School Science Lessons
Please send comments to: J.Elfick@uq.edu.au
See websites: Drug abuse
11.11.0 Drug abuse (tranquillizers)
Table of contents
11.11.0 Drug abuse
11.11.01 Abuse of volatile substances, inhalants
11.11.3 Alcohol abuse, ethanol
11.11.6 Aspirin and analgesics, Paracetamol
220.127.116.11.5a Barbiturates (depressants)
11.11.1 Chroming, "huffing"
11.11.11 Cocaine and crack cocaine
11.11.13 Designer drugs
11.12.7 Doping in sport
11.11.0a Drugs terminology and classifications
11.11.9 Hallucinogenic drugs, hallucinogens
18.104.22.168 LSD, Lysergic acid diethylamide
11.12.6 Misuse of prescription drugs
11.11.14 Morphine and derivatives
11.11.16 Nicotine, tobacco smoking and chewing
3.45.2 Nitrous oxide sniffing
11.11.2 Petrol sniffing
11.11.1b Reasons for trying drugs
22.214.171.124 Skin prick tests for allergy
126.96.36.199 "Speed" and "base"
188.8.131.52.5b Benzodiazepines (tranquillizers)
11.13.0 National Wasterwater Drug Monitoring Program
11.12.4 Drug interactions
11.12.5 Drug tolerance
184.108.40.206 GHB, 4-hydroxybutanoic acid
11.12.1 Tranquillizers 1, major tranquillizers, phenothiazines, chlorchromazine (Largactil),
promethazine (Phenergan), depressants.
11.12.2 Tranquillizers 2, minor tranquillizers, benzodiapines, diazepam (Valium), oxazepam (Seraz, Serenid),
nitrazepam (Mogadon), nitrazepam (Roh)
220.127.116.11 Tranquillizers 3, minor tranquillizers, dibenzazepines, imipramine (Tofranil), desipramine (Pertofran),
amitriptyline (Tryptanol), nortriptyline (Allegron)
18.104.22.168 Monoamine oxidase inhibitors (MAOI), tyramine, C8H11NO
11.11.0a Drugs terminology and classifications
11.11.2a Classification of drugs
11.11.3a Cocaine and amphetamines
11.11.5a Drug dependence
11.11.6a Drugs and medications
11.11.7a Harm reduction
11.11.8a Mode of action of drugs
11.11.9a Therapeutic index
11.11.10a Types of drug use
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").
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.
11.11.2a 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.
These drugs include opiates, e.g. morphine, codeine, aspirin, ibuprofen, "Tylenol".
2. Anticonvulsants inhibit the spread of cortical stimulation, e.g. "Dilantin",
3. Hallucinogens, psychotropics, "mood changers" can alter perceptions
and sense of time and space.
These drugs include 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.
These drugs may increase sleep, lessen anxiety, create calm.
These drugs include alcohol, cannabis, sedatives, tranquillizers, barbiturates,
e.g. phenobarbital, "Nembutal", amytal, benzodiazepines,
e.g. "Librium", "Valium", sleeping pills and opioid drugs, e.g. heroin,
5. Stimulants increase the activity of the central nervous system.
They are addictive and may affect the cardiovascular system.
These drugs include amphetamines, ecstasy, cocaine, nicotine, xanthines,
e.g. caffeine, "diet pills", "Sudafed", "Actifed".
11.11.3a 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.
This term refers to the means by which the drug-dependent person may
withdraw from the effects of that drug in a supervised way.
11.11.5a Drug dependence
This term describes the pattern of behaviour shown by drug dependent
users and the physical changes experienced by them.
This term includes harm suffered through changed behaviour because of
the intoxicating effects of the drug, dependent use of the drug,
poor nutrition and poor hygiene, impurities or contaminants in the drug used and harm from diseases contracted because of lack of health
care, e.g. HIV/AIDS.
11.11.6a Drugs and medications
To avoid confusion between "medication" and widely prohibited "drugs"
such as cocaine, heroin and other substances, distinguishing it
between these two words is advisable.
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,
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
"Drug" refers to alcohol, tobacco, psychoactive drugs (amphetamines,
ecstasy) illicit drugs (heroin, cannabis, cocaine C17H21ON4)
volatile substances (petrol, some fluorocarbons) and anabolic steroids.
