CHAPTER 7 - Licit And Illicit Drugs

I.  Drug Dynamics.

A.  Drugs work because they physically resemble chemicals produced naturally in the body and attach to the receptor sites for the natural chemicals.
B.  There are six categories of drugs:
        1. Prescription drugs are those drugs that can be obtained only with the written prescription of a licensed physician.
        2.  Over-the-counter drugs can be purchased in pharmacies and discount stores.
        3.  Recreational drugs is a vague category containing alcohol, tobacco, chocolate, and coffee.
        4.  Herbal preparations includes teas and preparations of botanical origin.
        5.  Illicit or illegal drugs are generally recognized as harmful and have laws governing them.
        6.  Commercial preparations are perfumes, cosmetics, household cleaners, etc.
C.  There are several routes of drug administration (see Figure 7.1).
        1.  Oral ingestion is the most common route.  Effects are felt from 20 minutes to 1 hour after ingestion.
        2.  Infection involves use of a hypodermic needle to introduce a drug to the body.
            a. Intravenous infection puts the drug directly into the vein, effects are felt within 3 minutes.
            b. Intramuscular infection results in slower absorption through muscle tissue.
            c. Subcutaneous infection puts the drug into the fat layer beneath the skin.
        3.  Inhalation refers to administration of drugs through the nostrils.  Effects are noticed within seconds and were aff faster than slower routes of administration.
        4.  Inunction introduces a chemical into the body through the skin, such as nicotine patches.
        5.  Suppositories are absorbed through the rectal walls.

II.  Using, Misusing, and Abusing Drugs.

A.  Drug misuse is generally considered to be the use of a drug for a purpose for which it was not intended.  Drug abuse is the excessive use of any drug.

B.  Addiction is continued involvement with a substance or activity despite ongoing negative consequences.

1. Diagnosis is usually based on several criteria:
    a. Withdrawal or the physical and psychological symptoms from stopping the drug.
    b. An associated pattern of pathological behavior.
    c. Relapse or the tendency to return to the behavior after quitting.

C. There are several universal signs of addiction:

1.Compulsion, characterized by obsession or excessive preoccupation with the behavior.

2. Loss of control, or the inability to predict reliably whether an isolated occurrence of the behavior will be healthy or damaging.

3.Negative consequences such as physical damage, legal trouble, financial problems, etc.

4. Denial, or the inability to perceive the behavior is self-destructive.

III. Prescription Drugs.

A. There are several common types of prescription drugs:

1.Antibiotics are drugs used to fight bacterial infections.
2. Sedatives are central nervous system depressants. 
    a. These drugs are usually included in the list of top selling prescription drugs.
3.Tranquilizers are another central nervous system depressant, over-prescribed in the 60s and 70s.
4. Antidepressants are used to treat endogenous major clinical depression.

B. Generic drugs are medications sold under their chemical name rather than under a brand name.

IV. Over -the-Counter Drugs.

A. OTC drugs are non-prescription drugs we use in the course of self-diagnosis and self-medication. 

B. There are criteria for prescription drugs to become OTC drugs:

1.The drug must have been marketed as a prescription drug for at least three years.
2.The use of the drug must have been relatively high while a prescription drug.
3.Adverse side effects must not be alarming and the frequency of side effects should not have increased during the time the drug was available to the public.

C. There are several types of OTC drugs.

1.Analgesics are pain relievers that come in many forms.
    a. Aspirin relieves pain by inhibiting the body's production of prostaglandins.
    b. Acetaminophen is an aspirin substitute which is also an antipyretic, but not anti-inflammatory.
    c. Ibuprofen is another form of pain reliever.
    d. Aleve is a new pain reliever with longer lasting effects.
2. Cough, cold, allergy and asthma relief are common OTC drugs.
    a. Expectorants are formulated to loosen phlegm.
    b. Antitussives are used to calm cough reflex.
    c. Antihistamines are CNS depressants that dry up runny noses.
    d. Decongestants are designed to reduce nasal stuffiness.
    e. Anticholinergics reduce nasal secretions and tears.
3. Stimulants heighten wakefulness, alertness, and reduce fatigue.
4. Sleeping aids and relaxants induce drowsy feelings that precede sleep.
5. Dieting aids are designed to be appetite suppressants.
    a. Laxatives and diuretics have been used as diet aids.

