Gary L Fisher. Encyclopedia of Substance Abuse Prevention, Treatment, and Recovery. Editor: Gary L Fisher & Nancy A Roget. Volume 1. Sage Publications, 2009.
Although there are different methods that are used to classify drugs, the most common scheme groups drugs by their pharmacological similarity. However, this scheme does not work well for “club drugs,” which are discussed as a separate classification. This entry describes, for each drug classification, the common drugs contained in the classification, some common street names, major effects, signs of intoxication, signs of overdose, tolerance, withdrawal, and acute and chronic effects. It should be noted that the term drugs includes both legal and illegal mood-altering substances.
Central Nervous System Depressants
Central nervous system (CNS) depressants (also referred to as sedative-hypnotics) depress the overall functioning of the CNS to induce sedation, drowsiness, and coma. The drugs in this classification include the most commonly used and abused psychoactive drug, alcohol; prescription drugs used for anxiety, sleep disturbance, and seizure control; and over-the-counter medications for sleep disturbance, colds and allergies, and coughs. In general, CNS depressants are extremely dangerous. According to the Centers for Disease Control, excessive alcohol consumption is the third-leading cause of preventable death in the United States. Alcohol in combination with other drugs accounted for about one third of drug abuse-related emergency room episodes in 2005.
Drugs in This Classification
Alcohol is the best-known CNS depressant because of its widespread use and legality. The alcohol content of beer is generally 3% to 6%; wine, 11% to 20%; liqueurs, 25% to 35%; and liquor (whiskey, gin, vodka, etc.), 40% to 50%. Barbiturates are prescription drugs used to aid sleep for insomniacs and for the control of seizures. These drugs include Seconal (reds, red devils), Nembutal (yellows, yellow jackets), Tuinal (rainbows), Amytal (blues, blue heaven), and phenobarbital. There are also nonbarbiturate sedative-hypnotics with similar effects but with different pharmacological properties. These include Doriden (goodballs), Quaalude (ludes), Miltown, and Equinil.
The development of benzodiazepines, or minor tranquilizers, reduced the number of prescriptions for barbiturates written by physicians. These drugs were initially seen as safe and having little abuse potential. Although the minor tranquilizers cannot be used easily in suicide as can barbiturates, the potential for abuse is significant. The benzodiazepines are among the most widely prescribed drugs and include Valium, Librium, Dalmane, Halcion, Xanax, and Ativan.
Finally, certain over-the-counter medications contain depressant drugs. Sleep aids such as Nytol and Sominex, cold and allergy products, and cough medicines may contain scopolamine, antihistamines, or alcohol to produce the desired effects.
Major Effects
The effects of CNS depressants are related to the dose, method of administration, and tolerance of the individual. At low doses, these drugs produce a feeling of relaxation and calmness. They induce muscle relaxation, disinhibition, and a reduction in anxiety. Judgment and motor coordination are impaired, and there is a decrease in reflexes, pulse rate, and blood pressure. At high doses, the person demonstrates slurred speech, staggering, and, eventually, sleep. phenobarbital and Valium have anticonvulsant properties and are used to control seizures. Benzodiazepines are also used to clinically control the effects from alcohol withdrawal.
Overdose
Alcohol overdose (being “drunk”) is common. The symptoms include staggering, slurred speech, extreme disinhibition, and blackouts (an inability to recall events that occurred when the individual was intoxicated). Generally, the stomach goes into spasm, and the person will vomit, helping to eliminate alcohol from the body. However, the rapid ingestion of alcohol, particularly in a nontolerant individual, may result in coma and death. This happens most frequently with young people who participate in drinking contests.
As these drugs depress the central nervous system, overdose is extremely dangerous and can be fatal. Since the fatal dosage is only 10 to 15 times the therapeutic dosage, barbiturates are often used in suicides, which is one reason they are not frequently prescribed. It is far more difficult to overdose on the minor tranquilizers. However, CNS depressants have a synergistic or potentiation effect, meaning that the effect of a drug is enhanced as a result of the presence of another drug. For example, if a person has been drinking and then takes a minor tranquilizer such as Xanax, the effect of the Xanax may be dramatically enhanced. This combination has been the cause of many accidental deaths and emergency room visits.
