocaine/free base/crack,
- heroin, and most of the old-time