Drug Classes: Examples

1. Opioids 2. Stimulants 3. Depressants 4. Hallucinogens

(Narcotics)
1.1 Opium 2.1 Cocaine 3.1 Alcohol* 4.1 LSD
1.2 Morphine, 2.2 Amphetamine 3.2 Barbiturates 4.2 Mescaline
codeine 2.3 Methamphetamine 3.3 Benzodiazepines 4.3 Peyote
1.3 Heroin, 2.4 Ecstasy 3.4 Gamma- 4.4 Psilocybin
hydrocodone, 2.5 Nicotine* Hydroxybutyrate (GHB); mushrooms
oxycodone, and 2.6 Caffeine* Rohypnol
hydromorphone
5. Others
1.4 Methadone, 5.1 Dissociative anesthetics (phencyclidine [PCP], ketamine)
fentanyl, and 5.2 Inhalants solvents, gases, nitrites
meperidine 5.3 Cannabinoids (marijuana, hashish)
5.4 Khat/Miraa

Universal Prevention Curriculum, (UPC) Curriculum 2 (Colombo Plan)

1. OPIOIDS (NARCOTICS)
Opioids/narcotics are natural,
semisynthetic, or synthetic
derivatives of the opium poppy.
1.1 Opium
1.2 Morphine, codeine
1.3 Heroin, hydrocodone, oxycodone,
and hydromorphone
1.4 Methadone, fentanyl, and
meperidine

By Dinkum - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=27085845

1. OPIOIDS (NARCOTICS)

1.1 Opium
Origin
Opium is the semi dried sap of the plant and is 100 percent
natural.

Appearance
Opium (and heroin) are generally sold in tar-like black or
brown chunks or blocks.

Mode of administration Photo from:

Opium is most commonly smoked. https://www.deamuseum.org/ccp/opium/production

-distribution.html

Image from:
https://www.dea.gov/pr/multimedia-library/image-gallery/opium/opium2.jpg
1. OPIOIDS (NARCOTICS)

1.2 Morphine, codeine

Origin
• Two of the most prevalent alkaloids (plant compounds
with psychoactive properties) in opium are morphine
and codeine.
• Morphine and codeine can be isolated and processed
as separate drugs.

Appearance 5mg/ml vial of Morphine Sulfate manufactured by Baxter Healthcare. By Vaprotan, Own
work, https://commons.wikimedia.org/wiki/File:Morphine_vial.JPG

Morphine is available as a liquid (for injecting) or tablet.

1. OPIOIDS (NARCOTICS)

1.3 Heroin
Origin
• Heroin is a semisynthetic opioid, meaning that it can be synthesized from opium.
Other semisynthetic opioids are hydrocodone, oxycodone, and hydromorphone.
• Heroin is the most widely abused opioid. Although heroin was originally
developed in an attempt to find an effective painkiller with less addictive
potential than morphine, it turned out to be five to eight times more powerful
than morphine and to act more quickly, making it even more addicting.
Appearance
(Opium and) heroin are generally sold in tar-like black or brown chunks or blocks.
Heroin often is sold as a white or brown powder.

Mode of administration
Heroin can be smoked, inhaled (either as a powder or liquefied in a nasal spray
bottle), or injected (intramuscularly or intravenously). Two types of heroin. Public Domain,
https://commons.wikimedia.org/w/index.php?curid=70754
1. OPIOIDS (NARCOTICS)

1.4 Methadone
Origin
Methadone, fentanyl, and meperidine are synthetic opioids.
Synthetic opioids are not derived from natural opium but are
manufactured to work in similar ways.

Appearance
Methadone is available in tablets or an oral liquid. Most
synthetic opioids are available as tablets or capsules.

Photo from:
http://www.opiateaddictionresource.com/media/images/met
hadone_tablets
1. OPIOIDS (NARCOTICS)
Other modes of administration
• Other opioids are more commonly taken orally, in tablet form.
• When used medically for pain relief, some opioids are administered via
slow-release capsules or patches. OxyContin, a slow-release capsule, has
become a major problem in some areas of the United States. People break
open the capsule, dilute the contents, and inject the solution. Patches are
sometimes abused by cutting them open and eating or injecting the
contents.
How long an opioid high lasts depends on the specific drug. Some opioids
are short acting, and some are long acting. The effects of heroin usually last
3 to 4 hours.
1. OPIOIDS (NARCOTICS)
Medical uses
• The primary medical use for opioids is for pain relief.
• Opioids also can be used to treat severe diarrhea and coughing.

