Welcome to iChoose, a social media based anti prescription drug abuse campaign.

This site is intended to bring awareness to the iChoose program as well as serve as a reference site on trending drugs/ forms of abuse for parents, educators, social workers and other interested parties in order to help establish a strong drug abuse prevention network.



In 2011, the iChoose initiative was created to serve 18-25 year olds in Allen, Auglaize, & Hardin counties. Designed to promote a strong anti prescription drug abuse message using social media and internet technologies with the goal of reaching a broad spectrum of people within the local communities. In the coming months iChoose will be rolling out various internet and social media presentations to promote the campaign message of choosing a clean and healthy lifestyle. By incorporating the use of social media outlets into the program, more young adults will be able to stay connected to iChoose through personal computers and cell phones.

iChoose is a local initiative founded by Partnership for Violence Free Families and the Mental Health & Recovery Services Board of Allen, Auglaize and Hardin Counties. The iChoose program will be working with area colleges, businesses, and community organizations to promote the message that you are in control of your own actions. Be yourself, be clean, be proud to say iChoose!

The iChoose team consists of Chelsea Verhoff, iChoose Program Coordinator, and Laura Ulrick, Social Media Technical Specialist Coordinator.


Donna Dickman - PVFF Director
Chelsea Verhoff - iChoose Program Coordinator
Laura Ulrick - Social Media Technical Specialist Coordinator

For immediate assistance, please contact

Emergency 911
Adult Protection Services 419-228-2621
Children Services 419-227-8590
Crime Victims Services 419-222-8666
Crossroads Crisis Center 1-877-228-4357
HOPE Line 1-800-567-HOPE
Legal Aid of Western Ohio 1-888-534-1432
Rape Crisis Line 1-800-934-9840
***All 800 Numbers are Toll Free

:

Within the community, iChoose will be working with colleges, community organizations, youth groups, and visiting businesses that cater to young adults. The campaign is designed to engage young adults 18-25 and promote a clean and healthy lifestyle.

iChoose is designed to 'think outside the box' as a preventivecare program, with the knowledge that tranditional methods of reaching a target audience need to be combined with new ideas on how to bring the anti prescription drug abuse awareness message to young adults where they gather- both within the community and online.

From hosting flash tshirt mobs, to holding pizza parties, to attending local events- the iChoose campaign will be spreading a message of awareness on prescription drug abuse and providing area young adults with information and resources to help combat the growing trend of prescription drug abuse.

iChoose's program coordinator, Chelsea Verhoff will be spearheading the community wide public campaign. She can be reached at 419-905-2734


In a sample survey of 2884 people across 14 countries, on an average, users log in twice a day to social networking sites and 9 times a month on professional websites- 18-25 year old currently hold the highest percentages of use for social media websites and a study in 2009 showed that 99 percent of individuals age 18-24 report having an active profile on at least one social networking site, making social media a perfect outreach effort for iChoose.

Facebook- is ranked the number 2 site in the US, 99% of all 18-25 year olds have a Facebook account, largest age group including males and females on Facebook is the 18-34 year olds at 42%
Twitter- is ranked as the top 20 website in the US, largest age group at 45% is the 18-34 age group, six out of ten in the 18 to 29  have twitter accounts 
YouTube- is the 4th ranked website in the USA, 35% of YouTube accounts belong to 18-25 year olds,

Through social media sites like Facebook, iChoose can present information and resources to users who fan the page, engage in conversations about alternitives to drug abuse and organize grass roots efforts to combat prescription drug abuse within our community. Along with the use of social media, iChoose intergrates various web technologies and applications into it's campaign to help stay current and up to date. Using resources such as live webcasts, QR codes, blogs, podcasts, smart phones, ect- iChoose is able to present the anti prescription drug abuse message to a larger audience than formerly possible using trending internet technologies.

iChoose Social Media Technical Specialist Coordinator Laura Ulrick can be reached at 419-905-2714

 

 

  • Drug Fact PDFs
  • Multimedia
  • About Addiction
  • ADHD Meds
  • Bath Salts
  • Cigarettes/Tobacco
  • Club Drugs
  • Steroids
  • Resource Links

***You may request a copy of any of the follwing Powerpoint presentations by emailing Laura Ulrick at lulrick@pvff.org

Drug Facts Powerpoint (click to preview)

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NIDA InfoFacts: Understanding Drug Abuse and Addiction

 

Many people do not understand why or how other people become addicted to drugs. It can be wrongfully assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so. Through scientific advances, we know more about how drugs work in the brain than ever, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.

Drug abuse and addiction have negative consequences for individuals and for society. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs, exceed $600 billion annually. This includes approximately $181 billion for illicit drugs,1 $193 billion for tobacco,2 and $235 billion for alcohol.3 As staggering as these numbers are, they do not fully describe the breadth of destructive public health and safety implications of drug abuse and addiction, such as family disintegration, loss of employment, failure in school, domestic violence, and child abuse.

What Is Drug Addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge a person’s self control and ability to resist intense impulses urging them to take drugs.

Fortunately, treatments are available to help people counter addiction’s powerful disruptive effects. Research shows that combining addiction treatment medications with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal treatment failure—rather, it indicates that treatment should be reinstated, adjusted, or that an alternative treatment is needed to help the individual regain control and recover.

What Happens to Your Brain When You Take Drugs?

Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain’s natural chemical messengers and (2) by overstimulating the “reward circuit” of the brain.

Some drugs (e.g., marijuana and heroin) have a similar structure to chemical messengers called neurotransmitters, which are naturally produced by the brain. This similarity allows the drugs to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.

Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters (mainly dopamine) or to prevent the normal recycling of these brain chemicals, which is needed to shut off the signaling between neurons. The result is a brain awash in dopamine, a neurotransmitter present in brain regions that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this reward system, which normally responds to natural behaviors linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to psychoactive drugs. This reaction sets in motion a reinforcing pattern that “teaches” people to repeat the rewarding behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. The result is a lessening of dopamine’s impact on the reward circuit, which reduces the abuser’s ability to enjoy the drugs, as well as the events in life that previously brought pleasure. This decrease compels the addicted person to keep abusing drugs in an attempt to bring the dopamine function back to normal, except now larger amounts of the drug are required to achieve the same dopamine high—an effect known as tolerance.

Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse, even devastating consequences—that is the nature of addiction.

Why Do Some People Become Addicted While Others Do Not?

No single factor can predict whether a person will become addicted to drugs. Risk for addiction is influenced by a combination of factors that include individual biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

  • Biology. The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.

  • Environment. A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life.

  • Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to more serious abuse, which poses a special challenge to adolescents. Because their brains are still developing in the areas that govern decisionmaking, judgment, and self-control, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse.

Prevention Is the Key

Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. Thus, education and outreach are key in helping youth and the general public understand the risks of drug abuse. Teachers, parents, medical and public health professionals must keep sending the message that drug addiction can be prevented if one never abuses drugs.

Other Information Sources

For information on understanding drug abuse and addiction, please see our booklet, Drugs, Brains, and Behavior—The Science of Addiction, at www.nida.nih.gov/scienceofaddiction.

For more information on prevention, please visit www.nida.nih.gov/drugpages/prevention.html.

For more information on treatment, please visit www.nida.nih.gov/drugpages/treatment.html. To find a publicly funded treatment center in your State, please call 1-800-662-HELP or visitwww.findtreatment.samhsa.gov.

References

1. Office of National Drug Control Policy (2004). The Economic Costs of Drug Abuse in the United States, 1992-2002. Washington, DC: Executive Office of the President (Publication No. 207303). Available atwww.ncjrs.gov/ondcppubs/publications/pdf/economic_costs.pdf

2 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, U.S. Department of Health and Human Services. Best Practices for Comprehensive Tobacco Control Programs—2007. Available at:http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2007/bestpractices_complete.pdf.

3 Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon Y., Patra, J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373(9682):2223–2233, 2009.

Revised March 2011


NIDA InfoFacts: Stimulant ADHD Medications - Methylphenidate and Amphetamines

 

Stimulant medications (e.g., methylphenidate and amphetamines) are often prescribed to treat individuals diagnosed with attention-deficit hyperactivity disorder (ADHD). ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. This pattern of behavior usually becomes evident in the preschool or early elementary years, and the median age of onset of ADHD symptoms is 7 years. For many individuals, ADHD symptoms improve during adolescence or as age increases, but the disorder can persist into adulthood. In the United States, ADHD is diagnosed in an estimated 8 percent of children ages 4–17 and in 2.9–4.4 percent of adults.1,2,3

How Do Prescription Stimulants Affect the Brain?