D.  OTC drugs must be used as recommended to reduce the incidence of problems.

E. Drug interactions can be dangerous.

1. Synergism (potentiation) is an interaction of two or more drugs in which the effects of the individual drugs are multiplied beyond what would normally be expected, i.e. 2+2=10
    a. It is most likely to occur with CNS depressants.
    b. It can occur with OTC drugs.
2. Antagonism is when drugs work at the same receptor site so that one drug blocks the action of the other.
3. Inhibition is when the effects of one drug are eliminated or reduced by the presence of another drug at the receptor site.
4. Intolerance occurs when drugs combine in the body to produce extremely uncomfortable reactions, i.e. antabuse used to help alcoholics give up drinking alcohol.
5. Cross tolerance is when a person develops a tolerance to one drug and shows similar tolerance to selected other drugs as a result.

V.  Illicit Drugs.

    A.  Illicit drugs are those drugs that are illegal to possess, produce, or sell.

    B. In 1997, an estimated 13.9 million Americans were current illicit drug users. Use has been increasing among youth, especially marijuana use.

    C. Illicit drug users come from all walks of life.

1.In 2000, NIDA noted that 9.7% of the population age 12-17 reported using an illicit drug during the past year.
2.Drug use among college students has been increasing in recent years, but is generally lower than the population of similar aged individuals (except alcohol) (see Table 7.1)

    D. People who develop drug problems begin with the belief that they can control their use.  Because many of these drugs have the ability to produce dependence quickly, this may be a foolish thought.

VI. Controlled Substances.

    A.  Drugs are classified into five "schedules" or categories ( see Table 7.2).

1. Schedule I has high potential for abuse, addiction, and no accepted medical use.
2. Schedule II has high potential for abuse, addiction and restricted medical use.
3. Schedule III has some potential for abuse, addiction and is currently accepted for medical use.
4. Schedule IV has low potential for abuse, addiction and is currently accepted for medical use.
5. Schedule V has the lowest potential for abuse, addiction and is accepted for medical use.
6. Illegal drugs are either schedule I or II and are divided into five representative categories:
    a. Stimulants, including cocaine,  crack, amphetamines, and methamphetamines-crank and ice.
    b. Marijuana and its derivatives, such as hashish.
    c. Depressants, including opiates, barbiturates, and alcohol.
    d. Psyhedelics and deliriant, including LSD, mescaline, psilocybin, PCP, inhalants.
    e. Designer drugs, including MDMA also known as Ecstasy, and Ketamine.

B. Cocaine is described by the NIDA as "the most powerful naturally occurring stimulant."

1. It is a crystalline white alkaloid powder derived from leaves of the coca shrub.
2.Cocaine can be snorted, smoked (freebased), or injected.
3.Cocaine binds with receptor sites in the CNS and produces an intense pleasure which abates quickly, leaving the user with a desire to use again.
    a. Cocaine is an anesthetic and a CNS stimulant.
    b. There are many symptoms of increased dosage including irritability, paranoia, dramatic weight loss, convulsions, irregular heartbeat and eventual death from overdose that can cause stroke, heart attack or brain seizures.
    c. Withdrawal symptoms include pervasive long-term depression, loss of the ability to feel joy and many others.  Sometimes these are permanent.
4. Cocaine, when taken during pregnancy, can cause many birth defects needing extensive medical attention.
    a. Some risks include small head, premature delivery, reduced birth weight, increased irritability and subtle learning and cognitive deficits.
    b. Baby goes through withdrawal at birth, is unable to sleep or eat properly.
    c. They are able to respond normally to care and are difficult to console and comfort, negatively affecting social and emotional development.
5. Freebase cocaine is a form of cocaine that is more costly and more powerful than powder or chip forms.
    a. It is converted to pure base by removing the hydrochloride salts and cutting agents.
    b. It reaches the brain quickly causing an intense, short-lasting, high.
6. Crack is a form of cocaine that has been processed using ammonia or sodium bicarbonate and heat to remove the hydrochloride.
    a. It is five times as powerful as cocaine.
    b. Addiction is accelerated by the speed at which crack is absorbed through the lungs.
7.Cocaine use affects society and the individual.

