jueves, 30 de agosto de 2012

Health Effects | National Institute on Drug Abuse

Health Effects | National Institute on Drug Abuse

NIH

Cannabis (Marijuana)
Greenish-gray mixture of the dried, shredded leaves, stems, seeds, and/or flowers of Cannabis sativa or cannabis indica—the hemp plant
Health Effects
AcuteHeightened sensory perception; euphoria, followed by drowsiness/relaxation; impaired short-term memory, attention, judgment, coordination and balance; increased heart rate; increased appetite
Long-termAddiction: About 9 percent of users; about 1 in 6 of those who started using in their teens; 25 to 50 % of daily users. Mental disorders: may be a causal factor in schizophreniform disorders (in those with a pre-existing vulnerability); is associated with depression and anxiety.
Smoking related: chronic cough; bronchitis; lung and upper airway cancers is undetermined.
In combination with alcoholMagnified tachychardia and effect on blood pressure;  amplified impairment of cognitive, psychomotor, and driving performance
Withdrawal symptomsIrritability, difficulty sleeping, strange nightmares, craving, and anxiety.
Associated Special Vulnerabilities/Populations
YouthAlmost 44 percent of teens have tried marijuana by the time they graduate from high school (MTF, 2010)
Treatment options
MedicationsThere are no FDA-approved medications to treat marijuana addiction.
Behavioral Therapies
  • Cognitive-behavioral therapy (CBT)
  • Contingency management, or motivational incentives
  • Motivational Enhancement Therapy (MET)
  • Behavioral treatments geared to adolescents
(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)
Cocaine
White crystalline powder that can be snorted, injected or smoked
Health Effects
Acute
Dilated pupils; increased body temperature, heart rate, and blood pressure; nausea; increased energy, alertness; euphoria; decreased appetite and sleep.
High doses: Erratic and violent behavior, panic attacks
Long-termAddiction, restlessness, anxiety, irritability, paranoia, panic attacks, mood disturbances; insomnia; nasal damage and difficulty swallowing from snorting; GI problems; HIV
In combination with alcoholWhen combined, there is a greater risk of overdose and sudden death than either drug alone.
Withdrawal symptomsDepression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation 
Associated Special Vulnerabilities/Populations
PregnancyPremature delivery, low birth weights, and smaller for gestational age. 
Treatment options
MedicationsThere are no FDA-approved medications to treat cocaine addiction.
Behavioral Therapies
  • Cognitive-behavioral therapy (CBT)
  • Community reinforcement approach plus vouchers
  • Contingency management, or motivational incentives The matrix model
  • 12-Step facilitation therapy
(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)
Prescription Stimulants (Abuse)
Amphetamine (Dexedrine, Adderall), Methylphenidate (Ritalin, Concerta)
Health Effects
AcuteIncreased alertness, attention, energy; irregular heartbeat, dangerously high body temperature, potential for cardiovascular failure or seizures.
Long-termHigh doses especially, or alternate routes of administration (e.g., snorting, injecting) can lead to anxiety, hostility, paranoia, psychosis; addiction.
In combination with alcoholMasks the depressant action of alcohol, increasing risk of alcohol overdose. May increase blood pressure; jitters. 
Withdrawal symptomsDepression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation 
Associated Special Vulnerabilities/Populations
Female adolescentsUnlike some illicit drugs and alcohol, stimulants are used at equal or greater frequency by young females vs. males.  Use is often to lose weight, stay awake to study, or perform better on exams.
Mixing with antidepressants or OTC cold medicinesMay enhance adverse effects; cause blood pressure to become dangerously high or lead to irregular heart rhythms.
Treatment options
MedicationsThere are no FDA-approved medications to treat stimulant addiction.
Behavioral TherapiesBehavioral therapies that have proven effective for treating addiction to illicit stimulant drugs, such as cocaine and methamphetamine, may be useful in addressing prescription stimulant addiction.

