DRUG CLASSIFICATION

Drugs can be categorized according to the nature of their physiological effects.  Most psychoactive drugs fall into one of six general categories: stimulants, depressants, hallucinogens, cannabis, narcotics, and inhalants.

Stimulants

In general, stimulants excite or increase the activity of the central nervous system (CNS).  Also called “uppers,” stimulants alert the CNS by increasing heart rate, blood pressure, and the rate of brain function.  Users feel uplifted and less fatigued.  Examples of stimulant drugs include caffeine, amphetamines, and cocaine.  Most stimulants produce psychological dependence and tolerance relatively quickly, but they are unlikely to produce significant physical dependence when judged by life-threatening withdrawal symptoms.  The important exception is cocaine, which seems to be capable of producing psychological dependence and withdrawal so powerful that continued use of the drug is inevitable in some users.

Caffeine

Caffeine, the tasteless drug found in chocolate, some soft drinks, coffee, tea, some aspirin products, and OTC “stay awake” pills, is a relatively harmless stimulant when consumed in moderate amounts.  Many coffee drinkers believe that they cannot start the day successfully without the benefit of a cup or two of coffee in the morning.

For the average healthy adult, moderate consumption of caffeine is unlikely to pose any serious health threat.  However, excessive consumption (equivalent to ten or more cups of coffee daily) could lead to anxiety, diarrhea, restlessness, delayed onset of sleep or frequent awakening, headache, and heart palpitations.  Pregnant women are advised to consume caffeine sparingly.

Amphetamines

Amphetamines produce increased activity and mood elevation in almost all users.  The amphetamines include several closely related compounds: amphetamine, dextroamphetamine, and methamphetamine.  These pounds do not have any natural sources and are completely manufactured in the laboratory.  Medical use of amphetamines is limited primarily to the treatment of obesity, narcolepsy, and attention deficit hyperactivity disorder (ADHD).

 Amphetamines can be ingested, injected, or snorted (inhaled).  At low-to-moderate doses, amphetamines elevate mood and increase alertness and feelings of energy by stimulating receiptor sites for two naturally occurring neurotransmitters.  They also slow the activity of the stomach and intestine and decrease hunger.  In the 1960s and 1970s, in fact, amphetamines were commonly prescribed for dieters.  Later, when it was discovered that the appetite suppression effect of amphetamines lasted only a few weeks, most physicians stopped prescribing them.  At high doses, amphetamines can increase heart rate and blood pressure to dangerous levels.  As amphetamines are eliminated from the body, the user becomes tired.

When chronically abused, amphetamines produce rapid tolerance and strong psychological dependence.  Other effects of chronic use include impotence and episodes of psychosis.  When use is discontinued, periods of depression may develop.

Today the use of amphetamines is a more pressing concern than it has been in the recent past because of the sharp increase in abuse of methamphetamine.  Known by a variety of names and forms, including “crank,” “ice,” “crystal,” “meth,” “speed,” “crystal meth,” and “zip,” methamphetamine is produced in illegal home laboratories.

Ice Crystal meth, or ice, is among the most dangerous forms of methamphetamine that looks like rock candy.  When smoked, the effects of ice are felt in about seven seconds as a wave of intense physical and psychological exhilaration.  This is due to the drug telling the brain to release large amounts of dopamine.  This effect last for several hours (much longer than the effects of crack) until the user become physically exhausted.  Chronic use leads to nutritional difficulties, weight loss, reduced resistance to infection, and damage to the liver, lungs, and kidneys.  Psychological dependence is quickly established.  Withdrawal causes acute depression and fatigue but not significant physical discomfort.

Ephedra health professional are warning people about the dangers of using any over-the-counter herbal supplement containing ephedra.  Also known as ma huang, ephedra is an amphetamine-like drug that can be specially dangerous for people with hypertension or other cardiovascular disease.  Presently, ephedra is used in many over-the-counter decongestants and asthma drugs.  However, in these products, warning labels indicate possible harmful side effects and drug interactions.  Some herbal products that contain ephedra are promoted as weight control aids.  At the time of this writing, some states were banning ephedra as a weight-control aid.

Ritalin A prescription stimulant drug that has surged in popularity in recent years is Ritalin.  This drug is typically prescribed to children and adolescents (and increasing number of young adults) to help them focus attention if they are hyperactive or cannot concentrate.  Ritalin can be abused when the drug is shared among friends.  Critics of Ritalin use argue that it is being over prescribed to treat a variety of problems, when a preferred course would be to identify and treat root causes of the problems.  Supporters respond that Ritalin has enabled youth to succeed in school.

