Health hazards and extent of illicit use of drugs

Heroin-"Smack"-"Junk"-“Thai”

Heroin is a highly addictive drug, and its use is a serious problem in America. Recent studies suggest a shift from injecting heroin to snorting or smoking because of increased purity and the misconception that these forms of use will not lead to addiction.

Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for heroin include "smack," "H," "skag," and "junk." Other names may refer to types of heroin produced in a specific geographical area, such as "Mexican black tar."

Health Hazards

Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and infectious diseases, including HIV/AIDS and hepatitis.

The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Long-term effects of heroin appear after repeated use for some period of time. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration.

In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.

Heroin has been ranked worldwide as the second most frequently mentioned drug in overall drug-related deaths.

Tolerance, Addiction, and Withdrawal

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.

Treatment

There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin (or other opiate) use and return to more stable and productive lives.

Opiates – “Heroin”-"Smack"-"Junk"-“Thai”

Narcotics defined:

Some of the drugs that depress the Central Nervous System are called 'Narcotics'. Such drugs include heroin, opium, codeine, morphine, Demerol, Darvon, Percodan, and others. Of the Narcotics mentioned, adolescents are most fond of heroin.

Where does it come from?

Opium, morphine and heroin all come from the opium poppy and belong to a group of drugs called opiates. In pure form, heroin is a fine, white, crystalline powder. However, it is usually sold on the streets as a brown powder or dark brown chunk.

How is it used?

Heroin can be smoked, snorted through the nose, or injected. The paraphernalia are similar to those mentioned in the stimulants section for snorting and injecting the drug. Because heroin is more potent today, it does not have to be injected. As a result, more and more adolescents are using this drug.

What are the street names?

The street names for heroin are as follows: "horse", "smack", "chiva", "black tar", and "junk" to name a few. Nonetheless, this drug is very addicting and comes with possibly more negative side effects than positive side effects, many of which are physical.

What are the effects of opiates sold on the street?

SHORT - TERM EFFECTS

• euphoria
• sense of emotional detachment
• absence of pain and stress
• altered mood and mental processes
• sleepiness
• vomiting
• loss of appetite
• reduced sex drive
• itchy skin
• increased urination
• sweating
• inability to concentrate
• impaired vision
• death

LONG TERM EFFECTS

• mental and physical health problems
• severe constipation
• contracted pupils
• moodiness
• menstrual irregularities
• lung, liver, kidney and brain damage
• collapsed veins from injecting the drug
• loss of weight
• reduction of sex hormone levels
• frequent infections
• pregnancy complications including still birth
• death

Opiate dependence occurs very rapidly, sometimes within weeks. Once your child becomes addicted to heroin, they will continue to use the drug not only for the purpose of intoxication, but too avoid the painful withdrawal symptoms that naturally come with opiate addiction.

Narcotics withdrawal symptoms:

The general withdrawal symptoms include insomnia, severe anxiety, profuse sweating, muscle spasms, and diarrhea. This onset can occur five hours after the last dose, lasting seven to ten days. Medical treatment is necessary for detoxifying the body of a heroin user before counseling can take place. Withdrawal from heroin is extremely painful and dangerous, and this is why medical intervention is needed.

LSD- “Acid” LSD (lysergic acid diethylamide) is one of the major drugs making up the hallucinogen class. LSD was discovered in 1938 and is one of the most potent mood-changing chemicals. It is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.

LSD, commonly referred to as "acid," is sold on the street in tablets, capsules, and, occasionally, liquid form. It is odorless, colorless, and has a slightly bitter taste and is usually taken by mouth. Often LSD is added to absorbent paper, such as blotter paper, and divided into small decorated squares, with each square representing one dose.

The strength of LSD samples obtained currently from illicit sources ranges from 20 to 80 micrograms of LSD per dose. This is considerably less than the levels reported during the 1960s and early 1970s, when the dosage ranged from 100 to 200 micrograms, or higher, per unit.

Health Hazards

The effects of LSD are unpredictable. They depend on the amount taken; the user's personality, mood, and expectations; and the surroundings in which the drug is used. Usually, the user feels the first effects of the drug 30 to 90 minutes after taking it. The physical effects include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth and tremors.

Sensations and feelings change much more dramatically than the physical signs. The user may feel several different emotions at once or swing rapidly from one emotion to another. If taken in a large enough dose, the drug produces delusions and visual hallucinations. The user's sense of time and self changes. Sensations may seem to "cross over," giving the user the feeling of hearing colors and seeing sounds. These changes can be frightening and can cause panic.

Users refer to their experience with LSD as a "trip" and to acute adverse reactions as a "bad trip." These experiences are long - typically they begin to clear after about 12 hours.

Some LSD users experience severe, terrifying thoughts and feelings, fear of losing control, fear of insanity and death, and despair while using LSD. Some fatal accidents have occurred during states of LSD intoxication.

Many LSD users experience flashbacks, recurrence of certain aspects of a person's experience, without the user having taken the drug again. A flashback occurs suddenly, often without warning, and may occur within a few days or more than a year after LSD use. Flashbacks usually occur in people who use hallucinogens chronically or have an underlying personality problem; however, otherwise healthy people who use LSD occasionally may also have flashbacks. Bad trips and flashbacks are only part of the risks of LSD use. LSD users may manifest relatively long lasting psychoses, such as schizophrenia or severe depression. It is difficult to determine the extent and mechanism of the LSD involvement in these illnesses.

Most users of LSD voluntarily decrease or stop its use over time. LSD is not considered an addictive drug since it does not produce compulsive drug-seeking behavior as do cocaine, amphetamine, heroin, alcohol, and nicotine. However, like many of the addictive drugs, LSD produces tolerance, so some users who take the drug repeatedly must take progressively higher doses to achieve the state of intoxication that they had previously achieved. This is an extremely dangerous practice, given the unpredictability of the drug. NIDA is funding studies that focus on the neuro-chemical and behavioral properties of LSD. This research will provide a greater understanding of the mechanisms of action of the drug.

Amphetamine- "Speed", "Uppers", "Bennies"

Amphetamine, dextroamphetamine, and methamphetamine are collectively referred to as amphetamines. Their chemical properties and actions are so similar that even experienced users have difficulty knowing which drug they have taken.

Amphetamine was first marketed in the 1930s as Benzedrine in an over-the-counter inhaler to treat nasal congestion. By 1937, amphetamine was available by prescription in tablet form and was used in the treatment of the sleeping disorder narcolepsy and the behavioral syndrome called minimal brain dysfunction (MBD), which today is called attention deficit hyperactivity disorder (ADHD). During World War II, amphetamine was widely used to keep the fighting men going; both dextroamphetamine (Dexedrine) and methamphetamine (Methedrine) became readily available.

As use of amphetamines spread, so did their abuse. Amphetamines became a cure-all for helping truckers to complete their long routes without falling asleep, for weight control, for helping athletes to perform better and train longer, and for treating mild depression. Intravenous amphetamine abuse spread among a subculture known as "speed freaks." With experience, it became evident that the dangers of abuse of these drugs outweighed most of their therapeutic uses.

Increased control measures were initiated in 1965 with amendments to the federal food and drug laws to curb the black market in amphetamines. Many pharmaceutical amphetamine products were removed from the market and doctors prescribed those that remained less freely. In order to meet the ever-increasing black market demand for amphetamines, clandestine laboratory production mushroomed, especially methamphetamine laboratories on the West Coast. Today, most amphetamines distributed to the black market are produced in clandestine laboratories.

Amphetamines are generally taken orally or injected. However, the addition of "Tik," the slang name for crystallized methamphetamine hydrochloride, has promoted smoking as another mode of administration. Just as "crack" is smoke-able cocaine, "ice" is smoke-able methamphetamine. Both drugs are highly addictive and toxic.

The effects of amphetamines, especially methamphetamine, are similar to cocaine, but their onset is slower and their duration is longer. In general, chronic abuse produces a psychosis that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with one's own thoughts, and auditory and visual hallucinations. Violent and erratic behavior is frequently seen among chronic abusers of amphetamines.

Effects

Euphoria. Feeling of enhanced well being, increased energy and loss of appetite. Potent stimulus -- used to compensate for sleep deprivation (Truck drivers, students, etc.) Both adrenergic and dopamine-ergic -- increasing "energy" and enhanced athletic ability. WITHDRAWAL OFTEN POSSIBLE WITHOUT HOSPITALIZATION (if good support system is fully utilized!).

Incidence of abuse

Very common - especially in trucking industry and among athletes. Methamphetamine is increasing in popularity among "recreational" users .... with number of clandestine labs increasing!

Chemical names

Dextro-amphetamine and dextro-methamphetamine

Forms and street names

• Amphetamine = Speed, Uppers, Pep pills, Bennies, Wake ups, Eye-openers, Co-pilots, Coast-to-coast, Cartwheels, A's, Black beauties •
• Methamphetamine = Crank, Speed, Met, Crystal met, Crystal Smoke-able = "Tik." Methamphetamine is available on the street in liquid form and many abusers "inject."

Preferred routes of administration

Ingested, snorted, or used I.V. Methamphetamine: "Crystal Met" or "crank" is illegally made in simple and ubiquitous clandestine labs. Smoke-able form of Met. is called "ice." Amphetamine: Abused for decades; but has legitimate uses: for obesity, ADD, premature ejaculation, et. al.

