Crack (Crack Cocaine) Abuse and Addiction

Crack cocaine is a solid, smokable cocaine that is made using baking soda or sodium hydroxide in a process to convert powder cocaine into a freebase form of the drug.

Crack cocaine, when processed correctly, may contain most of the original cocaine alkaloid as it did before being what is called on the streets as buffed.  Buffing cocaine is the process of adding different substances, usually chemicals closely related to the original alkaloid, in attempts of increasing the size of the yielded product.

Crack cocaine is one of the most addictive “street drugs” available, with an estimated 500,000 regular users in the U.S. today.

Crack cocaine affects brain chemistry, causing euphoria, supreme confidence, loss of appetite, insomnia, alertness, increased energy, craving for more cocaine and potential paranoia between doses.  Its initial effect is to release a large amount of dopamine, a brain chemical inducing euphoric feelings, with the high lasting 5-10 minutes, followed by plummeting dopamine levels that lead to feelings of depression.

The levels of dopamine in the brain take a long time to replenish themselves, so rapid doses of the drug lead to increasingly less intense highs. However, a person might binge for 3 or more days without sleep, while partying with occasional hits from the pipe.

The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure.  Large amounts (several hundred milligrams or more) intensify the user’s high, but may also lead to bizarre, erratic, and violent behavior and can also induce tremors, vertigo and paranoia.  Some users of cocaine report feelings of restlessness, irritability, and anxiety.  In rare instances, sudden death can occur on the first use of cocaine or unexpectedly afterwards.

Crack-related deaths are often a result of a heart attack or seizures followed by respiratory arrest.

When large amounts of dopamine are released by crack consumption, it becomes easier for the brain to generate motivation for other activities. The activity also releases a large amount of adrenaline into the body, which tends to increase heart rate and blood pressure, leading to long-term cardiovascular problems.

Binging on cocaine, when the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia.

This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.  Stimulant drug abuse (particularly amphetamine and cocaine) can lead to delusional parasitosis, a mistaken belief they are infested with parasites and feel them crawling under their skin.  These delusions are also associated with high fevers or extreme alcohol withdrawal, often together with visual hallucinations about insects.  People experiencing these hallucinations might scratch themselves to the extent of serious skin damage and bleeding, especially when they are delirious.

Tolerance inevitably develops over prolonged use.  Some users will increase their doses more and more frequently to intensify and prolong the euphoric effects.  Users can also become more sensitive to cocaine’s anesthetic and convulsant effects.  This increased sensitivity may explain some deaths occurring after low doses of cocaine.

One of the more dangerous trends among users is “speedballing” or “snowballing” (mixing cocaine with heroin).  studies show that this combination leads to a higher rate of fatalities than either drug used on its own.

Mothers who use cocaine during the early months of pregnancy run the risk of miscarriage.  Later in pregnancy, it can trigger preterm labor (labor that occurs before 37 weeks of pregnancy) or cause the baby to grow poorly.  Low-birthweight babies are 20 times more likely to die in their first month of life than normal-weight babies, and face an increased risk of lifelong disabilities such as mental retardation and cerebral palsy.

Crack Cocaine is a powerfully addictive drug.  Even with short term use, many individuals experience withdrawal symptoms when they stop using. The symptoms are more pronounced in individuals who have been using crack for a long time and in high doses.

Withdrawal symptoms include intense cravings, irritability, hunger, anxiety and paranoia.

Medical treatment for crack abuse and addiction is highly recommended.  The physical and psychological dependence of crack is intense and most people find it extremely difficult to escape the addictive cycle.  Medical detoxification is usually required, and should be followed by psychotherapeutic and social counseling, ongoing peer support, and social reintegration.

Opium Abuse and Addiction

Opium is a dried liquid obtained from opium poppies which contains up to 12% morphine.  Morphine is the alkaloid that is used to produce heroin for the illegal drug trade.

Being of similar structure, the opiate molecules occupy many of the same nerve-receptor sites and bring on the same analgesic effect as the body’s natural painkillers.

Opiates first produce a feeling of pleasure and euphoria, but with their continued use the body demands larger amounts to reach the same sense of well-being.  Malnutrition, respiratory complications, and low blood pressure are some of the illnesses associated with long-term use.  Morphine is also responsible for harmful effects such as lung edema, respiratory difficulties, and even cardiac or respiratory collapse.

Long-term use of morphine in chronic pain management can lead to physical dependence.  Chronic pain patients will find that, at an appropriate dose of medication, tolerance to the euphoric effects develops while pain is successfully controlled for years at the same dose. A drug abuser posing as a pain patient will quickly develop tolerance to the euphoric side-effects of the opiate he is prescribed for pain.  As a result, such patients will demand an increase in their dose more often.