“Desirable” effects
• Physical pain relief
• Emotional numbness
• Euphoria, followed by a sense of well-being
• Calm drowsiness or sedation
• Alternating wakefulness and drowsiness
• Dreaminess
1. OPIOIDS (NARCOTICS)
Side effects
• Nausea and vomiting • Uncoordinated muscle
• Confusion movements, rigid muscles
• Slowed breathing • Rash, hives, itching
• Constipation • Facial flushing
• Blurred or double vision • Dry mouth
• “Pinpoint” pupils • Weakness
• Dizziness, faintness, floating • Agitation
feeling, light-headedness • Headache
• Memory loss • Appetite loss
1. OPIOIDS (NARCOTICS)
Possible medical consequences with chronic use
• Infection of the heart lining and valves
• Liver or kidney disease
• Pulmonary complications, including various types of pneumonia, resulting from the
poor health of the user as well as from the depressing effects on respiration
• Intestinal complications resulting from chronic constipation
• Consequences directly associated with injecting, including abscesses and collapsed
veins
• Spontaneous abortion

Babies born to women who are opioid addicted may have low birth weight and/or go
through withdrawal, with symptoms lasting 5 to 8 weeks. Unlike adults, babies can die
from opioid withdrawal.
1. OPIOIDS (NARCOTICS)
Possible medical consequences with chronic use
Overdose is a major risk of opioid abuse. Signs and symptoms of opioid
overdose include:
• Cold, clammy skin • Stupor
• Weak, floppy muscles • Coma
• Fluid in the lungs • Slow and difficult breathing
• Greatly lowered blood pressure and heart • Bluish-colored fingernails and lips from
rate reduced oxygen intake
• “Pinpoint” or dilated pupils • Muscle cramping

Overdose is a particular risk when opioids are combined or are used with
other depressant drugs (including alcohol).
1. OPIOIDS (NARCOTICS)
Withdrawal syndrome
In addition to intense drug craving, opioid withdrawal symptoms include:
• Restlessness • Dilated pupils
• Severe muscle, joint, and bone pain • Insomnia
• Muscle cramping • Diarrhea and vomiting
• Sweating and running nose • Fever and chills with severe shivering and
• Rapid pulse goose bumps
• Coughing and yawning • Kicking movements
Symptoms can begin as early as a few hours after the last drug administration. Major withdrawal symptoms
peak between 48 and 72 hours after the last dose and typically subside after about a week. Some
individuals may show persistent withdrawal symptoms for months. Withdrawal from opioids is usually not
medically dangerous for adults (unless the person is in very poor health) but is extremely painful. For this
reason, medically managed withdrawal using medications to control symptoms is more likely to be
successful than “just quitting.”
2. STIMULANTS
Stimulant drugs derive from both natural and synthetic
sources.
2.1 Cocaine
2.2 Amphetamine
2.3 Methamphetamine
2.4 Ecstasy
2.5 Nicotine*
2.6 Caffeine*
2. STIMULANTS
Mode of administration
Stimulants are taken:
• Orally
• By snorting (inhaled nasally after crushing tables)
• By smoking
• By injecting after dissolving crushed tablets in water
2. STIMULANTS

2.1 Cocaine
Origin
The cocaine alkaloid is found in the leaves of the coca
bush that grows primarily in the Andes Mountains of
Peru.

Appearance
From: https://commons.wikimedia.org/wiki/File:Colcoca03.jpg

Cocaine is typically available as a white powdery

substance but can be processed into “crack cocaine” (a
mixture of cocaine, water, and baking soda that is
made into a paste and dried); the hard mixture is then
broken up into “rocks,” which are smoked.
Left photo: Unknown, U.S. Government photo available through the National Archives -
http://www.iprc.indiana.edu/graphics/photographs/cocaine3.gif

Right photo: By DEA - Found on a US government site, then cropped., Public Domain,
https://commons.wikimedia.org/w/index.php?curid=70839
2. STIMULANTS

2.1 Cocaine
Mode of administration
Cocaine is taken (1) by inhaling powder (snorting), (2) by injecting, and (3) by smoking.