11.11.7a Harm reduction
This term refers to the new approach being taken to all drug-related
The aim of any intervention is not so much stopping drug use but focussing
on the reduction of specific drug-related harm.
Harm reduction for injecting drug users primarily aims to help them to
avoid the negative health consequences of drug injection and
improve their health and social status.
To this end, harm reduction approaches recognize that for many drug users,
total abstinence from psychoactive substances is not a
feasible option in the short term, and aim to help drug users reduce
their injection frequency and increase injection safety.
The following are components that typically have a significant potential
to reduce individual risk behaviours associated with drug
1. Needle-syringe programmes (NSP) aim to ensure that those drug users
who continue injecting have access to clean injection
paraphernalia, including 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 based on the
prescription of opiate agonists, e.g. methadone.
3. HIV-related treatment and care primarily aims to help drug users living
with HIV and AIDS cope with their infection.
11.11.8a Mode of action of
The effect of drugs is strongly influenced by the personal and social
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.).
11.11.9a Therapeutic index
This term refers to the ratio of the toxic dose to the effective dose.
The larger the index the safer the use of the drug.
11.11.10a Types of drug
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
Such dependent use becomes habitual.
Abstinence may be associated with the onset of withdrawal symptoms and
the discomfort of withdrawal will become a motivator for
renewed drug use.
11.11.1b 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
Try to find out if they felt pressured.
This may lead to better ways for them to handle a similar situation in
Consider using examples of times when you have had to deal with similar
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,
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
Ask what can be done to make things better.
Discuss whether the problems returned after the effects of the drug wore
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.
11.11.01 Abuse of volatile
A volatile substance is a compound that gives off a vapour or fumes at
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 and anaesthetic products.
Product: Inhalants can include general household and office products,
e.g. solvents, aerosols, glue, petrol.
Nitrous oxide: laughing gas, whippits, nitrous, 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
Potential problems: Brain damage, paralysis, pains in the chest, muscles,
joints, heart trouble, severe depression, fatigue, loss of
appetite, bronchial spasms, sores on nose or mouth, nosebleeds, diarrhoea,
bizarre or reckless behaviour, suffocation, sudden death.
The recreational sniffing of gases and solvents has become relatively
common, particularly among adolescents in Australia, with the
mean age of solvent abusers being 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 including a 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
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
Other symptoms include chronic or frequent cough, tinnitus, chest pain
or angina, nosebleeds, extreme tiredness or weakness,
increased nasal secretions, red, watery eyes, 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.
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
Sometimes, 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 or other members of the family.
These films can be used in the education of other abusers of volatile
11.11.1 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
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.
Medical evidence suggests damage done to hyopcampal stem cells in the
brain causes memory impairment and to cerebral cortex cells
causes personality changes, hallucinations and memory impairment.
However, one report suggests that it very difficult to find a link between
chroming and hallucinations.
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",
because 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" that does not contain lead and contains only
a very low level of the aromatic hydrocarbons that give petrol sniffers
The substitution of Opal for normal petrol has been a very effective
way to stop petrol-sniffing.
11.11.3 Alcohol abuse
12.3.02 Kidney, Blood water
No specific level or pattern of drinking alcohol should be considered
It has been agreed from available evidence that 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%), 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, so
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 and symptoms of possible hazardous alcohol use 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 that has already led to psychological
damage or to impairment of social functioning, including
disturbance of marital or family relationships, drink driving or other
convictions, 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
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
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
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
Northern Chinese and Japanese may oxidize the alcohol more quickly, causing
red cheeks and unpleasant sensations from the sudden
increase of acetaldehyde in he blood.
Eventually the 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.
Some amphetamine derivatives:
4-MA, C10H15N, 4-Methylamphetamine, Aptro, stimulant
4-MMA, C11H17N, 4-Methylmethamphetamine
4-MMC, MCAT, C11H15NO, Mephedrone, 4-methylmethcathinone,
MDA, C10H13NO2, 3, 4-Methylenedioxyamphetamine,
tenamfetamine (INN) ("Sally", "Sass", "Sass-a-frass", "Mellow Drug")
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,
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".
synthetic drug, decongestant and central nervous system stimulant.
Proprietary name is "Benzedrine".
