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General Questions

1Drug and Substance Abuse
The abuse of drugs or other substances, whether they are illegal drugs or prescription drugs, alcohol, or tobacco is one of the nation's most pressing public health issues. Drug abuse occurs when people willingly consume illegal substances or legal, prescription drugs for the purpose of altering their mood, or getting “high”. Regular drug abuse may lead to drug addiction or other bodily harm. Drug abuse usually involves selling, buying or abusing these substances, which can lead to arrest, criminal charges, and imprisonment.

The term “drug abuse” is often associated with illegal drugs such as cocaine, heroin, or marijuana. More recently, dangerous designer drugs such as bath salts or club drugs such as ecstasy have become increasingly popular.

Designer drugs are synthetic chemicals altered in often unknown ways to produce substances that may be more potent, and frequently more dangerous.

  • Designer drugs may resemble the effects of other illegal drugs, because the chemical formula of a designer drug is manipulated, they often cannot be classified as illegal until state or federal regulations are changed.
  • Club drugs are used by youth in all-night “rave” or dance parties, at bars and at concerts for their psychoactive effects.

Recent surveys have reported that the rates of alcohol and tobacco use by the nation’s youth are declining; however, the use of illicit drugs by America’s teenagers continues to be the highest of any country in the world.

Abused substances are not always illegal
  • Drug abuse can also occur with legal prescription drugs used in illegal ways. The levels of prescription narcotic abuse in the U.S. surpasses the abuse of many illegal drugs. The unlawful use of steroids as performance enhancing drugs, seen in college-level, Olympic and professional sports has resulted in a unique set of international anti-doping standards.
  • Alcohol and cigarette tobacco (nicotine) use, although declining in teenagers, remains as some of the most abused substances in the U.S. Alcoholism, chronic liver disease, emphysema, lung cancers and death are the ultimate outcome of many of the legal substances that are frequently abused in the nation.
2Drugs and substances commonly abused
The following list outlines common drugs or other substances of abuse. Sections include descriptions, extent and methods of abuse, typical user experience, health and pregnancy hazards:
  • GHB
3What is Medically Managed Detox?
According to the American Society of Addiction Medicine (ASAM)’s criteria levels of care, there are five types of detoxification strategy that may be administered to patients with alcohol or substance abuse disorders. Two of these strategies involve medically monitored detoxification for the more intense cases of withdrawal: Level III.7-D and Level IV-D.Level III.7-D is medically monitored inpatient detoxification and is used to treat severe cases of withdrawal. Patients assigned to this level of treatment require 24-hour nursing care and physician supervision, evaluation, withdrawal management and visitation when necessary. It usually takes place within a licensed health care facility, rehabilitation facility or a freestanding detoxification center. If the patient experiences no complications after two to three days at Level III.7-D, then staff may place the patient in a lower level of detoxification, such as Level III.5-D, which involves a therapeutic community, providing continued support during withdrawal, structural support during risk of relapse and reinforcing commitment to the program.Level IV-D is medically managed intensive inpatient detoxification and is used to treat severe and unstable cases of withdrawal. These patients require 24-hour nursing care and daily physician visitation. This level of care is similar to the medical setting provided in Level III.7-D, but patients at Level IV-D require primary medical and nursing care services. Treatment may take place in a psychiatric hospital, general care hospital or a chemical dependency specialty care facility with life-support equipment available.
4What is the difference with Inpatient and Outpatient Treatment for Substance Abuse - Topic Overview
Inpatient and Outpatient Treatment for Substance Abuse

If you have a drug or alcohol problem, your doctor may suggest treatment at an inpatient or outpatient facility. At inpatient facilities, you stay overnight. At outpatient facilities, you come only during the day. How long you stay varies among programs.
5How are inpatient and outpatient treatment similar?
Inpatient and outpatient treatment programs both usually involve the 12-step program used by Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Treatment may include group therapy, one-on-one counseling, drug and alcohol education, medical care, and family therapy.

Your doctor or counselor will help you decide whether you should have inpatient or outpatient treatment. The choice may depend on:
  • How severe your addiction is.
  • Your mental health.
  • Your family support.
  • Your living situation.
  • How the treatment will be paid for.

Inpatient treatment
Inpatient treatment may be part of a hospital program or found in special clinics. You'll sleep at the facility and get therapy in the day or evening.
Inpatient treatment may be a good option if:
  • You've tried outpatient treatment but it didn't work.
  • You have other physical or mental health problems.
  • Your home situation makes it hard to stay away from drugs or alcohol.
  • You don't live near an outpatient treatment clinic.

You may stay for 1 to 6 weeks, depending on how your recovery is going. After inpatient treatment, you should go to outpatient treatment for more counseling and group therapy. Inpatient treatment also may be residential, which means you stay at the facility for months.

Outpatient treatmentOutpatient treatment happens in mental health clinics, counselors' offices, hospital clinics, or local health department offices. Unlike inpatient treatment, you don't stay overnight.

Outpatient programs can be a challenge because you may continue to face problems at work and home. But it will help you build the skills you need to handle everyday problems.

In standard outpatient treatment, you may have 1 or 2 group therapy sessions a week. Treatment may go on for a year or more. Sessions may be in the evening or on weekends so you can go to work.

Intensive outpatient treatment (IOP) usually involves around 10 to 20 hours of counseling or group therapy spread over 3 days a week. This may last for 1 to 3 months. A more intensive form of outpatient treatment is day hospital. This means you go for treatment 5 days a week, usually for most of the day.
6What are Turning Leaf Recovery Network's Customer Service Hours ?
Of course! Our friendly and knowledgeable admission specialist are available to answer your general questions: Monday thru Friday 7am until 7pm MST.

Emergencies please contact your local emergency room or dial 911 immediately.


Common or street names: Flakka, Ivory Wave, Vanilla Sky, Cloud Nine, Blue Silk, Purple Sky, Bliss, Purple Wave, Red Dove, Zoom, Bloom, Ocean Snow, Lunar Wave, White Lightening, Scarface, Hurricane Charlie, Drone, Energy-1, Meow Meow, Sextasy, Ocean Burst, Pure Ivory, Snow Leopard, Stardust, White Night, White Rush, Charge Plus, White Dove, plant fertilizer, plant food
Psychoactive bath salts (PABS) are a designer drug of abuse that has led to reports of dangerous intoxication from emergency departments across the US. "Bath salts" are not a hygiene product, as the name might imply. "Bath salts" are central nervous system stimulants that inhibit the norepinephrine-dopamine reuptake system and can lead to serious, and even fatal adverse reactions. The most commonly reported ingredient in "bath salts" is methylenedioxypyrovalerone (MDPV), although other stimulants may be present, such as mephedrone and pyrovalerone.MDPV is of the phenethylamine class and is structurally similar to cathinone, an alkaloid found in the khat plant and methamphetamine. Mephedrone has been reported to have a high potential for overdose.

On September 7, 2011 the US Drug Enforcement Agency announced emergency scheduling to control MDPV, mephedrone and methylone, all chemicals found in "bath salts". In July of 2012, U.S. President Barack Obama signed into law a ban on mephedrone, methylone and MDVP, all chemicals found in "bath salts, by placing them on the Schedule I controlled substances list. Schedule I controlled substances cannot be sold under any circumstances and cannot be prescribed for medical purposes. The law also bans any future designer chemical compounds meant to mimic the effects of bath salts. Having possession or selling these chemicals or any product that contains them is illegal in the US.
MDVP is structurally related to methylenedioxymethamphetamine (MDMA) and cathinone derivatives. MDMA is a schedule I hallucinogenic substance and cathinone derivatives (cathinone, methcathinone) are listed as schedule I stimulants. Animals studies have demonstrated elevated levels of extracellular dopamine 60 minutes after admininstration of MDVP.

Before the DEA ruling, "bath salts" were noted to be easily accessible in convenience stores, gas stations, over the Internet and in "head" or smoke shops. "Bath salts", packaged in powder form in small plastic or foil packages of 200 to 500 milligrams, sold for roughly $20 per package. Most packages were labeled "not for human consumption". The "bath salt" powder appeared white, off-white or slightly yellow-colored.

"Bath salts" are noted for producing a "high" similar to methamphetamine and have been called "legal cocaine". "Bath salt" users usually snort the drug intranasally, but it can also been injected, smoked, orally ingested or used rectally. Effects may occur with doses as low as 3 to 5 milligrams, but average doses range from 5 to 20 milligrams. There is a great risk for overdose because retail packages may contain up to 500 milligrams. If ingested orally, absorption is rapid with a peak "rush" at 1.5 hours, the effect lasting 3 to 4 hours, then a hard "crash". The total "bath salts" experience may last upwards of 8 hours.

