Drug abuse, tranquillizers.

School Science Lessons
(UNBiol5b)
2024-10-27

Drug abuse, Tranquillizers
Please send comments to: j.elfick@uq.edu.au
Contents
5.5.0 Drug abuse
5.6.0 Tranquillizers
5.7.0 Drugs terminology and classifications
5.8.0 National Wasterwater Drug Monitoring Program

5.5.0 Drug abuse
5.5.1 Prescription drugs misuse
5.5.2 Abuse of volatile substances, inhalants
5.5.3 Alcohol abuse, ethanol
5.5.4 Amphetamines
5.5.5 Antihistamines
5.5.6.0 Aspirin
5.5.7 Barbiturates
5.5.8 Cannabis
5.5.9 Chroming, "huffing"
5.5.10 Cocaine and crack cocaine
5.5.11 Date rape drugs, Rohypnol, GHB, Ketamine
5.5.12 Designer drugs
5.5.13 Doping in sport
5.5.14 "Ecstasy"
5.5.15 Hallucinogenic drugs, hallucinogens
5.5.16 Heroin
5.5.17 "Ice"
5.5.18 LSD, Lysergic acid diethylamide
5.5.19 Mephedrone and Methamphetamine
5.5.20 Morphine and derivatives
5.5.21 Nicotine, tobacco smoking and chewing
5.5.22 Petrol sniffing
5.5.23 Reasons for trying drugs
5.5.24 Skin-prick tests for allergy
5.5.25 "Speed" and "base"

5.5.6.0 Aspirin
5.5.6.1 Aspirin, acetylsalicylic acid
5.5.6.3 Aspirin crystals, Prepare aspirin
5.5.6.2 Tests for aspirin

5.6.0 Tranquillizers
5.6.1 Drug interactions
5.6.2 Drug tolerance
5.6.3 GHB, 4-hydroxybutanoic acid
5.6.4 Ketamine
5.6.5 Tranquillizers 1, major tranquillizers, phenothiazines, chlorchromazine (Largactil), promethazine (Phenergan)
5.6.6 Tranquillizers 2, minor tranquillizers, benzodiapines, diazepam (Valium), oxazepam (Seraz,), nitrazepam (Mogadon), nitrazepam
5.6.7 Tranquillizers 3, minor tranquillizers, dibenzazepines, imipramine (Tofranil), desipramine (Pertofran), amitriptyline, Tryptanol)
5.6.8 Monoamine oxidase inhibitors (MAOI), tyramine, C8H11NO

5.7.0 Drugs terminology and classifications
5.7.1 Addiction
5.7.2 Classification of drugs
5.7.3 Cocaine and amphetamines
5.7.4 Detoxification
5.7.5 Drug dependence
5.7.6 Drugs and medications
5.7.7 Harm reduction
5.7.8 Mode of action of drugs
5.7.9 Therapeutic index
5.7.10 Types of drug use

5.5.1 Prescription drugs misuse
Recognizing and dealing with patients who seek drugs for non-medical purposes may be a difficult problem for doctors.
Some patients may be prescription shoppers or have a chronic non-malignant pain problem.
The main drugs they seek include the following:
1. Benzodiazepines, e.g. Alprazolam, "Xanax", C17H13ClN4, and the benzodiazepine derivative drug Diazepam ("Valium), C16H13ClN2O.
It is prescribed for anxiety, insomnia and seizures.
2. Opioids, e.g. Oxycodone, "Oxycodin", C18N21NO4, derived from thebaine, and Tramadol, "Ultram, C16H25NO2, prescribed as painkillers.
Misuse of prescription drugs can take the form of injecting oral drugs, selling them on the street.
Also, overusing the prescribed mount so that patients run short before the due date and then request extra prescriptions from the doctor.
Doctors must rely on our clinical skills and the patient's behaviour over time to detect problematic prescription drug misuse.
Management strategies may include saying no to patients, having a treatment plan, and adopting a universal precaution approach toward all patients.
Among patients with chronic non-malignant pain, requests for increasing opioid doses need careful assessment to explain any non-medical factors.

5.5.2 Abuse of volatile substances, inhalants
Abuse of volatile substances
1. A volatile substance is a compound that gives off a vapour or fumes at room temperature.
A volatile substance is not a drug, but misuse of them may cause similar problems to misuse of drugs.
Volatile substances include petroleum fuels, propellants from aerosol products, chlorinated hydrocarbons, glue, nail polish remover, antifreeze, paint thinners.
Product: Inhalants can include general household and office products, e.g. solvents, aerosols, glue, petrol.
Nitrous oxide: laughing gas, whippits, nitrous, used for nitrous oxide sniffing.
Amyl nitrate: snappers, poppers, pearlers, rushamines.
Butyl nitrate: locker room, bolt, bullet, rush, climax, red gold.
Symptoms: Slurred speech, impaired co-ordination, nausea, vomiting, slowed breathing, euphoria.
Potential problems: Brain damage, paralysis, pains in the chest, muscles, joints, heart trouble, severe depression, fatigue, loss of appetite, bronchial spasms
Also, sores on nose or mouth, nosebleeds, diarrhoea, bizarre or reckless behaviour, suffocation, sudden death.
2. The recreational sniffing of gases and solvents has become relatively common, particularly among adolescents in Australia.
The mean age of solvent abusers is 12 to 15 years.
All volatile substances are fat soluble and are stored in the fat deposits within the body, particularly in the brain.
This leads to a prolonged effect on the level of consciousness, even hours after the inhalation has stopped.
This is an extremely dangerous practice and sudden death may occur even during the first usage.
Substances are generally placed into a plastic bag, or another vessel, and placed directly over the nose and mouth and inhaled deeply.
The effect of substances inhaled in this manner produces alterations in the level of consciousness, is pleasurable feeling of intoxication and visual hallucinations.
The most important problem of volatile solvent use is the occurrence of potentially fatal cardiac arrhythmia, because of intoxication.
Respiratory depression can also occur.
Although there are doubts about physical addiction, psychological dependence is common.
Behavioural indicators of use include persistent truancy from school, unruly behaviour, lack of attention in the classroom, frequent use of handkerchiefs.
Continual sniffing or sucking of shirt sleeves or jacket sleeves, change in sleep pattern, truculent moody behaviour, difficult communication with parents or teachers.
The effects of a single use, while potentially very dangerous, usually wear off after a few hours and the cardiovascular symptoms predominate.
Symptoms include chronic or frequent cough, tinnitus, chest pain or angina, nosebleeds, extreme tiredness or weakness, increased nasal secretions, red, watery eyes.
Also, a dreamlike state with hallucinations, depression and / or anxiety.
The effects of inhalation are immediate, lasting from 5 to 45 minutes after cessation of sniffing.
While initial effects may fade after several minutes, depending on the method of inhalation, effects may be felt for several hours.
For most users, effects will pass within an hour of ceasing inhalation of the volatile substance.
Chronic users may experience withdrawal symptoms similar to those experienced from a general anaesthetic.
Hangover effects may persist for several days, and may be characterized by tremor, headache, nausea, vomiting and delirium.
3. Most users of volatile substances are young adolescents, 12 to 15 years.
In some groups, there is predominantly chronic or dependent use, e.g. among Aboriginal youths, i.e. between the ages of 15 and 24 years.
The use of computer games to stimulate recreational activity has been found useful in those young people who are seeking and achieving abstinence from solvents.
A video role play approach has been helpful by using the role play in discussions involving resolution of crisis and difficulties in relationships with parents.
These films can be used in the education of other abusers of volatile substances.

5.5.3 Alcohol abuse
Alcohol abuse
No specific level or pattern of drinking alcohol should be considered safe.
A range of drinking that most people would consider low risk and drinking that is considered hazardous, dangerous or dysfunctional, can be defined.
Low risk drinking.
Female: Never more than two standard drinks in a day (except for pregnancy).
Male: Never more than four standard drinks in a day.
(1 standard drink = 10 grams of alcohol).
Hazardous drinking refers to drinking that raises the blood alcohol level (BAL) above 50 mg alcohol/100 mL blood (0.05%).
Also Police Random Breath Test Blood Alcohol 0.05.
Alcoholic drinks mixed with zero calorie artificial sweeteners will register a higher BAL reading than drinks mixed with soft drinks.
Drinks mixed with "diet coke" will cause a higher BAL reading than drinks mixed with "regular coke".
The presence of food in the stomach can reduce breath alcohol concentrations, so "Never drink alcohol on an empty stomach".
Clinical signs include: morning nausea and vomiting, dyspepsia, recurrent diarrhoea, hypertension, palpitations, anxiety, hand tremor, financial difficulties,
depression in spouse or family members.
Dysfunctional drinking is drinking to impairment of social functioning, including disturbance of marital or family relationships, impaired job efficiency.
National health and medical research council recommendations:
In 1992 the National Health and Medical Research Council published a series of recommendations about responsible drinking behaviour.
That the idea of a standard drink, or unit, containing 8-10 grams of absolute alcohol be adopted for clinical and educational purposes.
That the following guidelines be promoted as consistent with responsible drinking:
1. that the consumption of alcohol by men should not exceed 4 units or 40 grams of absolute alcohol per day on a regular basis,
2. that the consumption of alcohol by women should not exceed 2 units per day or 14 units per week on a regular basis
3. that 2-4 units per day or 14-28 units per week be considered hazardous and
4. that more than 4 units per day or 28 per week be considered harmful.
Caucasians oxidize ethanol slowly to acetaldehyde then further oxidation to acetic acid occurs.
So they tend to become drunk, because the alcohol stays unchanged in the body.
Northern Chinese and Japanese may oxidize the alcohol more quickly, causing red cheeks and unpleasant sensations from increase of acetaldehyde in the blood.
Alcohol is metabolized by the slow acting alcohol dehydrogenase enzyme in the liver, assisted by the extra-enzyme cytochrome mono-oxygenase in heavy drinkers.
Alcohol dehydrogenase converts alcohol in the liver to acetaldehyde.
Fast acetylators can be embarrassed by the flushing that occurs after drinking alcohol, because of the sudden release of acetaldehyde.
The further oxidation to acetic acid occurs at the same rate in both fast and slow acetylators.