The multiple mechanisms of amphetamine include:
1. Blocks uptake of adrenergic drugs and Dopamine.
2. Simulation of release of monamines, e.g. Serotonin, Norepinephrine (noradrenaline).
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
Amphetamines are a family of drugs that include methamphetamine, so amphetamine
has a broad range of psychoactive derivatives,
e.g. MDMA, "Ecstasy", and the N-methylated form, methamphetamine.
Amphetamine-type stimulants are synthetic drugs, they are made by combining
various chemical ingredients, not occurring naturally.
These drugs are similar in their chemical make-up and affect the messages
going to the body's central nervous system.
Currently, methamphetamines are more common in Australia than other amphetamines.
These types of drugs are sold in different forms such as powder, paste,
liquid, pills and crystals.
The potency of these forms varies, with the most potent being the crystalline
form, typically called "Ice" or "Crystal Meth".
Methylamine is used in the illegal manufacture of the drug MDMA (ecstasy), and methamphetamine.
Ecstasy, MDMA, 3, 4-methylenedioxymethamphetamine, 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
1. The psychoactive compounds, phenylethylamines (mescaline analogues),
e.g. catecholamines, amphetamine, methamphetamine, .
3, 4-methylenedioxyamphetamine (MDA, ecstasy) and 3, 4-methylenedioxymethamphetamine
Amphetamine overdose may cause tachycardia, hypertension, hyperthermia,
diaphoresis, mydriasis, agitation, muscle rigidity, and
Death usually results from arrhythmia, hyperthermia or intracerebral
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
The hallucinogenic drug phencyclidine hydrochloride is known as "angel
22.214.171.124 "Speed" and "base"
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, 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
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 with attention and memory, paranoia and paranoid delusions,
anxiety, panic attacks, hallucinations, depression, mood swings,
aggression, violence, 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
A "speedbomb" is speed wrapped in cigarette paper to form a pill, which,
when swallowed, may cause stomach pains, inflammation
Speed may be "cut" (diluted) with milk powder, Paracetamol and other
white powders, but the pink grey "base speed" is usually more
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".
"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,
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
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.
See diagram 14.05: Histamine, dexchlorpheniramine
Many people are allergic to pollen, stings, and dust.
An allergen is a substance that initiates the allergic response.
It is usually a protein , but is sometimes a polysaccharide.
For a person with pollen allergy, a pollen grain enters the nose and
clings to the mucous membrane.
The nasal secretions acting on the pollen grain release the grain's allergens
and other soluble components, which penetrate the outer
layer of the mucous membrane.
By a series of events that are not well understood, the allergen forms
a complex with an antibody of a type that is present in unusually
high concentrations in allergic persons.
The complex is responsible for the release of the allergy mediators,
one of the most potent being histamine.
Histamine is formed by the breakdown of the amino acid histidine.
It accounts for many symptoms of hay fever and other allergies.
Antihistamines are most widely used for treating allergies, and there
are more than 50 types available.
Like histamine, many contain an ethylamine group, -CH2CH2N
These drugs compete with histamine for the receptor sites normally occupied
by it on cells and thus prevent it from causing allergic
An example of a well known antihistamine is Polaramine.
Some tricyclic antidepressants have antihistamine effects as well, because
they also contain the ethylamine group.
126.96.36.199 Skin-prick tests
Put a drop of the solution containing the suspected allergen on the person's
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.
11.11.6 Aspirin and analgesics,
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. .
Acetaminophen, C8H9O2 (Paracetamol,
Tylenol) relieves pain and fever:.
Some analgesics, e.g. 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.
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, consult a doctor because these symptoms could be
an early sign of Reye's syndrome, a rare but 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,
take other drugs containing prescription or non prescription.
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
Ask a doctor before use if stomach bleeding warning applies to you, you
have a history of stomach problems, such as heartburn, you
have high blood pressure, heart disease, liver cirrhosis, or kidney disease,
you are taking a diuretic, you have asthma.
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 you experience any of the following signs
of stomach bleeding: feel faint, vomit blood, have bloody or
black stools, have stomach pain that does not get better, pain gets worse
or lasts more than 10 days, 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.
lt is especially important not to use aspirin during the last 3 months
of pregnancy , unless definitely directed to do so by a doctor.
because it may cause problems in the unborn child or complications during
Keep out of reach of children.