Cocaine is a relatively short-acting drug, and faster absorption usually means shorter
duration of action. The high from inhaling cocaine may last 15 to 30 minutes, but the high
from smoking it may last only 5 to 10 minutes. To sustain the high, a person who uses
cocaine has to administer the drug again. For this reason, cocaine is sometimes abused
in binges—taken repeatedly within a relatively short period, at increasingly higher doses.

Medical uses
Cocaine is a topical anesthetic, sometimes used to numb nasal passages when inserting
a breathing tube, to numb the eye or throat during surgery, and to deaden the pain of
chronic sores.
2. STIMULANTS

2.2 Amphetamine
Origin
Amphetamines are commercially manufactured; they include Adderall, Dexedrine, and biphetamine.
Although not as strong, some amphetamine-like drugs have similar effects and are abused to some extent:
methylphenidate (Ritalin),fenfluramine, pemoline, and phentermine.

Appearance
Commercially manufactured amphetamines are available in tablet or capsule form.

Mode of administration
Amphetamine effects generally last from 4 to 6 hours.

Medical uses
Amphetamines are most often used to treat narcolepsy (uncontrolled and sudden episodes of sleep),
obesity, and attention deficit/hyperactivity disorder (ADHD).
2. STIMULANTS

2.3 Methamphetamine
Origin
Methamphetamine is also synthetic. It is commercially manufactured (Desoxyn) but is
more typically synthesized in clandestine laboratories.

Appearance
Methamphetamine is typically white or yellowish, odorless, and bitter tasting, and is in the
form of crystalline powder or chunks.

Medical uses
Methamphetamine has been used as a treatment for ADHD and obesity.
2. STIMULANTS

2.4 Ecstasy
Origin
MDMA (3,4methylenedioxymethamphetamine), also known as ecstasy, is a synthetic,
psychoactive drug that is chemically similar to both the stimulant methamphetamine and
the hallucinogen mescaline, but it is generally classified as a stimulant.

Mode of administration
Ecstasy is taken orally.

Medical uses
There are no medical uses for ecstasy.
2. STIMULANTS
“Desirable” Effects of Stimulants
• Euphoria
• Increased energy and endurance
• Talkativeness
• Increased mental alertness
• Feelings of happiness and power
• Release of social inhibitions
• Unrealistic feelings of cleverness, great competence, and power
• Enhanced sensations of sight, sound, and touch
• Enhanced sexual desire and performance (at low doses)
2. STIMULANTS

2.4 Ecstasy
“Desirable” Effects
Those who take ecstasy also experience:

• Heightened feelings of emotional warmth and increased empathy for self

and others
• Distortions in time perception
• Heightened sensation
• Visual distortions and hallucinations
2. STIMULANTS
Side effects
• Dilated pupils From intranasal inhaling:
• Increased body temperature, heart • Loss of the sense of smell
rate, and blood pressure • Chronic nosebleeds
• Headaches • Problems with swallowing
• Restlessness and insomnia • Chronically runny nose
• Anxiety and irritability From smoking:
• Abdominal pain and nausea • Thirst
• Decreased appetite • Coughing
• Increased aggression and violence • Hoarseness
• Decreased sexual response (at
higher doses)
• Feelings of paranoia
2. STIMULANTS
Possible medical consequences with chronic use
• Acute cardiovascular or cerebrovascular emergencies, such as a
heart attack or stroke, which may cause sudden death
• A temporary state of full-blown paranoid psychosis
• Severe dental problems, including cracked teeth from extreme jaw
clenching when high and severe tooth decay resulting from dry
mouth and acidic effects of cocaine or methamphetamine trickling
into the mouth from nasal ingestion
• Severe bowel gangrene from ingesting cocaine as a result of
reduced blood flow
• Severe allergic reactions at injection sites
2. STIMULANTS
Possible medical consequences with chronic use
• Serious respiratory complications, including pneumonia,
hemorrhage, and respiratory failure from smoking
• Facial and body sores from scratching, sometimes leading to
infections
• Extreme weight loss and malnutrition
• Strokes
• Heart infections
• Lung disease
• Kidney damage
• Liver damage
2. STIMULANTS
Possible medical consequences with chronic use
When used by a pregnant woman, increased risk of:
• Placental separation and hemorrhage
• Premature birth
• Birth defects, including cardiac defects, cleft palate, club foot
• Fetal brain hemorrhage and stroke
• Overdose risk:
 Seizures
 Severely elevated body temperature
 Stroke
 Cardiac incidents
2. STIMULANTS

2.3 Methamphetamine
Possible medical consequences with chronic use
Chronic methamphetamine abuse significantly changes how the brain functions.
Noninvasive brain imaging studies have shown alterations in brain activity that are
associated with reduced motor performance and impaired verbal learning. Severe
structural and functional changes also are seen in areas of the brain associated with
emotion and memory.