5.5.4 Amphetamines
Amphetamine, C9H13N.
Some amphetamine derivatives:
4-FMA, 4-Fluoromethamphetamine
4-Hydroxy-3-methoxymethamphetamine, C11H17NO2
4-MA, C10H15N, 4-Methylamphetamine, Aptro, stimulant drug
4-MMA, C11H17N, 4-Methylmethamphetamine
4-MMC, MCAT, C11H15NO, Mephedrone, 4-methylmethcathinone, 4-methylephedrone
MDA, C10H13NO2, 3, 4-Methylenedioxyamphetamine, tenamfetamine, ("Sally", "Sass", "Sass-a-frass", "Mellow Drug")
MDMA, C11H15NO2, 3,4-methylenedioxy-methamphetamine, psychoactive drug, "ecstasy" ("E", "X", "XTC", "Mandy", "Molly)
MMDA, C11H15NO3, 3-methoxy-4, 5-methylenedioxyamphetamine, psychoactive drug, from nutmeg
MMMA, C11H17NO, meta-methoxymethamphetamine, 3-Methoxymethamphetamine, from cloves
PMA, C10H15NO, para-Methoxyamphetamine (4-methoxyamphetamine), ("Death", "Dr. Death")
PMMA, C11H17NO, 4-Methoxymethamphetamine, stimulant and psychedelic drugs
PMMC, C11H15NO2, Methedrone, 4-methoxymethcathinone, methoxyphedrine, "recreational drug".

Amphetamine
Amphetamine, C9H13N, C6H5CH2CH(CH2)NH2, synthetic drug, decongestant and central nervous system stimulant.
The proprietary name is "Benzedrine", because "Benzedrine" is a trade name for dl-Amphetamines.
The multiple mechanisms of amphetamine include:
1. Blocks uptake of adrenergic drugs and dopamine,
2. Simulation of release of monamines, e.g. Serotonin, Noradrenaline and Norepinephrine,
3. Inhibits monamine oxidase.
Amphetamine is a drug and has an effect like a psychotic state.
The levo-amphetamine form of the molecule has stronger cardiovascular effects, but the dextro-amphetamine form has stronger psychoactive effects.
Amphetamines are a family of drugs that include methamphetamine, so amphetamine has a broad range of psychoactive derivatives
Methylamine is used in the illegal manufacture of the drug MDMA (ecstasy), and methamphetamine.

5.5.5 Antihistamines
See diagram 14.05: Histamine, dexchlorpheniramine (Polaramine).
Antihistamines
An allergen is a protein or polysaccharide that initiates an allergic response.
For a person with pollen allergy, a pollen grain enters the nose and clings to the mucous membranes.
The mucous membranes release the pollen grain's allergens and histamine is released.
Histamine, C5H9N3, imidazole, neurotransmitter, stimulant of gastric secretion, a constrictor of bronchial smooth muscle.
It occurs in Hippospongia communis, Ramalina fraxinea, and other organisms with data available.
Dexchlorpheniramine, C16H19ClN2, (Polaramine), an alkylamine, is an antihistamine used to treat allergic conditions, e.g. hay fever.
The salt dexchlorpheniramine maleate, C20H23ClN2O4, is used to treat life-threatening allergic reactions, e.g. peanuts, bee stings.
These chemicals prevent the actions of histamine on bronchial smooth muscle, capillaries and gastrointestinal smooth muscle.

5.5.6.1 Aspirin
See diagram 16.3.4.11: Aspirin.
1. Aspirin, C9H8O4, CH3COOC6H4COOH, 2-Acetoxybenzoic acid, odourless white crystals or crystalline powder, slightly bitter taste
It is a benzoic acid, i.e. salicylic acid, (HOC6H4COOH), with an acetoxy group, (−OCOCH3), replacing a hydrogen.
Aspirin is a non-steroidal anti-inflammatory drug, and , a non-narcotic analgesic, so is a commonly used drug for the treatment of pain and fever.
It is a cause of accidental poisoning in young children, so do not give to children < 12 years old.
Aspirin occurs in the white willow tree, Salix alba
Acetyl salicyclic acid is hydrolysed with hydrochloric acid to salicylic acid and acetic acid.
Old bottles of aspirin may have a vinegar (acetic acid) smell, because of this reaction.
2. Aspirin and analgesics, Paracetamol
Both salicylic acid and acetylsalicylic acid (aspirin) can breach the protective barrier in the stomach and cause stomach bleeding.
For most people, the bleeding produced is trivial.
However, including children, it can be bleeding of hundreds of millilitres and require emergency hospitalization.
In acid solution, aspirin is not ionized and is fat soluble and can diffuse through the stomach's protective barrier.
Once through, it is in a neutral environment where ionizes and then cannot pass back again.
The rate of diffusion is enhanced by alcohol, even when the contents of the stomach have a low acidity.
Such co-operative action may be called synergism.
Aspirin has the effect of slowing the release of the prostaglandins that promote inflammation and stimulate pain receptors.
The related Methyl salicylate, oil of wintergreen, is used externally to ease the pain from rheumatism and strained muscles.
Aspirin kept too long begins to hydrolyse to salicylic acid, which is not well tolerated by the human body.
Soluble aspirin is either the sodium or the calcium salt of normal aspirin.
These salts immediately form aspirin in the acid stomach as fine crystals and possibly cause less gastric distress.
3. Acetaminophen, C8H9O2 (Paracetamol, Tylenol) relieves pain and fever.
Panadol, contain p-acetylaminophenol (4-hydroxyacetanilide, Paracetamol), that is comparable to aspirin as a pain reliever, but is gentler to the stomach.
Instructions for using Aspirin tablets.
4. Aspirin 325 mg tablet is a NSAID (non-steroidal anti-inflammatory drug), pain reliever / fever reducer.
It temporarily relieves headache, muscle pain, toothache, menstrual pain, pain and fever of colds, and minor pain of arthritis.
Children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product.
When using this product, if changes in behaviour with nausea and vomiting occur, these symptoms could be an early sign of Reye's syndrome, a serious illness.
Aspirin may cause a severe allergic reaction which may include: hives, facial swelling, asthma (wheezing), and shock.
This NSAID may cause severe stomach bleeding.
The chance is higher if you are age 60 or over.
Stop use and ask a doctor if you have had stomach ulcers or bleeding problems, take a blood thinning (anticoagulant) or steroid drug.
NSAIDs (aspirin, ibuprofen, naproxen, or others), have 3 or more alcoholic drinks every day while using this product, take more or for a longer time than directed.
Do not use this product if you are allergic to aspirin or any other pain reliever/fever reducer.
Ask a doctor before use if stomach bleeding, stomach problems, such as heartburn, high blood pressure, heart disease, liver cirrhosis, or kidney disease.
Ask a doctor or pharmacist before use if you are taking a prescription drug for gout, diabetes, arthritis.
Stop use and ask doctor if an allergic reaction occurs.
Seek medical help right away.
Stop use and ask a doctor if stomach bleeding: feel faint, vomit blood, have bloody or black stools, stomach pain that lasts more than 10 day.
Also, redness or swelling is present, fever lasts more than 3 days, new symptoms occur, a ringing in the ears or a loss of hearing occurs.
If pregnant or breast feeding, ask a health professional before use.
Do not to use aspirin during the last 3 months of pregnancy, because it may cause problems in the unborn child or complications during delivery.
In case of overdose, get medical help or contact a Poison Control Centre right away.
5. Directions for use.
Drink a full glass of water with each dose.
Adults and children 12 years and over: Take 1 or 2 tablets every 4 hours or 3 tablets every 6 hours, not to exceed 1 2 tablets in 24 hours.
Children under 12 years consult a doctor.
6. Rates of reaction of aspirin.
Be Careful! Aspirin is a drug so do not let the students take them.
Soluble aspirins dissolve in water with a well defined end point and constants interaction time.
Use these tablets to investigate the effects of temperature, stirring, crushing and varying the water volume on reaction time.
Investigate the temperature change required to halve the reaction time between one tablet and known quantity of water at room temperature.
Investigate the number of tablets or fractions of tablets required to exactly double the reaction time in a known quantity of water at room temperature.
7. Salicylate intolerance
Salicylates are in medicine for painkilling, anti-inflammatory action and as preservatives in processed foods.
Salicylates include salicylic acid and sodium salicylates.
Salicylates usually do not cause harm to healthy adults, but aspirin may be harmful to children and to elderly people.
Other salicylate painkillers include extract of the bark of the willow tree (Salix alba vulgaris), and oil from meadow sweet, (Spirea ulmaria).
Other naturally occurring salicylates are in many fruits and vegetables in very small amounts.
Aspirin, analgesic, acetylsalicylic acid (2-acetyloxybenzoic acid), is made in factories from salicylic acid, HOC6H4COOH, 1-hydroxybenzoic acid.
Salicylanilide, a compound of salicylic acid and aniline derivatives, is as an antiseptic in soap.
Most fruits and many vegetables contain natural salicylates, and some also have high amine levels.
Salicylates have a natural preservative action and are concentrated near any surface of fruits and vegetables.
Levels of salicylates are higher in unripe fruits and decrease with ripening.
In many cases these natural chemicals are concentrated near the skin and you can avoid them by peeling, e.g. potatoes and pears.
Natural chemical content also varies with ripeness.
Flavoured or fruit yoghurt may also contain salicylates.
Spicy processed meats can also contain salicylates or MSG, e.g. salami, seasoned meats, meat pies, sausages and sausage rolls, frankfurters, meat pastess.
5.5.6.2 Tests for aspirin
Crush half an aspirin tablet and dissolve the powder by heating it with sodium carbonate (washing soda), solution in a test-tube.
Cool the test-tube and make the liquid slightly acid by adding dilute sulfuric acid or sodium hydrogen sulfate (sodium bisulfate), solution.
Add drops of ammonium iron (III) sulfate solution.
The liquid turns a mauve or violet colour.

5.5.6.3 Prepare aspirin crystals
See diagram 16.3.4.11: Aspirin.
Dissolve an aspirin table in methylated spirit.
BE CAREFUL! Filter if necessary.
Heat the solution.

