Substance Abuse
Chapter 2: Drugs that Get Abuse
II. The Drugs that Get Abused
We'll begin with a look at the substances themselves that are most commonly abused. These are the drugs most people think of when the subject of substance abuse is mentioned. Some of the common names for these drugs include marijuana, Methamphetamines, barbiturates, Hallucinogens, etc.
A. Drug Chart
The following table from the National Institute on Drug Abuse (NIDA 0225) provides a breakdown of the more commonly abused drugs, slang names for them and their effects:
|
Substance: |
Examples of Commercial |
Intoxication Effects/Potential Health Consequences | |
|
Cannabinoids |
euphoria, slowed thinking and reaction time, confusion, impaired balance and coordination/cough, frequent respiratory infections; impaired memory and learning; increased heart rate, anxiety; panic attacks; tolerance, addiction | ||
|
hashish |
boom, chronic, gangster, hash, hash oil, hemp |
I/swallowed, smoked | |
|
marijuana |
blunt, dope, ganja, grass, herb, joints, Mary Jane, pot, reefer, sinsemilla, skunk, weed |
I/swallowed, smoked | |
|
Depressants |
reduced anxiety; feeling of well-being; lowered inhibitions; slowed pulse and breathing; lowered blood pressure; poor concentration/fatigue; confusion; impaired coordination, memory, judgment; addiction; respiratory depression and arrest, death Also, for barbiturates: sedation, drowsiness/depression, unusual excitement, fever, irritability, poor judgment, slurred speech, dizziness, life-threatening withdrawal.
for flunitrazepam: visual and gastrointestinal disturbances, urinary retention, memory loss for the time under the drug's effects for GHB: drowsiness, nausea/vomiting, headache, loss of consciousness, loss of reflexes, seizures, coma, death
| ||
|
barbiturates |
Amytal, Nembutal, Seconal, Phenobarbital; barbs, reds, red birds, phennies, tooies, yellows, yellow jackets |
II, III, V/injected, swallowed | |
|
benzodiazepines (other than flunitrazepam) |
Ativan, Halcion, Librium, Valium, Xanax; candy, downers, sleeping pills, tranks |
IV/swallowed, injected | |
|
Rohypnol; forget-me pill, Mexican Valium, R2, Roche, roofies, roofinol, rope, rophies |
IV/swallowed, snorted | ||
|
gamma-hydroxybutyrate; G, |
I/swallowed | ||
|
methaqualone |
Quaalude, Sopor, Parest; ludes, mandrex, quad, quay |
I/injected, swallowed | |
|
Dissociative Anesthetics |
increased heart rate and blood pressure, impaired motor function/memory loss; numbness; nausea/vomiting | ||
|
ketamine |
Ketalar SV; cat Valiums, K, Special K, vitamin K |
III/injected, snorted, smoked | |
|
PCP and analogs |
phencyclidine; angel dust, boat, hog, love boat, peace pill |
I, II/injected, swallowed, smoked | |
|
Hallucinogens |
altered states of perception and feeling; nausea; persisting perception disorder (flashbacks) mescaline: increased body temperature, heart rate, blood pressure; loss of appetite, sleeplessness, numbness, weakness, tremors | ||
|
LSD |
lysergic acid diethylamide; acid, blotter, boomers, cubes, microdot, yellow sunshines |
I/swallowed, absorbed through mouth tissues | |
|
mescaline |
buttons, cactus, mesc, peyote |
I/swallowed, smoked | |
|
psilocybin |
magic mushroom, purple passion, shrooms |
I/swallowed | |
|
pioids and Morphine Derivatives |
pain relief, euphoria, drowsiness/nausea, constipation, confusion, sedation, respiratory depression and arrest, tolerance, addiction, unconsciousness, coma, death
| ||
|
codeine |
Empirin with Codeine, Fiorinal with Codeine, Robitussin A-C, Tylenol with Codeine; Captain Cody, Cody, schoolboy; (with glutethimide) doors & fours, loads, pancakes and syrup |
II, III, IV/injected, swallowed | |
|
fentanyl and fentanyl analogs |
Actiq, Duragesic, Sublimaze; |
I, II/injected, smoked, snorted | |
|
heroin |
diacetylmorphine; brown sugar, dope, H, horse, junk, skag, skunk, smack, white horse |
I/injected, smoked, snorted | |
|
morphine |
Roxanol, Duramorph; M, Miss Emma, monkey, white stuff |
II, III/injected, swallowed, smoked | |
|
opium |
laudanum, paregoric; big O, black stuff, block, gum, hop |
II, III, V/swallowed, smoked | |
|
oxycodone HCL |
Oxycontin; Oxy, O.C., killer |
II/swallowed, snorted, injected | |
|