Some of these changes persist long after methamphetamine abuse is stopped, and some
reverse after sustained periods of abstinence (e.g., 2 years).
2. STIMULANTS

2.4 Ecstasy
Possible medical consequences with chronic use
Ecstasy has its own medical risks:
• Severe dehydration (especially when mixed with alcohol), leading to heatstroke, muscle damage, and
kidney failure
• Seizures
• In high doses, can interfere with the body’s ability to regulate temperature
• On rare but unpredictable occasions, can lead to a sharp increase in body temperature, which can result
in liver, kidney, and cardiovascular system failure and death
• Increased heart rate and blood pressure can cause serious cardiovascular problems in susceptible
individuals
• Can interfere with its own metabolism (breakdown within the body), allowing potentially harmful levels to
be reached by repeated MDMA administration in short periods
• Research in animals indicates that MDMA can be harmful to the brain. One study on nonhuman
primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals
that was evident 6 to 7 years later.
2. STIMULANTS
Withdrawal syndrome
Withdrawal symptoms depend on the dosage and length and frequency of use.
Withdrawal from stimulants can be very unpleasant but is not inherently dangerous.
Atypical withdrawal pattern is as follows:
Immediately after a binge:
• Extreme lack of energy and motivation and need for sleep
• Depression
Within a few days of abstinence:
• Symptoms lessen
• Energy returns
Starting within 5 to 7 days of abstinence and lasting for weeks or months:
• Severe drug cravings
• Energy level drops again
2. STIMULANTS

2.4 Nicotine*
The next 6 slides (on Smoking) have been lifted from Seatca’s presentation:
7,000 chemicals, 70 carcinogens
in cigarette smoke

US Surgeon General’s Report 2010

ATHEROSCLEROSIS
Normal Artery
- smooth inside surface of a
normal blood vessel

Hardened Artery
- rough inside surface of a
diseased artery.

DR.VILLARREIZ
WARNING

CIGARETTES
CAUSE STROKES
477% risk of stroke
compared to non-smokers

A smoker’s risk of
heart attack is more
than twice that of
nonsmokers.
English DR, Holman CD et al. The quantification of drug
caused mortality and morbidity in Australia, 1995 edition.
 Other effects

 Eyes: cataract, macular degeneration, optic

nerve and retinal ischemia
 Depression
 Effects on hormones
and many more…

US CDC fact sheet 2010

The Smoker’s Body
WHO poster

Download at:
http://www.who.int/tobacco/research/smokers_body/en/
Tobacco Companies Sell a Product
that Kills
• Tobacco kills
• Half of all regular users will die prematurely
• Secondhand smoke kills.

• Tobacco is not like any other product.

• Tobacco industry is not like any other industry.

seatca.org
3. DEPRESSANTS
The depressant category includes:
3.1 Barbiturates (i.e., Nembutal, phenobarbital, seconal)
3.2 Benzodiazepines (i.e., Valium, Xanax, rohypnol)
3.3 Methaqualone (i.e., Quaalude, Sopor)
3.4 Gamma-hydroxybutyrate (GHB)
3.5 Alcohol*

Appearance
Tablets and capsules of varied sizes, shapes, and colors. GHB can be produced in clear
liquid, white powder, tablet, and capsule forms.
3. DEPRESSANTS

3.1 Barbiturates
Origin
• Barbiturates were originally synthesized to treat anxiety, insomnia, and seizure
disorders but are now rarely used for those purposes as newer medications have taken
their place.
Mode of administration
Oral

Medical uses
Barbiturates are sometimes used as adjuncts to general anesthesia and for certain cases
of seizure disorder.
3. DEPRESSANTS

3.2 Benzodiazepines
Origin
Chemically synthesized as an alternative to barbiturates, benzodiazepines were found to be more effective
at lowering anxiety than barbiturates but without the over sedating effects of those medications. It was also
thought that benzodiazepines had less addictive potential. There are more than 30 benzodiazepines. The
most commonly used are alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),diazepam
(Valium), lorzepam (Ativan), oxazepam (Serax), and clonazepam (Klonopin).

