Treating,
With Care.

Although many programs claim to “deal with your feelings,” Chapman House actually developed the process! You will know how to deal with your feelings when you complete our program.

SUBHEADING

Substances We Treat

Simple, our program works! It is the only program of its kind that actually deals with the emotional state of an addicted individual.

Overview

Alcohol, also known as ethanol or ethyl alcohol, is one of the most popular psychoactive and addicting substances worldwide. Addiction to alcohol, commonly known as “alcoholism,” remains a serious problem in the United States. The National Institute on Alcohol Abuse and Alcoholism reported that 6.2% of Americans aged 21 and over had an alcohol use problem in 2015. Medically, alcoholism is referred to as “alcohol use disorder.”

Alcohol also goes under the names “booze,” “brew,” and “juice.”

How Alcohol Works in the Brain

Alcohol is a central nervous depressant that slows down the ability to react and induces a calming effect. It is believed to exert its effects by increasing the activity of a GABA (gamma-Aminobutyric acid), our body’s natural “slow chemical.” By enhancing the effect of GABA, users feel a sense of relaxation and lowered inhibitions. This mechanism is similar to benzodiazepines such as Xanax and Valium, an addicting class of central nervous system depressants.

Why is Alcohol Addicting?

In addition to finding the relaxing effects addicting, alcohol may also play a role in the brain’s reward pathway. The reward pathway is a primitive system in our brain that “rewards” us for performing activities essential to survival such as eating, drinking and procreating. When this system is activated, it causes a pleasurable feeling that drives us to repeat the behavior. Since alcohol stimulates this system, it essentially tricks our brain into rewarding us for drinking it.

Not all people that drink alcohol become addicted to it. Some can drink moderately without becoming addicted while others can become addicted soon after being introduced to it.

Research has shown that some people have a genetic predisposition towards alcohol use disorder. Combined with ease of access and lack of a support system, many people can easily spiral down the path of addiction.

Short Term Effects of Alcohol

  • Slurred speech – If someone has had too much to drink, they nearly always have slurred speech and may not be able to enunciate words clearly.
  • Drowsiness – Alcohol can make a user feel tired and drowsy. Excessive drinking can even cause the user to become unconscious
  • Nausea – In many ways the body treats alcohol as a poison, in fact some byproducts of alcohol metabolism are indeed toxic.4 Like any poison, the body will attempt to remove it by vomiting.
  • Impaired Coordination – Because alcohol slows down the body, the ability to coordinate muscle movements is impaired.
  • Slow Reaction Time – Alcohol can slow down the time it takes to react, making performing activities such as driving incredibly dangerous.
  • Amnesia - Alcohol impairs the ability to form memories will under the influence, often known as “blacking out.”

Alcohol Poisoning

Alcohol overdose, more commonly known as “alcohol poisoning,” occurs when a dangerously large amount of alcohol is consumed. People suffering from alcohol poisoning may exhibit the following signs and symptoms

  • Respiratory depression (slow breathing)
  • Seizures
  • Blue-tinged skin
  • Unconsciousness
  • Coma

Alcohol poisoning can be deadly, particularly when other drugs are involved such as benzodiazepines or opioids.

What Exactly Makes Someone an “Alcoholic?”

Alcohol use disorder, commonly referred to as “alcoholism,” is a disorder characterized by excessive alcohol consumption. If alcohol is completely legal for those over the age of 21 and many can drink moderately with no health concerns, what exactly counts as alcoholism and what classifies someone as an “alcoholic?”

The Diagnostic and Statistical Manual of Mental Disorders, the most authoritative tool for diagnosis of mental disorders, has developed a set of criteria in the form of a questionnaire. An individual meeting at least 2 of the 11 criteria in the same 12-month period receives a diagnosis of “alcohol use disorder.” Select criteria for diagnosis is listed below (not all criteria is listed)

  • Had times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects?
  • Experienced craving — a strong need, or urge, to drink?
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?

Signs of Alcohol Use Disorder

In general, the following signs may indicate that someone has an alcohol use disorder:

  • Biological – Some people’s brains are simply wired in a way that predisposes them to addiction; these individuals have a much more difficult time resisting urges to drink.
  • Genetic – A family history of alcoholism may put an individual at greater risk of developing it themselves.
  • Social – Because drinking is a common, accepted, and sometimes even encouraged aspect of socialization, many people find themselves surrounded by those who engage in unsafe alcohol consumption, even at a young age.

Alcohol Withdrawal

Individuals with a drinking problem will often drink larger amounts to overcome the tolerance built up over time. This leads to dependence, where the individual needs to drink in order to function normally. Someone dependent on alcohol will suffer serious withdrawal symptoms if they do not drink, some of which can be life-threatening.

Some symptoms of alcohol withdrawal are listed below

  • Anxiety
  • Insomnia
  • Depression
  • Fatigue
  • Uncontrollable shaking (known as “delirium tremens,” or “DT’s”)
  • Rapid heart rate
  • Seizures

Alcohol Detox

When someone with an alcohol use disorder decides to stop drinking, the first priority is ensuring safe discontinuation of alcohol. Since sudden discontinuation, also called “cold turkey,” can cause life-threatening seizures. It is important that heavy drinkers see a medical professional during the initial detox period.

Control of initial withdrawal symptoms may involve the use of the benzodiazepine Valium (diazepam) or Librium (chlordiazepoxide) to prevent or control seizures and anxiety, as well as sleep aids to help insomnia.

Controlling withdrawal symptoms during the detox period is not the same as treating alcohol use disorder itself, which is a far more complex substance abuse disorder.

Drug Treatments for Alcohol Use Disorder Treatment

  • Antabuse - The drug Antabuse (disulfiram) creates an artificial sensitivity to alcohol. If someone drinks alcohol while taking Antabuse, they will immediately suffer symptoms similar to an extreme hangover such as vomiting, nausea, headache and fast heart rate. In most cases these effects would be unwelcome, however in this case they are designed to be felt in order to deter drinking.
  • Vivitrol – Vivitrol is a drug containing the opioid-antagonist naltrexone. It is injected into the muscle where it stays and releases the drug slowly over four weeks. While it is not known exactly how Vivitrol works for alcohol dependence, it appears to reduce cravings.
  • Campral – Campral is the brand name of the drug acamprosate. It is believed to work by stabilizing chemical signaling in the brain that would normally be disrupted by alcohol withdrawal9 It is only effective as a supportive therapy to psychosocial support such as counseling and group therapy.

Behavioral Treatment for Alcohol Use Disorder

Most treatment programs involve the use of counseling sessions to focus on the behavioral modifications necessary to treat alcohol use disorder. Some treatment programs may feature group counseling sessions, where people recovering from alcoholism can discuss their problems and progress in a support group atmosphere.

Ambien (zolpidem)

The Centers for Disease Control (CDC) estimates that approximately 35% of Americans receive less than seven hours of sleep daily and one in four Americans will develop acute insomnia at least once every year.

Ambien – An Overview

Ambien is a prescription-only sleep aid belonging to the non-benzodiazepine, sedative hypnotic class of sleep medications known as “z-drugs.” It is approved by the FDA (Food and Drug Administration)to treat insomnia characterized by difficulty falling asleep. Due to its habit-forming nature, it should not be taken long term (> 6 weeks) due to the potential for dependence and addiction.

Originally developed as a safer alternative to benzodiazepine drugs such as Xanax (alprazolam), Valium (diazepam) and Ativan (lorazepam), Ambien carries significantly less risk of seizures upon withdrawal as compared to benzodiazepines, however seizures can still occur. It was also marketed as being less addictive than benzodiazepines as it takes longer to develop tolerance and dependence. Research has shown that Ambien carries less potential for rebound insomnia upon discontinuation than benzodiazepines. While safer than benzodiazepines, Ambien still carries a significant risk of addiction and dependence, even in those without a history of substance abuse.

Side Effects

  • Hallucinations: false visual or auditory sensations that appear real
  • Psychosis: a loss of contact with reality associated with difficulty determining what is real and what is not real
  • Amnesia: the inability to remember events that have occurred while under the influence of the drug

Due to these side effects, it is imperative that Ambien be taken immediately before going to sleep.

Real Life Stories of Ambien Gone Awry

Listed below are real examples of when an individual did not go to sleep after taking Ambien

  • An airplane passenger removed all his clothing and ran up to the first-class aisle completely naked
  • A man had experienced hallucinations of pirates in his bedroom. Upon waking up the next day he noticed a small fire had been started in the corner of his room
  • A woman spent $2,980 on an Ambien-induced online shopping spree

Because of Ambien’s strong amnesiac effects, these individuals remembered  nothing about the events.

Tolerance and Dependence

If Ambien is taken longer than the recommended maximum of six weeks, dependence and tolerance can develop, even in those who began taking the drug for a legitimate medical purpose. Tolerance occurs when the dose of Ambien that helped an individual get to sleep is no longer effective, necessitating an increase in the dose to achieve the same effect. Dependence can also occur, where sleep is difficult to achieve without Ambien and withdrawal symptoms are experienced upon discontinuation. Discontinuation may result in withdrawal symptoms such as depression, anxiety, sweating, and abdominal/muscle cramps. Withdrawal symptoms will generally peak 3-5 days after discontinuation and subside after 1-2 weeks.

It is important to note that while tolerance and dependence will develop in those who take Ambien for a prolonged period, this does not imply Ambien abuse, as dependence and tolerance will occur regardless of whether the drug is being abused. Some individuals will intentionally abuse the drug, either taking more than what was prescribed, obtaining the drug illegally without a prescription and/or taking it in a manner not consistent with how it was prescribed such as crushing or snorting it.

More Addicting Than Previously Thought

While Ambien was originally developed as a less addictive alternative to benzodiazepines, a growing body of evidence has suggested it may be much more addictive than previously thought, with the potential for abuse and addiction being as severe as its benzodiazepine counterparts. Research has shown that both Ambien and triazolam, a benzodiazepine also FDA-approved for the treatment of insomnia, showed a similar degree of “drug-liking,” a measurement of a drug’s potential for abuse.

Addiction Treatment

Ambien addiction is a serious problem; those seeking addiction treatment require the assistance of a healthcare professional such as an addiction specialist. In most cases, the goal is discontinuation of Ambien to eliminate reliance on the drug to fall asleep. In order to accomplish this goal, a taperprogram is often used, where the dose of the drug is decreased slowly over time. By tapering off Ambien, the body can slowly adjust to reductions in dose. This is required because reducing the dose too quickly can result in withdrawal symptoms such as insomnia, anxiety, sweating and drug-craving.

Users may attempt to quit Ambien by going “cold-turkey,” where they suddenly and completely stop taking the drug after prolonged use. It is critical to note that this practice is extremely dangerous, as seizures have been reported upon discontinuation of high-dose Ambien. Rather, a safer and more effective way to detox from Ambien is to consult with a qualified addiction specialist in a treatment center who will develop an individualized taper regimen to slowly wean off the drug, minimizing withdrawal symptoms.

The Taper Timeline

How long a taper will last is highly dependent on the individual and includes factors such as the Ambien dose, length of Ambien use and the ability to tolerate withdrawal symptoms upon dose-reductions.

  • Gradually decrease the number of days per week the individual takes Ambien. Example: take six tablets per week for two weeks, then five tablets per week for two weeks.
  • Slowly taper by reducing the dose by 10% every week
  • Slowly taper by reducing the dose by 10% every other week
  • Quickly taper by reducing the dose by 25% every week until able to quit completely

The important thing to remember is that tapering is not a race; every individual will respond differently and there is no advantage to getting off faster.

Managing Withdrawal Symptoms

Even with a slow taper, withdrawal symptoms may be experienced. Below are some drugs that may be used to manage the withdrawal symptoms experienced when discontinuing and/or tapering Ambien.

Valium (diazepam) As A Tapering Tool

Some treatment options for Ambien addiction may involve the use of a long-acting benzodiazepine such as Valium to taper. It may seem strange that a benzodiazepine would be used in the treatment of Ambien addiction, considering it was discussed earlier that benzodiazepines are more dangerous than Ambien. The rationale for their use is due to the drugs’ half-life, a measure of how long a drug stays in the body. In general, the longer the half-life of a drug, the longer it takes until withdrawal symptoms start and the less severe they are. Ambien has a half-life of approximately 2.6 hours while Valium has a half-life between 20-50 hours depending on age. Because Valium and Ambien work similarly on a chemical level, Valium can be used to “replace” the Ambien, reducing the intensity of withdrawal symptoms and their time to onset.


Barbiturates Overview

Barbiturates are a class of drugs that act as central nervous system depressants. They are used for the treatment of seizure disorders, anxiety, insomnia and headaches. While they are still used as effective agents for the treatment of headaches, their use has largely fallen out of favor for treating seizures, anxiety and insomnia, as newer, safer sedative hypnotics have been developed such as benzodiazepines.

Barbiturates are available in pill form, suppositories and intravenous solution for injection. Also known as barbs, Christmas Trees, Goof Balls, and Red Devils, barbiturates are notable for their addictive potential and narrow therapeutic index.

Some common barbiturates are listed below:

  • Fioricet (butalbital + Tylenol + caffeine)*
  • Fiorinal (butalbital + aspirin + caffeine)*
  • Luminal (phenobarbital)
  • Mysoline (primidone)
  • Seconyl sodium (secobarbital)
  • Pentothal (thiopental)

** Only the butalbital component of this drug combination is a barbiturate

How Barbiturates Work in the Brain

Barbiturates mimic a natural chemical in our brain called GABA (gamma-aminobutyric acid), the primary inhibitory neurotransmitter of the central nervous system. By mimicking GABA, barbiturates are essentially “stepping on the brakes” in our brain by slowing down brain activity. While this makes them effective drugs for anxiety and seizures (overactive brain activity), slowing brain activity down too much can result in coma and death.

Effects of Barbiturates

As central nervous system depressants, the effects of barbiturates resemble that of alcohol and benzodiazepines such as Xanax (alprazolam) and Valium (diazepam). The table below lists some of the psychological and physical effects of barbiturates.

Psychological EffectsPhysical EffectsEuphoriaShallow breathingMemory impairmentWeak pulseLowered inhibitions, impaired judgementClammy skinDizzinessDilated pupilsSedationComa and death

Narrow Therapeutic Index – A Small Window of Safety

A major reason why barbiturates are so dangerous is due to their narrow therapeutic index. The therapeutic index of a drug is a measure of a drug’s safety. It is essentially a “window” between a dose low enough to be effective and a dose at which it becomes dangerous.