In case of overdose, get medical help or contact a Poison Control Centre
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
Children under 12 years consult a doctor.
Phenobarbital, amylobarbital, pentobarbital, thiopental.
See 188.8.131.52.5a: Barbiturates.
Previously, barbiturates were 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
Replacement of the hydrogen atoms at the fifth carbon position with alkyl
or aryl substituents yields drugs with sedative or hypnotic
More than 2000 barbiturates have been synthesized, but only a few have
become widely adopted in medicine.
Thiopental is the standard injectable general anaesthetic.
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
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
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
Barbiturates and alcohol are both metabolized in the liver and even when
each is at a non-toxic dosage, 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
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),
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
6. The therapeutic index is the ratio of the toxic dose to the effective
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.
11.11.9 Hallucinogenic drugs,
See diagram 16.21.7: Mescaline, dopamine,
psilocybin, serotonin, ergine, LSD, tropane
Hallucinogenic drugs include mescaline, psilocybin, scopolamine (hyoscine),
atropine, LSD, tryptamine, cocaine, THC cannabis.
Psilocybin: mushies, blue meanies, magic mushrooms, gold tops, datura,
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
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 Ipomea (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
Trichocereus pachanoi (T. peruvianus), San Pedro cactus, mescaline alkaloid,
184.108.40.206 LSD, Lysergic
LSD, C20H25N3O, hallucinogenic drug
Psilocybin, an acid, psychedelic 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
usually supplied as oxycodone hydrochloride.
Opioid analgesics based on thebaine (paramorphine), C19H21NO3,
include oxycodone ("Oxycontin", "Oxynorm"), oxycodone
These powerful analgesic drugs may be hazardous and harmful and cause
The song "Lucy in the sky with diamonds" has no connection with LSD.
Cannabis ("pot", "marihuana", "Indian hemp", "hashish", "bhang").
Product: Marijuana, hashish, Indian hemp", Cannabis sativa, δ-9-tetrahydrocannabinol
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,
reduced coordination and concentration, apathy, bloodshot or
glassy eyes, increased appetite, dryness of the mouth.
Potential problems: Mood swings, memory impairment, weight gain, chronic
bronchitis, increased risk of cancer of the lung, mouth,
throat and tongue, panic attacks, anxiety, depression, paranoid thinking,
decreased motivation, interference with reproductive function,
learning difficulties, psychological dependence, suicidal thoughts, risk
of psychosis 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 in the extract is tetrahydrocannabinol, THC,
obtained from the fruiting or flowering tops of the cannabis plant.
here are many ingredients in cannabis other than THQ and their long-term
effects are unknown.
Recent analysis of samples of purchased marihuana indicates an average
of 10% tetrahydrocannabinol, about 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"
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.
The effects of cannabis include feelings of self-confidence, euphoria,
well being and relaxation, altered perception of time and space,
heightened perceptions of taste, smell, touch, and hearing, delusions
The main at risk groups are young people with friends who are illicit
Recurrent use may lead to impaired fertility.
In males, cannabis use diminishes testosterone production and decreases
It also results in abnormal shape and chemical composition of the sperm
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
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.
11.11.11 Cocaine and crack
Product: 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
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
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
MDMA, C11H15NO2, 3, 4-methylenedioxy-methamphetamine,
psychoactive drug, "ecstasy" ("E", "X", "XTC", "Mandy", "Molly)
Ecstasy, MDMA, 3, 4-methylenedioxymethamphetamine (molly), is also an
amphetamine-type stimulant and mild psychedelic,
because it has a chemical structure that is similar to amphetamines.
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 powder is also available.
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.
Ecstasy is a derivative of amphetamine and has similar properties.
It 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
Users may suffer extreme dehydration and even death.
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
However, it may have a 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.
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, such as 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
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
In Australia, amphetamines have been used to treat some medical conditions,
however these drugs are both potentially addictive and
The best known members of this group of stimulants are dexamphetamine
(e.g. dexedrine), 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
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
Truck drivers use amphetamines, so they can drive for long periods without
rest and make more trips per week.
The drug has a reputation of facilitating social and sexual interactions:.
1. Implications for HIV transmission, i.e. if enhanced sexuality is not
accompanied by safer sexual practices.
2. Amphetamines are often used in a casual fashion accompanied by alcohol.
The setting is not conducive to 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.
