Other Drugs
Ecstasy (MDMA)
3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.
MDMA was initially popular in the nightclub scene and at all-night dance parties ("raves"), but the drug now affects a broader range of people who more commonly call the drug Ecstasy or Molly.
People who use MDMA usually take it as a capsule or tablet, though some swallow it in liquid form or snort the powder. The popular nickname Molly (slang for "molecular") often refers to the supposedly "pure" crystalline powder form of MDMA, usually sold in capsules. However, people who purchase powder or capsules sold as Molly often actually get other drugs such as synthetic cathinones ("bath salts") instead.
Other street names include: Adam, Beans, Biscuit, Clarity, Disco Biscuit, E, Eve, Go, Hug Drug, Lover’s Speed, Peace, STP, X, XTC.
MDMA increases the activity of three brain chemicals:
- Dopamine—produces increased energy/activity and acts in the reward system to reinforce behaviors
- Norepinephrine—increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems
- Serotonin—affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.
Other health effects include:
- nausea
- muscle cramping
- involuntary teeth clenching
- blurred vision
- chills
- sweating
MDMA's effects last about 3 to 6 hours, although many users take a second dose as the effects of the first dose begin to fade. Over the course of the week following moderate use of the drug, a person may experience:
- irritability
- impulsiveness and aggression
- depression
- sleep problems
- anxiety
- memory and attention problems
- decreased appetite
- decreased interest in and pleasure from sex
It's possible that some of these effects may be due to the combined use of MDMA with other drugs, especially marijuana.
GHB
Gamma-Hydroxybutyric acid (or γ-hydroxybutyric acid (GHB), also known as 4-hydroxybutanoic acid) is a naturally occurring neurotransmitter and a depressant drug. It is a precursor to GABA, glutamate, and glycine in certain brain areas. It acts on the GHB receptor and is a weak agonist at the GABAB receptor.
GHB is a central nervous system depressant used as an intoxicant. It has many street names. Its effects have been described as comparable with ethanol (alcohol) and MDMA use, such as euphoria, disinhibition, enhanced libido and empathogenic states. A review comparing ethanol to GHB concluded that the dangers of the two drugs were similar. At higher doses, GHB may induce nausea, dizziness, drowsiness, agitation, visual disturbances, depressed breathing, amnesia, unconsciousness, and death. One potential cause of death from GHB consumption is polydrug toxicity. Co-administration with other CNS depressants such as alcohol or benzodiazepines can result in an additive effect (potentiation), as they all bind to gamma-aminobutyric acid (or "GABA") receptor sites. The effects of GHB can last from 1.5 to 4 hours, or longer if large doses have been consumed. Consuming GHB with alcohol can cause respiratory arrest and vomiting in combination with unrousable sleep, which can lead to death.
GHB has been used as a club drug, apparently starting in the 1990s, as small doses of GHB can act as a euphoriant and are believed to be aphrodisiac. Slang terms for GHB include liquid ecstasy, lollipops, G, Georgia Home Boy, Grievous Bodily Harm, Scoop, liquid X or liquid E due to its tendency to produce euphoria and sociability and its use in the dance party scene.
GHB became known to the general public as a date-rape drug by the late 1990s. GHB is colourless and odorless and has been described as "very easy to add to drinks". When consumed, the victim will quickly feel groggy and sleepy and may become unconscious. Upon recovery they may have an impaired ability to recall events that have occurred during the period of intoxication. In these situations evidence and the identification of the perpetrator of the rape is often difficult.
Khat
Khat or qat (Amharic: ጫት ch’at; Oromo: Jimaa, Somali: qaad, khaad, khat or chat, Arabic: القات al-qāt) is a flowering plant native to eastern and southern Africa. Khat contains the alkaloid cathinone, a stimulant, which is said to cause excitement, loss of appetite, and euphoria. Among communities from the areas where the plant is native, khat chewing has a history as a social custom dating back thousands of years analogous to the use of coca leaves in South America and betel nut in Asia.[3]
The World Health Organization (WHO) classified it in 1980 as a drug of abuse that can produce psychological dependence, although the WHO does not consider khat addiction to be a serious problem.
