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Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is available only through a prescription that cannot be refilled. There are a few accepted medical reasons for its use, such as the treatment of narcolepsy, attention deficit disorder, and -- for short-term use -- obesity; but these medical uses are limited.
Inhalants are volatile substances that produce chemical vapors that can be inhaled to induce a psychoactive, or mind-altering, effect. Although other abused substances can be inhaled, the term "inhalants" is used to describe a variety of substances whose main common characteristic is that they are rarely, if ever, taken by any route other than inhalation. This definition encompasses a broad range of chemicals found in hundreds of different products that may have different pharmacological effects. As a result, precise categorization of inhalants is difficult. One classification system lists four general categories of inhalants-volatile solvents, aerosol, gases, and nitrites-based on the form in which they are often found in household, industrial, and medical products.
Early attempts to prevent steroid abuse concentrated on drug testing and on educating students about the drugs' adverse effects.
A more sophisticated approach has shown promise for preventing steroid abuse among players on high school sports teams. In the ATLAS program, developed for male football players, coaches and team leaders discuss the potential effects of anabolic steroids and other illicit drugs on immediate sports performance, and they teach how to refuse offers of drugs. They also discuss how strength training and proper nutrition can help adolescents build their bodies without the use of steroids. Later, special trainers teach the players proper weightlifting techniques.
A program designed for adolescent girls on sports teams, patterned after the program designed for boys, is currently being tested.
The following is a condensed list of commonly used steroids and the category (oral or injectable) in which they fall.
Deca-Durabolin (nandrolone decanoate)
Durabolin (nandrolone phenpropionate)
Depo-Testosterone (testosterone cypionate)
Equipoise (boldenone undecylenate)
Many brain systems may be involved in the anesthetic, intoxicating, and reinforcing effects of different inhalants. Nearly all abused inhalants (other than nitrites) produce a pleasurable effect by depressing the CNS. Evidence from animal studies suggests that a number of commonly abused volatile solvents and anesthetic gases have neurobehavioral effects and mechanisms of action similar to those produced by CNS depressants, which include alcohol and medications such as sedatives and anesthetics.
A recent study indicates that toluene, a solvent found in many commonly abused inhalants including airplane glue, paint sprays, and paint and nail polish removers, activates the brain's dopamine system. The dopamine system has been shown to play a role in the rewarding effects of many drugs of abuse. Nitrites, in contrast, dilate and relax blood vessels rather than acting as anesthetic agents.
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 the oral types, 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.
Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpensive over-the-counter ingredients.
Methamphetamine is commonly known as "speed," "meth," and "chalk." In its smoked form it is often referred to as "ice," "crystal," "crank," and "glass." It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. The effects of methamphetamine can last 6 to 8 hours. After the initial "rush," there is typically a state of high agitation that in some individuals can lead to violent behavior.
Ecstasy, Herbal Ecstasy, Rohypnol, GHB, and Ketamine are among the drugs used by teens and young adults who are part of a nightclub, bar, rave, 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.
People who abuse inhalants are found in both urban and rural settings. Research on factors contributing to inhalant abuse suggests that adverse socioeconomic conditions, rather than racial or cultural factors per se, may account for most reported racial and ethnic differences in rates of inhalant abuse. Poverty, a history of childhood abuse, poor grades, and dropping out of school all are associated with inhalant abuse. Native American youths who live on reservations, where socioeconomic distress and school dropout rates are high, typically have higher rates of inhalant abuse than both the general population of young people and those Native American youths who do not live on reservations.
MDMA 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.
Many abusers who inject anabolic steroids use nonsterile injection techniques or share contaminated needles with other abusers. In addition, some steroid preparations are manufactured illegally under non-sterile conditions. These factors put abusers at risk for acquiring life-threatening viral infections, such as HIV and hepatitis B and C. Abusers also can develop infective endocarditis, a bacterial illness 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.
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.
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.
The effects of LSD are unpredictable. 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.
Many LSD users experience flashbacks, recurrence of certain aspects of a person's experience, without the user having taken the drug again. 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.
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.