Opium, like almost all illicit substances, causes withdrawal symptoms when use is stopped or temporarily interrupted.  The desire to avoid the sometimes intolerable feelings of withdrawal keeps many opium users using despite the negative consequences.

Opium withdrawal symptoms include: nausea, sweating, diarrhea, mood swings, insomnia, depression and muscle twitching.

Pharmacologically based treatments are available, including naltrexone, methadone or ibogaine.  However, it should be emphasized that these treatments are for those suffering from true opioid addiction, and not from physical dependence resulting from the appropriate use of opioids for chronic pain.

In the event that a patient with chronic pain no longer suffers from the same degree of pain, it is not difficult for the patient and treating physician to gradually taper down the prescribed opioids until the patient has entirely discontinued opioids use.  Of course this is only possible if the patient’s underlying pain has been mitigated, successfully treated, or otherwise been resolved.

Methcathinone Abuse and Addiction

Methcathinone is a stimulant drug similar to methamphetamine.  It is an illegal recreational drug and is considered highly addictive.  It is usually snorted, but can be smoked, injected or taken orally.  Some of the its more common street names include: MCat, Meow, Bathtub Speed, Kitty and Meth’s Cat.  Methcathinone is currently a Drug Enforcement Agency (DEA) Schedule I controlled substance in the United States.

Chronic high dosage of methcathinone may result in acute mental confusion ranging from mild paranoia to psychosis.

These symptoms typically disappear quickly if use is stopped. Unlike methamphetamine, methcathinone is not legal under any circumstances in the US due to its classification as a Schedule I substance. Conversely, methamphetamine has certain medical uses such as treatment of morbid obesity, narcolepsy and ADHD.

The effects of methcathinone are similar to methamphetamine, although sometimes considered less intense and more euphoric.  The effects have been compared to those of cocaine, since it regularly causes hypertension (elevated blood pressure) and tachycardia (elevated heart rate).  Other effects include increased alertness, rapid breathing, inability to stop talking, increased empathy and communication, both decreased and increased sexual function and desire, and loss of cognitive ability.

Methcathinone can be highly psychologically addictive and can produce methamphetamine-like withdrawals.

Abrupt cessation of long-term use, or even high-volume short term use, of methcathinone is commonly followed by depression, anxiety, and craving for the drug.  Withdrawal is usually followed by fatigue and a “crash.” Upon awakening there is continued sleepiness, depression and anhedonia (an absence of feeling).  Anergia (lack of energy) is typical as the patient will rarely arise for anything other than a need to go to the bathroom.  Mood generally returns after several days although in some cases anhedonia and anergia can last for several weeks.

Cravings for the drug may continue for several weeks to several months.

Users relapse when anhedonia and dysphoria are present, and reinitiate use in an effort to avoid the “crash.”  Relapse is also connected with exposure to stimuli which evoke memories of the euphoric effects of the drug.

Treatment for methcathinone addiction includes supportive therapy and specialized treatment by medical professionals.

Tryptamine Abuse and Addiction

Tryptamine is an alkaloid found in in plants, fungi and animals, and is chemically related to the amino acid tryptophan from which its name is derived.

Tryptamine is found in trace amounts in the brains of mammals and is believed to play a role as a neuromodulator or neurotransmitter.

Tryptamine is also the backbone for a group of compounds known collectively as tryptamines.  This group includes many biologically active compounds including neurotransmitters and psychedelic drugs.  The best-known tryptamines are serotonin, an important neurotransmitter, and melatonin, a hormone involved in regulating the sleep-wake cycle.

Tryptamine alkaloids found in fungi, plants and animals are commonly used by humans for their psychotropic effects.

Prominent examples of tryptamines include psilocybin (known as “magic mushrooms”) and DMT (from numerous plant sources, e.g. chacruna, often used in ayahuasca brews).  Many synthetic tryptamines have also been made, including the migraine drug sumatriptan, bufotenine, DMT (dimethyl tryptamine), AMT (a-Methyl tryptamine), and others.

Synthetic tryptamines are psychoactive agents which mimic the naturally occurring neurotransmitter tryptamines, but which produce psychedelic effects similar to LSD.

Behavioral effects of synthetic tryptamines tend to be more bizarre than most hallucinogens, and include paranoia and psychosis.  Some tryptamines are also physically toxic, producing effects such as vomiting, sweating, and respiratory and cardiac difficulties.

