COCAINE
DEFINITION
Cocaine is derived from the leaves of the coca bush, which grows in the
Andes of South America. Used for centuries by Indians to combat the
effects of hunger, hard work, and thin air, in the mid 1800s its effects
were praised by Freud, among others. Until 1906, this substance was a
chief ingredient of Coca-Cola and was also used as a topical anesthetic.
Widespread use and addiction led to government efforts against cocaine
in the early 1900s. The danger associated with cocaine was ignored in
the 1970s and early 1980s, and cocaine was proclaimed by many to be
safe. With the accumulating medical evidence of cocaine's deleterious
effects and the introduction and widespread use of "crack"
cocaine, the public and government have become alarmed again about its
growing use. To many Americans, especially health care and social
workers who deal with crack users and have witnessed the personal and
societal devastation it produces, the pervasive use of cocaine is, by
far, the most serious drug problem in the United States.
EFFECTS AND METHODS OF INGESTION
Like the amphetamines, cocaine stimulates the central nervous system.
This drug is usually ingested in three ways.
- Sniffing or snorting it into the nose, where
it is absorbed by the mucous membranes
- Injecting it intravenously
- Freebase smoking
(Occasionally this substance may be
swallowed or sprayed from an atomizer into the back of the mouth or
throat.)
Crack is smoked in cigarettes or glass pipes
and sometimes mixed with marijuana. Much of it is laced with other
drugs, such as amphetamines.
The effects of cocaine are pleasurable,
immediate, and brief. It produces intense but short-lived euphoria and
can make users feel more energetic. Like caffeine, cocaine produces
wakefulness and reduces hunger. Psychological effects include feelings
of well-being and a grandiose sense of power and ability mixed with
anxiety and restlessness. As the drug wears off, these temporary
sensations of mastery are replaced by depression.
HEALTH EFFECTS
Even though the public is often regaled with highly publicized accounts
of deaths from cocaine, many still mistakenly believe the drug,
especially when sniffed, to be nonaddictive and not as harmful as other
illicit drugs. Cocaine's immediate physical effects include raised
breathing rate, raised blood pressure and body temperature, and dilated
pupils.
By causing the coronary arteries to constrict,
blood pressure rises and the blood supply to the heart diminishes,
possibly causing heart attacks or convulsions within an hour after use.
Chronic users and those with hypertension, epilepsy, and cardiovascular
disease are at particular risk. Studies show that even those with normal
coronary arteriograms risk cardiac complications from cocaine. Increased
use may sensitize the brain to the drug's effects so that less of the
substance is needed to induce a seizure. Those who inject the drug are
at high risk for AIDS and hepatitis when they share needles. Allergic
reactions to cocaine or other substances mixed in with the drug may also
occur.
Other unpleasant side effects of cocaine
include:
- Insomnia and headache
- Nausea and vomiting
- Loss of appetite leading to malnutrition and
weight loss
- Cold sweats
- Swelling and bleeding of mucous membranes
- Restlessness and anxiety
In the 1970s cocaine was expensive and
considered a "status" drug. The introduction of inexpensive
crack increased the accessibility of this substance, and crack has
become the drug of choice for many drug users, especially inner-city
disadvantaged youth. Crack's convenience, ease of concealment, wide
availability, and low cost have increased its use. The fact that it is
smoked rather than snorted or injected (ingestion methods associated
with the stigma of being a "junkie") has contributed to its
popularity.
Crack is particularly dangerous for several
reasons.
- Because it is inhaled and rapidly absorbed
through the lungs, into the blood, and carried swiftly to the brain,
the chances of overdosing and poisoning leading to coma,
convulsions, and death are greatly increased over other forms of
cocaine ingestion.
- Crack's rapid rush—5 to 7 minutes of
intense pleasure— quickly subsides, leading to depression that
needs to be relieved by more crack. This cycle enhances the chances
of addiction and dependency. Because of the brief high, users are
constantly thinking about and devising ways to get more crack.
- Psychologically, the drug reduces
concentration, ambition, and drive, and increases confusion and
irritability, wreaking havoc on users' professional and personal
lives.
- Habitual use may lead to cocaine psychosis,
causing paranoia, hallucinations, and a condition known as
formication, in which insects or snakes are perceived to be crawling
under the skin. The paranoia and depression can instigate violent
and suicidal behavior.
The side effects of adulterants increase
cocaine's risks. The drug is often cut with one or more of any number of
other substances, such as the cheaper drugs procaine, lidocaine, and
benzocaine, and substances that pose no serious risks, such as sugars (mannitol
and sucrose), or starches. However, when quinine or amphetamines are
added, the potential for serious side effects increases dramatically.