All stimulants work by increasing dopamine levels in the brain—dopamine is a brain chemical (or neurotransmitter) associated with pleasure, movement, and attention. The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine, which are similar to the natural production of the chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. However, when taken in doses and routes other than those prescribed, stimulants can increase brain dopamine in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.

What Is the Role of Stimulants in the Treatment of ADHD?

Treatment of ADHD with stimulants, often in conjunction with psychotherapy, helps to improve the symptoms of ADHD, as well as the self-esteem, cognition, and social and family interactions of the patient. The most commonly prescribed medications include amphetamines (e.g., Adderall®, a mix of amphetamine salts) and methylphenidate (e.g., Ritalin and Concerta—a formulation that releases medication in the body over a period of time). These medications have a paradoxically calming and “focusing” effect on individuals with ADHD. Researchers speculate that because methylphenidate amplifies the release of dopamine, it can improve attention and focus in individuals who have dopamine signals that are weak.4

One of the most controversial issues in child psychiatry is whether the use of stimulant medications to treat ADHD increases the risk of substance abuse in adulthood. Research thus far suggests that individuals with ADHD do not become addicted to their stimulant medications when taken in the form and dosage prescribed by their doctors. Furthermore, several studies report that stimulant therapy in childhood does not increase the risk for subsequent drug and alcohol abuse disorders later in life.5,6,7 More research is needed, however, particularly in adolescents treated with stimulant medications.

Why and How Are Prescription Stimulants Abused?

Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high). For the former, they suppress appetite (to facilitate weight loss), increase wakefulness, and increase focus and attention. The euphoric effects of stimulants usually occur when they are crushed and then snorted or injected. Some abusers dissolve the tablets in water and inject the mixture. Complications from this method of use can arise because insoluble fillers in the tablets can block small blood vessels.

What Adverse Effects Does Prescription Stimulant Abuse Have on Health?

Stimulants can increase blood pressure, heart rate, body temperature, and decrease sleep and appetite, which can lead to malnutrition and its consequences. Repeated use of stimulants can lead to feelings of hostility and paranoia. At high doses, they can lead to serious cardiovascular complications, including stroke.

Addiction to stimulants is also a very real consideration for anyone taking them without medical supervision. This most likely occurs because stimulants, when taken in doses and routes other than those prescribed by a doctor, can induce a rapid rise in dopamine in the brain. Furthermore, if stimulants are used chronically, withdrawal symptoms—including fatigue, depression, and disturbed sleep patterns—can emerge when the drugs are discontinued.

How Widespread Is Prescription Stimulant Abuse?

Monitoring the Future Survey*
Each year, the Monitoring the Future (MTF) survey assesses the extent of drug use among 8th-, 10th-, and 12th-graders nationwide. For amphetamines and methylphenidate, the survey measures only past-year use, which refers to use at least once during the year preceding an individual’s response to the survey. Use outside of medical supervision was first measured in the study in 2001; nonmedical use of stimulants has been falling since then, with total declines between 25 percent and 42 percent at each grade level surveyed. MTF data for 2008 indicate past-year nonmedical use of Ritalin by 1.6 percent of 8th-graders, 2.9 percent of 10th-graders, and 3.4 percent of 12th-graders.

Since its peak in the mid-1990s, annual prevalence of amphetamine use fell by one-half among 8th-graders to 4.5 percent and by nearly one-half among 10th-graders to 6.4 percent in 2008. Amphetamine use peaked somewhat later among 12th-graders and has fallen by more than one-third to 6.8 percent by 2008. Although general nonmedical use of prescription stimulants is declining in this group, when asked, “What amphetamines have you taken during the last year without a doctor’s orders?” 2.8 percent of all 12th-graders surveyed in 2007 reported they had used Adderall. Amphetamines rank third among 12th-graders for past-year illicit drug use.

Other Information Sources

For more information on treating ADHD, visit the Web site for the National Institute of Mental Health, National Institutes of Health, at www.nimh.nih.gov.

For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit www.whitehousedrugpolicy.gov/.



* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th graders’ illicit drug use and related attitudes since 1975; in 1991, 8th and 10th graders were added to the study. The latest data are online atwww.monitoringthefuture.org/



1 Centers for Disease Control and Prevention. Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder–United States, 2003. Morb Mortal Wkly Rep 54:842–847, 2005.

2 Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163:716–723, 2006.

3 Faraone SV, Biederman J. Prevalence of adult ADHD in the United States. Paper presented at the American Psychiatric Association annual meeting, New York, 2008.

4 Volkow ND, Fowler JS, Wang G, Ding Y, Gatley SJ. Mechanism of action of methylphenidate: insights from PET imaging studies. J Attention Disorders 6(Suppl. 1):S31–S43, 2002.

5 Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111:179–185, 2003. 

6 Mannuzza S, Klein RG, Truong NL, et al. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. Am J Psychiatry 165(5):604–609, 2008. Epub April 1, 2008. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18381904?dopt=Abstract.

7 Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study. Am J Psychiatry 165(5):597-603, 2008. Epub March 3, 2008. Available at: 
http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2007.07091486v1


Revised 6/09

Comprehensive Drug Information on MDPV, Mephedrone ("Bath Salts")--- © Hunterdon Drug Awareness Program (HDAP)

What are "Bath Salts"
(Updated 14-Aug-11)

The term ‘bath salts’ refer to commercially available products that have as part of their composition a legal stimulant called 3, 4-Methylenedioxypyrovalerone, or MDPV.

Currently illegal in New Jersey and in other states, but legal nationally. They are sold mostly on the internet, but can also be found in select shops locally. They're known by a variety of names, including "Red Dove," "Blue Silk," "Zoom," "Bloom," "Cloud Nine," "Ocean Snow," "Lunar Wave," "Vanilla Sky," "Ivory Wave," "White Lightning," "Scarface" “Purple Wave,” “Blizzard,” “Star Dust,” "Lovey, Dovey," “Snow Leopard,” "Aura," and "Hurricane Charlie.” While they have become popular under the guise of selling as "bath salts", they are sometimes sold as other products such as insect repellant, or plant food with names like "Bonsai Grow" among others.

Much like the marketing of Synthetic Cannabinoids (Spice/K2) as incense, MDPV has been market as “bath salts” and just like Spice/K2 MDPV is specifically labeled “not for human consumption.”




What are MDPV and Mephedrone?
(Updated 17-Mar-11)

As stated before, MDPV is a legal stimulant who's chemical name is 3, 4-Methylenedioxypyrovalerone, and is the active ingredient in "Bath Salts". A DEA report from December 2010 states that “preliminary testing indicates that the active ingredients in many brands [of bath salts] contain MDPV (3,4-methylenedioxypyrovalerone) and/or mephedrone.” Mephedrone, also known as 4-methylmethcathinone (4-MMC), or 4-methylephedrone, is a synthetic stimulant drug of the amphetamine and cathinone classes. Slang names include “meph,” “drone,” “MCAT,” and "meow, meow."

Mephedrone is reportedly manufactured in China and is chemically similar to the cathinone compounds found in the khat plant of eastern Africa. It comes in the form of tablets or a powder, which users can swallow, snort or inject, producing similar effects to MDMA, amphetamines and cocaine. Because of the emergent nature of this class of substances, there has been some questioning as to what is in the composition of ‘bath salts’, though most evidence is leaning towards MDPV as being the compound of choice currently in ‘bath salts’.

Bruce Talbot, a former police officer and expert on emergent drug trends expressed the following concerns regarding MDPV and what would likely happen when MDPV becomes illegal. He suspects that when MDPV is finally added to either an emergency ban or to the controlled substance list it will likely “only to be replaced by 4'-methyl-a-pyrrolidinopropiophenone (MPPP) and 3',4'-methylenedioxy-a-pyrrolidinopropiophenone (MDPPP).” Mephedrone is another that would be substituted.

What has been seen with K2/Spice is the U.S. government pushing to ban certain of the synthetic cannabinoids (JWH-018, JWH-073, JWH-200, CP 49,479 and CP 49,479 C8), but the companies making K2/Spice come out with the same product sprayed with chemicals not covered by state or national bans. The same pattern is likely to come true with MDPV. Mephedrone or the following drugs would likely replace MDPV should we see a national ban on this compound. These "chemical cousins include Mephedrone and 3 others. These 3 others include a-pyrrolidinopropiophenone (a-PPP). Little is known about this compound, but it has been detected by laboratories in Germany as an ingredient in "ecstasy" tablets seized by law enforcement authorities.