Length of time detectable after use

1 to 4 days Elimination is pH dependent. ACIDIC URINE ENHANCES EXCRETION!

Caution

• Acidification will "backfire" on donor by increasing urinary concentration!
• Do not acidify urine during intoxication because this can exacerbate myoglobinuric renal failure secondary to rhabdomyolysis! [EMERGENCY MEDICINE, JULY 1995]

PCP- "Angel dust"

PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Use of PCP in humans was discontinued in 1965, because it was found that patients often became agitated, delusional, and irrational while recovering from its anesthetic effects.

PCP is illegally manufactured in laboratories and is sold on the street by such names as "angel dust," "ozone," "wack," and "rocket fuel." "Killer joints" and "crystal supergrass" are names that refer to PCP combined with marijuana.

The variety of street names for PCP reflects its bizarre and volatile effects. PCP is a white crystalline powder that is readily soluble in water or alcohol. It has a distinctive bitter chemical taste. PCP can be mixed easily with dyes and turns up on the illicit drug market in a variety of tablets, capsules, and colored powders. It is normally used in one of three ways: snorted, smoked, or eaten. For smoking, PCP is often applied to a leafy material such as mint, parsley, oregano, or marijuana.

Health Hazards

PCP is addicting; that is, its use often leads to psychological dependence, craving, and compulsive PCP-seeking behavior. It was first introduced as a street drug in the 1960s and quickly gained a reputation as a drug that could cause bad reactions and was not worth the risk. Many people, after using the drug once, will not knowingly use it again. Yet others use it consistently and regularly. Some persist in using PCP because of its addicting properties. Others cite feelings of strength, power, invulnerability and a numbing effect on the mind as reasons for their continued PCP use.

Many PCP users are brought to emergency rooms because of PCP's unpleasant psychological effects or because of overdoses. In a hospital or detention setting, they often become violent or suicidal, and are very dangerous to themselves and to others. They should be kept in a calm setting and should not be left alone.

At low to moderate doses, physiological effects of PCP include a slight increase in breathing rate and a more pronounced rise in blood pressure and pulse rate. Respiration becomes shallow, and flushing and profuse sweating occur. Generalized numbness of the extremities and muscular incoordination also may occur. Psychological effects include distinct changes in body awareness, similar to those associated with alcohol intoxication. Use of PCP among adolescents may interfere with hormones related to normal growth and development as well as with the learning process.

At high doses of PCP, there is a drop in blood pressure, pulse rate, and respiration. This may be accompanied by nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance, and dizziness. High doses of PCP can also cause seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication). Psychological effects at high doses include illusions and hallucinations. PCP can cause effects that mimic the full range of symptoms of schizophrenia, such as delusions, paranoia, disordered thinking, a sensation of distance from one's environment, and catatonia. Speech is often sparse and garbled.

People who use PCP for long periods report memory loss, difficulties with speech and thinking, depression, and weight loss. These symptoms can persist up to a year after cessation of PCP use. Mood disorders also have been reported. PCP has sedative effects, and interactions with other central nervous system depressants, such as alcohol and benzodiazepines, can lead to coma or accidental overdose.

"Club Drugs"

Ecstasy, Herbal Ecstasy, Rohypnol, GHB, and Ketamine (each individually discussed in detail further down this page) are among the drugs used by teens and young adults who are part of a nightclub, bar, "rave" party, or trance scene. Raves and trance events are generally night-long dances, often held in warehouses. Many who attend raves and trances do not use drugs, but those who do may be attracted to the generally low cost, seemingly increased stamina, and intoxicating highs that are said to deepen the rave or trance experience. Recent hard science, however, is showing serious damage to several parts of the brain from use of these drugs.

Many users tend to experiment with a variety of club drugs in combination. Also, combinations of any of these drugs with alcohol can lead to unexpected adverse reactions and death. Club drugs are an increasing challenge for treatment programs. Many teens and young adults enter treatment with a number of these drugs and alcohol, rather than a single drug, as their primary problem.

Club drug use appears to be increasing in many cities around the world. A recently completed survey in the Seattle area found that 20 percent of young, gay men reported using Ecstasy. GHB is the drug of choice among white, gay males in New Orleans' French Quarter and is popular among high school and college students.

Ecstasy

MDMA, called "Adam," "Ecstasy," or "XTC," on the street, is a synthetic, psychoactive drug with hallucinogenic and amphetamine-like properties.

Many problems MDMA users encounter are similar to those found with the use of amphetamines and cocaine. Psychological difficulties can include confusion, depression, sleep problems, severe anxiety, and paranoia. Physical problems can include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Use of the drug has also been associated with increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease. Recent research also links Ecstasy use to long-term damage to those parts of the brain critical to thought, memory and pleasure.

