Brief Description

Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. Alcohol is produced by the fermentation of yeast, sugars, and starches. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. A standard drink equals 0.6 ounces of pure ethanol, or 12 ounces of beer; 8 ounces of malt liquor; 5 ounces of wine; or 1.5 ounces (a "shot") of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey). NIDA does not conduct research on alcohol; for more information, please visit the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control (CDC).

Effects

Alcohol affects every organ in the drinker's body and can damage a developing fetus. Intoxication can impair brain function and motor skills; heavy use can increase risk of certain cancers, stroke, and liver disease. Alcoholism or alcohol dependence is a diagnosable disease characterized by a strong craving for alcohol, and/or continued use despite harm or personal injury. Alcohol abuse, which can lead to alcoholism, is a pattern of drinking that results in harm to one's health, interpersonal relationships, or ability to work.

Statistics and Trends

Monitoring the Future Study: Trends in Prevalence of Alcohol for 8th Graders, 10th Graders, and 12th Graders; 2014 (in percent)*
Drug	Time Period	8th Graders	10th Graders	12th Graders
Alcohol	Lifetime	26.80	[49.30]	[66.00]
	Past Year	20.80	[44.00]	60.20
	Past Month	9.00	[23.50]	37.40

National Survey on Drug Use and Health: Trends in Prevalence of Alcohol for Ages 12 or Older, Ages 12 to 17, Ages 18 to 25, and Ages 26 or Older; 2013 (in percent)*
Drug	Time Period	Ages 12 or Older	Ages 12 to 17	Ages 18 to 25	Ages 26 or Older
Alcohol	Lifetime	[81.50]	30.80	83.80	87.30
	Past Year	66.30	[24.60]	76.80	69.60
	Past Month	52.20	[11.60]	59.60	55.90

^ indicate low precision; no estimate reported.
Data in brackets indicate statistically significant change from the previous year. Previous NSDUH Data

DrugFacts: 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.

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”—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.”

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 3,4-methylenedioxypyrovalerone (MDPV), mephedrone (“Drone,” “Meph,” or “Meow Meow”), and methylone, but there are many others. Much is still unknown 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 norepinephrine 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.

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.”

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/publications/drug-profiles/synthetic-cathinones

DrugFacts: 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 DrugFacts) 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.
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.

How Do Club Drugs Affect the Brain?

GHB acts on at least two sites in the brain: the GABA_B 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 GABA_A 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 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.
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.

What Treatment Options 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
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?

Monitoring the Future (MTF) Survey*

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 2014 MTF survey, 1.0 percent of 12th-grade students reported past-year use of GHB, a statistically significant decrease from peak-year use of 2.0 percent in 2004. GHB use among 8^th- and 10th-grade students was not reported.

Past-year use of ketamine was reported by 1.5 percent of 12th-graders in 2014. This also represents a significant decrease from the peak year of 2002, in which 2.6 percent reported past-year use.

For Rohypnol, 0.3 percent of 8th-graders, 0.5 percent of 10th-graders, and 0.7 percent of 12th-graders 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 12th-graders (1.6 percent).

Learn More

For additional information about club drugs, visit www.drugabuse.gov/drugs-abuse/club-drugs.

Data Sources

* These data are from the 2014 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, U.S. 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.

DrugFacts: Cocaine

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. It produces short-term euphoria, energy, and talkativeness in addition to potentially dangerous physical effects like raising heart rate and blood pressure.

Cocaine pile

How Is Cocaine Used?

The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream.

Crack is a form of cocaine that has been processed to make a rock crystal (also called “freebase cocaine”) that can be smoked. The crystal is heated to produce vapors that are absorbed into the blood-stream through the lungs. (The term “crack” refers to the crackling sound produced by the rock as it is heated.)

The intensity and duration of cocaine’s pleasurable effects depend on the way it is administered. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes; the high from smoking may last 5 to 10 minutes.

In order to sustain their high, people who use cocaine often use the drug in a binge pattern—taking the drug repeatedly within a relatively short period of time, at increasingly higher doses. This practice can easily lead to addiction, a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.

How Does Cocaine Affect the Brain?

Cocaine is a strong central nervous system stimulant that increases levels of the neurotransmitter dopamine in brain circuits regulating pleasure and movement.

Normally, dopamine is released by neurons in these circuits in response to potential rewards (like the smell of good food) and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine prevents the dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. This amplifies the dopamine signal and ultimately disrupts normal brain communication. It is this flood of dopamine that causes cocaine’s characteristic high.

With repeated use, cocaine can cause long-term changes in the brain’s reward system as well as other brain systems, which may lead to addiction. With repeated use, tolerance to cocaine 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 their high, but this can also increase the risk of adverse psychological or physiological effects.

What Are the Other Health Effects of Cocaine?

Cocaine affects the body in a variety of ways. It constricts blood vessels, dilates pupils, and 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.

Most seriously, people who use cocaine can suffer heart attacks or strokes, which may cause sudden death. Cocaine-related deaths are often a result of the heart stopping (cardiac arrest) followed by an arrest of breathing.

People who use cocaine also put themselves at risk for contracting HIV, even if they do not share needles or other drug paraphernalia. This is because cocaine intoxication impairs judgment and can lead to risky sexual behavior.

Some effects of cocaine depend on the method of taking it. Regular 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 by the mouth 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, hepatitis C, 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.

Cocaine is more dangerous when combined with other drugs or alcohol (poly-drug use). For example, the combination of cocaine and heroin (known as a “speedball”) carries a particularly high risk of fatal overdose.

DrugFacts: Hallucinogens - LSD, Peyote, Psilocybin, and PCP

Hallucinogenic compounds found in some plants and mushrooms (or their extracts) have been used—mostly during religious rituals—for centuries. Almost all hallucinogens contain nitrogen and are classified as alkaloids. Many hallucinogens have chemical structures similar to those of natural neurotransmitters (e.g., acetylcholine-, serotonin-, or catecholamine-like). While the exact mechanisms by which hallucinogens exert their effects remain unclear, research suggests that these drugs work, at least partially, by temporarily interfering with neurotransmitter action or by binding to their receptor sites. This DrugFacts will discuss four common types of hallucinogens:

LSD (d-lysergic acid diethylamide) is one of the most potent mood-changing chemicals. It was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.
Peyote is a small, spineless cactus in which the principal active ingredient is mescaline. This plant has been used by natives in northern Mexico and the southwestern United States as a part of religious ceremonies. Mescaline can also be produced through chemical synthesis.
Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is obtained from certain types of mushrooms that are indigenous to tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance.
PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its use has since been discontinued due to serious adverse effects.

How Are Hallucinogens Abused?

The very same characteristics that led to the incorporation of hallucinogens into ritualistic or spiritual traditions have also led to their propagation as drugs of abuse. Importantly, and unlike most other drugs, the effects of hallucinogens are highly variable and unreliable, producing different effects in different people at different times. This is mainly due to the significant variations in amount and composition of active compounds, particularly in the hallucinogens derived from plants and mushrooms. Because of their unpredictable nature, the use of hallucinogens can be particularly dangerous.

LSD is sold in tablets, capsules, and, occasionally, liquid form; thus, it is usually taken orally. LSD is often added to absorbent paper, which is then divided into decorated pieces, each equivalent to one dose. The experiences, often referred to as “trips,” are long; typically, they end after about 12 hours.

Peyote: The top of the peyote cactus, also referred to as the crown, consists of disc-shaped buttons that are cut from the roots and dried. These buttons are generally chewed or soaked in water to produce an intoxicating liquid. The hallucinogenic dose of mescaline is about 0.3 to 0.5 grams, and its effects last about 12 hours. Because the extract is so bitter, some individuals prefer to prepare a tea by boiling the cacti for several hours.

Psilocybin: Mushrooms containing psilocybin are available fresh or dried and are typically taken orally. Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) and its biologically active form, psilocin (4-hydroxy-N,N-dimethyltryptamine), cannot be inactivated by cooking or freezing preparations. Thus, they may also be brewed as a tea or added to other foods to mask their bitter flavor. The effects of psilocybin, which appear within 20 minutes of ingestion, last approximately 6 hours.

PCP is a white crystalline powder that is readily soluble in water or alcohol. It has a distinctive bitter chemical taste. PCP can be mixed easily with dyes and is often sold on the illicit drug market in a variety of tablet, capsule, and colored powder forms that are normally snorted, smoked, or orally ingested. For smoking, PCP is often applied to a leafy material such as mint, parsley, oregano, or marijuana. Depending upon how much and by what route PCP is taken, its effects can last approximately 4–6 hours.

How Do Hallucinogens Affect the Brain?

LSD, peyote, psilocybin, and PCP are drugs that cause hallucinations, which are profound distortions in a person’s perception of reality. Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but are not. Some hallucinogens also produce rapid, intense emotional swings. LSD, peyote, and psilocybin cause their effects by initially disrupting the interaction of nerve cells and the neurotransmitter serotonin.¹ Distributed throughout the brain and spinal cord, the serotonin system is involved in the control of behavioral, perceptual, and regulatory systems, including mood, hunger, body temperature, sexual behavior, muscle control, and sensory perception. On the other hand, PCP acts mainly through a type of glutamate receptor in the brain that is important for the perception of pain, responses to the environment, and learning and memory.

There have been no properly controlled research studies on the specific effects of these drugs on the human brain, but smaller studies and several case reports have been published documenting some of the effects associated with the use of hallucinogens.

LSD: Sensations and feelings change much more dramatically than the physical signs in people under the influence of LSD. The user may feel several different emotions at once or swing rapidly from one emotion to another. If taken in large enough doses, the drug produces delusions and visual hallucinations. The user’s sense of time and self is altered. Experiences may seem to “cross over” different senses, giving the user the feeling of hearing colors and seeing sounds. These changes can be frightening and can cause panic. Some LSD users experience severe, terrifying thoughts and feelings of despair, fear of losing control, or fear of insanity and death while using LSD.

LSD users can also experience flashbacks, or recurrences of certain aspects of the drug experience. Flashbacks occur suddenly, often without warning, and may do so within a few days or more than a year after LSD use. In some individuals, the flashbacks can persist and cause significant distress or impairment in social or occupational functioning, a condition known as hallucinogen-induced persisting perceptual disorder (HPPD).

Most users of LSD voluntarily decrease or stop its use over time. LSD is not considered an addictive drug since it does not produce compulsive drug-seeking behavior. However, LSD does produce tolerance, so some users who take the drug repeatedly must take progressively higher doses to achieve the state of intoxication that they had previously achieved. This is an extremely dangerous practice, given the unpredictability of the drug. In addition, cross-tolerance between LSD and other hallucinogens has been reported.

Peyote: The long-term residual psychological and cognitive effects of mescaline, peyote’s principal active ingredient, remain poorly understood. A recent study found no evidence of psychological or cognitive deficits among Native Americans that use peyote regularly in a religious setting.² It should be mentioned, however, that these findings may not generalize to those who repeatedly abuse the drug for recreational purposes. Peyote abusers may also experience flashbacks.

Psilocybin: The active compounds in psilocybin-containing “magic” mushrooms have LSD-like properties and produce alterations of autonomic function, motor reflexes, behavior, and perception.³ The psychological consequences of psilocybin use include hallucinations, an altered perception of time, and an inability to discern fantasy from reality. Panic reactions and psychosis also may occur, particularly if a user ingests a large dose. Long-term effects such as flashbacks, risk of psychiatric illness, impaired memory, and tolerance have been described in case reports.

PCP: The use of PCP as an approved anesthetic in humans was discontinued in 1965 because patients often became agitated, delusional, and irrational while recovering from its anesthetic effects. PCP is a “dissociative drug,” meaning that it distorts perceptions of sight and sound and produces feelings of detachment (dissociation) from the environment and self. First introduced as a street drug in the 1960s, PCP quickly gained a reputation as a drug that could cause bad reactions and was not worth the risk. However, some abusers continue to use PCP due to the feelings of strength, power, and invulnerability as well as a numbing effect on the mind that PCP can induce. Among the adverse psychological effects reported are—

Symptoms that mimic schizophrenia, such as delusions, hallucinations, paranoia, disordered thinking, and a sensation of distance from one’s environment.
Mood disturbances: Approximately 50 percent of individuals brought to emergency rooms because of PCP-induced problems—related to use within the past 48 hours—report significant elevations in anxiety symptoms.⁴
People who have abused PCP for long periods of time have reported memory loss, difficulties with speech and thinking, depression, and weight loss. These symptoms can persist up to one year after stopping PCP abuse.
Addiction: PCP is addictive—its repeated abuse can lead to craving and compulsive PCP-seeking behavior, despite severe adverse consequences.

What Other Adverse Effects Do Hallucinogens Have on Health?

Unpleasant adverse effects as a result of the use of hallucinogens are not uncommon. These may be due to the large number of psychoactive ingredients in any single source of hallucinogen.³

LSD: The effects of LSD depend largely on the amount taken. LSD causes dilated pupils; can raise body temperature and increase heart rate and blood pressure; and can cause profuse sweating, loss of appetite, sleeplessness, dry mouth, and tremors.
Peyote: Its effects can be similar to those of LSD, including increased body temperature and heart rate, uncoordinated movements (ataxia), profound sweating, and flushing. The active ingredient mescaline has also been associated, in at least one report, to fetal abnormalities.⁵
Psilocybin: It can produce muscle relaxation or weakness, ataxia, excessive pupil dilation, nausea, vomiting, and drowsiness. Individuals who abuse psilocybin mushrooms also risk poisoning if one of many existing varieties of poisonous mushrooms is incorrectly identified as a psilocybin mushroom.
PCP: At low-to-moderate doses, physiological effects of PCP include a slight increase in breathing rate and a pronounced rise in blood pressure and pulse rate. Breathing becomes shallow; flushing and profuse sweating, generalized numbness of the extremities, and loss of muscular coordination may occur.

At high doses, blood pressure, pulse rate, and respiration drop. This may be accompanied by nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance, and dizziness. PCP abusers are often brought to emergency rooms because of overdose or because of the drug’s severe untoward psychological effects. While intoxicated, PCP abusers may become violent or suicidal and are therefore dangerous to themselves and others. High doses of PCP can also cause seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication). Because PCP can also have sedative effects, interactions with other central nervous system depressants, such as alcohol and benzodiazepines, can also lead to coma.

What Treatment Options Exist?

Treatment for alkaloid hallucinogen (such as psilocybin) intoxication—which is mostly symptomatic—is often sought as a result of bad “trips,” during which a patient may, for example, hurt him- or herself.⁶ Treatment is usually supportive: provision of a quiet room with little sensory stimulation. Occasionally, benzodiazepines are used to control extreme agitation or seizures.

There is very little published data on treatment outcomes for PCP intoxication. Doctors should consider that acute adverse reactions may be the result of drug synergy with alcohol.⁷ Current research efforts to manage a life-threatening PCP overdose are focused on a passive immunization approach through the development of anti-PCP antibodies.⁸ There are no specific treatments for PCP abuse and addiction, but inpatient and/or behavioral treatments can be helpful for patients with a variety of addictions, including that to PCP.

How Widespread Is the Abuse of Hallucinogens?

According to the 2013 National Survey on Drug Use and Health (NSDUH)*, more than 1.1 million people aged 12 or older reported using hallucinogens within the past 12 months.

