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Overview of Drugs
19
Ecstasy
Ecstasy (MDMA) is a semisynthetic psychedelic entactogen of the phenethylamine
family that is much less visual with more stimulant like effects than most all other
common “trip” producing psychedelics. It is considered mainly a recreational drug
that’s often used with sex and associated with club drugs, as an entheogen, and
a tool in use to supplement various types of practices for transcendence including
in meditation, psychonautics, and illicit psychedelic psychotherapy whether self
administered or not. The primary effects of MDMA include an increased awareness
of the senses, feelings of openness, euphoria, empathy, love,happiness, heightened
self-awareness, feeling of mental clarity and an increased appreciation of music
and movement. Tactile sensations are enhanced for some users, making physical
contact with others more pleasurable. Other side effects, such as jaw clenching
and elevated pulse, are common.
Opium
Opium is a resinous narcotic formed from the latex released by lacerating (or “scoring”)
the immature seed pods of opium poppies (Papaver somniferum). It contains up to
16% morphine, an opiate alkaloid, which is most frequently processed chemically
to produce heroin for the illegal drug trade. Opium has gradually been superseded
by a variety of purified, semi-synthetic, and synthetic opioids with progressively
stronger effect, and by other general anesthesia. This process began in 1817, when
Friedrich Wilhelm Adam Sertürner reported the isolation of pure morphine from
opium after at least thirteen years of research and a nearly disastrous trial on
himself and three boys.
Citation: https://i2.wp.com/listverse.com/wp-content/uploads/2007/09/opium.jpg
20
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Marijuana
Cannabis, known as marijuana in its herbal form, is a psychoactive product of the
plant Cannabis sativa. Humans have been consuming cannabis since prehistory,
although in the 20th century there was a rise in its use for recreational, religious
or spiritual, and medicinal purposes. It is estimated that about four percent of the
world’s adult population use cannabis annually. It has psychoactive and physiological
effects when consumed, usually by smoking or ingestion. The minimum amount of
THC required to have a perceptible psychoactive effect is about 10 micrograms per
kilogram of body weight. The state of intoxication due to cannabis consumption is
colloquially known as a “high”; it is the state where mental and physical facilities
are noticeably altered due to the consumption of cannabis. Each user experiences
a different high, and the nature of it may vary upon factors such as potency, dose,
chemical composition, method of consumption and set and setting.
Citation: https://www.californiamarijuanadelivery.com/wp-content/uploads/2016/09/Salinas-
Medical-Marijuana-Delivery.jpg
Psilocybin Mushrooms
Psilocybin mushrooms (also called psilocybian mushrooms) are fungi that contain the
psychedelic substances psilocybin and psilocin, and occasionally other psychoactive
tryptamines. There are multiple colloquial terms for psilocybin mushrooms, the
most common being magic mushrooms or ‘shrooms. When psilocybin is ingested,
it is broken down to produce psilocin, which is responsible for the hallucinogenic
effects. The intoxicating effects of psilocybin-containing mushrooms typically last
anywhere from 3 to 7 hours depending on dosage, preparation method and personal
metabolism. The experience is typically inwardly oriented, with strong visual and
auditory components. Visions and revelations may be experienced, and the effect
can range from exhilarating to distressing. There can be also a total absence of
effects, even with large doses.
Overview of Drugs
21
PCP
PCP (Phencyclidine) is a dissociative drug formerly used as an anesthetic agent,
exhibiting hallucinogenic and neurotoxic effects. It is commonly known as Angel
Dust, but is also known as Wet, Sherm, Sherman Hemsley, Rocket Fuel, Ashy Larry,
Shermans Tank, Wack, Halk Hogan, Ozone, HannaH, Hog, Manitoba Shlimbo, and
Embalming Fluid, among other names. Although the primary psychoactive effects
of the drug only last hours, total elimination from the body is prolonged, typically
extending over weeks. PCP is consumed in a recreational manner by drug users,
mainly in the United States, where the demand is met by illegal production. It
comes in both powder and liquid forms (PCP base dissolved most often in ether),
but typically it is sprayed onto leafy material such as marijuana, mint, oregano,
parsley or Ginger Leaves, and smoked. PCP has potent effects on the nervous system
altering perceptual functions (hallucinations, delusional ideas, delirium or confused
thinking), motor functions (unsteady gait, loss of coordination, and disrupted eye
movement or nystagmus), and autonomic nervous system regulation (rapid heart rate,
altered temperature regulation). The drug has been known to alter mood states in
an unpredictable fashion causing some individuals to become detached and others
to become animated.
Citation: https://d3819ii77zvwic.cloudfront.net/wp-content/uploads/2013/08/PCP.jpg
Drug Usage
Knowledge and understanding about patterns and correlates of drug use are derived
from various sources including surveys. Surveys of drug use are usually (1) conservative
estimates of prevalence and (2) do not give an indication of the number of people
using drugs in problematic ways. In the clinical setting careful, individualised
assessment is required to determine patterns and levels of use.
