Family doctor

What are the dangers of recreational drug use?

There is evidence that recreational drug use in on the rise, and people using drugs should be aware that there are several risks associated with illegal drug use.

Taking drugs can lead to physical or psychological dependence on the drug:

• Physical dependence occurs when a person becomes used to the drug's effects and withdrawal symptoms are noticed when the drug is suddenly stopped.
• Psychological dependence occurs when a person believes they rely on the drug to be happy and find they cannot easily stop taking the drug.

All areas of a person's life can be affected by drug use. Relationships can break up due to arguments over drug use, or a person using drugs may be more likely to make mistakes at work. People are also more at risk of unsafe sex while under the influence of drugs.

As there are no controls over illegal drugs, there are often added risks of overdose, poisoning or adverse reactions.

Cocaine, amphetamines and ectasy all carry a risk of brain haemorrhage. The death and disability rate of people who suffer a brain haemorrhage linked to substance abuse is greater than those who suffer a brain haemorrhage without using illegal drugs.

Illegal drugs are often mixed with other substances, and in many cases users cannot be sure of what they are taking.

Most drugs will also have some effect on unborn children. Avoid using any illegal drugs while pregnant and check with your doctor before taking both prescribed and unprescribed medicines.

Here is a list of some drugs of abuse, their potential side effects, and risks of overdose. A separate article on alcohol and marijuana dependence is available on the FamilyDoctor site.

Amphetamines:

This is a group of drugs known as speed. It is normally sold as white or yellow powder or as tablets or capsules.

They were developed in the 1920s. In the 1960s they began being used by doctors to treat depression and obesity. These days they are normally only prescribed for uncontrolled sleeping (narcolepsy) and some forms of childhood hyperactivity.

Amphetamines are used illegally because of the drugs potential to increase feelings of alertness, well being, and self confidence.

The risks of long term use of amphetamines include malnutrition, trouble sleeping and psychotic events. People who use the drug for prolonged periods may also find they need more to produce the same feelings the drug produced when first using amphetamines.

People are also more likely to have sex without a condom under the influence of amphetamines, which could lead to sexually transmitted diseases.

Injecting amphetamines carries the risk of infection with HIV or hepatitis C. Long term injection of amphetamines can lead to abscesses and blocked blood vessels (mainly due to the substances often mixed with illegal amphetamines).

Pregnant women who use amphetamines have a higher risk of miscarriage, premature births and having a low birth-weight baby. There is some evidence the babies also experience withdrawal symptoms after birth.

An overdose can cause an irregular heartbeat, heart attack, high fever and burst blood vessels in the brain.

A severe headache after using amphetamines could indicate the possibility of a brain haemorrhage.

Ecstasy:

Ecstasy is officially known as Methylenedioxymethamphetamine or MDMA, and has been dubbed "E" or the "love drug" by users of the drug.

The drug's make up is similar to a combination of both amphetamines (speed) and hallucinogens (i.e. LSD), and comes in the form of white, yellow, pink and green tablets.

There have also been reports of people injecting Ecstasy which is risk factor for infection with HIV and hepatitis C.

Ecstasy is used as a mood enhancer and the effects may depend on the person's environment, so if a person is at a nightclub the stimulant effects are likely to increase, making the individual prone to vigorous dancing.

The drug increases the heart rate, body temperature and blood pressure and provides feelings of increased self confidence, well being and intimacy with others.

Other possible side effects include teeth grinding, nausea, anxiety, loss of appetite, paranoia, sweating, trouble sleeping and kidney failure.

Come down effects can include depression, fatigue, trouble concentrating and insomnia.

Flashbacks with recurrence of hallucinationary effects can occur days, months and possibly even years after taking the drug.

At high doses ecstasy can cause seizures, vomiting, irrational behaviour and hallucinations. An overdose can cause a dangerously rapid heart beat and high blood pressure. The drug is particularly dangerous for those with an existing heart condition or high blood pressure.

The drug is also responsible for a number of drug-related deaths world wide.

Death can occur due to the drug causing the following medical emergencies:

• Heart attack or brain haemorrhage.
• Overheating: Ecstasy combined with prolonged vigorous dancing can raise the body temperature causing death by hyperthermia (overheating).
• Over-drinking: Avoid drinking too much water if you are taking ecstasy because deaths have been reported from dilutional hyponatremia (the brain drowning from drinking excessive fluids).

A brain haemorrhage can occur after a single dose of Ecstasy. A severe headache following the use of the drug could indicate the possibility of a brain haemorrahage.

Warnings:

People with heart disease, high blood pressure, diabetes, liver disorders, epilepsy and a history of mental illness are putting themselves at greater risk if they take ecstasy. Serious interactions can occur with some antidepressant medication.

Hallucinogens:

These are also known as psychedelic drugs and were fashionable in the 1960s. They include drugs such as LSD (acid), magic mushrooms, PCP (angel dust), and mescaline (peyote cactus).

LSD can come in liquid form, as tablets or put on squares of gelatine or blotting paper.

