Dr. MJ Bazos MD, Patient Handout
Drug Facts:
  1. Are there any herbal products that are addictive?
No, otherwise 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).
  1. What is buprenorphine?
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.
  1. 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.
  1. What are the differences between a "sedative", "tranquilizer", "anxiolytic", and "neuroleptic"?
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 These terms have mostly been replaced by "anxiolytics" (anxiety reducers) and "neuroleptics" (anti-schizophrenic drugs).
  1. Part of the variability in response to drugs from person to person is due to "set" and "setting".
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.
  1. 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.
  1. There are an enormous number of chemicals in the world. Why do people use some to get "high"?
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.
  1. 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.
  1. Nicotine, given to animals, is extremely toxic. Why can humans smoke nicotine in cigarettes?
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.
  1. How long does the effect of Rohypnol (date rape drug) last?
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!
  1. All of the inhalants that children use are extremely dangerous.
Inhalants include 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 "recreational" purposes.
  1. 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.
  1. 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 dependent.
  1. The following drugs are all equally dependence-producing:
  1. If a person becomes tolerant (needs increasing doses) to a drug, does it mean they are "addicted"?
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 dependence ("addiction").
  1. 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 narcotic.
  1. Which 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.
  1. What is the "addictive personality"?
This phrase actually has two meanings:
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.
19. Is Xanax addicting?
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.
  1. Is phenobarbital addicting?
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 epilepsy.
  1. Should marijuana be legalized?
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.
  1. 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.
  1. 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 effects.
  1. The term "narcotic" is outmoded.
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".
  1. What is "dope"?
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.
25.Nicotine is 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 legal.
  1. 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 dependence.
  1. How many people who use marijuana become dependent ("addicted")?
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.
  1. The term "substance abuse" is vague, weak, misleading, and inaccurate in many cases.
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 "substance"?
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.
31. What percentage of the public is dependent on drugs?
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" occur?
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 blackouts.
34. What causes LSD flashbacks?
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 "craving"?
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 depressants"?
"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 stimulation).
39. How do drugs produce "craving"?
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 studied.
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 socially.
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:
  1. greatly increased risk of lung cancer and heart disease,
  2. increased incidence of other cancers (particularly oral-pharyngeal),
  3. halitosis (bad breath),
  4. early signs of aging (wrinkled skin, etc.), and
  5. 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 lung cancer.
42. Why do people smoke?
Three factors are traditionally cited as being important reasons for beginning to smoke:
  1. peer pressure (acceptance),
  2. poor education about the negative effects of smoking, and
  3. advertising.
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 necessary.
43. What is a rave?
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"?
"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 reasons:
  1. 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),
  2. using the second drug to stop the first drug's actions (for example, an amphetamine can "perk up" a person who is drowsy from alcohol), or
  3. 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 tranquilizers?
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 asthma.
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 criteria.
49. The old-time barbiturates were notorious for their addictive qualities.
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 produce hallucinations?
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 effects.
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 cancer?
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 word "substance"?
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).
56. Whatever happened to meprobamate (Miltown, Equanil)?
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 qualities.
57. Whatever 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!
60. Do amphetamines such as Ritalin and Adderall lead to addiction when used for reducing the symptoms of Attention Deficit Hyperactivity Disorder (ADHD)?
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 drugs.
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 unknown.
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 body.
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 dependence ("addiction").
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 addicted.
70. Lots of drugs are abused:
- 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 Neurontin).
71. Addiction is not a "too much. Too often, withdrawal disease", it's an "I can't stop without help disease".
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 "dependence-producing".
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 addicting.
74. A popularly-abused drug is "Oxycontin". What is this drug?
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 susceptible individuals.
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:
78. Causes of death due to overdose with the following drugs are:
Overdoses with 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 ("addiction").
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 action.
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.
81. Marijuana jargon:
82. The big challenge in developing medications to treat chemical dependency is to obtain high potency, great specificity, and no significant side effects.
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":
These include:
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 ingested.
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 actions.
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 drugs.
A few that we're hearing about these days include:
Club 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 potential.
87. Methylphenidate (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 drugs.
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., marijuana).
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 ("addiction").
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 ("hypnotics").
Anxiolytic benzodiazepines include:
  1. Alprazolam (Xanax),
  2. Chlordiazepoxide (Librium), and
  3. Diazepam (Valium).
Hypnotic benzodiazepines include:
  1. Flurazepam (Dalmane),
  2. Triazolam (Halcion), and
  3. 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 "genetic" disease?
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 time.
There are two types of withdrawal:
  1. physical hyperexcitability (the most common) as seen in withdrawal from central nervous system depressants such as heroin, and
  2. 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.
97. Pharmacotherapy (pharmaceutical treatment) of chemical dependence:
- falls into two general categories:
a) those that reduce withdrawal severity and
b) those that reduce craving leading to drug seeking/relapse.
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).
98. What is GVG?
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 buprenorphine?
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 drug.
100. What is bupropion?
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 addicted?
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 pregnancy?
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 about LSD?
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 work?
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 drugs"?
These are mood- and consciousness-altering drugs that can be dangerous, and are often used at "rave parties".
They include:
  1. methamphetamine (meth, crank, ice),
  2. rohypnol (roofies),
  3. phencyclidine (PCP, angel dust),
  4. LSD (acid),
  5. MDMA (ecstasy, X), and
  6. 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" because:
- 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 heroin.
109. The use of methadone to treat heroin dependence is highly effective, because:
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 controlled by:
- 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, among others.
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, and seizures.
112. Addicting drugs act at the cellular (nerve cell) level by activating "receptors" that help to propagate certain types of signals from cell to cell.
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 time.
113. "Club drugs" are drugs taken presumably to enhance people's experiences during dance parties and "raves".
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 heroin.
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 system.
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 doses.
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?
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 analgesics).
121. What are neurotransmitters?
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 (GABA).
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 forebrain bundle"?
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 here).
125. MDMA (ecstasy, or just "e"):
- 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 dependence?
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?
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 drug's effects).
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 centuries.
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 marijuana.
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 with alcohol.
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 religious ceremonies).
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:
  1. orally (by mouth),
  2. smoking (to the lungs via the trachea from the mouth),
  3. the nasal membranes ("snorting"),
  4. by vein (intravenously),
  5. under the skin (subcutaneously),
  6. into a muscle (intramuscularly),
  7. by artery (injection into a major neck artery, for example),
  8. into the rectum (rectally, as by suppository), and
  9. 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 a misnomer.
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 dependence.
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 criteria.
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 of using.
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 consequences.
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.
139. What is a drug?
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, particularly addiction.
141. Benzodiazepines are drugs that reduce anxiety, enhance sleep, and reduce seizures.
Examples of this drug class are:
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 system.
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 illegal (illicit).
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 get "high".
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 definitions: