Inhalants! - Frank D. Lanterman Regional Center

Transcription

Many products readily found in the home or workplace—such as spray paints, markers, glues, and cleaning fluids—contain volatile substances that have psychoactive (mind-‐
altering) properties when inhaled. People do not typically think of these products as drugs because they were never intended for that purpose. However, these products are some-‐
times abused in that way. They are especially (but not exclusively) abused by young children and adoles-‐
cents, and are the only class of sub-‐
stance abused more by younger than by older teens. Definition Although other abused drugs can be inhaled, the term inhalants is reserved for the wide variety of substances—
including solvents, aerosols, gases, and nitrites—that are rarely, if ever, taken via any other route of administration. (See below for a list of examples.) High-‐School Students Repor:ng Having Ever Used Inhalants 8th Grade Inhalants 10th 12th 0.00% 5.00% 10.00% 15.00% Source: University of Michigan, 2011 Monitoring the Future Study. Survey data can be found at www.drugabuse.gov How Are Inhalants Abused? Abusers of inhalants breathe them in through the nose or mouth in a varie-‐
ty of ways (known as “huffing”). They may sniff or snort fumes from a con-‐
tainer or dispenser (such as a glue bottle or a marking pen), spray aero-‐
sols (such as computer cleaning dust-‐
ers) directly into their nose or mouth, or place a chemical-‐soaked rag in their mouth. Abusers may also inhale fumes from a balloon or a plastic or paper bag. Although the high produced by inhalants usually lasts just a few minutes, abusers often try to prolong it by continuing to inhale repeatedly over several hours. People tend to abuse different inhal-‐
ant products at different ages. New users ages 12–15 most commonly abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. New users ages 16–17 most commonly abuse ni-‐
trous oxide or “whippets.” Adults most commonly abuse a class of in-‐
halants known as nitrites (such as amyl nitrites or “poppers”). Inhalants • September 2012 • Page 1
How Do Inhalants Affect the Brain? Most abused inhalants other than ni-‐
trites depress the central nervous sys-‐
tem in a manner not unlike alcohol. The effects are similar—including slurred speech, lack of coordination, euphoria, and dizziness. Inhalant abusers may also experience light-‐
headedness, hallucinations, and delu-‐
sions. With repeated inhalations, many users feel less inhibited and less in control. Some may feel drowsy for several hours and experience a linger-‐
ing headache. Unlike other types of inhalants, nitrites enhance sexual pleasure by dilating and relaxing blood vessels. Although it is not very common, ad-‐
diction to inhalants can occur with re-‐
peated abuse. What Are the Other Health Effects of Inhalants? Chemicals found in different types of inhaled products may produce a vari-‐
ety of other short-‐term effects, such as nausea or vomiting, as well as more serious long-‐term consequences. The-‐
se may include liver and kidney dam-‐
age, hearing loss, or bone marrow damage. Effects may also include loss of coordination and limb spasms due to damage to myelin—a protective sheathing around nerve fibers that helps nerves transmit messages in the brain and peripheral nervous system. Inhalants can also cause brain damage by cutting off oxygen flow to the brain. Inhalants can even be lethal. Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly cause heart failure within minutes. This syndrome, known as “sudden sniffing death,” can result from a single session of inhalant use by an otherwise healthy young Products Abused as Inhalants Volatile solvents—liquids that vaporize at room temperature: Industrial or household products, including paint thinners or removers, degreasers, dry-‐
cleaning fluids, gasoline, and lighter fluid Art or office supply solvents, including correc-‐
tion fluids, felt-‐tip marker fluid, electronic con-‐
tact cleaners, and glue Aerosols—sprays that contain propellants and solvents: Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol computer cleaning products, and vegetable oil sprays Gases—found in household or commercial prod-‐
ucts and used as medical anesthetics: Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or dispensers (“whippets”), and refrigerant gases Medical anesthetics, such as ether, chloro-‐
form, halothane, and nitrous oxide (“laughing gas”) Nitrites—used primarily as sexual enhancers: Organic nitrites are volatiles that include cy-‐
clohexyl, butyl, and amyl nitrites, commonly known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When marketed for illicit use, organic nitrites are of-‐
ten sold in small brown bottles labeled as “vid-‐
eo head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.” person. High concentrations of inhal-‐
ants may also cause death from suffo-‐
cation, especially when inhaled from a paper or plastic bag or in a closed ar-‐
ea. Even when using aerosols or vola-‐
tile products for their legitimate pur-‐
poses like painting or cleaning, it is wise to do so in a well-‐ventilated room or outdoors. Nitrites are a special class of inhalants that are abused to enhance sexual pleasure and performance. They can be associated with unsafe sexual prac-‐
tices that increase the risk of contract-‐
ing and spreading infectious diseases like HIV/AIDS and hepatitis. Inhalants • September 2012 • Page 2
Learn More For additional information on inhal-‐
ants and inhalant abuse, please see http://www.drugabuse.gov/publicati
ons/research-‐reports/inhalant-‐abuse Inhalants • September 2012 • Page 3
Synthetic Cathinones (“Bath Salts”)
The term “bath salts” refers to an emerging family of drugs containing one or
more synthetic chemicals related to
cathinone, an amphetamine-like stimulant found naturally in the Khat plant.
Reports of severe intoxication and dangerous health effects associated with use
of bath salts have made these drugs a
serious and growing public health and
safety issue. The synthetic cathinones in
bath salts can produce euphoria and increased sociability and sex drive, but
some users experience paranoia, agitation, and hallucinatory delirium; some
even display psychotic and violent behavior, and deaths have been reported in
several instances.
they are sold online and in drug paraphernalia stores under a variety of brand
names, such as “Ivory Wave," "Bloom,"
"Cloud Nine," "Lunar Wave," "Vanilla
Sky," "White Lightning," and “Scarface.”
In Name Only
The synthetic cathinone products
marketed as “bath salts” to evade detection by authorities should not be
confused with products such as Epsom salts that are sold to improve the
experience of bathing. The latter have
no psychoactive (drug-like) properties.
Bath salts typically take the form of a
white or brown crystalline powder and
are sold in small plastic or foil packages
labeled “not for human consumption.”
Sometimes also marketed as “plant
food”—or, more recently, as “jewelry
cleaner” or “phone screen cleaner”—
How Are Bath Salts Abused?
Bath salts are typically taken orally, inhaled, or injected, with the worst outcomes being associated with snorting or
needle injection.
How Do Bath Salts Affect the Brain?
Common synthetic cathinones found in
bath salts include 3,4methylenedioxypyrovalerone (MDPV),
mephedrone (“Drone,” “Meph,” or “Meow Meow”), and methylone, but there
are many others. Much is still unknown
“Bath Salts” • November 2012 • Page 1
An Evolving Threat
When bath salts emerged at the
end of the last decade, they rapidly
gained popularity in the U.S. and
Europe as “legal highs.” In October
2011, the U.S. Drug Enforcement
Administration placed three common synthetic cathinones under
emergency ban pending further investigation, and in July 2012, President Obama signed legislation
permanently making two of them—
mephedrone and MDPV—illegal,
along with several other synthetic
drugs often sold as marijuana substitutes (“Spice”).
Although the new law also prohibits
chemically similar “analogues” of
the named drugs, manufacturers
are expected to respond by creating new drugs different enough
from the banned substances to
evade legal restriction. After
mephedrone was banned in the
United Kingdom in 2010, for example, a chemical called naphyrone
quickly replaced it, and is now being sold as “jewelry cleaner” under
the brand name “Cosmic Blast.”
about how these substances affect the
human brain, and each one may have
somewhat different properties. Chemically, they are similar to amphetamines
(such as methamphetamine) as well as
to MDMA (ecstasy).
The energizing and often agitating effects reported in people who have taken
bath salts are consistent with other
drugs like amphetamines and cocaine
that raise the level of the neurotransmitter dopamine in brain circuits regulating
reward and movement. A surge in dopamine in these circuits causes feelings
of euphoria and increased activity. A
similar surge of the transmitter norepi-
nephrine can raise heart rate and blood
pressure. Bath salts have been marketed
as cheap (and until recently, legal—see
Box) substitutes for those stimulants. A
recent study found that MDPV—the
most common synthetic cathinone found
in the blood and urine of patients admitted to emergency departments after bath
salts ingestion—raises brain dopamine
in the same manner as cocaine but is at
least 10 times more potent.
The hallucinatory effects often reported
in users of bath salts are consistent with
other drugs such as MDMA or LSD that
raise levels of another neurotransmitter,
serotonin. A recent analysis of the effects
in rats of mephedrone and methylone
showed that these drugs raised levels of
serotonin in a manner similar to MDMA.
What Are the Other Health Effects of
Bath Salts?
Bath salts have been linked to an alarming surge in visits to emergency departments and poison control centers across
the country. Common reactions reported
for people who have needed medical attention after using bath salts include
cardiac symptoms (such as racing heart,
high blood pressure, and chest pains)
and psychiatric symptoms including
paranoia, hallucinations, and panic attacks.
Patients with the syndrome known as
“excited delirium” from taking bath salts
also may have dehydration, breakdown
of skeletal muscle tissue, and kidney
failure. Intoxication from several synthetic cathinones including MDPV,
mephedrone, methedrone, and butylone
has proved fatal in several instances.
Early indications are that synthetic cathinones have a high abuse and addiction
potential. In a study of the rewarding
and reinforcing effects of MDPV, rats
showed self-administration patterns and
escalation of drug intake nearly identical
to methamphetamine. Bath salts users
have reported that the drugs trigger intense cravings (or a compulsive urge to
use the drug again) and that they are
highly addictive. Frequent consumption
may induce tolerance, dependence, and
strong withdrawal symptoms when not
taking the drug.
The dangers of bath salts are compounded by the fact that these products may
contain other, unknown ingredients that
may have their own harmful effects.
Also, drug users who believe they are
purchasing other drugs such as ecstasy
may be in danger of receiving synthetic
cathinones instead. For example,
mephedrone has been found commonly
substituted for MDMA in pills sold as ecstasy in the Netherlands.
Learn More
For additional information on bath salts,
please see
http://www.emcdda.europa.eu/publicat
ions/drug-profiles/synthetic-cathinones
Cocaine
Cocaine is a powerfully addictive stimulant
drug. The powdered hydrochloride salt form
of cocaine can be snorted or dissolved in
water and then injected. Crack is the street
name given to the form of cocaine that has
been processed to make a rock crystal,
which, when heated, produces vapors that
are smoked. The term “crack” refers to the
crackling sound produced by the rock as it is
heated.