Tryptamines have become a common “party drug” and should be suspected in any case of sudden, unexplained, bizarre behavior, especially in persons in the age range of 14-25 years.

Rohypnol Abuse and Addiction

Rohypnol is a strong hypnotic sedative, anticonvulsant, anxiolytic, amnestic, and skeletal muscle relaxant drug.  Rohypnol is sold in other countries under the trade names Flunitrazepam, Hipnosedon, Hypnodorm, Flunipam, Nilium, Vulbegal, Silece, Darkene, Ilman, Insom and Fluscand.  The street name for Rohypnol is “roofie.”

Despite the fact that Rohypnol is still classified as a Schedule IV controlled substance, it is no longer commercially available in the United States.

Due to its misuse and overuse, particularly as a so-called “date rape” drug, the DEA is recommending that Rohypnol be reclassified to Schedule I.

Rohypnol was prescribed for treatment of chronic or severe insomnia in patients that were not responsive to other hypnotics.  It was intended to be administered on a short-term basis under controlled conditions such as with inpatient treatment.

Rohypnol became known as a “date rape” drug due to its high potency, sudden and strong effects, and its ability to cause amnesia during its duration.

Individuals who have been given Rohypnol without their knowledge are unable to remember events that they experienced while under the influence of the drug.  Victims of sexual assault may be unable to clearly recall the assault, the assailant, or the events surrounding the assault.

Rohypnol is also frequently as a recreational drug by high school and college students, particularly at so-called “rave parties.”  It is also used by heroin or opiate users to increase the effects of these drugs or to ease the effects of withdrawal.  Cocaine and methamphetamine users often use Rohypnol to counteract insomnia, paranoia, and tremors, or to soften the so-called “crash” which follows heavy stimulant use.

Adverse effects include both physical and psychological dependence, reduced sleep quality resulting in somnolence, and overdose resulting in excessive sedation, impairment of balance and speech, respiratory failure, coma, and death.

Prolonged and high-dosage use of Rohypnol can lead to physical dependence as well as and what is known as the “benzodiazepine withdrawal syndrome,” which is characterized by seizures, psychosis, severe insomnia and extreme anxiety.  Rebound insomnia, worse than baseline insomnia, typically occur after discontinuation of Rohypnol, even after short term use.

Rohypnol can create paradoxical symptoms in some individuals, including anxiety, agitation, confusion, talkativeness, loss of impulse control, violent behavior, and convulsions.

Overdose of Rohypnol may result in excessive sedation, impairment of balance, and slurred speech.  Severe overdoses may result in respiratory failure, coma, and possibly death.

Risk of overdose is increased if the drug is taken in combination with depressants such as alcohol and opiates.

Methamphetamine Abuse and Addiction

Methamphetamine is a psychoactive stimulant that increases alertness and energy, and in high doses, can induce euphoria, enhance self-esteem and increase sexual pleasure.  Methamphetamine is FDA approved in the United States for the treatment of ADHD and some forms of obesity, under the trademark name, Desoxyn.

Methamphetamine has a high potential for abuse, activating the psychological reward system by increasing levels of dopamine, norepinephrine and seratonin in the brain.

Methamphetamine is a potent central nervous system stimulant that affects neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions.  Users experience an increase in focus, increased mental alertness, and the elimination of fatigue, as well as a decrease in appetite.

Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, energy, self-esteem, self-confidence, sociability, irritability, aggression, psychosomatic disorders, hubris, excessive feeling of power and invincibility, repetitive and obsessive behaviors, paranoia, and with chronic and/or high doses, amphetamine psychosis.

Withdrawal is characterized by excessive sleeping, increased appetite and depression, often accompanied by anxiety and drug-craving.

Regular use can lead to amphetamine-induced psychosis, though for most patients these symptoms will stop within 7–10 days of discontinuing the drug.  However, a small percentage of long-term or “heavy” users will continue experiencing intermittent psychotic episodes (experiencing hallucination, delusions, and/or paranoia) on an ongoing basis within the first year of abstinence.  Although not common, these users offer some anecdotal evidence about the neurotoxicity of long-term amphetamine use, and the healing process that a user experiences when these neurotoxic effects are either partially or fully reversed.

Spontaneous and long-term recurrences (akin to “flashbacks”) are hypothesized to be triggered (or exacerbated) by high stress and by sleep deprivation.  In extremely rare cases, this condition is documented to persist beyond one year.

The key distinction between amphetamine psychosis and a psychotic disorder or schizophrenia is that the symptoms will eventually subside, but only with abstinence and proper treatment.