NHSDA reports the nature and extent of drug use among the American household popula tion aged 12 and older. In the 1996 NHSDA estimates, the percentage of the population aged 12 and older who had ever used LSD (the lifetime prevalence rate) had increased to 7.7 percent from 6.0 percent in 1988. Among youths 12 to 17 years old, the 1996 LSD lifetime prevalence rate was 4.3 percent, and for those aged 18 to 25, the rate was 13.9 percent. The rate for past-year use of LSD among the population ages 12 and older was 1 percent in 1996. Past-year prevalence was highest among the age groups 12 to 17 (2.8 percent) and 18 to 25 (4.6 percent). The rate of current LSD use in 1996 for those aged 18 to 25 was 0.9 percent, and it was 0.8 percent for 12- to 17-year-old youths.
At this time the most effective treatments for methamphetamine addiction are cognitive behavioral interventions. These approaches are designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Methamphetamine recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery.
There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs such as methamphetamine.
There are some established protocols that emergency room physicians use to treat individuals who have had a methamphetamine overdose. Because hyperthermia and convulsions are common and often fatal complications of such overdoses, emergency room treatment focuses on the immediate physical symptoms. Overdose patients are cooled off in ice baths, and anticonvulsant drugs may be administered also.
Acute methamphetamine intoxication can often be handled by observation in a safe, quiet environment. In cases of extreme excitement or panic, treatment with antianxiety agents such as benzodiazepines has been helpful, and in cases of methamphetamine-induced psychoses, short-term use of neuroleptics has proven successful.
Although the chemical substances found in inhalants may produce various pharmacological effects, most inhalants produce a rapid high that resembles alcohol intoxication with initial excitation, then drowsiness, disinhibition, lightheadedness, and agitation. If sufficient amounts are inhaled, nearly all solvents and gases produce anesthesia, a loss of sensation and even unconsciousness.
The chemicals found in solvents, aerosol sprays, and gases can produce a variety of additional effects during or shortly after use. These effects are related to inhalant intoxication and may include belligerence, apathy, impaired judgment, and impaired functioning in work or social situations. Dizziness, drowsiness, slurred speech, lethargy, depressed reflexes, general muscle weakness, and stupor are other possible effects. Nausea and vomiting are other common side effects.
Inhaled nitrites dilate blood vessels, increase heart rate, and produce a sensation of heat and excitement that can last for several minutes. Other effects can include flush, dizziness, and headache.
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 ecstacy," "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.
PCP is addicting.
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.
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.
Psychological effects at high doses include illusions and hallucinations. PCP can cause effects that mimic the full range of symptoms of schizophrenia. 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.
A strong need to continue using inhalants has been reported among many individuals, particularly those who abuse inhalants for prolonged periods over many days. Compulsive use and a mild withdrawal syndrome can occur with long-term inhalant abuse. Additional symptoms exhibited by long-term inhalant abusers include weight loss, muscle weakness, disorientation, inattentiveness, lack of coordination, irritability, and depression.
In 1996, MTF began to collect data on MDMA use among students. Rates of use remained relatively stable from 1996 to 1999 for students in the 8th grade, while usage among 10th- and 12th-graders has increased.
The number of 12th-graders that had used MDMA in their lifetime increased from 5.8 percent in 1998 to 8.0 percent in 1999. Use in the past year also increased from 3.6 percent in 1998 to 5.6 percent in 1999. In addition, 12th-graders use of MDMA in the past month also increased from 1.5 percent in 1998 to 2.5 percent in 1999.
On the other hand, the largest change for 10th-graders occurred in past year use, which increased from 3.3 percent in 1998 to 4.4 percent in 1999.
Increased HIV and hepatitis B and C transmission are likely consequences of increased methamphetamine abuse, particularly in individuals who inject the drug and share injection equipment.
Research also indicates that methamphetamine and related psychomotor stimulants can increase the libido in users, in contrast to opiates which actually decrease the libido. However, long-term methamphetamine use may be associated with decreased sexual functioning, at least in men. Additionally, methamphetamine seems to be associated with rougher sex which may lead to bleeding and abrasions. The combination of injection and sexual risks may result in HIV becoming a greater problem among methamphetamine abusers than among opiate and other drug abusers, something that already seems to be occurring in California.