Tolerance
There is a rapid development of tolerance to all CNS depressant drugs. Cross-tolerance also develops. This is one reason why overdose is such a problem. The tolerance that develops to the CNS depressants is also one reason that the use of the minor tranquilizers has become problematic. People are given prescriptions to alleviate symptoms such as anxiety and sleep disturbance that are the result of other problems such as marital discord. The minor tranquilizers temporarily relieve the symptoms, but the real problem is never addressed. The person continues to use the drug to alleviate the symptoms but tolerance develops and increasing dosages must be used to achieve the desired effect. This is a classic paradigm for the development of addiction, overdose, or both.
Withdrawal
The withdrawal syndrome from CNS depressants can be medically dangerous. These symptoms may include anxiety, irritability, loss of appetite, tremors, insomnia, and seizures. In the severe form of alcohol withdrawal, called delirium tremens (DTs), additional symptoms are fever, rapid heartbeat, and hallucinations. People can and do die from the withdrawal from these drugs. Therefore, the detoxification process for CNS depressants should include close supervision and the availability of medical personnel. Chronic, high-dosage users of these drugs should be discouraged from detoxifying without support and supervision. For detoxification in a medical setting, minor tranquilizers can be used, in decreasing dosages, to reduce the severity of the withdrawal symptoms.
Acute and Chronic Effects
In terms of damage to the human body and to society, alcohol is the most dangerous psychoactive drug (tobacco causes far more health damage). Alcohol has a damaging effect on every organ system. Chronic effects include permanent loss of memory, gastritis, esophagitis, ulcers, pancreatitis, cirrhosis of the liver, high blood pressure, weakened heart muscles, and damage to a fetus, including fetal alcohol syndrome. Other chronic effects include family, social, occupational, and financial problems. Acutely, alcohol is the cause of many traffic and other accidents and is involved in many acts of violence and crime. The yearly monetary cost to the United States attributable to alcohol is estimated to be more than $200 billion based on a report prepared for the National Institute on Alcohol Abuse and Alcoholism.
Certainly, the other CNS depressants can cause the same acute problems that are the result of injury and accident and chronic effects on the individual and family due to addiction.
Central Nervous System Stimulants
CNS stimulants affect the body in the opposite manner as do the CNS depressants. These drugs increase respiration, heart rate, motor activity, and alertness. This classification includes highly dangerous, illegal substances such as crack cocaine, medically useful stimulants such as Ritalin, drugs with relatively minor psychoactive effects such as caffeine, and the most deadly drug used, nicotine. Cocaine was mentioned in 55% of the drug abuse-related emergency room episodes.
Drugs in This Classification
Cocaine (coke, blow, toot, snow) and the freebase or smokeable forms of cocaine (crack, rock, base) are the most infamous of the CNS stimulants. Cocaine is found in the leaves of the coca shrub that grows in Central America and South America. The leaves are processed and produce coca paste. The paste, in turn, is processed to form the white hydrochloride salt powder most people know as cocaine. Of course, before it is sold on the street, it is adulterated or “cut” with substances such as powdered sugar, talc, arsenic, lido-caine, strychnine, or methamphetamine. Crack is produced by mixing the cocaine powder with baking soda and water and heating the solution. The paste that forms is hardened and cut into hard pieces or rocks. The mixing and heating process removes most of the impurities from the cocaine. The vaporization point is lowered so the cocaine can be smoked, reaching the brain in one heartbeat less than if it is injected. Therefore, crack is a more pure form of cocaine than is cocaine hydrochloride salt powder.
Amphetamines are also CNS stimulants, and one form in particular, methamphetamine, is a major drug of addiction. The amphetamines include Benzedrine (crosstops, black beauties), Methedrine or methamphetamine (crank, meth, crystal), and Dexedrine (dexies). There are also nonamphetamine stimulants with similar properties such as Ritalin and Cylert (used in the treatment of attention deficit hyperactivity disorder) and Preludin (used in the treatment of obesity). These drugs are synthetics (not naturally occurring), and the amphetamines were widely prescribed in the 1950s and 1960s for weight control.
Some forms of CNS stimulants are available without a prescription and are contained in many substances used on a regular basis. Caffeine is found in coffee, teas, colas, and chocolate, as well as in some over-the-counter products designed to help people stay awake (e.g., NoDoz, Alert, Vivarin). Phenylpropanolamine is a stimulant found in diet-control products sold over the counter (e.g., Dexatrim). These products are abused by individuals who chronically diet (e.g., individuals with anorexia).