How Is Cocaine Abused?
Three routes of administration are commonly
used for cocaine: snorting, injecting, and
smoking. Snorting is the process of inhaling
cocaine powder through the nose, where it
is absorbed into the bloodstream through
the nasal tissues. Injecting is the use of a
needle to insert the drug directly into the
bloodstream. Smoking involves inhaling
cocaine vapor or smoke into the lungs,
where absorption into the bloodstream is as
rapid as it is by injection. All three methods
of cocaine abuse can lead to addiction and
other severe health problems, including
increasing the risk of contracting HIV/AIDS
and other infectious diseases.
Updated March 2010
The intensity and duration of cocaine’s
effects—which include increased energy,
reduced fatigue, and mental alertness—
depend on the route of drug administration.
The faster cocaine is absorbed into the
bloodstream and delivered to the brain, the
more intense the high. Injecting or smoking
cocaine produces a quicker, stronger high
than snorting. On the other hand, faster
absorption usually means shorter duration
of action: the high from snorting cocaine
may last 15 to 30 minutes, but the high from
smoking may last only 5 to 10 minutes. In
order to sustain the high, a cocaine abuser
has to administer the drug again. For this
reason, cocaine is sometimes abused in
binges—taken repeatedly within a relatively
short period of time, at increasingly higher
doses.
How Does Cocaine Affect
the Brain?
Cocaine is a strong central nervous system
stimulant that increases levels of dopamine,
a brain chemical (or neurotransmitter)
associated with pleasure and movement, in
the brain’s reward circuit. Certain brain cells,
or neurons, use dopamine to communicate.
Page 1 of 5
Normally, dopamine is released by a
neuron in response to a pleasurable signal
(e.g., the smell of good food), and then
recycled back into the cell that released it,
thus shutting off the signal between neurons.
Cocaine acts by preventing the dopamine
from being recycled, causing excessive
amounts of the neurotransmitter to build up,
amplifying the message to and response
of the receiving neuron, and ultimately
disrupting normal communication. It is this
excess of dopamine that is responsible for
cocaine’s euphoric effects. With repeated
use, cocaine can cause long-term changes
in the brain’s reward system and in
other brain systems as well, which may
eventually lead to addiction. With repeated
use, tolerance to the cocaine high also
often develops. Many cocaine abusers
report that they seek but fail to achieve
as much pleasure as they did from their
first exposure. Some users will increase
their dose in an attempt to intensify and
prolong the euphoria, but this can also
increase the risk of adverse psychological
or physiological effects.
What Adverse Effects
Does Cocaine Have on
Health?
Abusing cocaine has a variety of adverse
effects on the body. For example, cocaine
constricts blood vessels, dilates pupils, and
Updated March 2010
increases body temperature, heart rate, and
blood pressure. It can also cause headaches
and gastrointestinal complications such
as abdominal pain and nausea. Because
cocaine tends to decrease appetite, chronic
users can become malnourished as well.
Different methods of taking cocaine can
produce different adverse effects. Regular
intranasal use (snorting) of cocaine, for
example, can lead to loss of the sense
of smell; nosebleeds; problems with
swallowing; hoarseness; and a chronically
runny nose. Ingesting cocaine can cause
severe bowel gangrene as a result of
reduced blood flow. Injecting cocaine
can bring about severe allergic reactions
and increased risk for contracting
HIV/AIDS and other blood-borne diseases.
Binge-patterned cocaine use may lead
to irritability, restlessness, and anxiety.
Cocaine abusers can also experience
severe paranoia—a temporary state of
full-blown paranoid psychosis—in which
they lose touch with reality and experience
auditory hallucinations.
Regardless of the route or frequency of
use, cocaine abusers can experience
acute cardiovascular or cerebrovascular
emergencies, such as a heart attack or
stroke, which may cause sudden death.
Cocaine-related deaths are often a result
of cardiac arrest or seizure followed by
respiratory arrest.
Page 2 of 5
Added Danger: Cocaethylene
Polydrug use—use of more than one
drug—is common among substance
abusers. When people consume two or
more psychoactive drugs together, such as
cocaine and alcohol, they compound the
danger each drug poses and unknowingly
perform a complex chemical experiment
within their bodies. Researchers have found
that the human liver combines cocaine
and alcohol to produce a third substance,
cocaethylene, which intensifies cocaine’s
euphoric effects. Cocaethylene is associated
with a greater risk of sudden death than
cocaine alone.1
What Treatment Options
Exist?
Behavioral interventions—particularly,
cognitive-behavioral therapy—have been
shown to be effective for decreasing
cocaine use and preventing relapse.
Treatment must be tailored to the individual
patient’s needs in order to optimize
outcomes—this often involves a combination
of treatment, social supports, and other
services.
Currently, there are no FDA-approved
medications for treating cocaine addiction;
thus, developing a medication to treat
Updated March 2010
cocaine and other forms of addiction
remains one of NIDA’s top research
priorities. Researchers are seeking to
develop medications that help alleviate the
severe craving associated with cocaine
addiction, as well as medications that
counteract cocaine-related relapse triggers,
such as stress. Several compounds are
currently being investigated for their safety
and efficacy, including a vaccine that would
sequester cocaine in the bloodstream and
prevent it from reaching the brain. Current
research suggests that while medications are
effective in treating addiction, combining
them with a comprehensive behavioral
therapy program is the most effective
method to reduce drug use in the long term.
How Widespread
Is Cocaine Abuse?
Monitoring the Future Survey†
According to the 2009 Monitoring the
Future survey—a national survey of 8th,
10th-, and 12th-graders—there were
continuing declines reported in the use of
powder cocaine, with past-year†† usage
levels reaching their lowest point since
the early 1990s. Significant declines in
use were measured from 2008 to 2009
among 12th-graders across all three survey
categories: lifetime use decreased from
Page 3 of 5
7.2 percent to 6.0 percent; past-year use
dropped from 4.4 percent to 3.4 percent;
and past-month use dropped from 1.9
percent to 1.3 percent. Survey measures
showed other positive findings among
12th-graders as well; their perceived risk
of harm associated with powder cocaine
use increased significantly during the same
period. Additionally, survey participants
in the 10th grade reported significant
changes, with past-month use falling from
1.2 percent in 2008 to 0.9 percent in
2009.
Use of Cocaine by Students
2009 Monitoring the Future Survey
8th Grade
10th Grade
12th Grade
Lifetime
2.6%
4.6%
6.0%
Past Year
1.6%
2.7%
3.4%
Past Month
0.8%
0.9%
1.3%
Crack Cocaine Use by Students
8th Grade
10th Grade
12th Grade
Lifetime
1.7%
2.1%
2.4%
Past Year
1.1%
1.2%
1.3%
Past Month
0.5%
0.4%
0.6%
Updated March 2010
National Survey on Drug Use and
†††
Health (NSDUH)
According to the 2008 National Survey
on Drug Use and Health, the estimated
percentage of persons aged 12 or older
who used cocaine in the past month (0.7
percent) was similar to the percentage in
2007 and 2002. However, the percentage
of past-month crack users in 2008 (0.1
percent of the population) was lower than
in 2007 and all other years going back
to 2002, with the exception of 2004.
From 2002 to 2008, rates of past-month
cocaine use among youth aged 12 to 17
declined significantly, from 0.6 percent to
0.4 percent. Past-month cocaine use also
dropped significantly among young adults
aged 18 to 25 during this time period,
from 2.0 percent to 1.5 percent.
Significant declines in the number or
percentage of past-year cocaine initiates
were also estimated among several age
groups measured, including persons 12
or older and those aged 18 to 25. The
percentage of past-year initiates also
dropped significantly from 2007 to 2008
for crack use among the 12–17 age group.
Page 4 of 5
Other Information Sources
For additional information on cocaine, please
refer to the following sources on NIDA’s Web
site, www.drugabuse.gov:
For street terms searchable by drug name,
cost and quantities, drug trade, and drug
use, visit www.whitehousedrugpolicy.
gov/streetterms/default.asp.
• Cocaine: Abuse and Addiction—
Research Report Series
• Various issues of NIDA Notes (search
by “cocaine” or “crack”)
Data Sources
†
These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National
Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s
Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in
1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov.
“Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during
the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days
preceding an individual’s response to the survey.
††
NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans
aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of
Health and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone
from NIDA at 877–643–2644.
†††
Reference
1
Harris DS, et al. The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug
Alcohol Depend 72(2):169–182, 2003.
Updated March 2010
Page 5 of 5
Heroin
Heroin is an opiate drug that is synthesized
from morphine, a naturally occurring
substance extracted from the seed pod of
the Asian opium poppy plant. Heroin usually
appears as a white or brown powder or as a
black sticky substance, known as “black tar
heroin.”
How Is Heroin Abused?
Heroin can be injected, snorted/sniffed, or
smoked—routes of administration that rapidly
deliver the drug to the brain. Injecting is
the use of a needle to administer the drug
directly into the bloodstream. Snorting
is the process of inhaling heroin powder
through the nose, where it is absorbed into
the bloodstream through the nasal tissues.
Smoking involves inhaling heroin smoke into
the lungs. All three methods of administering
heroin can lead to addiction and other
severe health problems.
How Does Heroin Affect
the Brain?
Heroin enters the brain, where it is converted
to morphine and binds to receptors known as
opioid receptors. These receptors are located
in many areas of the brain (and in the body),
especially those involved in the perception
of pain and in reward. Opioid receptors are
also located in the brain stem—important for
Updated March 2010
automatic processes critical for life, such as
breathing (respiration), blood pressure, and
arousal. Heroin overdoses frequently involve a
suppression of respiration.
After an intravenous injection of heroin, users
report feeling a surge of euphoria (“rush”)
accompanied by dry mouth, a warm flushing
of the skin, heaviness of the extremities, and
clouded mental functioning. Following this
initial euphoria, the user goes “on the nod,”
an alternately wakeful and drowsy state.
Users who do not inject the drug may not
experience the initial rush, but other effects
are the same.
With regular heroin use, tolerance
develops, in which the user’s physiological
(and psychological) response to the drug
decreases, and more heroin is needed to
achieve the same intensity of effect. Heroin
users are at high risk for addiction—it is
estimated that about 23 percent of individuals
who use heroin become dependent on it.