Rohypnol, GHB, and Ketamine

Rohypnol, GHB, and Ketamine are predominantly central nervous system depressants. Because they are often colorless, tasteless, and odorless, they can be easily added to beverages and ingested unknowingly. These drugs have emerged as the so called "date rape" drugs. Rohypnol Rohypnol, a trade name for flunitrazepam, has been of particular concern for the last few years because of its abuse in date rape. When mixed with alcohol, Rohypnol can incapacitate a victim and prevent them from resisting sexual assault. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants.

In addition to sedative-hypnotic effects including muscle relaxation and amnesia, Rohypnol it can produce physical and psychological dependence. In Miami - one of the earliest sites of Rohypnol abuse - poison control centers report an increase in withdrawal seizures among people addicted to Rohypnol.

Rohypnol is not approved for use in the United States and its importation is banned. Illicit use of Rohypnol began in Europe in the 1970s and started appearing in the United States in the early 1990s, where it became known as "rophies," "roofies," "roach," and "rope."

Another very similar drug is now being sold as "roofies" in Miami, Minnesota, and Texas. This is clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril. It is sometimes abused to enhance the effects of heroin and other opiates. Based on emergency room admission information, Boston, San Francisco, Phoenix, and Seattle appear to have the highest use rates of clonazepam.

GHB

Since about 1990, GHB (gamma hydroxy-butyrate) has been abused in the U.S. for euphoric, sedative, and anabolic (body building) effects. It is a central nervous system depressant that was widely available over-the-counter in health food stores during the 1980s, purchased largely by body builders to aid fat reduction and muscle building. As with Rohypnol and clonazepam, GHB has been associated with sexual assault in cities throughout the country. GHB has not been sold over-the-counter in the U.S. since 1992. However products containing gamma butyrolactone (GBL), a chemical that is converted by the body into GHB, are used in a number of dietary supplements in health food stores and gymnasiums.

Reports from Detroit indicate liquid GHB is being used in nightclubs for effects similar to those of Rohypnol. It is also common in the club scene in Phoenix, Honolulu, and Texas, where it is known as "liquid ecstasy," "somatomax," "scoop," "Georgia Home Boy," or "grievous bodily harm." In Miami, poison control center calls have reflected problems associated with increased GHB use, including loss of consciousness. In New York City, there have been reports of GHB use among those in the fashion industry. GHB is one of the most popular manufactured drugs in Atlanta. It is available in some gyms and reputed to be widely accessible at some gay male party venues.

A Poison Control Center in Denver reports that in 1998, 33 calls involved GHB, and almost half of these cases were considered life threatening. GHB accounts for an increasing number of sexual assault cases in Los Angeles and overdose deaths involving drug combinations.

Coma and seizures can occur following abuse of GHB and, when combined with methamphetamine, there appears to be an increased risk of seizure. Combining use with other drugs such as alcohol can result in nausea and difficulty breathing. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors and sweating.

Ketamine

Ketamine is another central nervous system depressant abused as a "date rape" drug. Ketamine, or "Special K," is a rapid-acting general anesthetic. It has sedative-hypnotic, analgesic, and hallucinogenic properties. It is marketed in the U.S. and a number of foreign countries for use as a general anesthetic in both human and veterinary medical practice.

It is similar to phencyclidine (PCP), although ketamine has a more rapid onset and is less potent. Depending on the dose, ketamine induces everything from feelings of pleasant weightlessness to full-fledged out-of-body or near-death experiences. Ketamine is reportedly used as an alternative to cocaine and is generally snorted.

Ketamine abuse has been reported in many cities around the country. It has even been reportedly stolen from veterinary supply sources in some instances.

Street Terms for "Club Drugs"

Cocaine-"Crack"

Cocaine is a powerfully addictive drug of abuse. Once having tried cocaine, an individual cannot predict or control the extent to which he or she will continue to use the drug.

The major routes of administration of cocaine are sniffing or snorting, injecting, and smoking (including free-base and crack cocaine). Snorting is the process of inhaling cocaine powder through the nose where it is absorbed into the bloodstream through the nasal tissues. Injecting is the act of using a needle to release the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection.

"Crack" is the street name given to cocaine that has been processed from cocaine hydrochloride to a free base for smoking. Rather than requiring the more volatile method of processing cocaine using ether, crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride, thus producing a form of cocaine that can be smoked. The term "crack" refers to the crackling sound heard when the mixture is smoked (heated), presumably from the sodium bicarbonate.

There is great risk whether cocaine is ingested by inhalation (snorting), injection, or smoking. It appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted. Smoking allows extremely high doses of cocaine to reach the brain very quickly and brings an intense and immediate high. The injecting drug user is at risk for transmitting or acquiring HIV infection/AIDS if needles or other injection equipment are shared.