Although it has mild euphoric properties, nicotine is the highly addictive stimulant drug found in tobacco products. According to the Centers for Disease Control and Prevention, an estimated 440,000 Americans die each year from smoking-related illnesses.
Major Effects
The uses of CNS stimulants have an interesting history. As many people know, Sigmund Freud wrote “Uber Coca,” which described the use of cocaine to treat a number of medical problems. Originally, Coca-Cola contained cocaine. In the 1980s, cocaine was depicted in the popular press as a relatively harmless drug. Amphetamines were used in World War II to combat fatigue and were issued by the U.S. Armed Forces during the Korean War. These drugs have a long history of use by long-distance truck drivers, students cramming for exams, and women trying to lose weight.
As with most of the psychoactive drugs, some of the CNS stimulants (cocaine and amphetamines) have a recreational use. The purpose is to “get high,” or to experience a sense of euphoria. Amphetamine and cocaine users report a feeling of self-confidence and self-assurance. There is a “rush” that is experienced, particularly when cocaine is smoked and when cocaine and methamphetamine are injected. The high from amphetamines is generally less intense but longer acting than the high from cocaine.
CNS stimulants result in psychomotor stimulation, alertness, and elevation of mood. There is an increase in heart rate and blood pressure. Performance may be enhanced with increased activity level, one reason why athletes use CNS stimulants. These drugs also suppress appetite and combat fatigue.
Overdose
CNS stimulants activate the reward center of the brain. The most powerful of these drugs result in the body’s not experiencing hunger, thirst, or fatigue. There is no built-in satiation point, so humans can continue using cocaine and amphetamines until there are no more or they die. Therefore, the compulsion to use, the desire to maintain the high, and the unpleasantness of withdrawal make overdose fairly common. There may be tremors, sweating and flushing, rapid heartbeat (tachycardia), anxiety, insomnia, paranoia, convulsions, heart attack, or stroke. Death from overdose has been widely publicized because it has occurred with some famous movie stars, musicians, and athletes. However, far more people experience chronic problems from CNS stimulant addictions than from overdose reactions.
Tolerance
There is a rapid tolerance to the pleasurable effects of cocaine and amphetamines and the stimulating effects of tobacco and caffeine. If you drink five or six cups a day of combinations of coffee, tea, and colas, you probably know this with regard to caffeine. You will find that if you stop using caffeine for a couple of weeks and then start again, the initial doses of caffeine produce a minor “buzz,” alertness, or restlessness.
The rapid tolerance to the euphoric effects of cocaine and amphetamines leads to major problems with these drugs. The pleasurable effects are so rewarding, particularly when the drugs are smoked or injected, that the user is prone to compulsively use in an effort to recapture the euphoric effects. When injected or smoked, the effects are enhanced but of relatively short duration. Continual use to achieve the high leads to rapid tolerance. The user is then unable to feel the pleasure but must continue to use the drug to reduce the pain of withdrawal.
A sensitization or reverse tolerance can occur, particularly with cocaine. In this instance, a chronic user with a high tolerance has an adverse reaction (i.e., seizure) to a low dose.
Withdrawal
Unlike the withdrawal from CNS depressants, the withdrawal from CNS stimulants is not medically dangerous. However, it is extremely unpleasant. The withdrawal from cocaine and amphetamines is called “crashing.” The severe symptoms usually last 2 to 3 days and include intense drug craving, irritability, depression, anxiety, and lethargy. However, the depression, drug craving, and an inability to experience pleasure may last for several months as the body chemistry returns to normal. Suicidal ideation and attempts are frequent during this time, as are relapses. Recovering cocaine and amphetamine addicts can become very discouraged with the slow rate of the lifting of depression; therefore, support is very important during this time.
Acute and Chronic Effects
As previously stated, the acute effects of CNS stimulants can be dramatic and fatal. These effects include heart attacks, strokes, seizures, and respiratory depression. However, the results of chronic use cause the most problems. The addictive properties of these drugs are extremely high. Individuals with addictions to cocaine and amphetamines spend a tremendous amount of money to obtain drugs, and they encounter serious life problems related to their addiction. Also, there is an increased risk of strokes and cardiovascular problems, depression, and suicide in chronic users. Symptoms of paranoid schizophrenia can occur. If cocaine or amphetamines are snorted, perforation of the nasal septum can occur. Injection of CNS stimulants has the same risks (e.g., hepatitis, AIDS) as injecting other drugs. Because these drugs suppress appetite, chronic users are frequently malnourished.