Reports from emergency departments note that "bath salt" use can lead to sympathetic nervous system effects such as tachycardia (fast heart rate), hypertension (high blood pressure), hyperthermia (elevated body temperature), seizures (convulsions). Death has been reported.4 Altered mental status may present as severe panic attacks, agitation, paranoia, delusions, hallucinations, and violent behavior (including self-mutilation, suicide attempts and homicidal activity.)
The full extent of "bath salt" abuse is not known. In addition to use in the US, DEA reports of illicit MDPV use have been noted in Europe and Australia. The first reports of MDPV seizure was from Germany in 2007.3 The United Kingdom, Australia, Canada and Israel have banned the chemicals.6 According to the DEA, the first US reports came in during 2009.3 From 2010 to 2011, reports in the US increased dramatically. As of March 22, 2011, poison control centers in 45 states and the District of Columbia had received calls related to "bath salts". In the first 3 months of 2011, US poison control centers have received 5 times as many calls relating to "bath salts" as compared to the total number of calls in 2010.5 In 2015, authorities in Florida have cited the use of a new type of cathinone called 'flakka" that illicits a delusional state in it's users.

Prior to the federal ban, many states had enacted their own bans on at least some of the chemicals found in "bath salts". Marquette County, Michigan took quick and local action to restrict abuse of "bath salts" in February of 2011 due to a rash of emergency admissions from November 2010 through March 2011. An emergency public health order was executed by the Marquette County Health Department to allow seizure of "bath salts" from a local store. Subsequent testing found that the products contained MDPV. Among 35 patients, 17 were hospitalized, and one died. The median age of the patient was 28 years (range 20-55 years), with men accounting for 54% of admissions. Twenty-four of these 35 patients (69%) had a self-reported history of drug abuse, 16 patients (46%) had a history of mental illness, and six patients (17%) reported suicidal thoughts or attempts that may have been related to "bath salt" use.
The pharmacological activity of MDPV, and related chemicals may result in serious and potentially fatal adverse effects. MDPV inhibits the norepinephrine-dopamine reuptake system and leads to central nervous system stimulation. Acute side effects may include rapid heart rate, high blood pressure, hyperthermia (elevated body temperature), vessel constriction, muscle spasm/tremor, and seizures. Higher doses can lead to behavioral and psychiatric effects such as severe panic attacks, psychosis (hallucinations, delusions), paranoia, agitation, insomnia (inability to sleep), irritability, and violent behavior.1,4 In the reported Marquette County, Michigan cases the most common signs and symptoms of toxicity were agitation (66%), tachycardia (63%), and delusions/hallucinations (40%). Accidental deaths due to overdose and "bath salt"-related suicides have been reported.

Care of patients with an overdose may require admission to the intensive care unit, use of intravenous sedatives, antipsychotics, and/or restraints, or other measures to protect the patient and health care providers from harm. Rhabdomyolysis (the destruction of muscle fibers and the release of myoglobin, a protein, into the bloodstream that may lead to kidney damage) may occur, as well.1,5 Supportive care is given in overdose cases as there is no known antidote.
"Bath salts" have been reported to have a powerful addictive potential, as well as the ability to induce tolerance (more of the drug is required over time to get an equivalent "high"). Reports note intense cravings similar to what methamphetamine users experience.2 As "bath salts" may be cut with other unknown and potentially addictive substances, the true magnitude of toxicity and addiction may be even higher. As of September 2011, routine drug screens do not detect "bath salt" psychoactive ingredients.


Cocaine (C17H21NO4) is a powerfully addictive, psychoactive, stimulant drug. On the street it is usually sold as a fine, white powder. The powdered, hydrochloride salt form of cocaine can be snorted or dissolved in water and injected. Freebase, or crack is cocaine hydrochloride that is processed with ammonia or sodium bicarbonate (baking soda solution) and heated to remove the hydrochloride salt. This ‘freebase’ form of cocaine is not water-soluble; it comes in a rock crystal that can be heated and its vapors smoked. Crack may be processed with a high percentage of impurities. The term "crack" refers to the crackling sound heard when it is heated prior to smoking. Cocaine use in the U.S. is illegal when used as recreational drug.

In the U.S. cocaine is classified as a Schedule II drug, meaning it has a high potential for abuse but can be administered by a physician for legitimate medical uses. By prescription, it is available in the U.S. as a solution for local mucosal anesthesia, but is infrequently used due to safer alternatives, such as lidocaine or benzocaine.

Cocaine originates from coca leaves, and has been used for centuries in a variety of cultural applications. Pure cocaine is extracted from the Erythroxylon coca bush, found primarily in the South American countries of Peru, Bolivia, and Columbia. Coca-leaf infusions or teas have been used to combat altitude sickness and boost energy in many native tribes of South America.
Cocaine is most commonly abused by snorting, smoking or injecting the drug. It can also be rubbed onto mucous membranes.

Cocaine hydrochloride (HCL) is water soluble due to the HCL salt and can be injected; it is also snorted in powder form. Cocaine hydrochloride, when purchased on the street, is usually ‘cut’ with adulterants such as baking soda, talcum powder, lactose sugar, or other local anesthetics such as lidocaine or benzocaine. This increases the weight of the cocaine and allows the seller to make more profit on the street. Other more dangerous adulterants, such as methamphentamine, may also be used to cut cocaine.

When cocaine is snorted, the drug is usually laid out on a mirror, plate or other flat surface, separated into ‘lines’ and snorted nasally through a straw, rolled-up dollar bill or other inhaling device. The cocaine is absorbed into the bloodstream through the nasal tissues. The effect, or ‘high’ with snorting may last 15 to 30 minutes, but does not occur as quickly as smoking or injecting it. Alternatively, smoking crack or injecting cocaine may have a rapid and more intense effect, but the ‘high’ only lasts 5 to 10 minutes. Cocaine is often repeatedly used in short periods of time to sustain the high, an action called ‘binging’.
Cocaine’s effect is described as euphoric with increased energy, reduced fatigue, and heightened mental altertness. Users may be talkative, extraverted, and have a loss of appetite or need for sleep. Cocaine’s psychoactive, pleasurable effects are short-lived without continued administration.

Cocaine’s effect occurs in the midbrain region called the ventral tegmental area (VTA). Neuronal fibers from the VTA connect to the nucleus accumbens, an area of the brain responsible for rewards. Animals studies show that levels of a brain chemical (neurotransmitter) known as dopamine are increased in this area during rewards. Normally, dopamine is released and recycled in response to these rewards. The use of cocaine can interfere with this process, allowing dopamine to accumulate and send an amplified ‘reward’ signal to the brain, resulting in the euphoria described by users.

Some users of cocaine report feelings of restlessness, irritability, and anxiety. A tolerance to the high may develop - many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive to cocaine's anesthetic and convulsant effects without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, may lead to a state of increasing irritability, restlessness, and paranoia. This can result in a period of paranoid psychosis, in which the user loses touch with reality and experiences auditory hallucinations.
Cocaine is metabolized primarily in the liver, with less than one percent of the parent drug being excreted in the urine. The primary metabolite is benzoylecgonine and is detectable in the urine for up to eight days after cocaine consumption.
The immediate physical effects of cocaine use include constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. Health complications associated with cocaine use include disturbances in heart rhythm and heart attacks, chest pain and respiratory failure, strokes, seizures and headaches, and gastrointestinal complications such as abdominal pain and nausea.

The various means of using cocaine can produce different adverse reactions. Snorting cocaine can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose. Ingesting cocaine can cause severe bowel gangrene due to reduced blood flow. People who inject cocaine can experience severe allergic reactions and, as with all injecting drug users, are at increased risk for contracting HIV, viral hepatitis and other blood-borne diseases.

Cocaine abuse can lead to acute cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke, which may result in sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest.

A particularly concerning, yet often unknown interaction between alcohol and cocaine has been reported. The National Institute on Drug Abuse (NIDA) has found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine's euphoric effects but may increase the risk of sudden death. According to the NIDA, this drug-drug interaction, between cocaine and alcohol, is the most common two-drug combination that results in drug-related deaths.

Cocaine is a strongly addictive drug. Long-term effects of cocaine use can lead to tolerance, meaning high doses and/or more frequent use is needed to attain the same level of pleasure during the initial period of use. Because cocaine has a tendency to decrease appetite, many chronic users can become malnourished. If cocaine is used in a binge fashion, with frequent, repeated use over a short period of time, panic and paranoia may set in, with psychosis and auditory hallucinations possible.
The National Survey on Drug Use and Health (NSDUH) estimates that in 2010 there were 1.5 million cocaine users aged 12 or older, roughly 0.6 percent of the U.S. population. These estimates were similar to the number and rate in 2009 (1.6 million or 0.7 percent), but were lower than the estimates in 2006 (2.4 million or 1.0 percent).