What Other Adverse Effects
Does Heroin Have on
Health?
Heroin abuse is associated with serious
health conditions, including fatal overdose,
spontaneous abortion, and—particularly
Page 1 of 5
in users who inject the drug—infectious
diseases, including HIV/AIDS and hepatitis.
Chronic users may develop collapsed
veins, infection of the heart lining and
valves, abscesses, and liver or kidney
disease. Pulmonary complications, including
various types of pneumonia, may result
from the poor health of the abuser as well
as from heroin’s depressing effects on
respiration. In addition to the effects of
the drug itself, street heroin often contains
toxic contaminants or additives that can
clog blood vessels leading to the lungs,
liver, kidneys, or brain, causing permanent
damage to vital organs.
Chronic use of heroin leads to physical
dependence, a state in which the body
has adapted to the presence of the drug.
If a dependent user reduces or stops
use of the drug abruptly, he or she may
experience severe symptoms of withdrawal.
These symptoms—which can begin as
early as a few hours after the last drug
administration—can include restlessness,
muscle and bone pain, insomnia, diarrhea
and vomiting, cold flashes with goose
bumps (“cold turkey”), and kicking
movements (“kicking the habit”). Users also
experience severe craving for the drug
during withdrawal, which can precipitate
continued abuse and/or relapse. Major
withdrawal symptoms peak between 48
and 72 hours after the last dose of the
Updated March 2010
drug and typically subside after about 1
week. Some individuals, however, may
show persistent withdrawal symptoms for
months. Although heroin withdrawal is
considered less dangerous than alcohol or
barbiturate withdrawal, sudden withdrawal
by heavily dependent users who are in poor
health is occasionally fatal. In addition,
heroin craving can persist years after drug
cessation, particularly upon exposure to
triggers such as stress or people, places,
and things associated with drug use.
Heroin abuse during pregnancy, together
with related factors like poor nutrition
and inadequate prenatal care, has been
associated with adverse consequences
including low birthweight, an important risk
factor for later developmental delay. If the
mother is regularly abusing the drug, the
infant may be born physically dependent on
heroin and could suffer from serious medical
complications requiring hospitalization.
Exist?
A range of treatments exist for heroin
addiction, including medications and
behavioral therapies. Science has taught us
that when medication treatment is combined
with other supportive services, patients are
often able to stop using heroin (or other
opiates) and return to stable and productive
lives.
Page 2 of 5
Treatment usually begins with medically
assisted detoxification to help patients
withdraw from the drug safely. Medications
such as clonidine and buprenorphine can
be used to help minimize symptoms of
withdrawal. However, detoxification alone
is not treatment and has not been shown
to be effective in preventing relapse—it is
merely the first step.
Medications to help prevent relapse include
the following:
• Methadone has been used for more
than 30 years to treat heroin addiction.
It is a synthetic opiate medication that
binds to the same receptors as heroin;
but when taken orally, it has a gradual
onset of action and sustained effects,
reducing the desire for other opioid drugs
while preventing withdrawal symptoms.
Properly administered, methadone is not
intoxicating or sedating, and its effects do
not interfere with ordinary daily activities.
Methadone maintenance treatment
is usually conducted in specialized
opiate treatment programs. The most
effective methadone maintenance
programs include individual and/or
group counseling, as well as provision
of or referral to other needed medical,
psychological, and social services.
Updated March 2010
• Buprenorphine is a more recently
approved treatment for heroin addiction
(and other opiates). Compared with
methadone, buprenorphine produces less
risk for overdose and withdrawal effects
and produces a lower level of physical
dependence, so patients who discontinue
the medication generally have fewer
withdrawal symptoms than those who
stop taking methadone. The development
of buprenorphine and its authorized use
in physicians’ offices give opiate-addicted
patients more medical options and extend
the reach of addiction medication. Its
accessibility may even prompt attempts
to obtain treatment earlier. However, not
all patients respond to buprenorphine—
some continue to require treatment with
methadone.
• Naltrexone is approved for treating
heroin addiction but has not been widely
utilized due to poor patient compliance.
This medication blocks opioids from
binding to their receptors and thus
prevents an addicted individual from
feeling the effects of the drug. Naltrexone
as a treatment for opioid addiction is
usually prescribed in outpatient medical
settings, although initiation of the
treatment often begins after medical
detoxification in a residential setting. To
prevent withdrawal symptoms, individuals
Page 3 of 5
must be medically detoxified and opioidfree for several days before taking
naltrexone.
• Naloxone is a shorter-acting opioid
receptor blocker, used to treat cases of
overdose.
For pregnant heroin abusers, methadone
maintenance combined with prenatal
care and a comprehensive drug treatment
program can improve many of the
detrimental maternal and neonatal
outcomes associated with untreated heroin
abuse. Preliminary evidence suggests
that buprenorphine may also be a safe
and effective treatment during pregnancy,
although infants exposed to either
methadone or buprenorphine prenatally
may still require treatment for withdrawal
symptoms. For women who do not want or
are not able to receive pharmacotherapy
for their heroin addiction, detoxification
from opiates during pregnancy can be
accomplished with medical supervision,
although potential risks to the fetus and the
likelihood of relapse to heroin use should be
considered.
individual or group counseling; contingency
management, which uses a voucher-based
system where patients earn “points” based
on negative drug tests—these points can
be exchanged for items that encourage
healthy living; and cognitive-behavioral
therapy, designed to help modify a patient’s
expectations and behaviors related to drug
abuse, and to increase skills in coping with
various life stressors.
How Widespread Is Heroin
Abuse?
According to the Monitoring the Future
survey, there was little change between
2008 and 2009 in the proportion of 8thand 12th-grade students reporting lifetime,††
past-year, and past-month use of heroin.
There also were no significant changes in
past-year and past-month use among 10thgraders; however, lifetime use increased
significantly among this age group, from
1.2 percent to 1.5 percent. Survey measures
indicate that injection use rose significantly
among this population at the same time.
Use of Heroin by Students
There are many effective behavioral
treatments available for heroin addiction—
usually in combination with medication.
These can be delivered in residential
or outpatient settings. Examples are
8th Grade
10th Grade
12th Grade
Lifetime
1.3%
1.5%
1.2%
Past Year
0.7%
0.9%
0.7%
Past Month
0.4%
0.4%
0.4%
Updated March 2010
Page 4 of 5
Health (NSDUH)†††
According to the 2008 National Survey
on Drug Use and Health, the number of
current (past-month) heroin users aged 12
or older in the United States increased from
153,000 in 2007 to 213,000 in 2008.
There were 114,000 first-time users of
heroin aged 12 or older in 2008.
For additional information on heroin, please
refer to the following links on NIDA’s Web
site, www.drugabuse.gov:
• Heroin Abuse—Research Report Series
• Various issues of NIDA Notes (search by
“heroin” or “opiates”)
Data Sources
1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov.
†
††
NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged
12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health
and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at
877–643–2644.
†††
Updated March 2010
Page 5 of 5
MDMA (“Ecstasy”) MDMA (3,4-‐methylenedioxy-‐
methamphetamine), popularly known as ecstasy, is a synthetic, psychoactive drug that has similarities to both the stimu-‐
lant amphetamine and the hallucinogen mescaline. It produces feelings of in-‐
creased energy, euphoria, emotional warmth and empathy toward others, and distortions in sensory and time percep-‐
tion. MDMA was initially popular among White adolescents and young adults in the nightclub scene or at “raves” (long dance parties), but the drug now affects a broader range of users and ethnicities. How Is MDMA Abused? MDMA is taken orally, usually as a capsule
or tablet. Its effects last approximately 3 to
6 hours, although it is not uncommon for
users to take a second dose of the drug as
the effects of the first dose begin to fade. It
is commonly taken in combination with
other drugs. For example some urban gay
and bisexual men report using MDMA as
part of a multiple-drug experience that includes cocaine, GHB, methamphetamine,
ketamine, and the erectile-dysfunction drug
sildenafil (Viagra).