4'-methyl-a-pyrrolidinopropiophenone (MPPP) is a stimulant drug. It is very structurally similar to a-PPP. MPPP was sold in Germany as a designer drug in the late 1990s and early 2000s, although it has never achieved the same international popularity as its better-known relations a-PPP and MDPV.

3',4'-methylenedioxy-a-pyrrolidinopropiophenone (MDPPP) is a stimulant designer drug. It was sold in Germany in the late 1990s and early 2000s as an ingredient in imitation ecstasy (MDMA) pills. It shares a similar chemical structure with a-PPP and MDPV.

In the United States, MDPV was packaged as “bath salts” but easy research from the internet showed that “bath salts” such as ‘Ivory Wave’ were being packaged as legal alternative stimulant drugs, and avoid prosecution by putting “Not For Human Consumption” on the packaging. However, some of these can barely contain themselves for what they really are, with one brand having a picture of Al Pacino’s ‘Scarface’ on its packaging.

They are sold over the internet, and on the street, in convenience stores, discount tobacco outlets, gas stations, pawnshops, tattoo parlors, and truck stops, among other locations. The various brands are sold in 50-milligram to 500-milligram packets. Prices range from $25 to $50 per 50-milligram packet.




MDPV Timeline
(Updated 14-Aug-11)

  • MDPV was developed in the 1960s, and has been used for the treatment of chronic fatigue, but caused problems of abuse and dependence.
  • 1969: Boehringer Ingelheim files a patent application for MDPV.
  • 2005: MDPV appears as a recreational drug; first mention on Drugs-Forum.
  • 2007: First seizure of MDPV as a recreational drug, by customs officials in the German state of Saxony. The drug had been shipped from China.
  • 2008: First seizure of MDPV in the United States.
  • 2009: MDPV made illegal in Denmark.
  • 2010: MDPV made a controlled drug in the UK, Sweden, Germany, Australia and Finland. First reports of the widespread retail marketing of 'bath salts' containing MDPV in the US. The US considers both Mephedrone (July, 2010) and MDPV (December, 2010) "a drug and chemical of concern".
  • 2011: MDPV sale and possession are banned in the US states of Alabama, Florida, Idaho, Iowa, Louisiana, Michigan, Mississippi, New Jersey, North Carolina, North Dakota, Pennsylvania (on August 22, 2011), and Utah, with legislation being introduced in many other states.



The Effects of MDPV/Mephedrone ("Bath Salts")
(Updated 23-Mar-11)

MDPV is a powerful stimulant that functions as a dopamine-norepinephrine reuptake inhibitor (NDRI). It has stimulatory effects on the central nervous system and cardiovascular system. Physical symptoms include: rapid heartbeat, increase in blood pressure, vasoconstriction, sweating. Mental symptoms include: euphoria, increases in alertness & awareness, increased wakefulness and arousal, anxiety, agitation, perception of a diminished requirement for food and sleep, and intense desire to re-dose. MDPV reportedly has four times the potency of Ritalin and Concerta. MDPV is sometimes labeled online as legal cocaine or legal amphetamines.

The effects have a duration of roughly 3 to 4 hours, with after effects such as tachycardia, hypertension, and mild stimulation lasting from 6 to 8 hours. High doses have been observed to cause intense, prolonged panic attacks in stimulant-intolerant users, and there are anecdotal reports of psychosis from sleep withdrawal and addiction at higher doses or more frequent dosing intervals. It's addiction potential is not fully known at this time. However, one of the effects of MDPV is an intense desire to redose and there have been online reports from both professionals and users that MDPV is “strongly addicting”.




Are There Any Dangers Involved in Using "Bath Salts" (MDPV, Mephedrone)
(Updated 14-Aug-11)

Yes. Until a drug is tested, it cannot be considered safe. MDPV and its ‘chemical cousins’ have not been tested by the FDA and thus little is known as to the harm potential. Some anecdotal stories involving ‘bath salt’ usage and their potential for harm come in news stories from across the nation, local emergency room reports and data collected from the American Association of Poison Control Center.

In 2010 there were 303 calls about MDPV (bath salt) products according to the American Association of Poison Control Centers’ National Poison Data System (NPDS). As of July 31, 2011 poison centers reported 4,137 calls (2,371 calls as of May 31, 2011). This shows the trend of how popular this class of drug has become, and the dangers associated with its increased popularity (over 13 times as many calls in the first 7 months of 2011 than there were for all of 2010). 

In February, 2011, Congressman Charles Schumer (D-NY) introduced legislation that would add bath salts to a list of federally controlled substances. NIDA has made a public statement about MDPV on their website, stating that it is a dangerous chemical and giving some limited information the drug. Dr. Volkow, the NIDA Director stated: “Because these products are relatively new to the drug abuse scene, our knowledge about their precise chemical composition and short- and long-term effects is limited.”

KMBC.com in Louisiana reported that fake bath salts are being investigated in the death of a Kansas man. They also reported that a 21-year-old recently jumped in front of a vehicle on I-135 near Salina, killing himself. Investigators said he had small amounts of the fake bath salts in his system. In New Jersey on March 16, 2011, a young man reportedly addicted to Bath Salts and also suffering from Bipolar Disorder, allegedly killed his girlfriend at his home. This tragic death of a Rutgers University student prompted three NJ legislatures to introduce a bill to ban the active ingredients in these "bath salts". 

There have been reports that clients are reporting chest pains, increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia, and delusions and suicidal thoughts. One online report from Louisiana has attempted to correlate 3 deaths with prior usage of MDPV.




How Legal/Illegal is MDPV/Mephedrone ("Bath Salts") Nationally and in New Jersey?
(Updated 14-Aug-11)

MDPV, Mephedrone and 4 other synthetic stimulants are now illegal in New Jersey as of April 28, 2011. However, these substances are still legal Nationally. As stated above, Congressman Charles Schumer (D-NY) has introduced legislation that would add bath salts to a list of federally controlled substances. MDPV is getting the attention in many states as they talk about what to do with this substance, in terms of making it a scheduled controllable substance. In New Jersey, the 6 banned substances are:
  1. 3,4 – Methylenedioxypyrovalerone (MDPV)
  2. 4 – Methylmethcathinone (Mephedrone, 4-MMC)
  3. 3,4 – Methylenedioxymethcathinone (Methylone, MDMC)
  4. 4 – Fluoromethcathinone (Flephedrone, 4-FMC)
  5. 3 – Fluoromethcathinone (3-FMC)
  6. 4 – Methoxymethcathinone (Methedrone, bk-PMMA, PMMC)
This ban in New Jersey was caused by very swift action by the legislature and Division of Consumer Affairs. On March 16, 2011, it was announced Assembly Deputy Speaker John McKeon (D-Essex), Assemblywoman Linda Stender (D-Union), and state Senator John Girgenti (D-Passaic) sponsored the legislation introduced into the Assembly and Senate, that led to the ban on Mephedrone and MDPV and the 4 other synthetic stimulants 6 weeks later.

MDPV and/or Mephedrone are currently illegal in 12 states: New Jersey(MDPV, Mephedrone and the 4 others listed above), Alabama (MDPV, Mephedrone), Florida (MDPV, Mephedrone), Idaho (MDPV, Mephedrone),Iowa (MDPV, Mephedrone, Sativa), Louisiana (MDPV, Mephedrone), Maine(MDPV, Mephedrone), Michigan (Mephedrone only), Mississippi (MDPV, Mephedrone), North Carolina (MDPV, Mephedrone), North Dakota(Mephedrone only), Pennsylvania (as of August 22, 2011) and Utah (MDPV, Mephedrone), with other states either considering, introducing or awaiting governor signing of legislation to make these substances illegal (e.g., New York, Missouri, Kentucky, Georgia, Ohio and Illinois among others).

As Schedule I CDS in NJ, the drugs are now subject to the strictest level of state control. Manufacture, distribution, sale, or possession of the chemicals is now a third-degree crime. Violators may be subject to a fine of up to $25,000 and imprisonment for a three- to five-year term. 

While we applaud this swift action by NJ, all that needs to happen is for the makers of "bath salts" to replace their current synthetic stimulant(s) (MDPV, Mephedrone) with not yet banned stimulants. Then we will likely see "bath salts" back on the streets of New Jersey before long. This is exactly what has happened with the March 1, 2011 national ban on synthetic cannabinoids.