5.5.7 Barbiturates
Thiopental, C11H17N2NaO2S, is the standard injectable general anaesthetic.
Barbiturates were formerly the major ingredients used in sleeping pills and provided adjuncts to anaesthetics.
Phenobarbital has distinctive anticonvulsant properties useful in the treatment of epilepsy.
Barbiturates are derivatives of barbituric acid that is not pharmacologically active.
Replacement of the hydrogen atoms at the fifth carbon position with alkyl or aryl substituents yields drugs with sedative or hypnotic properties.
More than 2000 barbiturates have been synthesized, but only a few have become widely adopted in medicine.
The chain length of the substituents at the C-5 position affect the action of a particular barbiturate, e.g. phenyl group or alkyl group for anticonvulsant activity.
However, convulsants are produced if the chain is too long, or if alkyl groups are placed on the two nitrogen atoms at positions one and three.
If thiourea, CH4N2S, is used in place of urea in the synthesizing reaction, thiobarbiturates are obtained, e.g. thiopental.
The more fat soluble the barbiturate with non-polar groups, the more rapid the onset of the action.
Hypnotic properties may often be increased by increasing fat solubility and may be abolished by introducing polar groups on the side chains.
Barbiturates and alcohol are both metabolized in the liver and the combination can be toxic, because the alcohol retards the excretion of the barbiturate.
When hypnotics are first taken, they may reduce dreaming and interrupt sleep.
Barbiturates classification.
Classification of barbiturates according to action time: (The names in parentheses are trade names.).
1. Long-acting: phenobarbital, methylphenobarbital (Prominalb).
2. Intermediate: amylobarbital (Amytal), butobarbital (Sonabarb), butethal (Neonal), hexethal (Ortal), vinbarbital (Delvinal).
3. Short-acting: cyclobarbital (Amnosed), pentobarbital (Nembutal, Petab, Sommital, Penbon, Sodepent, Pentone, Pentobeta), secobarbital (Seconal).
4. Ultrashort-acting: hexobarbital sodium (Evipal), thiamylal sodium (Surital), thiopentone sodium (Pentothal).
5. The thiobarbiturates (Pentothal and Surital) are inactive by mouth and can be administered only by intravenous or rectal routes.
They belong to the group of infamous "truth drugs".
Both tolerance (increasing quantities needed for an effect) and physical dependence occur with high doses.
The barbiturates stimulate enzymes in the liver that breakdowns the drug, thus reducing its effect.
Although tolerance develops to the sedative effect of the drugs, the lethal dose remains essentially constant.
As tolerance increases, therefore, the margin of safety decreases, and accidental poisoning may occur at doses that no longer provide sedation.
6. The therapeutic index is the ratio of the toxic dose to the effective dose.
The larger this factor is, the greater the safety in the use of the drug.
The therapeutic index is dependent on two types of drug tolerance:
6.1 Pharmokinetic tolerance to changes in the concentration of the drug in the body caused by changes in liver activity.
6.2 Pharmodynamic tolerance caused by the receptor (where the drug acts) requiring more drug while the concentration for receptor poisoning may not change.

5.5.8 Cannabis
Cannabis ("pot", "marihuana", "Indian hemp", "hashish", "bhang").
Cannabis: Marijuana, hashish, Indian hemp", Cannabis sativa, δ-9-tetrahydrocannabinol, C21H30O2. (THC), hallucinogenic drug
: Street names: Pot, grass, weed, reefer, joint, Mary-Jane, Acapulco Gold (high strength), rope, mull, cone, spliff, dope, skunk, bhang, ganja, hash, chronic, yarndi.
Symptoms: Difficulty concentrating, slow reflexes, impaired motor skills, bloodshot or glassy eyes, increased appetite, dryness of the mouth.
Problems: Mood swings, memory impairment, weight gain, chronic bronchitis, panic attacks, anxiety, depression, and psychotic symptoms.
Cannabis serves as barrier against self-awareness, and may interfere with a young person's development including possible interference with reproductive function.
The most active ingredient is tetrahydrocannabinol, THC, obtained from the fruiting or flowering tops of the cannabis plant.
Purchased marihuana may contain 10% tetrahydrocannabinol, double the average concentration 25 years ago when marihuana was commonly called "grass".
Cannabis is the psychotropic product from the plant Cannabis sativa, which is one of mankind's oldest cultivated plants.
It is used for its fibrous qualities (hemp) as well as its medicinal properties, because of compounds called cannabinoids.
The major active ingredient is the cannabinoid "D9 tetrahydrocannabinol" or "THC".
It is fat soluble, so it may remain in the body tissues such as the brain for many days after a single dose.
If cannabis is smoked, a "high feeling" is attained much more quickly, but if eaten the effects are long lasting.
Additive effects are observed with alcohol and other CNS depressants, but no clear interaction has been noted with stimulants.
Effects: feelings of self-confidence, euphoria, well being and relaxation, altered perception of taste, smell, touch, and hearing, delusions and hallucinations.
The main at risk groups are young people with friends who are illicit drug users.
Recurrent use may lead to impaired fertility.
In males, cannabis use diminishes testosterone production and decreases sperm count.
It also results in abnormal shape and chemical composition of the sperm cells.
In females, cannabis can affect fertility by disrupting the reproductive cycle through changes to ovulation and menstrual cycles.
Another concern is the possibility of foetal damage during pregnancy.
In the long-term may result in impotence, loss of normal sex drive and infertility.
Heavy cannabis use produces a change in personality and in behaviour that is more dramatically shown by children and adolescents than it is by adults.
Some adolescents who use cannabis have been observed to be devoid of the drive and energy normally seen in adolescents.
Cannabis is known to be both mutagenic and carcinogenic as well as destructive to lung tissue.
Since cannabis smoke is inhaled deeply, held for much longer and contains more tar than tobacco, the adverse effects are greater.
As a result, smoking 2-3 cannabis cigarettes may carry the same risk of lung damage as smoking a whole packet of tobacco cigarettes.
Use of cannabis may lead to use of "hard" drugs and to drug dependence.
Cannabis, (Cannabis sativa), Cannabaceae

Dr Gary Chan, National Centre for Youth Substance Use Research, University of Queensland
Regular cannabis use has harmful effects regardless of the age a person starts using, a University of Queensland-led study has found.
The study examined people who began regular cannabis use in high school or in their early 20s, and compared both with non-users.
The results linked regular cannabis use with negative life outcomes by age 35.
“Regular cannabis users were more likely to engage in high-risk alcohol consumption, smoke tobacco, use other illicit drugs, not be in a relationship at age 35”,
“These outcomes were more common among those who started using cannabis regularly in adolescence.
“They were also at higher risk of depression and less likely to have a paid job.
“Overall, regular use of cannabis – more than weekly and especially daily use – was found to have harmful consequences, regardless of the age people using it.”
The research project followed 1792 Australian high school students aged 15 in 1992, investigating patterns of cannabis use across 20 years.
“Two-thirds of people who use cannabis regularly started use in their early 20s,” he said.
“Because adult-onset is a lot more common than adolescent on-set, most of the harms associated with cannabis are in fact in the group who begin later on.”
“Those who began regular use as a young adult have highest proportion of subsequent illicit drug use and tobacco, much higher proportion of high-risk drinking.

5.5.9 Chroming, "huffing"
"Chroming" refers to sniffing aerosol spray paint can fumes usually from plastic bags or drink bottles.
The term comes from the lead chromate in silver gold and bronze coloured paint that have a high concentration of toxic compounds that can get you "high".
Other inhalants used for chroming are typewriter correction fluid, "White Out" or "Liquid Paper" thinner and model aircraft cement.
The drunken dizzy feeling induced is often accompanied by excitability, euphoria, decreased inhibitions, delusions of grandeur, and reckless behaviour.
Long-term use can lead to permanent damage to major organs, depression and anxiety disorders, and dependence.
Some addicts become suffocated by the plastic bags used.
Effects: damage to hyopcampal stem cells in the brain causes memory impairment and to cerebral cortex cells causes personality changes,and memory impairment.

5.5.10 Cocaine and crack cocaine
Cocaine, crack cocaine.
Street names: Cocaine: coke, flake, snow, happy dust, Charlie, gold dust, Cecil, C, freebase, toot, white girl, Scotty, white lady.
Crack cocaine: crack, rock, base, sugar block.
Symptoms: Anxiety, agitation, increased pulse rates, enlarged pupils, paranoia, hallucinations, excitability, euphoria, talkativeness.
Potential problems: High risk of addiction, erratic behaviour, hallucinations, cocaine psychosis, eating or sleeping disorders, impaired sexual performance, ongoing respiratory problems, ulceration of the mucous membrane of the nose, collapse of the nasal septum, cardiac arrest, convulsions.
Cocaine is an alkaloid of the coca shrub Erythroxylon coca.
It was formerly used as a local anaesthetic for throat surgery.
It is prepared as a salt, cocaine hydrochloride.
This salt can be inhaled into the nostril or injected by intravenous injection.
The cocaine salt can also be converted to free base cocaine that is burned and the smoke inhaled.
Most cocaine users begin with intra-nasal administration and later change to injecting use or inhalation of smoke.
The free base cocaine, "crack", sold in the streets of American cities is called "crack".
In USA, the cheap "crack cocaine" is used by lower socio-economic groups, and expensive pure crystalline cocaine is used by higher socio-economic groups.
Cocaine is a highly addictive drug.
It produces feelings of increased confidence and exhilaration.
High doses cause loss of coordination, dizziness, hallucinations and violent or aggressive behaviour, respiratory paralysis, and death.
Unhygienic injections of the drug can cause infections including hepatitis B, hepatitis C and HIV/AIDS.
As tolerance to cocaine develops rapidly, social problems develop, e.g. debts, job loss, and impaired productivity.
Women have taken to prostitution to support the cost of their cocaine addiction.
Users may mix cocaine use with other drugs, e.g. heroin, called "speedball", to enhance effects.
Withdrawal from cocaine is a slow and difficult process requiring skilled medical management.
5.5.11 "Date rape"
"Date rape"
The so-called "date rape" drugs are mainly as follows:
1. Rohypnol, C16H12FN3O3, flunitrazepam, Narcozep, Roipnol, a 1,4-benzodiazepinone, hypnotic sedative and amnestic drug.
It is used to treat chronic insomnia and as a sedative.
It may be used as a date rape drug and cause violent behavior. (Importation banned in the US).
2. GHB, C4H8O3, 4-Hydroxybutanoic acid, 4-Hydroxybutyric acid, a 4-hydroxy monocarboxylic acid.
It is used as a general anaesthetic, sedative and neurotoxin.
It is illegal in multiple countries, but sold in th US as Xyrem.
It occurs in the human the human central nervous system, wine, beef, and citrus fruits.
The street names for illegal juice as a date rape drug include Juice, Liquid Ecstasy, and G.
3. Ketamine, C13H16ClNO, a cyclohexanone.
It is used to treat chronic pain and as an veterinary anaesthetic, and it may have hallucinogenic effects.
The street names for illegal juice as a date rape drug include Special K, and Ketalar.