Opioids
The opioids are naturally occurring (opium poppy extracts) and synthetic drugs that are commonly used for their analgesic (pain relief) and cough-suppressing properties. Opium was used by early Egyptian, Greek, and Arabic cultures for the treatment of diarrhea because of its constipating effect. Greek and Roman writers such as Homer and Virgil wrote of the sleep-inducing properties of opium, and recreational use of the drug in these cultures did occur. Morphine was isolated from opium in the early 1800s and was widely available without prescription until the early 1900s when the nonmedicai use of opioids was banned. Opioids accounted for 20% of drug abuse-related emergency room episodes in 2005.
Drugs in This Classification
The opioids include opium, codeine, morphine, heroin (smack, horse), Vicodin, Dilaudid, OxyContin, Percodan, methadone, Darvon, Demerol, Talwin, buprenorphine, and levo-alpha acetyl methadol ([LAAM] long-acting methadone).
Major Effects
Opioids have medically useful effects including pain relief, cough suppression, and constipation. Obviously, there is also a euphoric effect that accounts for the recreational use of these drugs. They can produce nausea and vomiting and itching. A sedating effect occurs, and the pupils of the eyes become constricted.
Methadone, or Dolophine, is a synthetic opioid that does not have the dramatic euphoric effects of heroin, has a longer duration of action (12 to 24 hours compared with 3 to 6 hours for heroin), and blocks the symptoms of withdrawal when heroin is discontinued. This is the reason for the use of methadone in the treatment of opioid addiction. The action of LAAM has an even longer duration. Buprenorphine is now being prescribed in an office setting to treat opioid dependence.
Overdose
Death from overdose of injectable opioids (usually heroin) can occur from the direct action of the drug on the brain, resulting in respiratory depression. Death can also occur from an allergic reaction to the drug or to substances used to cut it, possibly resulting in cardiac arrest. Overdose of other drugs in this classification may include symptoms such as slow breathing rate and decreased blood pressure, pulse rate, temperature, and reflexes. The person may become extremely drowsy and lose consciousness. There may be flushing and itching skin, abdominal pain, and nausea and vomiting.
Tolerance
Frequency of administration and dosage of opioids is related to the development of tolerance. Tolerance develops rapidly when the drugs are repeatedly administered but does not develop when there are prolonged periods of abstinence. The tolerance that does develop is to the euphoric, sedative, analgesic, and respiratory effects of the drugs. This tolerance results in the individual’s using doses that would kill a non-tolerant person. The tolerant individual becomes accustomed to using high doses, which accounts for death due to overdose in longtime opioid users who have been detoxified and then go back to using.
Cross-tolerance to natural and synthetic opioids does occur. However, there is no cross-tolerance to CNS depressants. This fact is important, because the combination of moderate to high doses of opioids and alcohol or other CNS depressants can (and often does) result in respiratory depression and death.
Withdrawal
When these drugs are used on a continuous basis, there is a rapid development of physical dependence. Withdrawal symptoms are unpleasant and uncomfortable but rarely dangerous. The symptoms are analogous to a severe case of the flu, with running eyes and nose, restlessness, goose bumps, sweating, muscle cramps or aching, nausea, vomiting, and diarrhea. There is significant drug craving. These symptoms rapidly dissipate when opioids are taken, which accounts for relapse when a person abruptly quits on his or her own (“cold turkey”). When the drugs are not available to the dependent individual, the unpleasant withdrawal symptoms also result in participation in criminal activities in order to purchase the drugs.
Acute and Chronic Effects
There is an acute danger of death from overdose from injecting opioids, particularly heroin. Also, the euphoric effects of opioids rapidly decrease as tolerance increases, and as this tolerance occurs, the opioid use is primarily to ward off the withdrawal symptoms.