Cocaine

Cocaine, perhaps the strongest of the stimulant drugs, has received much media attention.  It is the primary psychoactive substance found in the leaves of the South American coca plant.  Regardless of the form in which it is consumed, cocaine produces an immediate, near-orgasmic “rush,” or feeling of exhilaration.  This euphoria is quickly followed by a period of marked depression.  Used only occasionally as a topical anesthetic, cocaine is usually inhaled (snorted), injected, or smoked (as freebase or crack).  There is overwhelming scientific evidence that users quickly develop a strong psychological dependence using cocaine.

There is considerable evidence that physical dependence also rapidly develops.  Cocaine users risk a weakened immune system making them “more susceptible to infections, including HIV,”  However, physical dependence on cocaine does not lead to death upon withdrawal.

Freebasing

Freebasing and the use of crack cocaine are the most used techniques for maximizing the psychoactive effects of the drug.  Freebasing first requires that the common form of powdered cocaine (cocaine hydrochloride) be chemically altered (alkalized).  This altered form is then dissolved in a solvent, such as ether or benzene.  This liquid solution is heated to evaporate the solvent.  The heating process leaves the freebase cocaine in a powder form that can then be smoked, ften through a water pipe.  Because of the large surface area of the lungs, smoking cocaine facilitates fast absorption into the bloodstream.

One danger of freebasing cocaine is the risk related to the solvents used.  Ether is a highly volatile solvent capable of exploding and causing serious burns.  Benzene is a known carcinogen associated with the development of leukemia.  Clearly, neither solvent can be used without increasing the level of risk normally associated with cocaine use.  This method of making smoke able cocaine led to a new epidemic of cocaine use, smoking crack.

Crack

In contrast to freebase cocaine, crack is made by combining cocaine hydrochloride with common baking soda.  When this pastelike mixture is allowed to dry, a small rocklike crystalline material remains.  This crack is heated in the bowl of a small pipe, and the vapors are inhaled into the lungs.  Some crack users spend hundreds of dollars a day to maintain their habit.

The effect of crack is almost instantaneous.  Within 10 seconds of inhalation, cocaine reaches the CNS and influences the action of several neurotransmmiters at specific sites in the brain.  As with the use of other forms of cocaine, convulsions, seizures, respiratory distress, and cardiac failure have been reported with this sudden, extensive stimulation with the nervous system.

Within about 6 minutes, the stimulating effect of crack becomes completely expended, and users frequently become depressed.  Dependence develops within a few weeks, since users consume more crack in response to the short duration of stimulation and rapid onset of depression.

Intravenous administration has been the preferred route for cocaine users who are also regular users of heroin and other injectable drugs.  Intravenous injection results in an almost immediate high, which lasts about 10 minutes.  A “smoother ride” is said to be obtained from a “speedball,” the injectable mixture of heroin and cocaine (or methamphetamine).  This type of mixture can be volatile and even fatal.

Depressants

Depressants (sedatives) sedate the user, slowing down CNS function.  Drugs included in this category are alcohol, barbiturates, and tranquilizers.  Depressants produce tolerance in abusers, as well as strong psychological and physical dependence.

Barbiturates

Barbiturates are the so-called sleeping compounds that function by enhancing the effect of inhibitory neurotransmmiters.  They depress the CNS to the point where the user drops off to sleep or, as is the case with surgical anesthetics, the patient becomes anesthetized.  Medically, barbiturates are used in widely varied dosages as anesthetics and for treatment of anxiety, insomnia, and epilepsy.  Regular use of a barbiturate quickly produces tolerance eventually such a high dose is required that the user still feels the effects of the drug throughout the next morning.  Some abusers then begin to alternate barbiturates with stimulants, producing a vicious cycle of dependence.  Other misusers combine alcohol and barbiturates or tranquilizers, inadvertently producing toxic or even lethal results.  Abrupt withdrawal from barbiturate use frequently produces a withdrawal syndrome that can involve seizures, delusions, hallucinations, and even death.

Methaqualone (Quaalude “ludes,” Sopor) was developed as a sedative that would have the dependence properties of other barbiturates.  Although this did not happen, Quaaludes were occasionally prescribed for anxious patients.  Today, compounds resembling Quaaludes are manufactured in home laboratories and sold illegally so that they can be combined with small amounts of alcohol for an inexpensive, drunklike effect.