5.5.12 Designer drugs
Designer drugs: A new wave of designer has lead to death or permanent brain damage in Europe.
Some synthetic drugs are derivatives of Ecstasy, but are known on the rave scene as "Super E", because they are up to 30 times more powerful.
1. "Flatliner" (synthetic drug 4MTA), has been blamed for deaths in Britain.
2. "Golden Eagle", an amphetamine-based concoction, is powerfully hallucinogenic, causing "trips", which last up to twenty hours.
3. "DOB" (death of body, "Nexus", "Spectrun", BZP, N-benzylpiperazine), is 10 to 20 times more potent than amphetamine.
4. BZP tablets, especially those that also contain the hallucinogen TFMPP [1-(3-trifluoromethylphenyl) piperazine], often are sold as MDMA (3, 4-methylenedioxymethamphetamine), are also called
"Ecstasy" or are promoted as an alternative to MDMA.
Designer drugs
1. The psychoactive compounds, phenylethylamines (mescaline analogues), e.g. catecholamines, amphetamine, methamphetamine.
3,4-methylenedioxyamphetamine (MDA, ecstasy) and 3,4-methylenedioxymethamphetamine (MDMA).
Amphetamine overdose may cause tachycardia, hypertension, hyperthermia, diaphoresis, mydriasis, agitation, muscle rigidity, and hyper-reflexia.
Death usually results from arrhythmia, hyperthermia or intracerebral haemorrhage.
2. Synthetic opioid derivatives, derivatives of fentanyl (e.g. α-methylfentanyl, 3-methylfentanyl), or pethidine (meperidine).
3. Arylhexylamines, e.g. phencyclidine (PCP), a derivative of the anaesthetic ketamine.
The hallucinogenic drug phencyclidine hydrochloride is known as "angel dust".

5.5.13 Doping in sport
by V. Birzniece, School of Medicine, University of Western Sydney, 13 June 2014 (modified and edited).
Doping in sport 1. Most reports on doping in sport focus on elite athletes.
Recreational athletes are the group with the highest rates of drug misuse.
Elite athletes who abuse performance-enhancing substances may escape detection and many recreational athletes are never going to be tested.
Major emphasis is placed on doping detection, with less attention to the detrimental effects of doping agents on the health of athletes.
Most of the doping agents exert serious side effects, especially when used in combination, at high doses and for a long duration.
The extent of long-term health consequences is difficult to predict, but likely to be substantial.
2. Anabolic androgenic steroids (AAS)
Anabolic androgenic steroids (AAS) are the most commonly used substances to improve an exercise performance and body image of an athlete.
AAS with other substances increases anabolic/performance-enhancing effect [growth hormone (GH), insulin, insulin-like growth factor (IGF)-l].
It enhances fat and water loss [diuretics, Beta2-adrenoreceptor (Beta2-AR) agonists ]
It reduces side effects of androgens [aromatase inhibitors, selective oestrogen receptor modulators (SERMI)].
Athletes commonly combine different steroids (called stacking) and use AAS in cycles.
AAS abuse has been reported in 11% of adult gym users, 39% of bodybuilders and 67% of power lifters.
The effect of testosterone on muscle mass is dose-dependent.
Testosterone exerts not only an anabolic effect, but also a substantial effect on muscle strength.
AAS abuse is linked with many serious side effects, sudden cardiac death in otherwise healthy
adults who have been abusing testosterone for years.
AAS abuse is linked to acute myocardial infarction and fatal ventricular arrhythmia.
3. Human growth hormone (GH)
Human growth hormone (GH), is one of the major anabolic hormones and is abused with anabolic androgenic steroids in about 25% of users.
Growth hormone abuse is popular among athletes probably, because of the perceived benefit on muscle mass and function, and difficulty of detection.
Growth hormone increases whole body protein synthesis in healthy young men and conserves protein during exercise.
However, this effect may be lost in highly trained athletes.
Growth hormone increases lean body mass in healthy adults.
However, only when a growth hormone is combined with testosterone does an increase in active muscle mass occur.
Up to 80% of healthy adults who have received growth hormone report side effects, mostly arising from fluid retention, including sweating, fatigue and dizziness.
4. Insulin and IGF-l
Insulin and IGF-l are increasingly used as doping agents.
IGF-l is produced in the liver and is the primary mediator of the effects of growth hormone.
The actions of insulin and IGF-I that may enhance performance include protein anabolism, glucose uptake and glycogen storage in muscle.
Insulin promotes net amino acid uptake and protein anabolism in skeletal muscle by reducing protein breakdown, whereas IGF-I stimulates protein synthesis.
The effects of IGF-I on glucose metabolism largely resemble those of insulin.
However, during IGF-I infusion, insulin levels drop and so does the fat sparing effect of insulin.
Thus, insulin and IGF-I stimulate muscle anabolism and may increase glucose availability for exercising muscle to use.
Most of the subjects reported the side effect of hypoglycaemia (57%).
Insulin and IGF-I abuse may cause an increase in cancer risk.
5. Erythropoeitin (Epo)
Erythropoeitin (Epo) doping, has been reported among elite athletes in cycling, because of its ability to increase oxygen-carrying capacity of blood.
However it may cause increased risk of thrombosis, autoimmune reactions and possibly cancer.
6. Beta-adrenergic agents
Beta-adrenergic agents have bronchodilator, anabolic and anti-inflationary actions, but with little effect on aerobic exercise performance despite an improvement in lung function.
Positive effects on performance muscle tremors in sports such as rifle shooting and archery, but reduce endurance and sprint capacity.
Positive effects may result from use of Beta 20-AR agonists, but side effects may include tachycardia, faster than normal heart rates at rest.
Beta 20-AR agonists may be used to relieve anxiety and muscle tremor.

5.5.14 "Ecstasy"
"Ecstasy"
1. MDMA, C11H15NO2, (3,4-methylenedioxy-methamphetamine), psychoactive drug, "ecstasy" (other names: "E", "X", "XTC", "Mandy", "Molly")
It is also an amphetamine-type stimulant and mild psychedelic, because it is a derivative of amphetamine and has similar properties.
The effects of ecstasy are different from amphetamines and can bring on some effects more typically found in hallucinogenic substances.
Ecstasy pills contain about 40 mg of MDMA, but Ecstasy powder is also available.
2. Research show that consistent users of this drug experience slight memory difficulties and mild depression, but some people have more severe symptoms.
The short term effects for a small fraction of users my include severe overheating or water intoxication leading to death.
The drug may cause long-term damage to the serotonin system.
3. Ecstasy may cause long-term damage to the serotonin system.
Amphetamine / methamphetamine.
Speed, base and ice are currently the most common street names for these types of drugs.
They share the same symptoms and potential consequences, but can differ in severity.
4. Ecstasy is used at dance parties and other social venues.
With increased use, the negative aspects of use tend to increase while the positive effects decrease, so few people have dependence problems with it.
The physical effects are teeth grinding, restlessness, dry mouth, increased sweating, hot and cold flushes, nausea and vomiting.
Users experience a feeling of improved personal relations, communication and intimacy, and euphoria.
However, this may lead to visual hallucinations, anxiety, loss of control and panic.
Users may suffer extreme dehydration and even death.
5. Product: MDMA (Methylenedioxymethamphetamine) (3,4-methylenedioxy-N-methylamphetamine).
Street name: Adam, E, Ex, E and C, eccy, Ecstasy, eggs, Essence, love drug, MDMA, PMA, XTC.
Symptoms: Increased blood pressure and pulse rates, sweating, overheating, jaw clenching, teeth grinding, nausea, anxiety, excitability, tremors, insomnia, enlarged pupils, loss of appetite.
MDMA is not a psychodelic drug in that it does not induce hallucinations, but it floods the brain with serotonin, making the users feel euphoric.
However, it may have a medical use in assisting the psychotherapy of patients suffering from post-traumatic stress disorder (PTSD).
Potential problems: Sleep problems, cracked teeth through grinding, high blood pressure, dehydration, nervousness, hallucinations, memory and attention impairment, decreased emotional control, lethargy, severe depression, possible nerve cell damage, thermal meltdown, death from heart failure.
6. Amphetamines were once used to treat obesity, mild depression and narcolepsy, (a tendency to fall asleep at any time), and certain behavioural disorders in children.
Amphetamines are "pep pills".
Ordinary doses of 10 to 30 mg per day provide a feeling of well being and increased alertness.
Amphetamines are structurally similar to the naturally occurring biogenic amines, e.g. ephedrine, which act as stimulants of the central nervous system, in a similar manner to epinephrine.
Amphetamine and epinephrine are optically active, i.e. two compounds with the same formula with structures mirror images of each other and cannot be superimposed.
You cannot place one hand in an identical position on top of the other.
However, if you hold them parallel.
One hand is as the mirror image of the other.
A pair of chemicals related in this way are called left-handed, l, and right-handed, d.
Compounds differing only in this way can be biologically very different in their activity.
Benzedrine is a 50: 50 mixture (racemic) of the l-amphetamine and d-amphetamine, but while the l-form is less active on the central nervous system, the pure d-form, dexedrine, is nearly twice as potent.
Amphetamines and barbiturates were often used in conjunction.
Thus amphetamines may be consumed in the morning to alleviate the symptoms of a barbiturate hangover, while the barbiturates may be necessary to counteract the stimulant properties of amphetamines and allow the user to sleep.
In case of overdose they were also used as mutual antidotes.
The deeply held belief by the public in antidotes is somewhat dangerous, because although two substances may be antidote in one aspect, they can reinforce each other (synergism) in other side effects.
The death rate can be very high.
The amphetamines also form a family of drugs, although the pattern is somewhat difficult to see and tends to overlap other categories of drugs.
In Australia, amphetamines have been used to treat some medical conditions, however these drugs are both potentially addictive and quite toxic.
The best known members of this group of stimulants are dexamphetamine (e.g. dexedrine "dexos"), methamphetamine (e.g. methedrine), and the amphetamines (e.g. benzedrine).
Amphetamines are simple amines with many effects including cardiovascular and central nervous system stimulant actions, which is similar to the naturally occurring hormone adrenaline.
They stimulate and excite all areas of the nervous system, including the brain.
As they inhibit sleep and fatigue, the main concern is the self-medication of amphetamines by truck drivers, students and businessmen, who use amphetamines to stave off normal fatigue and enable them to work for days with little sleep or food.
Young people who frequent night clubs use amphetamines, so they can dance all night.
Truck drivers use amphetamines, so they can drive for long periods without rest and make more trips per week.
When Nazi germany invaded France, the tank crew could keep active for long periods, because they were given amphetamines
The drug has a reputation of facilitating social and sexual interactions:
* Implications for HIV transmission, i.e. if enhanced sexuality is not accompanied by safer sexual practices.
* Amphetamines are often used in a casual fashion, accompanied by alcohol.
The setting does not encourage the use of clean needles and amphetamine use is an independent risk factor for HIV infection.
Injecting drug users are increasingly emerging as a poly drug-abusing group and as amphetamines are cheaper than heroin on the street, more IDUs are including amphetamines in their repertoire of drug use.
Immediate effects at low doses include sensations of euphoria, enhanced self-awareness, self-confidence, increased visual awareness, heightened alertness, increased capacity for concentration, greater energy.
Users become hyperactive, talkative, excited, irritable and restless.
Effects at high doses include dry mouth, fever, sweating, headache, blurred vision, rapid or slurred speech and collapse.
Long-term effects include malnutrition, since amphetamines suppress appetite, and sudden acts of aggression.
Multiple drug uses may take depressant drugs such as alcohol and barbiturates in combination to fight the side effects of amphetamine use, such as sleeplessness.
Prolonged use may lead to drug dependence.
This term refers to people with a pattern of behaviour that make their lives become unmanageable, e.g. addiction to alcohol and drugs ("a jones").