Compared with the chronic use of CNS depressants, chronic use of opioids is less dangerous to the body. However, the route of administration and the lifestyle associated with chronic opioid use clearly has serious consequences. Obviously, there is the risk of communicable disease from the intravenous use of opioids and sharing needles. The lifestyle of heroin addicts often includes criminal activity to secure enough money to purchase heroin. Women may participate in prostitution, which adds the associated risks of diseases and violence. Nutrition is frequently neglected. However, those individuals who have been involved in methadone maintenance programs for long periods do not experience negative health consequences from the use of methadone (which is taken orally).
Hallucinogens
Many of the hallucinogens are naturally occurring and have been used for thousands of years. Some have been (and are currently) used as sacraments in religious rites and have been ascribed with mystical and magical properties. Today, many types of hallucinogens are synthetically produced in laboratories. Some of the hallucinogens became very popular in the 1960s and 1970s, with a drop in use in the 1980s. While there was a resurgence of use from 1992 to 2001 among youth, recent surveys have shown the lowest use of hallucinogens since the surveys were started in 1975.
Drugs in This Classification
This classification comprises a group of heterogeneous compounds. Although there may be some commonality in terms of effect, the chemical structures are quite different. The hallucinogens include LSD (acid, fry), psilocybin (magic mushrooms, shrooms), morning glory seeds (heavenly blue), mescaline (mese, big chief, peyote), STP (serenity, tranquility, peace), and PCP (angel dust, hog). PCP is used as a veterinary anesthetic, primarily for primates.
Major Effects
These drugs produce an altered state of consciousness, including altered perceptions of visual, auditory, olfactory, and/or tactile senses and an increased awareness of inner thoughts and impulses. Sensory experiences may cross into one another (e.g., hearing color). Common sights and sounds may be perceived as exceptionally intricate and astounding. In the case of PCP, there may be increased suggestibility, delusions, and depersonalization and dissociation. Physiologically, hallucinogens produce a rise in pulse and blood pressure.
Overdose
With the exception of PCP, the concept of “overdose” is not applicable to the hallucinogens. “Bad trips” or panic reactions occur and may include paranoid ideation, depression, undesirable hallucinations, and/or confusion; these effects usually are managed by providing a calm and supportive environment. An overdose of PCP may result in acute intoxication, acute psychosis, or coma. In acute intoxication or psychosis, the person may be agitated, confused, and excited and may exhibit a blank stare and violent behavior. Analgesia (insensibility to pain) occurs, which may result in self-inflicted injuries and injuries to others when attempts are made to restrain the individual.
Tolerance
Tolerance to the hallucinogenic properties of these drugs occurs, as well as cross-tolerance between LSD and other hallucinogens. No cross-tolerance to cannabis has been demonstrated. Tolerance to PCP has not been demonstrated in humans.
Withdrawal
There is no physical dependence that occurs from the use of hallucinogens, although psychological dependence, including drug craving, does occur.
Acute and Chronic Effects
A fairly common and well-publicized adverse effect of hallucinogens is the experience of flashbacks. Flashbacks are the recurrence of the effects of hallucinogens long after the drug has been taken. Reports of flashbacks more than 5 years after taking a hallucinogen have been reported, although abatement after several months is more common.
With regard to LSD, there are acute physical effects, including a rise in heart rate and blood pressure, higher body temperature, dizziness, and dilated pupils. Mental effects include sensory distortions, dreaminess, depersonalization, altered mood, and impaired concentration. “Bad trips” involve acute anxiety, paranoia, fear of loss of control, and delusions. Individuals with preexisting mental disorders may experience more severe symptoms. With regard to chronic effects, the rare but frightening experience of flashbacks may occur. PCP use results in significant adverse effects. Chronic use may result in psychiatric problems, including depression, anxiety, and paranoid psychosis. Accidents, injuries, and violence occur frequently.
Cannabinols
Marijuana is the most widely used illegal drug. Nearly 17% of adults in the 18- to 25-year range reported using marijuana in the previous month. The earliest references to the drug date back to 2700 bc. In the 1700s, the hemp plant (Cannabis sauva) was grown in the colonies for its fiber, which was used in rope. Beginning in 1926, states began to outlaw the use of marijuana because it was claimed to cause criminal behavior and violence. Marijuana use became popular with mainstream young people in the 1960s. Some states have basically decriminalized possession of small amounts of marijuana although, according to the federal government, it remains a Schedule I drug. However, emergency room episodes in which marijuana was mentioned constituted 30% of the total drug abuse-related emergency room visits in 2005.