Gender differences in inhalant abuse have been identified at different points in childhood. One study indicates inhalant abuse is higher for boys than girls in grades 4 through 6, occurs at similar rates in grades 7 through 9-when overall use is highest-and becomes more prevalent again among boys in grades 10 through 12. The National Household Survey on Drug Abuse (NHSDA), an annual survey of drug use among the Nation's noninstitutionalized civilians, reports that similar percentages of 12- to 17-year-old boys and girls abused inhalants in 1998. However, the percentage of 18- to 25-year-old males who abused inhalants was more than twice that of females in that age group, suggesting that sustained abuse of inhalants is more common among males.
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.
Volatile solvents are liquids that vaporize at room temperatures. They are found in a multitude of inexpensive, easily available products used for common household and industrial purposes. These include paint thinners and removers, dry-cleaning fluids, degreasers, gasoline, glues, correction fluids, and felt-tip marker fluids.
Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence. Subsequently, when these hormones reach certain levels, they signal the bones to stop growing, locking a person into his or her maximum height.
When a child or adolescent takes anabolic steroids, the resulting artificially high sex hormone levels can signal the bones to stop growing sooner than they normally would have done.
Inhalants-particularly volatile solvents, gases, and aerosols- are often among the first drugs that young children use. Inhalants also are one of the few substances abused more by younger children than by older ones. Nevertheless, inhalant abuse can become chronic and extend into adulthood.
Generally, inhalant abusers will abuse any available substance. In certain parts of the country, "Texas shoe-shine," a shoe-shining spray containing the chemical toluene, is a local favorite. Silver and gold spray paints, which contain more toluene than other spray colors, also are popular inhalants.
Data from national and state surveys suggest inhalant abuse reaches its peak at some point during the seventh through ninth grades. For example, the American Drug and Alcohol Survey of children in the 4th through 12th grades indicates that the percentage of children who have ever used inhalants peaks in the 8th grade.
MDMA, called "Adam," "ecstasy," or "XTC" on the street, is a synthetic, psychoactive (mind-altering) drug with amphetamine-like and hallucinogenic properties. Its chemical structure (3-4 methylenedioxymethamphetamine) is similar to two other synthetic drugs, MDA and methamphetamine, which are known to cause brain damage.
As a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. A brief, intense sensation, or rush, is reported by those who smoke or inject methamphetamine. Oral ingestion or snorting produces a long-lasting high instead of a rush, which reportedly can continue for as long as half a day.
Methamphetamine has toxic effects. The large release of dopamine produced by methamphetamine is thought to contribute to the drug's toxic effects on nerve terminals in the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions.
Long-term methamphetamine abuse results in many damaging effects, including addiction. In addition to being addicted to methamphetamine, chronic methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin, called "formication").
In some cases, abusers forego food and sleep while indulging in a form of binging known as a "run," injecting as much as a gram of the drug every 2 to 3 hours over several days.
Chronic abuse can lead to psychotic behavior, characterized by intense paranoia, visual and auditory hallucinations, and out-of-control rages that can be coupled with extremely violent behavior.
Although there are no physical manifestations of a withdrawal syndrome when methamphetamine use is stopped, users may feel depression, anxiety, fatigue, paranoia, aggression, and an intense craving for 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, tranquillity, and conviviality.
Each year, NHSDA reports on the nature and extent of drug use among the American household population aged 12 and older. The 1998 survey found that an estimated 1.5 percent (3.4 million) of Americans at least 12 years old had used MDMA at least once during their lifetime. By age group, the heaviest use (5 percent or 1.4 million people) was reported for those between 18 and 25 years old.
Methamphetamine can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain. Hyperthermia (elevated body temperature) and convulsions occur with methamphetamine overdoses, and if not treated immediately, can result in death.
Chronic methamphetamine abuse can result in inflammation of the heart lining, and among users who inject the drug, damaged blood vessels and skin abscesses. Methamphetamine abusers also can have episodes of violent behavior, paranoia, anxiety, confusion, and insomnia. Psychotic symptoms can sometimes persist for months or years after use has ceased.
Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent.
Fetal exposure to methamphetamine also is a significant problem in the United States. At present, research indicates that methamphetamine abuse during pregnancy may result in prenatal complications, increased rates of premature delivery, and altered neonatal behavioral patterns, such as abnormal reflexes and extreme irritability. Methamphetamine abuse during pregnancy may be linked also to congenital deformities.