The annual number of cocaine initiates (first time using cocaine) declined from 1.0 million in 2002 to 637,000 in 2010. The number of initiates of crack declined during this period from 337,000 to 83,000. For adults 26 years of age or older, 0.5 percent were estimated as being current users of cocaine in the past year. The average age at first use was for cocaine was 21.2 years old.

Use of any illicit drug, but especially drugs such as cocaine, are of great concern with youth. According to the 2010 Monitoring the Future Survey, a national drug use survey of 8th-, 10th- and 12th-graders in the U.S., the use of cocaine continues to decline compared to previous years. In 2010, 12th-grade use was at 2.9 percent, a decline from 3.4 percent in 2009. Crack use held steady in 2010 compared to 2009, with 1.4 and 1.3 percent, respectively, of high school seniors reporting past year use of crack.4 According to the NSDUH, 2 out of every 1000 (0.2 percent) youth age 12 to 17 were current users of cocaine. For young adults aged 18 to 25, the current use of cocaine was estimated at 1.5 percent, or 1.5 out of every 100 young adults.


1What is Kratom?
Kratom (Mitragyna speciosa) is a tropical evergreen tree from Southeast Asia and is native to Thailand, Malaysia, Indonesia and Papua New Guinea. Kratom, the original name used in Thailand, is a member of the Rubiaceae family. Other members of the Rubiaceae family include coffee and gardenia. The leaves of kratom are consumed either by chewing, or by drying and smoking, putting into capsules, tablets or extract, or by boiling into a tea. The effects are unique in that stimulation occurs at low doses and opioid-like depressant and euphoric effects occur at higher doses. Common uses include treatment of pain, to help prevent withdrawal from opiates (such as prescription narcotics or heroin), and for mild stimulation.

Traditionally, kratom leaves have been used by Thai and Malaysian natives and workers for centuries. The stimulant effect was used by workers in Southeast Asia to increase energy, stamina, and limit fatigue. However, some Southeast Asian countries now outlaw its use.

In the US, the herbal product has been used as an alternative agent for muscle pain relief, diarrhea, and as a treatment for opiate addiction and withdrawal. Patients with PTSD have reported positive effects. However, its safety and effectiveness for these conditions has not been clinically determined.
2Kratom Effects and Actions
Most of the psychoactive effects of kratom have evolved from anecdotal and case reports. Kratom has an unusual action of producing both stimulant effects at lower doses and more CNS depressant side effects at higher doses. Stimulant effects manifest as increased alertness, boosted physical energy, talkativeness, and a more social behavior. At higher doses, the opioid and CNS depressant effects predominate.

Effects are dose-dependent and occur rapidly, reportedly beginning within 10 minutes after consumption and lasting from one to five hours.

Beside pain, other uses include as an anti-inflammatory, antipyretic (to lower fever), antitussive (cough suppressant), antihypertensive (to lower blood pressure), as a local anesthetic, to lower blood sugar, and as an antidiarrheal. It has also been promoted to enhance sexual function. None of the uses have been studied clinically.

In addition, it has been reported that opioid-addicted individuals use kratom to help avoid narcotic-like withdrawal side effects when other opioids are not available. Kratom withdrawal side effects may include irritability, anxiety, craving, yawning, runny nose, stomach cramps, sweating and diarrhea; all similar to opioid withdrawal.
3DEA Scheduling of Kratom
Kratom was on the DEA’s list of drugs and chemicals of concern for several years. On August 31, 2016, the DEA published a notice that it was planning to place kratom in Schedule I, the most restrictive classification of the Controlled Substances Act. Its two primary active ingredients, mitragynine and 7-hydroxymitragynine, would be temporarily placed onto Schedule I on September 30, according to a filing by the DEA. The DEA reasoning was "to avoid an imminent hazard to public safety. The DEA did not solicit public comments on this federal rule, as is normally done. However, the scheduling of kratom did NOT occur on September 30th, 2016. Dozens of members of Congress, as well as researchers and kratom advocates have expressed an outcry over the scheduling of kratom and the lack of public commenting. The DEA withheld scheduling at that time and opened the docket for public comments.

Over 23,000 public comments were collected before the closing date of December 1, 2016, according to the American Kratom Association. The American Kratom Association is a lobbying and advocacy group in support of kratom use. The American Kratom Association reports that there are a "number of misconceptions, misunderstandings and lies floating around about Kratom."

As reported by the Washington Post in December 2016, Jack Henningfield, an addiction specialist from Johns Hopkins University and Vice President, Research, Health Policy, and Abuse Liability at Pinney Associates, was contracted by the American Kratom Association to research the kratom's effects. In Henningfield's 127 page report he suggested that kratom should be regulated as a natural supplement, such as St. Johns Wort or Valerian, under the FDA's Food, Drug and Cosmetic Act. The American Kratom Association then submitted this report to the DEA during the public comment period.

Next steps include review by the DEA of the public comments in the kratom docket, review of recommendations from the FDA on scheduling, and determination of additional analysis. Possible outcomes could include emergency scheduling and immediate placement of kratom into the most restrictive Schedule I; routine DEA scheduling in schedule 2 through 5 with more public commenting; or no scheduling at all. The timing for the determination of any of these events is unknown.

According to the American Kratom Association, kratom is legal in 44 states. State laws have restricted its use in six states - Indiana, Tennessee, Wisconsin, Vermont, Arkansas and Alabama. These states classify kratom as a schedule I substance. Kratom is also noted as being banned in Sarasota County, Florida and San Diego County, California.
4Kratom Pharmacology
More than 20 alkaloids in kratom have been identified in the laboratory, including those responsible for the majority of the pain-relieving action, the indole alkaloid mitragynine. Mitragynine is classified as a kappa-opioid receptor agonist and is roughly 13 times more potent than morphine. Mitragynine, structurally similar to yohimbine, is thought to be responsible for the opioid-like effects.

Kratom, due to its opioid-like action, has been used for treatment of pain and opioid withdrawal but structurally it is not the same as the common opioids morphine or codeine. Animal studies suggest that the primary mitragynine pharmacologic action occurs at the mu and delta-opioid receptors, as well as serotonergic and noradrenergic pathways in the spinal cord. Stimulation at post-synaptic alpha-2 adrenergic receptors, and receptor blocking at 5-hydroxytryptamine 2A may also occur. Additional animals studies show that these opioid-receptor effects are reversible with the opioid antagonist naloxone.

Time to peak concentration in animal studies is reported to be 1.26 hours, and elimination half-life is 3.85 hours.
5Extent of Kratom Use
Doses at the lower end of the range, roughly 1 to 5 grams of the leaves, are said to produce mild stimulant effects or anxiety, while higher doses (5 to 15 grams) produce euphoria effects more in-line with opioids. Doses exceeding 15 grams can lead to a state of excessive sedation and stupor. Effects can vary from patient to patient, and a reaction from a low dose or high dose may not be the same in all people.

While some people may use kratom for recreational use, others may be using it for pain relief or opioid withdrawal. However, it is important to note that these anecdotal doses have not been substantiated or shown in clinical trials to be safe or effective.

On the Internet, kratom is marketed in a variety of forms: raw leaf, powder, gum, dried in capsules, pressed into tablets, and as a concentrated extract. In the US and Europe, it appears its use is expanding, and recent reports note increasing use by the college-aged population.

The DEA states that drug abuse surveys have not monitored kratom use or abuse in the US, so its true demographic extent of use, abuse, addiction, or toxicity is not known. According to Susan Ash, founder, American Kratom Association, "kratom is a natural botanical product consumed by millions of Americans daily", but the exact numbers of kratom users are officially not known.
6Kratom Side Effects and Health Hazards
Expected opioid-like side effects that may occur with kratom in the dose range of 5 to 15 grams include:

Dry mouth
Increased urination
Loss of appetite

While definite side effects linked to kratom have not been determined from clinical studies, case reports describe the following adverse effects from mitragynine: addiction, withdrawal, hypothyroidism, and liver injury, aching of muscles and bones and jerky limb movements. Kratom addiction and chronic use has led to cases of psychosis with hallucinations, delusion, and confusion. Tremor, anorexia and weight loss are other possible side effects with long-term use. Seizures have been reported when kratom was combined with modafinil in at least one case report.

A case series from Kronstad, et al. described a fatal drug interaction with kratom. A substance, dubbed “Krypton” - a mixture of mitragynine and a metabolite of tramadol - was found post-mortem in nine people in Sweden over a one year period. Tramadol, an opioid-like prescription pain drug, was most likely added to kratom to boost its narcotic-like effect.