C10H15N (methylamphetamine desoxyephedrine), is an
anorectic and central nervous system stimulant and
sympathomimetic and is highly addictive and is becoming widely used in
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
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.
11.11.13 Designer drugs
A new wave of designer has lead to death or permanent brain damage in
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
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.
11.11.14 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.
Symptoms: Lethargy, drowsiness, nausea, constipation, constricted pupils,
Potential problems: High risk of addiction, mood swings, depression,
anxiety, chronic constipation, infection at sites of injection, HIV
and hepatitis infections through sharing of needles, non-fatal overdoses,
death from overdose.
Morphine was first isolated from the latex of the opium poppy, in PapaverPapaver
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 used to be characterized
as: heroin 4 to 5 days, morphine 1 week, pethidine 10
days to 2 weeks, methadone 1 month.
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 Papaver, Papaver somniferum.
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.
11.11.16 Nicotine, tobacco
smoking and chewing
1. Tobacco comes from the leaf of 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, but
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 and 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, frustration, anger, anxiety, difficulty
concentration, decreasing heart rate and in creases appetite and weight
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
Replacing the nicotine in cigarettes with nicotine in skin patches, "Nicabate",
"Nicorette", or chewing gum helps people to stop smoking
and to quit smoking altogether.
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
Nicotine inhalers allow flexible dosage and the familiar hand to mouth
action of smoking.
An antidepressant tablets to help quit smoking may be available on doctor's
prescription., e.g. byprion, C13H18ClNO, "Zyban",
partial agonist varenicline, C13H13N3,
varenicline tartrate "Chantix" and "Champix".
There is great reduction in risk in people who stop smoking, even those
who stop at 50 or 60 years including less risk of heart attack,
high blood pressure, stroke, limb amputation and chronic respiratory
Children of smokers are more likely to become smokers.
Passive smoking in the home increases the infant's risk of pneumonia
Asthmatic children in a smoking households have more frequent and severe
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
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, coupled with technology
for mass production, 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
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)
The carbon monoxide reacts preferentially with the red corpuscles in
On removal of the source of carbon monoxide, the equilibrium with oxygen
is gradually restored.
The levels of these compounds are determined by using smoking machines.
However, smokers do not conform to smoking machines, and manufacturers
can design cigarettes to do well on the machines, while
dosing smokers at high levels.
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'
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 (hence the
need to breathe the smoke into the lungs), 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.
When heavy smokers are unknowingly given cigarettes with a higher content
of nicotine, they subconsciously reduce the number smoked
and alter their puffing pattern to maintain about their usual level of
Conversely when given low nicotine cigarettes, they increase the number
smoked and / or puff more efficiently.
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
This long delay makes it difficult for law enforcement authorities to
decide whether the drug was in use while driving, if this should be
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.
11.12.1 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,
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.
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: 220.127.116.11.5
and its derivatives.
1. Aliphatic series.
Generic name, Trade name.
Chlorpromazine, Trade name: Largactil, Protran, Promacid.
Promethazine, Trade name: Phenergan, "Meth-Zin", Progan, Prothazine,
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
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.
11.12.2 Tranquillizers 2
Tranquillizers 2, minor tranquillizers, benzodiapines, diazepam (Valium), oxazepam (Seraz, Serenid) nitrazepam (Mogadon),
The most common of the minor tranquillizers are built up on a benzodiazepine
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.
The so-called "date rape" drugs are mainly Rohypnol (flunitrazepam),
GHB (γ-hydroxybutyric acid), and Ketamine (ketamine
18.104.22.168 GHB, 4-hydroxybutanoic
GHB, 4-hydroxybutanoic acid, C4H8O3,
Product: γ-hydroxybutyrate (GHB).
Street name: Fantasy, grievous bodily harm (GBH) liquid ecstasy, liquid
Symptoms: Drowsiness, induced sleep, nausea, reduced inhibitions, dizziness,
headache, increased sociability, initial euphoria leading to
confusion and agitation.
Potential problems: Extreme drowsiness, loss of consciousness, hallucinations,
difficulty focussing eyes, vomiting, impaired movement
and speech, reduced muscle tone, disorientation, convulsions/seizures,
coma, respiratory distress, slowed heart rate, lowered blood
pressure, amnesia, death.