22
The following provides brief highlights of key drug use patterns:
Illustrated Handbook of Drugs & Alcohol Related Health Issues
What is a psychoactive drug?
Psychoactive drugs affect the central nervous system and alter a person’s mood,
thinking and behaviour.
Psychoactive drugs may be divided into four categories:
■ Depressants: Drugs that decrease alertness by slowing down the activity
of the central nervous system (e.g. heroin, alcohol and analgesics).
■ Stimulants: Drugs that increase the body’s state of arousal by increasing
the activity of the brain (e.g. caffeine, nicotine and amphetamines).
■ Hallucinogens: Drugs that alter perception and can cause hallucinations,
such as seeing or hearing something that is not there (e.g. LSD and ‘magic
mushrooms’). Other: Some drugs fall into the ‘other’ category, as they may
have properties of more than one of the above categories (e.g. cannabis
has depressive, hallucinogenic and some stimulant properties).
Why do people use drugs?
People use drugs for a variety of reasons.
Young people often use drugs for the same reasons that adults do.
Some of these include:
■ to have fun
■ to relax and forget problems
■ to gain confidence
■ to socialise
■ out of curiosity
■ as a form of escapism
■ to lessen inhibitions
■ to remove personal responsibility for decisions
■ to celebrate or commiserate
■ to relieve boredom and stress
■ self-medication to cope with problems
Overview of Drugs
Polydrug Use
23
Citation: http://i.imgur.com/WVtcpIw.jpg
Until recently it was common to characterise illicit drug use by the drug, or class
of drug, primarily used. For instance, heroin users were identified as a distinct
category of user, as were stimulant users. These characterisations are no longer valid.
Most illicit drug users are likely to use a variety of substances. Drug substitution
also occurs. When there is a shortage of some drugs (e.g. heroin) other drugs (e.g.
amphetamines, alcohol) may be used as an alternative. Increased ease of availability
of drugs is likely to have contributed to diversity in patterns of use.
Certain associations are well recognised; for example:
■ cigarettes and alcohol often go hand in hand, particularly where heavy
use of either substance is involved
■ cannabis smokers are almost invariably tobacco smokers (although obviously
the reverse is not the case)
■ heroin users often also take drugs such as cocaine and benzodiazepines,
and nearly all heroin users are also cigarette smokers
■ heavy drinkers also often use illicit drugs
Many illicit drug users possess sophisticated pharmacological knowledge. Users
often exhibit considerable skill in the titration of various substances when used
in concert with one another. For example, combinations of drugs such as heroin
and cocaine allow the sedative action of one drug (i.e. the heroin) to take the
sharp edge off the stimulant (i.e. the cocaine). Similarly, some substances are less
commonly taken when using another preferred drug e.g. some users avoid taking
ecstasy and alcohol concurrently.
24
Citation: https://www.teenrehabcenter.org/wp-content/uploads/2016/10/hummingbird-3.jpg
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Multiple substance use complicates the assessment process. Signs and symptoms of
intoxication for various drugs can be similar. Also concurrent use can complicate
withdrawal. Polydrug use also confounds our understanding of dependence problems.
A person who uses a range of different psychoactive substances may not be dependent
on all drugs that he/she uses. Comprehensive drug use histories are required, and
no assumptions should be made about patterns of use or non-use. It is important
to note that most available assessment tools assess dependence (and not usually
problematic use) and for a single drug only, or provide separate substance specific
measures. Careful decisions regarding prioritisation for treatment are needed. This
should be done in consultation with the client/patient.
Routes of Administration
Drugs can be taken in various ways. The mode of administration is a significant
mediating factor on the effect of a drug. Various routes of administration are
preferred because they can enhance or facilitate drug effects. Different modes of
administration have advantages and disadvantages.
The most common routes of administration are:
■ Oral ingestion: probably the oldest and the most common form of taking
drugs. Advantages are convenience, no special paraphernalia is required
and degree of safety for some drugs. Disadvantages are the slow absorption
of some substances.
■ Chewing: used for coca leaf, tobacco, betel-nut and tea. Absorption occurs
across the oral mucosa
Overview of Drugs
■ Nasal insufflation: includes snuffing, nasal inhalation or snorting. Absorption
is through the nasal mucosa. Snuffing can be used for cocaine, powdered
opium, heroin and tobacco. Sniffing of amyl nitrite occurs, as does sniffing
of petrol and other volatile substances
■ Smoking: is used for a wide variety of substances including tobacco,
cannabis, opium, heroin, cocaine, amphetamines and phencyclidine (PCP)
■ Rectal administration: commonly used in medical treatment, it is also a
method sometimes used by drug users. Disadvantages are the potential for
irregular, unpredictable and incomplete absorption
■ Parenterally (via injection): became possible in the late 19th century with
the development of the hypodermic needle. Arguably this has irrevocably
transformed hedonistic drug use. Administration can be intravenous (via
a vein), intramuscular (via a muscle), or subcutaneous (under the skin).
