Factile of drugs
   People have taken drugs for centuries, both as medicines or remedies, and as recreational stimulantsDrugs have different effects on different people - and many of the alleged side-effects, especially links with mental illnesses, are still in dispute. Some drugs, like cannabis, are categorised as illegal drugs in some cultures, while forming part of a traditional diet in others. As it becomes easier to buy drugs from different parts of the world, mainstream recreational drugs have become more widely available.

   Cocaine abuse indicators increased in many U.S. metropolitan areas during 1998 and the first half of 1999, according to a NIDA-supported network of drug abuse researchers who regularly report data on drug abuse in the United States. The rise follows several years of stable or declining use, the researchers reported at the December 1999 meeting of the Community Epidemiology Work Group (CEWG).

       CEWG researchers meet twice a year to report on such drug abuse indicators as drug-related deaths, hospital emergency department (ED) visits, and treatment admissions. Data from 20 cities presented at the December meeting indicate that marijuana and heroin abuse also continued to increase in most areas of the country. However, methamphetamine abuse declined in most cities, including some areas that have been hardest hit by the problem. Highlights from the meeting's advance report are:
                                                                                                                                             

Q)What is Cocaine?
(A) Cocaine is derived from the leaves of the coca bush, which grows in SouthAmerica. Cocaine has been 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 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, cocaine addiction is, by far, the most serious drug problem in the United States.


(Q) How is cocaine used?

A) There are four primary methods of ingesting cocaine. These are:
          1) "Snorting" - absorbing cocaine through the mucous membranes of the nose.
          2) Injecting - users mix cocaine powder with water and use a syringe to inject the solution                  intravenously.
          3) Freebasing - Cocaine hydrochloride is converted to a "freebase" which can then be                  smoked.
          4) Crack Cocaine - Cocaine hydrochloride is mixed with ammonia or sodium bicarbonate                  (baking soda) and other ingredients, causing it to solidify into pellets or "rocks". The                   crack is then smoked in glass pipes.


(Q) How widespread is cocaine or crack addiction?

(A) In 1997, there were approximately 1.5 million regular users of crack cocaine or powdered cocaine.


(Q) Why would anyone become addicted to cocaine?

(A) The effects of cocaine are immediate, extremely pleasurable, and brief. Cocaine and crack cocaine both produce 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 an intense depression, and the drug abuser will then "crash", becoming lethargic and typically sleeping for several days.


(Q) What are the physical effects of crack cocaine addiction?

Changes in blood pressure, heart rates, and breathing rates
Nausea
Vomiting
Anxiety
Convulsions
Insomnia
Loss of appetite leading to malnutrition and weight loss
Cold sweats
Swelling and bleeding of mucous membranes
Restlessness and anxiety
Damage to nasal cavities
Damage to lungs
Possible heart attacks, strokes, or convulsions

 
(Q)What is heroin?

(A)Heroin is an illegal, highly addictive drug, and is abused more than any other opiate. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as "black tar heroin." Although purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.

Other names for heroin:
"smack", "junk", "horse", "skag", "H", "China white"


(Q)How is heroin used?

(A)Heroin is usually injected, sniffed/snorted, or smoked. Typically, a heroin abuser may inject up to four times a day. Intravenous injection provides the greatest intensity and most rapid onset of euphoria (7 to 8 seconds), while intramuscular injection produces a relatively slow onset of euphoria (5 to 8 minutes). When heroin is sniffed or smoked, peak effects are usually felt within 10 to 15 minutes. Although smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

        Injection continues to be the main method of use among heroin addicts; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking. In fact, sniffing/snorting heroin is now a widely reported means of taking heroin among users admitted for drug treatment in Newark, Chicago, New York, and Detroit.


(Q)What are the long-term effects of heroin addiction and use?

(A)One of the most detrimental long-term effects of heroin is heroin addiction itself. Addiction is a chronic problem, characterized by compulsive drug seeking and use, and by neurochemical and molecular changes in the brain. Heroin also produces profound degrees of tolerance and physical dependence, which are also powerful motivating factors for compulsive use and abuse. As with abusers of any addictive drug, heroin addicts gradually spend more and more time and energy obtaining and using the drug. Once they are addicted, the heroin abusers' primary purpose in life becomes seeking and using drugs. The drugs literally change their brains.

    Physical dependence develops with higher doses of the drug. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. Major withdrawal symptoms peak between 24 and 48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Heroin withdrawal is never fatal to otherwise healthy adults, but it can cause death to the fetus of a pregnant addict.

     At some point during continuous heroin use, a person can become addicted to the drug. Sometimes addicted individuals will endure many of the withdrawal symptoms to reduce their tolerance for the drug so that they can again experience the rush.

      Physical dependence and the emergence of withdrawal symptoms were once believed to be the key features of heroin addiction. We now know this may not be the case entirely, since craving and relapse can occur weeks and months after withdrawal symptoms are long gone. We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict.

(Q)What are the medical complications of chronic heroin addiction and use?

(A)Medical consequences of chronic heroin abuse include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health condition of the abuser as well as from heroin's depressing effects on respiration. Many of the additives in street heroin may include substances 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. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

    One of the greatest risks of being a heroin addict is death from heroin overdose. Each year about one percent of all heroin addicts in the United States die from an overdose of heroin despite having developed a fantastic tolerance to the effects of the dr ug. In a nontolerant person the estimated lethal dose of heroin may range from 200 to 500 mg, but addicts have tolerated doses as high as 1800 mg without even being sick.