According to Dr. Henningfield in his report for the the American Kratom Association, no "there have been no reports of fatal overdose from kratom per se", as of August 2015. However, in September 2016 the DEA noted that they were aware of 15 deaths related to kratom use since 2014, but whether those deaths involved other substances was not reported.

As with many herbal alternatives, designer drugs, or illicit products sold on the Internet, the possibility exists that kratom may also be contaminated with illegal drugs, black market prescription medications, or even poisonous products. Consumers should by wary of buying unknown drug products from the Internet. When combined with other drugs -- recreational, prescription, or alcohol -- the effects of kratom are unknown and may be dangerous.
7Is Kratom Addictive?
Kratom is well-known to be addictive, as found with traditional use by natives over many years in Southeast Asian countries. Withdrawal effects similar to narcotic withdrawal and drug-seeking behaviors have been described in users in Southeast Asia. Many Southeast Asian countries have restricted the use of kratom due to the potential for abuse.

ConclusionKratom, an herbal product that originated in Southeast Asia, is being used in the US to treat chronic pain and to reverse opioid withdrawal symptoms, and often purchased over the Internet. However, recreational use may be on the rise, too. The primary psychoactive component, mitragynine, is many times more potent than morphine. DEA lists kratom as a drug and chemical of concern, and is in the process of evaluating kratom for placement into controlled substances scheduling. Putting kratom into schedule I would place it in the same category as heroin or marijuana, and prevent access for medical research, a concern for many experts, consumers, and advocacy groups.

Lack of quality scientific evidence confounds the evaluation of the safety of kratom. There have been cases of fatal toxicity and acute liver injury associated with kratom. Concerns exists that the general public would not be able to identify or confirm the quality or purity of kratom from any Internet source.

Advocates of kratom report its beneficial effects for pain and opioid withdrawal effects, and one researcher has reported that kratom's potential for abuse may be as low as that with "nutmeg and St. John's Wort".

However, the FDA has warned consumers not to use any products labeled as containing kratom. Health care professionals and consumers should report any adverse events related to products containing kratom to the FDA’s MedWatch program.

PCP (Phencyclidine)
Psilocybin (Magic Mushrooms)
Speed (methamphetamine)
Synthetic Marijuana (Spice or K2)
TCP (Tenocyclidine)
U-47700 (Pink)


  • Cannabis sativa, also known as hemp, is a species of the Cannabinaceae family of plants.
  • Cannabis contains the chemical compound THC (delta-9 tetrahydrocannabinol), which is believed to be responsible for most of the characteristic psychoactive effects of cannabis.
  • The dried leaves and flowers of the cannabis plant are known as marijuana, which can be smoked (through a pipe or bong or hand-rolled into a joint) or taken orally with food (baked in cookies).
  • The resinous secretions of the plant are known as hashish, which can be smoked or eaten.
  • The fiber of the cannabis plant is cultivated as industrial hemp with uses in textile manufacturing.
  • Do not drive, operate machinery, or perform other hazardous activities while using cannabis. It may cause dizziness, drowsiness, and impaired judgment.
  • Do not drink alcohol while using cannabis. Alcohol will increase dizziness, drowsiness, and impaired judgment.
  • Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
  • Cannabis is a Schedule 1 drug under the Controlled Substances Act.
The effects experienced by the cannabis user are variable and will depend upon the dose, method of administration, prior experience, any concurrent drug use, personal expectations, mood state and the social environment in which the drug is used.

Effects of cannabis include:
  • an altered state of consciousness. The user may feel "high", very happy, euphoric, relaxed, sociable and uninhibited.
  • distorted perceptions of time and space. The user may feel more sensitive to things around them, and may also experience a more vivid sense of taste, sight, smell and hearing.
  • increased pulse and heart rate, bloodshot eyes, dilated pupils, and often increased appetite.
  • impaired coordination and concentration, making activities such as driving a car or operating machinery difficult and dangerous.
  • negative experiences, such as anxiousness, panic, self-consciousness and paranoid thoughts.
People who use large quantities of cannabis may become sedated or disoriented and may experience toxic psychosis - not knowing who they are, where they are, or what time it is. High doses may also cause fluctuating emotions, fragmentary thoughts, paranoia, panic attacks, hallucinations and feelings of unreality.

The effects of cannabis are felt within minutes, reach their peak in 10 to 30 minutes, and may linger for two or three hours. THC is highly lipid soluble and can be stored in fat cells potentially for several months. The stored THC is released very slowly, and unevenly, back into the bloodstream.

On August 29, 2013, the DOJ issued guidance to Federal prosecutors concerning marijuana enforcement under the CSA. The DOJ is focused on priorities, such as:
  • Preventing the distribution to minors
  • Preventing revenues from sale of marijuana towards criminal activity
  • Preventing diversion of marijuana from states where it is legal to states where it is not legal
  • Preventing state-legalized marijuana from being a cover for other illegal drugs or activity
  • Prevent violence and guns in the cultivation and distribution of marijuana
  • Prevent drugged driving and other public health issues
  • Prevent the use of public land for marijuana cultivation
  • Preventing marijuana possession or use on federal property
For more information see: Marijuana.
Long term effects of heavy use can include:
  • irritation to the lungs, risk of developing chronic bronchitis and an increased risk of developing cancer of the respiratory tract (more likely to do with smoking).
  • exacerbation of pre-existing cardiovascular disease, as cannabis use significantly raises the heart rate.
  • decreased concentration levels, reduced short-term memory and difficulties with thinking and learning (resolved if cannabis use stops). decreased sex drive in some people. Chronic use can lower sperm count in males and lead to irregular periods in females (resolved if cannabis use stops).
  • dependence on cannabis - compulsive need to use the drug, coupled with problems associated with chronic drug use.
  • Do not drive, operate machinery, or perform other hazardous activities while using cannabis. Cannabis may cause dizziness, drowsiness, and impaired judgment.
  • Do not drink alcohol while using cannabis. Alcohol will increase dizziness, drowsiness, and impaired judgment. Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
  • Do not use cannabis if you are pregnant or could become pregnant. There is some evidence that women who smoke cannabis during the time of conception or while pregnant may increase the risk of their child being born with birth defects. Pregnant women who continue to smoke cannabis are probably at greater risk of giving birth to low birthweight babies.
  • Do not use cannabis if you are breast-feeding a baby.
  • Seek emergency medical attention.
  • Symptoms of overdose include fatigue, lack of coordination, paranoia and psychosis.
  • Cannabis may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants.
  • For more information on Drug Interactions, please visit the Drug Interactions Checker


1What is Heroin?
Heroin (diacetylmorphine) is derived from the morphine alkaloid found in opium and is roughly 2-3 times more potent. A highly addictive drug, heroin exhibits euphoric ("rush"), anxiolytic and analgesic central nervous system properties. Heroin is classified as a Schedule I drug under the Controlled Substances Act of 1970 and as such has no acceptable medical use in the United States. Pure heroin is a white powder with a bitter taste. Most illicit heroin is sold as a white or brownish powder and is usually "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine. It can also be cut with strychnine or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Another form of heroin known as "black tar" may be sticky, like roofing tar, or hard, like coal. Its color may vary from dark brown to black.
2Other Health Hazards of Heroin
With regular heroin use, tolerance develops where the abuser must use more heroin to achieve the same intensity or effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped. Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered much less dangerous than alcohol or barbiturate withdrawal.

Extent of Heroin UseHeroin addiction is a treatable condition, but its use is increasing in recent years. According to the 2011 Survey on Drug Use and Health by the US Substance Abuse and Mental Health Administration, it is estimated that 607,000 persons per year used heroin in the years 2009-2011, compared to 374,000 during 2002-2005. Similarly, the estimated number of new heroin users increased from 109,000 per year during 2002-2005 to 169,000 per year during 2009-2011.

The increase in initiation is evident among young adults aged 18 to 25 and adults aged 26 and older. There were 28,000 youth initiates per year in 2002-2005 and 27,000 in 2009-2011. Young adult initiates increased from 53,000 per year to 89,000 per year, and older adult initiates increased from 28,000 to 54,000 for these combined time periods. Past year use estimates for 2002-2005 and 2009-2011 showed the same pattern: for youths, estimates were 43,000 and 39,000; for young adults, the estimates were 124,000 and 208,000; and for older adults, the estimates were 207,000 and 361,000. Monitoring the Future (MTF) data indicates an increase for young adults aged 19 to 28 and a decrease for 10th graders in rates of past year heroin use between 2002 and 2011. MTF data did not indicate any changes among 8th and 12th graders between these 2 years.