Health Hazards

Cocaine is a strong central nervous system stimulant that interferes with the re-absorption process of dopamine, a chemical messenger associated with pleasure and movement. Dopamine is released as part of the brain's reward system and is involved in the high that characterizes cocaine consumption.

Physical effects of cocaine use include constricted peripheral blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine's immediate euphoric effects, which include hyper-stimulation, reduced fatigue, and mental clarity, depends on the route of administration. The faster the absorption, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation.

Some users of cocaine report feelings of restlessness, irritability, and anxiety. An appreciable tolerance to the high may be developed, and many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Scientific evidence suggests that the powerful neuropsychological reinforcing property of cocaine is responsible for an individual's continued use, despite harmful physical and social consequences. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. However, there is no way to determine who is prone to sudden death.

High doses of cocaine and/or prolonged use can trigger paranoia. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users. When addicted individuals stop using cocaine, they often become depressed. This also may lead to further cocaine use to alleviate depression. Prolonged cocaine snorting can result in ulceration of the mucous membrane of the nose and can damage the nasal septum enough to cause it to collapse. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Added Danger: Coca ethylene

When people mix cocaine and alcohol consumption, they are compounding the danger each drug poses and unknowingly forming a complex chemical experiment within their bodies. NIDA-funded researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, coca ethylene, that intensifies cocaine's euphoric effects, while possibly increasing the risk of sudden death.

Treatment

The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.

NIDA's top research priority is to find a medication to block or greatly reduce the effects of cocaine, to be used as one part of a comprehensive treatment program. NIDA-funded researchers are also looking at medications that help alleviate the severe craving that people in treatment for cocaine addiction often experience. Several medications are currently being investigated to test their safety and efficacy in treating cocaine addiction.

In addition to treatment medications, behavioral interventions, particularly cognitive behavioral therapy, can be effective in decreasing drug use by patients in treatment for cocaine abuse. Providing the optimal combination of treatment services for each individual is critical to successful treatment outcome.

"Ecstasy"- MDMA

MDMA, called "Adam," "ecstasy," or "XTC" on the street, is a synthetic, psychoactive (mindaltering) drug with amphetamine-like and hallucinogenic properties. Its chemical structure (3-4 methylene dioxy methamphetamine) is similar to two other synthetic drugs, MDA and methamphetamine, which are known to cause brain damage.

Health Hazards Beliefs about MDMA are reminiscent of the claims made about LSD in the 1950s and 1960s, which proved to be untrue. According to its proponents, MDMA can make people trust each other and can break down barriers between therapists and patients, lovers, and family members.

Many of the risks users face with MDMA use are similar to those found with the use of amphetamines and cocaine. They are:

• Psychological difficulties, including confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia - during and sometimes weeks after taking MDMA (even psychotic episodes have been reported).
• • Physical symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating.
• • Increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease.

Recent research findings also link MDMA use to long-term damage to those parts of the brain critical to thought and memory. It is thought that the drug causes damage to the neurons that use the chemical serotonin to communicate with other neurons. In monkeys, exposure to MDMA for 4 days caused brain damage that was evident 6 to 7 years later. This study provides further evidence that people who take MDMA may be risking permanent brain damage.

Also, there is evidence that people who develop a rash that looks like acne after using MDMA may be risking severe side effects, including liver damage, if they continue to use the drug.

MDA, the parent drug of MDMA, is an amphetamine-like drug that has also been abused and is similar in chemical structure to MDMA. Research shows that MDA destroys serotonin-producing neurons in the brain, which play a direct role in regulating aggression, mood, sexual activity, sleep, and sensitivity to pain. It is probably this action on the serotonin system that gives MDA its purported properties of heightened sexual experience, tranquility and conviviality.

MDMA also is related in its structure and effects to methamphetamine, which has been shown to cause degeneration of neurons containing the neurotransmitter dopamine. Damage to these neurons is the underlying cause of the motor disturbances seen in Parkinson's disease. Symptoms of this disease begin with lack of coordination and tremors and can eventually result in a form of paralysis.

"Inhalants"

Inhalants are breathable chemical vapors that produce psychoactive (mind-altering) effects. Although people are exposed to volatile solvents and other inhalants in the home and in the workplace, many do not think of inhalable substances as 'drugs' because most of them were never meant to be used in that way.

Young people are likely to abuse inhalants, in part because inhalants are readily available and inexpensive. Sometimes children unintentionally misuse inhalant products that are found in household products. Parents should see that these substances are monitored closely so that they are not inhaled by young children.