Because of their narrow therapeutic index, it is incredibly easy to overdose on barbiturates compared to other central nervous system depressants such as benzodiazepines. During the 1960s and 1970s, when barbiturates were at the peak of their use in the United States, they were responsible for the deaths of many celebrities, including:

  • Jimi Hendrix (famous guitarist)
  • Judy Garland (actress from The Wizard of Oz)
  • Marilyn Monroe (acclaimed actress and singer)

While dangerous on their own, the potential for deadly overdose increases dramatically when barbiturates are combined with other central nervous system depressants such as alcohol and opioids.

Barbiturate Abuse

As a drug of abuse, many barbiturate users will take the drug in higher doses than prescribed or obtain it illegally to feel the “high” associated with their use. It is also a popular drug to soften the crash associated with cocaine and methamphetamine.

Many users prefer the use of short-acting barbiturates such as pentobarbital and secobarbital, which are particularly dangerous because withdrawal symptoms such as seizures begin soon after the effects of the drug wear off.

Psychological symptoms of barbiturate abuse involve degradation in the user’s mental health, and may include the following:

  • Depression
  • Lack of motivation
  • Drug craving

Physical symptoms of barbiturate abuse include the following:

  • Dulled reflexes
  • Slurred speech
  • Ataxia (impaired coordination)

Tolerance and Dependence

Tolerance to barbiturates develops quickly. Tolerance is when a higher dose is required to exert the same effect that was felt at a lower dose. Even after 1-2 weeks of taking barbiturates, higher doses of barbiturates may be required to exert similar effects, which may lead to users increasing the dose and exposing themselves to dangerous side effects.

Both physical and psychological dependence to barbiturates may develop upon extended use.

Psychological dependence to barbiturates develops when users must take it to feel normal and experience craving for the drug when the effects wear off.  Physical dependence to barbiturates can also develop, where the body adapts to the use of the drug. Physical dependence will always develop when barbiturates are used long term, even in those without a history of substance abuse.

Withdrawal from Barbiturates

Withdrawal from barbiturates can be life-threatening if not managed appropriately. When the body becomes dependent on barbiturates to function normally, stopping the drug results in withdrawal symptoms. Withdrawal symptoms can be both psychological or physical and are listed in the table below.

Psychological Withdrawal Symptoms

Physical Withdrawal SymptomsDrug cravingSeizuresAnxietyTremorsAgitationFeverInsomniaNausea and vomiting

The most dangerous withdrawal symptom of barbiturates is seizures, as they can be deadly if not controlled. How long it takes until seizures develop depends on the half-life of the barbiturate being abused. The half-life of a drug is a measure of how long it stays in the body. Barbiturates with a short half-life are eliminated quickly, and seizures can develop as soon as 16 hours following the last dose, lasting up to five days. Barbiturates with a longer half-life stay in the body longer and take longer until withdrawal symptoms appear.

Treatment of Barbiturate Addiction

Treatment involves managing both the psychological and physical effects of barbiturate addiction. While the goal of treatment is to discontinue use or limit use only to the degree necessary to treat the problem, it is imperative that barbiturates not be discontinued suddenly (“cold turkey”), as it exposes the individual to lethal seizures.

To control the immediate withdrawal symptoms associated with barbiturates, a barbiturate with a long half-life, such as phenobarbital, is often used to replace the barbiturate being abused. Because phenobarbital stays in the body for a long period of time, it allows withdrawal symptoms to stay under control while the dose of the drug is slowly decreased (tapered).

Some clinicians may choose to switch to a long-acting benzodiazepine such as Valium (diazepam) to taper, as it is safer than barbiturates.

It is important to keep in mind that attempting to detox from barbiturates by suddenly discontinuing (cold turkey) is incredibly dangerous and should not be attempted. A much safer and more effective way to detox from barbiturates is to seek the help of a qualified addiction specialist that will help choose an individualized plan to manage addiction.


Benzodiazepines Overview

Benzodiazepines are a class of prescription-only central nervous system (CNS) depressants used for the treatment of several conditions including anxiety disorder, seizure disorder, muscle spasms, insomnia and alcohol dependence. While benzodiazepines are invaluable for the treatment of these conditions, their potential for addiction and extensive side effect profile make them as dangerous as they are useful. Tolerance develops quickly and long term use of benzodiazepines can lead to both physical and psychological dependence. Once dependent, withdrawal from benzodiazepines can be deadly.

Benzodiazepines were initially introduced as a safer alternative to barbiturates, a dangerous class of drugs similar in effect to benzodiazepines. While safer than barbiturates and unlikely to cause significant harm when used appropriately, long term use of benzodiazepines must be approached carefully.

Listed below are examples of common prescription benzodiazepines.

  • Ativan (lorazepam)
  • Klonopin (clonazepam)
  • Librium (chlordiazepoxide)
  • Onfi (clobazam)
  • Valium (diazepam)
  • Xanax (alprazolam)

Benzodiazepines also go by street names such as benzos, downers, planks and tranks.

How Benzodiazepines Work in the Brain

Benzodiazepines work by enhancing the effect of a natural chemical in our brain called GABA (gamma-aminobutyric acid), the primary inhibitory neurotransmitter of our central nervous system. By increasing the activity of GABA, benzodiazepines “slow things down” in our brain, which is why they are effective at treating conditions such as anxiety and epilepsy. While this is beneficial for anxiety, slowing down brain activity too much can be dangerous, especially when benzodiazepines are combined with other drugs such as opioids or alcohol.

Medical Uses of Benzodiazepines

  • Insomnia – Insomnia is a sleep disorder characterized by difficulty falling asleep and/or staying asleep. Benzodiazepine’s hypnotic properties can induce a feeling of sleepiness, making it easier to fall asleep. While effective in the short term, long term use of benzodiazepines for insomnia may lead to dependence and withdrawal.
  • Generalized Anxiety Disorder (GAD) – Generalized Anxiety Disorder is an anxiety disorder characterized by persistent and unwarranted worrying.
  • Panic disorder – Panic disorder is a type of anxiety disorder characterized by episodes of severe, frightening anxiety accompanied by a spike in heart rate and blood pressure. Fast-acting benzodiazepines are effective for panic disorder as they act quickly to calm down an individual.
  • Seizures – Because benzodiazepines exhibit anti-convulsant effects, they are used to prevent and control seizures.
  • Agitation – In emergency cases of agitation, such as those resulting from drug-induced psychosis, the sedative effect of benzodiazepines can be helpful to tranquilize severely agitated individuals.

Benzodiazepine Side Effects

Benzodiazepines are associated with a plethora of physical and psychological side effects. The intensity of these side effects is directly related to the dose taken, with higher doses causing more pronounced effects.

  • Amnesia (impaired memory) – One of the most dangerous psychological side effects is amnesia, or the inability to remember events while under the influence of the drug. This had led to its use as a popular “date-rape” drug.
  • Drowsiness – Benzodiazepines can make a user feel tired and drowsy. It is important to not take benzodiazepines before driving or operating heavy machinery.
  • Depression – Long term use of benzodiazepines has been associated with depression.
  • Confusion – Users often feel confused while taking the drug and may take longer to make decisions.
  • Nervousness/Agitation – While generally effective at treating nervousness and agitation, some users may experience a paradoxical increase in feelings of nervousness and/or agitation.

Benzodiazepine Overdose

Benzodiazepine overdose occurs when an excessive dose of the drug is taken. Users who overdose on benzodiazepines may experience extreme sedation and/or confusion.

Acute overdose of benzodiazepines can cause respiratory depression, potentially leading to coma or death. While death due to benzodiazepine overdose alone is uncommon, the use of benzodiazepines in combination with other CNS depressants such as alcohol and opioids spells a recipe for disaster.

The graph above shows the number of overdose deaths due to benzodiazepines alone and in combination with other drugs such as opioids (dark green line). The data clearly shows that when benzodiazepines are combined with opioids, the probability for deadly overdose is significantly higher.

Benzodiazepine overdose can be treated with the drug flumazenil, which acts as an antidote to the sedative effects of benzodiazepines.

Benzos – The “Date Rape Drug”

There is growing concern regarding the use of benzodiazepines in drug-facilitated sexual assault, commonly known as “date rape.”  Benzodiazepine pills can be easily dissolved in beverages such as beer or glass of wine. Because they dissolve easily and may not change the color of the beverage, it can be difficult or impossible to detect. This is especially true for strong-tasting alcoholic drinks that mask the bitter taste of the pill. Once under the influence, the victim may fall asleep or become so disoriented they cannot defend themselves against an assault.

In one study that exampled urine samples of those suspected to be victims of drug-facilitated sexual assault, a staggering 15.4% of positive-urine samples contained benzodiazepines.

The drug Rohypnol (flunitrazepam), also known as “roofie,” is one of the most common benzodiazepines used in drug-facilitated sexual assaults. Despite not being available as a prescription drug in the United States, it is often imported illegally.

Benzodiazepine Addiction

Because benzodiazepines make users feel relaxed or even euphoric, their use is associated with a significant potential for abuse and addiction.

Signs of chronic benzodiazepine addiction may include the following:

  • Always appearing tired
  • Slurred speech
  • Unexplained feelings of depression or lack of motivation
  • Difficulty falling asleep if the user does not take the benzodiazepine
  • Exhibiting drug seeking behavior such as drug craving, deception, or stealing

While many users will abuse benzodiazepines obtained illegally, it is just as easy, if not easier, to abuse benzodiazepines with a valid prescription. In these situations, a user may take higher doses or take it more often than prescribed.

A 2018 study found that of the nearly one in eight Americans who had used a benzodiazepine within the following year, more than 17% had misused them, with misuse being defined as taking the drug in any way not consistent with how it was prescribed or having been obtained illegally. Misuse was found to be highest among adults aged 18-25 years old. Of those who had misused benzodiazepines, nearly half had explained that they used it “relax or relieve tension.” Among those taking benzodiazepines without a valid prescription, the most common source was a friend or relative.

Tolerance and Dependence

Tolerance

When benzodiazepines are taken for an extended period of time, the body develops tolerance to their effects, whereby a higher dose is necessary to achieve the same effect. Tolerance will develop quickly to the sleep-inducing properties of benzodiazepines, usually within days or weeks. Because of this, their use as a sleep aid should be limited only to a time necessary to treat insomnia. Tolerance also develops to a benzodiazepine’s ability to relieve anxiety. There is little evidence to suggest that they retain their anxiolytic effect after four months of continued use.

Dependence

In addition to the development of tolerance, psychological and physical dependence to benzodiazepines may occur if taken long term. Dependence occurs when the body requires the drug to function normally. Once dependent, if a user does not take the benzodiazepine, they will suffer withdrawal symptoms.

It is important to note that dependence to benzodiazepines can be both physical and/or psychological.

Psychological dependence occurs when the user must take the drug to feel normal, usually accompanied by drug-seeking behavior when the effects wear off.

Physical dependence occurs when the body experiences physical withdrawal symptoms when the effects of the drug wear off. Physical dependence can occur even if benzodiazepines are taken exactly as prescribed. Although physical dependence does not imply addiction, the two are often seen together.

Benzodiazepine Withdrawal

Because a user who is dependent on benzodiazepines requires the drug to function normally, they will suffer withdrawal soon after the effects wear off. Some of the symptoms associated with withdrawal include:

  • Sleep disturbance
  • Irritability
  • Anxiety and insomnia
  • Sweating
  • Muscle ache/pain
  • Drug craving
  • Seizures

The most dangerous withdrawal symptom associated with benzodiazepines is seizures, which can be life-threatening if not managed appropriately. How soon withdrawal symptoms will appear following the last dose depends on the half-life of the benzodiazepine.

The half-life of a drug is a measure of how long it stays in the body. Benzodiazepines with a short half-life are eliminated faster than those with a long half-life. Consequently, users who abuse benzodiazepines with a short half-life will suffer withdrawal symptoms sooner than those who abuse benzodiazepines with a long half-life.

Below is a table showing benzodiazepines with varying half-lives and the time until withdrawal symptoms will appear.

BenzodiazepineTime Until Withdrawal Onset Following Last DoseXanax (alprazolam)12 – 24 hoursAtivan (lorazepam)10 – 20 hoursKlonopin (clonazepam)1-3 daysValium (diazepam)1-5 days

Treatment for Benzodiazepine Addiction

Treatment for benzodiazepine addiction involves slowly reducing the dose of the drug over time, a process known as tapering. The drug is tapered until it can be discontinued safely. How long a tapering period will last depends on many factors such as the length of abuse, dose of the benzodiazepine being abused and ability to tolerate dose reductions. An example tapering period may involve initially reducing the dose by 25%, then gradually decreasing by 5-25% every 1-4 weeks as tolerated.

It is incredibly important that benzodiazepines are not discontinued suddenly, also known as “cold turkey,” as this greatly increases the risk for life-threatening seizures.

Throughout the tapering period, a holistic approach is taken towards managing the user’s substance abuse habit. Because drug addiction is a psychological disorder, special care is taken to ensure the user’s mental health is maintained as well as their physical health. This can be accomplished by several means such as counseling and group therapy sessions

Cocaine Overview

Cocaine is a stimulant drug abused for its euphoric effects. While it serves a legitimate medical purpose as a topical anesthetic for surgeries, it is more commonly encountered as a powerful and addicting illegal drug.

Usually sold as a white powder or rock-like substance (crack cocaine), users will snort, smoke or inject cocaine to feel its energizing, euphoric effects. In an attempt to increase profits, dealers will often dilute cocaine with other substances such as talc, baking soda, cornstarch, or drugs such as methamphetamine and fentanyl.

Popular street names for cocaine include “coke,” “blow,” “crack,” “snow,” and “rock.”

Cocaine Statistics

Cocaine use remains a major problem in the United States. The National Institute on Drug Abuse shares the following statistics regarding cocaine use:

  • 5 million cocaine users aged 12 and older (0.6% of the population)
  • The most common age group of users is 18-25
  • 913,000 Americans addicted to cocaine
  • Cocaine is responsible for nearly 40% of drug abuse-related emergency room visits

Cocaine VS Crack – What’s the Difference?

Cocaine comes in two main forms, powdered cocaine, also known as “cocaine hydrochloride,” and crack cocaine. Pure powdered cocaine is a white, crystalline powder that can be snorted and injected. It cannot be smoked in this form because it is inactivated by high temperatures such as exposure to a flame. To make the drug smokable, it must be converted into a form known as “crack.”

Crack cocaine is made by mixing cocaine powder, baking soda and water, then boiling it until a solid rock-like substance is formed.