Mode of administration: Oral

Medical uses. Benzodiazepines are used:
• To treat anxiety, acute stress reactions, panic attacks, and sleep disorders
• To control seizures
• As muscle relaxants
• In medically managed alcohol withdrawal
• As presurgery sedation
3. DEPRESSANTS

3.3 Methaqualone
Origin
Methaqualone also was used to treat insomnia but is rarely used now.

Mode of administration
Oral
3. DEPRESSANTS

3.4 Gamma-hydroxybutyrate (GHB)

Origin
• GHB is associated with sexual assault in the United States.
• GHB is a designer drug.
Appearance
GHB can be produced in clear liquid, white powder, tablet, and capsule forms.
Mode of administration
Oral
3. DEPRESSANTS
“Desirable” effects Side effects
• Relaxation • Poor concentration
• Decreased anxiety • Muscle weakness
• Decreased inhibitions • Lack of coordination
• Sense of well-being • Slurred speech
• Mild euphoria • Dizziness
• Slowed reflexes
• Nausea and vomiting
• Impaired judgment
• Mental confusion
• Memory loss
• Emotional blunting
3. DEPRESSANTS
Possible medical consequences with chronic use
• May cause or aggravate depression
• Respiratory depression can occur at high doses or when combined with
other depressant drugs, particularly alcohol
• Those who use benzodiazepines chronically may experience paradoxical
effects at high doses; these effects include aggressive behavior, agitation,
and lack of inhibition instead of the typical sedation and anti-anxiety
effects.
3. DEPRESSANTS
Possible medical consequences with chronic use
Depressants are sometimes primary drugs of abuse. However, they are most commonly
abused along with other substances to enhance desired effects or to counter undesirable
effects. For example:
• Benzodiazepines have effects similar to alcohol, and some people take them when
they drink to enhance the effect. This use is highly dangerous because the risk of
potentially fatal respiratory depression is greatly increased.
• People who abuse stimulant drugs often take a depressant to “come down” from
excess stimulation or to sleep following a stimulant binge. This combination is
associated with spasms of coronary heart muscle that can damage the heart.
• People addicted to heroin often use depressants when they cannot get heroin to ease
withdrawal symptoms.
3. DEPRESSANTS
Withdrawal syndrome
Depressant withdrawal can be medically dangerous and difficult to manage, in part because the drugs
tend to stay in body tissues for long periods. There are relatively short and long-acting barbiturates and
benzodiazepines, and the timing of expected symptoms varies depending on which type has been
abused. Withdrawal symptoms may begin within 1 day for short-acting depressants but may be
delayed for up to 5days with longer acting benzodiazepines. Symptoms tend to last for 7 to 20 days for
short-acting drugs and up to 28 days for longer acting drugs. Symptoms include:
• Drug craving • Yawning
• Headache • Rapid heart rate and increased blood pressure
• Tremors and muscle twitches • Muscle cramps
• Nausea and vomiting • Sleep problems
• Anxiety • Hallucinations
• Restlessness • Multiple seizures, which can be fatal
The worst symptoms occur when the drug is stopped abruptly. Depressants need to be carefully
tapered over time (up to a month) to avoid severe problems.
3. DEPRESSANTS

3.5 Alcohol
3. DEPRESSANTS

3.5 Alcohol
4. HALLUCINOGENS
This category includes:
4.1 LSD

4.2 Mescaline

4.3 Peyote

4.4 Psilocybin mushrooms

4. HALLUCINOGENS

4.1 LSD
Origin
LSD (d-lysergic acid diethylamide) is manufactured from lysergic
acid, which is found in ergot, a fungus that grows on rye and
other grains.
Appearance
Manufactured as a liquid, then converted to different forms;
tablets or capsules of varying sizes, shapes, and colors; liquid on
blotter paper; powder

Mode of administration
Oral. The psychoactive effects of hallucinogens begin within about
1 hour and last up to 12 hours.
Medical use
None
https://www.drugabuse.gov/sites/default/files/hallucinogensrrs4.pdf
4. HALLUCINOGENS

4.2 Mescaline
Origin
Mescaline is the principal active psychedelic compound in peyote (and in a few other varieties of cactus).
Mescaline can also be chemically synthesized in laboratory.

Appearance
Usually a white or brown powder in capsules

Mode of administration
Can be taken orally in capsule form. The psychoactive effects of hallucinogens begin within about 1 hour
and last up to 12 hours.