Patients with heroin addiction should seek advice from health care providers who can guide them with the most appropriate and safe treatment. Combined behavioral and medical therapies may allow the patient to integrate back into mainstream society and lead a positive and productive life.
3Methods of Heroin Use
Heroin is most often injected, however, it may also be vaporized ("smoked"), sniffed ("snorted"), used as a suppository, or orally ingested. Smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection. Oral ingestion does not usually lead to a "rush", but use of heroin in suppository form may have intense euphoric effects. Heroin can be addictive by any given route.
4Side Effects of Heroin Use
Heroin is metabolized to morphine and other metabolites which bind to opioid receptors in the brain. The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria (the "rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user experiences an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Other effects that heroin may have on users include respiratory depression, constricted ("pinpoint") pupils and nausea. Effects of heroin overdose may also include slow and shallow breathing, hypotension, muscle spasms, convulsions, coma, and possible death.

Intravenous heroin use is complicated by other issues such as the sharing of contaminated needles, the spread of HIV/AIDS, hepatitis, and toxic reactions to heroin impurities. Other medical complications that may arise due to heroin use include collapsed veins, abscesses, spontaneous abortion, and endocarditis (inflammation of the heart lining and valves). Pneumonia may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration. Heroin addiction can remove an otherwise healthy and contributing member from society, and may lead to severe disability and eventually death.


1What is Ketamine?
Ketamine (Ketalar) is a dissociative general anesthetic that has been available by prescription in the U.S. since the 1970s for human and veterinary uses. It has also been used for pain control in burn therapy, battlefield injuries, and in children who cannot use other anesthetics due to side effects or allergies. Pharmacologically, ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, but at higher doses may also bind to the opioid mu and sigma receptors. It is related to phencyclidine (PCP), but has less than 10 percent of the potency of pure PCP.

Ketamine has become a drug of abuse and recreational drug. Ketamine for recreational purposes is sourced illegally via the diversion of the prescription products. Ketamine is available in a clear liquid or off-white powder form. Ketamine may be injected intravenously or intramuscularly, consumed orally, or added to marijuana and smoked.2 In the U.S., ketamine (Ketalar) is in DEA schedule III drug under the Controlled Substances Act; however, it is not classified as a narcotic.

Abuse of ketamine can lead to powerful visual hallucinations that are intensified by environmental stimuli. When higher doses of ketamine are abused, it is reported to produce an “out-of-body”, “K-hole” or “near-death” hallucinogenic experience, often reported as terrifying. More recently, ketamine has become popular in the U.S. as a “club drug”, often used by teens and young adults at dance “rave” parties. Ketamine has also been used in instances of “date rape” due to its strong side effect of confusion and/or amnesia.
2Ketamine Health Hazards & Side Effects
Tolerance can build to the effects of ketamine over time, requiring more of the drug to reach the same level of effect. Reports suggest that the dissociative effect may disappear over time. Dissociative means that drug alters the users perception of light and sound and produces feelings of detachment from one's self and surroundings. Binge use, where the user indulges in the drug in excess amounts in a short period of time has been reported, as well.

Other reported side effects include:

chest pain
respiratory depression
elevated heart rate
loss of coordination
muscle rigidity
violent behavior
death from overdose (rare)

A 2011 clinical review of over 110 cases describes lower urinary tract toxicity, also known as ketamine-induced vesicopathy, in association with chronic ketamine abusers. The syndrome results in symptoms such as urge incontinence (strong, sudden need to urinate due to bladder spasms or contractions), decreased bladder volume, detrusor muscle overactivity, and blood in the urine. Stopping ketamine use is the only effective treatment to decrease symptoms and prevent failure of the kidney function.

Withdrawal may occur after chronic, extended use of ketamine. Withdrawal symptoms may include chills, sweats, excitation, hallucinations, teary eyes, and drug cravings.
3Extent of Use
The only known source of ketamine is via diversion of prescription products. There have been reports of veterinarian offices being robbed for their ketamine stock. Also, according to the DEA, a major U.S. source of illicit ketamine arrives across the border from Mexico.

Widespread ketamine abuse began in the late 1970s as subcultures (e.g., mind explorers, new agers, spiritualists) experimented with the drug. Ketamine may be injected intravenously or intramuscularly, used intranasally (“snorted”), consumed orally, or added to marijuana and smoked. In social situations, illicit ketamine is most frequently used orally or intranasally.

As reported in the 2011 Monitoring the Future Survey, the annual prevalence of ketamine use in grades 8, 10, and 12 in 2011 was 0.8%, 1.2%, and 1.7%, respectively. These rates have fallen since the early 2000’s, when rates were roughly 1.6%, 2.1%, and 2.5% in grades 8, 10, and 12, respectively.

Illicit production of ketamine usually involves evaporating the liquid from the diverted injectable solution to produce a powder that is formed into tablets or sold as a powder for intranasal use. Injection of ketamine produces the fastest response, with effects occurring in 1 to 5 minutes; “snorting” takes roughly 5 to 15 minutes; and oral consumption between 5 and 30 minutes. The effects of ketamine abuse typically last 1 to 2 hours, but the users judgement, senses and coordination may be affected for up to 24 hours or longer.

Doses of 1 to 2 milligram per kilogram of body weight produce intense hallucinogenic and dissociative effects for roughly one hour. Sensations may include floating, stimulation and visual effects. Larger doses may result in the “k-hole”, where users are near full sedation and is said to mimic an “out-of-body” or “near-death” experience. High doses may dangerously reduce breathing, lead to muscles spasms or weakness, dizziness, balance difficulty, impaired vision, slurred speech, nausea and vomiting, and severe confusion.
4Ketamine Overdose?
With an overdose of ketamine, emergency care, such as 911, should be contacted immediately. There is no antidote for ketamine. Overdose situations with ketamine are treated with symptomatic and supportive care in the hospital setting. Benzodiazepines may be used if needed for seizures or excitation. Respiratory support is rarely needed, but assisted ventilation or supplemental oxygen may be required.


1What is Marijuana or Hashish and how is it used?
Hashish is a potent form of cannabis (marijuana) produced by collecting and compressing trichomes, the most potent material from cannabis plants.

Trichomes are the fine growths on cannabis plants that produce a sticky resin.

Marijuana is a green, brown or gray mixture of dried, shredded leaves, stems, seeds and flowers of the hemp plant Cannabis sativa.

There are over 200 street names for marijuana including pot, herb, dope, reefer, grass, weed, ganja, Mary Jane, boom, gangster and chronic. Sinsemilla, hashish and hash oil are stronger forms of marijuana.

It is usually smoked as a cigarette (called a joint or a nail) or in a pipe or bong. In recent years, marijuana has appeared in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, sometimes in combination with another drug, such as crack. Some users also mix marijuana into foods or use it to brew tea.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). Marijuana's effects on the user depend on the strength or potency of the THC it contains. Hashish contains the same active ingredients as marijuana, like THC and other cannabinoids, but with higher concentrations.

THC has been used to treat wasting syndrome in AIDS patients.
2Effects of Heavy Marijuana on Learning and Social Behavior
Marijuana or hashish affects memory, judgment and perception. Learning and attention skills are impaired among people who use marijuana or hashish heavily. Longitudinal research on marijuana use among young people below college age indicates those who use marijuana have lower achievement than the non-users, more acceptance of deviant behavior, more delinquent behavior and aggression, greater rebelliousness, poorer relationships with parents, and more associations with delinquent and drug-using friends.
3What are the short-term effects of Marijuana or Hashish use?
The short-term effects of marijuana or hashish use include problems with memory and learning; distorted perception (sights, sounds, time, touch); difficulty in thinking and problem solving; loss of coordination; and increased heart rate, anxiety, and panic attacks.

THC in marijuana is strongly absorbed by fatty tissues in various organs. Generally, traces of THC can be detected by standard urine testing methods several days after a smoking session. In heavy chronic users, traces can sometimes be detected for weeks after they have stopped using marijuana.
4Effects on Pregnancy
Any drug of abuse can affect a mother's health during pregnancy. Some studies have found that babies born to mothers who used marijuana during pregnancy were smaller than those born to mothers who did not use the drug. In general, smaller babies are more likely to develop health problems.

A nursing mother who uses marijuana passes some of the THC to the baby in her breast milk. Research indicates that the use of marijuana by a mother during the first month of breast-feeding can impair the infant's motor development.
5What are the long-term effects of Marijuana or Hashish use?
People who smoke marijuana often have the same respiratory problems as cigarette smokers. These individuals may have daily cough and phlegm, symptoms of chronic bronchitis, and more frequent chest colds. They are also at greater risk of getting lung infections like pneumonia. Marijuana contains some of the same, and sometimes even more, of the cancer-causing chemicals found in cigarette smoke.
6Addictive Potential
A drug is addicting if it causes compulsive, uncontrollable drug craving, seeking, and use, even in the face of negative health and social consequences.

While not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent or addicted to the drug.