The table below highlights the differences between powdered cocaine and crack cocaine.

While all forms of cocaine are dangerous, crack cocaine’s low cost makes it particularly dangerous because it is more accessible. Due to its low price, ease of use and intense effects, crack is often considered to be more addicting than its powdered cocaine counterpart.

How is Cocaine Taken?

Most users choose to snort powdered cocaine, however it can be injected or smoked as well.

  • Snorting – When snorting cocaine, the user will often make “lines,” narrow strips of powder arranged on a flat surface. These lines are then snorted, or taken up through the nose, where the drug diffuses through the membranes of the nose. Long term effects of snorting cocaine involve diseases such as perforated septum (a hole in the lining that separates each nostril), nosebleeds and a permanent loss in sense of smell.
  • Injection – Cocaine is easily dissolved in water and can be injected directly into a vein. When taken this way, the drug is immediately introduced into the bloodstream and its effects are nearly instantaneous. Users who inject cocaine and share needles are at a high risk for acquiring blood-borne diseases such as HIV and hepatitis C.
  • Smoking – When smoked as crack cocaine, the drug diffuses across the lungs and into the blood. Similar to injection, when cocaine is smoked, the effects hit instantly and last for 5-10 minutes. Smoking crack cocaine long term can damage the lungs and cause respiratory problems such as asthma.

How Does Cocaine Work and Why is it So Addicting?

Cocaine works by stimulating our brain’s “reward pathway,” a primitive part of our brain responsible for reinforcing positive stimuli necessary for survival. For example, when we are hungry and eat food, our reward pathway “rewards” us for eating by releasing dopamine, leading to a pleasurable and satisfying feeling. Cocaine hijacks this system and enhances its effect, tricking our brains into rewarding us for cocaine use.

Effects of Cocaine

Cocaine abuse is associated with significant side effects. Short term effects of cocaine may include the following:

  • Dilated pupils
  • Increased blood pressure
  • Increased or irregular heartbeat
  • Heart attacks
  • Tremors, muscle twitching
  • Paranoia
  • Seizures

All amounts of cocaine can produce these effects, however the higher the dose, the more likely and severe these effects will be. Injecting and smoking will produce stronger effects that appear faster, while snorting will produce more mild effects that may taker longer to set in.

Long term effects of cocaine use include the following and will vary depending on how the drug is taken:

  • Snorting – loss of smell, perforated septum, chronic bloody nose
  • Smoking – asthma, respiratory infections, chronic cough
  • Injection – high risk of HIV, hepatitis C and skin or soft tissue infections, collapsed veins

Cocaine Overdose

Since cocaine is often diluted with other ingredients, including dangerous drugs such as fentanyl, its true strength is nearly impossible to determine. This opens up the possibility of a dangerous overdose.

Overdose on cocaine is life-threatening and may involve the following symptoms:

  • Extremely high heart rate
  • Irregular heart rhythm
  • High blood pressure
  • Hallucinations and extreme paranoia or anxiety
  • Seizures

No antidote for cocaine exists – treatment for overdose is often supportive and will involve treating the symptoms.

Cocaine Addiction

Cocaine is a powerfully addictive drug; users can become addicted even after a single use. Repeated use of the drug may lead to addiction.

Signs and symptoms of addiction may include the following:

  • Weight loss – Since cocaine is a stimulant drug, it causes a decrease in appetite. Over time, a lack of appetite can cause the user to lose weight. Many long-term users are malnourished and may be severely underweight.
  • Drug-seeking behavior – Someone who is addicted to cocaine will often focus all their activities around acquiring the drug. They may exhibit extreme drug-seeking behavior such as lying and stealing from friends and family.
  • Physical appearance changes – Depending on how the drug is being taken, users may exhibit deterioration in their physical appearance such as weight loss, lack of hygiene and nose-related problems.

Tolerance, Dependence and Withdrawal

When used repeatedly, tolerance will develop to the euphoric effects of cocaine, where more of the drug must be taken to achieve the same effects.

Long term use can cause a user to become dependent, where they require the drug to feel normal. If dependent, the user will suffer withdrawal symptoms if the drug is not taken.

Withdrawal symptoms of cocaine include:

  • Agitation and restlessness
  • Depression
  • Increased appetite
  • Extreme drug craving

There are no notable physical withdrawal symptoms, however this does not make cocaine easy to quit, as the drug craving associated with cocaine withdrawal can last months after quitting.

Addiction Treatment

Since withdrawal from cocaine is not physically dangerous, addiction treatment does not require admittance to a treatment center or rehab, however a user may still benefit greatly from the support of a therapist specializing in substance use disorders.

  • Fioricet (butalbital + Tylenol + caffeine)*
  • Fiorinal (butalbital + aspirin + caffeine)*
  • Luminal (phenobarbital)
  • Mysoline (primidone)
  • Seconyl sodium (secobarbital)
  • Pentothal (thiopental)


Fentanyl Overview

Fentanyl is an extremely potent and dangerous synthetic opioid drug. As a prescription drug, it is used for severe pain in those who have built tolerance to other opioids. The term “synthetic opioid” means that it is completely man-made in a laboratory; no form of fentanyl exists in nature. As an opioid pain reliever, fentanyl was designed to be 50 to 100 times more potent than morphine. Due to its strength, the risk of overdose is incredibly high. Because it is relatively cheap and easy to manufacture, fentanyl is often added to other illegal opioids such as heroin to increase their strength. At Chapman House, we understand just how dangerous this drug can be for your life. Getting help from one of our Fentanyl rehab programs can bring your life back into focus. With our Fentanyl addiction treatment, you’ll have caring health professionals who can guide you every step of the way during recovery.

Forms of Fentanyl

Several versions of fentanyl exist, including prescription products such as a transdermal patch, lollipop, solution for injection as well as illegal street powder and blotter paper.

  • Transdermal patch – Available under the brand name Duragesic. This form is a small patch that is applied to the skin. The drug is absorbed slowly through the skin and into the blood stream. Users will sometimes break open the fentanyl patch and extract the pure fentanyl.
  • Lollipop – Available under the brand name Actiq. This form of fentanyl contains the drug in a flavored lollipop that is slowly sucked on. The drug is absorbed through the tissue of the mouth.
  • Solution for injection – Available under the brand name Sublimaze. This form of fentanyl is dissolved in a solution to be injected into the muscle or vein for fast-acting pain relief in a hospital setting.
  • Powder – Fentanyl obtained illegally is usually obtained as a powder, which may vary in color due to adulterants used to dilute it, also known as “cutting.” This form is incredibly dangerous because there is no way to determine its true potency. It may also contain other dangerous ingredients. Users may dissolve the drug and inject it into their vein, snort it or smoke it.
  • Blotter Paper – Also obtained illegally, distributors soak small strips of absorbent paper (blotter paper) with the drug. Similar to LSD, users will place the blotter paper on their tongue where the drug is absorbed quickly.

Fentanyl – A New Player in The Opioid Epidemic

An opioid epidemic has swept the United States, involving widespread use of both prescription and illegal opioids. From 1999 – 2017, opioids have been responsible for approximately 400,000 deaths, with nearly 130 deaths every day being attributed to opioids.

Fentanyl is a relatively new player in the opioid epidemic. While fentanyl has been available as a prescription product in the United States since the 1960s, its use as an illicit drug has only started to rise since the early 2010s. It is believed that most illegally produced fentanyl is manufactured in China and smuggled into the United States through Mexico.

A Quickly Rising Killer

A recent report from the Centers for Disease Control and Prevention clearly illustrates the dangers of fentanyl. In 2016, the number of deaths involving fentanyl was estimated to be 18,335 compared to only 1,663 in 2011. This represents more than a ten-fold increase in deaths involving fentanyl from 2011 to 2016.

Because drug dealers will often add fentanyl to heroin, the rise of heroin-related deaths has grown due to fentanyl’s popularity. As shown on the graph above, heroin-related deaths have increased rapidly since 2011.

How Fentanyl Works in The Brain

Fentanyl is an opioid agonist, meaning it binds to opioid receptors in the central nervous system. When fentanyl binds to opioid receptors, it blocks pain signals, making them invaluable tools for alleviating pain. Despite its use a legitimate painkiller, it also has the potential to make the user feel euphoric, which is why it is so addicting.

Side Effects of Fentanyl

Opioids like fentanyl also cause a significant amount of side effects. Listed below are some of the most common side effects of fentanyl.

  • Nausea and vomiting
  • Severe constipation
  • Tiredness
  • Sweating
  • Respiratory depression

The most dangerous side effect of fentanyl is respiratory depression. Respiratory depression is when breathing becomes shallow and ineffective. If too much fentanyl is taken, respiratory depression can be so severe the user stops breathing completely.

While all opioids carry the risk of respiratory depression, fentanyl’s high potency significantly increases the risk of overdose because only a small amount is required to cause respiratory depression.

Fentanyl Overdose

Fortunately, there is a product that can reverse the deadly respiratory depression associated with a fentanyl overdose – Narcan. Narcan is a nasal spray containing the drug naloxone, an opioid antagonist. It works by removing fentanyl from the user’s system to restore breathing.

Narcan is available without a prescription in California. If you or someone you know is addicted to fentanyl, having Narcan on-hand can mean the difference between life and death.

It is important to know the signs of fentanyl overdose, which can include:

  • Pinpoint pupils
  • Slow, labored breathing (respiratory depression)
  • Slow heartbeat
  • Unconsciousness

Fentanyl Abuse

Because fentanyl is incredibly strong at even small doses, many users will take it when they no longer feel the effects from weaker opioids such as heroin. This can easily lead to continued abuse and addiction, which is something Chapman House is here to help prevent or provide support with in recovery through our Fentanyl addiction treatments.

The length of time until the effects of fentanyl can be felt (onset) and how long the effects last (duration) depend on how it is taken.

OnsetDurationIntravenous injectionInstantly30 min – 1 hourSmokedInstantly30 min – 1 hourSkin patch6 hours72 hours

Since the high from injecting and smoking fentanyl is felt instantly, most users will choose to inject or smoke it rather than apply the patch, which can take up to six hours to feel the effects.

Tolerance and Dependence

Like all opioids, tolerance can develop to fentanyl, where more of the drug is required to feel the same effects.  This leads to users taking more fentanyl to feel the same effects and further exposing themselves to dangerous side effects.

Dependence on fentanyl can also occur when it is taken long term. Dependence is when the body requires the drug to function normally. Once a user is dependent, withdrawal can occur if they do not take the drug. However, even once dependent, there is always a chance to overcome your addiction, especially with help from caring professionals at Chapman House’s Fentanyl rehab programs.

Withdrawal

Withdrawal from fentanyl, while usually not life-threatening, can be incredibly painful and uncomfortable. Most users who are addicted to fentanyl will continue taking it not only to feel high but also avoid withdrawal.

Some withdrawal symptoms of fentanyl are listed below.

  • Diarrhea
  • Cold sweats
  • Muscle aches/cramps
  • Depression
  • Insomnia

Withdrawal symptoms will start within 24 hours of the last fentanyl dose, peak within 1-3 days and subside over the following 1-2 weeks.

Addiction Treatment

Since this is an opioid, Fentanyl addiction treatment will follow typical guidelines for opioid use disorders.

While the goal of addiction treatment is complete detoxification from the drug, the immediate goal is to control withdrawal symptoms. This can be accomplished by switching to a long-acting opioid such as methadone to control withdrawal symptoms. Some practitioners may recommend the use of newer drugs for opioid dependence such as Suboxone or Subutex.

Once fentanyl is replaced with a safer opioid, the dose is slowly tapered (decreased) over time until it can be safely discontinued. How long the tapering period will last is dependent on many factors including how long the user was abusing fentanyl, the dose of fentanyl being abused and the ability to tolerate dose reductions during the tapering period. If you have been struggling with your own addiction, let the experts at Chapman House help you along the road to recovery through our Fentanyl rehab programs!

Heroin Overview

Heroin is an illegal opioid drug abused for its intense euphoric effects. While it can be smoked or snorted, most users choose to inject heroin intravenously. Following injection, users immediately experience an intense, pleasurable “rush” followed by hours of a relaxed, trance-like state known as a “nod.”

Heroin is often seen as a white or brown powder; its color and consistency may vary depending on impurities added to it. “Black tar heroin” is a sticky, gummy form of heroin resembling roofing tar that is commonly seen in areas of the United States west of the Mississippi River.

Unlike a prescription opioid such as hydrocodone or oxycodone, which is legal to possess with a prescription, all forms of heroin are illegal.

Opium – The Source of Heroin

Heroin is derived from morphine, a natural alkaloid of the opium poppy plant. Most illicit opium originates in Afghanistan, where it is grown as a cash crop and exported to Europe and the United States. The opium is refined into morphine, then converted into heroin through chemical processes.

The conversion of morphine to heroin makes it stronger and facilitates more rapid movement across the blood-brain-barrier, allowing the effects to hit faster.

Dirty and Dangerous

Heroin may be “cut”, or diluted, with dangerous impurities to bulk up its weight. Not only is this dangerous because the user can never be sure how much heroin they are taking, but the impurities themselves can be dangerous. Some impurities that are commonly added to heroin include:

  • Talc powder
  • Baking soda
  • Caffeine
  • Flour
  • Fentanyl

Of all the impurities, fentanyl is perhaps the most dangerous. Fentanyl, like heroin, is an opioid, except significantly stronger. Only small amounts of fentanyl are required to cause an overdose, making heroin diluted fentanyl particularly deadly.

Heroin and the Opioid Epidemic

The United States is currently experiencing an “opioid epidemic.” Over the past 20 years, opioids have contributed to an increasing number of deaths countrywide.  The Centers for Disease Control (CDC) estimates that between 1999 and 2017, opioids have been responsible for more than 700,000 deaths.3

The number of overdose deaths due to heroin has risen dramatically from 1,960 in 1999 to 15,482 in 2017, nearly an eight-fold increase.

How Heroin Works in the Brain

Heroin is a potent opioid agonist that binds to opioid receptors in the central nervous system. After injection, heroin enters the brain and latches on to opioid receptors, causing an intense, pleasurable feeling known as the “rush.”

When heroin is used repeatedly, opioid receptors become less sensitive to its effects. This results in tolerance, where a higher dose of the drug is required to feel the same effect.

Effects of Heroin

In addition to the feeling of euphoria, heroin is also associated with a significant amount of side effects, which include:

  • Flushing of the skin
  • Nausea and vomiting
  • Severe itching
  • Constipation
  • Respiratory depression

Respiratory depression is characterized by slow, ineffective breathing that can be fatal if not treated quickly.

