Recreational drugs
- 3 main types – stimulants, depressants/sedatives, hallucinogens
Table 12.4Illicit substance abuse: a summary of hallmarks
| Drug | Physical symptoms | Look for | Dangers |
|---|---|---|---|
| Amphetamines including methamphetamines (3 forms) speed—powder base—oily paste ice—crystalline | Aggressive or agitated behaviour; giggling; silliness; euphoria; rapid speech; fever; confused thinking; anorexia; insomnia; extreme fatigue; dry mouth; shakiness; anxiety | Jars of pills of varying colours; chain smoking; white powder and crystals can also be snorted or injected | Hypertension; death from overdose; hallucinations; paranoia; may cause temporary psychosis; stroke; cardiac arrest |
| Ecstasy (methylene-dioxymethamphetamine) | Anxiety; panic; sweating; ‘loving’ feelings; jaw clenching, teeth grinding; bizarre overactive behaviour; hallucinations; increased heart rate, BP and body temperature; confidence; feelings of happiness and love | Small tablets of various colours, shapes, sizes and designs; also comes in powder and capsules | Convulsions; risk of death from heart attack, cerebral haemorrhage, hyperthermia, fluid imbalance with hyponatraemia, acute kidney failure, DIC, liver toxicity; hangover; depression |
| Fantasy (gamma-hydroxybutyrate) | Relaxation and drowsiness; dizziness; relaxed inhibition/euphoria; increased sexual arousal; impaired mobility and speech | Colourless, odourless liquid; also powder and capsules | Tremors and shaking; amnesia; coma; convulsions; death from high doses |
| Barbiturates | Drowsiness; stupor; dullness; slurred speech; drunk appearance; vomiting | Pills of various colours | Death from overdose or as a result of withdrawal; addiction; convulsions |
| Cannabis/marijuana | Initial euphoria; floating feeling; sleepiness; lethargy; wandering mind; enlarged pupils; lack of coordination; craving for sweets; changes of appetite; memory impairment; tacchycardia | Strong odour of burnt leaves; small seeds in pocket lining; cigarette paper; discoloured fingers | Inducement to take stronger narcotics; recent medical findings reveal that prolonged usage causes cognitive defects, precipitates or exacerbates schizophrenia; hyperemesis |
| Volatile substances including glue, solvents or petrol sniffing | Aggression and violence; drunk appearance; slurred speech; dreamy or blank expression; hallucinations; ataxia | Tubes of glue; glue smears; large paper or plastic bags or handkerchiefs | Lung/brain/liver damage; death through suffocation or choking |
| LSD (lysergic acid diethylamide) | Severe hallucinations; feelings of detachment; incoherent speech; cold hands and feet; vomiting; laughing and crying | Cube sugar with discolouration in centre; strong body odour; small tube of liquid | Suicidal tendencies; unpredictable behaviour; chronic exposure causes brain damage; LSD causes chromosomal breakdown |
| Narcotics (a) opioids (e.g. heroin) | Stupor/drowsiness; marks on body; watery eyes; loss of appetite; running nose; constricted pupils; loss of sex drive; agitation; hypoventilation | Needle or hypodermic syringe; cotton; tourniquet— string, rope, belt; burnt bottle, caps or spoons; bloodstain on shirt sleeve; glass in envelopes | Death from overdose; respiratory depression; mental deterioration; destruction of brain and liver; hepatitis; embolisms |
| (b) cocaine | Similar effects to amphetamines—muscle pains, irritability, paranoia, hyperactivity, jerky movements, euphoria, dilated pupils | Powder: in microwave ovens; inhaled, snorted or injected | Hallucinations; death from overdose—sudden death from arrhythmias; seizures; mental disorders; severe respiratory problems |
A street drug dictionary
| Amphetamines or uppers | |
| Benzedrine | Roses, beanies, peaches |
| Dexedrine | Dexies, speed, hearts, pep pills, fast, go-ee, uppers, sulphate |
| Methamphetamines | Meth, crystals, white light, ice, whiz |
| Drinamyl | Purple hearts, goof balls |
| Amphetamine derivatives | |
| Ecstasy Crank | E, eggs, eckies, XTC, ‘the love drug’, Mitsubishis, MDMA, vitamin E, X, Adam, death Crystal M, crank |