How Does MDMA Affect the Brain? MDMA acts by increasing the activity of three neurotransmitters, serotonin, do-‐
pamine, and norepinephrine. The emo-‐
tional and pro-‐social effects of MDMA are likely caused directly or indirectly by the release of large amounts of seroto-‐
nin, which influences mood (as well as other functions such as appetite and sleep). Serotonin also triggers the re-‐
lease of the hormones oxytocin and vas-‐
opressin, which play important roles in Is MDMA Addictive? Research thus far on MDMA’s addic-‐
tive properties has shown varying re-‐
sults, but we do know that some us-‐
ers report symptoms of dependence, including continued use despite knowledge of physical or psychologi-‐
cal harm, tolerance (or diminished response), and withdrawal effects. The neurotransmitter systems target-‐
ed by MDMA are the same as those targeted by other addictive drugs. Ex-‐
periments have shown that animals will self-‐administer MDMA—an im-‐
portant indicator of a drug’s abuse potential—although the degree of self-‐administration is less than some other drugs of abuse such as cocaine. MDMA (“Ecstasy”) • December 2012 • Page 1
love, trust, sexual arousal, and other so-‐
cial experiences. This may account for the characteristic feelings of emotional closeness and empathy produced by the drug; studies in both rats and humans have shown that MDMA raises the levels of these hormones. The surge of serotonin caused by taking MDMA depletes the brain of this im-‐
portant chemical, however, causing neg-‐
ative aftereffects—including confusion, depression, sleep problems, drug crav-‐
ing, and anxiety—that may occur soon after taking the drug or during the days or even weeks thereafter. Some heavy MDMA users experience long-‐lasting confusion, depression, sleep abnormalities, and problems with atten-‐
tion and memory, although it is possible that some of these effects may be due to the use of other drugs in combination with MDMA (especially marijuana). What Are the Other Health Effects of MDMA? MDMA can have many of the same phys-‐
ical effects as other stimulants like co-‐
caine and amphetamines. These include increases in heart rate and blood pres-‐
sure, which are particularly risky for people with circulatory problems or heart disease. MDMA users may experi-‐
ence other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. In high doses, MDMA can interfere with the body’s ability to regulate tempera-‐
ture. On rare but unpredictable occa-‐
sions, this can lead to a sharp increase in body temperature (hyperthermia), which can result in liver, kidney, or car-‐
diovascular system failure or even death. MDMA can interfere with its own me-‐
tabolism (breakdown within the body), causing potentially harmful levels to build up in the body if it is taken repeat-‐
edly within short periods of time. Compounding the risks of ecstasy use is the fact that other potentially harmful drugs (including synthetic cathinones, the psychoactive ingredients in “bath salts”) are sometimes sold as ecstasy. These drugs can be neurotoxic or pose other unpredictable health risks. And ec-‐
stasy tablets that do contain MDMA may contain additional substances such as ephedrine (a stimulant), dextrome-‐
thorphan (a cough suppressant), keta-‐
mine, caffeine, cocaine, or methamphet-‐
amine. The combination of MDMA with one or more of these drugs may be haz-‐
ardous. Users who intentionally or un-‐
knowingly combine such a mixture with additional substances such as marijuana and alcohol may be putting themselves at even higher risk for adverse health ef-‐
fects. Additionally, the closeness-‐promoting ef-‐
fects of MDMA and its use in sexually charged contexts (and especially in com-‐
Does MDMA Have Therapeu-‐
tic Value? MDMA was first used in the 1970s, not as a recreational drug but as an aid in psychotherapy—although without the support of clinical trial research or FDA approval. In 1985, the Drug Enforcement Administra-‐
tion labeled MDMA a Schedule I substance, or a drug with high abuse potential and no recognized medicinal use. Some researchers remain interested in its potential therapeutic value when adminis-‐
tered under carefully monitored conditions. It is currently in clinical trials as a possible pharmacothera-‐
py aid to treat post-‐traumatic stress disorder (PTSD) and anxiety in ter-‐
minal cancer patients. MDMA (“Ecstasy”) • December 2012 • Page 2
bination with sildenafil) may encourage unsafe sex, which is a risk factor for con-‐
tracting or spreading HIV and hepatitis. Learn More For additional information on MDMA, please see http://www.drugabuse.gov/publication
s/research-‐reports/mdma-‐ecstasy-‐
abuse MDMA (“Ecstasy”) • December 2012 • Page 3
Methamphetamine
Methamphetamine is a central nervous
system stimulant drug that is similar in
structure to amphetamine. Due to its high
potential for abuse, methamphetamine
is classified as a Schedule II drug and
is available only through a prescription
that cannot be refilled. Although
methamphetamine can be prescribed by a
doctor, its medical uses are limited, and the
doses that are prescribed are much lower
than those typically abused. Most of the
methamphetamine abused in this country
comes from foreign or domestic superlabs,
although it can also be made in small, illegal
laboratories, where its production endangers
the people in the labs, neighbors, and the
environment.
How Is Methamphetamine
Abused?
Methamphetamine is a white, odorless,
bitter-tasting crystalline powder that easily
dissolves in water or alcohol and is taken
orally, intranasally (snorting the powder), by
needle injection, or by smoking.
Updated March 2010
How Does Methamphetamine
Affect the Brain?
Methamphetamine increases the release and
blocks the reuptake of the brain chemical (or
neurotransmitter) dopamine, leading to high
levels of the chemical in the brain—a common
mechanism of action for most drugs of abuse.
Dopamine is involved in reward, motivation,
the experience of pleasure, and motor
function. Methamphetamine’s ability to release
dopamine rapidly in reward regions of the
brain produces the intense euphoria, or “rush,”
that many users feel after snorting, smoking, or
injecting the drug.
Chronic methamphetamine abuse significantly
changes how the brain functions. Noninvasive
human brain imaging studies have shown
alterations in the activity of the dopamine
system that are associated with reduced
motor skills and impaired verbal learning.1
Recent studies in chronic methamphetamine
abusers have also revealed severe structural
and functional changes in areas of the brain
associated with emotion and memory,2,3
which may account for many of the emotional
and cognitive problems observed in chronic
methamphetamine abusers.
Page 1 of 4
Repeated methamphetamine abuse can
also lead to addiction—a chronic, relapsing
disease characterized by compulsive drug
seeking and use, which is accompanied
by chemical and molecular changes in the
brain. Some of these changes persist long
after methamphetamine abuse is stopped.
Reversal of some of the changes, however,
may be observed after sustained periods of
abstinence (e.g., more than 1 year).4
What Other
Adverse Effects Does
Methamphetamine
Have on Health?
Taking even small amounts of
methamphetamine can result in many
of the same physical effects as those
of other stimulants, such as cocaine or
amphetamines, including increased
wakefulness, increased physical
activity, decreased appetite, increased
respiration, rapid heart rate, irregular
heartbeat, increased blood pressure, and
hyperthermia.
Long-term methamphetamine abuse has
many negative health consequences,
including extreme weight loss, severe
dental problems (“meth mouth”),
anxiety, confusion, insomnia, mood
disturbances, and violent behavior. Chronic
methamphetamine abusers can also
Updated March 2010
display a number of psychotic features,
including paranoia, visual and auditory
hallucinations, and delusions (for example,
the sensation of insects crawling under the
skin).
Transmission of HIV and hepatitis B and C
can be consequences of methamphetamine
abuse. The intoxicating effects of
methamphetamine, regardless of how it is
taken, can also alter judgment and inhibition
and can lead people to engage in unsafe
behaviors, including risky sexual behavior.
Among abusers who inject the drug, HIV/
AIDS and other infectious diseases can
be spread through contaminated needles,
syringes, and other injection equipment
that is used by more than one person.
Methamphetamine abuse may also worsen
the progression of HIV/AIDS and its
consequences. Studies of methamphetamine
abusers who are HIV-positive indicate that
HIV causes greater neuronal injury and
cognitive impairment for individuals in this
group compared with HIV-positive people
who do not use the drug.5,6
Exist?
Currently, the most effective treatments
for methamphetamine addiction are
comprehensive cognitive-behavioral
interventions. For example, the Matrix
Page 2 of 4
Model—a behavioral treatment approach
that combines behavioral therapy, family
education, individual counseling, 12-step
support, drug testing, and encouragement
for nondrug-related activities—has
been shown to be effective in reducing
methamphetamine abuse.7 Contingency
management interventions, which provide
tangible incentives in exchange for
engaging in treatment and maintaining
abstinence, have also been shown to be
effective.8 There are no medications at this
time approved to treat methamphetamine
addiction; however, this is an active area of
research for NIDA.
How Widespread Is
Methamphetamine Abuse?
Methamphetamine use among teens
appears to have dropped significantly in
recent years, according to data revealed
by the 2009 Monitoring the Future survey.
The number of high-school seniors reporting
past-year†† use is now only at 1.2 percent,
which is the lowest since questions about
methamphetamine were added to the survey
in 1999; at that time, it was reported at 4.7
percent. Lifetime use among 8th-graders
was reported at 1.6 percent in 2009, down
significantly from 2.3 percent in 2008. In
addition, the proportion of 10th-graders
Updated March 2010
reporting that crystal methamphetamine was
easy to obtain has dropped to 14 percent,
down from 19.5 percent 5 years ago.
Use of Methamphetamine by Students
8th Grade
10th Grade
12th Grade
Lifetime
1.6%
2.8%
2.4%
Past Year
1.0%
1.6%
1.2%
Past Month
0.5%
0.6%
0.5%
Health (NSDUH)†††
According to the 2008 National Survey on
Drug Use and Health, the number of pastmonth methamphetamine users age 12 and
older decreased by over half between 2006
and 2008. Current (past-month) users were
numbered at 731,000 in 2006, 529,000
in 2007, and 314,000 in 2008. Significant
declines from 2002 and 2008 also were
noted for lifetime and past-year use in this
age group.
From 2002 to 2008, past-month use of
methamphetamine declined significantly
among youths aged 12 to 17, from 0.3
percent to 0.1 percent, and young adults
aged 18 to 25 also reported significant
declines in past-month use, from 0.6 percent
in 2002 to 0.2 percent in 2008.
Page 3 of 4
For more information on the effects of
methamphetamine abuse and addiction,
visit www.drugabuse.gov/
drugpages/methamphetamine.html.
To find publicly funded treatment facilities
by state, visit www.findtreatment.
samhsa.gov.
Data Sources
1991, 8th- and 10th-graders were added to the study. Questions about crystal methamphetamine were added to the
12th-grade and followup surveys in 1990, and questions about methamphetamine were added to the study for all three
grades in 1999. The latest data are on line at www.drugabuse.gov.
†
††
NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged
12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health
and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at
877–643–2644.
†††
References
Volkow ND, Chang L, Wang GJ, et al. Association of dopamine transporter reduction with psychomotor impairment in
methamphetamine abusers. Am J Psychiatry 158(3):377–382, 2001.
1
London ED, Simon SL, Berman SM, et al. Mood disturbances and regional cerebral metabolic abnormalities in recently
abstinent methamphetamine abusers. Arch Gen Psychiatry 61(1):73–84, 2004.
2
Thompson PM, Hayashi KM, Simon SL, et al. Structural abnormalities in the brains of human subjects who use
methamphetamine. J Neurosci 24(26):6028–6036, 2004.
3
Wang GJ, Volkow ND, Chang L, et al. Partial recovery of brain metabolism in methamphetamine abusers after
protracted abstinence. Am J Psychiatry 161(2):242–248, 2004.
4
Chang L, Ernst T, Speck O, Grob CS. Additive effects of HIV and chronic methamphetamine use on brain metabolite
abnormalities. Am J Psychiatry 162(2):361–369, 2005.
5
Rippeth JD, Heaton RK, Carey CL, et al. Methamphetamine dependence increases risk of neuropsychological
impairment in HIV infected persons. J Int Neuropsychol Soc 10(1):1–14, 2004.
6
Rawson RA, Marinelli-Casey P, Anglin MD, et al. A multi-site comparison of psychosocial approaches for the treatment
of methamphetamine dependence. Addiction 99(6):708–717, 2004.
7
Roll JM, Petry NM, Stitzer ML, et al. Contingency management for the treatment of methamphetamine use disorders.
Am J Psychiatry 163(11):1993–1999, 2006.