LSD

In 2013, more than 24.8 million people aged 12 or older reported they had used LSD in their lifetime (9.4 percent) according to NSDUH. More than 1.1 million people had used the drug in the past year. Between 2012 and 2013, the number of past-year initiates of LSD increased only slightly.

Peyote and Psilocybin

It is difficult to gauge the extent of use of these hallucinogens because most data sources that quantify drug use exclude these drugs.

PCP

In 2013, 6.5 million people aged 12 or older reported that they had used PCP in their lifetime (2.5 percent) according to NSDUH. However, only 90,000 people reported use in the past year—a decrease from 172,000 in 2012.

Learn More

For more information on hallucinogens, please visit http://www.drugabuse.gov/drugs-abuse/hallucinogens.

Other Data Sources

* NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. This survey is available on line at www.samhsa.gov.

DrugFacts: Heroin

Prescription Opioid Abuse: A First Step to Heroin Use?

Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and they are currently among the most commonly abused drugs in the United States. Research now suggests that abuse of these drugs may open the door to heroin abuse.

Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin. Some individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids.

Many of these young people also report that crushing prescription opioid pills to snort or inject the powder provided their initiation into these methods of drug administration.

Heroin is an opioid 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.”

In 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) had used heroin at least once in their lives. It is estimated that about 23 percent of individuals who use heroin become dependent on it.

How Is Heroin Used?

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three routes of administration deliver the drug to the brain very rapidly, which contributes to its health risks and to its high risk for addiction, which is a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.

How Does Heroin Affect the Brain?

When it enters the brain, heroin is converted back into morphine, which binds to molecules on cells 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, which controls automatic processes critical for life, such as blood pressure, arousal, and respiration.

Heroin overdoses frequently involve a suppression of breathing. This can affect the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term psychological and neurological effects, including coma and permanent brain damage.

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.

Researchers are also investigating the long-term effects of opioid addiction on the brain. One result is tolerance, in which more of the drug is needed to achieve the same intensity of effect. Another result is dependence, characterized by the need to continue use of the drug to avoid withdrawal symptoms. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.

Injection Drug Use and HIV and HCV Infection

People who inject drugs are at high risk of contracting HIV and hepatitis C (HCV). This is because these diseases are transmitted through contact with blood or other bodily fluids, which can occur when sharing needles or other injection drug use equipment. (HCV is the most common blood-borne infection in the Unites States.) HIV (and less often HCV) can also be contracted during unprotected sex, which drug use makes more likely.

Because of the strong link between drug abuse and the spread of infectious disease, drug abuse treatment can be an effective way to prevent the latter. People in drug abuse treatment, which often includes risk reduction counseling, stop or reduce their drug use and related risk behaviors, including risky injection practices and unsafe sex. (See box, “Treating Heroin Addiction.”)

What Are the Other Health Effects of Heroin?

Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV (see box, “Injection Drug Use and HIV and HCV Infection”). Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the user as well as from heroin’s effects on breathing.

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.

Treating Heroin Addiction

A range of treatments including behavioral therapies and medications are effective at helping patients stop using heroin and return to stable and productive lives.

Medications include buprenorphine and methadone, both of which work by binding to the same cell receptors as heroin but more weakly, helping a person wean off the drug and reduce craving; and naltrexone, which blocks opioid receptors and prevents the drug from having an effect (patients sometimes have trouble complying with naltrexone treatment, but a new long-acting version given by injection in a doctor’s office may increase this treatment’s efficacy). Another drug called naloxone is sometimes used as an emergency treatment to counteract the effects of heroin overdose.

For more information, see NIDA’s handbook, Principles of Drug Addiction Treatment.

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.

Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization. According to a recent study, treating opioid-addicted pregnant mothers with buprenorphine (a medication for opioid dependence) can reduce NAS symptoms in babies and shorten their hospital stays.

Heroin Use

How does heroin use affect pregnant women?

Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent along with the mother. Symptoms include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting, and possibly death. NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms; the medication is gradually tapered off until the baby adjusts to being opioid-free. Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the outcomes associated with untreated heroin use for both the infant and mother, although infants exposed to methadone during pregnancy typically require treatment for NAS as well.

A recent NIDA-supported clinical trial demonstrated that buprenorphine treatment of opioid-dependent mothers is safe for both the unborn child and the mother. Once born, these infants require less morphine and shorter hospital stays as compared to infants born of mothers on methadone maintenance treatment.²⁴ Research also indicates that buprenorphine combined with naloxone (compared to a morphine taper) is equally safe for treating babies born with NAS, further reducing side effects experienced by infants born to opioid-dependent mothers.^25,26

Mothers' Buprenorphine Treatment During Pregnancy Benefits Infants

Mother's Buprenorphine treatment during pregnancy benefits infants
A NIDA-funded clinical trial found buprenorphine to be a safe and effective alternative to methadone for treating opioid dependence during pregnancy. Buprenorphine was also found to be effective in reducing neonatal abstinence syndrome in newborns born to opioid-dependent mothers.

What effects does heroin have on the body?

The greatest increase in heroin use is seen in young adults aged 18-25.

Heroin binds to and activates specific receptors in the brain called mu-opioid receptors (MORs). Our bodies contain naturally occurring chemicals called neurotransmitters that bind to these receptors throughout the brain and body to regulate pain, hormone release, and feelings of well-being.⁹ When MORs are activated in the reward center of the brain, they stimulate the release of the neurotransmitter dopamine, causing a sensation of pleasure.¹⁰ The consequences of activating opioid receptors with externally administered opioids such as heroin (versus naturally occurring chemicals within our bodies) depend on a variety of factors: how much is used, where in the brain or body it binds, how strongly it binds and for how long, how quickly it gets there, and what happens afterward.

What are the immediate (short-term) effects of heroin use?

Once heroin enters the brain, it is converted to morphine and binds rapidly to opioid receptors.¹¹ Abusers typically report feeling a surge of pleasurable sensation—a “rush.” The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the opioid receptors. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage.¹²

Brain image highlighting the limbic system, brain stem and spinal cord

Opioids Act on Many Places in the Brain and Nervous System

Opioids can depress breathing by changing neurochemical activity in the brain stem, where automatic body functions such as breathing and heart rate are controlled.
Opioids can increase feelings of pleasure by altering activity in the limbic system, which controls emotions.
Opioids can block pain messages transmitted through the spinal cord from the body.

What are the long-term effects of heroin use?

Repeated heroin use changes the physical structure¹³ and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed.^14,15 Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.^16-18 Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements. Major withdrawal symptoms peak between 24–48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Finally, repeated heroin use often results in addiction—a chronic relapsing disease that goes beyond physical dependence and is characterized by uncontrollable drug-seeking no matter the consequences.¹⁹ Heroin is extremely addictive no matter how it is administered, although routes of administration that allow it to reach the brain the fastest (i.e., injection and smoking) increase the risk of addiction. Once a person becomes addicted to heroin, seeking and using the drug becomes their primary purpose in life.

Why does heroin use create special risk for contracting HIV/AIDS and hepatitis B and C?

Heroin use increases the risk of being exposed to HIV, viral hepatitis, and other infectious agents through contact with infected blood or body fluids (e.g., semen, saliva) that results from the sharing of syringes and injection paraphernalia that have been used by infected individuals or through unprotected sexual contact with an infected person. Snorting or smoking does not eliminate the risk of infectious disease like hepatitis and HIV/AIDS because people under the influence of drugs still engage in risky sexual and other behaviors that can expose them to these diseases.

Injection drug users (IDUs) are the highest-risk group for acquiring hepatitis C (HCV) infection and continue to drive the escalating HCV epidemic: Each IDU infected with HCV is likely to infect 20 other people.²¹ Of the 17,000 new HCV infections occurring in the United States in 2010, over half (53 percent) were among IDUs.²² Hepatitis B (HBV) infection in IDUs was reported to be as high as 20 percent in the United States in 2010,²³ which is particularly disheartening since an effective vaccine that protects against HBV infection is available. There is currently no vaccine available to protect against HCV infection.

Drug use, viral hepatitis and other infectious diseases, mental illnesses, social dysfunctions, and stigma are often co-occuring conditions that affect one another, creating more complex health challenges that require comprehensive treatment plans tailored to meet all of a patient’s needs. For example, NIDA-funded research has found that drug abuse treatment along with HIV prevention and community-based outreach programs can help people who use drugs change the behaviors that put them at risk for contracting HIV and other infectious diseases. They can reduce drug use and drug-related risk behaviors such as needle sharing and unsafe sexual practices and, in turn, reduce the risk of exposure to HIV/AIDS and other infectious diseases. Only through coordinated utilization of effective antiviral therapies coupled with treatment for drug abuse and mental illness can the health of those suffering from these conditions be restored.

What are the medical complications of chronic heroin use?

Short- and Long-Term Effects of Heroin Use

Short-Term Effects

"Rush"
Depressed respiration
Clouded mental functioning
Nausea and vomiting
Suppression of pain
Spontaneous abortion

Long-Term Effects

Addiction
Infectious disease (e.g., HIV, hepatitis B and C)
Collapsed veins
Bacterial infections
Abscesses
Infection of heart lining and valves
Arthritis and other rheumatologic problems
Liver and kidney disease

No matter how they ingest the drug, chronic heroin users experience a variety of medical complications including insomnia and constipation. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health of the user as well as from heroin’s effect of depressing respiration. Many experience mental disorders such as depression and antisocial personality disorder. Men often experience sexual dysfunction and women’s menstrual cycles often become irregular. There are also specific consequences associated with different routes of administration. For example, people who repeatedly snort heroin can damage the mucosal tissues in their noses as well as perforate the nasal septum (the tissue that separates the nasal passages).

Medical consequences of chronic injection use include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils), and other soft-tissue infections. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

Sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse—infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.

What can be done for a heroin overdose?

Overdose is a dangerous and deadly consequence of heroin use. A large dose of heroin depresses heart rate and breathing to such an extent that a user cannot survive without medical help. Naloxone (e.g., Narcan^®) is an opioid receptor antagonist medication that can eliminate all signs of opioid intoxication to reverse an opioid overdose. It works by rapidly binding to opioid receptors, preventing heroin from activating them.²⁷ Because of the huge increase in overdose deaths from prescription opioid abuse, there has been greater demand for opioid overdose prevention services. Naloxone that can be used by nonmedical personnel has been shown to be cost-effective and save lives.²⁸ In April 2014, the U.S. Food and Drug Administration (FDA) approved a naloxone hand-held auto-injector called Evzio, which rapidly delivers a single dose of naloxone into the muscle or under the skin, buying time until medical assistance can arrive. Since Evzio can be used by family members or caregivers, it greatly expands access to naloxone.²⁹ NIDA and the FDA are working with drug manufacturers to support the development of nasal spray formulations of this live-saving medication.

In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) released an Opioid Overdose Prevention Toolkit in August 2013 that provides helpful information necessary to develop policies and practices to prevent opioid-related overdoses and deaths. The kit provides material tailored for first responders, treatment providers, and individuals recovering from an opioid overdose.

What are the treatments for heroin addiction?

A variety of effective treatments are available for heroin addiction, including both behavioral and pharmacological (medications). Both approaches help to restore a degree of normalcy to brain function and behavior, resulting in increased employment rates and lower risk of HIV and other diseases and criminal behavior. Although behavioral and pharmacologic treatments can be extremely useful when utilized alone, research shows that for some people, integrating both types of treatments is the most effective approach.

Woman comforting a man in a doctor's office.

Pharmacological Treatment (Medications)

Scientific research has established that pharmacological treatment of opioid addiction increases retention in treatment programs and decreases drug use, infectious disease transmission, and criminal activity.

When people addicted to opioids first quit, they undergo withdrawal symptoms (pain, diarrhea, nausea, and vomiting), which may be severe. Medications can be helpful in this detoxification stage to ease craving and other physical symptoms, which often prompt a person to relapse. While not a treatment for addiction itself, detoxification is a useful first step when it is followed by some form of evidence-based treatment.

Medications developed to treat opioid addiction work through the same opioid receptors as the addictive drug, but are safer and less likely to produce the harmful behaviors that characterize addiction. Three types of medications include: (1) agonists, which activate opioid receptors; (2) partial agonists, which also activate opioid receptors but produce a smaller response; and (3) antagonists, which block the receptor and interfere with the rewarding effects of opioids. A particular medication is used based on a patient’s specific medical needs and other factors. Effective medications include:

Methadone (Dolophine^® or Methadose^®) is a slow-acting opioid agonist. Methadone is taken orally so that it reaches the brain slowly, dampening the “high” that occurs with other routes of administration while preventing withdrawal symptoms. Methadone has been used since the 1960s to treat heroin addiction and is still an excellent treatment option, particularly for patients who do not respond well to other medications. Methadone is only available through approved outpatient treatment programs, where it is dispensed to patients on a daily basis.
Buprenorphine (Subutex^®) is a partial opioid agonist. Buprenorphine relieves drug cravings without producing the “high” or dangerous side effects of other opioids. Suboxone^® is a novel formulation of buprenorphine that is taken orally or sublingually and contains naloxone (an opioid antagonist) to prevent attempts to get high by injecting the medication. If an addicted patient were to inject Suboxone, the naloxone would induce withdrawal symptoms, which are averted when taken orally as prescribed. FDA approved buprenorphine in 2002, making it the first medication eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. This approval eliminates the need to visit specialized treatment clinics, thereby expanding access to treatment for many who need it. In February 2013, FDA approved two generic forms of Suboxone, making this treatment option more affordable.
Naltrexone (Depade^® or Revia^®) is an opioid antagonist. Naltrexone blocks the action of opioids, is not addictive or sedating, and does not result in physical dependence; however, patients often have trouble complying with the treatment, and this has limited its effectiveness. An injectable long-acting formulation of naltrexone (Vivitrol^®) recently received FDA approval for treating opioid addiction. Administered once a month, Vivitrol^® may improve compliance by eliminating the need for daily dosing.

Behavioral Therapies

The many effective behavioral treatments available for heroin addiction can be delivered in outpatient and residential settings. Approaches such as contingency management and cognitive-behavioral therapy have been shown to effectively treat heroin addiction, especially when applied in concert with medications. Contingency management uses a voucher-based system in which patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living. Cognitive-behavioral therapy is designed to help modify the patient’s expectations and behaviors related to drug use and to increase skills in coping with various life stressors. An important task is to match the best treatment approach to meet the particular needs of the patient.

Print Charts: List of Most Commonly Abused Drugs (PDF)

DrugFacts: Inhalants

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.)

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 sometimes abused in that way. They are especially (but not exclusively) abused by young children and adolescents, and are the only class of substance abused more by younger than by older teens.

Ever used Inhalants? 8th graders report 13%, 10th graders report 10% and 12th graders report 8%, 2011 Monitoring the Furture Survey

How Are Inhalants Abused?

Abusers of inhalants breathe them in through the nose or mouth in a variety of ways (known as “huffing”). They may sniff or snort fumes from a container or dispenser (such as a glue bottle or a marking pen), spray aerosols (such as computer cleaning dusters) 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 inhalant 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 nitrous oxide or “whippets.” Adults most commonly abuse a class of inhalants known as nitrites (such as amyl nitrites or “poppers”).

How Do Inhalants Affect the Brain?

Most abused inhalants other than nitrites depress the central nervous system 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 delusions. With repeated inhalations, many users feel less inhibited and less in control. Some may feel drowsy for several hours and experience a lingering headache.

Unlike other types of inhalants, nitrites enhance sexual pleasure by dilating and relaxing blood vessels.

Although it is not very common, addiction to inhalants can occur with repeated abuse.

What Are the Other Health Effects of Inhalants?

Chemicals found in different types of inhaled products may produce a variety of other short-term effects, such as nausea or vomiting, as well as more serious long-term consequences. These may include liver and kidney damage, 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 person. High concentrations of inhalants may also cause death from suffocation, especially when inhaled from a paper or plastic bag or in a closed area. Even when using aerosols or volatile products for their legitimate purposes 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 practices that increase the risk of contracting and spreading infectious diseases like HIV/AIDS and hepatitis.

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 correction fluids, felt-tip marker fluid, electronic contact 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 products 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, chloroform, halothane, and nitrous oxide (“laughing gas”)

Nitrites—used primarily as sexual enhancers

Organic nitrites are volatiles that include cyclohexyl, 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 often sold in small brown bottles labeled as “video head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.”

DrugFacts: K2/Spice ("Synthetic Marijuana")

"Spice" refers to a wide variety of herbal mixtures that produce experiences similar to marijuana (cannabis) and that are marketed as "safe," legal alternatives to that drug. Sold under many names, including K2, fake weed, Yucatan Fire, Skunk, Moon Rocks, and others — and labeled "not for human consumption" — these products contain dried, shredded plant material and chemical additives that are responsible for their psychoactive (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 ingredients 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. Because the chemicals used in Spice have a high potential for abuse and no medical benefit, the Drug Enforcement Administration (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 restrictions by substituting different chemicals 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 reported 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 2012, Marijuana/Hashish 36.4%, Synthetic Marijuana 11.3%, Hallucinogens 4.8%, Salvia 4.4%, MDMA 3.8%, Cocaine 2.7%

How Is Spice Abused?

Some Spice products are sold as “incense,” but they more closely resemble potpourri. Like marijuana, Spice is abused mainly by smoking. Sometimes Spice is mixed with marijuana or is prepared as an herbal infusion for drinking.

K2, a popular brand of “Spice” mixture. Image courtesy of Coolidge Youth Coalition

How Does Spice Affect the Brain?

Spice users report experiences similar to those produced by marijuana—elevated mood, relaxation, and altered perception—and in some cases the effects are even stronger than those of marijuana. Some users report psychotic effects like extreme anxiety, paranoia, and hallucinations.

So far, there have been no scientific studies 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 marijuana. 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 unknown, it is likely that some varieties also 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 cases it has been associated with heart attacks. 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 further analyses, it is difficult to determine whether this concern is justified.

DrugFacts: Marijuana

What is marijuana

Marijuana refers to the dried leaves, flowers, stems, and seeds from the hemp plant, Cannabis sativa. The plant contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC) and other related compounds. Extracts with high amounts of THC can also be made from the cannabis plant (see "Marijuana Extracts").

Marijuana is the most commonly used illicit drug in the United States (SAMHSA, 2014). Its use is widespread among young people. According to a yearly survey of middle and high school students, rates of marijuana use have steadied in the past few years after several years of increase. However, the number of young people who believe marijuana use is risky is decreasing (Johnston, 2014).

Legalization of marijuana for medical use or adult recreational use in a growing number of states may affect these views. Read more about marijuana as medicine in DrugFacts: Is Marijuana Medicine? at www.drugabuse.gov/publications/drugfacts/marijuana-medicine.

How do people use marijuana?

People smoke marijuana in hand-rolled cigarettes (joints) or in pipes or water pipes (bongs). They also smoke it in blunts—emptied cigars that have been partly or completely refilled with marijuana. To avoid inhaling smoke, more people are using vaporizers. These devices pull the active ingredients (including THC) from the marijuana and collect their vapor in a storage unit. A person then inhales the vapor, not the smoke.

Users can mix marijuana in food (edibles), such as brownies, cookies, or candy, or brew it as a tea. A newly popular method of use is smoking or eating different forms of THC-rich resins (see "Marijuana Extracts").

Marijuana Extracts

Smoking THC-rich resins extracted from the marijuana plant is on the rise. Users call this practice dabbing. People are using various forms of these extracts, such as:

hash oil or honey oil—a gooey liquid
wax or budder—a soft solid with a texture like lip balm
shatter—a hard, amber-colored solid

These extracts can deliver extremely large amounts of THC to users, and their use has sent some people to the emergency room. Another danger is in preparing these extracts, which usually involves butane (lighter fluid). A number of people who have used butane to make extracts at home have caused fires and explosions and have been seriously burned.

How does marijuana affect the brain?

Marijuana has both short- and long-term effects on the brain.

Image of a cross section of the brain with marked areas that are affected by THC.

THC (in magenta) acts on numerous areas in the brain.

Short-term effects

When a person smokes marijuana, THC quickly passes from the lungs into the bloodstream. The blood carries the chemical to the brain and other organs throughout the body. The body absorbs THC more slowly when the person eats or drinks it. In that case, the user generally feels the effects after 30 minutes to 1 hour.

THC acts on specific brain cell receptors that ordinarily react to natural THC-like chemicals in the brain. These natural chemicals play a role in normal brain development and function.

Marijuana overactivates parts of the brain that contain the highest number of these receptors. This causes the "high" that users feel. Other effects include:

altered senses (for example, seeing brighter colors)
altered sense of time
changes in mood
impaired body movement
difficulty with thinking and problem-solving
impaired memory

Silhouette of a seated young male, hunched over with his head resting in his hand.

Long-term effects

Marijuana also affects brain development. When marijuana users begin using as teenagers, the drug may reduce thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions.

Marijuana’s effects on these abilities may last a long time or even be permanent.

For example, a study showed that people who started smoking marijuana heavily in their teens and had an ongoing cannabis use disorder lost an average of eight IQ points between ages 13 and 38. The lost mental abilities did not fully return in those who quit marijuana as adults. Those who started smoking marijuana as adults did not show notable IQ declines (Meier, 2012).

A Rise in Marijuana’s THC Levels

The amount of THC in marijuana has been increasing steadily over the past few decades. For a new user, this may mean exposure to higher THC levels with a greater chance of a harmful reaction. Higher THC levels may explain the rise in emergency room visits involving marijuana use.

The popularity of edibles also increases the chance of users having harmful reactions. Edibles take longer to digest and produce a high. Therefore, people may consume more to feel the effects faster, leading to dangerous results.

Dabbing is yet another growing trend. More people are using marijuana extracts that provide stronger doses, and therefore stronger effects, of THC (see "Marijuana Extracts").

Higher THC levels may mean a greater risk for addiction if users are regularly exposing themselves to high doses.

What are the other health effects of marijuana?

Marijuana use may have a wide range of effects, both physical and mental.

Physical effects

Breathing problems. Marijuana smoke irritates the lungs, and frequent marijuana smokers can have the same breathing problems that tobacco smokers have. These problems include daily cough and phlegm, more frequent lung illness, and a higher risk of lung infections. Researchers still do not know whether marijuana smokers have a higher risk for lung cancer.
Increased heart rate. Marijuana raises heart rate for up to 3 hours after smoking. This effect may increase the chance of heart attack. Older people and those with heart problems may be at higher risk
Problems with child development during and after pregnancy. Marijuana use during pregnancy is linked to increased risk of both brain and behavioral problems in babies. If a pregnant woman uses marijuana, the drug may affect certain developing parts of the fetus’s brain. Resulting challenges for the child may include problems with attention, memory, and problem-solving.

Mental effects

Long-term marijuana use has been linked to mental illness in some users, such as:

temporary hallucinations—sensations and images that seem real though they are not
temporary paranoia—extreme and unreasonable distrust of others
worsening symptoms in patients with schizophrenia (a severe mental disorder with symptoms such as hallucinations, paranoia, and disorganized thinking)

Marijuana use has also been linked to other mental health problems, such as:

depression
anxiety
suicidal thoughts among teens

Is marijuana addictive?

Contrary to common belief, marijuana can be addictive. Research suggests that about 1 in 11 users becomes addicted to marijuana (Anthony, 1994; Lopez-Quintero 2011).This number increases among those who start as teens (to about 17 percent, or 1 in 6) and among people who use marijuana daily (to 25-50 percent) (Hall, 2009a; Hall, 2009b).

How Does Marijuana Affect a User’s Life?

Compared to nonusers, heavy marijuana users more often report the following:

lower life satisfaction
poorer mental health
poorer physical health
more relationship problems

Users also report less academic and career success. For example, marijuana use is linked to a higher likelihood of dropping out of school (McCaffrey, 2010). It is also linked to more job absences, accidents, and injuries (Zwerling, 1990).

How can people get treatment for marijuana addiction?

Long-term marijuana users trying to quit report withdrawal symptoms that make quitting difficult. These include:

grouchiness
sleeplessness
decreased appetite
anxiety
cravings

Behavioral support has been effective in treating marijuana addiction. Examples include therapy and motivational incentives (providing rewards to patients who remain substance free). No medications are currently available to treat marijuana addiction. However, continuing research may lead to new medications that help ease withdrawal symptoms, block the effects of marijuana, and prevent relapse.

Points to Remember

Marijuana refers to the dried leaves, flowers, stems, and seeds from the hemp plant, Cannabis sativa.
The plant contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC) and other related compounds.
People use marijuana by smoking, eating, drinking, and inhaling it.
Smoking THC-rich extracts from the marijuana plant (a practice called dabbing) is on the rise.
THC overactivates certain brain cell receptors, resulting in effects such as:
- altered senses
- changes in mood
- impaired body movement
- difficulty with thinking and problem-solving
- impaired memory and learning
Marijuana use may have a wide range of effects, both physical and mental, which include:The amount of THC in marijuana has been increasing steadily, creating more harmful effects for users.
- breathing illnesses
- possible harm to a fetus’s brain in pregnant users
- hallucinations and paranoia
Marijuana can be addictive.
Treatment for marijuana addiction includes forms of behavioral therapy. No medications currently exist for treatment.

Marijuana Research at NIDA

What kinds of marijuana research does NIDA fund?

As part of its mandate to study drug abuse and addiction and other health effects of both legal and illegal drugs, NIDA funds a wide range of research on marijuana (cannabis); its main psychoactive ingredient, delta-9-tetrahydrocannabinol (THC); and chemicals related to THC (cannabinoids), including:

Patterns and trends in marijuana use and attitudes, particularly among adolescents
Short- and medium-term effects of THC on the brain and behavior; driving under the influence of cannabis
Long-term effects of prenatal and adolescent cannabis exposure on brain development
The development and impact of prevention programs on marijuana use
Screening and brief assessment for marijuana abuse
Medications and behavioral treatments for cannabis use disorder
The working of the brain’s cannabinoid system, including its role in pain and HIV
Potential therapeutic uses of THC and other cannabinoids in treatment of pain, HIV, and addiction
Social, behavioral, and public health impacts of policy changes related to marijuana (i.e., “medical marijuana” and recreational legalization)

YouTube embedded video: https://www.youtube-nocookie.com/embed/7127QLM2YWA

Does NIDA permit or fund studies on therapeutic benefits of marijuana or its constituent chemicals?

Yes. Research suggests that THC and/or other cannabinoids (chemicals that act on the same receptors as THC in the brain and body) may have potential in the treatment of pain, nausea, obesity, wasting disease, addiction, autoimmune disorders, and other conditions. NIDA has provided and continues to provide funding for research related to therapeutic uses of cannabinoids, as it pertains to its mission, including studies on the use of THC and cannabidiol, another chemical constituent of marijuana, for the treatment of pain (as an alternative to opioid pain relievers), addiction, and other disorders. For example, one currently ongoing study is examining the antipsychotic effects of cannabidiol which may lead to new treatment options for people with schizophrenia. View the list of current NIDA-funded projects related to the therapeutic benefits of cannabis or cannabinoids.

Research on therapeutic uses of marijuana or of specific chemicals in the marijuana plant could be supported by any Institute or Center at NIH where the disease, conditions, or affected organs are studied. For instance, the National Institute on Alcohol Abuse and Alcoholism is supporting a preclinical (animal) study on the use of cannabinoids to reduce neuroinflammation caused by HIV and exacerbated by alcohol use. Similarly, the National Cancer Institute is funding a preclinical study on the potential benefits of cannabinoids for the treatment of breast-cancer induced bone pain.

Note that the vast majority of research proposals received and funded by NIH on therapeutic benefits of cannabinoids have examined individual cannabinoid chemicals or, in a few cases, marijuana leaves delivered through some other means than smoking. Various factors make smoked marijuana therapeutically less promising than medications derived from cannabinoids, including the potential harmful health effects both short-lasting (sedation, cognitive and motor impairment) and long lasting (addiction, respiratory effects). Marijuana leaves contain numerous poorly understood or even toxic chemicals besides THC. It is also difficult to standardize dosages of a highly variable herb delivered in cigarettes or food (see NIDA’s fact sheet, “Is Marijuana Medicine”). A few medications derived from THC, however, are now FDA approved for relieving nausea associated with cancer chemotherapy and stimulating appetite in patients with wasting syndrome that often accompanies AIDS.

Whether submitted to NIDA or another NIH institute, research proposals to study therapeutic benefits of marijuana or one of its ingredients must meet the same accepted standards of scientific design as any other proposal and, on the basis of peer review, should meet public health significance and Institute priorities and be competitive with other applications that qualify for funding.

Does NIDA have an official stand on legalization or decriminalization of marijuana for either recreational or therapeutic use?

No. NIDA is a scientific, not a policy-making agency (the same is true for the NIH as a whole). NIDA’s role is to conduct and support scientific research on drugs and drug abuse and to advise the public and policy-makers (such as Congress, the White House Office of the National Drug Control Policy, and the Drug Enforcement Administration) on the results of that research—with the goal of ensuring that the nation’s drug policies are informed by science.

That said, NIDA does closely watch legislative changes both nationally and at the state level, in order to anticipate and assess how changing drug policies—for instance laws around recreational or therapeutic use of marijuana—may affect rates of substance use and related public health issues that are our area of concern. The annual NIDA-supported Monitoring the Future survey of adolescent drug use and attitudes, for example, has over the past several years detected increasing use of marijuana by teens associated with a decreasing perception of marijuana’s harmfulness—a trend that may be linked to the public conversation about “medical marijuana” (and in some states legalization advocacy) over the same period of time. NIDA has encouraged its grantees to study effects of changing marijuana legislation, through administrative supplements to existing grants.

This page was last updated January 2014

NIDA Research on the Therapeutic Benefits of Cannabis and Cannabinoids

New Funding Announcement - Developing the Therapeutic Potential of the Endocannabinoid System for Pain Treatment (PA-15-188) - The purpose of this NIH Pain Consortium-endorsed funding opportunity announcement is to support projects examining the therapeutic potential of cannabinoids and endocannabinoid system across a variety of pain conditions

There is considerable interest in the possible therapeutic uses of marijuana (see our fact sheet, “Is Marijuana Medicine?”). As of January 31, 2014, there were 28 active grants related to this topic, funded by NIDA, in 6 different disease categories (see table, below). Therapeutic research is defined here as projects that include (as at least one of their specific aims) investigation of the potential medical benefit of the marijuana plant (Cannabis sativa) or its constituent cannabinoid chemicals in human or animal models of disease.

Most of these research projects are examining the medical benefits of individual cannabinoid chemicals derived from or related to those in the marijuana plant, not the plant itself, although a few use unprocessed plant material. Individual cannabinoid chemicals may be isolated and purified from the marijuana plant or synthesized in the laboratory, or they may be naturally occurring (endogenous) cannabinoids found in the body and modified using other, non-cannabinoid chemicals.