Drugs in This Classification
The various cannabinols include marijuana (grass, pot, weed, joint, reefer, dube), hashish, charas, bhang, ganja, and sinsemilla. The active ingredient is delta-9-tetrahydrocannabinol (THC). Hashish and charas have a THC content of 7% to 14%; ganja and sinsemilla, 4% to 7%; and bhang and marijuana, 2% to 5%. However, recent improvements in growing processes have increased the THC content of marijuana sold on the street. For simplicity, the various forms of cannabinols will be referred to as “marijuana.”
Major Effects
Marijuana users experience euphoria; enhancement of taste, touch, and smell; relaxation; increased appetite; altered time sense; and impaired immediate recall. An enhanced perception of the humor of situations or events may occur. The physiological effects of marijuana include increase in pulse rate and blood pressure, dilation of blood vessels in the cornea (which produces bloodshot eyes), and dry mouth. Motor skills and reaction time are slowed. Marijuana may be medically useful in reducing nausea and vomiting from chemotherapy, stimulating appetite in AIDS and other wasting-syndrome patients, treating spasticity and nocturnal spasms complicating multiple sclerosis and spinal cord injury, controlling seizures, and managing neuropathic pain. However, further clinical studies are necessary to reach conclusions on the value of marijuana in medical treatment.
Overdose
Overdose is unusual because the normal effects of marijuana are not enhanced by large doses. Intensification of emotional responses and mild hallucinations can occur, and the user may feel “out of control.” As with hallucinogens, many reports of overdose are panic reactions to the normal effects of the drug. In individuals with preexisting mental disorders (e.g., schizophrenia), high doses of marijuana may exacerbate symptoms such as delusions, hallucinations, dis-orientation, and depersonalization.
Tolerance
Tolerance is a controversial area with regard to marijuana. The difference of opinion as to whether tolerance develops slowly or quickly may be due to type of subject studied and various definitions of “dosage.” For example, tolerance rapidly occurs in animals but only with frequent use of high doses in humans. At the least, chronic users probably become accustomed to the effects of the drug and are experienced in administering the proper dosage to produce the desired effects. Cross-tolerance to CNS depressants, including alcohol, has been demonstrated.
Withdrawal
A withdrawal syndrome can be observed in chronic, high-dosage users who abruptly discontinue their use. The symptoms include irritability, restlessness, decreased appetite, insomnia, tremor, chills, and increased body temperature. The symptoms usually last 3 to 5 days.
Acute and Chronic Effects
Marijuana has been and continues to be controversial. Ballot measures in several states have involved marijuana laws. This controversy is related to the facts and myths regarding marijuana’s acute and chronic effects. The professional community has as many views of the “facts” regarding marijuana as does the general public. However, marijuana should clearly not be a Schedule I drug, although no psychoactive drug is safe. Marijuana can and does result in significant life problems for many people.
If death is the measure of dangerousness, marijuana is not acutely or chronically dangerous. However, the effect on motor skills and reaction time certainly impairs the user’s ability to drive a car, boat, plane, or other vehicle, and marijuana use has also been detected in a significant number of victims of vehicular and nonvehicular accidents.
Chronic use of marijuana does seem to have an adverse effect on lung function, although there is no direct evidence that it causes lung cancer. Although an increase in heart rate occurs, there does not seem to be an adverse effect on the heart. As is the case with CNS depressants, marijuana suppresses the immune system. Chronic marijuana use decreases the male hormone testosterone (as does alcohol) and adversely affects sperm formation. However, no effect on male fertility or sexual potency has been noted. Female hormones are also reduced, and impairment in ovulation has been reported.
Inhalants and Volatile Hydrocarbons
Inhalants and volatile hydrocarbons consist largely of chemicals that can be legally purchased and that are normally used for nonrecreational purposes. In addition, this classification includes some drugs that are used legally for medical purposes. As psychoactive drugs, most of these substances are used mainly by young people, particularly in low socioeconomic areas. Because most of these chemicals are accessible in homes and are readily available for purchase, they are easily used as psychoactive drugs by young people who are beginning drug experimentation and by individuals who are unable to purchase other mind-altering substances due to finances or availability.