On March 1st, the DEA announced the ban of 5 synthetic cannabinoids (JWH-018, JWH-073, JWH-200, CP 47,497 and CP 47,497 C8), however, before the ban was in place, generation 2 of synthetic cannabinoids were already being sold in NJ convenience stores with the makers touting none of the banned substances being in their product. See more about sythetic cannabinoids byclicking here.

In Pennsylvania (on June 23, 2011), SB 1006 was passed by the House, Senate and approved by the Governor. This bill SB 1006 bans 6 synthetic stimulants including MDPV and Mephedrone (this PA bill bans the same 6 synthetic stimulants that NJ banned on April, 28, 2011). This bill is also proposing to ban sativa and 8 synthetic cannabinoids and their analogues. You can view SB 1006's history by clicking here.

An amendment added to the PA SB 1006 also includes language barring all chemicals that are similar to the substances that are currently found in bath salts, synthetic cannabinoids and 2C (hallucinogens such as 2C-E, 2C-I, 2C-P, 2C-H and their analogues, congeners, homologues, isomers, salts and salts of analogues, congeners, homologues and isomers), and prohibits those chemical compounds from being used to create the same effect as the current bath salts, sytnthetic cannabinoids and 2C chemical structures. This addition to the law will make Pennsylvania’s the strongest such law in the nation.

In December, 2010, the DEA published a report listing MDPV as a drug of concern. On February 1, 2011 Gil Kerlikowske, Director of National Drug Control Policy, released the following statement following recent reports indicating the emergent threat of these synthetic stimulants, stating that he was “deeply concerned,” and that “public health officials are working on this emerging issue.” Because national public health officials have MDPV on their radar, it is expected by some that a national emergency ban will occur sometime in 2011.

In December, 2010, the DEA made a brief statement: “Currently, MDPV is not a scheduled drug under the Controlled Substances Act (CSA). However, if intended for human consumption, MDPV can be considered an analogue of a schedule I drug under the CSA (Title 21 United States Code 813). Therefore, law enforcement cases involving MDPV can be prosecuted under the Federal Analogue Act of the CSA.” However, all “bath salts” clearly state “Not for Human Consumption”.

In states where MDPV is not a scheduled drug currently, if the intention is to use it for human consumption, its structural similarity to illegal drugs of abuse means that it could be considered by law enforcement officials as a controllable substance analogue (under the Federal Analogue Act).

When a federal ban is finally enacted on a drug, it does not mean local authorities will take action on this drug. States still need to enact legislation to ban the substances in order for state (then local) authorities to take action. Federal bans will go after larger distributors, but it will be locally determined as to whether users and smaller, local distributors (such as non-chain convenience stores and gas stations) will be sought after without a state ban.




How Long Does MDPV Stay in Your System?
(Updated 02-Mar-11)

Redwood Toxicology Laboratory currently state they have detection for MDPV and Mephedrone. They do not have detection for a-PPP, MPPP or MDPPP in urine drug screens. The cost for the 2 panel is $40 ($30 if you do enough volume and have your entire drug screen business with Redwood Toxicology Laboratory), and $55 ($40) for the 14 panel test. There is reportedly a 48-72 hour detection window, depending on dosing.

Redwood has a 2 panel drug test (MDPV, Mephedrone) and a 14 panel drug test which tests for the following drugs:
  1. BZP (Benzylpiperazine)
  2. Butylone (ß-keto-N-methylbenzodioxolylpropylamine, bk-MBDB)
  3. Cathinone (Khat or Benzoylethanamine)
  4. Ethylone (3,4-methylenedioxy-N-ethylcathinone, MDEC, bk-MDEA)
  5. MBDB (Methylbenzodioxolylbutanamine, Methyl-J, “Eden”)
  6. mCPP (meta-Chlorophenylpiperazine)
  7. MDA (3,4-Methylenedioxyamphetamine, tenamfetamine)
  8. MDEA (3,4-Methylenedioxy-N-ethylamphetamine, MDEA, MDE, “Eve”)
  9. MDPV (Methylenedioxypyrovalerone, Cloud 9, Ivory Wave, White Lightning)
  10. MDMA (3,4-Methylenedioxymethamphetamine, ecstasy, “E”, “X”)
  11. Mephedrone (4-methylmethcathinone [4-MMC], 4-methylephedrone, “Meph”, “MCat”)
  12. Methcathinone (a-methylamino-propiophenone, may be confused with mephedrone)
  13. Methylone (3,4-methylenedioxy-N-methylcathinone, bk-MDMA, MDMC, “M1”)
  14. TFMPP (3-Trifluoromethylphenylpiperazine, “Legal X”)



Information from this article was gathered from the following sources:
  1. American Association of Poison Control Centers. (2011). Bath Salts Data Updated July 31, 2011.
  2. DEA. (2010). Increasing abuse of bath salts.
  3. DEA. (2010). Methylenedioxypyrovalerone [(MDPV) (1-(1,3-Benzodioxol-5-yl)-2-(1-pyrrolidinyl)-1-pentanone] 
  4. DEA. (2010)> 4-methylmethcathinone, Mephedrone, 4-MMC - Drugs and Chemicals of Concern.
  5. Drugs Forum. Information regarding MDPV accessed on February 22, 2011. 
  6. KMBC.com – Abuse of Fake ‘Bath Salts’ Sends Dozens to ER. 
  7. Linkedin.com. (2011). Emerging Drugs of Abuse Threads (Information quoting Mr. Bruce Talbot). The Emerging Drugs of Abuse forum is managed by J. Randall Webber.
  8. National Institute on Drug Abuse. (2011). Message from the Director on "Bath Salts" - Emerging and Dangerous Products. 
  9. Office of National Drug Control Policy. (2011). Statement from White House Drug Policy Director on Synthetic Stimulants, a.k.a “Bath Salts”. 
  10. The Poison Review. (2011). NBC’s Today Show reports on ‘bath salts’. 
  11. Psychonaut Webmapping Research Group. (2009). MDPV Report. Institute of Psychiatry, King’s College London: London, UK. 
  12. Redwood Toxicology Laboratories. (2011). Designer Stimulant Spreadsheet.
  13. Wikipedia: alpha-Pyrrolidinopropiophenone. 
  14. Wikipedia: Mephedrone
  15. Wikipedia: MPPP. 
  16. Wikipedia: MDPPP. 
  17. Wikipedia: MDPV. 
  18. WJHG.com – Florida makes sales and possession of bath salts illegal. 
  19. N.J. Senate, Assembly lawmakers to introduce bill banning 'bath salts' drug
  20. First step taken in banning bath salts in Missouri.
  21. Schumer seeks ban on bath salts used as drugs.
  22. Rutgers Student William Parisio, Accused In Pamela Schmidt's Murder, Used 'Bath Salts' To Get High.
  23. Pennsylvania’s Fox News 43: Battle Against Bath Salts & Synthetic Marijuana Gains Ground.
  24. New Jersey Division of Consumer Affairs Bans Designer Drugs Labeled as "Bath Salts"
  25. Pennsylvania's House Republican Caucus - Stern’s Fight to Get Bath Salts Listed as a Controlled Substance Moves One Step Closer to Becoming Law.
  26. Bangor Daily News Online – Maine Politics. ‘Bath salts’ ban takes effect; state’s top cop seeks to halt drug’s march into Maine.

 

 

 


Other Information Sources:

MDPV ("Bath Salts") 
http://en.wikipedia.org/wiki/Methylenedioxypyrovalerone
http://www.nida.nih.gov/about/welcome/MessageBathSalts211.html

NIDA InfoFacts: Cigarettes and Other Tobacco Products

Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Between 1964 and 2004, cigarette smoking caused an estimated 12 million deaths, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 1.1 million deaths from respiratory diseases, and 94,000 infant deaths related to mothers smoking during pregnancy.1According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 443,000 premature deaths in the United States each year—about 1 in every 5 U.S. deaths2—and an additional 8.6 million people suffer with a serious illness caused by smoking.3 Thus, for every one person who dies from smoking, 20 more suffer from at least one serious tobacco-related illness.3

The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death. Each year, an estimated 126 million Americans are regularly exposed to secondhand smoke and almost 50 thousand nonsmokers die from diseases caused by secondhand smoke exposure.4

How Does Tobacco Affect the Brain?

Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 1/2 packs (30 cigarettes) daily gets 300 “hits” of nicotine each day.

Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate. Glucose is released into the blood while nicotine suppresses insulin output from the pancreas, which means that smokers have chronically elevated blood sugar levels.

Like cocaine, heroin, and marijuana, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.5 A number of studies indicate that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco.

When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco. Treatments can help smokers manage these symptoms and improve the likelihood of successfully quitting.

What Other Adverse Effects Does Tobacco Have on Health?

Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. Smoking has also been linked to leukemia, cataracts, and pneumonia.1,2 On average, adults who smoke die 14 years earlier than nonsmokers.2

Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Carbon monoxide increases the chance of cardiovascular diseases. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. 

Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birthweight.2 Maternal smoking may also be associated with learning and behavioral problems in children. Smoking more than one pack of cigarettes per day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking.6

While we often think of medical consequences that result from direct use of tobacco products, passive or secondary smoke also increases the risk for many diseases. Secondhand smoke, also known as environmental tobacco smoke, consists of exhaled smoke and smoke given off by the burning end of tobacco products. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent7 and lung cancer by 20 to 30 percent.2 In addition, secondhand smoke causes respiratory problems, such as coughing, overproduction of phlegm, and reduced lung function and respiratory infections, including pneumonia and bronchitis, in both adults and children. In fact, each year about 150,000 – 300,000 children younger than 18 months old experience respiratory tract infections caused by secondhand smoke.4 Children exposed to secondhand smoking are at an increased risk for sudden infant death syndrome, ear problems, and severe asthma. Furthermore, children who grow up with parents who smoke are more likely to become smokers, thus placing themselves (and their future families) at risk for the same health problems as their parents when they become adults. 

Although quitting can be difficult, the health benefits of smoking cessation are immediate and substantial—including reduced risk for cancers, heart disease, and stroke. A 35-year-old man who quits smoking will, on average, increase his life expectancy by 5 years.8

Are There Effective Treatments for Tobacco Addiction?

Tobacco addiction is a chronic disease that often requires multiple attempts to quit. Although some smokers are able to quit without help, many others need assistance. Generally, rates of relapse for smoking cessation are highest in the first few weeks and months and diminish considerably after about 3 months. Both behavioral interventions (counseling) and medication can help smokers quit; but the combination of medication with counseling is more effective than either alone.

Behavioral Treatments
Behavioral treatments employ a variety of methods to assist smokers in quitting, ranging from self-help materials to individual counseling. These interventions teach individuals to recognize high-risk situations and develop coping strategies to deal with them. The U.S. Department of Health and Human Services’ (HHS) national toll-free quitline, 800-QUIT-NOW, is an access point for any smoker seeking information and assistance in quitting.

Nicotine Replacement Treatments
Nicotine replacement therapies (NRTs), such as nicotine gum and the nicotine patch, were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. NRTs deliver a controlled dose of nicotine to a smoker in order to relieve withdrawal symptoms during the smoking cessation process. They are most successful when used in combination with behavioral treatments. Current FDA-approved NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges.

Other Medications
Bupropion and varenicline are two FDA-approved non-nicotine medications that effectively increase rates of long-term abstinence from smoking. Bupropion, a medication that goes by the trade name Zyban, was approved by the FDA in 1997 for use in smoking cessation. Varenicline tartrate (trade name: Chantix) targets nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people resume smoking.

Current Treatment Research
Scientists are currently pursuing many other avenues of research to develop new smoking cessation therapies. One promising intervention is a vaccine called NicVax that works by targeting nicotine in the bloodstream, blocking its access to the brain and thereby preventing its reinforcing effects. Preliminary trials of this vaccine have yielded promising results, with vaccinated smokers achieving higher quit rates and longer term abstinence compared to smokers given placebo. NicVax is now being evaluated in Phase III clinical trials; successful completion will bring NicVax closer to final approval by the FDA.

How Widespread Is Tobacco Use?

Monitoring the Future Survey*
Current smoking rates among 8th- and 12th-grade students reached an all-time low in 2009. According to the Monitoring the Future survey, 6.5 percent of 8th-graders and 20.1 percent of 12th-graders reported they had used cigarettes in the past month. Current smoking also decreased among 10th-graders, to about 13 percent in 2009. Although unacceptably high numbers of youth continue to smoke, these numbers represent a significant decrease from peak smoking rates (21 percent in 8th-graders, 30 percent in 10th-graders and 36 percent in 12th-graders) that were reached in the late 1990s.

The decrease in smoking rates among young Americans corresponds to several years in which increased proportions of teens said they believed there was a “great” health risk associated with cigarette smoking and expressed disapproval of smoking one or more packs of cigarettes per day. Students’ personal disapproval of smoking has risen for some years; for example, the percentage of 12th-graders reporting disapproval of smoking one or more packs of cigarettes per day increased from 68.8 percent in 1998 to 81.8 percent in 2009. During the same period, the percentage of 8th-graders who said it was “very easy” or “fairly easy” to obtain cigarettes declined from 73.6 percent in 1998 to 55.3 percent in 2009. 

Current use of smokeless tobacco remained steady among 8th-graders and 12th-graders in 2009 (3.7 percent and 8.4 percent, respectively); however, current smokeless tobacco use among 10th-grade students increased significantly from 5.0 percent in 2008 to 6.5 percent in 2009.

National Survey on Drug Use and Health (NSDUH)**
In 2008, 28.4 percent of the U.S. population age 12 and older (approximately 70.9 million people) used a tobacco product at least once in the month prior to being interviewed. This figure includes 2.8 million young people aged 12 to 17 (11.4 percent of this age group). In addition, almost 60 million Americans (23.9 percent of the population) were current cigarette smokers; 13.1 million smoked cigars; almost 8.7 million used smokeless tobacco; and nearly 1.9 million smoked tobacco in pipes.

Other Information Sources

For additional information on tobacco abuse and addiction, please visit www.smoking.drugabuse.gov.

For more information on how to quit smoking, please visit www.smokefree.gov.

Data Sources

* These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study.

** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 877–643–2644.

References

1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. The Health Consequences of Smoking: What It Means to You, 2004. Available at:http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/whatitmeanstoyou.pdf.

2 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Smoking and Tobacco Use—Fact Sheet: Health Effects of Cigarette Smoking. Updated January 2008. Available at:http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm.

3 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Tobacco Use: Targeting the Nation’s Leading Killer—At a Glance 2009. Available at:http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/tobacco.pdf.

4 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Department of Health and Human Services. Smoking & Tobacco Use, Fast Facts. Available at:http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#toll. Accessed 7/22/2010.

5 Belluzzi JD, Wang R, Leslie FM. Acetaldehyde enhances acquisition of nicotine self-administration in adolescent rats. Neuropsychopharmacology 30:705–712, 2005.

6 Buka SL, Shenassa ED, Niaura R. Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: A 30-year prospective study. Am J Psychiatry 160:1978–1984, 2003.

7 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services, Smoking and Tobacco Use—Fact Sheet: Secondhand Smoke Causes Heart Disease. Updated May 2007. Available at:http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/#heart.

8 Office of the Surgeon General, Office of Public Health and Science, Office of the Secretary, Public Health Service, Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T/.

Revised 9/10 

 

Club Drugs (GHB, Ketamine, and Rohypnol)

Club Drugs (GHB, Ketamine, and Rohypnol)

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Club drugs are a pharmacologically heterogeneous group of psychoactive drugs that tend to be abused by teens and young adults at bars, nightclubs, concerts, and parties. Gamma hydroxybutyrate (GHB), Rohypnol, ketamine, as well as MDMA (ecstasy) and methamphetamine (which are featured in separate InfoFacts) are some of the drugs included in this group.

  • GHB (Xyrem) is a central nervous system (CNS) depressant that was approved by the Food and Drug Administration (FDA) in 2002 for use in the treatment of narcolepsy (a sleep disorder). This approval came with severe restrictions, including its use only for the treatment of narcolepsy, and the requirement for a patient registry monitored by the FDA. GHB is also a metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It exists naturally in the brain, but at much lower concentrations than those found when GHB is abused. 

  • Rohypnol (flunitrazepam) use began gaining popularity in the United States in the early 1990s. It is a benzodiazepine (chemically similar to sedative-hypnotic drugs such as Valium or Xanax), but it is not approved for medical use in this country, and its importation is banned. 

  • Ketamine is a dissociative anesthetic, mostly used in veterinary practice.

How Are Club Drugs Abused?