Each has advantages and disadvantages. Injection carries with it a range of
important health risks including transmission of viral and bacterial diseases
and tissue damage.
Harm minimisation strategies provide opportunities to educate users about safer ways
to administer drugs. Safe injecting techniques are especially important. Changing
from one route of administration to another may also be a useful stepping stone to
cutting down and quitting. Table 1 lists the major psychoactive drugs and describes
their intoxication effects and potential adverse health effects.
25
Table 1: Intoxication and potential adverse health effects
26
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Understanding Drug Use and Addiction
Many people do not understand why or how other people become addicted to
drugs. They may mistakenly think that those who use drugs lack moral principles
or willpower and that they could stop their drug use simply by choosing to. In
reality, drug addiction is a complex disease, and quitting usually takes more than
good intentions or a strong will. Drugs change the brain in ways that make quitting
hard, even for those who want to. Fortunately, researchers know more than ever
about how drugs affect the brain and have found treatments that can help people
recover from drug addiction and lead productive lives.
Drug Addiction
Addiction is a chronic disease characterized by drug seeking and use that is
compulsive, or difficult to control, despite harmful consequences. The initial decision
to take drugs is voluntary for most people, but repeated drug use can lead to brain
changes that challenge an addicted person’s self-control and interfere with their
ability to resist intense urges to take drugs. These brain changes can be persistent,
which is why drug addiction is considered a “relapsing” disease people in recovery
from drug use disorders are at increased risk for returning to drug use even after
years of not taking the drug.
It’s common for a person to relapse, but relapse does not mean that treatment does
not work. As with other chronic health conditions, treatment should be ongoing
and should be adjusted based on how the patient responds. Treatment plans need
to be reviewed often and modified to fit the patient’s changing needs.
Overview of Drugs
Citation: http://www.cadabams.org/images/rehabs%20drug%20addiction.jpg
What happens to the brain when a person takes drugs?
27
Most drugs affect the brain’s “reward circuit” by flooding it with the chemical
messenger dopamine. This reward system controls the body’s ability to feel pleasure
and motivates a person to repeat behaviors needed to thrive, such as eating and
spending time with loved ones. This overstimulation of the reward circuit causes the
intensely pleasurable “high” that can lead people to take a drug again and again.
As a person continues to use drugs, the brain adjusts to the excess dopamine by
making less of it and/or reducing the ability of cells in the reward circuit to respond
to it. This reduces the high that the person feels compared to the high they felt
when first taking the drug an effect known as tolerance. They might take more of
the drug, trying to achieve the same dopamine high. It can also cause them to get
less pleasure from other things they once enjoyed, like food or social activities.
Long-term use also causes changes in other brain chemical systems and circuits as
well, affecting functions that include:
■ learning
■ judgment
■ decision-making
■ stress
■ memory
■ behavior
Despite being aware of these harmful outcomes, many people who use drugs
continue to take them, which is the nature of addiction.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Why do some people become addicted to drugs while others don’t?
No one factor can predict if a person will become addicted to drugs. A combination
of factors influences risk for addiction. The more risk factors a person has, the
greater the chance that taking drugs can lead to addiction.
For example:
■ Biology. The genes that people are born with account for about half of a
person’s risk for addiction. Gender, ethnicity, and the presence of other
mental disorders may also influence risk for drug use and addiction.
■ Environment. A person’s environment includes many different influences,
from family and friends to economic status and general quality of life.
Factors such as peer pressure, physical and sexual abuse, early exposure to
drugs, stress, and parental guidance can greatly affect a person’s likelihood
of drug use and addiction.
■ Development. Genetic and environmental factors interact with critical
developmental stages in a person’s life to affect addiction risk. Although
taking drugs at any age can lead to addiction, the earlier that drug use
begins, the more likely it will progress to addiction. This is particularly
problematic for teens. Because areas in their brains that control decisionmaking, judgment, and self-control are still developing, teens may be
especially prone to risky behaviors, including trying drugs.
Can drug addiction be cured or prevented?
As with most other chronic diseases, such as diabetes, asthma, or heart disease,
treatment for drug addiction generally is not a cure. However, addiction is treatable
and can be successfully managed. People who are recovering from an addiction
will be at risk for relapse for years and possibly for their whole lives. Research
shows that combining addiction treatment medicines with behavioral therapy ensures
the best chance of success for most patients. Treatment approaches tailored to
each patient’s drug use patterns and any co-occurring medical, mental, and social
problems can lead to continued recovery.
More good news is that drug use and addiction are preventable. Results from NIDAfunded research have shown that prevention programs involving families, schools,
communities, and the media are effective for preventing or reducing drug use and
addiction. Although personal events and cultural factors affect drug use trends, when
young people view drug use as harmful, they tend to decrease their drug taking.