Drug abuse is the use of illicit drugs, or the abuse of prescription or over-the-counter drugs. The abuse of legitimate drugs (prescription or over-the-counter) can happen when people use the drugs in a manner or in quantities other than directed, or for purposes that are not legitimate. See also drug abuse first aid and drug abuse and dependence.

MARIJUANA (also called "grass," "pot," "reefer," "joint," "hashish," "cannabis," "weed," and "Mary Jane")

About 2 in 5 Americans have used marijuana at least once. Approximately 10% of the population uses it on a regular basis. Next to tobacco, and alcohol in some areas, marijuana is the most popular substance young people use regularly.

The source of marijuana is the hemp plant (cannabis sativa). The active ingredients are THC (delta-9-tetrahydrocannabinol) and other cannabinoids, which are found in the leaves and flowering shoots of the plant.

Hashish is a resinous substance, taken from the tops of female plants. It contains the highest concentration of THC.

The drug dose delivered from any particular preparation of marijuana varies greatly. The concentration of THC may vary as much as a hundred fold, due to diluting or contaminating materials.

The effects of marijuana may be felt from seconds to several minutes after inhaling the smoke (from a joint or a pipe), or within 30 - 60 minutes after ingestion (eating foods containing marijuana, such as "hash brownies").

Because the effects are felt almost immediately by the smoker, further inhalation can be stopped at any time to regulate the effect. In contrast, those eating marijuana experience effects that are slower to develop, cumulative (they add up), longer-lasting, and more variable, making unpleasant reactions more likely.

The primary effects of marijuana are behavioral, because the drug affects the central nervous system (CNS). Popular use of marijuana started because of its effects of euphoria (feeling of joy), relaxation, and increased visual, auditory (hearing), and taste perceptions that may occur with low-to-moderate doses. Most users also report an increase in their appetite ("the munchies").

Unpleasant effects that may occur include depersonalization (inability to distinguish oneself from others), changed body image, disorientation, and acute panic reactions or severe paranoia.

Some cases of severe delirium, hallucinations, and violence have also been reported. Such cases should raise suspicion that the marijuana may have been laced with another agent, such as PCP.

Marijuana has specific effects that may decrease one's ability to perform tasks requiring a great deal of coordination (such as driving a car). Visual tracking is impaired, and the sense of time is typically prolonged.

Learning may be greatly affected because the drug reduces one's ability to concentrate and pay attention. Studies have shown that learning may become "state-dependent," meaning that information acquired or learned while under the influence of marijuana is best recalled in the same state of drug influence.

Other marijuana effects may include:

• Blood-shot eyes
• Increased heart rate and blood pressure
• Bronchodilatation (widening of the airways)
• In some users, bronchial (airway) irritation leading to bronchoconstriction (narrowing of the airways) or bronchospasm (airway spasms, leading to narrowing of the airways)
• Pharyngitis, sinusitis, bronchitis, and asthma in heavy users
• Possible serious effects on the immune system

Regular users, upon stopping marijuana use, may experience withdrawal effects. These may include agitation, insomnia, irritability, and anxiety. Because the metabolite (the substance formed when the body breaks down the drug) of marijuana may be stored in the body's fat tissue, evidence of marijuana may be found in heavy users through urine testing up to 1 month after discontinuing the drug.

The active component in cannabis is believed to have medical properties. Many people maintain that it is effective in the treatment of nausea caused by chemotherapy in cancer patients.

Others claim that cannabis stimulates appetite in patients with AIDS, or is useful in the treatment of glaucoma. While the active ingredient in marijuana has been approved as a synthetic medication by the Food and Drug Administration (dronabinol) for these purposes, use of whole marijuana remains hugely controversial. Currently, cannabis is illegal even for medical use under federal law.

PHENCYCLIDINE (PCP, "angel dust")

It is difficult to estimate the current use of phencyclidine in the United States, because many individuals do not recognize that they have taken it. Other illicit substances (such as marijuana) can be laced with PCP without the user being aware of it.

A 1986 National Institute of Drug Abuse survey of high school seniors revealed that over 12% of the students had used hallucinogens (substances that cause hallucinations), and that many of these drugs probably contained PCP.