5.5.15 Hallucinogenic drugs, hallucinogens
Hallucinogenic drugs include: mescaline, psilocybin, scopolamine (hyoscine), atropine, LSD (Lysergic acid diethylamide, tryptamine, cocaine, THC cannabis.
Psilocybin: mushies, blue meanies, magic mushrooms, gold tops, datura, angel's trumpet.
Symptoms: Trance-like state, excitation, euphoria, increased pulse rates, insomnia, hallucinations, paranoia.
Potential problems: visual hallucinations may produce anxiety and fear, confusion and lack of coordination can result in greater risk of injury, self-inflicted injury, violent behaviour, paranoia, depression, anxiety, unpredictable flashbacks.
Hallucinogenic (or related psychotomimetic) drugs derived from various plants and fungi have been used from ancient times.
The use of the emetic toadstool Amanita muscaria extends over thousands of years.
The Aztec and Mayan cultures used the peyote cactus, from which mescaline is derived.
They also used the psilocybe mushroom (or sacred mushroom Teonanacatl, Psilocybe montana) the active principle of which is psilocybin, which is about 30 times as potent as mescaline.
From Ipomoea (morning glory) the Mexican Indians obtained a substance similar to lysergic acid, and from the plant Datura stramonium (thorn apple) they obtained scopolamine (hyoscine) and atropine from Atropa belladonna, deadly nightshade, belladonna.
Other plants used in Central and South America contained cocaine.
Tannin in tea contains gallic acid, which can be converted to mescaline.
Mescaline is classed as a catecholamine, along with amphetamines, to which it is structurally related.
Anhalonium lewinii, peyote cactus, mescaline alkaloid, Cactaceae
Lophophora williamsii, peyote cactus, mescal buttons, herbal medicine, illegal hallucinogenic drug mescaline, alkaloid, Aztec "sacred mushroom", Cactaceae, Trichocereus pachanoi (T. peruvianus), San Pedro cactus, mescaline alkaloid, Cactaceae.

5.5.16 Heroin
Heroin, C21H23NO5, is a drug derived from the opiate morphine.
Opiates are a group of drugs derived from opium obtained from the poppy flower in the Opium poppy, (Papaver somniferum), Papaveraceae
Heroin is safe and effective analgesic.
It should be used only to prevent severe and persistent pain, because it causes dependence.
Illegal use has produced much suffering and so many people think of it as a "horror drug".
The chemical is a white crystalline powder that is soluble in water.
The drug is administered by injection or smoking.
The onset of action is rapid and the duration of action is 3 to 4 hours.
The immediate effect or "rush" after an intravenous (IV) dose is, because of the high fat solubility of the drug and thus its rapid entry into the brain.
The drug bought by illegal users on the street results is a dose of variable amount diluted by substances of varying quality and safety.
Most users inject their dose using solvents for the powder they purchase.
These solvents may be contaminated, e.g. lemon juice.
Users may be harmed by overdose resulting in a fatal cardiovascular collapse.
Most complications of heroin use relate to the injection of contaminated material, or the use of non-sterile injecting equipment that can cause septicaemia and transmission of HIV/AIDS and hepatitis B disease.
Methadone, a synthetic opiate, is used to treat heroin users, but there are many arguments about using it.
It replaces heroin and has a longer life in the body than heroin.
Drug users in a methadone maintenance programme receive a single prescribed dose of methadone every day.
Methadone maintenance programmes are effective in reducing the frequency of injecting and the incidence of use of contaminated injecting equipment.
The Human Immunodeficiency Virus (HIV) can be transmitted through the exchange of HIV-infected body fluids from using HIV-infected injecting equipment.
Injection drug users should be warned about the risks of the use of contaminated injecting equipment and taught needle and syringe-cleaning techniques or the availability of clean needles and syringes or needle exchange programmes in the area.
They should use safer sexual practices and use condoms.
New users are at special risk, because their drug use is often unplanned and thus they may share needles, because they do not possess the necessary equipment.

5.5.17 "Ice"
"Ice" generally looks like colourless crystals or crystalline powder.
The difference between "Ice" and "Speed / Base" is the way it is made.
The chemicals are the same, but "Ice" is a highly potent drug that increases the severity of the potential consequences.
Product: Crystal methamphetamine hydrochloride.
Street name: "Ice", crystal, "crystal meth", sabu, batu, d-meth, tina, glass.
Other potential problems: In the short term, "Ice" can produce increased heart rate, hypertension, irregular body temperature, increase breathing rates, constrict blood vessels, and cause heart problems.
Longer term users of the drug can typically appear older than their age and may have damaged teeth, skin lesions, and greater risk of strike, decreased lung function and poorer cognitive function.
"Ice" users are at risk of experiencing a drug-induced psychosis, they can become paranoid and hallucinate.
A person can become increasingly aggressive and have violent behaviour, possibly requiring chemical and physical restraint or police intervention.
There is a high risk of addiction, including through smoking.
Damage can occur to lungs through smoking "Ice" and to the lining of the nose through snorting.
If injected it can lead to scarring, abscesses and vein damage.
The Queensland Department of Health reports that ingesting ice can cause addiction, emergency psychiatric care, violence, aggression, hallucinations, paranoia, anxiety, panic, depression, bizarre beliefs, and compulsive behaviour.

5.5.18 LSD, Lysergic acid diethylamide
LSD, Lysergic acid diethylamide, C20H25N3O, hallucinogenic drug
Street name: LSD, acid, trips, wedges, windowpane, blotter, microdot.
Lysergic acid diethylamide (LSD) is classed as an indoleamine.
It is one of the most potent drugs known.
Very low doses are capable of causing marked effects in susceptible individuals.
Lysergide was discovered while investigating a modified Ergotamine, as an improved drug for childbirth.
Ergot itself is found on many plants, particularly rye.
An ergot alkaloid is used to induce uterine contractions.
In Ergotamine, the diethylamino group is replaced by a peptide.
The opiate alkaloid oxycodone, "hillbilly heroin", made from thebaine (paramorphine), C19H21NO3, has unique stimulating properties is usually supplied as oxycodone hydrochloride.
Opioid analgesics based on thebaine (paramorphine), C19H21NO3, include oxycodone ("Oxycontin", "Oxynorm"), oxycodone hydrochloride ("Endone").
These powerful analgesic drugs may be hazardous and harmful and cause dependence.
The song "Lucy in the sky with diamonds" has no connection with LSD.
Oxycodone Oxycontin
Oxycodone, C18H21NO4, dihydrohydroxycodeinone, semi-synthetic, morphine-like opioid alkaloid with analgesic activity, which mimics the effects of endogenous opioids.
Oxycodone is a DEA Schedule II controlled substance, which has a high potential for abuse which may lead to severe psychological or physical dependence.
Oxycodone with acetaminophen has been linked to many cases of acute liver failure.
Oxycontin only refers to the extended-release formulation of oxycodone as a long-acting form of oxycodone, so both may also be called narcotic analgesics.
Oxycontin may be preferred, because with twice-daily dosing its effects can last for 24 hours and be used to treat cancer, shingles, injuries and trauma.
Oxycontin abuse by poor drug addicts has caused many deaths in the United States.