8
Updated March 2010
Page 4 of 4
Prescription and Over-‐the-‐Counter Medications Some medications have psychoactive (mind-‐altering) properties and, because of that, are sometimes abused—that is, taken for reasons or in ways or amounts not intended by a doctor, or taken by someone other than the person for whom they are prescribed. In fact, pre-‐
scription and over-‐the-‐counter (OTC) drugs are, after marijuana (and alcohol), the most commonly abused substances by Americans 14 and older. Past-‐Year Use of Illicit Drugs and Pharmaceu8cals among 12th Graders Marijuana/Hashish SyntheFc Marijuana Adderall Vicodin Cough Medicine Tranquilizers Hallucinogens SedaFves Salvia OxyConFn MDMA (Ecstasy) Inhalants Cocaine (any form) Ritalin 36.4% 11.3% 7.6% 7.5% 5.6% 5.3% 4.8% 4.5% 4.4% 4.3% 3.8% 2.9% Illicit Drugs 2.7% PharmaceuFcal 2.6% SOURCE: University of Michigan, 2012 Monitoring the Future Study The classes of prescription drugs most commonly abused are: opioid pain re-‐
lievers, such as Vicodin or Oxycontin; stimulants for treating Attention Deficit Hyperactivity Disorder (ADHD), such as Adderall, Concerta, or Ritalin; and cen-‐
tral nervous system (CNS) depressants for relieving anxiety, such as Valium or Xanax.1 The most commonly abused OTC drugs are cough and cold remedies con-‐
taining dextromethorphan. People often think that prescription and OTC drugs are safer than illicit drugs, but that’s only true when they are taken ex-‐
actly as prescribed and for the purpose intended. When abused, prescription and OTC drugs can be addictive and put abusers at risk for other adverse health effects, including overdose—especially when taken along with other drugs or al-‐
cohol. How Are Prescription Drugs Abused? Prescription and OTC drugs may be abused in one or more of the following ways: Taking a medication that has been pre-‐
scribed for somebody else. Unaware of the dangers of sharing medications, people often unknowingly contribute to this 1 These are proprietary names of particular drug products. Generic versions may also exist. Prescription and Over-the-Counter Medications • December 2012 • Page 1
form of abuse by sharing their unused pain relievers with their family mem-‐
Most teenagers who abuse pre-‐
scription drugs are given them for free by a friend or relative. bers. Taking a drug in a higher quantity or in another manner than prescribed. Most prescription drugs are dispensed orally in tablets, but abusers sometimes crush the tablets and snort or inject the pow-‐
der. This hastens the entry of the drug into the bloodstream and the brain and amplifies its effects. Taking a drug for another purpose than prescribed. All of the drug types men-‐
tioned can produce pleasurable effects at sufficient quantities, so taking them for the purpose of getting high is one of the main reasons people abuse them. ADHD drugs like Adderall are also often abused by students for their effects in promoting alertness and concentration. How Do Prescription and OTC Drugs Affect the Brain? Taken as intended, prescription and OTC drugs safely treat specific mental or physical symptoms. But when taken in different quantities or when such symp-‐
toms aren’t present, they may affect the brain in ways very similar to illicit drugs. For example, stimulants such as Ritalin increase alertness, attention, and energy the same way cocaine does—by boosting the amount of the neurotransmitter dopamine. Opioid pain relievers like Ox-‐
yContin attach to the same cell receptors targeted by illegal opioids like heroin. Prescription depressants produce sedat-‐
ing or calming effects in the same man-‐
ner as the club drugs GHB and rohypnol, by enhancing the actions of the neuro-‐
transmitter GABA (gamma-‐aminobutyric acid). When taken in very high doses, dextromethorphan acts on the same glu-‐
tamate receptors as PCP or ketamine, producing similar out-‐of-‐body experi-‐
ences. When abused, all of these classes of drugs directly or indirectly cause a pleasurable increase in the amount of dopamine in the brain’s reward path-‐
way. Repeatedly seeking to experience that feeling can lead to addiction. What Are the Other Health Effects of Prescription and OTC Drugs? Stimulants can have strong effects on the cardiovascular system. Taking high dos-‐
es of a stimulant can dangerously raise body temperature and cause irregular heartbeat or even heart failure or sei-‐
zures. Also, taking some stimulants in high doses or repeatedly can lead to hos-‐
tility or feelings of paranoia. Opioids can produce drowsiness, cause constipation, and—depending upon the amount taken—depress breathing. The latter effect makes opioids particularly dangerous, especially when they are snorted or injected or combined with other drugs or alcohol. CNS depressants slow down brain activi-‐
ty and can cause sleepiness and loss of coordination. Continued use can lead to physical dependence and withdrawal symptoms if discontinuing use. Prescription and Over-the-Counter Medications • December 2012 • Page 2
Dextromethorphan can cause impaired motor function, numbness, nausea or vomiting, and increased heart rate and blood pressure. On rare occasions, hy-‐
poxic brain damage—caused by severe respiratory depression and a lack of oxy-‐
gen to the brain—has occurred due to the combination of dextromethorphan with decongestants often found in the medication. All of these drugs have the potential for addiction, and this risk is amplified when they are abused. Also, as with other drugs, abuse of prescription and OTC drugs can alter a person’s judgment and decisionmaking, leading to dangerous behaviors such as unsafe sex and drugged driving. Learn More For more information on prescription and OTC drugs, visit http://www.drugabuse.gov/publication
s/research-‐reports/prescription-‐drugs Deaths per 100,000 popula8on Deaths from Opioid Pain Relievers Exceed Those from All Illegal Drugs Opioid pain relievers 12 10 4 8.3 7.1 8 6 Illegal drugs 10.4 4.4 3.7 5.3 6 5 2.5 2.2 1 2 0.3 0 15-‐24 25-‐34 35-‐44 45-‐54 Age Group 55-‐64 ≥65 Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011. Prescription and Over-the-Counter Medications • December 2012 • Page 3
Salvia
Salvia (Salvia divinorum) is an herb
common to southern Mexico and Central
and South America. The main active
ingredient in Salvia, salvinorin A, is a potent
activator of kappa opioid receptors in the
brain. These receptors differ from those
activated by the more commonly known
opioids, such as heroin and morphine.
1,2
Traditionally, S. divinorum has been
ingested by chewing fresh leaves or by
drinking their extracted juices. The dried
leaves of S. divinorum can also be smoked
as a joint, consumed in water pipes, or
vaporized and inhaled. Although Salvia
currently is not a drug regulated by the
Controlled Substances Act, several States
and countries have passed legislation to
regulate its use. The Drug Enforcement
Agency has listed Salvia as a drug of
concern and is considering classifying it as a
Schedule I drug, like LSD or marijuana.
3
Health/Behavioral Effects
People who abuse salvia generally
experience hallucinations or
“psychotomimetic” episodes (a transient
experience that mimics a psychosis).
4,5
Subjective effects have been described as
intense but short-lived, appearing in less
than 1 minute and lasting less than 30
minutes. They include psychedelic-like
changes in visual perception, mood and
body sensations, emotional swings, feelings
of detachment, and importantly, a highly
modified perception of external reality and
the self, leading to a decreased ability to
interact with one's surroundings. This last
effect has prompted concern about the
dangers of driving under the influence of
salvinorin. The long-term effects of Salvia
abuse have not been investigated
systematically. Recent experiments in
rodents demonstrated deleterious effects of
salvinorin A on learning and memory.6
5
Extent of Use
NIDA’s Monitoring the Future Survey of
8th, 10th, and 12th graders asked about salvia
abuse for the first time in 2009—5.7 percent
of high school seniors reported past year use
(greater than the percent reporting ecstasy
use). And according to the latest MTF
figures the use of Salvia reported by 8th
graders remained unchanged from 2011 to
2012 at 1.4 percent. Among 10th and 12th
graders there was a decline–2.5 percent of
10th graders and 4.4 percent of 12th graders
reported past year abuse.
Although information about this drug is
limited, its abuse is likely driven by drugrelated videos and information on Internet
sites. Because of the nature of the drug’s
effects—its use may be restricted to
individual experimentalists, rather than as a
social or party drug
3
5
Learn More
For more information on the effects of
hallucinogenic drugs, see NIDA’s Research
Report on Hallucinogens and Dissociative
Drugs at
www.nida.nih.gov/ResearchReports/hallucin
ogens/hallucinogens.html.
For more information on Salvia divinorum
and the Controlled Substances Act, visit
http://www.deadiversion.usdoj.gov/drugs_c
oncern/salvia_d.pdf.