Medical use
None
4. HALLUCINOGENS

4.3 Peyote
Origin
Peyote is a spineless cactus with small protrusions called buttons that have
psychoactive properties. Peyote is one of the oldest psychedelic agents
known.
Appearance
Small, gray-green buttons

Mode of administration
Can be chewed or brewed into tea. The psychoactive effects of
hallucinogens begin within about 1 hour and last up to 12 hours.

Medical use
None
https://www.drugabuse.gov/sites/default/files/hallucinogensrrs4.pdf
4. HALLUCINOGENS

4.4 Psilocybin mushrooms

Origin
Psilocybin mushrooms are fungi that contain the
psychoactive compounds psilocybin and psilocin.

Appearance
Small, gray-green buttons

Mode of administration
Psilocybin mushrooms can be chewed or brewed into
tea. Psilocybin also can be taken orally in capsule
form. The psychoactive effects of hallucinogens begin
within about 1 hour and last up to 12 hours. By Curecat - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=3162809

Medical use
None
4. HALLUCINOGENS
“Desirable” effects
Effects vary widely based on dose size, setting, and the user’s expectations and
personality (called “set and setting”):
• Heightened sensory experiences (e.g., • Preoccupation with trivial thoughts,
brighter colors, sharper visual experiences, or objects
definition,increased • Intense emotions
• hearing acuity, more distinguished taste) • Altered sense of time and self
• Vivid mental images and distorted vision • Synesthesia: Experiences seem to cross
• Altered space and time perception over different senses, giving the user the
• Joy, exhilaration feeling of hearing colors and seeing sounds
• Distorted sense of body (feeling either • Dreaminess
weighed down or weightless) • Introspection
• Loss of sense of reality; melding past • Hallucinations
experiences with present
4. HALLUCINOGENS
Side effects
• Intense nausea and vomiting (very • Dilated pupils
common with peyote) • Increased body temperature
• Appetite suppression • Increased heart rate and blood pressure
• Elevated body temperature and sweating. • Sweating
• Chills and shivering • Loss of appetite
• Highly adverse reactions (“bad trip”), • Sleeplessness
including frightening hallucinations, • Dry mouth
confusion,disorientation, paranoia, • Tremors
agitation, depression, panic, and/or terror • Difficult focusing, maintaining attention,
• Difficulty focusing, maintaining attention, concentrating, and thinking
concentrating, and thinking
4. HALLUCINOGENS
Possible medical consequences with chronic use
• Highly adverse reactions (“bad trip”), including suddenly, often without warning, and may
frightening hallucinations, confusion, occur within a few days or more than a year
disorientation, paranoia, agitation, depression, after LSD use; in some individuals, the
panic, and/or terror flashbacks can persist and cause significant
• Impaired reasoning and loss of judgment distress or impairment in social or
leading to extremely dangerous behavior occupational functioning, a condition known
• Worsening symptoms of existing mental illness as hallucinogen-induced persisting perceptual
or causing earlier onset of psychosis in a disorder
susceptible individual • Possible prolonged psychotic state similar to
• Flashbacks or recurrences of certain aspects that of paranoid schizophrenia insusceptible
of the drug experience; flashbacks occur individuals

Withdrawal syndrome
None
5. OTHERS
5.1 Dissociative anesthetics (phencyclidine [PCP], ketamine)
5.2 Inhalants solvents, gases, nitrites
5.3 Cannabinoids (marijuana, hashish)
5.4 Khat/Miraa
5. OTHERS

5.1 Dissociative anesthetics

Origin
Dissociative anesthetics include phencyclidine (PCP) and ketamine. Both are synthetic.

Appearance
• PCP: White crystalline powder; often processed into a liquid, tablets, or capsules
• Ketamine: Manufactured as a liquid; typically evaporated into a powder for illicit use

Mode of administration
• Oral
• Sprinkled on marijuana and smoked
• Inhaled intranasally

Medical uses
PCP and ketamine have been used as anesthetics in veterinary medicine. Ketamine is used in human
medicine in some cases. PCP was never approved for human use because of extreme side effects.
https://www.drugabuse.gov/sites/default/files/hallucinogensrrs4.pdf
5. OTHERS