Heroin Overdose – Recognize and Act

Someone who has overdosed on heroin is potentially at risk of death due to respiratory depression. It is important to be able to identify the signs and symptoms of heroin overdose.

  • Pinpoint pupils
  • Unresponsive at attempts to wake them up
  • Very slow, labored breathing
  • Bluish, cold and clammy skin
  • Bluish or purple fingernails
  • Slow or irregular heartbeat

If someone is suspected to have overdosed on heroin, emergency services should be called. The drug Narcan is used to reverse heroin overdose. Narcan is an opioid antagonist available as a nasal spray, working within minutes to reverse respiratory depression. It is available without a prescription in most states, including California.

Heroin Abuse and Addiction

Because heroin is illegal, any use is considered abuse as there is no medically accepted reason why someone should be taking it. People who use heroin repeatedly can quickly spiral down the path of addiction, where their life revolves around obtaining and taking the drug.

The following signs may signal addiction to heroin:

  • Trace marks – Users who inject heroin will often have bloodied or bruised arms due to repeated injections.
  • Drug seeking behavior – Many users will lie and steal from a friend or family member to support their substance abuse habit.
  • Chronic tiredness – When a user is “nodding off” after the initial rush, they may appear tired, “zoned out”, or have difficulty carrying on a conversation.
  • Pinpoint pupils – Heroin constricts the pupils, making them significantly smaller than normal. Constant pinpoint pupils may signal repeated use of heroin or another opioid.

Tolerance and Dependence

Over time, tolerance will develop to heroin, where the user takes more to achieve the same effect. Long term use will make the user dependent, meaning they require it to feel normal. Once dependent, a user will suffer painful withdrawal symptoms soon after the effects wear off.

Withdrawal from Heroin

Heroin withdrawal is an incredibly painful experience; so painful in fact that most users will continue taking heroin not only to experience the high, but also in fear of withdrawal. This is what makes heroin so difficult to quit, not only are the effects addicting, but stopping is painful.

Symptoms of heroin withdrawal are listed below:

  • Muscle aches/pains
  • Night sweats, feeling “hot and cold”
  • Diarrhea
  • Dilated pupils
  • Insomnia
  • Vomiting

Addiction Treatment

Treatment of heroin addiction marks the first step towards the restoration of a user’s physical and mental health. The end goal of addiction treatment is complete discontinuation of heroin use and prevention of use in the future.

While some may attempt to quit “cold turkey” by suddenly and completely stopping heroin, this is associated with extreme withdrawal symptoms; most people are unable to cope with the severity of withdrawal and continue using it to alleviate withdrawal. It is recommended that heroin users admit themselves to a treatment center for drug detox where they can receive the help they need.

There are several options for the treatment of heroin addiction. Among the most common is opioid replacement therapy (ORT) with methadone or Suboxone.

  • Methadone – One option is replacing heroin with methadone. Methadone is an opioid, however it stays in the body significantly longer than heroin, allowing long-lasting control of withdrawal symptoms. One major drawback of methadone is that it must be administered in a registered methadone clinic, which can be inconvenient and impractical for some.
  • Suboxone – Another option involves the use of Suboxone, a drug containing a combination of the opioid buprenorphine and the opioid antagonist naloxone. With a valid prescription, Suboxone can be bought at most retail pharmacies.

Seeking Help

Drug addiction is a difficult challenge to overcome, with heroin ranked as one the most difficult drugs to quit. Drug addiction specialists are available to keep users safe and mitigate the painful symptoms of withdrawal along the process of recovery.


Inhalants Overview

The term inhalant refers to any volatile substance that can be inhaled to produce a psychoactive effect. In most cases, inhalants are legal, household products that can be bought at any warehouse store. Despite their seemingly innocuous nature, these chemical vapors can be extremely dangerous, some even causing death or permanent brain damage the first time they are abused.

The National Institute on Drug Abuse estimates that 9.3% of Americans 12 years old and older have tried an inhalant at least once in their life.

Typical inhalants may include the following:

  • Volatile solvents (cleaning fluids, chloroform)
  • Aerosol sprays (hair sprays, spray paints)
  • Gases (nitrous oxide found in whipped cream cannisters)
  • Nitrites

Street names for inhalants include “air blast,” “bang,” “huff,” “dust,” and “whiteout.”

Who Is Using Inhalants?

Inhalants are unique in that they are more popular among younger teens compared to older teens and adults. In fact, the National Institute on Drug Abuse’s annual Monitoring The Future survey of 8th, 10th and 12th graders found inhalant abuse more popular among 8th graders than any other group.

Several factors may contribute to inhalants’ popularity among young teenagers:

  • Inhalants are legal and can be bought at any department store; most are already available in the household
  • Inhalants are relatively inexpensive compared to other drugs
  • Younger teenagers may lack connections to buy drugs, but can easily purchase inhalants

How Inhalants Are Used

Since inhalants are in a gaseous or aerosol form, they are breathed in through the mouth or nose into the lungs. When the inhalant reaches the lungs, it crosses into the bloodstream and exerts its effects almost instantly.

The high associated with inhalants usually only lasts minutes. Many people continue to inhale the drug in an effort to continue the high.

Inhalants can be taken in a variety of ways including:

  • Sniffing the fumes from a container
  • Spraying it directly into the nose or mouth, or into a bag and inhaling from the bag
  • Soaking a rag or towel with solvent, then inhaling the fumes
  • Filling a balloon with the inhalant, then inhaling the vapor as the balloon is decompressed

How Do Inhalants Work in the Brain?

Inhalants are a broad category of drugs with varying mechanisms of action, however most inhalants are central nervous system depressants similar to alcohol and benzodiazepines. One particularly inhalant, toluene (an ingredient in paint thinner), has been shown to increase dopamine in the brain. This mechanism is similar to how cocaine works. Nitrites, also known as “poppers” or “snappers,” work by dilating blood vessels to produce a lightheaded effect.

Because all inhalants are gaseous, they displace oxygen in the lungs, leading to deadly oxygen deprivation.

Poppers

Poppers are a particularly popular class of inhalants called nitrites – drugs that dilate blood vessels to produce a fast-acting sensation of relaxation accompanied by dizziness and lightheadedness. They can be bought online, at bars, or gas stations. Some common nitrites contained in poppers include:3

  • Amyl nitrite (most popular)
  • Isobutyl nitrite
  • Isopropyl nitrite

Supplied as a small vial containing the nitrite in gaseous form, when the cap is removed the drug is quickly inhaled through the mouth or nose.

Poppers are associated with a significant amount of side effects including eye damage, increased heart rate, migraines and fainting.

Poppers are currently illegal in the United States.

Short Term Effects of Inhalants

Depending on which type of inhalant has been used, it may produce any number of the following effects:

  • Drowsiness – CNS depressant inhalants will often make the user feel tired after inhalation.
  • Disinhibition – Similar to alcohol, many inhalants will make the user feel relaxed and impair judgement, potentially leading to high-risk behavior.
  • Nausea/vomiting – The body will often treat inhalants as poisons, causing nausea and vomiting.
  • Headache – Particularly with nitrites, dilation of blood vessels can lead to excruciating headaches.

Long Term Effects of Inhalants

Since inhalant use cuts of oxygen, an essential component to a health body and nervous system, many of the long term effects of inhalants involve problems with cognitive abilities or senses. Some of the long term effects include:

  • Loss of hearing or smell
  • Organ damage
  • Memory problems
  • Personality changes
  • Dementia

Inhalant Overdose

In high enough doses, most inhalants will produce anesthesia, or a loss of sensation often accompanied by unconsciousness. If the dose is too high, the user may slip into a coma and die.

Since many inhalants are very concentrated, it only takes a small amount of the drug to cause an overdose.

Sudden Sniffing Death Syndrome

Inhalant abuse can cause death even after the first attempt. A major cause of death due to inhalant abuse is Sudden Sniffing Death Syndrome. Since inhalants can cut off oxygen, many users die from oxygen deprivation.

Inhalants can also make the user more sensitive to natural chemicals that increase heart rate such as adrenaline. When adrenaline is released to make the heart beat faster, the heart can overreact and end in a heart attack.

Recognizing Inhalant Abuse

Since the effects of inhalant abuse are usually short-lived, it may be difficult to detect inhalant abuse while it is being abused. Nevertheless, the following signs may be signal inhalant abuse:

  • Slurred speech
  • Inability to hold a conversation
  • Disoriented and confused for no apparent reason
  • Hidden or suspicious placement of household chemicals such as spray paint, glue, or soaked rags
  • Chemical odors on clothing or breath

Treating Inhalant Addiction

Many users may come find the pleasurable feelings associated with inhalant use difficult to resist and may develop an addiction to them.

While users are unlikely to develop physical dependence on inhalants, their addiction may feature psychological dependence. These users may find it difficult to resist urges to use the drug and rely on it to feel normal.

An addiction specialist can help those suffering from inhalant addiction and provide a range of services to support both the user’s physical and mental health.

Behavioral therapies for addiction may be helpful to:

  • Change the attitude towards inhalant abuse
  • Promote health lifestyle choices
  • Stay disciplined in the use of addiction medications

Initial treatment for addiction can start in one of two settings – inpatient or outpatient.

  • Inpatient – In an inpatient setting, the user is admitted to a hospital-like residential setting where they can receive around-the-clock support for their addiction. If inhalant abuse has caused significant damage, an inpatient setting may be the best option.
  • Outpatient – In an outpatient setting, the user remains at home but visits a healthcare professional on a regular schedule. Many outpatient programs involve individual or group counseling sessions.

Inhalant abuse can cause long-term damage or death in a very short period of time, therefore it is imperative that inhalant addiction be managed as soon as possible.


Marijuana Overview

Marijuana, also known as “cannabis,” “weed,” “pot,” and “reefer,” is the most commonly abused illegal drug in the United States and the most commonly abused drug overall behind alcohol and tobacco.

THC VS CBD – What’s the Difference?

Marijuana contains compounds called cannabinoids, chemicals that bind to cannabinoid receptors in the brain. Some of these cannabinoids, such as THC, are psychoactive, meaning they produce a psychological effect or “high.” Other cannabinoids such as CBD do not produce the “high” associated with THC.

Who’s Smoking Marijuana?

According to a 2015 survey by the Substance Abuse Center for Behavioral Health Statistics and Quality, more than 11 million adults between the ages of 18 and 25 used marijuana in the past year. The 2018 Monitoring The Future survey by the National Institute on Drug Abuse reported that nearly 1 in 16 high school seniors reported daily use of marijuana.

Legalized Marijuana – Is It Really Legal?

As of 2019, 11 states, including California, have legalized marijuana for recreational use. In these states it is legal to purchase, possess and grow.

Despite individual states de-criminalizing marijuana, possession is not completely risk free. Marijuana is still considered an illegal substance under federal law, in the same category as heroin and LSD.

It is important to note that although many states are legalizing marijuana, this does not make the drug any less dangerous.

How Is Marijuana Used?

There are several different ways marijuana can be used.

  • Smoking – Users will often grind the plant material where it can be hand-rolled into a joint or smoked in a pipe or bong. Since smoking involves lighting the plant material on fire (combustion), users who choose to smoke marijuana also inhale carbon monoxide, a dangerous compound that causes dizziness and headaches.
  • Vaping – A growing number of people who use marijuana choose to vaporize Vaporization involves heating the marijuana to a temperature hot enough to release the psychoactive compounds without igniting the plant material and generating carbon monoxide. While this is often perceived to be healthier than smoking, a 2018 study found that vaporizing marijuana produced higher THC levels in the body compared to smoking.
  • Edibles – A less common way of taking marijuana is by eating food infused with THC. Since THC is fat-soluble, it is dissolved in butter, then used to prepare edibles such as brownies or cookies. Since edibles must first pass through the digestive tract before reaching the bloodstream, more time is required to take effect, however the effects last longer than smoking or vaping.

“Dabbing”

A particularly dangerous way of taking marijuana is called “dabbing.” The marijuana plant produces a waxy, oily, honey-like resin commonly referred to as “hash.” Hash contains a significantly higher concentration of THC than the plant material, making it much more potent.

The production of hash also requires the use of butane, a flammable compound found in lighter fluid. Several people have been admitted to the emergency room for burns acquired while making hash.

Effects of Marijuana

When smoked, marijuana is quickly absorbed from the lungs and into the bloodstream, where the user feels the effects almost instantly. Some of the effects include:

  • Altered senses – Colors may appear more vibrant or colorful and music may sound different.
  • Euphoria – Users may feel a sense of warmth, relaxation and happiness.
  • Paranoia – Many users have a negative reaction, feeling incredibly paranoid and anxious
  • Increased appetite – Most users report an increase in appetite, commonly known as the “munchies.”
  • Impaired memory – Users often have a difficult time remember things while under the influence of marijuana.
  • Cognitive impairment – It is often difficult to think clearly while under the influence of marijuana, making it harder to perform essential job or academic duties.

Signs of Abuse

  • Skunk-smelling odor – The marijuana plant has an incredibly strong and pungent odor resembling a skunk. Marijuana users will often either have this odor on their person if they have used it recently or their room/car may smell.
  • Failing drug tests – Most employers will screen a potential candidate for THC, which can be detected up to a month after use in a typical urine screen. Since most job candidates are aware they will be screened, failure of a pre-employment drug screen often indicates that the user has difficulty stopping.
  • Poor performance at work or school – Marijuana makes users feel mentally sluggish and can impact the ability to concentrate on a task. Poor performance at work such as frequently forgetting obligations, not completing tasks and arriving late may indicate abuse.

Is Marijuana Addictive?

Marijuana’s effects can be addicting, leading to a substance use disorder. In the context of marijuana abuse it is known as “marijuana use disorder.”

While marijuana is not often perceived as an addictive drug, research has shown that 9-30% of users may be dependent on marijuana and meet the criteria for marijuana use disorder.

Early use has been associated with marijuana use disorder. Those who begin using before the age 18 have been shown to be 4-7 times more likely to develop a marijuana use disorder.

Addiction Treatment

Treatment of marijuana addiction focuses primarily on behavioral modification therapies. Addiction treatment may occur in a treatment center or in an outpatient setting where the user regularly schedules appointments.

Some of the following strategies are often employed in treating marijuana addiction.