  • GHB and Rohypnol are available in odorless, colorless, and tasteless forms that are frequently combined with alcohol and other beverages. Both drugs have been used to commit sexual assaults (also known as “date rape,” “drug rape,” “acquaintance rape,” or “drug-assisted” assault) due to their ability to sedate and incapacitate unsuspecting victims, preventing them from resisting sexual assault. 

  • GHB is usually ingested orally, either in liquid or powder form, while Rohypnol is typically taken orally in pill form. Recent reports, however, have shown that Rohypnol is being ground up and snorted. 

  • Both GHB and Rohypnol are also abused for their intoxicating effects, similar to other CNS depressants. 

  • GHB also has anabolic effects (it stimulates protein synthesis) and has been used by bodybuilders to aid in fat reduction and muscle building. 

  • Ketamine is usually snorted or injected intramuscularly.

How Do Club Drugs Affect the Brain?

  • GHB acts on at least two sites in the brain: the GABAB receptor and a specific GHB binding site. At high doses, GHB’s sedative effects may result in sleep, coma, or death. 

  • Rohypnol, like other benzodiazepines, acts at the GABAA receptor. It can produce anterograde amnesia, in which individuals may not remember events they experienced while under the influence of the drug. 

  • Ketamine is a dissociative anesthetic, so called because it distorts perceptions of sight and sound and produces feelings of detachment from the environment and self. Ketamine acts on a type of glutamate receptor (NMDA receptor) to produce its effects, which are similar to those of the drug PCP., Low-dose intoxication results in impaired attention, learning ability, and memory. At higher doses, ketamine can cause dreamlike states and hallucinations; and at higher doses still, ketamine can cause delirium and amnesia.

Addictive Potential

  • Repeated use of GHB may lead to withdrawal effects, including insomnia, anxiety, tremors, and sweating. Severe withdrawal reactions have been reported among patients presenting from an overdose of GHB or related compounds, especially if other drugs or alcohol are involved.

  • Like other benzodiazepines, chronic use of Rohypnol can produce tolerance, physical dependence, and addiction.

  • There have been reports of people binging on ketamine, a behavior that is similar to that seen in some cocaine- or amphetamine-dependent individuals. Ketamine users can develop signs of tolerance and cravings for the drug.

What Other Adverse Effects Do Club Drugs Have on Health?

Uncertainties about the sources, chemicals, and possible contaminants used to manufacture many club drugs make it extremely difficult to determine toxicity and associated medical consequences. Nonetheless, we do know that: 

  • Coma and seizures can occur following use of GHB. Combined use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD), have been involved in poisonings, overdoses, date rapes, and deaths. 

  • Rohypnol may be lethal when mixed with alcohol and/or other CNS depressants. 

  • Ketamine, in high doses, can cause impaired motor function, high blood pressure, and potentially fatal respiratory problems.

What Treatment Options Exist?

There is very little information available in the scientific literature about treatment for persons who abuse or are dependent upon club drugs.

  • There are no GHB detection tests for use in emergency rooms, and as many clinicians are unfamiliar with the drug, many GHB incidents likely go undetected. According to case reports, however, patients who abuse GHB appear to present both a mixed picture of severe problems upon admission and a good response to treatment, which often involves residential services.3 

  • Treatment for Rohypnol follows accepted protocols for any benzodiazepine, which may consist of a 3- to 5-day inpatient detoxification program with 24-hour intensive medical monitoring and management of withdrawal symptoms, since withdrawal from benzodiazepines can be life-threatening.3

  • Patients with a ketamine overdose are managed through supportive care for acute symptoms, with special attention to cardiac and respiratory functions.

How Widespread Is Club Drug Abuse?

Monitoring the Future (MTF) Survey*

MTF has reported consistently low levels of abuse of these club drugs since they were added to the survey. For GHB and ketamine, this occurred in 2000; for Rohypnol, 1996. According to results of the 2009 MTF survey, 0.7 percent of 8th-grade and 1.1 percent of 12th-grade students reported past-year** use of GHB, a statistically significant decrease from peak-year use of 1.2 percent in 2000 for 8th-graders and 2.0 percent for 12th-graders in 2004. GHB use among 10th-grade students was reported at 1.0 percent, an increase from 2008 (0.5 percent), and statistically unchanged from peak use of 1.4 percent in 2002 and 2003.

Past-year use of ketamine was reported by 1.0 percent of 8th-graders, 1.3 percent of 10th-graders, and 1.7 percent of 12th-graders in 2009. These percentages also represent significant decreases from peak years: 2000 for 8th-graders (at 1.6 percent) and 2002 for 10th- and 12th-graders (at 2.2 and 2.6 percent, respectively).

For Rohypnol, 0.4 percent of 8th- and 10th-graders, and 1.0 percent of 12th-graders reported past-year use, also down from peak use in 1996 for 8th-graders (1.0 percent), 1997 for 10th-graders (1.3 percent), and 2002 and 2004 for 12th-graders (1.6 percent).

Other Information Sources

For more information about club drugs, visit www.clubdrugs.gov, www.teens.drugabuse.gov, and www.backtoschool.drugabuse.gov; or call NIDA at 877-643-2644. For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit http://www.whitehousedrugpolicy.gov/streetterms/default.asp.

Data Sources

* These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

References

1 Anis NA, Berry SC, Burton NR, Lodge D. The dissociative anaesthetics, datamine and phencyclidine, selectively reduce excitation of central mammalian neurons by N-methyl-aspartate. Br J Pharmacol 79(2): 565–575, 1983.

2 Kapur S, Seeman P. NMDA receptor antagonists ketamine and PCP have direct effects on dopamine D2 and serotonin 5-HT2 receptors – Implications for models of schizophrenia. Molecular Psychiatry 7: 837–844, 2002.

3 Maxwell JC, Spence RT. Profiles of club drug users in treatment. Subst Use Misuse 40(9–10):1409–1426, 2005.

4 Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: A review of problem use and dependence. J Psychoactive Drugs 33(2):151–158, 2001.

5 Smith KM, Larive LL, Romanelli F. Club Drugs: Methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and γ–hydroxybutyrate. Am J Health-Syst Pharm 59(11):1067–1076, 2002.

Revised 7/10 

 

NIDA InfoFacts: Prescription and Over-the-Counter Medications

 

Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives; tranquilizers can reduce anxiety and help patients with sleep disorders; and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed, or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction.

Patients, health care professionals, and pharmacists all have roles in preventing the abuse1 of and addiction to prescription medications. For example, patients should follow the directions for use carefully; learn what effects and side effects the medication could have; and inform their doctor/pharmacist whether they are taking other medications [including over-the-counter (OTC) medications or health supplements], since these could potentially interact with the prescribed medication. The patient should read all information provided by the pharmacist. Physicians and other health care providers should screen for past or current substance abuse in the patient during routine examination, including asking questions about what other medications the patient is taking and why. Providers should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been finished, as these may be indicators of abuse.1

Similarly, some OTC medications, such as cough and cold medicines containing dextromethorphan, have beneficial effects when taken as recommended; but they can also be abused and lead to serious adverse health consequences. Parents should be aware of the potential for abuse of these medications, especially when consumed in large quantities, which should signal concern and the possible need for intervention.

Commonly Abused Prescription Medications

Although many prescription medications can be abused, the following three classes are most commonly abused:

  • Opioids—usually prescribed to treat pain.
  • CNS depressants—used to treat anxiety and sleep disorders. 
  • Stimulants—prescribed to treat ADHD and narcolepsy.

Opioids

What Are Opioids? 
Opioids are analgesic, or pain-relieving, medications. Studies have shown that properly managed medical use (taken exactly as prescribed) of opioid analgesics is safe, can manage pain effectively, and rarely causes addiction.

Among the compounds that fall within this class are hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin—an oral, controlled-release form of the drug), morphine, fentanyl, codeine, and related medications. Morphine and fentanyl are often used to alleviate severe pain, while codeine is used for milder pain. Other examples of opioids prescribed to relieve pain include propoxyphene (Darvon); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain-relieving properties, some of these medications can be used to relieve severe diarrhea (for example, Lomotil, also known as diphenoxylate) or severe coughs (codeine).

How Are Opioids Abused?
Opioids can be taken orally, or the pills may be crushed and the powder snorted or injected. A number of overdose deaths have resulted from the latter routes of administration, particularly with the drug OxyContin, which was designed to be a slow-release formulation. Snorting or injecting opioids results in the rapid release of the drug into the bloodstream, exposing the person to high doses and causing many of the reported overdose reactions.