Common street names for khat include: • Abyssinian Tea, African Salad, Catha, Chat, Kat, and Oat
Khat consumption induces mild euphoria and excitement, similar to that conferred by strong coffee. Individuals become very talkative under the influence of the plant. Animal testing has shown that khat causes an increase in motoric activity. The effects of oral administration of cathinone occur more rapidly than the effects of amphetamine pills; roughly 15 minutes as compared to 30 minutes in amphetamine.[medical citation needed] Khat can induce manic behaviours and hyperactivity, similar in effects to those produced by amphetamine.
The use of khat results in constipation. Dilated pupils (mydriasis) are prominent during khat consumption, reflecting the sympathomimetic effects of the drug, which are also reflected in increased heart rate and blood pressure. Long-term use can precipitate permanent tooth darkening (of a greenish tinge), susceptibility to ulcers, and diminished sex drive. Khat is an effective anorectic, causing loss of appetite.
Kratom
Mitragyna speciosa (commonly known as kratom, an herbal leaf from a tree of the Rubiaceae family,) is a tropical evergreen tree in the coffee family native to Southeast Asia. It is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea, where it has been used in herbal medicine since at least the nineteenth century.[6] It has also historically been used for chewing, smoking, and tea. Kratom has opioid properties and some stimulant-like effects.
As of 2018, the efficacy and safety of kratom are unclear, and the drug was not approved as a therapeutic agent in the United States due to the poor quality of the research. In 2019, the United States Food and Drug Administration (FDA) stated that there is no evidence that kratom is safe or effective for treating any condition. Some people take it for managing chronic pain, for treating opioid withdrawal symptoms, or for recreational purposes. The onset of effects typically begins within five to ten minutes and lasts for two to five hours.
Anecdotal reports describe increased alertness, physical energy, talkativeness, sociability, sedation, changes in mood, and pain relief following kratom use at various doses. Common side effects include appetite loss, erectile dysfunction, nausea and constipation. More severe side effects may include respiratory depression (decreased breathing), seizure, addiction, and psychosis. Other side effects may include high heart rate and blood pressure, trouble sleeping, and, rarely, liver toxicity. When use is stopped, withdrawal symptoms may occur. Scores of deaths have been attributed to the use of kratom, both by itself and mixed with other substances. Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances.
As of 2018, kratom is a controlled substance in 16 countries and, in 2014, the FDA banned importing and manufacturing of kratom as a dietary supplement. As of 2018, there is growing international concern about a possible threat to public health from kratom use, while others have argued that it could be a tool to help the opioid crisis. In 2021, the World Health Organization's Executive Committee on Drug Dependency investigated the risks of kratom and declined to recommend a ban following a scientific review. The committee, however, recommended kratom be kept "under surveillance." In some jurisdictions, its sale and importation have been restricted, and several public health authorities have raised alerts.
As of 2018, there have been no formal trials to study the efficacy or safety of kratom to treat opioid addiction. Kratom is not approved for this or any other medical use.[22] However, because the withdrawal effects of kratom are often reported to be less severe than those associated with traditional opioids, some people use kratom in the attempt to manage opioid use disorder.[36] Stanciu et al. conducted a review of all literature and found insufficient evidence for any conclusions concerning whether kratom is harmful or whether can serve as harm reduction for those with opioid addiction. While some literature reviews claim that kratom has less potential for dependence or overdose than traditional opioids, other reviews note that kratom withdrawal itself can still be quite severe.
Mitragyna speciosa may cause many adverse effects and in November 2017 the FDA issued a public health advisory for the drug. The side effects of kratom appear to be dose-dependent and are more common with doses that exceed 8 g. While the incidence of adverse effects in people who use kratom is unknown, a 2019 review of 935 kratom exposures reported to U.S. poison control centers over a seven-year period listed the following signs and symptoms: agitation (18.6%), tachycardia (16.9%), drowsiness (13.6%), vomiting (11.2%), confusion (8.1%), seizure (6.1%), withdrawal (6.1%), hallucinations (4.8%), respiratory depression (2.8%), coma (2.3%), and cardiac or respiratory arrest (0.6%).[48][39] The study also reported two deaths and four cases of neonatal abstinence syndrome. A different 2019 review listed as common side effects: decreased appetite, anorexia, weight loss, temporary erectile dysfunction, insomnia, sweating, hyperpigmentation, hair loss, tremor, and constipation.