Complete MTF survey results are available at www.monitoringthefuture.org. For more information on the survey and its findings, also visit www.drugabuse.gov/related-‐
topics/trends-‐statistics/monitoring-‐future. Citations
1 Chavkin, C., Sud, S., Jin, W. et al. Salvinorin A, an active component of the hallucinogenic sage Salvia divinorum is a highly efficacious kappa-‐
opioid receptor agonist: structural and functional considerations. J Pharmacol Exp Ther. 308:1197–203, 2004. 2 Harding, W.W., et al. Salvinicins A and B, new neoclerodane diterpenes from Salvia divinorum. Organic Letters. 7:3017–3020, 2005. 3 http://www.deadiversion.usdoj.gov/drugs_conc
ern/salvia_d.pdf. Accessed September 24, 2007. 4 Roth, B.L., et al. Salvinorin A: a potent naturally occurring non-‐nitrogenous kappa opioid selective agonist. Proc Natl Acad Sci. 99:11934–11939, 2002. 5 Gonzalez, D., et al. Pattern of use and subjective effects of Salvia divinorum among recreational users. Drug Alcohol Depend. 85:157–162, 2006. 6 Braida D, Donzelli A, Martucci R, Capurro V, Sala M. Learning and memory impairment induced by salvinorin A, the principal ingredient of Salvia divinorum, in wistar rats. Int J Toxicol. 2011 Dec;30(6):650-‐61. About the Survey Since 1975, the MTF survey has measured drug, alcohol, and cigarette use and related attitudes among 12th graders, nationwide. In 1991, 8th and 10th graders were added to the survey. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. Overall, 44,449 students from 395 public and private schools in the 8th, 10th, and 12th grades participated in the 2012 survey. The survey is funded by NIDA and conducted by the University of Michigan. Results from the survey are released each December. Spice (Synthetic Marijuana) “Spice” refers to a wide variety of herbal mixtures that produce experiences simi-‐
lar to marijuana (cannabis) and that are marketed as “safe,” legal alternatives to that drug. Sold under many names, in-‐
cluding K2, fake weed, Yucatan Fire, Skunk, Moon Rocks, and others—and la-‐
beled “not for human consumption”—
these products contain dried, shredded plant material and chemical additives that are responsible for their psychoac-‐
tive (mind-‐altering) effects. False Advertising Labels on Spice products often claim that they contain “natural” psycho-‐
active material taken from a variety of plants. Spice products do contain dried plant material, but chemical analyses show that their active in-‐
gredients are synthetic (or designer) cannabinoid compounds. For several years, Spice mixtures have been easy to purchase in head shops and gas stations and via the Internet. Be-‐
cause the chemicals used in Spice have a high potential for abuse and no medical benefit, the Drug Enforcement Admin-‐
istration (DEA) has designated the five active chemicals most frequently found in Spice as Schedule I controlled substances, making it illegal to sell, buy, or possess them. Manufacturers of Spice products attempt to evade these legal re-‐
strictions by substituting different chem-‐
icals in their mixtures, while the DEA continues to monitor the situation and evaluate the need for updating the list of banned cannabinoids. Spice products are popular among young people; of the illicit drugs most used by high-‐school seniors, they are second only to marijuana. (They are more popular among boys than girls—in 2012, nearly twice as many male 12th graders report-‐
ed past-‐year use of synthetic marijuana as females in the same age group.) Easy access and the misperception that Spice products are “natural” and therefore harmless have likely contributed to their popularity. Another selling point is that the chemicals used in Spice are not easily detected in standard drug tests. Past-‐Year Use of Illicit Drugs by High School Seniors (percent) Marijuana/Hashish 36.4 SyntheBc Marijuana 11.3 Hallucinogens 4.8 Salvia 4.4 MDMA (Ecstasy) 3.8 Cocaine 2.7 0 20 40 SOURCE: University of Michigan, 2012 Monitoring the Future Study Spice (Synthetic Marijuana) • December 2012 • Page 1
How Is Spice Abused? Some Spice products are sold as “in-‐
cense,” but they more closely resemble potpourri. Like marijuana, Spice is abused mainly by smoking. Sometimes Spice is mixed with marijuana or is pre-‐
pared as an herbal infusion for drinking. K2, a popular brand of “Spice” m ixture. How Does Spice Affect the Brain? Spice users report experiences similar to those produced by marijuana—elevated mood, relaxation, and altered percep-‐
tion—and in some cases the effects are even stronger than those of marijuana. Some users report psychotic effects like extreme anxiety, paranoia, and hallucina-‐
tions. So far, there have been no scientific stud-‐
ies of Spice’s effects on the human brain, but we do know that the cannabinoid compounds found in Spice products act on the same cell receptors as THC, the primary psychoactive component of ma-‐
rijuana. Some of the compounds found in Spice, however, bind more strongly to those receptors, which could lead to a much more powerful and unpredictable effect. Because the chemical composition of many products sold as Spice is un-‐
known, it is likely that some varieties al-‐
so contain substances that could cause dramatically different effects than the user might expect. What Are the Other Health Effects of Spice? Spice abusers who have been taken to Poison Control Centers report symptoms that include rapid heart rate, vomiting, agitation, confusion, and hallucinations. Spice can also raise blood pressure and cause reduced blood supply to the heart (myocardial ischemia), and in a few cas-‐
es it has been associated with heart at-‐
tacks. Regular users may experience withdrawal and addiction symptoms. We still do not know all the ways Spice may affect human health or how toxic it may be, but one public health concern is that there may be harmful heavy metal residues in Spice mixtures. Without fur-‐
ther analyses, it is difficult to determine whether this concern is justified. Learn More For additional information on Spice, see http://www.emcdda.europa.eu/attache
ments.cfm/att_80086_EN_Spice%20The
matic%20paper%20—
%20final%20version.pdf Spice (Synthetic Marijuana) • December 2012 • Page 2
Many products readily found in the home or workplace—such as spray paints, markers, glues, and cleaning fluids—contain volatile substances that have psychoactive (mind-‐
altering) properties when inhaled. People do not typically think of these products as drugs because they were never intended for that purpose. However, these products are some-‐
times abused in that way. They are especially (but not exclusively) abused by young children and adoles-‐
cents, and are the only class of sub-‐
stance abused more by younger than by older teens. Definition Although other abused drugs can be inhaled, the term inhalants is reserved for the wide variety of substances—
including solvents, aerosols, gases, and nitrites—that are rarely, if ever, taken via any other route of administration. (See below for a list of examples.) High-‐School Students Repor:ng Having Ever Used Inhalants 8th Grade Inhalants 10th 12th 0.00% 5.00% 10.00% 15.00% Source: University of Michigan, 2011 Monitoring the Future Study. Survey data can be found at www.drugabuse.gov How Are Inhalants Abused? Abusers of inhalants breathe them in through the nose or mouth in a varie-‐
ty of ways (known as “huffing”). They may sniff or snort fumes from a con-‐
tainer or dispenser (such as a glue bottle or a marking pen), spray aero-‐
sols (such as computer cleaning dust-‐
ers) directly into their nose or mouth, or place a chemical-‐soaked rag in their mouth. Abusers may also inhale fumes from a balloon or a plastic or paper bag. Although the high produced by inhalants usually lasts just a few minutes, abusers often try to prolong it by continuing to inhale repeatedly over several hours. People tend to abuse different inhal-‐
ant products at different ages. New users ages 12–15 most commonly abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. New users ages 16–17 most commonly abuse ni-‐
trous oxide or “whippets.” Adults most commonly abuse a class of in-‐
halants known as nitrites (such as amyl nitrites or “poppers”). Inhalants • September 2012 • Page 1
How Do Inhalants Affect the Brain? Most abused inhalants other than ni-‐
trites depress the central nervous sys-‐
tem in a manner not unlike alcohol. The effects are similar—including slurred speech, lack of coordination, euphoria, and dizziness. Inhalant abusers may also experience light-‐
headedness, hallucinations, and delu-‐
sions. With repeated inhalations, many users feel less inhibited and less in control. Some may feel drowsy for several hours and experience a linger-‐
ing headache. Unlike other types of inhalants, nitrites enhance sexual pleasure by dilating and relaxing blood vessels. Although it is not very common, ad-‐
diction to inhalants can occur with re-‐
peated abuse. What Are the Other Health Effects of Inhalants? Chemicals found in different types of inhaled products may produce a vari-‐
ety of other short-‐term effects, such as nausea or vomiting, as well as more serious long-‐term consequences. The-‐
se may include liver and kidney dam-‐
age, hearing loss, or bone marrow damage. Effects may also include loss of coordination and limb spasms due to damage to myelin—a protective sheathing around nerve fibers that helps nerves transmit messages in the brain and peripheral nervous system. Inhalants can also cause brain damage by cutting off oxygen flow to the brain. Inhalants can even be lethal. Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly cause heart failure within minutes. This syndrome, known as “sudden sniffing death,” can result from a single session of inhalant use by an otherwise healthy young Products Abused as Inhalants Volatile solvents—liquids that vaporize at room temperature: Industrial or household products, including paint thinners or removers, degreasers, dry-‐
cleaning fluids, gasoline, and lighter fluid Art or office supply solvents, including correc-‐
tion fluids, felt-‐tip marker fluid, electronic con-‐
tact cleaners, and glue Aerosols—sprays that contain propellants and solvents: Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol computer cleaning products, and vegetable oil sprays Gases—found in household or commercial prod-‐
ucts and used as medical anesthetics: Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or dispensers (“whippets”), and refrigerant gases Medical anesthetics, such as ether, chloro-‐
form, halothane, and nitrous oxide (“laughing gas”) Nitrites—used primarily as sexual enhancers: Organic nitrites are volatiles that include cy-‐
clohexyl, butyl, and amyl nitrites, commonly known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When marketed for illicit use, organic nitrites are of-‐
ten sold in small brown bottles labeled as “vid-‐
eo head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.” person. High concentrations of inhal-‐
ants may also cause death from suffo-‐
cation, especially when inhaled from a paper or plastic bag or in a closed ar-‐
ea. Even when using aerosols or vola-‐
tile products for their legitimate pur-‐
poses like painting or cleaning, it is wise to do so in a well-‐ventilated room or outdoors. Nitrites are a special class of inhalants that are abused to enhance sexual pleasure and performance. They can be associated with unsafe sexual prac-‐
tices that increase the risk of contract-‐
ing and spreading infectious diseases like HIV/AIDS and hepatitis. Inhalants • September 2012 • Page 2
Learn More For additional information on inhal-‐
ants and inhalant abuse, please see http://www.drugabuse.gov/publicati
ons/research-‐reports/inhalant-‐abuse Inhalants • September 2012 • Page 3
Club Drugs (GHB, Ketamine, and Rohypnol)
Club drugs are a pharmacologically
heterogeneous group of psychoactive drugs
that tend to be abused by teens and young
adults at bars, nightclubs, concerts, and
parties. Gamma hydroxybutyrate (GHB),
Rohypnol, ketamine, as well as MDMA
(ecstasy) and methamphetamine (which are
featured in separate InfoFacts) are some of
the drugs included in this group.
GHB (Xyrem) is a central nervous system
(CNS) depressant that was approved by
the Food and Drug Administration (FDA) in
2002 for use in the treatment of narcolepsy
(a sleep disorder). This approval came
with severe restrictions, including its use
only for the treatment of narcolepsy, and
the requirement for a patient registry
monitored by the FDA. GHB is also a
metabolite of the inhibitory neurotransmitter
gamma-aminobutyric acid (GABA). It exists
naturally in the brain, but at much lower
concentrations than those found when GHB
is abused.
• Rohypnol (flunitrazepam) use began
gaining popularity in the United States in
the early 1990s. It is a benzodiazepine
(chemically similar to sedative-hypnotic
drugs such as Valium or Xanax), but it
is not approved for medical use in this
country, and its importation is banned.
Updated July 2010
• Ketamine is a dissociative anesthetic, mostly
used in veterinary practice.
How Are Club Drugs
Abused?
• GHB and Rohypnol are available in
odorless, colorless, and tasteless forms
that are frequently combined with alcohol
and other beverages. Both drugs have
been used to commit sexual assaults (also
known as “date rape,” “drug rape,”
“acquaintance rape,” or “drug-assisted”
assault) due to their ability to sedate
and incapacitate unsuspecting victims,
preventing them from resisting sexual
assault.
• GHB is usually ingested orally, either in
liquid or powder form, while Rohypnol
is typically taken orally in pill form.
Recent reports, however, have shown that
Rohypnol is being ground up and snorted.