5.5.19 Mephedrone and Methamphetamine
1. Mephedrone, C11H15NO, 3,4-methylenedioxy-N-methylcathinone, 4MMC, MCAT, bubbleluv, drone, miaow, a cheap ecstasy alternative, is an analogue of methcanthionone, MDMA, and may be given an innocent classification as a plant food.
It causes euphoria, talkativeness and increased sensitivity. has MDMA-like side effects, e.g. jaw tension, perspiration and depression.
Mephedrone, also known as 4-methylmethcathinone (4-MMC) or 4-methylephedrone, is a synthetic stimulant drug of the amphetamine and cathinone classes.
Slang names include drone, M-CAT, and meow meow.
It is chemically similar to the alkaloid cathinone, C9H11NO in the khat plant of eastern Africa, Catha edulis, Celastraceae.
2. Methamphetamine, C10H15N, (methylamphetamine desoxyephedrine), is an anorectic and central nervous system stimulant and sympathomimetic and is highly addictive and is becoming widely used in many countries.
Methamphetamine facilitates the release of the catecholines noradrenaline, dopamine and serotonin from brain nerve terminals and inhibits their uptake, causing increase synaptic concentration of these neurotransmitters.

5.5.20 Morphine and derivatives
Morphine and derivatives
Codeine, pethidine, heroin, methadone, opioids
Product: Heroin, morphine, codeine, methadone, buprenorphine, pethidine, Dilaudid, Kapanol, MS Contin.
Street name: Heroin: horse, hammer, H, dope, smack, junk, gear, boy.
Morphine: M, Miss Emma, Mister Blue, morph.
Methadone
Buprenorphine: Bupe.
Symptoms: Lethargy, drowsiness, nausea, constipation, constricted pupils, slowed breathing.
Problems: High risk of addiction, mood swings, depression, anxiety, chronic constipation, infection at sites of injection, HIV.
Also, hepatitis infections through sharing of needles, non-fatal overdoses, death from overdose.
Morphine was first isolated from the latex of the opium poppy, in the opium poppy, (Papaver somniferum), Papaveraceae
Another alkaloid, codeine, was isolated from opium.
Although codeine has only about one tenth of the potency of morphine, its prolonged use in low doses can cause physical dependence.
Morphine was acetylated to produce diacetylmorphine, heroin, which is more addictive than morphine.
The first potent analgesic to be prepared that did not depend upon opium for its prime source was pethidine.
The molecule can be drawn to show the morphine structure.
The first of the synthetic analgesics, based on 3, 3-diphenylpropylamine, was called methadone.
The molecule can be drawn to show the morphine structure.
The time of onset of physical addiction of the opiates: heroin 4 to 5 days, morphine 1 week, pethidine 10 days to 2 weeks, methadone 1 month.

5.5.21 Nicotine, tobacco smoking and chewing
1. Tobacco comes from the leaf of Tobacco plant, (Nicotiana tabacum)
Tobacco smoke contains carbon monoxide, nicotine, tars and poisonous chemicals, e.g. turpentine, acetone, benzene and ammonia.
Carbon monoxide is a poisonous gas that is absorbed into the blood stream and temporarily makes the heart work harder.
Tars are poisonous chemicals that enter the blood from the lungs and may cause many different cancers.
Cancer of the lung, mouth, throat, bladder and kidney are directly caused by some 43 carcinogenic chemicals in tobacco smoke.
Nicotine itself does not cause cancer.
2. Nicotine is an addictive drug that increases the blood pressure and heart rate.
The nicotine content is 0.2% to 5%, i.e. 0.05 to 2.0 mg per cigarette.
Nicotine is suspended in particles of tar and is quickly absorbed in the lungs and reaches the brain in about 8 seconds.
Like cocaine and amphetamines, nicotine releases dopamine to give good feeling and increase alertness.
Nicotine is both a stimulant and a sedative.
It releases adrenaline and then glucose and gives a temporary feeling of relaxation and well being.
However, this stimulation may be followed by depression and fatigue leading to the person wanting more nicotine.
The body of the smoker becomes accustomed to the presence of nicotine and becomes dependent on it.
Nicotine is not carcinogenic, does not cause respiratory disease, but can delay wound healing, increase insulin resistance
It may cause harmful effects on the foetal brain and lungs.
3. Withdrawal from nicotine for 24 hours may result in anger, hostility, aggression and less social co-operation.
Stopping access to nicotine abruptly may lead to depressed mood, difficulty in sleeping, irritability, anxiety, decreasing heart rate and increased weight gain.
Nicotine replacement therapy (NRT) increases sustained abstinence rates.
In Australia, nicotine transdermal patches, e.g. 21 mg / 24 hours, are listed on the Pharmaceutical Benefits Scheme as an aid to quitting smoking.
Replacing the nicotine in cigarettes with nicotine in skin patches, "Nicabate", "Nicorette", or chewing gum helps people to stop smoking and to quit moking.
Nicotine replacement allows smokers to control their craving for smoking tobacco and avoid withdrawal symptoms.
Nicotine can be extracted from tobacco with supercritical solvents.
Nicotine chewing gum may include 4 mg or less of nicotine, saccharin / saccharin sodium and flour, e.g. mint.
The nicotine is absorbed through the mouth lining so it should be chewed slowly.
Nicotine inhalers allow flexible dosage and the familiar hand to mouth action of smoking.
An antidepressant tablets to help quit smoking: Byprion, C13H18ClNO, "Zyban", and the partial agonist varenicline, C13H13N3, varenicline tartrate Chantix"
There is great reduction in risk in people who stop smoking, including less risk of heart attack, high blood pressure, stroke, chronic respiratory problems.
Children of smokers are more likely to become smokers.
Passive smoking in the home increases the infant's risk of pneumonia and bronchitis.
Asthmatic children in a smoking households have more frequent and severe asthma attacks.
Male smokers are more likely to be impotent and produce less sperm.
Female smokers take longer to conceive and are more likely to miscarry or have premature, stillborn babies or babies dying from cot death.
4. Nicotiana tabacum, derives from the entrepreneur who promoted its sale in France, Jean Nicot.
The active ingredient is nicotine.
New varieties, better methods of curing the leaf, allowed the introduction in the mid nineteenth century of the cigarette.
It was cheaper and neater than the cigar, with a smoke so mild it could be inhaled.
About 4000 compounds have been found in cigarette smoke.
No other drug of dependence causes cancer, and tobacco is the only environmental cause of cancer that is on the increase.
5. Classification for health purposes has concentrated on the levels of nicotine, tar (which contains the potent carcinogens) and carbon monoxide.
The carbon monoxide reacts preferentially with the red corpuscles in the blood.
On removal of the source of carbon monoxide, the equilibrium with oxygen is gradually restored.
A common ploy is to include fine holes just up from the filter, which lower the machine reading through dilution of the smoke with air.
However, when smoked for real, these holes are covered by the smokers' lips.
6. The nicotine content of tobaccos can vary from 0.2% to 5% and provides from 0.05 to 2.0 mg (1982 average 1.0 mg) per cigarette to a smoking machine.
In cigarettes, the nicotine is nearly always present in a protonated form in which it is less readily absorbed through the mouth.
This is in contrast to the basic form found in cigars and pipe tobaccos, (smoke pH 8.5).
The nicotine is suspended on the minute particles of tar and absorption from the lung occurs in seconds.
Peak concentrations found in the blood are typically 25 to 50 mg / mL.
If smoking low nicotine cigarettes, the smoker then takes in more tar and more carbon monoxide for the same level of nicotine.
The drug is slowly destroyed in the liver and excreted in the urine and faeces.
This long delay makes it difficult for law enforcement authorities to decide whether the drug was in use while driving, if this should be an offence.
7. Neurotransmitter release triggered by nicotine.
Acetylcholine --> Arousal, cognitive enhancement.
Dopamine --> pleasure, appetite suppression.
β-Endorphin --> Reduction of anxiety and tension.
GABA (γ-aminobutyric acid) --> Reduction of anxiety and tension.
Glutamate --> Learning, memory enhancement.
Noradrenaline --> Arousal, appetite suppression.
Seratonin --> Mood modulation, appetite suppression.

5.5.22 Petrol-sniffing
Petrol sniffing is a common practice among the youth of poor Aboriginal settlements in the Australian outback.
Besides damage, because of inhalation of the volatile components of petrol, lead poisoning may occur even from "unleaded petrol".
It still contains a small amount of lead that may be accumulated in body fat by persistent sniffing.
However, the petroleum company BP has produced a new form of gasoline called "Opal".
It does not contain lead and contains only a very low level of the aromatic hydrocarbons that give petrol sniffers their "high".
The substitution of Opal for normal petrol has been a very effective way to stop petrol-sniffing.

5.5.23 Reasons for trying drugs
Reasons students may give for trying drugs and what the teacher can say in reply:
1. "Someone had some and I thought I would try it.".
Dress your concern and question their decision.
Ask whether it was what they expected talk about the risks of further use.
Try to find out if they felt pressured.
This may lead to better ways for them to handle a similar situation in the future.
Consider using examples of times when you have had to deal with similar situations.
2. I always wanted to try that stuff.".
Ask what made that particular drug appealing, and what they expected to get from it.
Questions such as "What did you think it would be like?" and "Why that drug?" may be worthwhile.
You can probably discuss whether they have tried other drugs and if so, why.
Say that you are concerned with their behaviour and try to establish some ground rules.
3. "All my friends were doing it so I thought why not?".
Make your feelings about drug use clear and explain why you do not want them to use drugs.
Ask if they felt it was safe, because their friends were using it.
Ask why they thought their friends used it and whether they were aware of the risks.
Discuss the dangers of experimenting with drugs.
Discussing the importance of being able to make their own responsible decisions may be useful instead of following the crowd.
4. It made me feel really good.".
Try exploring the main reason the young person took the drug.
Find out how they have been feeling.
This is a good time to offer help and to find out if you can do anything for them or if they want to talk about another issue.
Talk about less risky way of feeling good.
5. "All my problems from school, home and life just went away.
This statement is a chance to really confront other issues.
You can express your concern about students who use drugs for coping.
Let them know that if there are problems, you would like to talk about them.
Ask what can be done to make things better.
Discuss whether the problems returned after the effects of the drug wore off.
Express your feelings about the dangers of using drugs to deal with problems.
Make it clear that you want to work together to find a better way of solving their problems.
6. It gave me more confidence.".
Let them know that this is of concern to you and explain that they do not need drugs to feel good about themselves.
Share your own experiences where you also found it difficult in social situations and explain ways that helped you gain more confidence.
These can be both positive and negative experiences.
By acknowledging your own behaviour, you will increase your credibility with the young person.
Consider ways in which you can help to improve the student's confidence and self esteem.