Kratom is a botanical with a known addiction liability and, in vulnerable individuals, dependence may develop rather quickly with tolerance noted at 3 months and 4- to 10-fold dose escalations required within the first few weeks. Kratom addiction carries a relapse risk as high as 78% to 89% at 3 months post-cessation. In cases of severe addiction, a similar approach to treatment of opioid addiction may be warranted.
Krokodil (Desomorphine)
A desomorphine product has been created by the public as a street drug, usually using codeine. Such product is highly impure, which lends the street drug the name of krokodil (Russian for crocodile), due to the scaly sores and necrosis that develop around the injection site.
The drug can be made from codeine and iodine derived from over-the-counter medications and red phosphorus from match strikers, in a process similar to the manufacturing of methamphetamine from pseudoephedrine. Like methamphetamine, desomorphine made this way is often contaminated with various agents. The street name in Russia for homemade desomorphine is krokodil (Russian: крокодил, crocodile), possibly related to the chemical name of the precursor α-chlorocodide, or the resemblance of the skin damage caused by the drug to a crocodile's leather.
Illicitly produced desomorphine is typically far from pure and often contains large amounts of toxic substances and contaminants as a result of the drug producers neglecting to remove highly toxic reactants and solvents left over from synthesis. This neglect could be due to the producers having a limited understanding of chemistry or as a way to avoid the costs of extracting the toxic material. Injecting any such mixture can cause serious damage to the skin, blood vessels, bone and muscles, sometimes requiring limb amputation in long-term users.
Loperamide (Imodium)
Loperamide, sold under the brand name Imodium, among others,[1] is a medication used to decrease the frequency of diarrhea. It is often used for this purpose in inflammatory bowel disease and short bowel syndrome.
In 2015, however, case reports of extremely high-dose loperamide use were published. The primary intent of users has been to manage symptoms of opioid withdrawal such as diarrhea, although a small portion derive psychoactive effects at these higher doses.[At these higher doses central nervous system penetration occurs and long term use may lead to tolerance, dependence, and withdrawal on abrupt cessation.Dubbing it "the poor man's methadone", clinicians warned that increased restrictions on the availability of prescription opioids passed in response to the opioid epidemic were prompting recreational users to turn to loperamide as an over-the-counter treatment for withdrawal symptoms. Since 2015, several reports of sometimes-fatal cardiotoxicity due to high-dose loperamide abuse have been published.
PCP (Angel Dust)
A dissociative drug developed as an intravenous anesthetic that has been discontinued due to serious adverse effects. Dissociative drugs are hallucinogens that cause the user to feel detached from reality. PCP is an abbreviation of the scientific name, phencyclidine.
Behavioral effects can vary by dosage. Low doses produce a numbness in the extremities and intoxication, characterized by staggering, unsteady gait, slurred speech, bloodshot eyes, and loss of balance. Moderate doses (5–10 mg intranasal, or 0.01–0.02 mg/kg intramuscular or intravenous) will produce analgesia and anesthesia. High doses may lead to convulsions. The drug is often illegally produced under poorly controlled conditions; this means that users may be unaware of the actual dose they are taking.
PCP's rewarding and reinforcing effects are at least partly mediated by blocking the NMDA receptors in the glutamatergic inputs to D1-type medium spiny neurons in the nucleus accumbens. PCP has been shown to produce conditioned place aversion and conditioned place preference in animal studies.
PCP comes in both powder and liquid forms (PCP base is dissolved most often in ether), but typically it is sprayed onto leafy material such as cannabis, mint, oregano, tobacco, parsley, or ginger leaves, then smoked.
PCP has also been shown to cause schizophrenia-like changes in N-acetylaspartate and N-acetylaspartylglutamate levels in the rat brain, which are detectable both in living rats and upon necropsy examination of brain tissue.[66] It also induces symptoms in humans that mimic schizophrenia.[67] PCP not only produced symptoms similar to schizophrenia, it also yielded electroencephalogram changes in the thalamocortical pathway (increased delta decreased alpha) and in the hippocampus (increase theta bursts) that were similar to those in schizophrenia.[68] PCP-induced augmentation of dopamine release may link the NMDA and dopamine hypotheses of schizophrenia.