Specifically, cannabinoids are classified here as:

Plant – plant leaves, flowers, stems, and seeds collected from the Cannabis sativa plant and ingested in some form (cigarettes, vapor); also known as phytocannabinoids.
Endogenous – cannabinoids made by the body: N-arachidonoylethanolamine or anandamide (AE) or 2-arachidonoylglycerol ( 2-AG). AE and 2-AG activity is manipulated by inhibiting their corresponding hydrolases FAAH or MAGL, preventing their degradation.
Purified – naturally occurring cannabinoids purified from plant sources: Cannabidiol (CBD), D9-tetrahydrocannabinol (THC), and Sativex (mixture of THC and CBD).
Synthetic –cannabinoids synthesized in a laboratory: CB1 agonists (CPP-55, ACPA), CB2 agonists (JWH-133, NMP7, AM1241), CB1/CB2 nonselective agonist (CP55,940), Ajulemic Acid (AJA), Nabilone, Dronabinol, and several other proprietary chemicals in development as potential cannabinoid agonists and antagonists for therapeutic use.

How the Portfolio Analysis Was Conducted:

An internal NIH database (QVR) was searched on January 31, 2014 using the following: TEXT word string “cannabinoid OR cannabis OR marijuana”; active grants
317 grants were manually screened to identify studies in which at least one specific aim included a therapeutic focus.
28 projects were identified (25 projects + 3 supplements) and are listed in the table below.

In the table, projects are divided into six disease categories: autoimmune diseases, inflammation, pain, psychiatric disorders, seizures, and substance use disorders (SUDs). Clicking on individual project titles leads to their descriptions in NIH RePorter. Also listed are the cannabinoid substances being examined and, except in cases when the whole plant was used, whether the studied chemicals are purified from the plant, synthetic, or endogenous; and whether the project uses human or animal subjects.

Autoimmune disease
Project Title	Cannabinoid	Study Model
TRANSDERMAL DELIVERY OF 2-ARACHIDONOYL GLYCEROL (2-AG) FOR THE TREATMENT OF ARTHR	Endogenous (2-AG)	Animal

Inflammation
Project Title	Cannabinoid	Study Model
CANNABINOID EPIGENOMIC AND MIRNA MECHANISMS IMPACT HIV/SIV DISEASE PROGRESSION	Purified (THC)	Animal
CANNABINOID MODULATION OF MICROGLIAL RESPONSE TO THE HIV PROTEIN TAT	Purified and Synthetic (THC and CP55940)	Cell culture and animal models

Pain
Project Title	Cannabinoid	Study Model
BEHAVIORAL ECONOMIC ANALYSIS OF MEDICAL MARIJUANA USE IN HIV+ PATIENTS	Plant (cannabis cigarettes)	Human
CANNABINOID MODULATION OF HYPERALGESIA	Endogenous (AE and 2-AG via URB597 FAAH inhibitor and JZL184 MAGL inhibitor)	Animal
CANNABINOID RECEPTOR AGONISTS FOR TREATMENT OF CHRONIC PAIN	Synthetic (CB2 agonist, proprietary)	Animal
OPTIMIZING ANALGESIA BY EXPLOITING CB2 AGONIST FUNCTIONAL SELECTIVITY	Synthetic (CB2 agonists, proprietary)	Animal
PERIPHERAL FAAH AS A TARGET FOR NOVEL ANALGESICS	Endogenous (AE via FAAH inhibitor (URB937))	Animal
THE EFFECT OF VAPORIZED CANNABIS ON NEUROPATHIC PAIN IN SPINAL CORD INJURY	Plant (cannabis, vaporized)	Human

Psychiatric Disorder
Project Title	Cannabinoid	Study Model
CANNABIDIOL MODULATION OF ???-9-THC???S PSYCHOTOMIMETIC EFFECTS IN HEALTHY HUMANS	Purified (Cannabidiol)	Human
CANNABIS, SCHIZOPHRENIA AND REWARD: SELF-MEDICATION AND AGONIST TREATMENT?	Synthetic and Plant (Dronabinol & cannabis cigarettes)	Human

Seizures
Project Title	Cannabinoid	Study Model
NEW DRUGS TO ENHANCE ENDOCANNABINOID RESPONSES FOR TREATING EXCITOTOXICITY, PHASE	Endogenous (AE via FAAH inhibitors)	Animal

SUD, Withdrawal, and Dependence
Project Title	Cannabinoid	Study Model
CANNABINERGIC MEDICATIONS FOR METHAMPHETAMINE ADDICTION	Synthetic (CB1 agonists and antagonists, proprietary)	Animal
EFFICACY AND SAFETY OF DRONABINOL (ORAL THC) FOR TREATING CANNABIS DEPENDENCE	Synthetic (Dronabinol)	Human
EVALUATION OF NOVEL PHARMACOTHERAPIES FOR THE TREATMENT OF OPIOID DEPENDENCE	Synthetic (Dronabinol, Nabilone)	Human
FAAH-INHIBITOR FOR CANNABIS DEPENDENCE	Endogenous (AE via PF-04457845 FAAH inhibitor)	Human
MARIJUANA RELAPSE: INFLUENCE OF TOBACCO CESSATION AND VARENICLINE	Sythetic (Dronabinol )+/- the noncannabinoid varenicline	Human
MEDICATIONS DEVELOPMENT FOR CANNABIS-USE DISORDERS: CLINICAL STUDIES	Purified (THC) and non-cannabinoids: Gabapentin & Tiagabine	Human
MONOACYLGLYCEROL LIPASE INHIBITORS FOR TREATING OPIOID USE DISORDERS+ supplement	Endogenous (2-AG via JZL184 MAGL inhibitor)	Animal
NABILONE FOR CANNABIS DEPENDENCE: IMAGING AND NEUROPSYCHOLOGICAL PERFORMANCE+ supplement	Synthetic (Nabilone)	Human
NOVEL MEDICATION APPROACHES FOR SUBSTANCE ABUSE	Synthetic (Dronabinol, Project 4)+noncannabinoid lofexidine	Human
NOVEL MEDICATIONS FOR CANNABIS DEPENDENCE	Synthetic (Modify THC and nabilone to create new cannabinoids)	Animal
SATIVEX ASSOCIATED WITH BEHAVIOURAL-PREVENTION RELAPSE STRATEGY AS TREATMENT FOR+ supplement	Purified (Sativex) +/- behavioral therapy	Human
STRESS-INDUCED MARIJUANA SELF-ADMINISTRATION: ROLE OF SEX AND OXYTOCIN	Plant (cannabis cigarettes)	Human
TREATMENT OF CANNABINOID WITHDRAWAL IN RHESUS MONKEYS	Purified (THC) and Endogenous (via AEA via FAAH inhibitors)	Animal

Independently Funded Studies Receiving Research Grade Marijuana - 1999 to present

This page was last updated May 2015

NIDA's Role in Providing Marijuana for Research

Under the 1961 international Single Convention on Narcotic Drugs (PDF, 680KB) (amended in 1972), cannabis is designated a Schedule I substance, and participating countries are required to restrict cultivation, possession and sale except for what is needed for research purposes. The DEA regulates the cultivation of marijuana for research purposes through licensing requirements and establishing annual aggregate production quotas under the authority of the 1970 Controlled Substances Act, which implements the Single Convention. To date, the DEA has only issued a single license for the cultivation of marijuana for research to the University of Mississippi which is funded through a NIDA contract. Questions on the authority to issue additional licenses would have to be addressed to the DEA.

NIDA contracts with the University of Mississippi to grow marijuana for use in research studies. The contract was renewed in 2015 under an open solicitation process. The University designates a secure plot of land where marijuana crops are grown every few years, depending on demand. The marijuana is grown, harvested, stored, and made into cigarettes or other purified elements of marijuana to use for research. For more information on the most recent marijuana farm contract see: Information on marijuana farm contract.

YouTube Embedded Video: NIDA TV Spotlight: https://www.youtube-nocookie.com/embed/IEJf2-TdU68

To obtain research-grade marijuana through the NIDA drug supply program, all applicants must fulfill the following three requirements:

Demonstrate scientific validity and ethical soundness through either:
- For NIH-funded projects - through NIH review, consisting of three steps: (1) the NIH peer review system, which assesses the scientific and technical merit of all grant applications; (2) the Institute’s National Advisory Council, comprising eminent scientists as well as public members from the community; and (3) the Institute Director, who makes the final decision on the merit of an application for funding, based on peer review, public health significance, and Institute priorities. To find studies approved through this NIH review process, go to http://projectreporter.nih.gov/reporter.cfm (you should use the search terms “marijuana,” “cannabis,” and “cannabinoid”).
  
  OR
- For studies not funded by NIH - through a Department of Health and Human Services (HHS) scientific review panel, which consists of experts from across HHS with backgrounds relevant to the research being proposed. The final decision as to whether or not to approve a proposal is based on the consensus of the experts on the review committee. To date, 18 applications to obtain marijuana for medical research have been submitted by potential researchers not funded by NIH; of those, 16 received approval to obtain research-grade marijuana from NIH. (Independently Funded Studies Receiving Research Grade Marijuana - 1999 to present)
An IND application on file with the FDA (for human research only); and
A DEA registration for a Schedule I controlled substance.

When the above steps have been completed, investigators then contact the NIDA Drug Supply Program to place an order for marijuana with specific THC concentrations. The program official verifies that the application is complete (with all the above-mentioned steps fulfilled), and forwards the order on to the contractor responsible for shipping the marijuana.

This page was last updated March 2015

Information on Marijuana Farm Contract

NIDA has awarded a contract under Request for Proposals (RFP) No. N01DA-15-7793 “Production, Analysis and Distribution of Cannabis, Marijuana Cigarettes and Related Materials" to the University of Mississippi. The RFP was posted on the Federal Business Opportunities website on September 26, 2014 and the period for receipt of proposals in response to the RFP closed on November 10, 2014. This Request for Proposal (RFP) was released under full and open competition procedures, therefore any individual or organization could have submitted a proposal. NIDA received more than one proposal, however the exact number and names of the individuals and/or organizations that submitted proposals for the RFP is procurement-sensitive information and cannot be released by the federal government. The contract is a base 1-year contract with four 1-year options.

The award notice and the RFP are posted on the Federal Business Opportunities website (https://www.fbo.gov/spg/HHS/NIH/NIDA-01/N01DA-15-7793/listing.html). Information on the proposal submission/review process can be found in Sections L (Instructions, Conditions, and Notices to Offerors) and M (Evaluation Factors For Award) of the RFP and in NIH Policy Manual Chapter 6315-1, Initiation, Review, Evaluation, and Award of Research & Development (R&D) Contracts — http://oma1.od.nih.gov/manualchapters/contracts/6315-1/.

To serve the research community, NIDA has tried to build farm capacity flexible enough to accommodate various levels of demand for research marijuana and marijuana products over the next five years. While demand is generally low at this time, we cannot predict future needs. As a result, the highest figure in the new contract includes the costliest possible scenario that might involve a large increase in the demand for these products. It is unlikely that there will be such a level of demand but NIDA will be prepared if the budget can be acquired to fund them. NIDA receives its budget on an annual basis and any projections of costs beyond the current fiscal year are for planning purposes only; there is no assurance that such funds would be available. What can be confirmed is that NIDA has obligated approximately $1.5m for FY15.

This page was last updated April 2015

Print Charts: List of Most Commonly Abused Drugs (PDF)

DrugFacts: MDMA (Ecstasy or Molly)

MDMA (3,4-methylenedioxy-methamphetamine), popularly known as ecstasy or, more recently, as Molly, is a synthetic, psychoactive drug that has similarities to both the stimulant amphetamine and the hallucinogen mescaline. It produces feelings of increased energy, euphoria, emotional warmth and empathy toward others, and distortions in sensory and time perception.

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. The popular term Molly (slang for “molecular”) refers to the pure crystalline powder form of MDMA, usually sold in capsules. The drug’s 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, dopamine, and norepinephrine. The emotional and pro-social effects of MDMA are likely caused directly or indirectly by the release of large amounts of serotonin, which influences mood (as well as other functions such as appetite and sleep). Serotonin also triggers the re-lease of the hormones oxytocin and vasopressin, which play important roles in love, trust, sexual arousal, and other social 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 important chemical, however, causing negative after effects—including confusion, depression, sleep problems, drug craving, 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 attention 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).

Is MDMA Addictive?

Research thus far on MDMA’s addictive properties has shown varying results, but we do know that some users report symptoms of dependence, including continued use despite knowledge of physical or psychological harm, tolerance (or diminished response), and withdrawal effects.

The neurotransmitter systems targeted by MDMA are the same as those targeted by other addictive drugs. Experiments have shown that animals will self-administer MDMA—an important indicator of a drug’s abuse potential—although the degree of self-administration is less than some other drugs of abuse such as cocaine.

What Are Other Health Effects of MDMA?

MDMA can have many of the same physical effects as other stimulants like cocaine and amphetamines. These include increases in heart rate and blood pressure, which are particularly risky for people with circulatory problems or heart disease. MDMA users may experience 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 temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), which can result in liver, kidney, or cardiovascular system failure or even death. MDMA can interfere with its own metabolism (breakdown within the body), causing potentially harmful levels to build up in the body if it is taken repeatedly within short periods of time.

Compounding the risks is the fact that ecstasy tablets and even capsules of supposedly pure “Molly” sometimes actually contain other drugs instead or in addition. Those may include ephedrine (a stimulant), dextromethorphan (a cough suppressant), ketamine, caffeine, cocaine, methamphetamine, or even, most recently, synthetic cathinones (the psychoactive ingredients in “bath salts”). These substances are harmful alone and may be particularly dangerous mixed with MDMA. Users who intentionally or unknowingly combine such a mixture with additional substances such as marijuana and alcohol may be putting themselves at even higher risk for adverse health effects.

Additionally, the closeness-promoting effects of MDMA and its use in sexually charged contexts (and especially in combination with sildenafil) may encourage unsafe sex, which is a risk factor for contracting or spreading HIV and hepatitis.

Does MDMA Have Therapeutic 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 Administration 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 administered under carefully monitored conditions. It is currently in clinical trials as a possible pharmacotherapy aid to treat post-traumatic stress disorder (PTSD) and anxiety in terminal cancer patients.

DrugFacts: Methamphetamine

Revised January 2014

Methamphetamine (also called meth, crystal, chalk, and ice, among other terms) is an extremely addictive stimulant drug that is chemically similar to amphetamine. It takes the form of a white, odorless, bitter-tasting crystalline powder.

How Is Methamphetamine Abused?

Methamphetamine is taken orally, smoked, snorted, or dissolved in water or alcohol and injected. Smoking or injecting the drug delivers it very quickly to the brain, where it produces an immediate, intense euphoria. Because the pleasure also fades quickly, users often take repeated doses, in a “binge and crash” pattern.

How Does Methamphetamine Affect the Brain?

Methamphetamine increases the amount of the neurotransmitter dopamine, leading to high levels of that chemical in the brain. 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 euphoric “rush” or “flash” that many users experience. Repeated methamphetamine use can easily lead to addiction—a chronic, relapsing disease characterized by compulsive drug seeking and use.

Is Meth a Prescription Drug?