5.5.24 Skin-prick tests for allergy
Skin-prick tests
Put a drop of the solution containing the suspected allergen on the person's forearm.
Prick the skin under the drop with a sterilized needle.
Any itchiness, reddening of the skin or white swelling indicates an allergy to the suspected allergen.

5.5.25 "Speed" and "base"
"Speed": Product: Methamphetamine hydrochloride, amphetamine sulfate (grey, dirty white, pinkish powder, paste, liquid and pills).
Street name: Speed, whiz, go-ee, zip, oxblood, dexy's midnight runners, phets, meth, base, glass, uppers, whizz, billy, sulph, base, paste, pure, gas, amphets.
Symptoms: Common responses to intoxication include euphoria, increased blood pressure and pulse rates, increased and irregular breathing and heartbeat.
Also, insomnia, loss of appetite and dilated pupils, confidence, increased energy, talkativeness and excitability.
These drugs can cause anxiety, restlessness, sweating, overheating, blurred vision, nausea and diarrhoea, jaw clenching and / or teeth grinding.
Potential problems: Sleep problems, dental problems (e.g. cracked teeth through grinding) weight loss, stroke or heart problems, high risk of dependence.
Injecting the drug is also associated with a risk of contracting blood borne viruses, like hepatitis C and HIV.
Problems: attention and memory, paranoia and paranoid delusions, anxiety, panic attacks, hallucinations, depression, mood swings, aggression, violence.
Also, social and financial problems, compulsive repetition of actions, family arguments and conflict, the risk of family breakdown and losing friends.
Speed is the street name for amphetamine and a range of amphetamines.
Amphetamine is similar to norepinephrine, the "fright hormone" that causes the response to sudden stress or excitement.
The pharmaceutical classes of amphetamine include:
1. laevo or dl-amphetamine ("Benzedrine"), called "bennies",
2. dextroamphetamine ("Dexedrine") called "Dexo", and
3. methylamphetamine ("Methedrine") called "crystal meth".
Speed is usually amphetamine sulfate that contains equal amounts of laevo-amphetamine and dextroamphetamine.
A "speedbomb" is speed wrapped in cigarette paper to form a pill, which, when swallowed, may cause stomach pains, inflammation and ulcers.
Speed may be "cut" (diluted) with milk powder, Paracetamol and other white powders, but the pink grey "base speed" is usually more pure.
People take speed, because it gives them a feeling of awareness and excitement, they get "high".
In night clubs, people take it to help them to dance all night.
Formerly, amphetamines were prescribed by doctors for overweight patients, because amphetamines reduce appetite.
Injected speed produces and quicker and longer "high" then a slow "comedown".

5.6.1 Drug interactions
Drug interactions
Drugs that are taken orally have to be absorbed through the gut, and this can be influenced by other material present.
By using suitable coatings, a drug can be absorbed either in the acidic stomach or the alkaline duodenum.
Once the drug is in the plasma it can become bound to protein and only a small percentage remains free and active.
This percentage can be drastically altered by another drug, which kicks the first one off its protein site.
Often use is made of this method to boost the efficiency of a drug.
Also, a drug can affect the efficiency of an enzyme and hence influence the rate at which a second drug is broken down by that enzyme.
The MAO inhibitor drugs and the consequences of eating cheese while they are being taken is a good example.
Drugs are metabolized by the body depends on genetic factors, so that comparisons between animals and humans, and between individuals, can be misleading.
They also depend on physiological factors, such as age, diet, hormones (including the effects of pregnancy) and disease states, especially if the liver is involved.
The old are particularly liable to be treated with several drugs simultaneously and theywill have impaired metabolism, which will affect the drug's effects on them.
Very often a drug is changed in the body to another compound.
Sometimes the new compound is inactive or it may be less active or more active than the original.
The original may even be completely inactive and it is the new compound (metabolite) that is the "real" drug.
The body can be used as a chemical factory.
The liver has an important role in the metabolism of drugs.
Also, many drugs used in treatment of illness have high molecular mass, greater than 400.
These are excreted in the bile as well as the urine, so they are frequently subject to bacterial metabolism in the intestines.
These products can be reabsorbed and further metabolized by the liver, producing a cycle of absorption.

5.6.2 Drug tolerance
Drug tolerance
Drug users often develop tolerance to the chemical they are using.
In the case of the opiates, most of the tolerance comes from the adaptation of the cells in the nervous system to the action of the drug.
A group of depressants of the central nervous system (CNS) chronic use causes the capacity of the enzymes that metabolize the drugs to increase.br> So you can remove the alcohol faster.
Occasional alcohol drinkers can metabolize ethanol only with the liver's slow acting enzyme, alcohol dehydrogenase.
Chronic drinkers induce a new alcohol destroying enzyme of the P-450, cytochrome mono-oxygenase type in the liver.
Such persons can do well on difficult tasks at blood alcohol levels above 0.2 mg / mL.
After several weeks of abstinence from drinking alcohol, the capacity of this enzyme declines
So the abstinent alcoholic and normal individual metabolize alcohol at the same low rate.
Chronic use often means a higher blood concentration is needed to produce the same effects, i.e. it produces pharmodynamic tolerance.
This in turn means that to obtain the same effects, the person will consume more of the drug.
However, the fatal dose of the drug does not change.
The result is often death by overdose.
When the same enzymes are involved, tolerance to one drug can cause cross tolerance to another, e.g. cross tolerance of alcohol with benzodiazepine.
So chronic drinkers will deal not only with alcohol more effectively, but also with Valium.
If they consume both drugs at the same time, the alcohol will monopolize the enzyme, which then is not free to deal with the Valium so the effect of the Valium is enhanced and prolonged.
The point at which marked intoxication is caused by drinking alcohol can be monitored by measuring the blood alcohol level or breath level.
However, there is a difference between intoxication "on the way up", i.e. while drinking, compared to "on the way down", i.e. after drinking alcohol has stopped.
This is because the effect on behaviour appears to be far less "on the way down" than "on the way up".
So motor car drivers caught by a breathalyser test the morning after a heavy drinking may be unaware that their level is still high.
Westerners oxidize ethanol only slowly in the first stage to acetaldehyde.
Japanese and Chinese may have a gene for an enzyme that oxidizes it faster.
A few sips of ethanolic beverage bring a deep red colour to their cheeks and an unpleasant tingling.

5.6.3 GHB, 4-hydroxybutanoic acid
GHB, 4-hydroxybutanoic acid, C4H8O3, Product: γ-hydroxybutyrate (GHB).
Street name: Fantasy, grievous bodily harm (GBH) liquid ecstasy, liquid E, G.
Symptoms: Drowsiness, induced sleep, nausea, reduced inhibitions, dizziness, headache, increased sociability, initial euphoria leading to confusion and agitation.
Problems: Extreme drowsiness, loss of consciousness, hallucinations, difficulty focussing eyes, vomiting, impaired movement and speech, reduced muscle tone.
Also, disorientation, convulsions/seizures, coma, respiratory distress, slowed heart rate, lowered blood pressure, amnesia, death.
GHB can be addictive with prolonged use.

5.6.4 Ketamine
Ketamine
Product: Ketamine hydrochloride, C13H17Cl2NO
Street name: Green, K, super K, special K, Vitamin K.
Symptoms: Altered perception, disorientation, drowsiness, hallucinations, numbness, strange muscle movements, nausea, vomiting.
Problems: Accidents from lack of coordination, quick development of tolerance, weight loss and loss of appetite, psychological dependence, psychosis
Also, flashbacks, loss of memory, attention and vision impairment.
Ketamine is an anaesthetic.
When used with depressant drugs such as alcohol, heroin or tranquillizers, it can be particularly harmful.
It has the potential to shut down the body, causing vital organs such as the lungs or heart to stop functioning.

5.6.5 Tranquillizers 1
Tranquillizers 1, major tranquillizers, phenothiazines, chlorchromazine (Largactil) promethazine (Phenergan) depressants.
Product: Sleeping pills, minor tranquillizers.
Street name: Benzos, ternazzies, Valium, tranks, sleepers, Serapax, serries, Mandrax, mandies.
Symptoms: Drowsiness, confusion in coordination, slurred speech, depressed pulse rates, shallow breathing.
Potential problems: Anxiety, depression, restlessness, tremors, insomnia, changes in eyesight, high risks of addiction, suicide.
Tranquillizers.
These are drugs that sedate without inducing sleep.
The major tranquillizers are used in the treatment of schizophrenia by blocking dopamine receptors in the brain.
Many are based on phenothiazine and its derivatives.
1. Aliphatic series.
Generic name, Trade name.
Chlorpromazine, Trade name: Largactil, Protran, Promacid.
Promethazine, Trade name: Phenergan, "Meth-Zin", Progan, Prothazine, Avomine.
2. Piperidine series.
Thioridazine Trade name: Melleril, Aldazine.
Pericyazine, Trade name: Neulactil.
3. Piperazine series
Generic name, Trade name.
Prochlorperazine, Trade name: Stemetil, Compazine, Anti-Naus.
Thiopropazate, Trade name: Dartalan.
Fluphenazine, Trade name: Anatensol.
Fluphenazine decanoate, Trade name: Modecate.
Trifluoperazine, Trade name: Stelazine, Calmazine.
4. Thioxanthine tranquillizers are derivatives of phenothiazine that retain the sulfur atom, but not the nitrogen Generic name, Trade name.
Chlorprothizene, Trade name: Taractan
Clopenthixol, Trade name: Sordinol
Flupenthixol, Trade name: Fluanxol
Thiothixene, Trade name: Navane.
If the sulfur and the nitrogen atoms of phenothiazine are replaced by (-CH=CH-) and (-CH-) respectively, one of the derivatives is protriptyline.
These compounds are used to relieve the symptoms of schizophrenia and reduce the likelihood of relapse.
They affect the brain stem rather than the cortex.
Their use has profoundly modified the problems of the mental hospital, but they do carry a high incidence of adverse reactions.