5.1 Dissociative anesthetics

“Desirable” effects
• Both are dissociative drugs, meaning that they distort perceptions of sight and sound and produce
feelings of detachment (dissociation) from the environment and self
• Feelings of strength and power
• Relaxation
• Mild euphoria

Side effects
• Mood disturbances: anxiety and depression • Blurred vision
• Shallow breathing and increased breathing rate • Delirium (hallucinations or disorientation)
• Flushing • Increased heart rate and blood pressure
• Sweating • Impaired motor function
• Numbness in extremities • Numbness
• Nausea and vomiting • Depression
• Loss of coordination • Dizziness
• Decreased pain response • Anger, aggression, and violence
5. OTHERS

5.1 Dissociative anesthetics

Possible medical consequences with chronic use
• Seizures • People who have abused PCP for long
• PCP causes symptoms that mimic periods have reported memory loss,
schizophrenia, such as delusions, difficulties with speech and thinking,
hallucinations, paranoia, disordered depression, and weight loss; these
thinking, and a sensation of distance from symptoms can persist up to 1 year after
one’s environment stopping PCP abuse
• Because PCP can have depressant effects, • Severe depression with suicidal thoughts
interactions with other depressants, such as and attempts
alcohol and benzodiazepines, can lead to • Injuries from accidents and fights.
respiratory depression and coma

Withdrawal syndrome
None known
5. OTHERS

5.2 Inhalants
Origin
Inhalants generally fall into the following four categories:
5.2.1 Volatile solvents: Liquids that vaporize at room temperature:
• Industrial or household products, including paint thinners or removers, degreasers, drycleaning fluids, gasoline, and
lighter fluid
• Art or office supply solvents, including correction fluids, felt-tip marker fluid, electronic contact cleaners, and glue
5.2.2 Aerosols: Sprays that contain propellants and solvents:
• Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol
computer cleaning products, and vegetable oil sprays
• Gases: Found in household or commercial products and used as medical anesthetics
• Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or
dispensers (whippets), and refrigerant gases
5.2.3 Medical anesthetics, such as ether, chloroform, halothane, and nitrous oxide:
5.2.4 Nitrites: A special class of inhalants that are used primarily as sexual enhancers
• Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as “poppers”
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5.2 Inhalants
Mode of administration
Inhaled in a variety of ways:
• Sniffing fumes directly from the container
• Spraying aerosols directly into the nose or mouth
• Placing an inhalant-soaked rag in the mouth
• Inhaling fumes from a balloon or a plastic or paper bag that contains the
inhalant
The intoxication produced by inhalants usually lasts just a few minutes. Users
often try to extend the “high” by continuing to inhale repeatedly over several
hours.
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5.2 Inhalants
Medical uses
Mostly none, although:
• Amyl nitrite is still used in certain diagnostic medical procedures
• Nitrous oxide is used as an anesthetic, particularly for dental procedures

“Desirable” effects
• Euphoria • Lessened inhibition and anxiety
• Giddiness • Hallucinations
Side effects
• Headache • Drowsiness
• Confusion • Slurred speech
• Nausea and vomiting • Lack of coordination
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5.2 Inhalants
Possible medical consequences with chronic use
• Hearing loss (spray paints, glues, • Bone marrow damage (gasoline)
de-waxers, dry-cleaning chemicals, • Liver and kidney damage
correction fluids) (correction fluids, dry-cleaning
• Peripheral neuropathies or limb fluids)
spasms (glues, gasoline, whipped • Blood oxygen depletion (varnish
cream dispensers, gas cylinders) removers, paint thinners).
• Central nervous system or brain
damage (spray paints, glues, de-
waxers)
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5.2 Inhalants
Possible medical consequences with chronic use
Long-term inhalant abuse can also break down myelin, a fatty tissue that surrounds and
protects some nerve fibers. Damage to myelin can lead to muscle spasms and tremors or
permanent difficulty with basic actions such as walking, bending, and talking.
Sniffing highly concentrated amounts of the chemicals in solvents, butane, propane, or
aerosol sprays can directly induce heart failure and death within minutes of a session of
repeated inhalation, even in a single session by an otherwise healthy young person.
High concentrations of inhalants may also cause death from suffocation by displacing oxygen
in the lungs, causing the user to lose consciousness and stop breathing.
Deliberately inhaling from a paper or plastic bag or in a closed area greatly increases the
chances of suffocation.
Withdrawal syndrome
None
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5.3 Cannabinoids (marijuana, hashish)

Origin
Natural; derived from the plant Cannabis sativa.
Appearance
• Marijuana: Dry, shredded green and brown mix of flowers, stems, seeds,
and leaves.
• Hashish: The concentrated, sticky resin of marijuana; can be pressed
into cakes or further concentrated into oil.