PCP (Phencyclidine) Abuse and Addiction

Phencyclidine (PCP) is a dissociative drug formerly used as an anaesthetic that creates both hallucinogenic and neurotoxic effects.   It is a member of the family of dissoaciative anesthetics and is significantly more dangerous than other categories of hallucinogens.  It is classified as a Schedule II substance in the U.S.

Although the primary psychoactive effects of PCP lasts for just a few hours, the total elimination rate from the body typically extends 8 days or longer.

PCP was initially used as a surgical and veterinary anesthetic but due to adverse side effects of hallucinations, mania, delirium and disorientation, and also due to its long half-life in the human body, the drug is considered unsuitable for medical applications.

PCP comes in both powder and liquid forms.  PCP base powder is usually dissolved in either.  It is often sprayed onto leafy material such as cannabis, mint, oregano, parsley or ginger leaves, and then smoked.

Behavioral effects vary with dosage. Small doses produce intoxication  and numbness in the extremities, characterized by unsteady gait, slurred speech, bloodshot eyes, and loss of balance.  Moderate doses will produce analgesia and anesthesia.  High doses may cause convulsions.

Psychological effects include severe changes in body image, loss of ego boundaries, and depersonalization.  Hallucinations and eurphoria are reported infrequently. The drug has been known to alter mood states in an unpredictable fashion, causing some individuals to become detached, and others to become animated.

Intoxicated individuals may act in a highly unpredictable fashion, possibly driven by their delusions and hallucinations.

PCP induced behavior has included physical attacks on others, destruction of property, self-harming, and suicide.  Some researchers believe that the analgesic properties of the drug can cause users to feel less pain, and that they can then persist in violent or injurious acts.

Large recreational doses of the drug can induce a psychotic state that resembles schizophrenic episodes, and which can last for months at a time.

Medical and law enforcement personnel remember the symptoms of PCP intoxication by using the mneumonic device RED DANES, which stands for: rage, erythema (skin redness), dilated pubils, delusions, amnesia, nystagmus (oscillation of the eyeball when moving laterally), excitation and skin dryness.

Management of PCP intoxication mostly consists of physically supportive care such as controlling breathing, circulation, and body temperature, followed by treatment of the psychiatric symptoms.  Benzodiazepines, are used to control agitation and seizures when present.  Antipsycholtics have been used to control psychotic symptoms.  Ongoing psycho-social treatment is often recommended for long-term users who show signs of dependence.

Morphine Abuse and Addiction

Morphine is an extremely potent opiate analgesic drug.  In clinical medicine, morphine is regarded as the benchmark for analgesics used to relieve pain due to its effectiveness. Like other opioids OxyContin, Percocet, Percodan,Dilaudid, and diamorphine (heroin), morphine acts directly on the central nervous system to relieve pain.

Morphine has a high potential for addiction because tolerance and dependence develop very rapidly.

Morphine was the most commonly abused analgesic in the world until diamorphine (heroin) was synthesized.  Morphine became a controlled substance in the U.S. in 1914.  Possession without a subscription is a criminal offense.

The common effects of morphine euphoria, heightened ambition, nervousness, relaxation, and drowsiness.  when taken in large doses a very serious narcotic habit can develop in a matter of weeks.

The withdrawal symptoms of morphine are usually experienced within 6 to 12 hours of the last administration.  Symptoms include watery eyes, insomnia, diarrhea, runny nose, yawning, dysphoria, sweating and in most cases a strong drug craving.  As withdrawal progresses, severe headache, restlessness, irritability, loss of appetite, body aches, severe abdominal pain, nausea, and uncontrollable tremors may occur.  Craving for the drug continues to increase, and severe depression and vomiting are very common.

If withdrawal becomes acute, heart rate and blood pressure increase significantly, leading to possible heart attack or stroke.

Chills or cold flashes with goose bumps (“cold turkey”) alternating with flushing (hot flashes), kicking movements of the legs (“kicking the habit”) and excessive sweating are also characteristic symptoms.  Severe pains in the bones and muscles of the back and extremities occur, as do muscle spasms.  At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms.

Major withdrawal symptoms peak between 48 and 96 hours after the last dose and subside after about 8 to 12 days.  Psychological withdrawal from morphine, however, is a very long and painful process.  Addicts often suffer severe depression, anxiety, insomnia, mood swings, amnesia, low self-esteem, confusion, paranoia, and other psychological disorders.

Without treatment, the psychological dependence on morphine can last a lifetime.  There is a good chance that relapse will occur unless a change occurs in both the physical environment and behavioral motivators that contributed to the abuse.  Abusers of morphine (and heroin), have one of the highest relapse rates among all drug users.