GHB can be addictive with prolonged use.
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.
Potential problems: Accidents from lack of coordination, quick development
of tolerance, weight loss and loss of appetite,
psychological dependence, psychosis, 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 as it has the potential to shut
down the body, causing vital organs such as the lungs or heart to stop
3, minor tranquillizers, dibenzazepine, imipramine (Tofranil), desipramine
(Pertofran), amitriptyline (Tryptanol),
Depression is a problem that faces many people and the "tricyclics",
usually derived from dibenzazepine, form a popular family of
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.
22.214.171.124 Monoamine oxidase
inhibitors (MAOI), tyramine, C8H11NO
Monoamine oxidase inhibitors (MAOI) are still occasionally used to treat
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 in certain parts of the central nervous system, so that by
inhibiting their destruction, their level is increased.
An example of a biogenic is the amine pheneizine that is similar to amphetamine.
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,
Tranylcypromine, Parnate (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 such as Marmite and Bovril, and
must not take any other medication without consulting their doctor.
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, which in turn causes
a sudden 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.
11.12.4 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.
The way and speed with which drugs are metabolized by the body can also
depend 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 they, in particular, will 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, and as a consequence, 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, metabolism by the body,
excretion, bacterial metabolism, reabsorption and metabolism by the body.
11.12.5 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.
In the case of alcohol, barbiturates and related hypnotics, a group of
depressants of the central nervous system (CNS) chronic use
causes the capacity of the enzymes that metabolize the drugs to increase,
i.e. you can remove the alcohol faster.
Occasional alcohol drinkers can metabolize ethanol only with the liver's
slow acting enzyme, alcohol dehydrogenase.
Chronic drinkers are no more efficient with this enzyme, but they 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 that 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
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
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
However, there is a difference between the level that is found to correspond
to intoxication "on the way up", i.e. while drinking,
compared to "on the way down", i.e. after drinking alcohol has stopped
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
but Japanese and Chinese may have a gene for an enzyme
that oxidizes it faster so a few sips of ethanolic beverage bring a deep
red colour to their cheeks and an unpleasant tingling.
11.12.6 Misuse of prescription
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
The main drugs they seek include the following:.
1. Benzodiazepines, e.g. Alprazolam, "Xanax", C17H13ClN4,
and the benzodiazepine derivative drug Diazepam ("Valium),
C16H13ClN2O, prescribed for anxiety,
insomnia and seizures.
2. Opioids, e.g. Oxycodone, "Oxycodin", C18N21NO4,
derived from thebaine, and Tramadol, "Ultram, C16H25NO2,
Misuse of prescription drugs can take the form of injecting oral drugs,
selling them on the street, or simply overusing the prescribed
mount so that patients run short before the due date and then request
extra prescriptions from the doctor.
Adequate prescription monitoring mechanisms at the systems level are
lacking so 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 prescribed drugs of addiction.
Among patients with chronic non-malignant pain, requests for increasing
opioid doses need careful assessment to explain any
11.12.7 Doping in sport
by V. Birzniece, School of Medicine, University of Western Sydney, 13
June 2014 (modified and edited).
1. Most reports on doping in sport focus on elite athletes.
However, less attention is given to the use of performance-enhancing
and body-image-enhancing drugs in recreational athletes, 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
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) are the most
commonly used substances to improve an exercise performance and body image
of an athlete.
AAS are used often in combination with other substances to increase anabolic/performance-enhancing
effect [growth hormone (GH),
insulin, insulin-like growth factor (IGF)-l], to enhance fat and water
loss [diuretics, Beta2-adrenoreceptor (Beta2-AR) agonists ] or to
reduce 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 inked with many serious side effects AAS use in supra-physiological
doses is associated with cardiovascular
complications, with recent reports of sudden cardiac death in otherwise
health adults who have been abusing testosterone for years.
AAS abuse is linked to acute myocardial infarction and fatal ventricular
3. 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 are increasingly used as doping
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
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
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) 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 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
Beta 20-AR agonists may be used to relieve anxiety and muscle tremor.
11.13.0 National Wasterwater Drug Monitoring Program
Report of 5 August 2018
The 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 illic drug.
There is an increase of licit and illicit use of fentayl.
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]
Mephedone, Oxycodone, Fentanyl, Nicotine and Alcohol.