Drugs in This Classification
The industrial solvents and aerosol sprays that are used for psychoactive purposes include gasoline, kerosene, chloroform, airplane glue, lacquer thinner, acetone, nail polish remover, model cement, lighter fluid, carbon tetrachloride, fluoride-based sprays, and metallic paints. Volatile nitrites are amyl nitrite (poppers), butyl, and isobutyl (locker room, rush, bolt, quick silver, zoom). Amyl nitrite has typically been used in the gay community. In addition, nitrous oxide (“laughing gas”), a substance used by dentists, is also included in this classification.
Major Effects
The solvents and sprays reduce inhibition and produce euphoria, dizziness, slurred speech, an unsteady gait, and drowsiness. Nystagmus (constant involuntary movements of the eyes) may be noted. The nitrites alter consciousness and enhance sexual pleasure. The user may experience giddiness, headaches, and dizziness. Nitrous oxide produces giddiness, a buzzing or ringing in the ears, and a sense that the user is about to pass out.
Overdose
Overdose of these substances may produce hallucinations, muscle spasms, headaches, dizziness, loss of balance, irregular heartbeat, and coma from lack of oxygen.
Tolerance
Tolerance does develop to nitrous oxide but does not seem to develop to the other inhalants.
Withdrawal
There does not appear to be a withdrawal syndrome associated with these substances.
Acute and Chronic Effects
The most critical acute effect of inhalants is a factor of the method of administration, which can result in loss of consciousness, coma, or death from lack of oxygen. Respiratory arrest, cardiac arrhythmia, or asphyxiation may occur. Many of these substances are highly toxic, and chronic use may cause damage to the liver, kidneys, brain, and lungs.
Club Drugs
Rather than sharing pharmacological similarities, the drugs discussed in this section are grouped together because of the environment in which they are commonly used. The use of these drugs is primarily by youth and young adults associated with dance clubs, bars, and all-night dance parties (“raves”).
It would not make sense to discuss the common characteristics of overdose, tolerance, withdrawal, and acute and chronic effects because these drugs are not related pharmacologically. However, it is important to reference these drugs as a separate class because of the wide media coverage of club drugs. The most appropriate pharmacological classification for each drug is referenced.
Rohypnol (roofies) is a benzodiazepine (CNS depressant) that is illegal in the United States but widely prescribed in Europe as a sleeping pill. When used in combination with alcohol, Rohypnol produces disinhibition and amnesia. Rohypnol has become known as the “date rape” drug because of reported instances in which women have been unknowingly given the drug while drinking. When women are sexually assaulted, they cannot easily remember the events surrounding the incident.
MDMA (ecstasy) has the properties of the CNS stimulants and hallucinogens. It is taken in tablet form primarily but can also be found in powder and liquid forms. It is relatively inexpensive and long lasting. The euphoric effects include rushes of exhilaration and the sensation of understanding and accepting others. Some people experience nausea, and depression may be experienced following use. Deaths have been reported from ecstasy use primarily as a result of severe dehydration from dancing for long periods without drinking water. Ecstasy can be used compulsively and become psychologically addictive.
Ketamine (K or special K) is generally considered to be a hallucinogen. It is used as a veterinary anesthetic and is usually cooked from its liquid form into a white powder and snorted. The euphoric effect of ketamine involves dissociative anesthetics or separating perception from sensation. Users report feeling “floaty” or outside their body. Higher doses expand this experience. They may have some numbness in extremities. Ketamine is very dangerous in combination with depressants, as higher doses depress respiration and breathing. Frequent use may lead to mental disorders due to the hallucinogenic properties of the drug. Psychological dependence also occurs in frequent users.
GHB (gamma hydroxybutyrate) is actually a synthetic steroid originally sold over the counter in health food stores as a bodybuilding aid. GHB is usually sold as an odorless liquid that has a slight salty taste. The effects are similar to those of CNS depressants, with low doses resulting in euphoria, relaxation, and happiness. However, higher doses can cause dizziness, drowsiness, vomiting, muscle spasms, and loss of consciousness. Overdoses can result in coma or death, as can mixing GHB with other CNS depressants such as alcohol. Physical dependence can occur.
Other drugs, such as LSD, PCP, mescaline, and marijuana are sometimes classified as club drugs. However, because these drugs have a wider use, they were discussed in other drug classifications.