C. Amphetamines stimulate the CNS.

1. Small doses can cause increased alertness, but there are many negative side-effects associated with prolonged use and high doses. Effects of use and withdrawal symptoms are very similar to that of cocaine.
2. Therapeutic uses include treatment for obesity and hyperactivity.

D. There are several new generation stimulants, known as methamphetamines.
           1.  Their effects last much longer than cocaine with their immediate effects including irritability and anxiety; increased body temperature, heart rate, and blood pressure; and possible death.
            2. Prolonged use of these drugs can cause fatal lung and kidney damage. 

E. Marijuana is derived from cannabis sativa or cannabis indica (hemp) plants.

1.The psychoactive substance in marijuana is THC.
    a. The THC levels have increased over the years, going from between 1 to 2 percent to between 4 and 6 percent.
    b. Hashish is derived from the plant resin and can contain up to 70% THC.
2. Marijuana can be smoked, ingested, or brewed.
    a. The most noticeable effect of use is dilation of the eye's blood vessels.  User also experiences coughing, dry mouth and throat, increased thirst and appetite, lowered blood pressure, muscular weakness.
    b. Anxiety or paranoia are negative reactions to the drug.
    c. Users may experience intensified reactions to various stimuli.
3. Studies on the long-term effects of marijuana have not been done due to the illegality of the drug.
    a. Studies from other countries show damage similar to cigarette smoking.
    b. The immune system is suspected to be compromised with this drug use.
    c. Other long term effects include blood pressure changes, and impaired memory function.
    d. Pregnant women who smoke have higher risk for stillbirth, miscarriage, low birth weight babies, abnormalities or the nervous system, and other symptoms similar to fetal alcohol syndrome.
4. Marijuana has been used to help control the side-effects of chemotherapy and reduce the eye pressure of glaucoma, and for AIDS patients.
5. Marijuana use reduces a driver's ability to react and make quick decisions, contributing to auto accidents.

F. Opiates, also called narcotics, are all derived from the parent drug opium which comes from the poppy plant. They include opium, morphine, codeine, and heroin.

1. Opiates such as morphine and codeine are still used today in medicine.
2. Opiates are powerful CNS depressants. Besides relieving pain they:
    a. Lower heart rate, respiration and blood pressure.
    b. Cause weakness, dizziness, nausea, vomiting, euphoria, decreased sex drive, visual disturbances, and lack of coordination.
    c. Symptoms of tolerance and withdrawal can occur within three weeks of first use.
    d. Withdrawal symptoms include an intense desire to use, yawning, a runny nose, sweating, crying, sleep disturbance, loss of appetite, irritability, muscle tremors, nausea, abdominal cramps, vomiting, diarrhea, extreme anxiety, elevated blood pressure, rapid heartbeat and respiration.
3. All opiate addictions follow the same progression as heroin.
4. Heroin and black tar heroin are illegal opiates.
    a. Heroin use is on the rise because of increased availability.
    b. Using heroin by infection can increase risk of getting AIDS.
    c. The most common route of administration is "mainlining".
5. Treatment programs for heroin addiction have not been very successful.
    a. Heroin withdrawal produces intense symptoms.
    b. Methadone helps decrease the heroin withdrawal symptoms.
    c. The use of methadone is controversial because critics say the use is replacing one addiction with another.