TREATMENT
Treatment for cocaine abuse utilizes counseling and rehabilitation.
Individuals who are suicidal, psychotic, or very ill may need
hospitalization. Several programs, such as Cocaine Anonymous, which uses
AA as a model, provide self-help groups. Certain medications are being
researched as alternatives for unsuccessful rehabilitative efforts, but
no medication has yet been found to be generally effective.
Cocaine is quickly cleared from the body, and
detoxification generally takes several days, but feelings of anxiety and
depression may last for weeks. Recovering individuals may mourn the loss
of a lifestyle and friendships centered around drugs and may have to
confront unpleasant family and economic situations.
MARIJUANA
Marijuana is the most widely used illegal drug. Derived from the plant
Cannabis sativa (the hemp plant), this psychoactive (mind-altering) drug
is grown wild and cultivated in many parts of the world.
EFFECTS AND METHODS OF INGESTION
Marijuana can be put in foods and eaten, but generally it is smoked in
cigarettes or "joints," made of the dried leaves, flowers, and
small stems of the plant. The active ingredient in this drug is
delta-9-tetrahydrocannabinol (THC); the average joint may contain up to
6 percent THC, a substantial rise from the 0.4 percent average content
of joints in the early 1970s. Hashish, or hash, is the resinous part of Cannabis,
pressed into cakes that are smoked. This much more potent form of the
drug contains between 3 and 8 percent THC.
The psychological effects of marijuana are a
mild sense of well-being, a disconnected sense of time, a dreamy
consciousness and self-absorption, and a reduced ability to think and
communicate clearly.
Undesirable mental and physical effects
include:
- Paranoia, panic, anxiety and fear
- Unpleasant hallucination-like distortions of
the senses
- Faster heartbeat (increased by up to 50
percent)
- Bloodshot eyes, dry mouth and throat
- Decreased motor abilities and reaction time
- Altered depth perception
- Impaired short-term memory
At doses usually used in this country,
marijuana usually does not produce physical addiction, but dependence
may result with regular long-term use. The harmfulness of dependence is
clearly seen in teen users who suffer impaired learning abilities (both
verbal and mathematical), reduced attention span, and lowered
problem-solving skills and reading comprehension. Use of this drug
between one and three times per day may interfere with acquiring
necessary social skills at crucial times of development, and teenagers
may turn to the isolation and escapism of the drug rather than
developing healthy coping mechanisms.
Teenagers introduced to marijuana by their
friends experience social pressure to use the drug, which is reinforced
by the ritual of rolling and smoking a joint and by the fact that
marijuana is illegal, enhancing its attraction. While marijuana use is
often preceded by alcohol use and smoking, the relationship between use
of these substances is complex. Heavy marijuana users are more likely
than moderate users to use other drugs such as barbiturates,
amphetamines, LSD, or cocaine.
Studies show that long-term marijuana use may
cause cancer. Marijuana smoke, like any smoke, inflames the lungs,
irritates air passages, and impairs pulmonary function. It contains
several carcinogenic tars and because smokers hold the smoke in the
lungs deeply, lung tissue is exposed to these toxins for a prolonged
period. Chronic marijuana use results in metaplasia, a precancerous
condition of lung cells.
Pregnant women should not use marijuana because
it enters the baby's bloodstream through the placenta. The drug may
cause stillbirth or spontaneous abortion, and fetuses exposed to
marijuana may be born at lower weight than babies of nonsmoking mothers.
Breastfeeding mothers should also abstain since evidence indicates the
drug is transferred to breast milk.
OPIATES
Opiates—derived from the opium poppy, grown mostly in Asia—include
opium, morphine, and heroin. Opiates were both legal and widely
available in the 1800s and were thought to have beneficial effects on
disorders such as diabetes, diarrhea, and "women's troubles."
After these drugs were used to relieve pain during the Civil War, many
wounded soldiers became addicted.
METHODS OF INGESTION AND EFFECTSM
Opiates can be eaten, inhaled, smoked, and injected (sometimes called
"mainlining"). They act as painkillers and tranquilizers and
produce euphoria in experienced users; pleasurable sensations are not
usually reported by first-time users. Long-term users may experience
pleasure when administration of opiates quells the drug's withdrawal
symptoms such as shakes, sweating, tremors, hot and cold flashes,
anxiety, and craving.
Unlike alcohol, which produces alcoholism only
in susceptible individuals over a period of time ranging from 5 to 10
years, opiates can rapidly produce addiction in almost any regular user.