Gases include medical anesthetics as well as gases used in household or commercial products. Medical anesthetic gases include ether, chloroform, halothane, and nitrous oxide, commonly called "laughing gas." Nitrous oxide is the most abused of these gases and can be found in whipped cream dispensers and products that boost octane levels in racing cars. Household or commercial products containing gases include butane lighters, propane tanks, whipped cream dispensers, and refrigerants.
Club drug use appears to be increasing in many cities around the country,* with Atlanta, Seattle, Chicago, Detroit, Miami, and Newark reporting widespread use at rave and club scenes. 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.
Methamphetamine is classified as a psychostimulant as are such other drugs of abuse as amphetamine and cocaine. We know that methamphetamine is structurally similar to amphetamine and the neurotransmitter dopamine, but it is quite different from cocaine. Although these stimulants have similar behavioral and physiological effects, there are some major differences in the basic mechanisms of how they work at the level of the nerve cell. However, the bottom line is that methamphetamine, like cocaine, results in an accumulation of the neurotransmitter dopamine, and this excessive dopamine concentration appears to produce the stimulation and feelings of euphoria experienced by the user. In contrast to cocaine, which is quickly removed and almost completely metabolized in the body, methamphetamine has a much longer duration of action and a larger percentage of the drug remains unchanged in the body. This results in methamphetamine being present in the brain longer, which ultimately leads to prolonged stimulant effects.
An undetermined percentage of steroid abusers become addicted to the drugs, as evidenced by their continuing to take steroids in spite of physical problems, negative effects on social relations, or nervousness and irritability. Also, they spend large amounts of time and money obtaining the drugs and experience withdrawal symptoms such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and the desire to take more steroids. The most dangerous of the withdrawal symptoms is depression, because it sometimes leads to suicide attempts. Untreated, some depressive symptoms associated with anabolic steroid withdrawal have been known to persist for a year or more after the abuser stops taking the drugs.
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.
Methamphetamine, traditionally associated with white, male, blue-collar workers, is being used by more diverse population groups that change over time and differ by geographic area.
According to the 1996 National Household Survey on Drug Abuse, an estimated 4.9 million people (2.3 percent of the population) have tried methamphetamine at some time in their lives. In 1994, the estimate was 3.8 million (1.8 percent), and in 1995 it was 4.7 million (2.2 percent).
Data from the 1996 Drug Abuse Warning Network (DAWN), reported that methamphetamine-related episodes decreased by 39 percent between 1994 and 1996, after a 237 percent increase between 1990 and 1994.
NIDA's Community Epidemiology Work Group (CEWG), an early warning network of researchers that provides information about the nature and patterns of drug use in major cities, reported in its June 1997 publication that methamphetamine continues to be a problem in Hawaii and in major Western cities, such as San Francisco, Denver, and Los Angeles.
Ketamine is another central nervous system depressant abused as a "date rape" drug. Ketamine, or "Special K," is a rapid-acting general anaesthetic. 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.
Nitrites often are considered a special class of inhalants. Unlike most other inhalants, which act directly on the central nervous system (CNS), nitrites act primarily to dilate blood vessels and relax the muscles. And while other inhalants are used to alter mood, nitrites are used primarily as sexual enhancers. Nitrites include cyclohexyl nitrite, isoamyl (amyl) nitrite, and isobutyl (butyl) nitrite. Cyclohexyl nitrite is found in room odorizers. Amyl nitrite is used in certain diagnostic procedures and is prescribed to some patients for heart pain. Illegally diverted ampules of amyl nitrite are called "poppers" or "snappers" on the street. Butyl nitrite is an illegal substance that is often packaged and sold in small bottles also referred to as "poppers."
The term drug includes any non-food chemical substance or preparation administered for the purpose of correcting or attenuating a disease process (therapeutic drug) or for pleasure (recreational drug). Almost all drugs of interest in the realm of behavioral health care achieve their primary effects in the brain (central nervous system) and may also be referred to as psychoactive or psychotropic. Many such drugs (e.g., morphine, diazepam, amphetamine, nitrous oxide) may be used for either of these two purposes.
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.
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.