Methamphetamine can be prescribed by a doctor to treat attention deficit hyperactivity disorder and other conditions, although it is rarely used medically, and only at doses much lower than those typically abused. It is classified as a Schedule II drug, meaning it has high potential for abuse and is available only through a prescription that cannot be refilled.

People who use methamphetamine long-term may experience anxiety, confusion, insomnia, and mood disturbances and display violent behavior. They may also show symptoms of psychosis, such as paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects crawling under the skin).

Chronic methamphetamine use is accompanied by chemical and molecular changes in the brain. Imaging studies have shown changes in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning. In studies of chronic methamphetamine users, severe structural and functional changes have been found in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in these individuals.

Some of these brain changes persist long after methamphetamine use is stopped, although some may reverse after being off the drug for a sustained period (e.g., more than 1 year).

How is Meth Made?

Most of the methamphetamine abused in the United States is manufactured in “superlabs” here or, more often, in Mexico. But the drug is also easily made in small clandestine laboratories, with relatively inexpensive over-the-counter ingredients such as pseudoephedrine, a common ingredient in cold medicines. To curb production of methamphetamine, pharmacies and other retail stores are required by law to keep logs of purchases of products containing pseudoephedrine; individuals may only purchase a limited amount of those products on a single day.

Methamphetamine production also involves a number of other, very hazardous chemicals. Toxicity from these chemicals can remain in the environment around a methamphetamine production lab long after the lab has been shut down, causing a wide range of health problems for people living in the area.

What Are the Other Health Effects of Methamphetamine?

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. These include increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and increased body temperature.

Long-term methamphetamine use has many negative consequences for physical health, including extreme weight loss, severe dental problems (“meth mouth”), and skin sores caused by scratching.

Methamphetamine use also raises the risk of contracting infectious diseases like HIV and hepatitis B and C. These can be contracted both by sharing contaminated drug injection equipment and through unsafe sex. Regardless of how it is taken, methamphetamine alters judgment and inhibition and can lead people to engage in these and other types of risky behavior.

Methamphetamine use may also worsen the progression of HIV/AIDS and its consequences. Studies indicate that HIV causes more injury to neurons and greater cognitive impairment in individuals who are HIV-positive and use methamphetamine than it does in HIV-positive people who do not use the drug.

DrugFacts: Prescription and Over-the-Counter Medications

Commonly Abused Drugs:

Commonly abused classes of prescription drugs include opioids (for pain), central nervous system (CNS) depressants (for anxiety and sleep disorders), and stimulants (for ADHD and narcolepsy).

Opioids include:

Fentanyl (Duragesic®)
Hydrocodone (Vicodin®)
Oxycodone (OxyContin®)
Oxymorphone (Opana®)
Propoxyphene (Darvon®)
Hydromorphone (Dilaudid®)
Meperidine (Demerol®)
Diphenoxylate (Lomotil®)

Central nervous system depressants include:

Pentobarbital sodium (Nembutal®)
Diazepam (Valium®)
Alprazolam (Xanax®)

Stimulants include:

Dextroamphetamine (Dexedrine®)
Methylphenidate (Ritalin® and Concerta®)
Amphetamines (Adderall®)

Statistics and Trends

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th Graders, 10th Graders, and 12th Graders; 2014 (in percent)*
Drug	Time Period	8th Graders	10th Graders	12th Graders
Any Prescription Drug	Past Year	-	-	[13.90]
Amphetamine	Past Year	4.30	7.60	8.10
Adderall	Past Year	1.30	4.60	6.80
Ritalin	Past Year	0.90	1.80	1.80
Cough Medicine (non-prescription)	Past Year	[2.00]	3.70	4.10
Narcotics other than Heroin	Past Year	-	-	[6.10]
Vicodin	Past Year	1.00	3.40	4.80
OxyContin	Past Year	[1.00]	3.00	3.30
Tranquilizers	Past Year	1.70	3.90	4.70

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, prescription and over-the-counter (OTC) drugs are, after marijuana (and alcohol), the most commonly abused substances by Americans 14 and older.

Past year illicit use among 12th graders, Marijuana 36.4%, Amphetamines 8.7%, Synthetic Marijuana 7.9%, Adderall 7.4%, Vicodin 5.3%, Cough med 5.0%, Tranquilizers 4.6%, Hallucinogens 4.5%, Sedatives 4.8%, Salvia 3.4%, Oxycontin 3.6%, MDMA 4.0%, Inhalants 2.5%, Cocaine 2.6%, Ritalin 2.3%

The classes of prescription drugs most commonly abused are: opioid pain relievers, such as Vicodin or Oxycontin; stimulants for treating Attention Deficit Hyperactivity Disorder (ADHD), such as Adderall, Concerta, or Ritalin; and central nervous system (CNS) depressants for relieving anxiety, such as Valium or Xanax.¹ The most commonly abused OTC drugs are cough and cold remedies containing dextromethorphan.

People often think that prescription and OTC drugs are safer than illicit drugs, but that’s only true when they are taken exactly 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 alcohol.

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 prescribed for somebody else. Unaware of the dangers of sharing medications, people often unknowingly contribute to this form of abuse by sharing their unused pain relievers with their family members.

Most teenagers who abuse prescription drugs are given them for free by a friend or relative.

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 powder. This hastens the entry of the drug into the bloodstream and the brain and amplifies its effects.

Graphic showing the spectrum of Prescription Drug Abuse from improper use to abuse: 1 Taking someone else's prescription to self-medicate. 2 Taking a prescription medication in a way other than prescribed. 3 Taking a medication to get high.

Taking a drug for another purpose than prescribed. All of the drug types mentioned 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 seeking to improve their academic performance. However, although they may boost alertness, there is little evidence they improve cognitive functioning for those without a medical condition.

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 symptoms aren’t present, they may affect the brain in ways very similar to illicit drugs.

For example, stimulants such as Ritalin achieve their effects by acting on the same neurotransmitter systems as cocaine. Opioid pain relievers such as OxyContin attach to the same cell receptors targeted by illegal opioids like heroin. Prescription depressants produce sedating or calming effects in the same manner as the club drugs GHB and rohypnol. And when taken in very high doses, dextromethorphan acts on the same cell receptors as PCP or ketamine, producing similar out-of-body experiences.

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 pathway. Repeatedly seeking to experience that feeling can lead to addiction.

What Are the Other Health Effects of Prescription and OTC Drugs?

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.

Opioids and Brain Damage

While the relationship between opioid overdose and depressed respiration (slowed breathing) has been confirmed, researchers are also studying the long-term effects on brain function. Depressed respiration can affect the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term psychological and neurological effects, including coma and permanent brain damage.

Researchers are also investigating the long-term effects of opioid addiction on the brain. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.

More people die from overdoses of prescription opioids than from all other drugs combined, including heroin and cocaine (see "The Prescription Opioid Abuse Epidemic" below).

The Prescription Opioid Abuse Epidemic

Over 2 million people in the United States suffer from substance use disorders related to prescription opioid pain relievers. The terrible consequences of this epidemic include overdose deaths, which have more than quadrupled in the past decade and a half. The causes are complex, but they include overprescription of pain medications. In 2013, 207 million prescriptions were written for prescription opioid pain medications.

Opiod deaths (per 100,000 population) by age group, 15-24 years old, Opioids 3.7, illegal drugs 2.2, 25-34 year olds, Opiods 7.1, Illegal 4.4, 35-44 year olds, Opiods 8.3, illiegal 5.3, 45-54 year olds, Opioids 10.4, Illegal 6, 55-64 year olds, Opioids 5, Illegal 2.5, over 65, Opiods 1, Illiegal .3

Stimulants can have strong effects on the cardiovascular system. Taking high doses of a stimulant can dangerously raise body temperature and cause irregular heartbeat or even heart failure or seizures. Also, taking some stimulants in high doses or repeatedly can lead to hostility or feelings of paranoia.

CNS depressants slow down brain activity and can cause sleepiness and loss of coordination. Continued use can lead to physical dependence and withdrawal symptoms if discontinuing use.

Prescription Opioid Abuse: A First Step to Heroin Use?

Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and research now suggests that abuse of these drugs may actually open the door to heroin abuse.

Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin. Some individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids.

Many of these young people also report that crushing prescription opioid pills to snort or inject the powder provided their initiation into these methods of drug administration.

Fentanyl

Brief Description

Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. It is a schedule II prescription drug.

Names

In its prescription form, fentanyl is known as Actiq, Duragesic, and Sublimaze. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.

Effects

Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain's reward areas, producing a state of euphoria and relaxation. Medications called opiate receptor antagonists act by blocking the effects of opiate drugs. Naloxone is one such antagonist. Overdoses of fentanyl should be treated immediately with an opiate antagonist.

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. However, the type of fentanyl associated with recent overdoses was produced in clandestine laboratories and mixed with (or substituted for) heroin in a powder form.

Mixing fentanyl with street-sold heroin or cocaine markedly amplifies their potency and potential dangers. Effects include: euphoria, drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, tolerance, and addiction.

DrugFacts: Salvia

Salvia (Salvia divinorum) is an herb in the mint family native to southern Mexico. It is used to produce hallucinogenic experiences.

Salvia, an herb common to southern Mexico, Central, and South America.

How Is Salvia Used?

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 in rolled cigarettes or pipes or vaporized and inhaled.

Although information about salvia is limited, its use may be driven in part by drug-related videos and information on Internet sites. Because of the nature of the drug’s effects—brief hallucinogenic experiences that mimic psychosis—it is more likely to be used in individual experimentation than as a social or party drug.

How Does Salvia Affect the Brain?

The main active ingredient in salvia, salvinorin A, is a potent activator of nerve cell targets called kappa opioid receptors. (These receptors differ from the receptors activated by commonly known opioid drugs such as heroin and morphine.) Although salvia is generally considered a hallucinogen, it does not act at serotonin receptors that are activated by other hallucinogens like LSD or psilocybin, and its effects are reported by experienced users to be different from those drugs.

Is Salvia Illegal?

Salvia currently is not a drug regulated by the Controlled Substances Act, but several States and countries have passed legislation to regulate its use.

Subjective effects of salvia use 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 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.

What Are the Other Health Effects of Salvia?

The psychological or physical health effects of salvia use have not been investigated systematically, and consequences of long-term use are not known. Experiments in rodents demonstrated deleterious effects of salvinorin A on learning and memory, but there is little evidence of salvia causing dependence or long-term psychiatric problems in humans.

DrugFacts: Anabolic Steroids

“Anabolic steroids” is the familiar name for synthetic variants of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids (abbreviated AAS)—“anabolic” referring to muscle-building and “androgenic” referring to increased male sexual characteristics.

Anabolic steroids can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS. But some athletes, bodybuilders, and others abuse these drugs in an attempt to enhance performance and/or improve their physical appearance.

How Are Anabolic Steroids Abused?

Anabolic steroids are usually either taken orally or injected into the muscles, although some are applied to the skin as a cream or gel. Doses taken by abusers may be 10 to 100 times higher than doses prescribed to treat medical conditions.

Steroids are typically taken intermittently rather than continuously, both to avert unwanted side effects and to give the body’s hormonal system a periodic chance to recuperate. Continuous use of steroids can decrease the body’s responsiveness to the drugs (tolerance) as well as cause the body to stop producing its own testosterone; breaks in steroid use are believed to redress these issues. “Cycling” thus refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a period of time and then restarted.

In addition, users often combine several different types of steroids and/or incorporate other steroidal or non-steroidal supplements in an attempt to maximize their effectiveness, a practice referred to as “stacking.”

How Do Anabolic Steroids Affect the Brain?

Anabolic steroids work very differently from other drugs of abuse, and they do not have the same acute effects on the brain. The most important difference is that steroids do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the rewarding “high” that drives the abuse of other substances.

However, long-term steroid use can affect some of the same brain pathways and chemicals—including dopamine, serotonin, and opioid systems—that are affected by other drugs, and thereby may have a significant impact on mood and behavior.

Abuse of anabolic steroids may lead to aggression and other psychiatric problems, for example. Although many users report feeling good about themselves while on steroids, extreme mood swings can also occur, including manic-like symptoms and anger (“roid rage”) that may lead to violence. Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Are Steroids Addictive?

Even though anabolic steroids do not cause the same high as other drugs, steroids are reinforcing and can lead to addiction. Studies have shown that animals will self-administer steroids when given the opportunity, just as they do with other addictive drugs. People may persist in abusing steroids despite physical problems and nega-tive effects on social relationships, reflecting these drugs’ addictive potential. Also, steroid abusers typically spend large amounts of time and money obtaining the drug—another indication of addiction.

Individuals who abuse steroids can experience withdrawal symptoms when they stop taking them—including mood swings, fatigue, rest-lessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression—when persistent, it can sometimes lead to suicide attempts. Research has found that some steroid abusers turn to other drugs such as opioids to counteract the negative effects of steroids.

What Are the Other Health Effects of Anabolic Steroids?

Steroid abuse may lead to serious, even irreversible, health problems. Some of the most dangerous consequences that have been linked to steroid abuse include kidney impairment or failure; damage to the liver; and cardiovascular problems including enlargement of the heart, high blood pressure, and changes in blood cholesterol leading to an increased risk of stroke and heart attack (even in young people).

Steroid use commonly causes severe acne and fluid retention, as well as several effects that are gender- and age-specific:

For men—shrinkage of the testicles (testicular atrophy), reduced sperm count or infertility, baldness, development of breasts (gynecomastia), increased risk for prostate cancer
For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes, and risk of not reaching expected height if steroid use precedes the typical adolescent growth spurt

In addition, people who inject steroids run the added risk of contracting or transmitting HIV/AIDS or hepatitis.

Print Charts: List of Most Commonly Abused Drugs (PDF)

DrugFacts: Cigarettes and Other Tobacco Products

Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 480,000 premature deaths in the United States each year—about 1 in every 5 U.S. deaths—and an additional 16 million people suffer with a serious illness caused by smoking. In fact, for every one person who dies from smoking, about 30 more suffer from at least one serious tobacco-related illness.¹

The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death. Each year, an estimated 88 million nonsmoking Americans are regularly exposed to secondhand smoke and almost 41,000 nonsmokers die from diseases caused by secondhand smoke exposure.^1-2

How Does Tobacco Affect the Brain?

Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over the period of about 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 pack (25 cigarettes) daily gets 250 “hits” of nicotine each day.

Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate.

Similar to other addictive drugs like cocaine and heroin, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.³

When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco. Treatments can help smokers manage these symptoms and improve the likelihood of successfully quitting.

What Other Adverse Effects Does Tobacco Have on Health?

Electronic Cigarettes

What Are They?

E-cigarettes are battery-operated devices that produce a flavored nicotine vapor that look like tobacco smoke.

Are They Safe?

Although e-cigarette vapor does not contain the tar currently responsible for most lung cancer and other lung diseases, it has been shown to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. E-cigarette products are not regulated by the FDA, so there are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown. NIDA is developing research programs to help answer these questions.

Can They Help People Quit Smoking Traditional Cigarettes?

Because they deliver nicotine without burning tobacco, e-cigarettes are thought by many to be a safer alternative to conventional cigarettes, and some people even think they may help smokers lower nicotine cravings while they are trying to quit smoking. However, studies of the effectiveness of e-cigarettes have not shown they help with smoking cessation. It has also been suggested that they could perpetuate the nicotine addiction and actually interfere with quitting.

Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. Smoking has also been linked to leukemia, cataracts, and pneumonia.^4-5On average, adults who smoke die 10 years earlier than nonsmokers.¹

Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Carbon monoxide increases the chance of cardiovascular diseases. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders.

Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birthweight.⁵Maternal smoking may also be associated with learning and behavioral problems in children. Smoking more than one pack of cigarettes per day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking.⁶

While we often think of medical consequences that result from direct use of tobacco products, passive or secondary smoke also increases the risk for many diseases. Secondhand smoke, also known as environmental tobacco smoke, consists of exhaled smoke and smoke given off by the burning end of tobacco products.

Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25–30 percent and lung cancer by 20–30 percent.⁷ In addition; secondhand smoke causes health problems in both adults and children, such as coughing, overproduction of phlegm, reduced lung function and respiratory infections, including pneumonia and bronchitis.. Each year about 150,000 – 300,000 children younger than 18 months old experience respiratory tract infections caused by secondhand smoke.⁷ Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, respiratory infections and death. In fact, more than 100,000 babies have died in the past 50 years from sudden infant death syndrome (SIDS), and other health complications as a result of parental smoking.⁸Children who grow up with parents who smoke are more likely to become smokers, thus placing themselves (and their future families) at risk for the same health problems as their parents when they become adults.

Although quitting can be difficult, the health benefits of smoking cessation are immediate and substantial—including reduced risk for cancers, heart disease, and stroke. A 35-year-old man who quits smoking will, on average, increase his life expectancy by 5 years.⁹

Are There Effective Treatments for Tobacco Addiction?

Tobacco addiction is a chronic disease that often requires multiple attempts to quit. Although some smokers are able to quit without help, many others need assistance. Both behavioral interventions (counseling) and medication can help smokers quit; but the combination of medication with counseling is more effective than either alone.

The U.S. Department of Health and Human Services’ (HHS) has established a national toll-free quitline, 800-QUIT-NOW, to serve as an access point for any smoker seeking information and assistance in quitting. NIDA’s scientists are looking at ways to make smoking cessation easier by developing tools to make behavioral support available over the internet or through text-based messaging. In addition, NIDA is developing strategies designed to help vulnerable or hard-to-reach populations quit smoking.

Behavioral Treatments

Behavioral treatments employ a variety of methods to help smokers quit, ranging from self-help materials to counseling. These interventions teach people to recognize high-risk situations and develop coping strategies to deal with them.

Nicotine Replacement Treatments

Nicotine replacement therapies (NRTs) were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. Current FDA-approved NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges. NRTs deliver a controlled dose of nicotine to a smoker in order to relieve withdrawal symptoms during the smoking cessation process. They are most successful when used in combination with behavioral treatments.

Other Medications

Bupropion and varenicline are two FDA-approved non-nicotine medications that have helped people quit smoking. Bupropion, a medication that goes by the trade name Zyban, was approved by the FDA in 1997, and Varenicline tartrate (trade name: Chantix) was approved in 2006. It targets nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people resume smoking.

Current Treatment Research

Scientists are currently developing new smoking cessation therapies. For example, they are working on a nicotine vaccine, which would block nicotine’s reinforcing effects by causing the immune system to bind to nicotine in the bloodstream preventing it from reaching the brain. In addition, some medications already in use might work better if they are used together. Scientists are looking for ways to target several relapse symptoms at the same time—like withdrawal, craving and depression.

How Widespread Is Tobacco Use?

Monitoring the Future Survey*

Current smoking rates among 8th-, 10th-, and 12th-grade students reached an all-time low in 2014. According to the Monitoring the Future survey, 4.0 percent of 8th-graders, 7.2 percent of 10th graders, and 13.6 percent of 12th-graders reported they had used cigarettes in the past month. Although unacceptably high numbers of youth continue to smoke, these numbers represent a significant decrease from peak smoking rates (21 percent in 8th-graders, 30 percent in 10th-graders, and 37 percent in 12th-graders) that were reached in the late 1990s.

The use of hookahs has also remained steady at high levels since its inclusion in the survey in 2010–past year use was reported by 22.9 percent of high school seniors. Meanwhile, past year use of small cigars has declined since 2010 yet remains high with 18.9 percent of 12^th graders reporting past year use. Past-month use of smokeless tobacco in 2014 was reported by 3.0 percent of 8th graders, 5.3 percent of 10th graders, and 8.4 percent of 12^th graders.

National Survey on Drug Use and Health (NSDUH)**

In 2013, 25.5 percent of the U.S. population age 12 and older used a tobacco product at least once in the month prior to being interviewed. This figure includes 2 million young people aged 12 to 17 (7.8 percent of this age group). In addition, almost 55.8 million Americans (21.3 percent of the population) were current cigarette smokers; 12.4 million smoked cigars; more than 8.8 million used smokeless tobacco; and over 2.3 million smoked tobacco in pipes.

Learn More

For additional information on tobacco abuse and addiction, please visit http://www.drugabuse.gov/drugs-abuse/tobacco-nicotine.

For more information on how to quit smoking, please visit www.smokefree.gov.

Data Sources

* These data are from the 2014 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, U.S. 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.

** 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, U.S. Department of Health and Human Services. This survey is available on line at www.samhsa.gov.

Treating Tobacco Use and Dependence Guidelines

U.S. PHS Clinical Practice Guideline Provides Roadmap on Treating Tobacco Use

In 2008, the U.S. Public Health Service released an updated Clinical Practice Guideline, Treating Tobacco Use and Dependence. The Guideline synthesizes more than 8,700 peer-reviewed articles and contains updated recommendations for clinicians, health systems, smokers and policymakers on successfully treating tobacco dependence.

The full Guideline, and other materials for clinicians and patients, is available at http://www.ahrq.gov/path/tobacco.htm

Also, Medscape is offering a free one-hour CME program based on the recommendations drawn from the updated Guideline. To access this free CME program, go to http://cme.medscape.com/viewprogram/17710

Other Web Sites

Online Guide to Quit Smoking (NCI)
NIDA for Teens
Transdisciplinary Tobacco Use Research Centers - NIDA, the National Cancer Institute, and the Robert Wood Johnson Foundation: Studying new ways to combat tobacco use
The Virtual Office of the Surgeon General - Guidelines to Quit Smoking
MEDLINEplus Health Information on Substance Abuse - National Library of Medicine, NIH
www.abovetheinfluence.com - Office of National Drug Control Policy
Healthfinder.gov

Emerging Trends

Revised May 2015

New drugs and drug use trends often burst on the scene rapidly. NIDA’S Community Epidemiology Work Group (CEWG), which functioned through 2014, was a network of researchers in major metropolitan areas and some states across the United States that reported data on emerging trends and patters of drug use. NIDA’s National Drug Early Warning System (NDEWS) replaces the CEWG and reports on emerging trends and patterns of drug use in many of the same metropolitan areas and states as the CEWG, but also reports data from other areas of the nation, as problems arise. On this page we will provide periodic updates based on NDEWS reports and other reliable information, as well as links for where to go for more information.

Related News Release

NIH system to monitor emerging drug trends (July 2014)

Increasing Overdoses From Synthetic Cannabinoids (“Spice,” "K2,” etc.) in Several States

Updated May 8, 2015

Recent surges in hospitalizations and calls to poison control centers linked to consumption of synthetic cannabinoid products--sold under brand names like “Spice,” “K2,” "No More Mr. Nice Guy," and others--are being reported in several southern and northeastern U.S. states and have prompted officials to issue health warnings. After a surge in synthetic cannabinoid exposures and poison center calls in April and May, 2015, the Maryland Poison Center issued an urgent notice about the dangers of these drugs. New York Governor Andrew Cuomo issued an alert after more than 160 patients were hospitalized following synthetic cannabinoid use in under two weeks in mid April, 2015.

Synthetic cannabinoids are chemically related to THC, the active ingredient in marijuana, and are sometimes called “synthetic marijuana” or “legal marijuana,” but actually the effects can be considerably more powerful and more dangerous than marijuana. Users can experience anxiety and agitation, nausea and vomiting, high blood pressure, shaking and seizures, hallucinations and paranoia, and they may act violently.

The Maryland notice lists several chemical compounds in materials from crime labs, including MAB-/AB-CHMINACA, FUBINACA, FUB-PB-22, and XLR11. Besides the brand names above, the New York State health alert lists other common names: Blonde, Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, Wicked X, AK-47; recent reports have involved products with the names Geeked Up, Ninja, Caution, Red Giant, and Keisha Kole.

For more information on synthetic cannabinoids, see DrugFacts: K2/Spice ("Synthetic Marijuana")

"Flakka" (alpha-PVP)

Updated April 6, 2015

Use of a dangerous synthetic cathinone drug called alpha-pyrrolidinopentiophenone (alpha-PDP), popularly known as "Flakka," is surging in Florida and is also being reported in other parts of the country, according to news reports.

image of bottle with white crystals pouring out

Alpha-PVP is chemically similar to other synthetic cathinone drugs popularly called "bath salts," and takes the form of a white or pink, foul-smelling crystal that can be eaten, snorted, injected, or vaporized in an e-cigarette or similar device. Vaporizing, which sends the drug very quickly into the bloodstream, may make it particularly easy to overdose. Like other drugs of this type, alpha-PVP can cause a condition called "excited delirium" that involves hyperstimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury. The drug has been linked to deaths by suicide as well as heart attack. It can also dangerously raise body temperature and lead to kidney damage or kidney failure.

U.S. and British Columbia Issue Alerts on Fentanyl

Updated March 18, 2015

The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the dangers of fentanyl and related compounds (fentanyl analogues). Fentanyl, an opioid that is 50-100 times more powerful than morphine, is both abused on its own and commonly added to heroin to increase its potency. Fentanyl and fentanyl-laced heroin have been a concern for over a decade and have caused numerous overdose deaths among injection drug users in several U.S. cities.

Heroin is not the only drug that can be laced with fentanyl, however. Officials in Vancouver, British Columbia, Canada, recently issued public warnings about a wide range of fentanyl-laced drugs causing overdose deaths among users. They warn that fentanyl is now being concealed in non-injection drugs, including oxycodone and various "party drugs" in powder or pill form, as well as in marijuana (although no deaths have been confirmed from fentanyl-laced marijuana). Because of this new threat, British Columbia officials are urging all recreational drug users to "know their source."

HIV Outbreak in Indiana Linked to Abuse of Opana

Posted February 27, 2015

Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases in the southeastern portion of the state that are linked to injection drug abuse of the powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in southeastern Indiana were transmitted sexually.

Officials advise that people in southeastern Indiana who have engaged in needle sharing or unprotected sex should get tested for HIV and then re-tested after 2-3 months, as HIV may not appear on tests immediately when the virus is contracted. To reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles, and having unprotected sex or sex with commercial sex workers.

Warning from Europe: "Superman" pills

Posted January 16, 2015

An alert was recently issued in The Netherlands warning about pills with a distinctive Superman logo, sold as MDMA (also called ecstasy or Molly) but actually containing a lethal dose of another substance, PMMA (paramethoxymethylamphetamine). These pills have not been reported in the U.S., but four people in the UK are thought to have died after taking these pills.

New Synthetic Cannabinoids—“Cloud 9,” “Mojo,” etc.

Posted November 13, 2014

Makers of designer drugs that are chemically similar to marijuana’s active ingredient THC—called synthetic cannabinoids or colloquially “synthetic marijuana” or “synthetic pot”—are constantly creating new products to evade legal bans on older compounds. Despite the similarity on the molecular level, these drugs are much more dangerous than marijuana, and have resulted in very serious health consequences including overdoses and aggressive or suicidal behavior in users.

Some new compounds have recently emerged that are sending many users to the hospital in cities around the country. They include:

AB-PINACA, AB-FUBINACA (sold as “Cloud 9,” “Relax,” or “Crown”) is sold as a liquid in eyedropper bottles and often used with vaporizing devices—e-cigarettes or “hookah pens.” Numerous hospitalizations in Michigan prompted the Macomb County Health Department to issue an emergency warning and ban on the sale of these drugs, which are reported to cause hallucinations, aggressive behavior, racing heartbeat, drowsiness, and vomiting.
MAB-CHMINACA, ADB-CHMINACA (sold as “Mojo,” “Spice,” “K2,” and “Scooby Snax”) resulted in over 150 hospital visits in Baton Rouge and Lafayette, LA in October, prompting the governor to ban the drug in that state. It is reported to cause severe agitation, anxiety, and paranoia; raised heartbeat and blood pressure; nausea and vomiting; muscle spasms, seizures, and tremors; intense hallucinations and psychotic episodes, including suicidal fixations and other harmful thoughts.

Read more about "K2" and "Spice" synthetic cannabinnoids

Caffeine Powder

Posted July 23, 2014

The death of an Ohio high school senior caused by an overdose of powdered caffeine has prompted the FDA to issue a safety advisory about caffeine powders. Bulk bags of pure caffeine powder are readily available online, and these products may be attractive to young people looking for added caffeine stimulation or for help losing weight, but they are extremely dangerous. Just a teaspoon of pure caffeine powder is equivalent to about 25 cups of coffee—a lethal amount. Besides death, severe caffeine overdose can cause fast and erratic heartbeat, seizures, vomiting, diarrhea, and disorientation—symptoms much more extreme than those of drinking too much coffee or tea or consuming too many sodas or energy drinks.

Although caffeine is generally safe at the dosages contained in popular beverages, caffeine powder is so potent that safe amounts cannot be measured with ordinary kitchen measuring tools, making it very easy to overdose on them even when users are aware of their potency. The FDA thus recommends that consumers avoid caffeine powder altogether, and wishes to alert parents to the existence of these products and their hazards.

Source: National Institute on Drug Abuse

Desomorphine (“crocodile”) injection among in-treatment drug users in Tbilisi, Georgia

Zura Sikharulidze

Z. Sikharulidze¹, N. Kapanadze¹, D. Otiashvili², S. Poole³, G.E. Woody³.¹Centre for Medical, Socio-economic and Cultural Issues–Uranti, Georgia; ²Addiction Research Center, Alternative Georgia, Georgia; ³Department of Psychiatry, School of Medicine, Treatment Research Institute, University of Pennsylvania, United States

Aims: Since 2010, use of the opiate desomorphine (“crocodile”) has increased dramatically in Georgia and neighboring countries. Crocodile is made in home-based laboratories and is relatively new on the drug scene; the risks associated with its use have not been studied. Here we present data on the prevalence and patterns of crocodile use among a recent cohort of patients admitted for drug treatment in the Uranti clinic in Tbilisi, Republic of Georgia.

Methods: A secondary analysis of medical records and interviews with patients was conducted.

Results: During the period 2011–2012, 220 patients (average age 32) were admitted to Uranti and 80% (n=160) reported using crocodile for an average period of 7 months. Crocodile was described as a highly toxic drug prepared from different ingredients, including codeine, iodine, gasoline, and phosphorus, which causes severe damage to soft tissues and neurological complications when injected. Patients described its effects as short lasting and requiring multiple injections that averaged three per day (range, 1–10). Group use of crocodile and sharing injection paraphernalia was reportedly widespread, as was combining crocodile with other drugs including methamphetamines (35%), and benzodiazepines and barbiturates (56%). During the study period, one case of a crocodile-related death caused by a pulmonary embolism was recorded as were three cases of HIV (1.3%); 85% of patients tested positive for hepatitis C virus on admission to treatment.