Tranquilizers

Tranquilizers are depressants that are intended to reduce anxiety and to relax people who are having problems managing stress.  They are not specifically designed to produce sleep rather to help people cope during their waking hours.  Such tranquilizers are termed minor tranquilizers, of which diazepam (Valium) and chlordiazepoxide (Librium) may be the most commonly prescribed examples.  Unfortunately, some people become addicted to these and other prescription drugs.

Some tranquilizers are further designed to control hospitalized psychotic patients who may be suicidal or who are potential threats to others.  These major tranquilizers subdue people physically but permit them to remain conscious.  Their use is generally limited to institutional settings.  All tranquilizers can produce physical and psychological dependence and tolerance.

“Date rape” Depressants “Date rape” drugs or club drugs are commonly used on college campuses.  These drugs are usually slipped into the drink of an unsuspecting woman and can result in a coma or even death.

Common “Date rape” drugs include GHB (Gamma hydroxybutyrate), also known as G, liquid ecstasy, Easy Lay, and Georgia Home Boy, and Rohypnol (“roophies”).  When these drugs are consumed they cause a drunklike or sleepy sate that can last for hours.  During this time is when unsuspecting individuals are taken advantage of, against their will and sometimes against their knowledge.

High school and college students should not accept drinks from people they do not know.  This recommendation extends to all parties where drinkers do not know what has been added to the punch or other drinks.

Congress passed the 1996 Drug-Induced Rape Prevention and Punishment Act and it is now a federal crime to give someone a drug, without the user’s knowledge, to aid in sexual assault.  The maximum penalty for this crime is 20 years in prison and a $250,000 fine.  GHB (G, liquid ecstasy) and ketamine (K, Special K, Cat) are additional depressants that are being used as date rape drugs.  These drugs should serve as a reminder to all partygoers to keep an extremely careful watch over any drink in their possession.   

Hallucinogens

As the name suggest, hallucinogens drugs produce halucinations – perceived distortions of reality.  Also known as psychedelic drugs or phantasticants, hallucinogens reached their height of popularity during the 1960s.  at that time, young people were encouraged to use hallucinogenic drugs to “expands the mind,” “reached an altered state” or “discover reality.” Not all of the reality distortion, or “trips,” were pleasant.  Many users reported “bummers,” or trips during which they perceived negative, frightening distortions.

Hallucinogenic drugs include laboratory-produced lysergic acid diethylamide (LSD), mescaline (from a particular genus of mushroom).  Consumption of hallucinogens seems to produce not physical dependence but mild levels of psychological dependence.  The development of tolerance is questionable.  Synesthesia, a sensation in which users report hearing a color, smelling music, or touching a taste, is sometimes produced with hallucinogen use.

The long-term effects of hallucinogenic drug use are not fully understood.  Questions about genetic abnormalities in offspring, fertility, sex drive and performance, and the development of personality disorders have not been fully answered.  One phenomenon that has been identified and documented is the development of flashbacks – the unpredictable return to a psychedelic trip that occurred months or even years earlier.  Flashbacks are thought to result from the accumulation of a drug within body cells.

LSD

The most well-known and powerful hallucinogen is lysergic acid diethylamide.  LSD (“acid”) is a drug that helped define the counterculture movement of the 1960s.  During the 1970s and the 1980s, this drug lost considerable popularity.  LSD use has made a comeback, with studies reporting that 6.6% of high school seniors and 14.7% of young adults age 18 – 20 had experimented with LSD.  Fear of cocaine and other powerful drugs, boredom, low cost, and an attempt to revisit the culture of the 1960s are thought to have increased LSD’s attractiveness to today’s young people.

LSD is manufactured in home laboratories and frequently distributed in blotter paper decorated with cartoon characters.  Users place the paper on their tongue or chew the paper to ingest the drug.  LSD can produce a psychedelic (mind-viewing) effect that includes altered perception of shapes, images, time, sound, and body form.  Synesthesia is common to LSD users.  Ingested in doses known as “hits,” LSD produces a 6- to 9-hour experience.

Although the typical doses (“hits”) today are about half as powerful as those in the 1960s, users still tend to develop high tolerance to LSD.  Physical dependence does not occur.  Not all LSD can be frightening and dangerous.  Users can injure or kill themselves accidentally during a bad trip.  Dangerous side effects include panic attacks, flashbacks, and occasional prolonged psychosis.

Designer Drugs

In recent years, chemists who produce many of the illicit drugs in home laboratories have designed versions of drugs.  These designer drugs are similar are similar to the controlled drugs on the FDA Schedule 1 but are sufficiently different so that they escape governmental control.  The designer drugs are either newly synthesized products that are similar to already outlawed drugs but against which no law yet exists, or they are reconstituted or renamed illegal substances.  Designer drugs are said to produce effects similar to their controlled drug counterparts.