  • Cognitive Behavioral Therapy (CBT) – This type of therapy focuses on helping the user identify and correct problematic behaviors associated with their marijuana use. Development of coping strategies is also a central theme of this therapy. For example, if a user identifies a pattern of using marijuana to cope with stress, a plan will be developed to deal with stress in a healthy way without the use of marijuana.
  • Contingency Management – This type of therapy focuses on providing rewards for meeting pre-defined therapy goals. For example, to reinforce abstinence a user may be awarded prizes for providing negative-drug screens.

There are no FDA-approved medications for treating marijuana addiction, however medications may be used to combat symptoms of marijuana withdrawal, which may help prevent relapse. Since insomnia is often a common symptom of marijuana withdrawal, sleep medications such as Ambien may be used short term.


Methamphetamine Overview

Methamphetamine, commonly known as “meth”, is a highly addictive stimulant drug that affects the central nervous system. While it is available as a prescription drug under the brand name Desoxyn® indicated for the treatment of attention deficit hyperactivity disorder and obesity, it is more commonly encountered as an illegal and dangerous street drug. Also known as blue, ice, crystal and speed, meth takes the appearance of a white, odorless, bitter-tasting crystalline powder that can be smoked, insufflated (snorted) or injected. When smoked or injected, the high from methamphetamine is felt instantly, peaks within 15 minutes and typically lasts 4-8 hours.

Statistics

According to a 2017 survey by the National Survey on Drug Use and Health, approximately 1.6 million Americans had reported using methamphetamine in the past year, with the average age of a first-time user being 23.3 years old. While methamphetamine is accessible anywhere in the country, its use is significantly more prevalent in the western and midwestern United States.

Meth Labs – Dirty and Dangerous

The Drug Enforcement Agency (DEA) has identified the primary source of large-scale methamphetamine production originating from Mexican drug cartels, which smuggle the drug across the United States-Mexico border.5 Meth is also produced in the United States as well, where users and/or distributors synthesize meth in clandestine “meth labs.” Far from pristine, meth labs use crude household products to manufacture meth in filthy conditions. Below are some of the ingredients used:

  • Acetone – an extremely flammable compound; primary ingredient in nail polish remover
  • Anhydrous ammonia – colorless, pungent gas used as agricultural fertilizer
  • Pseudoephedrine – the active ingredient found in the nasal decongestant Sudafed®; it is a key chemical precursor to methamphetamine
  • Lithium – corrosive chemical found in battery acid
  • Red phosphorus – highly flammable substance used for match tips
  • Toluene – a solvent used in the production of paint thinner

Possession of these ingredients should serve as a red flag to the possibility of meth production and/or use, particularly excessive purchasing of pseudoephedrine. In 2005, the Combat Methamphetamine Epidemic Act was passed to curb meth production. The Act mandates that retailers require photo identification upon purchase, track purchase history and limit the sale of pseudoephedrine-containing products.

How Meth Works in the Brain

Meth works by flooding the brain with dopamine, our body’s natural “feel-good” chemical, as well as norepinephrine, a chemical associated with arousal and alertness. As a result, users often experience intense euphoria, hyper-confidence and a feeling of never-ending energy.

Effects of Methamphetamine

Psychological symptoms of methamphetamine intoxication include:

  • Increased alertness/wakefulness
  • Nervousness
  • Decreased appetite
  • Paranoia

Physical symptoms of methamphetamine intoxication include:

  • increased and/or irregular heart rate
  • increase in blood pressure
  • increase in body temperature
  • Convulsions

The Meth “High”

While under the influence, users may feel capable of anything and often engage in high-risk behavior such as gambling, criminal activity and unprotected sex.

Due to its long-lasting stimulant properties, meth users may go several days without sleep. During this period of no sleep, known as “tweaking,” the user becomes increasingly paranoid, aggressive and prone to mood swings as the lack of sleep wreaks havoc on their mental health.

A Cycle of Abuse

The stages of methamphetamine abuse often follow a predictable “binge and crash” pattern outlined below:

  • The Rush – After administration, the user feels an intense “rush” of euphoria within seconds as dopamine and norepinephrine flood their brain.
  • The High – Once the initial rush subsides, the effects of the drug linger, lasting up to 14 hours. During this time the user may act aggressive and engage in high-risk behavior.
  • The Binge – In an effort to stay high, the user continues to use the drug for several days, often forgoing sleep and food completely.
  • The Crash – After binging for days without sleep, the user will inevitably suffer a crash when they either run out of meth or cannot stay awake any longer. The crash is associated with extreme exhaustion as they recover from days of sleep deprivation.

Signs of Methamphetamine Abuse

Meth addicts often exhibit a characteristic appearance.

  • Malnourished – Due to meth’s appetite suppressant properties, addicts are often underweight and have thin hair due to a lack of proper nutrient intake.
  • Tired – Many addicts have shallow, sunken eyes due to the extreme insomnia experienced during drug binges
  • Trace marks – Users who inject the drug may have bruised or bloodied “trace marks” on their arms at the site of injection.
  • Meth sores – During the binge portion of the abuse cycle, many users experience hallucinations of bugs crawling under their skin. As a result, users are often riddled with sores along their body from trying to pick off the imaginary bugs.

Long Term Effects of Methamphetamine Abuse

Long term effects of meth abuse can result in profound mental changes such as paranoia, psychosis and depression. Because meth addicts will often go days without eating and neglecting person hygiene, many addicts develop “meth mouth,” characterized by severe tooth decay. A 2015 study found that out of 571 meth users, 96% had cavities, 58% had untreated tooth decay and 31% had at least six missing teeth.

Many meth users choose to inject the drug intravenously, causing the effects to be felt instantly. This is perhaps the most dangerous method of taking meth, as research has shown that injecting a drug leads to addiction the fastest. In addition, the use of dirty needles can result in skin and soft tissue infections as well as heart valve infections such as endocarditis. Many users also share needles, drastically increasing the risk of contracting blood-borne diseases such as HIV and hepatitis C. The CDC estimates that intravenous drug users accounted for approximately 9% of HIV cases in 2016.

The Phases of Methamphetamine Withdrawal

  • Acute Phase – The acute phase of withdrawal, lasting 2-3 days, is characterized by extreme exhaustion and increased appetite, as the user has likely not slept or eaten during the binge portion of the drug cycle.
  • Post-Acute Phase – The next phase, lasting 7-10 days, is characterized by continued sleep difficulty and loss of appetite.8 Significant depression can occur during this stage as the drug has depleted the body’s “feel good” chemicals.
  • Lingering Symptoms – Withdrawal symptoms can persist for up to three weeks following the last dose, where sleep difficulties continue and the body’s heart rate remains low.

While these are general timelines, the length of each withdrawal phase varies for each individual. Users who have been abusing meth for a longer period can expect withdrawal to last longer, sometimes up to months until complete recovery.

Meth Addiction Treatment

Addiction treatment for meth is notoriously difficult, as there are no FDA-approved treatments. Unlike drugs such as opioids and benzodiazepines, withdrawal from meth is not likely to be physically dangerous, though that does not mean it is any easier to detox from.

The immediate goal of meth detoxification is complete cessation of meth and control of withdrawal symptoms. Some health care practitioners may choose to use benzodiazepines such as Xanax to control the anxiety and aggression associated with withdrawal as the body acclimates to functioning without meth. Treatment will primarily focus on behavioral therapies to reverse the psychological damage done by meth. These therapies may include counseling sessions and group therapy as part of the rehabilitation process.

Use of Naltrexone in Meth Addiction

Research has been conducted on the use of naltrexone, a drug commonly used to treat opioid and alcohol addiction, in the management of meth addiction. A 2015 study9 found that naltrexone significantly reduced meth craving following detoxification. It was also found to dull the pleasurable feelings associated with meth. With drug craving being a core symptom of meth addiction that persists long after withdrawal symptoms subside, naltrexone may have utility in preventing relapse following successful detoxification from meth.

Treatment of meth addiction is a difficult process that requires the support of a qualified healthcare professional. While some attempt to quit meth on their own without help, it is significantly more effective to enroll in a treatment program that can help manage withdrawal symptoms and build strategies to prevent future use.


Opiates Overview

The United States is in the midst of an “opioid epidemic,” aptly named considering that opioids are responsible for nearly 130 deaths every day in the United States. The drugs involved in the opioid epidemic range from illegal drugs such as heroin to legal, prescription drugs that can be bought at a pharmacy. Regardless of their legality, all opioids carry the potential for addiction.

Opiate vs Opioid

While often used interchangeably, the term opioid refers to any substance that binds to opioid receptors and includes natural, synthetic (man-made) and semi-synthetic drugs. The term opiate refers to a drug derived directly from the opium poppy, such as morphine and codeine. All opiates are opioids, but not all opioids are opiates.

A Brief Overview

Opioids are some of the most effective analgesics available and often the backbone of treatment regimens for chronic pain, particularly cancer, with approximately 50% of active cancer patients receiving opioids long term. They are also routinely used for short-term pain control following surgeries; some common opioid medications include hydrocodone, oxycodone, morphine and fentanyl. While excellent at controlling pain, their effectiveness comes at a cost – placing the patient at high risk for addiction and opioid misuse, even in those with no history of substance abuse. It is believed that roughly 80% of heroin users’ addiction started with the misuse of prescribed opioids initiated for legitimate, medically necessary reasons.

Statistics

The statistics on opioids in the United states are unsettling. The National Institute on Drug Abuse estimates that in 2018, 3.4% of 12th graders in the United States had tried a narcotic other than heroin.3 The Centers for Disease Control and Prevention (CDC) estimates that from 1999 – 2017, opioid overdoses have been responsible for more than 700,000 deaths in the United States, with fentanyl being responsible for the most drug overdoses doses of any drug in 2016. People who begin abusing opioids may have originally been prescribed opioids legitimately for pain or obtained them illegally. Regardless of the origin of addiction, opioid drugs and their addictive potential pose a significant threat to any user’s physical and mental health, as opiate addicts will often resort to extreme measures to chase the “high” associated with their use.

The “Opioid High”

You may have heard of or even experienced “runner’s high,” the euphoric feeling many runners get while going for a long jog. The feeling is due to the release of endorphins, our body’s natural painkillers – one runner describes the feeling as follows:

“It’s that euphoric feeling where my mind is all of a sudden significantly clearer. I feel a lot lighter emotionally — all of my worries and anxieties start to subside — and I feel instantly lighter on a physical level.”

Now, imagine feeling that same blissful state of euphoria where all your worries melt away, except you didn’t need to run 10 miles – you just had to take a pill. That is precisely what happens with opioids. Opioids mimic our body’s endorphins to both effectively treat pain, but also create that feeling of euphoria that leaves people wanting more.

Tolerance & Dependence

After prolonged use, the body develops tolerance to opioids, whereby more of the drug is required to exert the same effect. This often leads to people taking more of the drug to achieve the same feeling. Tolerance is unavoidable and will always develop following long-term opioid use; it is our body’s way of “adjusting” to the opioid.

As might be expected, once our body becomes adjusted to the opioid, abruptly stopping it can cause undesirable effects – this is called withdrawal. Withdrawal is the constellation of symptoms that occur when someone taking an opioid for a long period of time suddenly stops taking it. Withdrawal symptoms include severe diarrhea, sweating, muscle aches and intense cravings for the drug.

Side Effects

In addition to the feeling of euphoria, opioids can cause side effects such as:

  • Nausea
  • Constipation
  • Respiratory depression

The constipation associated with high-dose opioid use is not typical constipation that can be relieved with an over-the-counter laxative. This constipation can be so extreme that it is impossible to remove without a licensed professional to physically dislodge the fecal matter. In more severe cases surgery may be required. The most fatal side effect of opioids is respiratory depression, characterized by slow, shallow, and ineffective breathing. In many cases, respiratory depression is ultimately what kills individuals who overdose on opioids. The individual’s breathing becomes so slow and shallow that death results due to oxygen deprivation.

Narcan – The Opioid Antidote

Luckily, respiratory depression can be stopped if action is taken quickly. The drug Narcan® (naloxone) can be used to reverse the deadly effects of an opioid and is available in most states without a prescription, including California. It is most commonly used as a nasal spray that works within minutes to restore normal breathing function. While naloxone is effective at reversing the deadly respiratory depression associated with an opioid overdose, it reverses all the effects of an opioid, immediately throwing the individual into a state of painful withdrawal.

Addiction Treatment

Drug addiction is a complex disorder that requires the aid of qualified healthcare professionals who specialize in addiction treatment, a strong support system, and often medications that help control both the physical and psychological symptoms of withdrawal. Several options for addiction treatment include methadone, Suboxone and Subutex.

Methadone – The Gold Standard

Historically the drug methadone has been used as the gold standard for the treatment of opioid addiction. Methadone is itself an opioid, which may at first seem counter-intuitive to use for opioid addiction. It is effective because methadone stays in the body significantly longer than other opioids, providing long-lasting prevention of withdrawal. It has also been shown to suppress cravings for opioids in general. Many opioid-addicted individuals treated with methadone remain on methadone indefinitely, sometimes their entire lives. While it can be argued that this strategy is essentially choosing the lesser of two evils (replacing heroin or prescription opioids with methadone), maintenance therapy with methadone allows monitoring of addiction in a controlled environment with a well-studied drug. The major drawback of methadone is that patients can only receive it in a registered methadone treatment facility, which can be costly and inconvenient. Methadone is also associated with significantly more drug interactions than most opioids, including cardiac abnormalities.

Subutex and SuboxoneNewer Options

Newer options for the treatment of opioid addiction include Subutex (buprenorphine) and Suboxone, a combination of the drugs buprenorphine and naloxone. The naloxone in Suboxone is the same drug used to reverse the effects of opioids. Suboxone is available as sublingual films while Subutex is available as sublingual tablets. Both the tablets and films are dissolved under the tongue, where the drug diffuses into the bloodstream though the tissue in the tongue.

Buprenorphine is similar to methadone in that it is an opioid used to suppress withdrawal symptoms, however it doesn’t carry the risk of drug interactions associated with methadone. It also doesn’t require the patient be seen in a clinic; it can be picked up at any retail pharmacy. When Suboxone is taken correctly, by dissolving it under the tongue, the naloxone has essentially no effect. If, however, the drug is injected or snorted, the naloxone component of Suboxone kicks in with full effect, throwing the individual into a painful state of withdrawal. This mechanism deters abuse and ensures the drug is taken correctly.