Effects of chronic use include:
- Tolerance for the drug
- Psychological and physical addiction
manifested in intense craving
- Physical ailments such as liver dysfunction,
pneumonia, lung abscesses, and brain disorders (these are related to
the route of administration and impurities rather than the drug
itself)
Injections of opiates may result in:
- Skin abscesses and ulcers
- Phlebitis
- Excessive scarring
- Bacterial endocarditis
- AIDS if an infected needle is used
- Death from overdose when the central nervous
system is depressed and the heart rate is arrested
TREATMENT
Heroin addicts are often treated with methadone, a synthetic opiate that
eases withdrawal and, when administered as part of a comprehensive
outpatient program at a clinic or hospital, may help addicts stay off
the street and begin the recovery process. Whereas some heroin addicts
are able to do well on methadone, successfully detoxify, and stay
drug-free, others must stay on methadone for years in order to remain
off heroin. Even though methadone causes physical dependence,
chronically maintained individuals can work, refrain from illegal drugs
and activities, and appear normal. However, use of other drugs such as
cocaine and alcohol is a problem in many methadone programs. The
narcotic antagonist Naltrexone is not addicting and blocks the effects
of heroin. It has been especially useful in the treatment of employed
addicts with family support and needs to be given only three times a
week.
Nondrug treatments such as therapeutic
communities work well as long as addicts remain in residence, but the
dropout rate is high.
Craving for heroin can be triggered in times of
stress, anxiety, or depression, even if the addict has been drugfree for
years. Research continues on the possible social, psychological, and
biological causes of heroin addiction, and on appropriate treatment and
recovery programs.
PSYCHEDELIC
DRUGS
DEFINITION
The term psychedelic refers to mind-expanding or mind-manifesting
substances. The psychedelic drugs include lysergic acid diethylamide
(LSD or acid), mescaline derived from the peyote cactus, and psilocybin,
which comes from certain mushrooms.
METHODS OF INGESTION AND EFFECTS
These substances are almost always taken orally, although liquid forms
of LSD may be injected wtih great potential hazard.
The main effects are psychological rather than
physical and vary according to the user's mood and expectations, and the
environment in which the drug is ingested. The highly unpredictable
effects include:
- Distortion of sense perceptions
- Difficulty in speaking or communicating
- Suspended sense of time
- Feeling of motor paralysis alternating with
hyperactivity
- Depressed appetite and loss of sexual desire
Unpleasant experiences on these drugs
("bad trips") may cause paranoia, feeling out of control,
panic, and viewing other people as grotesque distortions.
Psychedelics do not produce physical or
psychological addiction. However, some individuals may experience
prolonged psychosis and may require therapy or institutionalization.
Whether these drugs cause this condition or merely expose a previous
tendency is unknown.
LSD users are susceptible to
"flashbacks" of the drug experience up to a year afterward,
and many experience spontaneous recurrence of visual or sensory
distortions. The long-term effects of heavy use include impaired mental
function and distorted abstract reasoning.
INHALANTS
DEFINITION AND METHODS OF INGESTION
Inhalants are volatile substances that, while never intended to be used
as drugs, are abused because of their mind-altering effects. The chief
abusers of inhalants are children from 7 to 17, who sniff these
household products because they are easily available at home or at the
supermarket.
The inhalants include solvents like gasoline,
cleaning fluids, liquid shoe polish, lacquer, nail polish remover, and
airplane glue; aerosols like spray paint, insecticides, and hair spray;
and anesthetics like nitrous oxide (laughing gas). Also abused are the
volatile nitrates such as amyl nitrate, which is used to treat chest
pains in heart patients by dilating blood vessels and accelerating heart
rate. Amyl nitrate is packaged in covered vials (poppers or snappers)
that are broken open and inhaled. Butyl nitrate is the over-the-counter
version of amyl nitrate.
EFFECTS
Inhalants temporarily stimulate before they depress the central nervous
system. Their immediate effects include:
- Dreamy euphoria, which may last from a few
minutes to hours
- Mental confusion
- Hallucinations
- Dizziness, nausea, and lack of coordination
- Fatigue
- Loss of appetite
- Blackouts
Death, which can occur from first-time
use, may result from instant heart failure, from sniffing substances in
high concentrations (oxygen is displaced in the lungs), and suffocation
from the depression of respiratory functions. Long-term effects include
weight loss, fatigue, muscle fatigue, and, in certain cases, damage to
the nervous system, liver, kidneys, blood, and bone marrow.