G. Hallucinogen or Psychedelic drugs alter feelings, perceptions, and thoughts in the user.

1. The major receptor sites for these drugs are in area of the brain, known as the reticular formation, which interprets outside stimuli. (see Figure 7.3)
2.The mixing of sensory messages is called synesthesia.
3. LSD is a psychedelic drug once used by psychiatrists to unlock secrets in the mind.
    a. Even in small doses, LSD can produce psychological and physical effects. 
    b. LSD stimulates uterine contractions and can cause premature labor.
    c. Euphoria is common, however sometimes dysphoria, a sense of evil and foreboding, occurs in many LSD users.
    d. LSD produces illusions and can lead to "bad trips" which are related to set or setting.
4. Mescaline is derived from the peyote cactus and is used in religious ceremonies of the Native American Church.
    a. Mescaline has similar effects to LSD.  Unlike LSD, mescaline is a powerful hallucinogen.  It is also a CNS stimulant.
    b. Street versions of mescaline are usually synthetic derivatives with names like DOM, STP, TMA, and MMDA.  These can be toxic in small quantities.
5. Psilocybin is an active chemical found in a group of mushrooms causing an effect similar to LSD.

H. Dissociative drugs distort perceptions of sight and sound, and produce feelings of detachment.

1.PCP was developed as an anesthetic but was too unpredictable for medical use.
    a. In small doses it produces feelings similar to strong CNS depressants. 
    b. Serious side-effects may occur with larger doses.  These include drastic drops in blood pressure, coma, muscular rigidity, violent outbursts, and possible convulsions and death.
    c. Long-term effect of PCP use is unknown.

I. Designer drugs are easy to produce in homes and chemical laboratories.  They are all illegal.

1. Called "Club Drugs": Ecstasy, GHB, Special K, and Rohypnol are designer drugs.
2. Prior to 1989, these drugs were not included in the drug laws. Now most states have look-alike laws that make designer drugs illegal.
3.Designer drug use can cause serious health problems and may result in death.

J. Inhalants are chemicals that produce vapors that, when inhaled, can cause hallucinations as well as create intoxicating and euphoric effects.

1. Inhalants are generally used by people who cannot afford illicit drugs.
2. Amyl nitrite is often prescribed to relieve chest pain in heart patients, but is used as an inhalant.
3. Nitrous oxide (laughing gas) is a common dental anesthesia and used as a propellant chemical in aerosol products such as whipped topping.
4. Inhalants can produce many unhealthy side effects.

K.  Steroids are ergogenic drugs used to enhance athletic performance. Anabolic steroids are artificial forms of testosterone that promote muscle growth and strength. They are now a Schedule III drug and use carries possibility of imprisonment and fines.

1 . They have become popular in competitive bodybuilding.
2. Anabolic steroids produce a state of euphoria, diminished fatigue, and increased bulk and power.
3. There are many adverse side-effects, including becoming aggressive and violent (roid rage), acne, liver tumors, elevated cholesterol levels, hypertension, kidney disease, and immune system disorders.
    a. Women may experience masculine changes: deeper voice, increased facial and body hair, male pattern baldness, enlarged clitoris, decreased breast size, and changes or absence of menstruation.
4. Steroid alternatives are being used more often. There are two common forms:
    a. GHB is an illegal drug that is the primary ingredient of some of the performance enhancing steroid alternatives.
    b. Clenbuterol is a popular black-market steroid alternative used in other countries on animals, but with no approved use in the US.
    c. A newer supplement, androstenedione (andro), is currently being used by baseball players, although the NFL, NCAA, and International Olympic Committee have banned it.

VII. Illegal Drug Use in the United States.

A. The economic cost of illegal drug use in the US is estimated to be about $97.7 billion.  This includes the costs of prevention, treatment, healthcare, lost productivity, crime and social welfare.  About half of this money is spent to combat crime.

 B. NIDA estimates that between 9.4 percent of all US workers use dangerous drugs on the job.

1.Many employers have instituted drug testing to counteract the drug epidemic.
    a. Critics say drug testing violates the rights of employees.
    b. Critics question the accuracy and the reliability of the tests.

D. There are strategies proposed to decrease the drug problem. (see Skills for Behavior Change)

1.  Scare tactics and total prohibition have been ineffective.
2.  A multi-modal approach to drug education is needed.
3.  Other strategies include stricter border surveillance, longer prison sentences for drug dealers, increased government spending on prevention and law enforcement.

Information drawn from Health: The Basics, by Donatelle and Davis
This page last updated 06/03/2003 .