Rohypnol (Roofies)
A benzodiazepine chemically similar to prescription sedatives such as Valium® and Xanax® that may be misused for its psychotropic effects. Rohypnol has been used to commit sexual assaults because of its strong sedation effects. In these cases, offenders may dissolve the drug in a person’s drink without their knowledge. This drug has never been approved for medical use in the United States by the Food and Drug Administration.
Common street names include: • Circles, Forget Pill, Forget-Me-Pill, La Rocha, Lunch Money Drug, Mexican Valium, Pingus, R2, Reynolds, Roach, Roach 2, Roaches, Roachies, Roapies, Robutal, Rochas Dos, Rohypnol, Roofies, Rophies, Ropies, Roples, Row-Shay, Ruffies, and Wolfies
The tablet can be swallowed whole, crushed and snorted, or dissolved in liquid. Adolescents may abuse Rohypnol® to produce a euphoric effect often described as a “high.” While high, they experience reduced inhibitions and impaired judgment. Rohypnol is also used in combination with alcohol to produce an exaggerated intoxication. In addition, abuse of Rohypnol® may be associated with multiple-substance abuse. For example, cocaine users may use benzodiazepines such as Rohypnol® to relieve the side effects (e.g., irritability and agitation) associated with cocaine binges.
Flunitrazepam is known to induce anterograde amnesia in sufficient doses; individuals are unable to remember certain events that they experienced while under the influence of the drug, which complicates investigations. This effect could be particularly dangerous if flunitrazepam is used to aid in the commission of sexual assault; victims may be unable to clearly recall the assault, the assailant, or the events surrounding the assault.
While use of flunitrazepam in sexual assault has been prominent in the media, as of 2015 it appears to be fairly rare, and use of alcohol and other benzodiazepine drugs in date rape appears to be a larger but underreported problem.
In a 2001 study, the benzodiazepines midazolam and temazepam were the two most common benzodiazepines utilized for date rape.
Salvia
A dissociative drug (Salvia divinorum) that is an herb in the mint family native to southern Mexico. Dissociative drugs are hallucinogens that cause the user to feel detached from reality.
The known active constituent of Salvia divinorum is a trans-neoclerodane diterpenoid known as salvinorin A (chemical formula C23H28O8). This compound is present in the dried plant at about 0.18%. By mass, salvinorin A "is the most potent naturally occurring hallucinogen." It is active at doses as low as 200 µg.
Although salvia is not regulated under the Controlled Substances Act, as of 2009, it had been made illegal in 13 states. Delaware banned it after salvia use was reported to have played a role in the suicide of a teenager. Alabama, Delaware, Illinois, Louisiana, Michigan, Missouri, Ohio, Texas, and other states have passed their own laws. Several other states have proposed legislation against salvia, including Alaska, California, Florida, Iowa, Maryland, New Jersey, New York, Oregon, and Pennsylvania. Many of these proposals have not made it into law, with motions having failed, stalled or otherwise died, for example at committee review stages.
Tranq (Xylazine)
Xylazine, a non-opioid veterinary tranquilizer not approved for human use, has been linked to an increasing number of overdose deaths nationwide in the evolving drug addiction and overdose crisis. Studies show people exposed to xylazine often knowingly or unknowingly used it in combination with other drugs, particularly illicit fentanyl.
Research has shown xylazine is often added to illicit opioids, including fentanyl, and people report using xylazine-containing fentanyl to lengthen its euphoric effects. Most overdose deaths linked to both xylazine and fentanyl also involved additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.
Also known as “tranq,” xylazine is a central nervous system depressant that can cause drowsiness and amnesia and slow breathing, heart rate, and blood pressure to dangerously low levels. Taking opioids in combination with xylazine and other central nervous system depressants—like alcohol or benzodiazepines—increases the risk of life-threatening overdose.
Repeated xylazine use is also associated with skin ulcers, abscesses, and related complications. People report using xylazine or xylazine-containing drugs by injecting, snorting, swallowing, or inhaling.
Sources: NIH, National Institute on Drug Abuse, DEA, SAMSA, Wikipedia. (Collected 2023)