Some frequent, heavy users of marijuana develop a tolerance for it. Tolerance means that the user needs larger doses of the drug to get the same desired results that he or she used to get from smaller amounts.


1What is GHB?
GHB or Gamma Hydroxybutyrate (C4H8O3) is a central nervous system (CNS) depressant that is commonly referred to as a “club drug” or “date rape” drug. GHB is abused by teens and young adults at bars, parties, clubs and “raves” (all night dance parties), and is often placed in alcoholic beverages. Euphoria, increased sex drive, and tranquility are reported positive effects of GHB abuse. Negative effects may include sweating, loss of consciousness (reported by 69 percent of users), nausea, hallucinations, amnesia, and coma, among other adverse effects.

Xyrem (sodium oxybate), a brand name prescription drug was approved by the Food and Drug Administration (FDA) in 2002 for the treatment of narcolepsy, a sleep disorder that causes excessive sleepiness and recurring daytime sleep attacks. It is the sodium salt of gamma hydroxybutyrate. Xyrem is a highly regulated drug in the U.S. It is a Schedule III controlled substance, and requires patient enrollment in a restricted access program.

GHB is also a naturally-occurring metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) found in the brain. The naturally-occurring metabolite GHB is present in much lower concentrations in the brain than those levels found when the drug is abused. As a result of fermentation, natural GHB may also be found in small but insignificant quantities in some beers and wines.
2Health Hazards Due to GHB Use on Human Beings and the like?
Euphoria, increased sex drive, and tranquility are reported positive effects of GHB abuse. However, immediate negative effects of GHB use may include sweating and loss of consciousness (reported by 69 percent of users), nausea, auditory and visual hallucinations, headaches, vomiting, exhaustion, sluggishness, amnesia, confusion, and clumsiness.

GHB can have an addictive potential if used repeatedly. Withdrawal effects may include insomnia, anxiety, tremors, and sweating. Withdrawal can be severe and incapacitating.

Combined use with alcohol, other sedatives or hypnotics (such as barbiturates or benzodiazepines) and other drugs that possess CNS depressant activity may result in nausea, vomiting and aspiration, and dangerous CNS and respiratory depression.

High doses of GHB, even without other illicit substances or alcohol, may result in profound sedation, seizures, coma, severe respiratory depression and death. Emergency department episodes related to the use of club drugs usually involve the use of multiple substances, such as marijuana, cocaine, and other club drugs, such as methamphetamine, Ecstasy, or Rohypnol.

GHB detection methods for emergency room use are not readily available. Emergency room physicians may be unaware that GHB has been abused when a patient presents to the hospital, as well. Due to the short half-life of the drug, detection in the urine may be difficult. Supportive care and keeping airways open are the primary measures used in the emergency overdose situation.
3Methods of GHB Abuse
GHB is available as an odorless, colorless drug that may be combined with alcohol and given to unsuspecting victims prior to sexual assaults. It may have a soapy or salty taste. Use for sexual assault has resulted in GHB being known as a “date rape” drug. Victims become incapacitated due to the sedative effects of GHB, and they are unable to resist sexual assault. GHB may also induce amnesia in it’s victim. Common user groups include high school and college students and rave party attendees who use GHB for its intoxicating effects.

GHB has also been postulated to have anabolic effects due to protein synthesis, and has been used by body-builders for muscle building and reducing fat.

GHB is bought on the streets or over the Internet in liquid form or as a white powdered material for illicit use. It is taken orally and is frequently combined with alcohol. Much of the GHB found on the streets or over the Internet is produced in illegal labs. GHB may be adulterated with unknown contaminants that may worsen it’s toxicity. The production of GHB usually involves the use of lye or drain cleaner mixed with GBL, a chemical cousin of GHB and an industrial solvent often used to strip floors.

In 1990, the Food and Drug Administration (FDA) issued an advisory declaring GHB use unsafe and illegal except under FDA-approved, physician-supervised protocols. In March 2000, GHB was placed in Schedule I of the Controlled Substances Act. The sodium salt of GHB, the brand product Xyrem (sodium oxybate), is a Schedule III drug when prescribed and used legally in a patient restricted-access program. Xyrem is not available at regular retail pharmacies. If Xyrem is trafficked as a recreational drug, it’s status converts to Schedule I and it becomes an illegal drug.
4Extent of GHB Abuse
GHB, typically with alcohol use, was linked to more than 60 deaths from January 1992 to May 2001. Roughly 60 percent of the deaths were in people between the ages of 20 and 29. According to one report, the number of emergency department visits in which GHB or GBL is mentioned increased from 56 in 1994 to 4,969 in 2000.

GHB use has been surveyed since the year 2000 in the Monitoring the Future Survey, and rates have remained historically low in the 8th to 12th grade U.S. population. The annual prevalence of GHB use in 2010 was 0.6%, 0.6%, and 1.4% in grades 8, 10, and 12, respectively. Comparatively, in 2009, 0.7 percent of 8th graders and 1.1 percent of 12th graders reported past-year use of GHB. The highest reported GHB use for 12th graders was in 2004 at 2 percent, for 8th graders in 2000 at 1.2 percent, and for 10th graders in 2002 and 2003 at 1.4 percent.
GHB acts at two receptor sites in the brain, the GABAB and specific GHB receptors. Action at these two receptor sites leads to the CNS depressant, stimulant and psychomotor impairment effects of GHB. Roughly 95 percent of GHB is metabolized in the liver, and it’s half-life ranges from 30 to 60 minutes. Only five percent of the parent drug is excreted via the kidneys. Detection of GHB in the urine may be difficult after 24 hours due to it’s short half-life.
6GHB Use in Pregnancy
Effects of GHB use in human pregnancy are not known. Women should not use GHB during pregnancy. Pregnant women, or those who are considering pregnancy, and who use GHB should seek the immediate advice of a health care provider.

Amnesia or memory loss is a complication of treatment that may result in relapse, with the patient returning to GHB use, unaware of the consequences of GHB addiction. Continued patient education is necessary to overcome this adverse effect.

Devil's Breath

1Devil's Breath: Urban Legend or the World's Most Scary Drug?
Medically reviewed on Sep 07, 2015 by L. Anderson, PharmD Next time someone tries to hand you a business card, should you think twice before grabbing it?

Some would say “yes”. There are stories circulating that a chemical known as “Devil's Breath” is making its way around the world, being blown into faces and soaked into business cards to render unsuspecting tourists incapacitated. The result? A “zombie-like” state that leaves the victim with no ability to control their actions, leaving them at risk of having their bank accounts emptied, homes robbed, organs stolen, or raped by a street criminal. Are these sensationalized stories part of an urban legend or a factual crime scene?

Devil's Breath is derived from the flower of the “borrachero” shrub, common in the South American country of Colombia. The seeds, when powdered and extracted via a chemical process, contain a chemical similar to scopolamine called “burandanga”. Borrachero has been used for hundreds of years by native South Americans in spiritual rituals. The compound is said to lead to hallucinations, frightening images, and a lack of free will. Amnesia can occur, leaving the victim powerless to recall events or identify perpetrators. According to a 1995 Wall Street Journal article, about half of all emergency room admissions in Bogota, Colombia were for burundanga poisoning. Scopolamine is also present in Jimson Weed (Datura stramonium), a plant found in most of the continental U.S.

And wouldn't you know it -- this street drug is available in prescription form, too. If you suffer from seasickness, maybe you've used scopolamine (Transderm Scop) on your last ocean adventure. The active ingredient is available in a 1 milligram transdermal patch worn behind your ear to help ward off motion sickness or postoperative nausea and vomiting. The medicine slowly absorbs through the skin from a specialized rate-controlling membrane found in the patch. It's worn for three days before being replaced. The low dose and slow absorption helps to prevent severe side effects in most people. Scopolamine transdermal patch is not classified by the DEA as a controlled substance.

Controlled substance or not, there could be true illegal use of the drug. High doses or spiked drinks could cause issues. The State Department notes on their website that scopolamine can render a victim unconscious for 24 hours or more. In Colombia, where its use seems to be most widespread, “unofficial estimates” of scopolamine events are at roughly 50,000 per year. In large doses it can cause “respiratory failure and death”. However, these effects are due to oral administration in “liquid or powder form in foods and beverages”, not being blown into one's face or absorbed via a piece of soaked paper. Not surprisingly, the majority of these Colombian incidents have occurred in night clubs and bars, reminiscent of the date-rape drug Rohypnol. However, some events in Colombia reportedly have an interesting twist: wealthy-appearing men are often targeted by young, attractive women; not the other way around.