• Both GHB and Rohypnol are also abused
for their intoxicating effects, similar to other
CNS depressants.
• GHB also has anabolic effects (it stimulates
protein synthesis) and has been used by
bodybuilders to aid in fat reduction and
muscle building.
• Ketamine is usually snorted or injected
intramuscularly.
Page 1 of 4
How Do Club Drugs Affect
the Brain?
• GHB acts on at least two sites in the
brain: the GABAB receptor and a specific
GHB binding site. At high doses, GHB’s
sedative effects may result in sleep,
coma, or death.
• Rohypnol, like other benzodiazepines,
acts at the GABAA receptor. It can
produce anterograde amnesia, in which
individuals may not remember events they
experienced while under the influence of
the drug.
• Ketamine is a dissociative anesthetic, so
called because it distorts perceptions of
sight and sound and produces feelings
of detachment from the environment and
self. Ketamine acts on a type of glutamate
receptor (NMDA receptor) to produce
its effects, which are similar to those of
the drug PCP.1,2, Low-dose intoxication
results in impaired attention, learning
ability, and memory. At higher doses,
ketamine can cause dreamlike states
and hallucinations; and at higher doses
still, ketamine can cause delirium and
amnesia.
Addictive Potential
• Repeated use of GHB may lead to
withdrawal effects, including insomnia,
anxiety, tremors, and sweating. Severe
Updated July 2010
withdrawal reactions have been reported
among patients presenting from an
overdose of GHB or related compounds,
especially if other drugs or alcohol are
involved.3
• Like other benzodiazepines, chronic
use of Rohypnol can produce tolerance,
physical dependence, and addiction.
• There have been reports of people
binging on ketamine, a behavior that is
similar to that seen in some cocaine- or
amphetamine-dependent individuals.
Ketamine users can develop signs of
tolerance and cravings for the drug.4
What Other Adverse
Effects Do Club Drugs Have
on Health?
Uncertainties about the sources, chemicals,
and possible contaminants used to
manufacture many club drugs make it
extremely difficult to determine toxicity
and associated medical consequences.
Nonetheless, we do know that:
• Coma and seizures can occur following
use of GHB. Combined use with other
drugs such as alcohol can result in nausea
and breathing difficulties. GHB and two
of its precursors, gamma butyrolactone
(GBL) and 1,4 butanediol (BD), have
been involved in poisonings, overdoses,
date rapes, and deaths.
Page 2 of 4
• Rohypnol may be lethal when mixed with
alcohol and/or other CNS depressants.
• Ketamine, in high doses, can cause
impaired motor function, high blood
pressure, and potentially fatal respiratory
problems.
Exist?
There is very little information available in
the scientific literature about treatment for
persons who abuse or are dependent upon
club drugs.
• There are no GHB detection tests for
use in emergency rooms, and as many
clinicians are unfamiliar with the drug,
many GHB incidents likely go undetected.
According to case reports, however,
patients who abuse GHB appear to
present both a mixed picture of severe
problems upon admission and a good
response to treatment, which often
involves residential services.3
• Treatment for Rohypnol follows accepted
protocols for any benzodiazepine, which
may consist of a 3- to 5-day inpatient
detoxification program with 24-hour
intensive medical monitoring and
management of withdrawal symptoms,
since withdrawal from benzodiazepines
can be life-threatening.3
Updated July 2010
• Patients with a ketamine overdose are
managed through supportive care for
acute symptoms, with special attention to
cardiac and respiratory functions.5
How Widespread Is Club
Drug Abuse?
MTF has reported consistently low levels of
abuse of these club drugs since they were
added to the survey. For GHB and ketamine, this occurred in 2000; for Rohypnol,
1996. According to results of the 2009
MTF survey, 0.7 percent of 8th-grade and
1.1 percent of 12th-grade students reported
past-year†† use of GHB, a statistically significant decrease from peak-year use of 1.2
percent in 2000 for 8th-graders and 2.0
percent for 12th-graders in 2004. GHB use
among 10th-grade students was reported
at 1.0 percent, an increase from 2008 (0.5
percent), and statistically unchanged from
peak use of 1.4 percent in 2002 and 2003.
Past-year use of ketamine was reported by
1.0 percent of 8th-graders, 1.3 percent
of 10th-graders, and 1.7 percent of 12thgraders in 2009. These percentages also
represent significant decreases from peak
years: 2000 for 8th-graders (at 1.6 percent)
and 2002 for 10th- and 12th-graders (at
2.2 and 2.6 percent, respectively).
Page 3 of 4
For Rohypnol, 0.4 percent of 8th- and
10th-graders, and 1.0 percent of 12thgraders reported past-year use, also down
from peak use in 1996 for 8th-graders
(1.0 percent), 1997 for 10th-graders (1.3
percent), and 2002 and 2004 for 12thgraders (1.6 percent).
For more information about club drugs,
visit www.clubdrugs.gov, www.
teens.drugabuse.gov, and www.
backtoschool.drugabuse.gov; or
call NIDA at 877-643-2644. For street
terms searchable by drug name, street
term, cost and quantities, drug trade,
and drug use, visit http://www.
whitehousedrugpolicy.gov/
streetterms/default.asp.
Data Sources
1991, 8th- and 10th-graders were added to the study.
†
††
Resources
Anis NA, Berry SC, Burton NR, Lodge D. The dissociative anaesthetics, datamine and phencyclidine, selectively
reduce excitation of central mammalian neurons by N-methyl-aspartate. Br J Pharmacol 79(2): 565–575, 1983.
1
Kapur S, Seeman P. NMDA receptor antagonists ketamine and PCP have direct effects on dopamine D2 and serotonin
5-HT2 receptors – Implications for models of schizophrenia. Molecular Psychiatry 7: 837–844, 2002.
2
3
Maxwell JC, Spence RT. Profiles of club drug users in treatment. Subst Use Misuse 40(9–10):1409–1426, 2005.
Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: A review of problem use and
dependence.
J Psychoactive Drugs 33(2):151–158, 2001.
4
Smith KM, Larive LL, Romanelli F. Club Drugs: Methylenedioxymethamphetamine, flunitrazepam, ketamine
hydrochloride, and γ–hydroxybutyrate. Am J Health-Syst Pharm 59(11):1067–1076, 2002.
5
Updated July 2010
Page 4 of 4
Marijuana Marijuana is a dry, shredded green and brown mix of leaves, flowers, stems, and seeds from the hemp plant Cannabis sa-‐
tiva. In a more concentrated, resinous form, it is called hashish, and as a sticky black liquid, hash oil. The main psycho-‐
active (mind-‐altering) chemical in mari-‐
juana is delta-‐9-‐tetrahydrocannabinol, or THC. Marijuana is the most common illicit drug used in the United States. After a period of decline in the last decade, its use has generally increased among young people since 2007, corresponding to a diminishing perception of the drug’s risks. More teenagers are now current (past-‐month) smokers of marijuana than of cigarettes, according to annual survey data. How Is Marijuana Used? Marijuana is usually smoked in hand-‐
rolled cigarettes (joints) or in pipes or water pipes (bongs). It is also smoked in blunts—cigars that have been emptied of tobacco and refilled with a mixture of marijuana and tobacco. Marijuana smoke has a pungent and distinctive, usually sweet-‐and-‐sour, odor. Marijuana can al-‐
so be mixed in food or brewed as a tea. How Does Marijuana Affect the Brain? When marijuana is smoked, THC rapidly passes from the lungs into the blood-‐
stream, which carries the chemical to the brain and other organs throughout the body. It is absorbed more slowly when ingested in food or drink. However it is ingested, THC acts upon specific molecular targets on brain cells, called cannabinoid receptors. These re-‐
ceptors are ordinarily activated by chem-‐
icals similar to THC called endocanna-‐
binoids, such as anandamide. These are naturally occurring in the body and are part of a neural communication network (the endocannabinoid system) that plays an important role in normal brain devel-‐
opment and function. The highest density of cannabinoid re-‐
ceptors is found in parts of the brain that Marijuana • December 2012 • Page 1
influence pleasure, memory, thinking, concentration, sensory and time percep-‐
tion, and coordinated movement. Mari-‐
juana overactivates the endocannabinoid system, causing the high and other ef-‐
fects that users experience. These in-‐
clude distorted perceptions, impaired coordination, difficulty with thinking and problem solving, and disrupted learning and memory. Effects on Life Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a per-‐
son's existing problems worse. In fact, heavy marijuana users generally re-‐
port lower life satisfaction, poorer mental and physical health, relation-‐
ship problems, and less academic and career success compared to their peers who came from similar back-‐
grounds. For example, marijuana use is associated with a higher likelihood of dropping out from school. Several studies also associate workers' mariju-‐
ana smoking with increased absences, tardiness, accidents, workers' com-‐
pensation claims, and job turnover. Research has shown that, in chronic us-‐
ers, marijuana's adverse impact on learning and memory persists after the acute effects of the drug wear off; when marijuana use begins in adolescence, the effects may persist for many years. Re-‐
search from different areas is converging on the fact that regular marijuana use by young people can have long-‐lasting nega-‐
tive impact on the structure and function of their brains. A recent study of marijuana users who began using in adolescence revealed a profound deficit in connections between
brain areas responsible for learning and
memory. And a large prospective study (following individuals across time) showed that people who began smoking marijuana heavily in their teens lost as much as 8 points in IQ between age 13 and age 38; importantly, the lost cogni-‐
tive abilities were not restored in those who quit smoking marijuana as adults. (Individuals who started smoking mari-‐
juana in adulthood did not show signifi-‐
cant IQ declines.) What Are the Other Health Effects of Marijuana? Marijuana use can have a variety of ad-‐
verse, short-‐ and long-‐term effects, espe-‐
cially on cardiopulmonary and mental health. Marijuana raises heart rate by 20-‐100 percent shortly after smoking; this effect can last up to 3 hours. In one study, it was estimated that marijuana users have a 4.8-‐fold increase in the risk of heart at-‐
tack in the first hour after smoking the drug. This may be due to increased heart rate as well as the effects of marijuana on heart rhythms, causing palpitations and arrhythmias. This risk may be great-‐
er in older individuals or in those with cardiac vulnerabilities. Marijuana and Driving Because it seriously impairs judgment and motor coordination, marijuana al-‐
so contributes to accidents while driv-‐
ing. A recent analysis of data from several studies found that marijuana use more than doubles a driver’s risk of being in an accident. Further, the combination of marijuana and alcohol is worse than either substance alone with respect to driving impairment. Marijuana smoke is an irritant to the lungs, and frequent marijuana smokers can have many of the same respiratory problems experienced by tobacco smok-‐