How Do Opioids Affect the Brain?
Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.

In addition, opioid medications can affect regions of the brain that mediate what one perceives as pleasure, resulting in the initial euphoria or sense of well-being that many opioids produce. Repeated abuse of opioids can lead to addiction—a chronic, relapsing disease characterized by compulsive drug seeking and abuse despite its known harmful consequences.

What Adverse Effects Can Be Associated With Opioids?

Opioids can produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death.

These medications are only safe to use with other substances under a physician’s supervision. Typically, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. Because these other substances slow breathing, their effects in combination with opioids could lead to life-threatening respiratory depression.

What Happens When You Stop Taking Opioids?

Patients who are prescribed opioids for a period of time may develop a physical dependence on them, which is not the same as addiction. Repeated exposure to opioids causes the body to adapt, sometimes resulting in tolerance (that is, more of the drug is needed to achieve the desired effect compared with when it was first prescribed) and in withdrawal symptoms upon abrupt cessation of drug use. Thus, individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but they should also be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.

Are There Treatments for Opioid Addiction?

Individuals who abuse or are addicted to prescription opioid medications can be treated. Initially, they may need to undergo medically supervised detoxification to help reduce withdrawal symptoms; however, that is just the first step. Options for effectively treating addiction to prescription opioids are drawn from research on treating heroin addiction. Behavioral treatments, usually combined with medications, have also been proven effective. Currently used medications are—

  • Methadone, a synthetic opioid that eliminates withdrawal symptoms and relieves craving, has been used successfully for more than 30 years to treat people addicted to heroin as well as opiates.
  • Buprenorphine, another synthetic opioid, is a more recently approved medication for treating addiction to heroin and other opiates. It can be prescribed in a physician’s office.
  • Naltrexone is a long-acting opioid receptor blocker that can be employed to help prevent relapse. It is not widely used, however, because of poor compliance, except by highly motivated individuals (e.g., physicians at risk of losing their medical license). It should be noted that this medication can only be used for someone who has already been detoxified, since it can produce severe withdrawal symptoms in a person continuing to abuse opioids. 
  • Naloxone is a short-acting opioid receptor blocker that counteracts the effects of opioids and can be used to treat overdoses.

CNS Depressants

What Are CNS Depressants?
CNS depressants (e.g., tranquilizers, sedatives) are medications that slow normal brain function. In higher doses, some CNS depressants can be used as general anesthetics or preanesthetics.

CNS depressants can be divided into three groups, based on their chemistry and pharmacology:

  • Barbiturates, such as mephobarbital (Mebaral) and sodium pentobarbital (Nembutal), are used as preanesthetics, promoting sleep.
  • Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), and estazolam (ProSom), can be prescribed to treat anxiety, acute stress reactions, panic attacks, convulsions, and sleep disorders. For the latter, benzodiazepines are usually prescribed only for short-term relief of sleep problems because of the development of tolerance and risk of addiction. 
  • Newer sleep medications, such as zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), are now more commonly prescribed to treat sleep disorders. These medications are nonbenzodiazepines that act at a subset of the benzodiazepine receptors and appear to have a lower risk for abuse and addiction.

How Are CNS Depressants Abused? 
CNS depressants are usually taken orally, sometimes in combination with other drugs or to counteract the effects of other licit or illicit drugs (e.g., stimulants).

How Do CNS Depressants Affect the Brain? 
Most of the CNS depressants have similar actions in the brain: they enhance the actions of the neurotransmitter gamma-aminobutyric acid (GABA)—neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, it is ultimately their common ability to increase GABA activity that produces a drowsy or calming effect.

What Adverse Effects Can Be Associated With CNS Depressants?
Despite their beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed.

CNS depressants should not be combined with any medication or substance that causes drowsiness, including prescription pain medicines, certain OTC cold and allergy medications, and alcohol. If combined, they can slow both heart rate and respiration, which can be fatal.

What Happens When You Stop Taking CNS Depressants? 
Discontinuing prolonged use or abuse of high doses of CNS depressants can lead to serious withdrawal symptoms. Because the drug works by slowing the brain’s activity, when one stops taking a CNS depressant, this activity can rebound to the point that seizures can occur. Someone who is either thinking about ending use of a CNS depressant, or who has stopped and is suffering withdrawal should seek medical treatment.

Are There Treatments for Addiction to CNS Depressants? 
In addition to medical supervision during withdrawal, counseling in an inpatient or outpatient setting can help people who are overcoming addiction to CNS depressants. For example, cognitive-behavioral therapy has been used successfully to help individuals in treatment for abuse of benzodiazepines. This type of therapy focuses on modifying a patient’s thinking, expectations, and behaviors while simultaneously increasing his or her skills for coping with various life stressors.

Stimulants

What Are Stimulants?
Stimulants (amphetamines [Adderall, Dexedrine] and methylphenidate [Concerta, Ritalin]) increase alertness, attention, and energy. They also increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and open up the pathways of the respiratory system. Historically, stimulants were prescribed to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the prescribing of stimulants by physicians began to wane. Now, stimulants are prescribed for treating only a few health conditions, most notably ADHD, narcolepsy, and, in some instances, depression that has not responded to other treatments.

How Are Stimulants Abused?
Stimulants may be taken orally, but some abusers crush the tablets, dissolve them in water, and then inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small blood vessels. Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high).

How Do Prescription Stimulants Affect the Brain?
Stimulants have chemical structures that are similar to key brain neurotransmitters called monoamines, including dopamine and norepinephrine. Their therapeutic effect is achieved by slow and steady increases of dopamine that are similar to the natural production of this chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. However, when taken in doses and routes other than those prescribed, stimulants can increase the brain’s dopamine levels in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.

What Adverse Effects Are Associated With Stimulant Abuse?
Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and/or the potential for cardiovascular failure or seizures. Taking some stimulants in high doses or repeatedly can lead to hostility or feelings of paranoia in some individuals.

Stimulants should not be mixed with antidepressants, which may enhance the effects of a stimulant; or with OTC cold medicines containing decongestants, which may cause blood pressure to become dangerously high or may lead to irregular heart rhythms.

Are There Treatments for Stimulant Addiction? 
Treatment of addiction to prescription stimulants is based on behavioral therapies proven effective for treating cocaine or methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction.

Depending on the patient’s situation, the first step in treating prescription stimulant addiction may be to decrease the drug’s dose slowly and attempt to treat withdrawal symptoms (mood changes, sleep and appetite disturbances). This process of detoxification could then be followed with one of many behavioral therapies: contingency management, for example, improves treatment outcomes by enabling patients to earn vouchers for drug-free urine tests; the vouchers can be exchanged for items that promote healthy living. Cognitive-behavioral therapies—which teach patients skills to recognize risky situations, avoid drug use, and cope more effectively with problems—are proving beneficial. Recovery support groups may also be effective in conjunction with a behavioral therapy.

Dextromethorphan (DXM)

What Is DXM?
DXM is the active ingredient found in OTC cough and cold medications. When taken in recommended doses, these medications are safe and effective.

How Is DXM Abused?
DXM is taken orally. In order to experience the mind-altering effects of DXM, excessive amounts of liquid or gelcaps must be consumed. The availability and accessibility of these products make them a serious concern, particularly for youth, who tend to be their primary abusers.

What Are the Consequences Associated With the Abuse of DXM?
In very large quantities, DXM can cause effects similar to those of ketamine and PCP because these drugs affect similar sites in the brain. These effects can include impaired motor function, numbness, nausea/vomiting, and increased heart rate and blood pressure. On rare occasions, hypoxic brain damage—caused by severe respiratory depression and a lack of oxygen to the brain—has occurred due to the combination of DXM with decongestants often found in the medication.

What Are the Trends in the Abuse of Prescription Drugs and OTC Medications?

Monitoring the Future (MTF) Survey2
Each year, the Monitoring the Future (MTF) survey assesses the extent of drug use among 8th-, 10th-, and 12th-graders nationwide. Nonmedical use of any prescription drug is reported only for 12th-graders, and in 2008, 15.4 percent reported past-year use. Prescription and OTC medications were the most commonly abused drugs by high school students after marijuana. In addition, they represent 6 of the top 10 illicit drugs reported by 12th-graders.

Prescription Painkillers. In 2002, MTF added questions to the survey about past-year nonmedical use of Vicodin and OxyContin. For Vicodin, past-year nonmedical use has remained stable at high levels for each grade since its inclusion in the survey.