Q)What are the treatments for heroin addiction?

(A)Treatments for heroin addiction fall into 2 broad categories. These are:

     1) Treatment involving substitute drugs or drugs that block the physical effects of narcotics addiction and,

     2) Treatment that addresses to root cause of why one becomes a drug addict. The latter tends to be more expensive but is much more successful in dealing permanently with heroin addiction.

 
(Q) Where did methadone come from?

 
(A) German scientists synthesized methadone during World War II because of a shortage of morphine. Although chemically unlike morphine or heroin, methadone produces many of the same effects.

Introduced into the United States in 1947 as an analgesic (Dolophine), Methadone is primarily used today for the treatment of narcotic addiction. The effects of methadone are longer-lasting than those of morphine-based drugs. Methadone's effects can last up to 24 hours, thereby permitting administration only once a day in heroin detoxification and maintenance programs.

Methadone is almost as effective when administered orally as it is by injection. Tolerance and dependence will develop, and withdrawal symptoms, though they develop more slowly and are less severe than those of morphine and heroin, are more prolonged. Ironically, methadone used to control narcotic addiction, is frequently encountered on the illicit market and has been associated with a number of overdose deaths.

(Q) What are the dangers of methadone?

(A) Following is an article by two doctors addressing this question.

Based on literature and analysis of mortality figures Dr Russell Newcombe concluded that methadone programmes as a form of harm-reduction possibly cause more victims than they prevent. We have doubts whether the conclusionabout methadone is fully justified. Looking at the mentioned literature gives a one-sided view at the problem. Moreover, the conclusions drawn are beyond those justified by the results of the analyses.

Methadone is not an innocent substance; 'one's methadone maintenance dose is another's poison' (2). A regular user of opiates develops a certain tolerance. Therefore, it is possible that a tolerant person can function normally with dosages which can be fatal to a non-tolerant person. Also, methadone dosage in the case of first entry to the programme has to be evaluated carefully. It is wise to begin with a low dosage that has to be increased slowly in the course of weeks or even months. At entry to the programme it has to be carefully evaluated whether a patient has a clear and unambiguous heroin dependence. In methadone maintenance programmes, methadone is dispensed to tolerant persons, moreover, this tolerance remains high because of daily use of methadone. Therefore, it is not surprising that deaths at the King's College Hospital caused by methadone were not those of participants of a methadone maintenance programme but were those of 'recreational' users of illicit methadone.

        In cases where more than one drug is used, the drug responsible for death due to overdose is difficult to establish. Moreover, the same drug prescribed by physicians can also be bought on the street. In seventy percent of the deaths due to overdose studied in Glasgow and Edinburgh a combination of different drugs was found (3).

        Prescribed drugs such as temazepam were often encountered in deaths in Glasgow. However, among only 14 of the 34 persons who died in 1992 and where temazepam was found, this was prescribed by their physician. Because of the presence of other drugs it is not clear whether temazepam really caused the death of these people. Probably the combination of these different drugs was fatal to them. This was also the case with the methadone deaths in Edinburgh. However, in Edinburgh, the authors could not determine whether methadone was prescribed or not. Both Hammersley and Obafunwa report that heroin/morphine deaths seldom occur in Edinburgh (4). 'The fall of the deaths due to overdose in the Lothian and Borders Region of Scotland (LBRS) after 1984 reflects in part the strict policing that took place, in particular in the Edinburgh area'.

        'The increase of methadone deaths is probably due to the introduction of a street trend to use this agent as a substitute to heroin'. The author suggests that methadone deaths are mainly caused by the use of illicit methadone.


Marijuana.

         Seventeen CEWG cities reported increases in problems associated with marijuana abuse. The percentage of drug abusers whose primary drug of abuse was marijuana continued to increase in many cities. Rates of marijuana-related ED visits also continued the consistent, often dramatic, increases shown over the last 6 years. Increases in marijuana-related problems may be tied to increased availability, higher potency, and lower prices for the drug along with perceptions that marijuana abuse is less risky than abuse of other drugs, the report indicate.

                                                                                                                                  Methamphetamine

            Indicators of methamphetamine abuse decreased in West Coast and Southwest areas where abuse of the drug has been a major problem for years. Sharp declines in methamphetamine-related ED visits were reported in 1998 in six CEWG areas. Several areas also reported that methamphetamine treatment admissions, hospital mentions, and deaths continued to decline in the first half of 1999. Researchers cited several possible reasons for these decreases, including initiation of national and community methamphetamine abuse prevention programs and enactment of laws that make it more difficult to obtain the chemicals needed to produce the drug.

Cannabis

Cannabis may impair short-term memory and affects body coordination.
First-time users may feel confused and distressed and anxiety, panic and suspicion are not uncommon side effects.
High doses can cause coma, but there are no records of fatal overdose.
Heavy use can lead to confusion, aggravate existing mental disorders and sap energy.
Some people believe cannabis can lead to hard drug use, such as heroin, but the majority of users do not go on to take heroin.
Long-term use of cannabis can cause lung cancer, bronchitis and other respiratory disorders associated with smoking.
It is unclear if there is more risk of these disorders than with tobacco. However, cannabis users tend to inhale more deeply and the drug does contain higher doses of tar.
People may become both physically and psychogically dependent on cannabis.
Studies also show that regular, heavy use of the drug may cause nerve damage and affect learning.
But there is evidence that cannabis can relieve the symptoms of some chronic conditions, such as multiple sclerosis.