2How is Devil's Breath classified?
Pharmacologically, scopolamine is classified as an anticholinergic medication and belladonna alkaloid. Side effects like dry mouth, blurred vision, headache, urinary retention, and dizziness can occur even at the low dose used in the transdermal patch. Overdoses can lead to a dangerous fast heart rate, dilated pupils, toxic psychosis, confusion, vivid hallucinations, seizures or coma, among other events. Use with alcohol is warned against in the official package labeling. Combining it with alcohol, as in a spiked drink, or with other sedative drugs would certainly hasten central nervous system depression. Confusion, disorientation, excitability, and amnesia could ensue with oral consumption. But immediate “zombie-like” side effects by blowing it into someones face? That seems unlikely, from a pharmacologic standpoint. Others have also questioned the reports of robberies taking place when the powder is blown into someone's face or placed on a business card.

Accounts of scopolamine being used worldwide are available. In Paris, a report from Newsweek Europe surfaced that elderly people were being targeted by a Chinese international network. The U.S. State Department also warns on its website that travelers to Colombia may be at risk of robbery due to criminals using a variety of drugs, not just scopolamine. Medical case reports have been published of women from London having prolonged headaches after possible clandestine scopolamine exposure. Reports of illegal use of scopolamine in the U.S. are available, but unsubstantiated. The reliability of these all of these reports are difficult to confirm.

Nonetheless, these news stories highlight an important travel point. To prevent assault due to scopolamine, or any drug, follow these rules, as recommended by the U.S. State Department:

Never leave food or drinks unattended when traveling. Do not accept food or drinks from strangers or new acquaintances. Travel in a large group when possible, and don't leave with a stranger. Always check the State Department's crime and safety warnings before traveling to a foreign country. Seek medical assistance immediately if you believe you have been drugged.

Is Devil's Breath actually scopolamine, an urban legend, or some other drug being used to incapacitate tourists? Maybe it's a combination of all three. Urban legend or not, the use of drugs to incapacitate, rob or rape victims can and does happen domestially and internationally. Because of that, a dose of good sense should always be used to avoid being poisoned, whether traveling abroad or just going out for the night in your own hometown.


1Do Individuals Abuse Opioids?
Get the facts on the misuse and abuse of prescription opioids such as hydrocodone, oxycodone, morphine, and codeine, and the illegal opioid, heroin.

Opioids are a class of drugs chemically similar to alkaloids found in opium poppies. Historically they have been used as painkillers, but they also have great potential for misuse. Repeated use of opioids greatly increases the risk of developing an opioid use disorder. The use of illegal opiate drugs such as heroin and the misuse of legally available pain relievers such as oxycodone and hydrocodone can have serious negative health effects. According to the CDC, 44 people die every day in the United States from overdose of prescription painkillers.
2Prescription Opioids
A number of opioids are prescribed by doctors to relieve pain. These include hydrocodone, oxycodone, morphine, and codeine. While many people benefit from using these medications to manage pain, prescription drugs are frequently diverted for improper use. In the 2013 and 2014 National Survey on Drug Use and Health (NSDUH), 50.5% of people who misused prescription painkillers got them from a friend or relative for free, and 22.1% got them from a doctor. As people use opioids repeatedly, their tolerance increases and they may not be able to maintain the source for the drugs. This can cause them to turn to the black market for these drugs and even switch from prescription drugs to cheaper and more risky substitutes like heroin.

According to the National Survey on Drug Use and Health (NSDUH) – 2014 (PDF | 3.4 MB):
  • 4.3 million Americans engaged in non-medical use of prescription painkillers in the last month.
  • Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year.
  • 1.4 million people used prescription painkillers non-medically for the first time in the past year.
  • The average age for prescription painkiller first-time use was 21.2 in the past year.


1What is Ecstasy?
Ecstasy (MDMA ,methylenedioxymethamphetamine) is a synthetic, psychoactive drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. Street names for MDMA include Ecstasy, Adam, XTC, hug drug, beans, and love drug. Ecstasy is an illegal drug that acts as both a stimulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences.

Ecstasy exerts its primary effects in the brain on neurons that use the chemical serotonin to communicate with other neurons. The serotonin system plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain.

Research in animals indicates that Ecstasy is neurotoxic; whether or not this is also true in humans is currently an area of intense investigation. Ecstasy can also be dangerous to health and, on rare occasions, lethal.

Health Hazards of Ecstasy Use
For some people, Ecstasy can be addictive. A survey of young adult and adolescent Ecstasy users found that 43 percent of those who reported ecstasy use met the accepted diagnostic criteria for dependence, as evidenced by continued use despite knowledge of physical or psychological harm, withdrawal effects, and tolerance (or diminished response), and 34 percent met the criteria for drug abuse. Almost 60 percent of people who use Ecstasy report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating.
2Effects of Ecstasy Use
Chronic users of Ecstasy perform more poorly than nonusers on certain types of cognitive or memory tasks. Some of these effects may be due to the use of other drugs in combination with Ecstasy, among other factors. Research indicates heavy Ecstasy may cause persistent memory problems in humans; however, a 2011 study has reported limited cognitive decline in users of Ecstasy.

Physical Effects: In high doses, Ecstasy can interfere with the body's ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), resulting in liver, kidney, and cardiovascular system failure, and death.

Because Ecstasy can interfere with its own metabolism (breakdown within the body), potentially harmful levels can be reached by repeated drug use within short intervals.

Users of Ecstasy face many of the same risks as users of other stimulants such as cocaine and amphetamines. These include increases in heart rate and blood pressure, a special risk for people with circulatory problems or heart disease, and other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.

Psychological Effects: These can include confusion, depression, sleep problems, drug craving, and severe anxiety. These problems can occur during and for days or weeks after taking Ecstasy.

Neurotoxicity: Research in animals links Ecstasy exposure to long-term damage to neurons that are involved in mood, thinking, and judgment. A study in nonhuman primates showed that exposure to Ecstasy for only 4 days caused damage to serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating Ecstasy's damaging properties suggests that Ecstasy is not a safe drug for human consumption.

Hidden Risk - Drug Purity: Other drugs chemically similar to Ecstasy, such as MDA (methylenedioxyamphetamine, the parent drug of Ecstasy) and PMA (paramethoxyamphetamine, associated with fatalities in the U.S. and Australia) are sometimes sold as Ecstasy. These drugs can be neurotoxic or create additional health risks to the user. Also, Ecstasy tablets may contain other substances in addition to MDMA, such as ephedrine (a stimulant); dextromethorphan (DXM, a cough suppressant that has PCP-like effects at high doses); ketamine (an anesthetic used mostly by veterinarians that also has PCP-like effects); caffeine; cocaine; and methamphetamine. While the combination of Ecstasy with one or more of these drugs may be inherently dangerous, users might also combine them with substances such as marijuana and alcohol, putting themselves at further physical risk.
3Extent of Ecstasy Use
The National Institute on Drug Abuse (NIDA) funds the Monitoring the Future survey (MTF), which is conducted by the University of Michigan's Institute for Social Research. In 2010, 4.6 percent of 12th-graders, 4.7 percent of 10th-graders, and 2.4 percent of 8th-graders reported they had used Ecstasy in the past year. In 2000, 8.2 percent of 12th-graders, 5.4 percent of 10th-graders and 3.1 percent of 8th-graders reported they had used Ecstasy. African American students showed considerably lower rates of Ecstasy use than white or Hispanic students in the 2010 MTF survey.

In 2010, the Substance Abuse and Mental Health Services Administration published the Results from the 2010 National Survey on Drug Use and Health. Among persons aged 12 to 49, the average age at first use for Ecstasy was 19.4 years. In 2010, an estimated 695,000 Americans aged 12 or older were current (past month) Ecstasy drug users, meaning they had used an Ecstasy drug during the month prior to the survey interview. The 2010 current use estimate is similar to that from 2009. The rate of current Ecstasy use among youths aged 12 to 17 declined to 0.3 percent in years 2004 through 2007, but increased to 0.5 percent in 2009 and 2010. To put overall Ecstasy use in perspective, in 2010 the illicit drug category with the largest number of current users among persons aged 12 or older was marijuana use (2.4 million), followed by abuse of pain relievers (2 million), tranquilizers (1.2 million), Ecstasy (0.9 million), inhalants (0.8 million), and cocaine and stimulants (0.6 million each). For more information, please visit The National Institute on Drug Abuse


1What is methamphetamine (meth) abuse?
Meth abuse is any use of meth, or needing more meth for the same effects you got from smaller amounts. Meth is an illegal drug that stimulates your central nervous system.
2What may happen right after I use meth?
You will have changes in your behavior and how you feel when you use meth. These changes usually occur right away. You may be more talkative, active, nervous, and you may anger more easily. You also may have an increased desire for sexual activity.
3What are the long-term effects of meth abuse?
  • Memory and concentration problems can make it hard to learn or remember information. You may feel confused. You may also do things more slowly than before.
  • Behavior problems may include violent or impulsive actions. Impulsive means you act without thinking first.
  • Physical problems include heart weakness or damage. Your heart may have trouble working correctly. Men may have a decreased ability to have sex.
  • Self-care problems include not keeping yourself clean and not eating properly because you are focused on using meth. Meth may cause you to look older than you really are.
  • Skin problems may happen if you start picking at your skin or do not care for needle marks. You may think you see or feel bugs on or under your skin and try to pick them off. Skin picking causes sores to grow, and the sores can get infected. Meth injection causes needle marks on your skin. Needle marks can also get infected.
  • Mouth problems can develop from meth use. Meth can cause dry mouth and make you chew, clench, or grind your teeth more than normal. This causes your teeth to wear down. Your teeth may turn dark or black. They may break, crumble, or fall apart. Your teeth may need to be pulled out.