Rate of Past-Year Use in 2008
Drug Name  8th-Grade  10th-Grade  12th-Grade
Vicodin 2.9% 6.7% 9.7%
OxyContin 2.1% 3.6% 4.7%

CNS Depressants. Nonmedical use of tranquilizers (benzodiazepines and others) by 10th-grade students decreased between 2001 and 2008 for all prevalence periods (lifetime,3 past-year, and past-month use). Use of sedatives (barbiturates), for which data are collected only from 12th-graders, has remained steady.

Rate of Past-Year Use in 2008
Drug Name  8th-Grade  10th-Grade  12th-Grade
Tranquilizers 2.4% 4.6% 6.2%
Sedatives -- -- 5.8%

Stimulants. Nonmedical use of stimulants is broken up by the type of stimulant used: amphetamines, methamphetamine, or Ritalin. For all three stimulants surveyed, rates have decreased significantly among 8th-, 10th-, and 12th-graders in 2001–2008.

Rate of Past-Year Use in 2008
Drug Name  8th-Grade  10th-Grade  12th-Grade
Amphetamines 4.5% 6.4% 6.8%
Methamphetamine 1.2% 1.5% 1.2%
Ritalin 1.6% 2.9% 3.4%

Cough Medicine. In 2006, a question about the use of cough and cold medicines to get high was asked for the first time.

Rate of Past-Year Use in 2008
Drug Name  8th-Grade  10th-Grade  12th-Grade
Cough Medicine 3.6% 5.3% 5.5%

National Survey on Drug Use and Health (NSDUH)4
According to the 2007 NSDUH, an estimated 6.9 million persons, or 2.8 percent of the population, aged 12 or older had used prescription psychotherapeutic medications nonmedically in the month prior to being surveyed. This includes 5.2 million using pain relievers (an increase from 4.7 million in 2005), 1.8 million using tranquilizers, 1.1 million using stimulants, and 350,000 using sedatives.

Past-month nonmedical use of prescription-type drugs among young adults aged 18 to 25 increased from 5.5 percent in 2002 to 6 percent in 2007. This was primarily due to an increase in pain reliever use, which was 4.1 percent in 2002 and 4.6 percent in 2007. However, nonmedical use of tranquilizers remained the same over the 6-year period.

Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 56.5 percent reported that they got the drug most recently used from someone they knew and that they did not pay for it. Another 18.1 percent reported that they obtained the drug from one doctor. Only 4.1 percent purchased the pain reliever from a drug dealer or other stranger, and just 0.5 percent reported buying the drug on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81 percent reported in a followup question that the friend or relative had obtained the drug from one doctor only.

Other Information Sources

For more information on addiction to prescription medications, visithttp://www.drugabuse.gov/drugpages/prescription.html.



1 A common vocabulary has not been established in the field of prescription drug abuse. Because much of the survey data collected in this area refer to nonmedical use of prescription drugs, this definition of “abuse,” rather than that of the Diagnostic and Statistical Manual of Mental Disorders (DSM), is used. Also, because physical dependence to prescription medications can develop during medically supervised appropriate use, the term “addiction” is used to reflect dependence as defined by the DSM.

2 These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

3 “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey. 

4 NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from NIDA at 877-643-2644.

Revised 7/09

NIDA InfoFacts: Steroids (Anabolic-Androgenic)

 

Anabolic-androgenic steroids (AAS) are synthetically produced variants of the naturally occurring male sex hormone testosterone. “Anabolic” refers to muscle-building, and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS.

How Are AAS Abused?

Some people, both athletes and non-athletes, abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected, typically in cycles rather than continuously. “Cycling” refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a period of time and then restarted. In addition, users often combine several different types of steroids in an attempt to maximize their effectiveness, a practice referred to as “stacking.”

How Do AAS Affect the Brain?

The immediate effects of AAS in the brain are mediated by their binding to androgen (male sex hormone) and estrogen (female sex hormone) receptors on the surface of a cell. This AAS–receptor complex can then shuttle into the cell nucleus to influence patterns of gene expression. Because of this, the acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference is that AAS are not euphorigenic, meaning they do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the “high” that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways and chemicals—such as dopamine, serotonin, and opioid systems—that are affected by other drugs of abuse. Considering the combined effect of their complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.

AAS and Mental Health
Preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects.1 For example, although many users report feeling good about themselves while on anabolic steroids, extreme mood swings can also occur, including manic-like symptoms that could lead to violence.2 Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Addictive Potential
Animal studies have shown that AAS are reinforcing—that is, animals will self-administer AAS when given the opportunity, just as they do with other addictive drugs.3,4 This property is more difficult to demonstrate in humans, but the potential for AAS abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations.5 Also, steroid abusers typically spend large amounts of time and money obtaining the drug: this is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking AAS—these include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression— when persistent, it can sometimes lead to suicide attempts.

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of AAS. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused AAS before trying any other illicit drug. Of these, 86 percent first used opioids to counteract insomnia and irritability resulting from the steroids.6

What Other Adverse Effects Do AAS Have on Health?

Steroid abuse can lead to serious, even irreversible health problems. Some of the most dangerous among these include liver damage; jaundice (yellowish pigmentation of skin, tissues, and body fluids); fluid retention; high blood pressure; increases in LDL (“bad” cholesterol); and decreases in HDL (“good” cholesterol). Other reported effects include renal failure, severe acne, and trembling. In addition, there are some gender- and age-specific adverse effects:

  • For men—shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer
  • For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
  • For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes; risk of not reaching expected height if AAS is taken before the typical adolescent growth spurt

In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.

What Treatment Options Exist?

There has been very little research on treatment for AAS abuse. Current knowledge derives largely from the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with education about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be needed.

How Widespread Is AAS Abuse?

Monitoring the Future Survey*
Monitoring the Future is an annual survey used to assess drug use among the Nation’s 8th-, 10th-, and 12th-grade students. While steroid use remained stable among all grades from 2007 to 2008, there has been a significant reduction since 2001 for nearly all prevalence periods (i.e., lifetime,** past-year, and past-month use) among all grades surveyed. The exception was past-month use among 12th-graders, which has remained stable. Males consistently report higher rates of use than females: for example, in 2008, 2.5 percent of 12th-grade males, versus 0.6 percent of 12th-grade females, reported past-year use.

Anabolic Steroid Use by Students
2008 Monitoring the Future Survey

   8th Grade  10th Grade  12th Grade
Lifetime** 1.4% 1.4% 2.2%
Past Year 0.9% 0.9% 1.5%
Past Month 0.5% 0.5% 1.0%

Other Information Sources

For a list of street terms used to refer to steroids and other drugs, visitwww.whitehousedrugpolicy.gov/streetterms/default.asp

For additional information on the effects of anabolic-androgenic steroids and information on healthy alternatives, please visit NIDA’s website on steroids,www.steroidabuse.org.



* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.



1 Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: A randomized controlled trial. Arch Gen Psychiatry 57(2):133–140, 2000.

2 Pope HG Jr, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry 145(4):487–490, 1988.

3 Arnedo MT, Salvador A, Martinez-Sanchis S, Gonzalez-Bono E. Rewarding properties of testosterone in intact male mice: A pilot study. Pharmacol Biochem Behav 65:327–332, 2000.

4 DiMeo AN, Wood RI. Self-administration of estrogen and dihydrotestosterone in male hamsters. Horm Behav 49(4):519–526, 2006.

5 Brower KJ. Anabolic steroid abuse and dependence. Curr Psychiatry Rep 4(5):377–387, 2002.

6 Arvary D, Pope HG Jr. Anabolic-androgenic steroids as a gateway to opioid dependence. N Engl J Med 342:1532, 2000.

Revised 7/09

Resource & Informational Links:

 

Developmental Assets

The Developmental Assets are 40 common sense, positive experiences and qualities that help influence choices young people make and help them become caring, responsible, successful adults. Because of its basis in youth development, resiliency, and prevention research and its proven effectiveness, the Developmental Assets framework has become one of the most widely used approach to positive youth development in the United States. 
You can find information on the 40 Developemental Assests here:

What Are Developmental Assets?
What Kids Need: The Building Blocks for Children and Youth
Developmental Assets Lists

 

Goverment Drug Reference Sites

National Institute on Drug Abuse

Drug Abuse Treatment Outcome Study (DATOS)

Drug Enforcement Administration

Methresources.gov

National Institute on Alcohol Abuse and Alcoholism (NIAAA)