| Hallucinogens | |
| LSD | Acid, blue cheer, strawberry fields, barrels, sunshine, pentagons, purple haze, peace pills, blue light, trips |
| Cannabis (Indian hemp) | Hash, resin |
| 1 Hashish (the resin) | Pot, tea, grass, hay, weed, locoweed, Mary Jane, rope, bong, jive, Acapulco gold |
| 2 Marijuana (from leaves) | Reefers, sticks, muggles, joints, spliffies, head, smoko, ganga |
| Cigarettes | Blow a stick, blast a joint, blow, get high, get stoned |
| Smoking pot | |
| Narcotics | |
| Morphine | Morph, Miss Emma |
| Heroin | H, Big H, Big Harry, GOM (God’s own medicine), crap, junk, horse dynamite (high-grade heroin), lemonade (low-grade heroin). Injection of dissolved powder: mainlining, blast, smack. Inhalation of powder: sniffing |
| Cocaine | Coke, snow, lady of the streets, nose candy, ICE, snort, C, flake, rock, blow, vitamin C, crack, shabu, baby |
| H & C | Speed balls |
| Oxycontin | Hillbilly heroin |
| Miscellaneous | |
| Fantasy | GBH (grievous bodily harm), liquid G, liquid E, liquid ecstasy, liquid X, fantasy |
| Barbiturates | Devils, barbies, goof balls |
| Benzodiazepines | Rowies, moggies |
| Ketamine | ‘K’, vitamin K, special K, K hole |
| Solvents | Chroming |
Stimulants
- Amphetamines, cocaine , MDMA
- Excitation, sympathomimetic, diaphoresis, flushing, mydriasis can lead to hallucinations
- Can lead to ACS, arrythmias, hyptension
- Treat – sedation, fluid resuscitation, treat hyperthermia
Cannabis toxicity
- Eyes – red, decrease IOP
- Dry skin and mouth
- Increased heart rate
- Muscle relaxation
- Depersonalisation, disorientation, decreased inhibition, altered mood, memory impairment, lack of attention, agitation, pscyosis
- Hyperemesis
- Anti-emetics, benzos, antipsychotics
Opiate overdose
- CNS depression, drowsiness, respiratory depression, hypothermia, miotic pupils, low to normal HR and bP
- Respiratory support
- Naloxone IV boluses 100mcg
Opioid withdrawal
Buprenorphine controlled withdrawal (short term) is used to prevent the emergence of a withdrawal syndrome in contradistinction from buprenorphine maintenance, where there is an extended treatment period.
INITIAL DOSE
- buprenorphine 4–8 mg (sublingual) as a single daily dose, increasing to 12 mg (max) on day 3, then reduce gradually over the next 3–5 days
- Note: If autonomic signs, use clonidine 5–15 mg/kg/day (o) in 3 divided doses for 7–10 days then taper off. If anxiety and agitation, use diazepam 5–20 mg (o) qid (with care). Clonidine can be used as first-line treatment because of relative safety but buprenorphine is preferred to clonidine and methadone for the management of opioid withdrawal. Avoid benzodiazepines unless supervision is available.
Maintenance programs for long-term opioid dependence
There are currently three alternative programs—methadone, buprenorphine and naltrexone—which are substitutes for heroin and other opioids. Seek specialist advice for the management of these drugs.
METHADONE
- Seek specialist advice before starting treatment. The dose needs to be determined individually according to past use and initial response to methadone.
- methadone 20 mg (o) daily initially. Stabilise dose over 3 weeks. Beware of doses >40 mg, especially in unwell patients. Maintenance 50–80 mg (o) daily. Usual maximum dose 120 mg.
BUPRENORPHINE:
- buprenorphine 2–8 mg sublingual, once daily initially, increase to 8–24 mg daily or alternative days once stabilised. It is less dependent and prone to overdose than methadone but can precipitate withdrawal if used too soon.
NALTREXONE
- Care is required in giving naltrexone to a person physically dependent on opioids. A naloxone challenge test is used. If no evidence of withdrawal give:
- naltrexone 25 mg (o) initially, increasing to 50 mg daily on day 2 if tolerated. Careful supervision with appropriate counselling is required.
The natural history of opioid dependence indicates that many patients do grow through their period of dependence and, irrespective of treatments provided, a high percentage become rehabilitated by their mid-30s.