PCP use in the U.S. dates back to 1967 when it was sold as the "Peace Pill" in the Haight-Ashbury district of San Francisco. Its use never became very popular because it had a reputation for causing "bad trips."

PCP use grew during the mid-1970s, primarily because of different packaging (sprinkling on leaves that are smoked) and marketing strategies. During the 1980s it became the most commonly used hallucinogen, with the majority of users aged 15 - 25.

Although phencyclidine was initially developed by a pharmaceutical company searching for a new anesthetic, it was not suitable for human use because of its psychotropic (mind-altering) side effects.

PCP is no longer manufactured for legitimate, legal purposes. Unfortunately it can be made rather easily and without great expense by anyone with a knowledge of organic chemistry. This makes it a prime drug for the illicit drug industry. It is available illegally as a white, crystalline powder that can be dissolved in either alcohol or water.

PCP may be administered in different ways. How fast it affects the user depends on the means of administration. If dissolved, PCP may be taken intravenously ("shot up") and its effects noted within seconds.

Sprinkled over dried parsley, oregano, or marijuana leaves, it can be smoked, and effects noted within 2 - 5 minutes, peaking at 15 - 30 minutes. Taken by mouth, in pill form or mixed with food or beverages, PCP's effects are usually noted within 30 minutes. The effects tend to peak in about 2 - 5 hours.

Lower doses of PCP typically produce euphoria (feelings of joy) and decreased inhibition similar to drunkenness. Mid-range doses cause numbness throughout the body, with changes in perception that may result in extreme anxiety and violence.

Large doses may produce paranoia, auditory hallucinations ("hearing voices"), and psychosis similar to schizophrenia. Massive doses, more commonly associated with ingesting the drug, may cause cardiac arrhythmias, seizures, muscle rigidity, acute kidney failure, and death. Because of the analgesic (pain-killing) properties of PCP, users who incur significant injuries may not feel any pain.

Ketamine, a compound related to PCP, has grown in popularity in recent years. It is commonly referred to as Special K.

HALLUCINOGENS

In addition to PCP, other commonly abused hallucinogens include LSD (lysergic acid diethylamide), psilocybin (mushrooms, "shrooms"), and peyote (a cactus plant containing the active ingredient mescaline).

The use of naturally occurring hallucinogens, specifically for religious rites, has been documented for centuries. Mushrooms containing psilocybin were used by the native people of Mexico, and peyote use was common among southwestern Native Americans.

In contrast, LSD is a synthetic substance, first developed by a legitimate pharmaceutical company in 1938. Today, most hallucinogens are used experimentally rather than on a regular basis, with most users reporting only single or several uses per year.

LSD is an extremely potent hallucinogen, with only tiny doses required to produce effects. Compared to LSD, psilocybin is 100 - 200 times less potent, and mescaline (peyote) is about 4,000 times less potent.

Hallucinogens are commonly associated with extreme anxiety and absence of contact with reality at the height of the drug experience ("bad trips"). These experiences can come back as a "flashback," even without using the drug again. Such experiences typically occur during times of increased stress, and tend to decrease in frequency and intensity if the individual stops taking the drugs.

STIMULANTS ("speed," "crack," "coke," "snow," "crank," "go," "speedball," "crystal," "cross-tops," "yellow jackets")

Cocaine

The abuse of cocaine increased dramatically in the late 1980s and early 1990s but is now on the decline.

Cocaine may be inhaled through the nose ("snorting"), or dissolved in water and administered intravenously. When mixed with heroin for IV use, the combination is referred to as a speedball.

Through a simple chemical procedure, cocaine may be changed into a smokeable form known as freebase or crack. Smoking produces an instant and intense euphoria (sense of joy), which is attractive to abusers. Other effects include local numbness, powerful stimulation of the central nervous system, and feelings of increased confidence and energy, along with decreased inhibition.

Increased use and addiction to cocaine are probably related to its specific characteristics of producing an extremely pleasurable high that is very short lived. This encourages the user into a more frequent or regular use, to get the desired effects.

Both tolerance (the need to use increasingly larger amounts off the drugs to get the same effect) and dependence may occur with chronic use of cocaine. Regular users may exhibit mood swings, depression, sleep problems, memory loss, social withdrawal, and loss of interest in school, work, family, and friends. Because heavy use may cause paranoia, cocaine users may become violent.