ers, such as daily cough and phlegm pro-‐
duction, more frequent acute chest ill-‐
Marijuana • December 2012 • Page 2
ness, and a heightened risk of lung infec-‐
tions. One study found that people who smoke marijuana frequently but do not smoke tobacco have more health prob-‐
lems and miss more days of work than Is Marijuana Medicine? Although many have called for the le-‐
galization of marijuana to treat condi-‐
tions including pain and nausea caused by HIV/AIDS, cancer, and other conditions, the scientific evidence to date is not sufficient for the marijuana plant to gain FDA approval, for two main reasons. First, there have not been enough clin-‐
ical trials showing that marijuana’s benefits outweigh its health risks in patients with the symptoms it is meant to treat. The FDA requires care-‐
fully conducted studies in large num-‐
bers of patients (hundreds to thou-‐
sands) to accurately assess the bene-‐
fits and risks of a potential medication. Also, to be considered a legitimate medicine, a substance must have well-‐
defined and measureable ingredients that are consistent from one unit (such as a pill or injection) to the next. This consistency allows doctors to de-‐
termine the dose and frequency. As the marijuana plant contains hundreds of chemical compounds that may have different effects and that vary from plant to plant, its use as a medicine is difficult to evaluate. However, THC-‐based drugs to treat pain and nausea are already FDA ap-‐
proved and prescribed, and scientists continue to investigate the medicinal properties of cannabinoids. For more information, see http://www.drugabuse.gov/publicatio
ns/drugfacts/marijuana-‐medicine nonsmokers, mainly because of respira-‐
tory illnesses. A number of studies have shown an as-‐
sociation between chronic marijuana use and mental illness. High doses of mariju-‐
ana can produce a temporary psychotic reaction (involving hallucinations and paranoia) in some users, and using mari-‐
juana can worsen the course of illness in patients with schizophrenia. A series of large prospective studies also showed a link between marijuana use and later development of psychosis. This relation-‐
ship was influenced by genetic variables as well as the amount of drug used and the age at which it was first taken—
those who start young are at increased risk for later problems. Associations have also been found be-‐
tween marijuana use and other mental health problems, such as depression, anxiety, suicidal thoughts among adoles-‐
cents, and personality disturbances, in-‐
cluding a lack of motivation to engage in typically rewarding activities. More re-‐
search is still needed to confirm and bet-‐
ter understand these linkages. Marijuana use during pregnancy is asso-‐
ciated with increased risk of neurobe-‐
havioral problems in babies. Because THC and other compounds in marijuana mimic the body’s own cannabinoid-‐like chemicals, marijuana use by pregnant mothers may alter the developing endo-‐
cannabinoid system in the brain of the fetus. Consequences for the child may in-‐
clude problems with attention, memory, and problem solving. Finally, marijuana use has been linked in a few recent studies to an increased risk of an aggressive type of testicular cancer in young men, although further research is needed to establish whether there is a direct causal connection. Is Marijuana Addictive? Marijuana • December 2012 • Page 3
Contrary to common belief, marijuana is addictive. Estimates from research sug-‐
gest that about 9 percent of users be-‐
come addicted to marijuana; this num-‐
ber increases among those who start young (to about 17 percent, or 1 in 6) and among daily users (to 25-‐50 per-‐
cent). Thus, many of the nearly 7 percent of high-‐school seniors who (according to annual survey data) report smoking ma-‐
rijuana daily or almost daily are well on their way to addiction, if not already ad-‐
dicted (besides functioning at a sub-‐
optimal level all of the time). Long-‐term marijuana users trying to quit report withdrawal symptoms including irritability, sleeplessness, decreased ap-‐
petite, anxiety, and drug craving, all of which can make it difficult to remain ab-‐
Rising Potency stinent. Behavioral interventions, includ-‐
ing cognitive-‐behavioral therapy and motivational incentives (i.e., providing vouchers for goods or services to pa-‐
tients who remain abstinent) have prov-‐
en to be effective in treating marijuana addiction. Although no medications are currently available, recent discoveries about the workings of the endocanna-‐
binoid system offer promise for the de-‐
velopment of medications to ease with-‐
drawal, block the intoxicating effects of marijuana, and prevent relapse. Learn More For additional information on marijuana and marijuana abuse, please see http://www.drugabuse.gov/publication
s/research-‐reports/marijuana-‐abuse The amount of THC in marijuana samples confiscated by police has been increasing steadily over the past few decades. In 2009, THC con-‐
centrations in marijuana averaged close to 10 percent, compared to around 4 percent in the 1980s. For a new user, this may mean exposure to higher concentrations of THC, with a greater chance of an adverse or un-‐
predictable reaction. Increases in po-‐
tency may account for the rise in emergency department visits involv-‐
ing marijuana use. For experienced users, it may mean a greater risk for addiction if they are exposing them-‐
selves to high doses on a regular ba-‐
sis. However, the full range of conse-‐
quences associated with marijuana's higher potency is not well under-‐
stood, nor is it known whether expe-‐
rienced marijuana users adjust for the increase in potency by using less. Marijuana • December 2012 • Page 4
Is Marijuana Medicine? The use of marijuana to treat various medical conditions—or “medical mariju-‐
ana”—is a controversial topic and has been for some time. Some people have argued that marijuana’s reported benefi-‐
cial effects on a variety of symptoms jus-‐
tify its legalization as a medicine for cer-‐
tain patients. Often the potential harm of marijuana use is not considered in these arguments, although risk is part of what the U.S. Food and Drug Administration (FDA) assesses when deciding whether to approve a medicine. Under Federal law, only FDA-‐approved medications are legal to prescribe—and marijuana is not one of those. Still, more than a dozen States have approved its use to alleviate a variety of symptoms. What Does Marijuana Do to the Body? Many of marijuana’s effects (including its psychoactive or mind-‐altering proper-‐
ties) stem from an ingredient called del-‐
ta-‐9-‐tetrahydrocannabinol (THC), which resembles a chemical that the body and brain make naturally (see figure). THC attaches to specialized proteins, called cannabinoid receptors (CBRs), to which the body’s natural chemicals (e.g., anan-‐
damide) normally bind. THC's chemical structure is similar to the brain chem-‐
ical anandamide. Similarity in structure allows drugs to be recognized by the body and to alter normal brain communication. CBRs are part of a vast communication network known as the endocannabinoid system (ECS), which plays a role in nor-‐
mal brain development and function. They cluster in brain areas that influence pleasure, memory, thinking, concentra-‐
tion, movement, coordination, and sen-‐
sory and time perception. When someone smokes marijuana, THC stimulates the CBRs artificially, disrupt-‐
ing function of the natural cannabinoids. An overstimulation of these receptors in key brain areas produces the marijuana "high" as well as its other effects on men-‐
tal processes. Marijuana Used for Medical Purposes July 2012 Page 1
even though some of marijuana’s specific ingredients may offer benefits. Finally, marijuana has certain adverse health effects that also must be taken in-‐
to account. Because it is usually smoked, marijuana can cause or worsen respira-‐
tory symptoms (e.g., bronchitis, chronic cough). It also impairs short-‐term memory and motor coordination; slows reaction time; alters mood, judgment, and decision-‐making; and in some peo-‐
ple can cause severe anxiety (paranoia) or psychosis (loss of touch with reality). And marijuana is addictive—about 4.5 million people in this country meet clini-‐
cal criteria for marijuana abuse or de-‐
pendence. Misperceptions of Safety Growing acceptance of medical marijuana may be influencing how young people perceive the harm associated with mariju-‐
ana use generally. Research shows that as high school seniors’ perception of mariju-‐
ana’s risks goes down, their marijuana use goes up, and vice versa (see graph). Sur-‐
veys show significant recent increases among 10th-‐ and 12th-‐graders for daily, current, and past-‐year marijuana use, now surpassing cigarette smoking. What’s the difference between medical and “street” marijuana? 60 Past-‐Year Use 50 Percent Perceived Risk 40 30 20 2010 2000 0 1990 10 1980 There is no difference between “medi-‐
cal-‐grade” marijuana and “street” mari-‐
juana. The marijuana sold in dispensaries as medicine is the same quality and car-‐
ries the same health risks as marijuana sold on the street. Along with THC, the marijuana plant contains over 400 other chemical com-‐
pounds, including other cannabinoids that may be biologically active and vary from plant to plant. This makes it diffi-‐
cult to consider its use as a medicine High School Seniors’ Past-‐Year Marijuana Use and Perceived Risk of Marijuana Use, 1975–2010 1975 Why Isn’t Marijuana an FDA-‐approved Medicine? In fact, THC is an FDA-‐approved medica-‐
tion. It was shown in carefully controlled clinical trials to have therapeutic benefit for relieving nausea associated with can-‐
cer chemotherapy and stimulating appe-‐
tite in patients with wasting syndrome (severe weight loss) that often accompa-‐
nies AIDS. However, the scientific evidence to date is not sufficient for the marijuana plant to gain FDA approval, and there are a number of reasons why: First, there have not been enough clinical trials showing that marijuana’s benefits outweigh its risks in patients with the symptoms it is meant to treat. The FDA requires carefully conducted studies in large numbers of patients (hundreds to thousands) to accurately assess the ben-‐
efits and risks of a potential medication. Second, to be considered a legitimate medicine, a substance must have well-‐
defined and measureable ingredients that are consistent from one unit (such as a pill or injection) to the next. This consistency allows doctors to determine the dose and frequency. Source: University of Michigan, 2011 Monitoring the Future Study Marijuana Used for Medical Purposes July 2012 Page 2
Could Marijuana Be Used in the Crea-‐
tion of FDA-‐Approvable Medicines? Yes. Research continues on the possible therapeutic uses of marijuana and its ac-‐
tive ingredients. Resulting medications show promise for treating neuropathic pain, addiction, multiple sclerosis, obesity, irritable bowel syndrome, and other con-‐
ditions. Learn More For more information on medical mari-‐
juana, visit http://www.drugabuse.gov/publication
s/research-‐reports/marijuana-‐abuse/ Marijuana Used for Medical Purposes July 2012 Page 3

Inhalants! - Frank D. Lanterman Regional Center

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