5.6.6 Tranquillizers 2
Tranquillizers 2, minor tranquillizers, benzodiapines, diazepam (Valium), oxazepam (Seraz, Serenid) nitrazepam (Mogadon),
flunitrazepam (Rohypnol)
The most common of the minor tranquillizers are built up on a benzodiazepine nucleus.
Generic name, Trade name.
Oxazepam, Trade name: Serenid.
Diazepam, Trade name: Valium.
Nitrazepam, Trade name: Mogadon.
Chlordiazepoxide, Trade name: Librium (sleeping pill).
Librium was used in the treatment of neuroses, behaviour disturbances, alcoholism and as premedication for anaesthesia.
Valium is used to reduce symptoms of anxiety.
The differences relate to how fast they metabolize to the fast acting actual drug, nordazepam.
Valium loses the 1-methyl group, while Librium hydrolyses the 2-methylamino group to an oxygen.

5.6.7 Tranquillizers 3, minor tranquillizers, dibenzazepine, imipramine (Tofranil), desipramine Pertofran).
Tricyclic antidepressants.
Depression is a problem that faces many people and the "tricyclics", usually derived from dibenzazepine, form a popular family of antidepressants.
These drugs have as many side effects as the tranquillizers.
They present a particular problem of overdose abuse.
Generic name, Trade name.
Imipramine, Trade name: Tofranil, Imiprin, Melipramin, Desipramine, Pertofran.
Amitriptyline, Trade name: Tryptanol, Laroxyl, Saroten, Amitrip, Endep.
Nortriptyline, Nortriptyline Trade name: Allegron, Nortab.
Trimipramine, Trade name: Surmontil A, Doxepin, Sinequan, Quitaxon, Deptran.

5.6.8 Monoamine oxidase inhibitors (MAOI), tyramine, C8H11NO
Monoamine oxidase inhibitors (MAOI) are still occasionally used to treat depression.
They can inhibit an enzyme normally responsible for removing certain substances such as norepinephrine (noradrenaline) and serotonin from the body.
Depressive illnesses are associated with a decrease in the level of these amines, so that by inhibiting their destruction, their level is increased.
An example of a biogenic is the amine pheneizine that is similar to amphetamine.
MAO inhibitors.
Generic name, Trade name.
Iproniazid, Trade name: Marsilid (5% rate of liver damage).
Phenelzine, Trade name: Nardil, Nialamide, Niamid (less effective than a placebo) (deleted from PBS) Isocarboxazid, Marplan, Tranylcyprominebr.
Parnate has a strong "cheese" effect.
Mebanazine, Trade name: Actomol (deleted from PBS).
Patients treated with these drugs should avoid eating cheese, red wine, certain beers, piquant foodstuffs, e.g. Marmite and Bovril.
The reason for this is that these foodstuffs contain tyramine, C8H11NO, which is normally broken down in the alimentary canal.
When MAOI drugs are used, the enzymes that do the breakdown are inhibited, allowing tyramine into the bloodstream.
This causes a massive release of norepinephrine, then fluctuation in blood pressure, intense headache and sometimes a hypertensive crisis, even death.
People who eat aged cheeses, e.g. Stilton, might get nightmares from the excess of tyramine in such cheeses, e.g. Ebenezer Scrooge.

5.7.1 Addiction
Addiction involves a strong desire to engage in the particular behaviour, impaired capacity to control the behaviour, distress when the behaviour is prevented, and persistence with the behaviour, despite evidence that it leads to problems.
People with an addiction need to face the reality of the situation and to have some positive experiences to regain self-esteem and hope.
They must attempt to find a new set of values or personal orientation to achieve successful control and cure.

5.7.2 Classification of drugs
Drugs can be classified based on the effects they have on the central nervous system.
Some drugs can fall into more than one of these categories, for example, cannabis can be classed as a depressant, but in sufficient doses it can also act as a hallucinogen.
1. Analgesics, "painkillers" relieve pain at the source of the pain or along the central nervous system, including opiates, e.g. morphine, codeine, aspirin, ibuprofen, "Tylenol".
2. Anticonvulsants inhibit the spread of cortical stimulation, e.g. "Dilantin", hypnotic sedatives.
3. Hallucinogens, psychotropics, "mood changers" can alter perceptions and sense of time and space, including ketamine, LSD, magic mushrooms, cannabis, antipsychotics, e.g. chlorpromazine, cocaine, antidepressants, e.g. imipramine, mood stabilizers, e.g. lithium, anti-anxiety drugs, e.g. "Valium", "Librium", alcohol, kava, St. John's wort.
4. Sedatives, hypnotics ("downers") depressants, suppress or decrease the activity of the central nervous system, and may increase sleep, lessen anxiety, create alm, including alcohol, cannabis, sedatives, tranquillizers, barbiturates, e.g. phenobarbital, "Nembutal", amytal, benzodiazepines, e.g. "Librium", "Valium", sleeping pills and opioid drugs, e.g. heroin, methadone, "Benadryl".
5. Stimulants increase the activity of the central nervous system, which are addictive and may affect the cardiovascular system, including amphetamines, ecstasy, cocaine, nicotine, xanthines, e.g. caffeine, "diet pills", "Sudafed", "Actifed".

5.7.3 Cocaine and amphetamines
Cocaine and amphetamines
These drugs belong to a group of drugs that mimic the natural substances that stimulate the central nervous system (CNS).
They cause an elevation of mood, a sense of increased strength and mental capacity, and less need for sleep or food.
The people living high in the Andes chewed the leaves of the coca bush for generations for just this purpose.
The cocaine is converted from the hydrochloride salt to the free base with alkali and extraction with organic solvents.
Absorption from the lungs is then increased dramatically.
The drug is highly addictive.

5.7.4 Detoxification
Detoxificationrefers to the means by which the drug-dependent person may withdraw from the effects of that drug in a supervised way.

5.7.5 Drug dependence
Drug dependence describes the pattern of behaviour shown by drug dependent users and the physical changes experienced by them.
Drug-related disabilities includes harm suffered through changed behaviour, because of the intoxicating effects of the drug and dependent use of the drug.
Also, poor nutrition and poor hygiene, impurities or contaminants in the drug used and harm from diseases contracted, because of lack of health care.

5.7.6 Drugs and medications
Drugs and medications
To avoid confusion between "medication" and widely prohibited "drugs" such as cocaine, heroin and other substances.
Drugs administered by medical prescription should be called "medications".
Drugs can be classified as analgesics (pain deadening) sedatives and tranquillizers (reduce anxiety) stimulants, anti-depressants, hallucinogens.
A drug is any chemical that changes the mental state and that may be used repeatedly for that effect by a person.
Drugs may adversely affect the health of the individual and the social surroundings.
"Drug" refers to alcohol, tobacco, psychoactive drugs (amphetamines, ecstasy) illicit drugs (heroin, cannabis, cocaine C17H21ON4).
Also, volatile substances (petrol, some fluorocarbons) and anabolic steroids.

5.7.7 Harm reduction
Harm reduction for injecting drug users primarily aims to help them to avoid the negative health consequences of drug injection and improve their health.
Ttotal abstinence from psychoactive substances is not a feasible option in the short term, and aim to help drug users reduce their injection frequency.
1. Needle-syringe programmes (NSP) aim to ensure that those drug users who continue injecting have access to clean injection paraphernalia.
This includes needles and syringes, filters, cookers, drug containers and mixing water.
2. Drug substitution therapy (DST) involves the medically supervised treatment of individuals with opiate dependency, e.g. methadone.
3. HIV-related treatment and care primarily aims to help drug users living with HIV and AIDS cope with their infection.

5.7.8 Mode of action of drugs
Mode of action of drugs is strongly influenced by the personal and social environment.
Traditional drugs used in traditional ways often cause few problems.
Opium and cocaine are good examples.
In a different legal and social climate their effects can be disastrous.
Opiates reduce pain, aggression and sexual drive.
(Opium, Greek opion poppy juice.).

5.7.9 Therapeutic index
Therapeutic index refers to the ratio of the toxic dose to the effective dose.
The larger the index the safer the use of the drug.

5.7.10 Types of drug use
Types of drug use
1. Social and recreational use for enhancing social interaction or the enjoyment of some leisure activity.
2. Symptomatic use for reducing unpleasant sensations or experiences or to avoid challenging situations or responsibilities.
3. Dependent use so that other responsibilities are neglected and harm may result.
Such dependent use becomes habitual.
Abstinence may be associated with the onset of withdrawal symptoms, discomfort of withdrawal will become a motivator for renewed drug use.

5.8.0 National Wasterwater Drug Monitoring Program
Report of 5 August 2018
National Wasterwater Drug Monitoring Program provides datasets of drug use and distribution patterns of drugs in Australia.
Alcohol and nicotine are the most consumed drugs, methylamphetamine is the most consumed illicit drug.
There is an increase of licit and illicit use of fentanyl, C22H28N2O.
Of 23 countries with comparable data, Australia ranks second after USA in drug use.
The program measures the presence of the following substances:
[Estimated national consumption]
Methylamphetamine [8, 387 kg]
Cocaine [3, 075 kg]
MDMA [1, 280 kg], (3,4-methylene dioxy methyl amphetamine), called ecstasy
Heroin [765 kg]
MDA, (3, 3-methylenedioxyamphetamine)
Mephedone, Oxycodone, Fentanyl, Nicotine and Alcohol.
Wastewater report
Drug use remains a serious issue in Queensland: 28 October 2021
Queensland still has high rates of MDMA, cocaine and methyl amphetamine consumption, in a report by the Australian Criminal Intelligence Commission (ACIC).
The April 2021 collection covered 56 per cent of the population, found methyl amphetamine consumption in Queensland had steadily increased.
MCMA use in the State's regional areas was the second highest in the country.
In contrast, alcohol consumption decreased in Brisbane and remained relatively stable outside the capital, while cannabis use fell.