AMPHETAMINES

During the 1950s and 1960s, amphetamines were commonly prescribed for conditions such as fatigue, obesity, and mild depression. Such use has ceased as the drugs have a high potential for addiction, and are now categorized as controlled substances.

Over-the-counter (OTC) amphetamine look-alike drugs are often abused. These drugs typically contain caffeine and other stimulant ingredients, and are marketed as appetite suppressants or stay-awake/stay-alert aids.

If taken in high doses, these OTC drugs may cause the same high and other effects associated with amphetamines. Regular users may exhibit irritability, restlessness, sleep disturbances, tremors, dilated pupils, skin flushing, and weight loss over time.

INHALANTS

Inhalant abuse became popular with young teens in the 1960s with "glue sniffing." Since then, a broader variety of inhalants have become popular. Inhalant use typically involves younger teens or school-age children. Groups of children will use inhalants usually as an experiment.

Commonly abused inhalants include model glue, spray paints, cleaning fluids, gasoline, liquid typewriter correction fluid, and aerosol propellants for deodorants or hair sprays.

The chemicals are poured into a plastic bag or soaked into rags, then inhaled. The drugs are absorbed through the respiratory tract and an altered mental state is noted within 5 - 15 minutes.

Adverse effects associated with inhalant abuse include liver or kidney damage, convulsions, peripheral neuropathy (nerve damage), brain damage, and sudden death. Most inhalant use occurs amongst teens or preteens who do not have access to illicit drugs or alcohol.

OPIATES, OPIOIDS, AND NARCOTICS

Opiates are derived from opium poppies. These include morphine and codeine. Opioids refer to synthetically produced substances that have the same effect as morphine or codeine.

Opiates and opioids include heroin, oxycodone, hydromorphone, meperidine, propoxyphene, and methadone. All of these substances, natural or synthetic, are considered narcotics. Used as pain-killers, these drugs promote sedation, decrease anxiety, and produce a different perception of painful stimuli.

Because heroin is commonly used intravenously (injected into a vein), health concerns related to sharing contaminated needles among IV drug users must be considered. Complications of sharing contaminated needles include hepatitis, HIV infection, and AIDS.

STAGES OF JUVENILE DRUG USE

There are several stages of drug use. Young people seem to progress more quickly through the stages than do adults.

• Experimental use -- typically involves peers, done for recreational use; the user may enjoy defying parents or other authority figures.
• Regular use -- the user misses more and more school or work; worries about losing drug source; uses drugs to "fix" negative feeling; begins to stay apart from friends and family; may change peer group to others who are regular users; takes pride in noting; increased tolerance and ability to "handle" the drug.
• Daily preoccupation -- the user looses any motivation; the user is indifferent toward school and work; behavior changes become obvious; preoccupation with drug use overrides all prior interests, including relationships; the user engages in secretive behavior; may begin dealing drugs to help support habit; use of other, harder drugs may increase; legal complications may increase.
• Dependence -- cannot face daily life without drugs; denial of problem; worsening physical condition; loss of "control" over use; may become suicidal; financial and legal complications worsen; may have severed ties with family members or friends by this time.

TREATMENT OVERVIEW

As with any other area of medicine, the least intensive treatment should be the starting point.

Comprehensive residential treatment programs monitor and address potential withdrawal symptoms and behaviors. These programs incorporate behavior modification techniques, and they are designed to get the user to recognize his behavior. Treatment programs include counseling both for the person (and perhaps family), and in group settings. Drug abuse treatment programs have a long after-care component (when the user is discharged from the medical facility), and provide peer support.

Drug addiction is a serious and complicated health condition that requires both physiological and psychological treatment and support. It is important to have an evaluation with a trained professional to determine appropriate care.

CALL YOUR HEALTH CARE PROVIDER

• If you are concerned about the addictive potential of currently prescribed medications
• If you are concerned about possible drug abuse by yourself or a family member
• If you are interested in more information regarding drug abuse
• If you are seeking treatment of drug abuse for yourself or a family member

Also seek out information and support from local 12-step support groups (such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Ala-teen-Alanon) or other support groups like SMART Recovery, Moderation Management, and LifeRing Recovery. See alcoholism - support group, chemical dependence - support group.