Inhalants fall into the following categories:

Solvents

• - industrial or household solvents or solvent-containing products, including paint thinners or solvents, degreasers (dry-cleaning fluids), gasoline, and glues
• art or office supply solvents, including correction fluids, felt-tip-marker fluid, and electronic contact cleaners

Gases

• gases used in household or commercial products, including butane lighters and propane tanks, whipping cream aerosols or dispensers (whippets), and refrigerant gases
• household aerosol propellants and associated solvents in items such as spray paints, hair or deodorant sprays, and fabric protector sprays
• medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide (laughing gas)

Nitrites

• aliphatic nitrites, including cyclohexyl nitrite, which is available to the general public; amyl nitrite, which is available only by prescription; and butyl nitrite, which is now an illegal substance.

Health Hazards

Although different in makeup, nearly all abused inhalants produce effects similar to anesthetics, which act to slow down the body's functions. When inhaled via the nose or mouth into the lungs in sufficient concentrations, inhalants can cause intoxicating effects. Intoxication can last only a few minutes or several hours if inhalants are taken repeatedly. Initially, users may feel slightly stimulated; with successive inhalations, they may feel less inhibited and less in control; finally, a user can lose consciousness.

Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly induce heart failure and death. This is especially common from the abuse of fluorocarbons and butane-type gases. High concentrations of inhalants also cause death from suffocation by displacing oxygen in the lungs and then in the central nervous system so that breathing ceases.

Other irreversible effects caused by inhaling specific solvents are as follows:

• Hearing loss - toluene (paint sprays, glues, de-waxers) and trichloroethylene (cleaning fluids, correction fluids)
• Peripheral neuropathies or limb spasms - hexane (glues, gasoline) and nitrous oxide (whipping cream, gas cylinders)
• Central nervous system or brain damage - toluene (paint sprays, glues, de-waxers)
• Bone marrow damage - benzene (gasoline).

Serious but potentially reversible effects include:

• Liver and kidney damage - toluene- containing substances and chlorinated hydrocarbons (correction fluids, dry- cleaning fluids)
• Blood oxygen depletion - organic nitrites ("poppers," "bold," and "rush") and methylene chloride (varnish removers, paint thinners).

Death from inhalants usually is caused by a very high concentration of fumes. Deliberately inhaling from an attached paper or plastic bag or in a closed area greatly increases the chances of suffocation. Even when using aerosols or volatile products for their legitimate purposes (i.e., painting, cleaning), it is wise to do so in a well-ventilated room or outdoors.

Amyl and butyl nitrites have been associated with Kaposi's sarcoma (KS), the most common cancer reported among AIDS patients. Early studies of KS showed that many people with KS had used volatile nitrites. Researchers are continuing to explore the hypothesis of nitrites as a factor contributing to the development of KS in HIV-infected people.

Extent of Use

Initial use of inhalants often starts early. Some young people may use inhalants as a cheap, accessible substitute for alcohol. Research suggests that chronic or long-term inhalant abusers are among the most difficult to treat and they may experience multiple psychological and social problems.

Marijuana-THC-"Grass"

Marijuana is a green or gray mixture of dried, shredded flowers and leaves of the hemp plant Cannabis sativa. There are over 200 slang terms for marijuana including "pot," "herb," "weed," "boom," "Mary Jane," "gangster" and "chronic." It is usually smoked as a cigarette (called a joint or a nail) or in a pipe or bong. In recent years, marijuana has appeared in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug, such as crack. Some users also mix marijuana into foods or use it to brew tea.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). In 1988, it was discovered that the membranes of certain nerve cells contain protein receptors that bind THC. Once securely in place, THC kicks off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana. The short term effects of marijuana use include problems with memory and learning; distorted perception; difficulty in thinking and problem-solving; loss of coordination; and increased heart rate, anxiety, and panic attacks.

Scientists have found that whether an individual has positive or negative sensations after smoking marijuana can be influenced by heredity. A recent study demonstrated that identical male twins were more likely than non-identical male twins to report similar responses to marijuana use, indicating a genetic basis for their sensations. Identical twins share all of their genes, and fraternal twins share about half.

Environmental factors such as the availability of marijuana, expectations about how the drug would affect them, the influence of friends and social contacts, and other factors that differentiate identical twins' experiences also were found to have an important effect; however, it also was discovered that the twins' shared or family environment before age 18 had no detectable influence on their response to marijuana.

Health hazards from marijuana use

Effects of Marijuana on the Brain

Researchers have found that THC changes the way in which sensory information gets into and is processed by the hippocampus. The hippocampus is a component of the brain's limbic system that is crucial for learning, memory, and the integration of sensory experiences with emotions and motivations. Investigations have shown that neurons in the information processing system of the hippocampus and the activity of the nerve fibers in this region are suppressed by THC. In addition, researchers have discovered that learned behaviors, which depend on the hippocampus, also deteriorate via this mechanism.