People who use designer drugs do so at great risk because the manufacturing of these drugs is unregulated.  The neurophysiological effect of these homemade drugs can be quiet dangerous.  So far, a synthetic heroin product (MPPP) and several amphetamine derivatives with hallucinogenic properties have been designed for the unwary drug consumer.

DOM (STP), MDA (the “love drug”), and ecstasy (MDMA or “XTC”) are examples of amphetamine derivative, hallucinogenic designer drugs.  These drugs produce mild LSD-like hallucinogenic experiences, positive feelings, and enhanced alertness.  They also have a number of potentially dangerous effects.  Experts are particularly concerned that ecstasy can produce strong psychological dependence and can deplete serotonin, an important excitatory neurotransmitter associated with a state of alertness.  Permanent brain damage is possible.

Phencyclidine

Phencyclidine (PCP, “anger dust”) has been classified variously as a hallucinogen, a stimulant, a depressant, and an anesthetic.  PCP was studied for years during the 1950s and 1960s and was found to be an unsuitable animal and human anesthetic.  PCP is an extremely unpredictable drug.  Easily manufactured in home laboratories in tablet or powder form, PCP can be injected, inhaled, taken orally, or smoked.  The effects vary.  Some users report mild euphoria, although most report bizarre perceptions, paranoid feelings, and aggressive behavior.  PCP overdose may cause convulsions, cardiovascular collapse, and damage to the brain’s respiratory center.

In a number of cases the aggressive behavior caused by PCP has led users to commit brutal crimes against both friends and innocent strangers.  PCP accumulates in cells and may stimulate bizarre behavior months after initial use.

Cannabis

Cannabis (marijuana) has been labeled a mild hallucinogen for a number of years.  However, most experts consider it to be a drug category in itself.  Marijuana produces mild effects like those pf stimulants and depressants.  The implication of marijuana in a large number of traffic fatalities makes this drug one whose consumption should be carefully considered.  Marijuana is actually a wild plant (Cannabis sativa) whose fibers were once used in the manufacture of hemp rope.  When the leafy material and small stems are dried and crushed, users can smoke the mixture in rolled cigarettes (“joints”), cigars (“blunts”), or pipes.  The resins collected from scraping the flowering tops of the plant yield a marijuana product called hashish, or hash, commonly smoked in a pipe.

The potency of marijuana’s hallucinogenic effect is determined by the percentage of the active ingredient tetrahydrocannabinol (THC) present in the product.  The concentration of THC averages about 3.5% for marijuana, 7% to 9% for higher-quality marijuana (sinsemilla), 8% to 14% for hashish, and as high as 50% for hash oil.  Today’s marijuana has THC levels that are higher than in past decades.

THC is a fat-soluble substance and thus is absorbed and retained in fat tissues within the body.  Before being excreted, THC can remain in the body for up to a month.  With the sophistication of today’s drug tests, trace metabolites of THC can be detected for up to 30 days after consumption.  It is possible that the THC that comes from passive inhalation of high doses (for example, during an indoor rock concert) can also be detected for a short time after exposure.

Once marijuana is consumed, its effects vary from person to person.  Being “high” or “stoned” or “wrecked” means different things to different people.  Many people report heightened sensitivity to music, cravings for particular foods, and a relaxed mood.  There is consensus that marijuana’s behavioral effects include four probabilities: (1) users must learn to recognize what a marijuana high is like, (2) marijuana impairs short-term memory, (3) users overestimate the passage of time, and (4) users loses the ability to maintain attention to a task.

The long-term effect of marijuana use a still being studied.  Chronic abuse may lead to an amotivational syndrome in some people.  The irritating effect of marijuana smoke on lung tissue are more pronounced than those of cigarettes smoke, and some of the over 400 chemicals in marijuana are now linked to lung cancer development.  In fact, one of the most potent carcinogens, benzopyrene, is found in higher levels in marijuana smoke than in tobacco smoke.  Marijuana smokers tend to inhale deeply and hold the smoke in the lungs for long periods.  It is likely that at some point the lungs of chronic marijuana smokers will be damaged.

Long-term marijuana use is also associated with damage to the immune system and to be the male and female reproductive systems and with an increase in birth defects in babies born to mothers who smoke marijuana.  Chronic marijuana use lowers testosterone levels in men, but the effect of this change is known.  The effect of long-term marijuana use on  a variety of types sexual behavior is also not fully understood.