Since 1975, MTF researchers have annually surveyed almost 17,000 high school seniors nationwide to determine trends in drug use and to measure attitudes and beliefs about drug abuse. Over the past 2 years, the percentage of seniors who have used LSD has remained relatively stable. Between 1975 and 1997, the lowest lifetime use of LSD was reported by the class of 1986, when 7.2 percent of seniors reported using LSD at least once in their lives. In 1997, 13.6 percent of seniors had experimented with LSD at least once in their lifetimes. The percentage of seniors reporting use of LSD in the past year nearly doubled from a low of 4.4 percent in 1985 to 8.4 percent in 1997.
In 1997, 34.7 percent of seniors perceived great risk in using LSD once or twice, and 76.6 percent said they saw great risk in using LSD regularly. More than 80 percent of seniors disapproved of people trying LSD once or twice, and almost 93 percent disapproved of people taking LSD regularly.
Almost 51 percent of seniors said it would have been fairly easy or very easy for them to get LSD if they had wanted it.
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.
Because of concern about these abused sedative-hypnotics, Congress passed the "Drug-Induced Rape Prevention and Punishment Act of 1996" in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault.
Drug analogs are chemical compounds that are similar to other drugs in their effects but differ slightly in their chemical structure. Some analogs are produced by pharmaceutical companies for legitimate medical reasons. Other analogs, sometimes referred to as "designer" drugs, can be produced in illegal laboratories and are often more dangerous and potent than the original drug.
NIDA's 1997 MTF shows that use of PCP by high school seniors has declined steadily since 1979, when 7.0 percent of seniors had used PCP in the year preceding the survey. In 1997, however, 2.3 percent of seniors used PCP at least once in the past year, up from a low of 1.2 percent in 1990. Past month use among seniors decreased from 1.3 percent in 1996 to 0.7 percent in 1997.
According to the 1996 NHSDA, 3.2 percent of the population aged 12 and older have used PCP at least once. Lifetime use of PCP was higher among those aged 26 through 34 (4.2 percent) than for those 18 through 25 (2.3 percent) and those 12 through 17 (1.2 percent).
A hallucinogenic drug is one that causes the user to have psychotic-like sensations and feelings of detachment and unreality. The user may "hear" colors or "see" music. The walls may look like they're melting. The user has a distorted view of objects and sounds. Users can also have hallucinations and delusions - seeing things that aren't there, and believing things that are impossible such as believing they can fly. LSD, psyillocybin mushrooms, peyote (mescaline) and jimsonweed are examples of hallucinogenic drugs. The "trip" lasts for about five hours, and mimics mental illnesses such as schizophrenia or delusional disorder. The hallucinogenic drugs are extremely dangerous; they are stored in the fatty areas of the body, such as the brain, and cause "flashbacks" days, months, or even years after the drug has been taken.
Fentanyl was introduced in 1968 by a Belgian pharmaceutical company as a synthetic narcotic to be used as an analgesic in surgical procedures because of its minimal effects on the heart. Fentanyl is particularly dangerous because it is 50 times more potent than heroin and can rapidly stop respiration. This is not a problem during surgical procedures because machines are used to help patients breathe. On the street, however, users have been found dead with the needle used to inject the drug still in their arms.
MDMA is used most often by young adults and adolescents at clubs, raves (large, all-night dance parties), and rock concerts.
Its abuse is increasingly reported in the 20 metropolitan areas included in the CEWG.
In Kings County, Washington, a recently completed survey of young men who have sex with men showed that MDMA was among the frequently used drugs (20 percent of the sample).
In Boston, a 1996-97 survey of public schools in Boston found that about 14 percent of male and 7 percent of female 12th graders had used MDMA during their lifetime. Increased use of MDMA among youth was also reported in Seattle.
Information about MDMA from other CEWG areas include the following:
In Atlanta, MDMA is reported as a popular stimulant.
In Chicago, it's use is common in the rave and club scenes, especially in the North Side.
In Miami, large-scale sales of drugs such as MDMA are occurring at raves.
In New Jersey, it is available across the state, particularly in college towns.
Case reports and small studies indicate that anabolic steroids, particularly in high doses, increase irritability and aggression. 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.
Anabolic steroids have been reported also to cause other behavioral effects, including euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, and confusion.
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.