Recent research findings also indicate that long-term use of marijuana produces changes in the brain similar to those seen after long-term use of other major drugs of abuse.

Effects of Marijuana on the Lungs

Someone who smokes marijuana regularly may have many of the same respiratory problems as tobacco smokers. These individuals may have daily cough and phlegm, symptoms of chronic bronchitis, and more frequent chest colds. Continuing to smoke marijuana can lead to abnormal functioning of lung tissue injured or destroyed by marijuana smoke.

Regardless of the THC content, the amount of tar inhaled by marijuana smokers and the level of carbon monoxide absorbed are three to five times greater than among tobacco smokers. This may be due to the marijuana users' inhaling more deeply and holding the smoke in the lungs and because marijuana smoke is unfiltered.

Effects of Marijuana on Heart Rate and Blood Pressure

Recent findings indicate that smoking marijuana while shooting up cocaine has the potential to cause severe increases in heart rate and blood pressure. In one study, experienced marijuana and cocaine users were given marijuana alone, cocaine alone, and then a combination of both. Each drug alone produced cardiovascular effects; when they were combined, the effects were greater and lasted longer. The heart rate of the subjects in the study increased 29 beats per minute with marijuana alone and 32 beats per minute with cocaine alone. When the drugs were given together, the heart rate increased by 49 beats per minute, and the increased rate persisted for a longer time. The drugs were given with the subjects sitting quietly. In normal circumstances, an individual may smoke marijuana and inject cocaine and then do something physically stressful that may significantly increase the risk of overloading the cardiovascular system.

Effects of Heavy Marijuana Use on Learning and Social Behavior

A study of college students has shown that critical skills related to attention, memory, and learning are impaired among people who use marijuana heavily, even after discontinuing its use for at least 24 hours. Researchers compared 65 "heavy users," who had smoked marijuana a median of 29 of the past 30 days, and 64 "light users," who had smoked a median of 1 of the past 30 days. After a closely monitored 19- to 24-hour period of abstinence from marijuana and other illicit drugs and alcohol, the undergraduates were given several standard tests measuring aspects of attention, memory, and learning. Compared to the light users, heavy marijuana users made more errors and had more difficulty sustaining attention, shifting attention to meet the demands of changes in the environment, and in registering, processing, and using information. These findings suggest that the greater impairment among heavy users is likely due to an alteration of brain activity produced by marijuana.

Longitudinal research on marijuana use among young people below college age indicates those who used marijuana have lower achievement than the non-users, more acceptance of deviant behavior, more delinquent behavior and aggression, greater rebelliousness, poorer relationships with parents, and more associations with delinquent and drug-using friends.

Research also shows more anger and more regressive behavior (thumb sucking, temper tantrums) in toddlers whose parents use marijuana than among the toddlers of non-using parents.

Effects of Marijuana on Pregnancy

Any drug of abuse can affect a mother's health during pregnancy, making it a time when expectant mothers should take special care of themselves. Drugs of abuse may interfere with proper nutrition and rest, which can affect good functioning of the immune system. Some studies have found that babies born to mothers who used marijuana during pregnancy were smaller than those born to mothers who did not use the drug. In general, smaller babies are more likely to develop health problems.

A nursing mother who uses marijuana passes some of the THC to the baby in her breast milk. Research indicates that the use of marijuana by a mother during the first month of breastfeeding can impair the infant's motor development (control of muscle movement).

Methamphetamine- "Meth"- "Speed"

Methamphetamine is an addictive stimulant drug that strongly activates certain systems in the brain. Methamphetamine is closely related chemically to amphetamine, but the central nervous system effects of methamphetamine are greater. Both drugs have some medical uses, primarily in the treatment of obesity, but their therapeutic use is limited.

Methamphetamine is made in illegal laboratories and has a high potential for abuse and dependence. Street methamphetamine is referred to by many names, such as "speed," "meth," and "chalk." Methamphetamine hydrochloride, clear chunky crystals resembling ice, which can be inhaled by smoking, is referred to as "tik," "crystal," and "glass."

Health Hazards

Methamphetamine releases high levels of the neurotransmitter dopamine, which stimulates brain cells, enhancing mood and body movement. It also appears to have a neuro-toxic effect, damaging brain cells that contain dopamine and serotonin, another neurotransmitter. Over time, methamphetamine appears to cause reduced levels of dopamine, which can result in symptoms like those of Parkinson's disease, a severe movement disorder.

Methamphetamine is taken orally or intra nasally (snorting the powder), by intravenous injection, and by smoking. Immediately after smoking or intravenous injection, the methamphetamine user experiences an intense sensation, called a "rush" or "flash," that lasts only a few minutes and is described as extremely pleasurable. Oral or intranasal use produces euphoria - a high, but not a rush. Users may become addicted quickly, and use it with increasing frequency and in increasing doses.