Modes of administration
• Smoked (in a pipe or rolled into cigarette papers or cigars). Hashish oil is
typically dripped onto dry marijuana to increase potency. The effects of
smoking are typically felt within a few minutes and generally wear off
within two to three hours.
• Oral (mixed with food or brewed into tea). When substance is eaten,
effects typically do not appear for 30 to 60 minutes but can last up to six
hours. Photos from:
https://www.drugabuse.gov/publications/drugfacts/marijuana
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5.3 Cannabinoids (marijuana, hashish)

Medical uses
In some countries, Marinol (a tablet) or smoking marijuana is sometimes used to treat
glaucoma because it reduces pressure in the eyes. It is used to decrease nausea in
patients receiving chemotherapy and to increase appetite in AIDS patients.

“Desirable” effects
• Physical relaxation, sedation • Giddiness
• Exaggerated mood • Changes in sensory and time
• Heightened empathy for others perception
• Heightened suggestibility • “Trailing” phenomenon (seeing
• Heightened novelty: even mundane afterimages of a moving object)
objects seem interesting • Increased appetite
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5.3 Cannabinoids (marijuana, hashish)

Side effects
• Increased heart rate and blood pressure
• Bloodshot eyes (resulting from increased blood flow through mucous
membranes in the eyes)
• Decreased muscular coordination
• Poor depth perception and tracking (ability to follow a moving object)
• Lung irritation and coughing
• Difficulty thinking and solving problems
• Panic reactions (pounding heart, extreme anxiety and fear, sweating,
dizziness)
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5.3 Cannabinoids (marijuana, hashish)

Possible medical consequences with chronic use
Respiratory problems (most severe in those who also smoke cigarettes), including:
• Chronic cough and bronchitis
• Damaged lung tissue
• Increased phlegm production and reduced ability to clear it
• Frequent respiratory illnesses
• Decreased cognitive/intellectual functioning
• Delayed emotional development
• Suppressed immune function that can lead to increased susceptibility to viral and bacterial infections
and can accelerate progression of HIV/AIDS
• Problems with short-term memory and learning that can last for days or weeks after last use
• At high doses, acute psychotic reactions in susceptible individuals, including triggering chronic
schizophrenia in those genetically predisposed
• Long-term use may lead to a motivational syndrome: reduced energy and ability to concentrate,
reduced desire to work, reduced interest in social or other activities
• At high doses, marijuana may worsen clinical depression
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5.3 Cannabinoids (marijuana, hashish)

Withdrawal syndrome
In addition to drug craving, people who use marijuana over a long term report:
• Irritability
• Sleeplessness
• Decreased appetite

Symptoms begin within about one day following abstinence, peak at two to three days,
and subside within one or two weeks.

Withdrawal from marijuana is not physically dangerous and does not require treatment.
Nicotine
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5.4 Khat/Miraa
Origin
Miraa is a plant containing cathinone and cathine, the
active chemicals that alter the mood of the user.
Appearance
Miraa/Khat (Catha edulisForsk, Celastraceae family) is
a leafy green shrub that can grow to tree size.

Modes of administration
• Fresh leaves and soft twigs are chewed
Photo from:
http://www.livescience.com/37948-what-is-khat-cathinone.html

• Less commonly, it can be consumed as a tea or

smoked
Medical uses
None
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5.4 Khat/Miraa
“Desirable” effects Side effects
• Mild euphoria • Loss of appetite
• Alertness • Sexual dysfunction
• Excitement • Insomnia
• Energy • Gastrointestinal problems
(such as constipation)
• Oral inflammation
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5.4 Khat/Miraa
Possible medical consequences with chronic use
• Oral cancer • If khat is used during pregnancy, the baby
• Depression may be born smaller than other babies
• Increase in severity of psychological • Chewing khat appears to reduce breast
problems milk production

Withdrawal syndrome
Heavy khat chewers have been shown to experience withdrawal symptoms such as:
• Minor laziness • Extreme tiredness and lack of energy
• Mild depression • Difficulty performing normal daily activities
• Nightmares • Slight trembling several days after having
• Slight tremor stopped chewing khat