SuboxoneSubutexIndicationOpioid addictionOpioid addictionIngredient(s)Buprenorphine + naloxoneBuprenorphineFormulationSublingual filmSublingual tablet

A Personalized Approach

There is no “one size fits all” drug for the treatment of opioid addiction, as each treatment has its own advantages and disadvantages. Your healthcare provider will help determine which option is best for you

Oxycontin Overview

OxyContin is a prescription-only opioid used in the management of moderate to severe pain. It is a special formulation of the drug oxycodone designed to slowly release the drug over an extended period of time, providing around-the-clock pain relief. Compared to other opioids which may last 6-8 hours, OxyContin provides sustained delivery of oxycodone for up to 12 hours to treat chronic pain.

Because it slowly releases the drug, the dose of oxycodone contained in OxyContin is significantly higher than other oxycodone product such as Percocet. OxyContin also contains pure oxycodone, whereas Percocet contains a combination of oxycodone and acetaminophen (the active ingredient in Tylenol).

Due to its high content of “pure” oxycodone, OxyContin carries a significantly higher abuse potential than other oxycodone products. Many users will attempt to crush the pill, bypassing the controlled-release mechanism in order to get the entire amount of oxycodone into their system faster.

Street names for OxyContin include oxys, OC’s, oxycotton, hillbilly heroin, and berries.

OxyContin – Fueling the Fire of the Opioid Epidemic

OxyContin was introduced to the US market in 1996 by Purdue Pharma. The manufacturer’s aggressive marketing campaign systematically downplayed the drug’s addiction potential, even training its sales representatives to tout the addiction potential as “less than one percent.”

Evidence based research has since shown OxyContin to be extremely addicting. Many states, most recently California, have brought lawsuits against the drug-maker for its deceptive sales practices.

OxyContin Medical Uses

OxyContin contains a large dose of oxycodone that is released over 12 hours to provide long term pain relief. This makes the drug incredibly useful for those suffering from chronic, severe pain. Medical professionals may issue an OxyContin prescription for the following:

  • Cancer pain
  • Pain uncontrolled by weaker opioids such as hydrocodone or codeine
  • Severe pain due to arthritis
  • Pain following surgery

How OxyContin Works in the Brain

OxyContin is an opioid agonist that binds to opioid receptors in the central nervous system. By binding to opioid receptors, OxyContin blocks pain signals, which is why it is used as a painkiller. While effective at treating pain, it also makes the user feel a strong sense of euphoria, making it incredibly addicting even for those without a history of substance abuse.

Side Effects

OxyContin is associated with a significant amount of side effects, which can include:

  • Constipation
  • Nausea and vomiting
  • Itching
  • Dizziness
  • Respiratory depression

Respiratory depression is defined as slow and shallow breathing; it is the most dangerous side effect of OxyContin. If OxyContin is taken in too large of a dose, as is common in those who abuse the drug by crushing it, respiratory depression can be fatal.

OxyContin Overdose

In cases of OxyContin overdose, the drug Narcan can be used to reverse respiratory depression. Narcan contains the opioid antagonist naloxone in the form of a nasal spray. When used correctly, it can save the life of someone who has overdosed. In most states, including California, it is available without a prescription.

OxyContin Abuse

Because OxyContin makes users feel incredibly euphoric, its use is associated with a significant potential for abuse and addiction. Even those who begin taking OxyContin for a legitimate medical reason are not immune to the addictive potential of OxyContin. Those who seek out the drug solely to abuse it will often crush the pill, breaking the time-release mechanism and releasing the entirety of its contents. Users will often attempt to snort or even inject the contents to feel the high immediately.

Injection of OxyContin is particularly dangerous, as it immediately introduces the drug into the bloodstream. The high experienced from injection is similar to heroin, which is why OxyContin is sometimes referred to as “hillybilly heroin.”

Users who inject OxyContin not only expose themselves to the dangers of an overdose, but sharing needles is associated with a significant risk of blood-borne diseases such as HIV and hepatitis C.

Tolerance and Dependence

When OxyContin is repeatedly used, the body builds resistance to its effects, known as tolerance. Tolerance develops quickly to the euphoric feelings of OxyContin, causing users to take more of the drug to feel the same effects.

When used over a long period time, the body can become dependent on the drug, requiring it to function normally. Users can become both psychologically and physically dependent on Oxycontin. Psychological dependence is characterized by needing the drug to feel normal. Physical dependence is when the user suffers physical withdrawal symptoms if they do not take it.

OxyContin Withdrawal

Symptoms of withdrawal can be both psychological and physical. Some withdrawal symptoms are listed below.

  • Diarrhea
  • Muscle aches/pain
  • Insomnia
  • Drug craving
  • Seizures

When a user experiences withdrawal from OxyContin, they will often engage in extreme drug seeking behavior such as drug craving and lying or stealing from friends and family members to obtain more of the drug.

Addiction Treatment

OxyContin addiction is a difficult challenge to overcome; the goals of treatment focus on both the physical and mental health of the individual.

Those admitted to an inpatient treatment facility will often be switched to a different opioid such as methadone or Suboxone to control withdrawal symptoms; this is known as “opioid replacement therapy” or “opioid substitution therapy.”

Methadone is a commonly used opioid for opioid replacement therapy, as it has a long half-life that provides sustained control of withdrawal symptoms. Some addiction specialists may recommend the use of newer therapies such as Suboxone or Subutex.

The dose of the replacement opioid is slowly decreased (tapered) over time, allowing the body to adjust to dose reductions until it can be safely discontinued.

Some users may attempt to suddenly discontinue OxyContin, known as “going cold turkey.” This is potentially dangerous, as seizures have been observed in those who suddenly discontinue high-dose opioids such as OxyContin.

It is highly recommended that anyone suffering from OxyContin addiction seek the help of a qualified addiction specialist who can help them with their substance use disorder and choose a therapy that fits their unique needs.

Prescription Drugs Overview

Most drugs can be grouped into one of two main categories – prescription and over the counter medications.

  • Prescription-only drugs drugs that require a prescription to buy
  • Over the counter (OTC) drugs – drugs that can be bought without a prescription

While many prescription drugs are safe and exhibit no potential for abuse, there are a significant amount of prescription drugs that can be addicting, even those used for legitimate medical conditions. Drugs deemed to carry the potential for abuse by the Drug Administration Agency (DEA) are called “controlled substances.” While many illegal drugs are controlled substances, some legal, prescription drugs are controlled substances as well.

All controlled substances are classified into categories called “schedules” depending on how likely they are to cause physical and/or psychological dependence. Below is a table showing the different schedules and examples of controlled substances belonging to each schedule.

It is important to note that while prescription-only controlled substances are completely legal for someone with a valid prescription to possess and take, it is illegal for anyone without a prescription to be in possession of a prescription-only controlled substance.

Some of the most common types of abused prescription drugs are listed below.

  • Opioids – Opioids are drugs that bind to opioid receptors in the brain. As prescription drugs, opioids are effective analgesics (painkillers) used in the management of both short-term and chronic pain. Opioids can be prescription drugs such as hydrocodone, oxycodone, morphine and fentanyl as well as illegal drugs such as heroin. Abuse of opioids is often associated with an intense high that can be incredibly addicting.
  • Stimulants – Stimulants are drugs that stimulate the central nervous system, increasing alertness and energy. Most prescription stimulants are used for the treatment of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). In individuals with these conditions, stimulants having a calming effect, however those who abuse the drug feel alert, hyperconfident and may engage in risky behavior while under the influence of the drug. Prescription stimulants include Adderall (dextroamphetamine salts), Ritalin (methylphenidate) and Vyvanse (lisdexamfetamine).
  • Depressants – Depressants are in many ways the “opposite” of stimulants in that they slow down the central nervous system and make a user feel more relaxed. Prescription depressants are often used to treat anxiety disorders as well as epilepsy. Examples of depressants includes benzodiazepines such as Xanax (alprazolam), Valium (diazepam) and Ativan (lorazepam) as well as barbiturates such as phenobarbital and butalbital. Long term use of depressants is associated with a significant risk for dependence and dangerous withdrawal symptoms such as seizures.
  • Steroids/Hormonal Products – Not all prescription drugs are abused because they make an individual feel high. Hormonal products such as testosterone is an example. Testosterone is a prescription-only controlled substance very similar to anabolic steroids, a dangerous class of performance-enhancing drugs used by some athletes to gain an unfair advantage.
Drug Abuse vs Misuse

You may hear two terms when reading about drug addiction, drug misuse and drug abuse. While similar, the differences between the two should be appreciated. Drug misuse is when a prescription drug is used for something other than its intended purpose while drug abuse is when an individual takes the drug with an intention to get high.

The fictional scenarios below illustrate examples of drug misuse vs drug abuse.

  • Drug Misuse – Mike was prescribed hydrocodone for pain following his wisdom teeth removal. He had some pills left over and decided to use it for a painful headache. Even though Mike has a valid prescription for hydrocodone, it was not prescribed to use for his headache. Mike engaged in prescription drug misuse.
  • Drug Abuse– Alex heard from a friend that hydrocodone can make him “feel high.” He knows that his grandmother had a prescription for hydrocodone and keeps it in the medicine cabinet. Alex steals some of the pills and takes them to get high. Because he did not have a prescription for hydrocodone and intentionally took them to get high, Alex has engaged in prescription drug abuse.
Prescription Drug Abuse – A Serious Problem in the United States

Overdose deaths due to prescription drug abuse is a major problem in the United States. The American Society of Addiction Medicine estimates that in 2015, 20,000 overdose deaths were due to prescription drugs.

The National Institute on Drug Abuse reports disturbing statistics regarding prescription drug abuse, particularly with teens and young adults.

  • Overdose deaths involving prescription opioids was nearly five times higher in 2016 than in 19991
  • 4% of young adults aged 18-25 had abused a prescription drug within the past year
  • Approximately six percent of high school seniors had taken Adderall without a prescription in the past year

Signs of Prescription Drug Abuse

The signs of prescription drug abuse can vary widely depending on the individual. Many drug abusers can hide their substance abuse habit, however the side effects that a user experiences are often difficult to hide. Listed below are typical side effects of prescription drugs that may signal abuse.

Stimulants

  • Rapid weight loss
  • Feeling jittery / speaking fast
  • Irritability and moodiness
  • Sleep difficulty

Depressants

  • Depression and/or lack of motivation
  • Slurred speech
  • Chronic fatigue or confusion
  • Poor concentration

Regardless of whether someone is abusing a stimulant or depressant, they may show signs of drug craving if they are not able to obtain the drug. Users may also exhibit drug-seeking behavior such as deception or stealing in order to support their drug habit.

Because many who abuse prescription drugs also have a prescription for it, the following may also serve as red flags that signal abuse:

  • Attempting to refill prescriptions earlier than allowed
  • Visiting different doctors to obtain several prescriptions for the same drug, also known as “doctor shopping”
  • Visiting different pharmacies to obtain the drug from multiple sources

Seeking Help

Addiction is, at its core, a disorder that significantly affects a user’s mental health. While prescription drugs are legal, it is important to keep in mind that they are no less dangerous than illegal drugs. Drug addiction is a difficult challenge to overcome, however there are many resources to help a user overcome their addiction.


Stimulants Overview

Stimulants are a class of drugs that increase the activity of the central nervous system. Some stimulants, such as Adderall and Ritalin, are prescription drugs used for the treatment of attention deficit hyperactivity disorder and narcolepsy. Other stimulants include illegal drugs such as methamphetamine, cocaine or ecstasy.

Stimulant drugs are one of the most abused classes of drugs in the United States, ranking 3rd behind marijuana and prescription drugs.1 The National Survey on Drug Use and Health reports that at least 14% of Americans have tried cocaine at least once in their life and at least 8.5% have tried an amphetamine such as Adderall without having a prescription.

While there are differences between each stimulant, stimulant abuse in general is associated with a short-lived, intense high, followed by a crash, where the user feels depressed and may crave the drug.

Cocaine

Cocaine is a naturally occurring alkaloid found in the leaves of the coca plant, indigenous to South America. While it is occasionally used as a topical anesthetic for surgeries due to its numbing effect, it is most often encountered on the street as a dangerous and addicting stimulant.

It is available on the street under several names such as “coke,” “blow,” “nose candy,” and “yayo,” usually as a white powder. Most users choose to snort it, however it is easily dissolved in water and injected into a vein. Powdered cocaine cannot be smoked however it can be converted into crack cocaine, a smokable form of the drug.

Crack Cocaine

A special form of cocaine, known as “crack” or “rock,” is made by adding baking soda to cocaine and heating the mixture up.2 This forms a solid rock that can be smoked, often in a pipe called a “crack pipe.” Compared to powdered cocaine, crack cocaine is significantly cheaper.

In many ways, crack cocaine is even more dangerous than powdered cocaine. Its low cost makes it more accessible, and because smoking it causes the effects to be felt immediately, crack has been shown be more addictive than powdered cocaine.

Effects of Cocaine

Cocaine is associated with an intense high, where the user feels focused, confident and may engage in risky behavior such as stealing, gambling or unprotected sex. It also carries a significant amount of side effects, listed below:3

  • Increased heart rate
  • Increased blood pressure
  • Insomnia
  • Panic/anxiety
  • Hallucinations
  • Seizures

Long term use may be associated with the following:

  • Blood vessel damage
  • Weight loss
  • Depression
  • Liver, kidney and lung damage

How long it takes to feel the effects of cocaine and how long they last depend on the way it was taken. When cocaine is smoked or injected, the effects are felt almost instantly. When snorted, it may take minutes to feel the effects.

Amphetamines

Amphetamines are a class of prescription stimulants used for several legitimate medical conditions. Some of the following medical uses of amphetamines are listed below:

  • Attention deficit hyperactivity disorder (ADHD)
  • Attention deficit disorder (ADD)
  • Obesity
  • Narcolepsy

Some of the most common amphetamine drugs include:

  • Adderall (mixed amphetamine salts)
  • Vyvanse (lisdexamfetamine)
  • Dexedrine (dextroamphetamine)

Methamphetamine, also known as “meth,” “crystal,” and “glass,” also belongs to the amphetamine class of drugs. While methamphetamine is available as a prescription drug to treat ADHD, it is most commonly seen on the street as an impure, rock-like substance that is smoked, snorted or injected.

Methamphetamine is an incredibly dangerous and addicting drug that can severely affect a user’s physical and mental health. Users will often abuse meth in a “binge and crash” cycle where they take the drug for days at a time, often going 3-4 days with no sleep. This is followed by a crash as they enter a state of depression and exhaustion.

Amphetamines – The Study Drug

Adderall, a prescription drug containing mixed amphetamine salts, is incredibly popular among college students. Because it can help users focus, it is often used to cram before big exams or term papers. In one survey asking 1,300 college students if they had used an amphetamine to help study, approximately 25% said they did, however only 8.9% of the students had a prescription for it.5

Methylphenidate

Methylphenidate is a stimulant drug similar to amphetamines. It goes under several brand names including Ritalin and Concerta, used to treat ADHD and narcolepsy. While not technically an amphetamine, its effects are virtually the same as amphetamine stimulants.