hydrocodone bitartrate, acetaminophen |
Vicodin; vike, Watson-387 |
II/swallowed | |
|
Stimulants |
increased heart rate, blood pressure, metabolism; feelings of exhilaration, energy, increased mental alertness/rapid or irregular heart beat; reduced appetite, weight loss, heart failure, nervousness, insomnia toxicity, renal failure, liver toxicity | ||
|
amphetamine |
Biphetamine, Dexedrine; bennies, black beauties, crosses, hearts, LA turnaround, speed, truck drivers, uppers |
II/injected, swallowed, smoked, snorted | |
|
cocaine |
Cocaine hydrochloride; blow, bump, C, candy, Charlie, coke, crack, flake, rock, snow, toot |
II/injected, smoked, snorted | |
|
MDMA (methylenedioxy- |
Adam, clarity, ecstasy, Eve, lover's speed, peace, STP, X, XTC |
I/swallowed | |
|
methamphetamine |
Desoxyn; chalk, crank, crystal, fire, glass, go fast, ice, meth, speed |
II/injected, swallowed, smoked, snorted | |
|
methylphenidate (safe and effective for treatment of ADHD) |
Ritalin; JIF, MPH, R-ball, Skippy, the smart drug, vitamin R |
II/injected, swallowed, snorted | |
|
nicotine |
cigarettes, cigars, smokeless tobacco, snuff, spit tobacco, bidis, chew |
not scheduled/smoked, snorted, taken in snuff and spit tobacco | |
|
Other Compounds | |||
|
anabolic steroids |
Anadrol, Oxandrin, Durabolin, Depo-Testosterone, Equipoise; roids, juice |
III/injected, swallowed, applied to skin |
no intoxication effects/hypertension, blood clotting and cholesterol changes, liver cysts and cancer, kidney cancer, hostility and aggression, acne; in adolescents, premature stoppage of growth; in males, prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; in females, menstrual irregularities, development of beard and other masculine characteristics |
|
inhalants |
Solvents (paint thinners, gasoline, glues), gases (butane, propane, aerosol propellants, nitrous oxide), nitrites (isoamyl, isobutyl, cyclohexyl); laughing gas, poppers, snappers, whippets |
not scheduled/inhaled through nose or mouth |
stimulation, loss of inhibition; headache; nausea or vomiting; slurred speech, loss of motor coordination; wheezing/unconsciousness, cramps, weight loss, muscle weakness, depression, memory impairment, damage to cardiovascular and nervous systems, sudden death |
*Schedule I and II drugs have a high potential for abuse. They require greater storage security and have a quota on manufacturing, among other restrictions. Schedule I drugs are available for research only and have no approved medical use; Schedule II drugs are available only by prescription (unrefillable) and require a form for ordering. Schedule III and IV drugs are available by prescription, may have five refills in 6 months, and may be ordered orally. Most Schedule V drugs are available over the counter.
**Taking drugs by injection can increase the risk of infection through needle contamination with staphylococci, HIV, hepatitis, and other organisms.
***Associated with sexual assaults.
You will notice that some of these drugs are legally available with a prescription but are used in a way contrary to what is prescribed, or the client may have manipulated the system to obtain more of the medication with the purpose of abusing it or satisy an addiction. This is especially common with pain medication with the elderly, and amphetamines for adolescents/young adults. Many stores limit the amount of cold medicine that can be purchased because of its amphetamine content. In some cases, illegal producers of methamphetamines send their customers out to different stores to buy the medicine in order to obtain the chemicals they need for making the drugs.
B. Drugs and athletics
Steroids are often prescribed for helping people with asthma, injury recovery and other medical reasons, but also used by athletes as performance enhancers. This is a good example of how much people are willing to risk their long term health for short term satisfaction. The use of steroids has filtered down to high school athletes in pursuit of greater physical achievement. Performance enhancers have made headlines for years in the track and field community and football, and the use of them by professional baseball players has become more publicized.