People under the influence of an hallucinogen are said to be "tripping", and the effects of the drug will often be unpredictable and depend on the amount taken, a person's size, their mood, and their environment.

The immediate effects of the drug last for up to 12 hours with the peak effects between 3 to 5 hours. Most people experience feelings of happiness, and distorted perceptions of sight, sound, time and space.

Other effects include numbness, muscle weakness, dilated pupils, increased body temperature, deep breathing and sweating alternating with the chills.

People taking hallucinogenics are more accident prone because they can become disorientated and see things which don't exist.

Hallucinogens can also cause bad trips in which a person may hallucinate about objects of fear such as spiders or rats, or experience feelings of paranoia or panic.

In pregnancy, LSD appears to be linked to an increased risk of miscarriage. Some studies have suggested a higher incidence of birth defects among mothers who took LSD during pregnancy, but the evidence is not conclusive.

Flashbacks can occur up to years after the drug was stopped. They usually last for a few minutes and involve seeing shapes or patterns which aren't there.

There is also evidence that that heavy use of LSD can cause memory and concentration problems in the long term.

Cocaine:

Cocaine is a stimulant which is a derivative of the coca plant which grows in many parts of South America. It is one of the most common illegal drugs used in the United States.

It normally comes in powdered form and is generally snorted through the nose or injected. Another extract of cocaine, known as freebase cocaine, can be smoked and results in a faster "high".

Cocaine was used in many medicines in the late 1800s and was used extensively as an anaesthetic. It is still used rarely in ear, nose and throat surgery. It was also an ingredient in Coca-Cola until 1903.

The effects of cocaine can last from just a few minutes to a couple of hours, and the immediate effects include an increased heart rate, sexual arousal, increased body temperature, feelings of euphoria and well being, poor judgment and aggressive behaviour.

High doses of the drug can lead to headaches, dizziness, violence, chest pain or a heart attack. An overdose can cause lung failure, heart failure and a brain haemorrhage.

A brain haemorrhage can occur after a single dose of cocaine. A severe headache or loss of consciousness following the use of the drug could indicate the possibility of a brain haemorrahage.

Prolonged use of cocaine can result in seizures, dependence and psychosis in some cases. Snorting cocaine can cause nosebleeds and tears in the nasal cavity, and smoking freebase cocaine can cause breathing problems and lung damage.

Severe withdrawal symptoms are common when a person who is dependent on cocaine decides to stop using it. These include:

• Severe depression
• Nausea
• Vomiting
• The shakes
• Hunger
• Long and disturbed sleep
• Muscle pain
• Suicidal feelings

Regular use of cocaine can also cause a number of social and financial problems. Users also find the can become tolerant to the effects of cocaine and need higher doses to achieve the same effects as when they first started using it.

Cocaine use in pregnancy can affect the fetus. There is some evidence that it can increase the risk of a miscarriage and other complications Babies of mothers using cocaine suffer withdrawal symptoms. The possibility of behavioural problems is still being investigated.

Heroin

Heroin belongs to a group of drugs known as narcotic analgesics which are strong pain killers. This group includes opium, morphine, codeine and pethidine. Heroin is normally produced from morphine or codeine, and is a depressant.

Morphine, codeine and pethidine are still used as pain killers for medicinal purposes. Heroin is only available legally under special scientific purposes.

Heroin is used by a small percentage of drug users to invoke a feeling of euphoria. It can be injected, snorted or smoked and the drug slows down the central nervous system due to its depressant effects.

Taking heroin can also cause nausea and vomiting, shallow breathing, itching, drowsiness and constipation.

If an overdose occurs, breathing slows, and the person can slip into a coma. An overdose can be fatal.

Heroin bought off the street is often mixed with other drugs and it is hard to know the strength and this can cause an accidental drug overdose.

Some of the biggest dangers relating to heroin use are sharing of needles to inject it. Sharing needles can lead to infection with HIV, hepatitis B and C, and blood poisoning.

Other health problems related to injecting drugs include:

• Collapsed veins
• Abscesses
• Tetanus
• Heart and respiratory problems
• Loss of appetite leading to weight loss
• Erectile dysfunction
• Irregular periods and possible infertility
• Pneumonia

Heroin can be particularly dangerous when combined with alcohol and minor tranquilisers which are also depressants which slow down the central nervous system.

Withdrawal symptoms occur if a drug dependent person stops using heroin. Some of the signs include cravings, leg and stomach cramps, tears, a runny nose, yawning, diarrhoea and goose bumps. But contrary to what some believe, withdrawal from heroin is safer than withdrawal from other drugs such as alcohol.

Withdrawal symptoms from heroin addiction peak after two to four days from last taking the drug and usually subside after one week. However, some people experience depression, anger management problems and low self confidence for several months after stopping the drug.

A methadone programme is available in most cities to help break addiction to opioids.

Getting help:

People who have become dependent on any drug should speak to their family doctor about how to break their addiction. Those who have decided to stop taking an illegal drug should also contact their doctor or local drug rehabilitation unit as help and support are available.