Alcohol Facts and Statistics

1Alcohol Use in the United States:
  • Prevalence of Drinking: According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month.
  • Prevalence of Binge Drinking and Heavy Drinking: In 2015, 26.9 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 7.0 percent reported that they engaged in heavy alcohol use in the past month.
2Alcohol Use Disorder (AUD) in the United States:
You will have changes in your behavior and how you feel when you use meth. These changes usually occur right away. You may be more talkative, active, nervous, and you may anger more easily. You also may have an increased desire for sexual activity.
3What are the long-term effects of meth abuse?
  • Memory and concentration problems can make it hard to learn or remember information. You may feel confused. You may also do things more slowly than before.
  • Behavior problems may include violent or impulsive actions. Impulsive means you act without thinking first.
  • Physical problems include heart weakness or damage. Your heart may have trouble working correctly. Men may have a decreased ability to have sex.
  • Self-care problems include not keeping yourself clean and not eating properly because you are focused on using meth. Meth may cause you to look older than you really are.
  • Skin problems may happen if you start picking at your skin or do not care for needle marks. You may think you see or feel bugs on or under your skin and try to pick them off. Skin picking causes sores to grow, and the sores can get infected. Meth injection causes needle marks on your skin. Needle marks can also get infected.
  • Mouth problems can develop from meth use. Meth can cause dry mouth and make you chew, clench, or grind your teeth more than normal. This causes your teeth to wear down. Your teeth may turn dark or black. They may break, crumble, or fall apart. Your teeth may need to be pulled out.
4Alcohol-Related Deaths:
  • An estimated 88,0009 people (approximately 62,000 men and 26,000 women, die from alcohol-related causes annually, making alcohol the fourth leading preventable cause of death in the United States.
  • In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities).
5Economic Burden:
  • In 2010, alcohol misuse cost the United States $249.0 billion.
  • Three-quarters of the total cost of alcohol misuse is related to binge drinking.
6Global Burden:
  • In 2012, 3.3 million deaths, or 5.9 percent of all global deaths (7.6 percent for men and 4.0 percent for women), were attributable to alcohol consumption.
  • In 2014, the World Health Organization reported that alcohol contributed to more than 200 diseases and injury-related health conditions, most notably DSM–IV alcohol dependence (see sidebar), liver cirrhosis, cancers, and injuries.14 In 2012, 5.1 percent of the burden of disease and injury worldwide (139 million disability-adjusted life-years) was attributable to alcohol consumption.
  • Globally, alcohol misuse is the fifth leading risk factor for premature death and disability; among people between the ages of 15 and 49, it is the first.15 In the age group 20–39 years, approximately 25 percent of the total deaths are alcohol attributable.


1Family Consequences:
More than 10 percent of U.S. children live with a parent with alcohol problems, according to a 2012 study.
2Underage Drinking:
  • Prevalence of Underage Alcohol Use:
    • Prevalence of Drinking: According to the 2015 NSDUH, 33.1 percent of 15-year-olds report that they have had at least 1 drink in their lives.18 About 7.7 million people ages 12–20,(20.3 percent of this age group, reported drinking alcohol in the past month (19.8 percent of males and 20.8 percent of females
    • Prevalence of Binge Drinking: According to the 2015 NSDUH, approximately 5.1 million people(about 13.4 percent20) ages 12–20 (13.4 percent of males and 13.3 percent of females, reported binge drinking in the past month.
    • Prevalence of Heavy Drinking: According to the 2015 NSDUH, approximately 1.3 million people19 (about 3.3 percent20) ages 12–20 (3.6 percent of males and 3.0 percent of females20) reported heavy alcohol use in the past month).
  • Consequences of Underage Alcohol Use:
  • Research indicates that alcohol use during the teenage years could interfere with normal adolescent brain development and increase the risk of developing AUD. In addition, underage drinking contributes to a range of acute consequences, including injuries, sexual assaults, and even deaths—including those from car crashes.
3Alcohol and College Students:
  • Prevalence of Alcohol Use:
    • Prevalence of Drinking: According to the 2015 NSDUH, 58.0 percent of full-time college students ages 18–22 drank alcohol in the past month compared with 48.2 percent of other persons of the same age.
    • Prevalence of Binge Drinking: According to the 2015 NSDUH, 37.9 percent of college students ages 18–22 reported binge drinking in the past month compared with 32.6 percent of other persons of the same age.
    • Prevalence of Heavy Drinking: According to the 2015 NSDUH, 12.5 percent of college students ages 18–22 reported heavy alcohol use in the past month compared with 8.5 percent of other persons of the same age.
  • Consequences—Researchers estimate that each year:
  • 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor-vehicle crashes.
  • 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
  • 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or date rape.
  • Roughly 20 percent of college students meet the criteria for AUD.
  • About 1 in 4 college students report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.
4Alcohol and Pregnancy:
  • The prevalence of Fetal Alcohol Syndrome (FAS) in the United States was estimated by the Institute of Medicine in 1996 to be between 0.5 and 3.0 cases per 1,000.
  • More recent reports from specific U.S. sites report the prevalence of FAS to be 2 to 7 cases per 1,000, and the prevalence of Fetal Alcohol Spectrum Disorders (FASD) to be as high as 20 to 50 cases per 1,000.
5Alcohol and the Human Body:
  • In 2013, of the 72,559 liver disease deaths among individuals ages 12 and older, 45.8 percent involved alcohol. Among males, 48.5 percent of the 46,568 liver disease deaths involved alcohol. Among females, 41.8 percent of the 25,991 liver disease deaths involved alcohol.
  • Among all cirrhosis deaths in 2013, 47.9 percent were alcohol related. The proportion of alcohol-related cirrhosis was highest (76.5 percent) among deaths of persons ages 25–34, followed by deaths of persons aged 35–44, at 70.0 percent.
  • In 2009, alcohol-related liver disease was the primary cause of almost 1 in 3 liver transplants in the United States.
  • Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast.
6Health Benefits of Moderate Alcohol Consumption:
  • Moderate alcohol consumption, according to the 2015–2020 Dietary Guidelines for Americans, is up to 1 drink per day for women and up to 2 drinks per day for men.
  • Moderate alcohol consumption may have beneficial effects on health. These include decreased risk for heart disease and mortality due to heart disease, decreased risk of ischemic stroke (in which the arteries to the brain become narrowed or blocked, resulting in reduced blood flow), and decreased risk of diabetes.
  • In most Western countries where chronic diseases such as coronary heart disease (CHD), cancer, stroke, and diabetes are the primary causes of death, results from large epidemiological studies consistently show that alcohol reduces mortality, especially among middle-aged and older men and women—an association which is likely due to the protective effects of moderate alcohol consumption on CHD, diabetes, and ischemic stroke.
  • It is estimated that 26,000 deaths were averted in 2005 because of reductions in ischemic heart disease, ischemic stroke, and diabetes from the benefits attributed to moderate alcohol consumption.
  • Expanding our understanding of the relationship between moderate alcohol consumption and potential health benefits remains a challenge, and, although there are positive effects, alcohol may not benefit everyone who drinks moderately.
  • More information about the potential health benefits, as well as risks, of moderate alcohol consumption can be found at


AUD is a medical condition that doctors diagnose when a patient’s drinking causes distress or harm. The fourth edition of the Diagnostic and Statistical Manual (DSM–IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM–5, integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications.
NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.

The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month.
SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.
For women, low-risk drinking is defined as no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA research shows that only about 2 in 100 people who drink within these limits have AUD.
Treatment received at a hospital (inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center to reduce alcohol use, or to address medical problems associated with alcohol use.
A fatality in a crash involving a driver or motorcycle rider (operator) with a BAC of 0.08 g/dL or greater.
A measure of years of life lost or lived in less than full health.
Alcohol use by anyone under the age of 21. In the United States, the legal drinking age is 21.

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