Animal research going back more than 20 years shows that high doses of methamphetamine damage neuron cell-endings. Dopamine- and serotonin-containing neurons do not die after methamphetamine use, but their nerve endings ("terminals") are cut back and re-growth appears to be limited.

The central nervous system (CNS) actions that result from taking even small amounts of methamphetamine include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hypothermia, and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hypothermia and convulsions can result in death.

Methamphetamine causes increased heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, producing strokes. Other effects of methamphetamine include respiratory problems, irregular heartbeat, and extreme anorexia. Its use can result in cardiovascular collapse and death.

A study in Seattle confirmed that methamphetamine use was widespread among the city's homosexual and bisexual populations. Of these groups, members using methamphetamine reported they practice sexual and needle-use behaviors that place them at risk of contracting and transmitting HIV and AIDS.

Rohypnol- a.k.a., the "Date Rape" drug

Flunitrazepam is marketed under the trade name Rohypnol- and is manufactured worldwide, particularly in Europe and Latin America, in 1- and 2-milligram tablets by Hoffman-La Roche, Inc., a large pharmaceutical manufacturer. However, the drug neither is manufactured nor approved for medical use in the United States.

Rohypnol (Flunitrazepam), commonly known as "Roofies," "Rophies," "Rope," and the "Forget Pill," is increasingly being used by youth -- in many cases as a date rape drug because of its ability to affect willpower. Rohypnol is legally sold in Latin America and Europe.

Because Flunitrazepam is sold under the trade name Rohypnol, the street name "Rophy" was derived. In South Florida, street names include "circles," "Mexican valium," "rib," "roach-2," "roofies," "roopies," "rope," "ropies," and "ruffies." Being under the influence of the drug is referred to as being "roached out." In Texas, flunitrazepam is called "R-2," or "roaches."

TEENAGERS AND OTHERS, NOTE: To stress the severity of trouble you could find yourself in - the "Drug Induced Rape Prevention and Punishment Act of 1996" was recently passed in the United States to increase the penalties for the possession and distribution of Flunitrazepam (Rohypnol).

Some of the penalties included in this legislation are:

• A maximum sentence of 20 years in prison for anyone who distributes a controlled substance to a person without that person's knowledge with intent to commit a crime of violence (including rape) against that person

• In domestic cases, for a simple "possession" case regardless of the quantity of Flunitrazepam involved, the maximum sentence is raised to three years in prison. (With the exception of crack cocaine, simple possession cases for all other drugs are subject to a maximum of one year for the first offense and two years for the second offense)

• For import/export cases involving Flunitrazepam regardless of quantity, the maximum prison sentence is 20 years unless death or serious bodily injury results, in which case, the minimum sentence is 20 years and the maximum is life. If the defendant has a prior drug felony conviction, the maximum is 30 years. It is a violation of U.S. law to manufacture or distribute Flunitrazepam in a foreign country intending or knowing that it will be illegally imported into the United States

Use and effects

Flunitrazepam is ingested orally, frequently in conjunction with alcohol or other drugs, including heroin. The drug's effects begin within 30 minutes, peak within 2 hours, and may persist for up to 8 hours or more, depending upon the dosage. Adverse effects associated with the use of flunitrazepam include decreased blood pressure, memory impairment, drowsiness, visual disturbances, dizziness, confusion, gastrointestinal disturbances, and urinary retention. Paradoxically, although the drug is classified as a depressant, flunitrazepam can induce excitability or aggressive behavior in some users.

Flunitrazepam use causes dependence in humans. Once dependence has developed, abstention induces withdrawal symptoms, including headache, muscle pain, extreme anxiety, tension, restlessness, confusion, and irritability. Numbness, tingling of the extremities, loss of identity, hallucinations, delirium, convulsions, shock, and cardiovascular collapse also may occur. Withdrawal seizures can occur a week or more after cessation of use. As with other benzodiazepines, treatment for flunitrazepam dependence must be gradual, with use tapering off.

Flunitrazepam is touted as an effective "parachute" or remedy for the depression that follows a stimulant high. Reports indicate that flunitrazepam is used by drug addicts in Spain and Malaysia to allay withdrawal symptoms and to gain a state of oblivion. Abuse of the drug in Western Europe and the Caribbean has been reported over the last 10 years. In Germany, Roche recently removed the 2-milligram dosage from retail distribution—restricting it to hospital use only—due to the increasing abuse of flunitrazepam in that country.

Two common misperceptions about flunitrazepam may explain the drug's popularity among young people: first, many erroneously believe that the drug is unadulterated—and therefore "safe"—because it comes in pre-sealed bubble packs; second, many mistakenly think its use cannot be detected by urinalysis testing. It can.