Signs and Symptoms of Stimulant Addiction

The signs and symptoms of stimulant abuse may vary from person to person. Individuals who are addicted to stimulants such as Adderall or Ritalin for study/work-related purposes may hide their addiction very well since they are likely to maintain success in work or academics. Some signs of stimulant addiction, however, are difficult to hide and may include:

  • Dilated pupils
  • Hyperactivity
  • Insomnia
  • Rapid, unexplained weight loss
  • Deceptive behavior
  • Mood changes

Tolerance and Dependence

Like most drugs of abuse, tolerance can develop to the effects of stimulants, where the user must take more in order to achieve the same effect. Dependence can also develop, where the user must take the drug to feel normal. Many college students who take stimulants such as Adderall or Ritalin illegally for a long period of time find it difficult to study without it.

Once a user is dependent on a stimulant they will experience withdrawal symptoms if they do not take it.

Withdrawal from Stimulants

Withdrawal from stimulants is generally not physically dangerous, however coping with the drug craving experienced during withdrawal can be incredibly difficult.

Some symptoms of stimulant withdrawal include the following:

  • Depression
  • Fatigue
  • Unpleasant dreams
  • Slow heart rate
  • Increased appetite and weight gain

Stimulant Addiction Treatment

Treatment for addiction to stimulants such as cocaine, methamphetamine or prescription amphetamines will often focus on repairing the mental health problems caused by long term stimulant use.

In some situations, antidepressants are used to help alleviate the depression associated with stimulant withdrawal and treat underlying depression. Naltrexone, a drug usually used for opioid dependence, is also used to help with drug craving as an adjunct to behavioral therapies.

Substance abuse is a very difficult challenge to overcome. While stimulant withdrawal is not physically dangerous, it is highly recommended that a user seek help from a healthcare professional who specializes in substance use disorders.

Suboxone Overview

Suboxone is the brand name of a drug combination containing buprenorphine and naloxone. It was approved by the Federal Drug Administration (FDA) in 2002 for the treatment of opioid dependence. Suboxone is available as sublingual films that are dissolved under the tongue (sublingual) or inside the cheek (buccal).

Opioid Addiction Statistics

The Centers for Disease Control (CDC) has described the current pattern of opioid use in the United States as an “opioid epidemic.” Below are some of the CDC’s harrowing statistics regarding the opioid epidemic in the United States.2

  • From 1999 – 2017, nearly 400,000 people have died from an opioid overdose (prescription painkillers or illegal drugs such as heroin).
  • The rate of opioid deaths has increased dramatically, with six times as many deaths due to opioid overdose in 2017 than in 1999.
  • Opioid overdose is responsible for approximately 130 deaths every day in the United States.

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2017 approximately 2.1 million people in the United States had abused or were dependent on opioids.3 Many of those dependent on opioids are prescribed Suboxone to treat their dependence.

Who Can Prescribe Suboxone?

Not all prescribers can prescribe Suboxone. Under the Drug Addiction and Treatment Act (DATA), only qualifying prescribers may prescribe Suboxone after completing a special training program. To find a Suboxone prescriber near you, visit the SAMHSA buprenorphine practitioner locator.

How Suboxone Works in the Brain

Opioids are drugs that bind to opioid receptors in the brain. They are addicting because they mimic endorphins, our body’s natural “feel good” chemicals. There are three main types of opioids in terms of how they interact with opioid receptors: agonists, partial agonists and antagonists.

Addicting opioids such as heroin, morphine, hydrocodone, oxycodone and fentanyl are all opioid agonists, drugs that fully activate the opioid receptor. As the dose of an agonist increases, so does the effect.

Buprenorphine, one of the two ingredients in Suboxone, is a partial agonist. As the dose of buprenorphine increases, so does the effect, but only until a ceiling is reached. As shown on the graph below (orange is Suboxone), as the dose increases, the effect increases steadily until a plateau is reached. Once the plateau is reached, the effect remains the same even when the dose increases. This is an important property of buprenorphine, as a user is less likely to abuse it by taking higher doses. Once the plateau is reached it is impossible for the user to feel “higher” by taking more of it.

Why Does Suboxone Contain Two Drugs?

In addition to the opioid buprenorphine, Suboxone also contains the opioid antagonist known as naloxone. When naloxone is taken, it blocks the effects of opioids. If someone who is not dependent on opioids takes naloxone, there will be no effect. However, if someone dependent on opioids takes naloxone, they will immediately suffer painful withdrawal symptoms as the naloxone flushes the opioids out of their system.

This may seem very strange at first. Why would a drug used to treat opioid addiction contain an ingredient that can cause painful withdrawal symptoms? The reason is due to naloxone’s bioavailability. Bioavailability is the percent of a drug that reaches the blood stream to exert an effect. The bioavailability of naloxone is different depending on how it is taken.

As shown in the table above, when naloxone is dissolved under the tongue or inside the cheek (the way Suboxone should be taken), it has no effect. If naloxone is injected or snorted, it exerts its full effect as an opioid antagonist, immediately producing painful withdrawal in an opioid-dependent individual.

Because naloxone causes no effect when taken as prescribed but can cause painful withdrawal when it is abused, it is added to Suboxone to deter drug abuse and ensure it is taken exactly as prescribed.

How to Use Suboxone

Suboxone is supplied as a sublingual film that can either be dissolved under the tongue or inside the cheek. The guides below should be followed on how to take Suboxone either sublingually or buccally.

Sublingual Administration (under the tongue)

  • Drink water to moisten your mouth.
  • Hold the film between two fingers by the outside edge.
  • Place the film under the tongue, close to the base of either the left or right side. If taking two films at a time, place each film on the opposite side.
  • Keep the film(s) in place until they have dissolved

Buccal Administration (inside the cheek)

  • Hold the film between two fingers by the outside edge.
  • Place the film on the inside of either the left or right cheek. If taking two films, place each film on the side of each cheek.
  • Keep the films in place until completely dissolved.

A burning sensation while the films are dissolving is normal, however do not take Suboxone if you are allergic to buprenorphine or naloxone. Each Suboxone prescription obtained at a pharmacy comes with a medication guide containing important information on how to use the drug.

Side Effects

Because Suboxone contains buprenorphine, an opioid, the user may experience side effects consistent with that of other opioids such as:

  • Sedation
  • Dizziness
  • Nausea and vomiting
  • Constipation
  • Respiratory depression

Overdose

The most dangerous side effect of Suboxone is respiratory depression, defined as shallow, labored breathing. Respiratory depression is distinct from breathing problems caused by asthma or COPD. Using a rescue inhaler will not treat respiratory depression caused by an opioid overdose. Because respiratory depression can result in death if not managed quickly, it is considered a medical emergency.

In cases of respiratory depression due to Suboxone overdose, the drug Narcan is used. Narcan is a nasal spray containing naloxone, the same opioid antagonist found in Suboxone. Narcan works within minutes to restore normal breathing and is available without a prescription in most states including California.7

It is important to note that while Suboxone contains the same ingredient as Narcan, the naloxone contained in Suboxone films is not effective at treating respiratory depression, only the Narcan nasal spray should be used.

Abuse Potential and Signs of Suboxone Abuse

Despite the buprenorphine in Suboxone being only a partial agonist, it is an opioid nonetheless and can still make the user feel high. Consequently, Suboxone carries the potential for abuse, though not as significant as opioids such as hydrocodone, oxycodone and fentanyl.

Because individuals being treated with Suboxone are already undergoing treatment for opioid dependence, one of the most telling signs of an individual abusing Suboxone is running out of it too soon.

By law, Suboxone can only be dispensed at a pharmacy for a 30-day supply each time it is picked up. If a user takes more than what is prescribed, they will inevitably run out of Suboxone before their next refill is due. Frequent attempts to refill Suboxone early may indicate that Suboxone is being abused.

Withdrawal

If a dose of Suboxone is missed, or the dose is reduced too quickly, a Suboxone user may experience symptoms of opioid withdrawal such as:

  • Diarrhea
  • Muscle aches and cramps
  • Feeling hot or cold
  • Insomnia
  • Runny nose
  • Drug craving

If Suboxone is discontinued completely, withdrawal symptoms may begin 12 hours following the last dose and peak within three days. Physical symptoms will begin to subside after 1-2 weeks, though lingering depression and drug craving may continue for weeks or months.

Suboxone should not be discontinued suddenly (“cold turkey”), as it increases the probability of experiencing withdrawal symptoms. Rather, Suboxone should be tapered by slowly decreasing the dose over time, allowing the body to adjust to lower doses of the opioid.

Suboxone Schedule – Induction, Maintenance, Taper

The timeline for treatment with Suboxone follows three main stages: induction, maintenance and tapering.

Induction – The initial period of Suboxone therapy is called induction, the goal of which is to safely suppress the symptoms of opioid withdrawal as quickly as possible with therapeutic doses of Suboxone.

Maintenance – Once induction is complete and withdrawal symptoms are adequately controlled, a maintenance period begins where a steady dose of Suboxone is taken to prevent the emergence of withdrawal symptoms.

Tapering – Once withdrawal symptoms are adequately controlled with a maintenance dose, the dose of Suboxone is tapered (reduced) over time until Suboxone can be safely discontinued.

The length of a Suboxone taper will depend on the individual. Some factors that may affect the length of a taper include:

  • The dose of the opioid being abused
  • How long the opioid was abused for (long term vs short term)
  • Ability to tolerate Suboxone dose reductions

Seeking Out Help

Drug addiction is a difficult disease to manage alone; it is highly recommended that an individual addicted to opioids seek help in the management of their condition. An addiction specialist can recommend several options such as Suboxone to manage withdrawal symptoms and help along the path to stopping drug abuse.

Synthetics (Designer Drugs) Overview

Synthetics, also known as “designer drugs,” are completely man-made drugs created in a laboratory. Many designer drugs are created legally and serve a legitimate medical purpose, in fact most prescription drugs are either semi-synthetic or fully synthetic. In the context of illicit drugs, the term “synthetic” or “designer drug” usually refers to an illegal drug made in a clandestine laboratory.

Natural VS Synthetic VS Semi-Synthetic, What’s the Difference?

All drugs can be classified into one of three categories – natural, semi-synthetic or synthetic.

  • Natural – Natural drugs refer to substances found in nature that have not been chemically modified. Examples of natural drugs include cannabis, opium and magic mushrooms.
  • Synthetic– Synthetic drugs are completely man-made in a laboratory. They are made from scratch by combining several chemicals and involve no natural precursors. Examples of synthetic drugs include fentanyl, K2 spice and bath salts.
  • Semi-Synthetic – Semi-synthetic drugs start with natural products as source material and are chemically modified to produce the final product. Semi-synthetic drugs aren’t considered “natural drugs” since they aren’t found in nature, but they aren’t fully synthetic either because the manufacturing process started with a natural drug.

Designer Drugs – A Matter of Chemistry

Designer drugs are often very similar to legal or illegal controlled substances. This is because many times the production of designer drugs involves slightly tweaking the molecular structure of the already-existing “parent drug” while still retaining its effects. Since designer drugs are technically different from their parent drug, distributors attempt to sell them under the guise of research chemicals, plant food, plant material, glass cleaner, even incense or potpourri.

Where Do They Come From?

The Drug Enforcement Agency has identified the main source of designer drugs to be East Asia, where they are distributed at wholesale throughout Europe and the United States.

Designer drugs can be purchased online, where they are often shipped discretely directly to the buyer’s house. Buying designer drugs online is dangerous, as the authenticity of the manufacturer can rarely be confirmed.

Bath Salts

Unlike cosmetic bath salts that are added to a relaxing bath, illicit bath salts are sold to be consumed for their psychoactive effects. They are often designed to have effects similar to stimulants such as cocaine, ecstasy and amphetamines.

Bath salts are easily purchased at gas stations, with common names including Bliss, Blue Silk, Cloud Nine, Drone, Energy-1, Ivory Wave, Burst, and Pure Ivory. These products are usually sold in 200-500 mg packets. The National Institute on Drug Abuse reports that many of these products will be labeled not for human consumption, though their manufacturers do indeed intend for them to be consumed.

The active ingredient in bath salts is nearly impossible to determine by the packaging, however they usually contain one or more synthetic cathinones, drugs with a chemical structure similar to amphetamine. The most common ingredients found in bath salts include MDPV, mephedrone and methylone. These drugs have stimulant and hallucinogenic properties while being highly addictive.

Bath Salt Effects

Bath salts can wreak havoc on the user’s physical and mental health. Some side effects are listed below.

  • Increased blood pressure
  • Seizures
  • Muscle spasm
  • Severe Paranoia
  • Psychosis
  • Body temperature increase

Severe psychotic symptoms are common those who present to the emergency department, occurring in up to 40% of cases. Those under the influence of bath salts have an altered perception and can be extremely violent, often harming themselves or others. In one case, a man under the influence of bath salts shot himself after murdering his wife; a toxicology report identified MDPV in his system.

Synthetic Cannabinoids – “Spice”

Synthetic cannabinoids, commonly referred to as “spice,” are man-made drugs designed to resemble THC, the primary psychoactive component in cannabis. Because spice binds to the same receptors as THC, it is sometimes referred to as “synthetic marijuana.” Some common names for synthetic cannabinoids are listed below:

  • Spice, K2 Spice
  • Legal weed
  • Blaze
  • Zoh

Like most designer drugs, spice is manufactured overseas then shipped to the United States and Europe. It is usually dissolved in a solvent, then sprayed onto herbal products where they absorb the psychoactive ingredients. The final product, sold in gas stations or bought online, usually resembles plant material but is sometimes sold as a powder. Standard urine drug tests do not screen for spice.

Effects of Spice

Since it is nearly impossible to determine the actual ingredient in spice, the effects of any given product are difficult to predict. General effects reported include:

  • Psychosis
  • Mood change
  • Memory impairment
  • Seizures
  • Increased heart rate
  • Heart attack

Heart attacks caused by spice are life-threatening. In one in case, a 19-year old who took spice collapsed from a heart attack and later died

Other Designer Drugs

While bath salts and spice remain the most popular designer drugs, there are others as well. Many of the following are sold online through unscrupulous retailers.