Because the drug can distort perceptions and thus perceptual ability (especially when combined with alcohol), its use with automobile drivers clearly jeopardize the lives of many innocent people.

The only medical uses for marijuana are to relieve the nausea caused by chemotherapy, to improve the appetite in AIDS patients, and to ease the pressure that builds up in the eyes of glaucoma patients.  However, a variety of other drugs, many of which are nearly as effective, are also used for these purposes.  In May 2001, the U.S. Supreme Court ruled an unanimously against the distribution of marijuana in medical clinics.

Narcotics

The Narcotics are among the most dependence-producing drugs.  Medically, narcotics are used to relieve pain and induce sleep.  On the basis of origin, narcotics can be subgrouped into the natural, quasisynthetic, and synthetic narcotics.

Natural Narcotics

Naturally occurring substances derived from the Oriental poppy plant include opium (the primary psychoactive substance extracted from the Oriental poppy), morphine (the primary active ingredient in opium), and thebaine (a compound not used as a drug).  Morphine and related compounds have medical use as analgesics in the treatment of mild to severe pain.

Quasisynthetic Narcotics

Quasisynthetic Narcotics are compounds created by chemically altering morphine.  These laboratory-produced drugs are intended to be used as analgesics, but their benefits are largely outweighed by a high dependence rate and a great risk of toxicity.  The best known of the quasisynthetic narcotics is heroin.  Although heroin is a fast-acting and very effective analgesic, it is extremely addictive.  Once injected into a vein or “skin-popped” (injected beneath the skin surface), heroin produces dreamlike euphoria and, like all narcotics, strong physical and psychological dependence and tolerance.

As with the use of all other injectable illegal drugs, the practice of sharing needles increases the likelihood of transmission of various communicable diseases, includiong HIV.  Abrupt withdrawal from heroin use is rarely fatal, but the discomfort during cold turkey withdrawal is reported to be overwhelming.  The use of heroin has increased during the last decade.  The purity of heroin has improved while the price has dropped.  Cocaine abusers may use heroin to “come down” form the high associated with cocaine.

Synthetic Narcotics

Meperidine (Demerol) and propoxyphene (Darvon), common postsurgical painkillers, and methadone, the drug prescribed during the rehabilitation of heroin addicts, are synthetic narcotics.  These opiate-like drugs are manufactured in medical laboratories.  They are not natural narcotics or quasisynthetic narcotics because they do not originated from the Oriental poppy plant.  Like true narcotics, however, these drugs can rapidly induce physical dependence.  Once important criticism of methadone rehabilitation programs is that in some cases, they merely shift the addiction from heroin to methadone.

OxyContin OxyContin, also known as hillybilly heroin, Oxy, Oxycotton, is a time-released legal prescription drug used to treat individuals with moderate to severe pain.  Illegal use of OxyContin brought national attention when individual in rural areas of the country were found abusing this drug.   Now abusing of OxyContin is continuing spread across the country.  Classified as a narcotic drug, OxyContin is an addictive controlled substance with an addiction potential similar to morphine.  This prescription drug is considered extremely dangerous as an illicit drug.  Some methods of usage that increase the likelihood of dangerous effects, including death, are chewing the tablets, snorting crushed tablets, and dissolving the tablets in water and then injecting the drug.  When OxyContin is not taken in tablet form, the controlled-release dosage is defeated and the user has a high potential of receiving a lethal dose due to the drug being released immediately into one’s system.  Many other long-term consequences of OxyContin abuse are physical dependence and severe respiratory depression that may lead to death.  Common withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements.  The FDA continues to monitor the abuse of OxyContin and has approved the strongest warning labels for this drug with the intent of changing prescription practice as well as increasing the physician’s focus on the potential for abuse.

Inhalants

Inhalants are a class of drugs that includes a variety of volatile (quickly evaporating) compounds that generally produce unpredictable, drunklike effects in users and feelings of euphoria.  Users of inhalants may also have some delusions and hallucinations.  Some users may become quite aggressive.  Drugs in this category include anesthetic gases (chloroform, nitrous oxide, and ether), petroleum products and commercial solvents (gasoline, kerosene, plastic cement, glue, typewriter correction fluid, paint, and paint thinner), and certain aerosols (found in some propelled spray products, fertilizers, and insecticides).

Most of the danger in using inhalants lies in the damaging, sometimes fatal effects on the respiratory and cardiovascular systems.  Furthermore, users may unknowingly place themselves in dangerous situations because of the drunklike hallucinogenic effects.  Aggressive behavior might also make users a threat to themselves and others