With the increasing popularity of steroid use it is important for the healthcare professional to know the effects of steroids. The following is provided by the National Institute of Drug Abuse:
What are
|
|
Commonly Abused Steroids | ||||||||||||
Oral Steroids |
What are steroidal
supplements?
In the
Steroidal supplements can be converted into testosterone (an important male sex hormone) or a similar compound in the body. Whether such conversion produces sufficient quantities of testosterone to promote muscle growth or whether the supplements themselves promote muscle growth is unknown. Little is known about the side effects of steroidal supplements, but if large quantities of these compounds substantially increase testosterone levels in the body, they also are likely to produce the same side effects as anabolic steroids.
What is the scope of steroid use in the United States?
The 2005 Monitoring the Future study, a NIDA-funded survey of drug use among adolescents in middle and high schools across the United States, reported that past year use of steroids decreased significantly among 8th- and 10th-graders since peak use in 2000. Among 12th-graders, there was a different trend—from 2000 to 2004, past year steroid use increased, but in 2005 there was a significant decrease, from 2.5 percent to 1.5 percent.
Steroid abuse affects individuals of various ages. However, it is difficult to estimate the true prevalence of steroid abuse in the United States because many data sources that measure drug abuse do not include steroids. Scientific evidence indicates that anabolic steroid abuse among athletes may range between one and six percent.
One of the main reasons people give for abusing steroids is to improve their athletic performance. Among athletes, steroid abuse has been estimated to be less that 6 percent according to surveys, but anecdotal information suggests more widespread abuse. Although testing procedures are now in place to deter steroid abuse among professional and Olympic athletes, new designer drugs constantly become available that can escape detection and put athletes willing to cheat one step ahead of testing efforts. This dynamic, however, may be about to shift if the saving of urine and blood samples for retesting at a future date becomes the standard. The high probability of eventual detection of the newer designer steroids, once the technology becomes available, plus the fear of retroactive sanctions, should give athletes pause.
Another reason people give for taking steroids is to increase their muscle size or to reduce their body fat. This group includes people suffering from the behavioral syndrome called muscle dysmorphia, which causes them to have a distorted image of their bodies. Men with muscle dysmorphia think that they look small and weak, even if they are large and muscular. Similarly, women with this condition think that they look fat and flabby, even though they are actually lean and muscular.
Some people who abuse steroids to boost muscle size have experienced physical or sexual abuse. In one series of interviews with male weightlifters, 25 percent who abused steroids reported memories of childhood physical or sexual abuse. Similarly, female weightlifters who had been raped were found to be twice as likely to report use of anabolic steroids or another purported musclebuilding drug, compared with those who had not been raped. Moreover, almost all of those who had been raped reported that they markedly increased their bodybuilding activities after the attack. They believed that being bigger and stronger would discourage further attacks because men would find them either intimidating or unattractive.
How are anabolic steroids abused?
Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are applied to the skin. Doses taken by abusers can be 10 to 100 times higher than the doses used for medical conditions.
Cycling, stacking, and pyramiding
Steroids are often abused in patterns called "cycling," which involve taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. Users also frequently combine several different types of steroids in a process known as "stacking." Steroid abusers typically "stack" the drugs, meaning that they take two or more different anabolic steroids, mixing oral and/or injectable types, and sometimes even including compounds that are designed for veterinary use.Abusers think that the different steroids interact to produce an effect on muscle size that is greater than the effects of each drug individually, a theory that has not been tested scientifically.
Another mode of steroid abuse is referred to as "pyramiding." This is a process in which users slowly escalate steroid abuse (increasing the number of steroids or the dose and frequency of one or more steroids used at one time), reaching a peak amount at mid-cycle and gradually tapering the dose toward the end of the cycle. Often, steroid abusers pyramid their doses in cycles of 6 to 12 weeks. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Abusers believe that pyramiding allows the body time to adjust to the high doses, and the drug-free cycle allows the body's hormonal system time to recuperate. As with stacking, the perceived benefits of pyramiding and cycling have not been substantiated scientifically.
Most data on the long-term effects of anabolic steroids in humans come from case reports rather than formal epidemiological studies. From the case reports, the incidence of lifethreatening effects appears to be low, but serious adverse effects may be underrecognized or underreported, especially since they may occur many years later. Data from animal studies seem to support this possibility. One study found that exposing male mice for one-fifth of their lifespan to steroid doses comparable to those taken by human athletes caused a high frequency of early deaths.