Conclusions: Crocodile injection and sharing of injection equipment associated with its use are becoming widespread and have significant health risks. Further research is needed to better understand the risks and consequences of crocodile injection and to develop effective interventions.

Abstract Year:

2013

Abstract Region:

Europe

Abstract Country:

Georgia

Source: NIDA

Emerging drug in Ukraine: “Crocodile” desomorphine

Pavlo Smyrnov

P. Smyrnov, S. Tatyana. International HIV/AIDS Alliance, Ukraine

Background: During a series of interviews with drug users conducted in July 2011 in Kyiv, Ukraine, many respondents mentioned desomorphine as a new popular street drug. Street desomorphine (named “crocodile”) is prepared by users from codeine-containing pills, red phosphorus, and iodine. This drug is very popular in neighboring Russia, but fewer reports on its use were received from Ukraine. We suggested that this drug already is being used by a considerable number of drug users in Ukraine, but this information was missed in the Behavior Surveillance Survey (BSS) since it is hidden under the general opiate category in the standard questionnaire.

Methods: To measure how prevalent this drug is among injecting drug users in Kyiv, as well as other cities of Ukraine, a particular question was included in the BSS conducted among injecting drug users in 26 cities in Ukraine. The prevalence of crocodile was calculated, and basic statistical analysis was conducted to understand how its use correlates with respondents’ sex and age, history of drug use, and other factors.

Results: The reported prevalence of the use of crocodile in the past 12 months was as high as 35.6%. At the same time, only 7 cities out of 26 reported use above an average of 5.6%. Its use correlated with age, being most popular among the 20–24 age group, and level of education.

Conclusion: Analysis of data from the BSS conducted in Ukraine in 2011 suggests that in the drug scene in Ukraine, crocodile has become a popular drug of choice; especially in some cities, it is important to monitor its use and adjust harm reduction interventions accordingly.

Abstract Year:

2012

Abstract Region:

Europe

Abstract Country:

Ukraine

Source: NIDA

Print Charts: List of Most Commonly Abused Drugs (PDF)

DrugFacts: High School and Youth Trends

2014’s Monitoring the Future survey of drug use and attitudes among American 8th, 10th, and 12th graders continued to show encouraging news about youth drug use, including decreasing use of alcohol, cigarettes, and prescription pain relievers; no increase in use of marijuana; decreasing use of inhalants and synthetic drugs, including K2/Spice and bath salts; and a general decline over the last two decades in the use of illicit drugs. However, the survey highlighted growing concerns over the high rate of e-cigarette use and softening of attitudes around some types of drug use, particularly decreases in perceived harm and disapproval of marijuana use.

Top Drugs among 8th and 12th Graders, Past Year Use

Alcohol

The 2014 survey showed continued declines in alcohol use by all grades. Nine percent of 8th graders, 23.5 percent of 10th graders, and 37.4 percent of 12th graders reported past-month use of alcohol, which was significantly lower than in 2009, when rates were 14.9 percent, 30.4 percent, and 43.5 percent, respectively. There was also a significant five-year drop in binge drinking (five or more drinks in a row in the previous 2 weeks) by seniors: 19.4 percent reported binge drinking in 2014, whereas 31.5 percent had reported the practice at its peak in 1998.

Tobacco and e-Cigarettes

Cigarette smoking by youth continues to drop and is currently at its lowest rate in the survey’s history. Only 1.4 percent of 8th graders reported smoking every day in 2014, compared to 2.7 percent in 2009; 3.2 percent of 10th graders reported smoking daily, compared to 4.4 percent in 2013 and 6.3 percent in 2009; and 6.7 percent of high school seniors reported smoking daily in 2014, down from 8.5 percent in 2013 and 11.2 percent in 2009. In 1997, at its peak, nearly a quarter of seniors were daily smokers.

However, other forms of tobacco remain popular. In 2014, past-year hookah use continued to increase among 12th graders to 22.9 percent—the highest rate since 2010, when the survey started capturing this type of tobacco use.

Also popular among teens is the use of e-cigarettes, which was measured for the first time in 2014. Use of e-cigarettes in the past 30 days was reported by 8.7 percent of 8th graders, 16.2 percent of 10th graders, and 17.1 percent of 12th graders. Only 14.2 percent of 12th graders view regular e-cigarette use as harmful. The nicotine in e-cigarettes is vaporized and inhaled (not smoked), but the health impact of e-cigarette use is not yet clear, nor do we know if e-cigarette use makes it more likely for people to use conventional cigarettes or other tobacco products. Survey findings show that while most e-cigarette users have also smoked conventional tobacco products, approximately 2.9 percent of 8th graders, 4.5 percent of 10th graders, and 3.8 percent of 12th graders who report past month use of e-cigarettes deny ever using tobacco cigarettes or smokeless tobacco.

Illicit Drugs

Use of any illicit drug has generally declined over the past two decades. Past-year use of illicit drugs for all grades combined was 27.2 percent in 2014, down from its peak at 34.1 percent in 1997. The MTF survey also shows a decline in the perceived availability of most substance over the past few years, including alcohol, cigarettes, marijuana, powder cocaine, crystal methamphetamine, and prescription painkillers.

Marijuana

Marijuana use remained stable in 2014, even though the percentage of youth perceiving the drug as harmful went down. Past-month use of marijuana remained steady among 8th graders at 6.5 percent, among 10th graders at 16.6 percent, and among 12th graders at 21.2 percent. Close to 6 percent of 12th graders report daily use of marijuana (similar to 2013), and 81 percent of them said the drug is easy to get. Among 8th graders, there was a drop in perceived availability in 2014, with 36.9 percent saying it is easy to get marijuana, compared to 39.1 percent in 2013.

Percent of Students Reporting Use of Marijuana in Past Year

Source: University of Michigan, 2014 Monitoring the Future Study

Although marijuana use has remained relatively stable over the past few years, there continues to be a shifting of teens’ attitudes about its perceived risks. The majority of high school seniors do not think occasional marijuana smoking is harmful, with only 36.1 percent saying that regular use puts the user at great risk, compared to 39.5 percent in 2013 and 52.4 percent in 2009. However, 56.7 percent of seniors say they disapprove of adults who smoke it occasionally, and 73.4 percent say they disapprove of adults smoking marijuana regularly.

Percent Perceiving Great Risk of Smoking Marijuana Regularly

Source: University of Michigan, 2014 Monitoring the Future Study

Marijuana use continues to exceed cigarette use in all three grade levels. In 2014, 21.2 percent of high school seniors had used marijuana in the past 30 days, whereas only 13.6 percent had smoked cigarettes.

Prescription and Over-the-Counter Drugs

Misuse and abuse (or “non-medical use”) of prescription and over-the-counter drugs continues to decline among the nation’s youth. Past-year use of the opioid pain reliever Vicodin has dropped significantly over the past 5 years; 4.8 percent of 12th graders used Vicodin for non-medical reasons in 2014, compared to 9.7 percent in 2009. Past-year use of narcotics other than heroin (which includes all opioid pain relievers) among high school seniors dropped from 7.1 percent in 2013 to 6.1 percent in 2014; 9.5 percent of seniors had reported past-year use of these drugs in 2004.

Past-year non-medical use of the stimulants Adderall and Ritalin (often prescribed for ADHD) remained relatively steady in 2014, at 6.8 percent and 1.8 percent respectively for high school seniors. The survey continues to show that most teens get these medicines from friends or relatives; a smaller percentage misuse or abuse pills that had been prescribed for them for a medical problem. Although teens did not misuse or abuse prescription stimulants at higher rates than in past years, there has been a decline in teens’ perceptions the risks of doing so. In 2014, 55.1 percent of seniors saw regularly taking prescription amphetamines as harmful, down from 69.0 percent in 2009.

In 2014, there was also a significant drop in the past-year use of cough/cold medicines containing dextromethorphan (DXM) among 8th graders, with only 2.0 percent using them for non-medical reasons, down from 2.9 percent in 2013 and 3.8 percent in 2009.

Other Illicit Drugs

Past-year use of MDMA (also known as ecstasy or “Molly”) saw a significant decline among 10th graders to 2.3 percent in 2014, from 3.6 percent in 2013 and 6.2 percent in 2001, when it peaked. Past-year use of heroin remained very low in all three grades despite increased use among adults over 26 years of age in 2013.¹

There has been a considerable decline in past-year use of synthetic cannabinoids (“K2/Spice,” sometimes misleadingly called “synthetic marijuana”) in the two years the survey has been tracking their use. Only 5.8 percent of 12th graders reported using K2/Spice in 2014, compared to 7.9 percent in 2013 and 11.3 percent in 2012. This was associated with an increase in the perceived risk of taking synthetic marijuana once or twice among 12th graders. Use of the hallucinogen salvia also dropped significantly among 12th graders in 2014 to 1.8 percent, from 3.4 percent in 2013.

Another harmful synthetic drug, bath salts (synthetic stimulants), was added to the survey in 2012; past-year use of bath salts remained low in 2014, and dropped considerably among 8th graders, to 0.5 percent, compared to 1 percent.

Inhalants

Current, past-year, and lifetime use of inhalants among 10th and 12th graders is at its lowest levels in the history of the survey. Rates of inhalant use are traditionally highest among the youngest adolescents (unlike most other drugs); in 2014, 5.3 percent of 8th graders reported using inhalants in the past year, down from 8.1 percent in 2009 and 12.8 percent in 1995, when use peaked.

Learn More

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.

About the Survey

Since 1975, the MTF survey has meas-ured 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 peri-ods: lifetime, past year, and past month. Overall, 41,551 students from 377 public and private schools in the 8th, 10th, and 12th grades participated in the 2014 survey.

The survey is funded by NIDA and con-ducted by the University of Michigan. Results from the survey are released each December.

Other sources of information on drug use trends among youth are available:

The annual National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration, gathers detailed data on drug, alcohol, and tobacco use by all age groups. It is a comprehensive source of information on substance use and dependence among Americans aged 12 and older. Data and reports can be found at www.samhsa.gov/data/population-data-nsduh.

The Youth Risk Behavior Survey is a school-based survey conducted every other year by the Centers for Disease Control and Prevention. It gathers data on a wide variety of health-related risk behaviors, including drug abuse, from students in grades 9 through 12. More information is available at www.cdc.gov/nccdphp/dash/yrbs/index.htm.

Reference

Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. HHS Publication No. (SMA) 14-4887. NSDUH Series H-49.

This page was last updated December 2014

Source: NIDA, NIH

Glossary

Addiction: A chronic, relapsing disease, characterized by compulsive drug seeking and use accompanied by neurochemical and molecular changes in the brain.

Agonist: A chemical compound that mimics the action of a natural neurotransmitter and binds to the same receptor on nerve cells to produce a biological response.

Antagonist: A drug that binds to the same nerve cell receptor as the natural neurotransmitter but does not activate the receptor, instead blocking the effects of another drug.

Buprenorphine: A partial opioid agonist for the treatment of opioid addiction that relieves drug cravings without producing the “high” or dangerous side effects of other opioids.

Craving: A powerful, often uncontrollable desire for drugs.

Detoxification: A process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal; often the first step in a drug treatment program.

Methadone: A long-acting opioid agonist medication shown to be effective in treating heroin addiction.

Naloxone: An opioid receptor antagonist that rapidly binds to opioid receptors, blocking heroin from activating them. An appropriate dose of naloxone acts in less than 2 minutes and completely eliminates all signs of opioid intoxication to reverse an opioid overdose.

Naltrexone: An opioid antagonist medication that can only be used after a patient has completed detoxification. Naltrexone is not addictive or sedating and does not result in physical dependence; however, poor patient compliance has limited its effectiveness. A new, long-acting form of naltrexone called Vivitrol^® is now available that is injected once per month, eliminating the need for daily dosing, improving patient compliance.

Neonatal abstinence syndrome (NAS): NAS occurs when heroin from the mother passes through the placenta into the baby’s bloodstream during pregnancy, allowing the baby to become addicted along with the mother. NAS requires hospitalization and treatment with medication (often a morphine taper) to relieve symptoms until the baby adjusts to becoming opioid-free.

Opioid: A natural or synthetic psychoactive chemical that binds to opioid receptors in the brain and body. Natural opioids include morphine and heroin (derived from the opium poppy) as well as opioids produced by the human body (e.g., endorphins); semi-synthetic or synthetic opioids include analgesics such as oxycodone, hydrocodone, and fentanyl.

Opioid use disorder: A problematic pattern of opioid drug use, leading to clinically significant impairment or distress that includes cognitive, behavioral, and physiological symptoms as defined by the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) criteria. Diagnosis of an opioid use disorder can be mild, moderate, or severe depending on the number of symptoms a person experiences. Tolerance or withdrawal symptoms that occur during medically supervised treatment are specifically excluded from an opioid use disorder diagnosis.

Partial agonist: A substance that binds to and activates the same nerve cell receptor as a natural neurotransmitter but produces a diminished biological response.

Physical dependence: An adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped; usually occurs with tolerance.

Rush: A surge of euphoric pleasure that rapidly follows administration of a drug.

Tolerance: A condition in which higher doses of a drug are required to produce the same effect as during initial use; often leads to physical dependence.

Withdrawal: A variety of symptoms that occur after use of an addictive drug is reduced or stopped.

Heroin

How does heroin use affect pregnant women?

Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent along with the mother. Symptoms include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting, and possibly death. NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms; the medication is gradually tapered off until the baby adjusts to being opioid-free. Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the outcomes associated with untreated heroin use for both the infant and mother, although infants exposed to methadone during pregnancy typically require treatment for NAS as well.

A recent NIDA-supported clinical trial demonstrated that buprenorphine treatment of opioid-dependent mothers is safe for both the unborn child and the mother. Once born, these infants require less morphine and shorter hospital stays as compared to infants born of mothers on methadone maintenance treatment.²⁴ Research also indicates that buprenorphine combined with naloxone (compared to a morphine taper) is equally safe for treating babies born with NAS, further reducing side effects experienced by infants born to opioid-dependent mothers.^25,26

Mothers' Buprenorphine Treatment During Pregnancy Benefits Infants

Mother's Buprenorphine treatment during pregnancy benefits infants
A NIDA-funded clinical trial found buprenorphine to be a safe and effective alternative to methadone for treating opioid dependence during pregnancy. Buprenorphine was also found to be effective in reducing neonatal abstinence syndrome in newborns born to opioid-dependent mothers.

What effects does heroin have on the body?

The greatest increase in heroin use is seen in young adults aged 18-25.

Heroin binds to and activates specific receptors in the brain called mu-opioid receptors (MORs). Our bodies contain naturally occurring chemicals called neurotransmitters that bind to these receptors throughout the brain and body to regulate pain, hormone release, and feelings of well-being.⁹ When MORs are activated in the reward center of the brain, they stimulate the release of the neurotransmitter dopamine, causing a sensation of pleasure.¹⁰ The consequences of activating opioid receptors with externally administered opioids such as heroin (versus naturally occurring chemicals within our bodies) depend on a variety of factors: how much is used, where in the brain or body it binds, how strongly it binds and for how long, how quickly it gets there, and what happens afterward.

What are the immediate (short-term) effects of heroin use?

Once heroin enters the brain, it is converted to morphine and binds rapidly to opioid receptors.¹¹ Abusers typically report feeling a surge of pleasurable sensation—a “rush.” The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the opioid receptors. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage.¹²

Brain image highlighting the limbic system, brain stem and spinal cord

Opioids Act on Many Places in the Brain and Nervous System

Opioids can depress breathing by changing neurochemical activity in the brain stem, where automatic body functions such as breathing and heart rate are controlled.
Opioids can increase feelings of pleasure by altering activity in the limbic system, which controls emotions.
Opioids can block pain messages transmitted through the spinal cord from the body.