In addition, opiate addicts show increased risk of infection such as increased pneumonia, tuberculosis and HIV.  This has led scientists to believe that morphine may also affect the immune system, further indicating a need for medically supervised detoxification.

Self detoxification from morphine is rarely successful and can be dangerous.  Morphine addiction withdrawal can cause physical and emotional trauma.  Methadone or other illicit drugs are often used to ease the distress of morphine withdrawal, creating a potential for further abuse.

The most successful detoxification and withdrawal scenario involves an inpatient setting removed from the normal stresses of living and the routines of the patient’s morphine addiction.  Medically supervised detoxification, followed by social therapy and psychotherapy, offers the best chance for a full recovery.

Mescaline Abuse and Addiction

Mescaline is a natural alkaloid that occurs in the peyote cactus and the San Pedro cactus.  It is an hallucinogen that is mainly used as a psychoactive substance in religious or spiritual practices.  It is also used as a recreational drug.

Tolerance grows with repeated usage, lasting for a few days.  Use of mescaline also causes cross-tolerance with LSD and other psychedelics. About half the initial dosage is excreted after 6 hours, but some studies suggest that it is not metabolized at all before excretion.

Mescaline hallucinations are different from those of LSD. Hallucinations are consistent with actual experience, but are typically magnified by the stimulus properties of objects and sounds.

Mescaline elicits a pattern of sympathetic arousal, with the peripheral nervous system being a major target for this drug with effects lasting up to 12 hours.  Mescaline is, however, much less potent than similar hallucinogens, like LSD and psilocybin.

Mescaline can also cause users to become irrational in their thinking or the user may experience feelings of anxiety and waves of hatred.  Headaches, dizziness, and nausea are common side effects as well.  Mescaline use can also accelerate the users heart rate, sometimes to an unhealthy level that could be fatal.

Large doses of mescaline can lower the body’s glucose level, possibly causing unconsciousness, or can induce convulsions, heart failure, and death due to respiratory failure.

Although mescaline does not create a physical dependency in users, the drug can be addictive due to the possibility of psychological dependency.  There are several dangers which are associated with mescaline, despite it’s reputation as a relatively mild hallucinogen.  First, there is the risk of entering states of what amount to temporary mental illness.  Users can go through periods of intense fear and anxiety, leading them to do foolish things.  In extreme cases, tranquilizers might even need to be used to control the reaction.

Mescaline can produce intensely terrifying thoughts and fears, magnifying sensation to the point where they become unbearable.

Long-term effects of mescaline can include flashbacks, which is a re-occurrence of hallucinations long after the drugs have left the user’s system.  These effects can occur after a single experience with the drug, and the scientific community is still puzzled as to why this happens.

MDMA Abuse and Addiction

MDMA, commonly known as Ecstasy, is an psychoactive drug that acts primarily on the central nervous system where it alters brain function that results in changes in mood, perception, consciousness and behavior.

Ecstasy is valued as a recreational drug for its tendency to induce a sense of intimacy with others along with diminished feelings of fear, anxiety, and depression.

MDMA is one of the most widely used recreational drugs in the world and is taken in a variety of contexts far removed from its roots in psychotherapeutic settings.  It’s most common association is with large electronic music dance parties known as “raves.”  MDMA is criminalized in most countries in the world and its possession, manufacture and sale is subject to arrest and prosecution.

There is some controversy within scientific, health care, and drug policy circles about the risks of MDMA, specifically regarding possible neurotoxic damage to the brain.

Before it was made a controlled substance, MDMA was used as an augmentation to psychotherapy, often couples therapy, and to help treat clinical depression and anxiety disorders.  Clinical trials are now testing the therapeutic potential of MDMA for post-traumatic stress disorder (PTSD) and anxiety associated with terminal cancer.

MDMA is occasionally known for being taken in conjunction with a number of substances including psychedelic drugs, such as LSD (“candy flipping”) or psilocybin mushrooms (“hippy flipping”), or even common drugs such as marijuana.  It has also been combined with ketamine (“kitty flipping”) and some even take mentholated products such as menthol cigarettes and lozenges after taking Ecstasy for their cooling sensation while experiencing the drug’s effects . This can have a harmful result on the upper respiratory tract.

A number of treatment options are available to treat Ecstasy dependence, usually involving detoxification, counseling, and behavior modification.

While abstinence may be a suitable management plan for those who have only used MDMA for the short term, it is not recommended  or long-term users.  Those who have used Ecstasy for a prolonged period can experience severe withdrawal symptoms, which can lead to serious medical complications including cardiovascular problems.

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