Hormonal system
Steroid abuse disrupts the normal production of hormones in the body, causing both reversible and irreversible changes. Changes that can be reversed include reduced sperm production and shrinking of the testicles (testicular atrophy). Irreversible changes include male-pattern baldness and breast development (gynecomastia) in men. In one study of male bodybuilders, more than half had testicular atrophy and/or gynecomastia.
In the female body, anabolic steroids cause masculinization. Breast size and body fat decrease, the skin becomes coarse, the clitoris enlarges, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects become irreversible.
Musculoskeletal system
Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence and provide the signals to stop growth as well. When a child or adolescent takes anabolic steroids, the resulting artificially high sex hormone levels can prematurely signal the bones to stop growing.
Cardiovascular system
Steroid abuse has been associated with cardiovascular diseases (CVD), including heart attacks and strokes, even in athletes younger than 30. Steroids contribute to the development of CVD, partly by changing the levels of lipoproteins that carry cholesterol in the blood. Steroids, particularly oral steroids, increase the level of low-density lipoprotein (LDL) and decrease the level of high-density lipoprotein (HDL). High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. If blood is prevented from reaching the heart, the result can be a heart attack. If blood is prevented from reaching the brain, the result can be a stroke.
Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle so that it does not pump blood effectively.
Liver
Steroid abuse has been associated with liver tumors and a rare condition called peliosis hepatis, in which blood-filled cysts form in the liver. Both the tumors and the cysts can rupture, causing internal bleeding.
Skin
Steroid abuse can cause acne, cysts, and oily hair and skin.
Infections
Many abusers who inject anabolic steroids may use nonsterile injection techniques or share contaminated needles with other abusers. In addition, some steroid preparations are manufactured illegally under nonsterile conditions. These factors put abusers at risk for acquiring lifethreatening viral infections, such as HIV and hepatitis B and C. Abusers also can develop endocarditis, a bacterial infection that causes a potentially fatal inflammation of the inner lining of the heart. Bacterial infections also can cause pain and abscess formation at injection sites.
What effects do anabolic steroids have on behavior?
Case reports and small studies indicate that anabolic steroids, when used in high doses, increase irritability and aggression. Some steroid abusers report that they have committed aggressive acts, such as physical fighting or armed robbery, theft, vandalism, or burglary. Abusers who have committed aggressive acts or property crimes generally report that they engage in these behaviors more often when they take steroids than when they are drug free. A recent study suggests that the mood and behavioral effects seen during anabolic-androgenic steroid abuse may result from secondary hormonal changes.
Scientists have attempted to test the association between anabolic steroids and aggression by administering high steroid doses or placebo for days or weeks to human volunteers and then asking the people to report on their behavioral symptoms. To date, four such studies have been conducted. In three, high steroid doses did produce greater feelings of irritability and aggression than did placebo, although the effects appear to be highly variable across individuals. In one study, the drugs did not have that effect. One possible explanation, according to the researchers, is that some but not all anabolic steroids increase irritability and aggression. Recent animal studies show an increase in aggression after steroid administration.
In a few controlled studies, aggression or adverse, overt behaviors resulting from the administration of anabolic steroid use have been reported by a minority of volunteers.
In summary, the extent to which steroid abuse contributes to violence and behavioral disorders is unknown. As with the health complications of steroid abuse, the prevalence of extreme cases of violence and behavioral disorders seems to be low, but it may be underreported or underrecognized.
Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for addiction to heroin or other opioids found that 9.3 percent had abused anabolic steroids before trying any other illicit drug. Of these 9.3 percent, 86 percent first used opioids to counteract insomnia and irritability resulting from anabolic steroids.
In addition to steroids other drugs are used as performance enhancers or become part of a sports sub-culture. In listening to sports talk show programs or reading various news sources, it is a not so unspoken belief that in addition to steroids, a drug of choice for baseball players is "speed" (Methamphetamines) , attributing its use to the grind of a 162 game season. For basketball, marijuana seems to be most commonly associated and some believe it to be used by a wide array of players. With sports being such a large part of our culture, and drug use allegedly being wide spread in some sports, the public spread of drug use has become a larger part of our culture than it was previously. That does not mean more people are using, however.