What are the long-term effects of heroin use?

Repeated heroin use changes the physical structure¹³ and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed.^14,15 Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.^16-18 Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements. Major withdrawal symptoms peak between 24–48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months. Finally, repeated heroin use often results in addiction—a chronic relapsing disease that goes beyond physical dependence and is characterized by uncontrollable drug-seeking no matter the consequences.¹⁹ Heroin is extremely addictive no matter how it is administered, although routes of administration that allow it to reach the brain the fastest (i.e., injection and smoking) increase the risk of addiction. Once a person becomes addicted to heroin, seeking and using the drug becomes their primary purpose in life.

Why does heroin use create special risk for contracting HIV/AIDS and hepatitis B and C?

Heroin use increases the risk of being exposed to HIV, viral hepatitis, and other infectious agents through contact with infected blood or body fluids (e.g., semen, saliva) that results from the sharing of syringes and injection paraphernalia that have been used by infected individuals or through unprotected sexual contact with an infected person. Snorting or smoking does not eliminate the risk of infectious disease like hepatitis and HIV/AIDS because people under the influence of drugs still engage in risky sexual and other behaviors that can expose them to these diseases.

Injection drug users (IDUs) are the highest-risk group for acquiring hepatitis C (HCV) infection and continue to drive the escalating HCV epidemic: Each IDU infected with HCV is likely to infect 20 other people.²¹ Of the 17,000 new HCV infections occurring in the United States in 2010, over half (53 percent) were among IDUs.²² Hepatitis B (HBV) infection in IDUs was reported to be as high as 20 percent in the United States in 2010,²³ which is particularly disheartening since an effective vaccine that protects against HBV infection is available. There is currently no vaccine available to protect against HCV infection.

Drug use, viral hepatitis and other infectious diseases, mental illnesses, social dysfunctions, and stigma are often co-occuring conditions that affect one another, creating more complex health challenges that require comprehensive treatment plans tailored to meet all of a patient’s needs. For example, NIDA-funded research has found that drug abuse treatment along with HIV prevention and community-based outreach programs can help people who use drugs change the behaviors that put them at risk for contracting HIV and other infectious diseases. They can reduce drug use and drug-related risk behaviors such as needle sharing and unsafe sexual practices and, in turn, reduce the risk of exposure to HIV/AIDS and other infectious diseases. Only through coordinated utilization of effective antiviral therapies coupled with treatment for drug abuse and mental illness can the health of those suffering from these conditions be restored.

What are the medical complications of chronic heroin use?

Short- and Long-Term Effects of Heroin Use

Short-Term Effects

"Rush"
Depressed respiration
Clouded mental functioning
Nausea and vomiting
Suppression of pain
Spontaneous abortion

Long-Term Effects

Addiction
Infectious disease (e.g., HIV, hepatitis B and C)
Collapsed veins
Bacterial infections
Abscesses
Infection of heart lining and valves
Arthritis and other rheumatologic problems
Liver and kidney disease

No matter how they ingest the drug, chronic heroin users experience a variety of medical complications including insomnia and constipation. Lung complications (including various types of pneumonia and tuberculosis) may result from the poor health of the user as well as from heroin’s effect of depressing respiration. Many experience mental disorders such as depression and antisocial personality disorder. Men often experience sexual dysfunction and women’s menstrual cycles often become irregular. There are also specific consequences associated with different routes of administration. For example, people who repeatedly snort heroin can damage the mucosal tissues in their noses as well as perforate the nasal septum (the tissue that separates the nasal passages).

Medical consequences of chronic injection use include scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils), and other soft-tissue infections. Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

Sharing of injection equipment or fluids can lead to some of the most severe consequences of heroin abuse—infections with hepatitis B and C, HIV, and a host of other blood-borne viruses, which drug abusers can then pass on to their sexual partners and children.

What can be done for a heroin overdose?

Overdose is a dangerous and deadly consequence of heroin use. A large dose of heroin depresses heart rate and breathing to such an extent that a user cannot survive without medical help. Naloxone (e.g., Narcan^®) is an opioid receptor antagonist medication that can eliminate all signs of opioid intoxication to reverse an opioid overdose. It works by rapidly binding to opioid receptors, preventing heroin from activating them.²⁷ Because of the huge increase in overdose deaths from prescription opioid abuse, there has been greater demand for opioid overdose prevention services. Naloxone that can be used by nonmedical personnel has been shown to be cost-effective and save lives.²⁸ In April 2014, the U.S. Food and Drug Administration (FDA) approved a naloxone hand-held auto-injector called Evzio, which rapidly delivers a single dose of naloxone into the muscle or under the skin, buying time until medical assistance can arrive. Since Evzio can be used by family members or caregivers, it greatly expands access to naloxone.²⁹ NIDA and the FDA are working with drug manufacturers to support the development of nasal spray formulations of this live-saving medication.

In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) released an Opioid Overdose Prevention Toolkit in August 2013 that provides helpful information necessary to develop policies and practices to prevent opioid-related overdoses and deaths. The kit provides material tailored for first responders, treatment providers, and individuals recovering from an opioid overdose.

What are the treatments for heroin addiction?

A variety of effective treatments are available for heroin addiction, including both behavioral and pharmacological (medications). Both approaches help to restore a degree of normalcy to brain function and behavior, resulting in increased employment rates and lower risk of HIV and other diseases and criminal behavior. Although behavioral and pharmacologic treatments can be extremely useful when utilized alone, research shows that for some people, integrating both types of treatments is the most effective approach.

Pharmacological Treatment (Medications)

Scientific research has established that pharmacological treatment of opioid addiction increases retention in treatment programs and decreases drug use, infectious disease transmission, and criminal activity.

When people addicted to opioids first quit, they undergo withdrawal symptoms (pain, diarrhea, nausea, and vomiting), which may be severe. Medications can be helpful in this detoxification stage to ease craving and other physical symptoms, which often prompt a person to relapse. While not a treatment for addiction itself, detoxification is a useful first step when it is followed by some form of evidence-based treatment.

Medications developed to treat opioid addiction work through the same opioid receptors as the addictive drug, but are safer and less likely to produce the harmful behaviors that characterize addiction. Three types of medications include: (1) agonists, which activate opioid receptors; (2) partial agonists, which also activate opioid receptors but produce a smaller response; and (3) antagonists, which block the receptor and interfere with the rewarding effects of opioids. A particular medication is used based on a patient’s specific medical needs and other factors. Effective medications include:

Methadone (Dolophine^® or Methadose^®) is a slow-acting opioid agonist. Methadone is taken orally so that it reaches the brain slowly, dampening the “high” that occurs with other routes of administration while preventing withdrawal symptoms. Methadone has been used since the 1960s to treat heroin addiction and is still an excellent treatment option, particularly for patients who do not respond well to other medications. Methadone is only available through approved outpatient treatment programs, where it is dispensed to patients on a daily basis.
Buprenorphine (Subutex^®) is a partial opioid agonist. Buprenorphine relieves drug cravings without producing the “high” or dangerous side effects of other opioids. Suboxone^® is a novel formulation of buprenorphine that is taken orally or sublingually and contains naloxone (an opioid antagonist) to prevent attempts to get high by injecting the medication. If an addicted patient were to inject Suboxone, the naloxone would induce withdrawal symptoms, which are averted when taken orally as prescribed. FDA approved buprenorphine in 2002, making it the first medication eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. This approval eliminates the need to visit specialized treatment clinics, thereby expanding access to treatment for many who need it. In February 2013, FDA approved two generic forms of Suboxone, making this treatment option more affordable.
Naltrexone (Depade^® or Revia^®) is an opioid antagonist. Naltrexone blocks the action of opioids, is not addictive or sedating, and does not result in physical dependence; however, patients often have trouble complying with the treatment, and this has limited its effectiveness. An injectable long-acting formulation of naltrexone (Vivitrol^®) recently received FDA approval for treating opioid addiction. Administered once a month, Vivitrol^® may improve compliance by eliminating the need for daily dosing.

Behavioral Therapies

The many effective behavioral treatments available for heroin addiction can be delivered in outpatient and residential settings. Approaches such as contingency management and cognitive-behavioral therapy have been shown to effectively treat heroin addiction, especially when applied in concert with medications. Contingency management uses a voucher-based system in which patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living. Cognitive-behavioral therapy is designed to help modify the patient’s expectations and behaviors related to drug use and to increase skills in coping with various life stressors. An important task is to match the best treatment approach to meet the particular needs of the patient.

Source: NIDA, NIH

Print Charts

List of Most Commonly Abused Drugs (PDF)

More Information

Brief Description

Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. Alcohol is produced by the fermentation of yeast, sugars, and starches. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. A standard drink equals 0.6 ounces of pure ethanol, or 12 ounces of beer; 8 ounces of malt liquor; 5 ounces of wine; or 1.5 ounces (a "shot") of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey). NIDA does not conduct research on alcohol; for more information, please visit the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control (CDC).

Effects

Alcohol affects every organ in the drinker's body and can damage a developing fetus. Intoxication can impair brain function and motor skills; heavy use can increase risk of certain cancers, stroke, and liver disease. Alcoholism or alcohol dependence is a diagnosable disease characterized by a strong craving for alcohol, and/or continued use despite harm or personal injury. Alcohol abuse, which can lead to alcoholism, is a pattern of drinking that results in harm to one's health, interpersonal relationships, or ability to work.

Statistics and Trends

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Alcohol for 8th Graders, 10th Graders, and 12th Graders; 2014 (in percent)*
Drug	Time Period	8th Graders	10th Graders	12th Graders
Alcohol	Lifetime	26.80	[49.30]	[66.00]
	Past Year	20.80	[44.00]	60.20
	Past Month	9.00	[23.50]	37.40

Swipe left or right to scroll.

National Survey on Drug Use and Health: Trends in Prevalence of Alcohol for Ages 12 or Older, Ages 12 to 17, Ages 18 to 25, and Ages 26 or Older; 2013 (in percent)*
Drug	Time Period	Ages 12 or Older	Ages 12 to 17	Ages 18 to 25	Ages 26 or Older
Alcohol	Lifetime	[81.50]	30.80	83.80	87.30
	Past Year	66.30	[24.60]	76.80	69.60
	Past Month	52.20	[11.60]	59.60	55.90

^ indicate low precision; no estimate reported.
Data in brackets indicate statistically significant change from the previous year. Previous NSDUH Data

DrugFacts: Synthetic Cathinones (“Bath Salts”)

Revised November 2012

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.

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”—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.”

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 3,4-methylenedioxypyrovalerone (MDPV), mephedrone (“Drone,” “Meph,” or “Meow Meow”), and methylone, but there are many others. Much is still unknown 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 norepinephrine 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.

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.”

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/publications/drug-profiles/synthetic-cathinones

DrugFacts: Club Drugs (GHB, Ketamine, and Rohypnol)

Revised December 2014

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 DrugFacts) 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.
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.

How Do Club Drugs Affect the Brain?

GHB acts on at least two sites in the brain: the GABA_B 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 GABA_A 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 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.
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.

What Treatment Options 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
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?

Monitoring the Future (MTF) Survey*

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 2014 MTF survey, 1.0 percent of 12th-grade students reported past-year use of GHB, a statistically significant decrease from peak-year use of 2.0 percent in 2004. GHB use among 8^th- and 10th-grade students was not reported.

Past-year use of ketamine was reported by 1.5 percent of 12th-graders in 2014. This also represents a significant decrease from the peak year of 2002, in which 2.6 percent reported past-year use.

For Rohypnol, 0.3 percent of 8th-graders, 0.5 percent of 10th-graders, and 0.7 percent of 12th-graders 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 12th-graders (1.6 percent).

Learn More

For additional information about club drugs, visit www.drugabuse.gov/drugs-abuse/club-drugs.

Data Sources

* These data are from the 2014 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, U.S. 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.

DrugFacts: Cocaine

Revised April 2013

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. It produces short-term euphoria, energy, and talkativeness in addition to potentially dangerous physical effects like raising heart rate and blood pressure.

Cocaine pile

How Is Cocaine Used?

The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream.

Crack is a form of cocaine that has been processed to make a rock crystal (also called “freebase cocaine”) that can be smoked. The crystal is heated to produce vapors that are absorbed into the blood-stream through the lungs. (The term “crack” refers to the crackling sound produced by the rock as it is heated.)

The intensity and duration of cocaine’s pleasurable effects depend on the way it is administered. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes; the high from smoking may last 5 to 10 minutes.

In order to sustain their high, people who use cocaine often use the drug in a binge pattern—taking the drug repeatedly within a relatively short period of time, at increasingly higher doses. This practice can easily lead to addiction, a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.

How Does Cocaine Affect the Brain?

Cocaine is a strong central nervous system stimulant that increases levels of the neurotransmitter dopamine in brain circuits regulating pleasure and movement.

Normally, dopamine is released by neurons in these circuits in response to potential rewards (like the smell of good food) and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine prevents the dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. This amplifies the dopamine signal and ultimately disrupts normal brain communication. It is this flood of dopamine that causes cocaine’s characteristic high.

With repeated use, cocaine can cause long-term changes in the brain’s reward system as well as other brain systems, which may lead to addiction. With repeated use, tolerance to cocaine 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 their high, but this can also increase the risk of adverse psychological or physiological effects.

What Are the Other Health Effects of Cocaine?

Cocaine affects the body in a variety of ways. It constricts blood vessels, dilates pupils, and 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.

Most seriously, people who use cocaine can suffer heart attacks or strokes, which may cause sudden death. Cocaine-related deaths are often a result of the heart stopping (cardiac arrest) followed by an arrest of breathing.

People who use cocaine also put themselves at risk for contracting HIV, even if they do not share needles or other drug paraphernalia. This is because cocaine intoxication impairs judgment and can lead to risky sexual behavior.

Some effects of cocaine depend on the method of taking it. Regular 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 by the mouth 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, hepatitis C, 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.

Cocaine is more dangerous when combined with other drugs or alcohol (poly-drug use). For example, the combination of cocaine and heroin (known as a “speedball”) carries a particularly high risk of fatal overdose.

DrugFacts: Hallucinogens - LSD, Peyote, Psilocybin, and PCP

Revised December 2014

Hallucinogenic compounds found in some plants and mushrooms (or their extracts) have been used—mostly during religious rituals—for centuries. Almost all hallucinogens contain nitrogen and are classified as alkaloids. Many hallucinogens have chemical structures similar to those of natural neurotransmitters (e.g., acetylcholine-, serotonin-, or catecholamine-like). While the exact mechanisms by which hallucinogens exert their effects remain unclear, research suggests that these drugs work, at least partially, by temporarily interfering with neurotransmitter action or by binding to their receptor sites. This DrugFacts will discuss four common types of hallucinogens:

LSD (d-lysergic acid diethylamide) is one of the most potent mood-changing chemicals. It was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.
Peyote is a small, spineless cactus in which the principal active ingredient is mescaline. This plant has been used by natives in northern Mexico and the southwestern United States as a part of religious ceremonies. Mescaline can also be produced through chemical synthesis.
Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is obtained from certain types of mushrooms that are indigenous to tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance.
PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its use has since been discontinued due to serious adverse effects.