  • LSD Derivatives – LSD derivatives are synthetic drugs similar to LSD. They are often sold online, usually shipped from overseas or Canada. Their effects may include long-lasting hallucinations, paranoia and psychosis. Examples include 1B-LSD, 1P-LSD and LSZ.
  • Tryptamines – Tryptamines are compounds similar to psilocybin, the primary psychoactive component in “magic mushrooms.” Like magic mushrooms, tryptamines are hallucinogenic and may cause long-lasting paranoia.
  • Benzodiazepine Derivatives – There is a growing market for benzodiazepine derivative drugs, modified forms of benzodiazepines that carry the same risks and side effects as prescription benzodiazepines. Examples in clonazolam, etizolam and flualprazolam.

The Mask of Legitimacy

Most designer drugs come in packaging that may appear official, even feigning compliance with regulatory authorities by labeling it with statements such “not for human consumption.” Make no mistake though, most designer drugs are created in clandestine laboratories with little to no quality control in the manufacturing process. The actual amount of drug may vary from batch to batch, making it impossible to know how strong the product is.

Valium Overview

Valium is the brand name of the prescription drug diazepam, a long-acting central nervous system depressant belonging to the benzodiazepine class of drugs. Its relaxing effect makes Valium useful to treat anxiety disorders, however many find this feeling addicting.

Tolerance to Valium develops quickly and long term use can result in both physical and psychological dependence. If stopped suddenly, a user can experience potentially life-threatening seizures.

Valium is frequently obtained with a prescription; in 2016 there were more than 6 million prescriptions in the United States.

Valium goes under the street names Vallies, Jellies, Moggies and Eggs.

History of Valium

Released in 1963, Valium was one of the first benzodiazepines brought to market in the United States. Benzodiazepines like Valium were originally designed to be safer alternatives to barbiturates, a class of dangerous central nervous system depressants. Despite their increased safety compared to barbiturates, benzodiazepines can still be dangerous, especially when combined with other drugs such as alcohol or opioids.

How Valium Works in the Brain

Valium exerts is calming effect by enhancing the activity of a natural “slow down” chemical in the brain called GABA (gamma-Aminobutyric acid).  GABA plays an important role in how fast neurons fire. Overactive neuronal firing can result in both psychological disorders such as crippling anxiety and physical disorders such as epilepsy. By enhancing the “slow down” chemical in our brain, Valium helps those with anxiety feel more relaxed.

Medical Uses for Valium

Valium has several legitimate medical uses including:

  • Anxiety Disorder – The calming effect can help those suffering from anxiety disorders and excessive worrying.
  • Panic Attack – Panic attacks are a specific type of anxiety disorder characterized by a sudden feeling of intense fear, often associated with increased heart rate and sweating. Valium can be used to relax individuals experiencing a panic attack.
  • Insomnia – Valium is effective for those who have trouble getting to sleep due to racing thoughts and anxiety. Because tolerance builds quickly to Valium’s sleep-inducing effects, its use as a sleep-aid should be limited to only a few weeks.
  • Agitation – Those experiencing psychotic episodes due to drug use or dementia tend to become agitated and/or violent. Valium can be used to calm these individuals so they are no longer a threat to themselves or others.
  • Alcohol Withdrawal Syndrome – Long time alcoholics attempting to detox from alcohol may experience extreme shaking (delirium tremens) and life-threatening seizures. Valium is effective at controlling these withdrawals symptoms.
  • Muscle Spasms – Valium is sometimes used to control painful muscle spasms when other agents have failed.

Side Effects of Valium

Valium use is associated with significant side effects. A Valium abuser may experience the following:

  • Amnesia – While under the influence of Valium, the ability to retain memories is impaired. Users may have difficulty remembering what happened after they took it.
  • Drowsiness – Valium can make users incredibly tired, especially when they start taking it. Users may fall asleep at work or while driving.
  • Confusion – Valium can make a user confused and disoriented; they may be incoherent and have difficulty following simple instructions.
  • Depression – Long term use of Valium can make a user feel depressed.
  • Agitation – Some people may experience an opposite effect from Valium and feel agitated/nervous when taking the drug.

How strong the effects of Valium will be is dependent on several factors, including:

  • Dose – Larger doses result in stronger effects.
  • Age – The elderly tend to be much more sensitive to the effects of Valium than younger people; it also tends to stay in the system much longer.
  • Body Weight – Lighter individuals require a lower dose to feel the effects of Valium.
  • Drug Mixing – When combined with other depressants such as alcohol or opioids, the effects of Valium are made significantly stronger. It is dangerous to use Valium and drink alcohol.

Valium Overdose

While Valium is usually safe when taken as prescribed, too much Valium can result in an overdose. This is especially true when taken with alcohol, which multiplies the effects of Xanax.

The signs and symptoms of Valium overdose may include the following:

  • Excessive drowsiness, unable to stay awake
  • Extreme confusion
  • Low blood pressure
  • Impaired reflexes
  • Coma
  • Respiratory depression

While a Valium overdose is unlikely to cause death by itself, when combined with alcohol or opioids such as hydrocodone, oxycodone or morphine, overdose can be lethal. The antidote for benzodiazepine overdose is a drug called flumazenil, however it is reserved for cases of severe respiratory depression.

Signs and Symptoms of Valium Addiction

Many users find the relaxing effects of Valium to be addicting. While many will intentionally seek out the drug, even those without a history of substance use disorders can become addicted.

Some signs and symptoms that may signal addiction to Valium are listed below.

  • Drug Craving – Users who are addicted to Valium may have strong cravings for the drug once its effects wear off, often resorting to stealing from a friend or family member to support their habit.
  • Social isolation – Once addicted, many users will become obsessive in their efforts to obtain and use the drug, often isolating themselves from friends and family.
  • Depression – Because Valium can cause depression when used long term, users may feel sad and lose motivation in activities they used to enjoy.

Tolerance and Dependence

Tolerance to Valium develops rapidly, where more of the drug is required to achieve the same effect. When tolerance develops, users will often take more of the drug to feel high. This vicious cycle continues indefinitely, with users taking increasingly higher doses only to further build tolerance.

If taken for more than 2-3 weeks, a user may become physically dependent on Valium.  Physical dependence occurs when the body adapts to the drug and eventually requires it to function properly. Once dependent, a user will suffer withdrawal if Valium is not taken.

Withdrawal Symptoms of Valium

Symptoms of withdrawal range from incredibly unpleasant to life-threatening. Some symptoms are listed below:

  • Insomnia
  • Shaking
  • Anxiety and panic attacks
  • Sweating
  • Muscle aches/pains
  • Seizures

Seizures associated with Valium withdrawal can be life-threatening and should be managed in a hospital setting.

Because Valium stays in the body longer than most benzodiazepines, withdrawal symptoms may not begin until days following the last dose.

Addiction Treatment

Addiction treatment for Valium abuse will often take place in a treatment facility, where the user can receive around-the-clock support. Medical detox in a treatment center will focus on managing both the user’s physical and mental health.

The initial goal for addiction treatment of Valium is to control withdrawal symptoms. In most cases of benzodiazepine withdrawal, the user is switched from whichever benzodiazepine they are abusing to Valium. In cases of Valium addiction, since the user is already taking Valium, the dose may be decreased (tapered) immediately to begin a tapering period.

Tapering

Discontinuing Valium completely and suddenly, know as going “cold turkey,” is incredibly dangerous and should never be attempted due to the risk of life-threatening seizures. To treat Valium addiction, the dose will be slowly tapered over time.

How long the tapering period will last is very dependent on the individual, however an example taper may include decreasing the dose by 5-25% every 1-4 weeks until it can be safely discontinued. The tapering period may last months, especially for long term users who require time to recover from dose reductions.

Getting Help

Substance abuse is a challenging problem to overcome. Because Valium is dangerous to quit without the help of a medical professional, it is recommended that anyone addicted to Valium seek out the help of a qualified addiction specialist.

Xanax Overview

Xanax is the brand name of alprazolam, a fast-acting benzodiazepine. While useful as a fast-acting treatment for anxiety, its use is associated with significant potential for abuse and dependence.

Tolerance to Xanax develops quickly, and if used for an extended period of time the user can become dependent on it. Once dependent on Xanax, a user can suffer life-threatening withdrawal symptoms such as seizures if the drug is discontinued.

In 2016, Xanax was the 19th most prescribed drug in the United States, with more than 27 million prescriptions being filled. Its use has been associated with an increasing number of emergency room visits, more than doubling from 57,419 in 2005 to 124,902 in 2010.

Xanax also goes under the street names zannies, zanbars, handlebars, and totem poles.

How Xanax Works in the Brain

Xanax works by enhancing the activity of a chemical in the brain called GABA (gamma-aminobutyric acid), the primary inhibitory neurotransmitter of the central nervous system. By enhancing GABA, Xanax acts in a very similar way to alcohol, slowing down brain activity and exerting a calming effect. While this is effective for treating anxiety and panic disorders, the relaxing effect can be addicting.

Medical Uses for Xanax

  • Generalized Anxiety Disorder (GAD) – Generalized anxiety disorder is a type of anxiety disorder characterized by a chronic state of worrying, often about trivial things that do not warrant the degree of anxiety experienced.
  • Panic Disorder – Panic disorder is a type of anxiety disorder characterized by episodes of debilitating anxiety, often accompanied by increased heart rate and profuse sweating. Xanax’s fast onset of action helps those suffering from panic attacks regain control.
  • Agitation – Sometimes patients with dementia or drug-induced psychosis experience episodes of agitation. Xanax’s fast onset can quickly calm these people down so they are no longer harmful to themselves or others.
  • Insomnia – Insomnia is difficulty getting to sleep and/or staying asleep. Xanax is often used short term to help people get to sleep. Because tolerance develops rapidly to Xanax’s sleep-inducing effects, its use in insomnia should be limited to no more than 1-2 weeks.

Xanax Side Effects

Xanax is associated with a significant amount of side effects. Some side effects are short term and only last while under the effect of the drug while others are seen when taken for a long period of time.

  • Amnesia – While taking Xanax, users may have a difficult time retaining memories of what happened while under the influence the drug.
  • Drowsiness/tiredness – Xanax can make a user feel incredibly tired. While this is useful as a sleep aid, those who abuse the drug may fall asleep at work or even while driving.
  • Confusion – Because Xanax slows down brain activity, it can make users feel confused and slow down their reaction time.
  • Agitation/nervousness – While most people feel calm and relaxed after taking Xanax, some users experience an opposite reaction and can feel agitated or nervous.
  • Depression – Long term use of Xanax is associated with significant depression and loss of motivation.

Xanax Overdose

Xanax can be dangerous if too much is taken. The amount of Xanax that results in an overdose ranges from person to person. Some factors that affect the severity of an overdose include:

  • Body weight – The effects of Xanax will be stronger in an individual with lower bodyweight, and vice versa. For example, a normal dose for a 250 lb male may result in a dangerous overdose for a 100 lb female.
  • Age – The effects of Xanax are stronger in the elderly compared to younger users.
  • Liver function – Xanax is processed through the liver. In older individuals or those with impaired liver function, Xanax can build up over time, causing increasingly severe side effects and eventual overdose.
  • Drug mixing – While Xanax alone is unlikely to cause death, even in cases of overdose, the combination of Xanax with other central nervous system depressants such as alcohol or opioids can result in death due to respiratory depression.

The symptoms of Xanax overdose are similar to the expected side effects except more pronounced. Symptoms of Xanax overdose may include:

  • Excessive confusion
  • Slurred speech
  • Slow reflexes
  • Unconsciousness
  • Respiratory depression

Despite Xanax overdose being dangerous, death is unlikely if it is the only drug involved. When combined with other central nervous system depressants such as alcohol or opioids, the risk of death increases dramatically. Benzodiazepines should never be mixed with alcohol and its use with opioids should be limited.

Xanax Abuse and Addiction

The relaxing effects of Xanax can be addicting. A 2018 study found that of those prescribed benzodiazepines such as Xanax, 17% had misused them. When asked why they misused benzodiazepines, the most common reason was to “relax or relieve tension.”

Addiction to Xanax sometimes starts out taking it as prescribed. Over time, a user may take more than what their doctor told them to. As the user takes more, their body becomes adjusted to the higher dose and they take more to feel the same effect. Because tolerance develops quickly, it does not take long to develop an addiction to Xanax.

Signs of Xanax Addiction

Signs of addiction may vary from individual to individual, however every user will experience side effects that are difficult to hide. The following are warning signs that may signal abuse of Xanax.

  • Constantly feeling tired – While Xanax is expected to cause drowsiness when used as directed, constant tiredness due to overuse may indication addiction.
  • Depression – Long term benzodiazepine use is associated with depression. A user may have a lack of motivation to do things they used to and neglect responsibilities at work or school.
  • Drug craving/drug seeking behavior – If a user is dependent on Xanax and not able to acquire it, they may exhibit drug seeking behavior such as drug craving, lying or stealing from a friend or family member.
Tolerance and Dependence

Tolerance to Xanax develops quickly. Tolerance is when the body adjusts to the drug and more is required to achieve the same effects. This will often lead to users taking larger doses or taking it more often to feel the relaxing feeling. Over time, a user may become dependent on Xanax to function normally; this is known as dependence. Once a user is dependent, withdrawal symptoms are experienced if they do not take it.

Xanax Withdrawal

Users who are psychologically dependent on Xanax require it to feel normal and may experience the following if it is stopped:

  • Anxiety
  • Insomnia
  • Irritability
  • Panic attacks

Long term use can also cause physical dependence, which is significantly more dangerous. If a user who is physically dependent on Xanax does not take it, they can experience the following:

  • Sweating
  • Muscle pain
  • Sensitivity to light and noise
  • Seizures

Of the physical withdrawal symptoms, seizures are by far the most dangerous as they can be life-threatening.

Treatment for Xanax Addiction

Treatment for Xanax addiction focuses on both the mental and physical health of the user.

Control of the mental cravings will focus on behavior modification therapies such as cognitive behavioral therapy, counseling sessions and group therapy.

If admitted to a treatment center, the first goal will be controlling withdrawal symptoms. Many times, a user will be switched to a longer-acting benzodiazepine such as Valium (diazepam), as it can provide longer control of withdrawal symptoms than Xanax due to its longer half-life.

Some users may attempt to suddenly discontinue Xanax after long term use. This dangerous practice known as “cold turkey” can result in life-threatening seizures and should never be attempted. Going cold turkey been shown to be less effective than slowly decreasing the dose over time (tapering).

Substance use disorders such as Xanax addiction are a difficult challenge to overcome. An addiction specialist can help you along the path to recovery to begin a drug-free life.