(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)
Methamphetamine
White, odorless, bitter-tasting crystalline powder that is easily dissolved in water or alcohol; can be ingested orally, intranasally, injected, or smoked
Health Effects
AcuteEnhanced  mood; increased heart rate, blood pressure, body temperature, energy and activity; decreased appetite; dry mouth; increased sexuality; jaw-clenching
Long-termAddiction, memory loss; weight loss; impaired cognition; insomnia, anxiety, irritability, confusion, paranoia, aggression, mood disturbances, hallucinations, violent behavior; liver, kidney, lung damage; severe dental problems; cardiac and neurological damage; HIV, Hepatitis
Withdrawal symptomsDepression, anxiety, fatigue, and intense craving for the drug.
Associated Special Vulnerabilities/Populations
PregnancyIncreased risk of premature birth, placental abruption, fetal growth retardation, and heart and brain abnormalities
Treatment options
MedicationsThere are no FDA-approved medications to treat methamphetamine addiction.
Behavioral Therapies
  • Cognitive-behavioral therapy (CBT)
  • Contingency management, or motivational incentives
  • The matrix model
  • 12-Step facilitation therapy
(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)
Inhalants
Volatile solvents, Aerosols, Gases, Nitrites (Poppers). Effects depend on the properties of the chemical, but inhalation is the common route of abuse
Health Effects
AcuteConfusion; nausea; slurred speech; lack of coordination; euphoria; dizziness; drowsiness; disinhibition, lightheadedness, hallucinations/ delusions; headaches; suffocation; convulsions/seizures; hypoxia; heart failure; coma; sudden sniffing death (butane, propane, and other chemicals in aerosols)
Nitrites - Systemic vasodilation; increased heart rate; brief sensation of heat and excitement; dizziness; headache.
Long-termMyelin break down leading to muscle spasms, tremors and possible permanent motor impairment; liver/kidney damage.
Addiction - A minority inhale on a regular basis, but among those, some report symptoms of addiction (need to continue using, despite severe adverse consequences).
Nitrites - HIV/AIDS and hepatitis; lipoid pneumonia
In combination with alcoholNitrites – Increased risk of adverse cardiovascular effects.  Alcohol may increase the blood-vessel relaxant effect of organic nitrates (such as amyl nitrite) and result in dangerously low blood pressure.
Withdrawal symptomsA mild withdrawal syndrome (e.g., irritability, restlessness, insomnia, headaches, poor concentration) can occur with long-term inhalant abuse.
Associated Special Vulnerabilities/Populations
YouthAbused mostly by younger (8th graders) rather than older teens (10th and 12th graders)
Nitrites have been linked to high risk sexual behaviors and HIV transmission. Because of their vasodilating actions on the anal sphincter, they are frequently used to facilitate anal intercourse by men who have sex with men. 
PregnancyAlthough rigorous studies have not been conducted, data from occupational exposure to abused solvents like toluene suggest increased spontaneous abortion and fetal malformations.
Treatment options
MedicationsThere are no FDA-approved medications to treat inhalant addiction
Behavioral TherapiesThere are no published reports of behavioral approaches for the treatment of inhalant abuse.
Prescription Sedatives, sleeping pills*, or anxiolytics (Abuse)
Central nervous system depressants include barbiturates (e.g., Nembutal) and benzodiazepines (e.g., Valium, Xanax)
Health Effects
AcuteDrowsiness, relaxation; overdose
Long-termTolerance, physical dependence, addiction
In combination with alcoholSlows both heart rate and respiration, which can be fatal
Withdrawal symptomsDiscontinuing prolonged use absent a physician’s guidance can lead to serious withdrawal symptoms, including seizures. For barbiturates, abrupt cessation can be life-threatening.
Treatment options
MedicationsAddicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered.
Behavioral TherapiesBehavioral therapies, such as cognitive behavioral therapy, that have proven effective for treating addiction to other illicit substances may be useful in addressing addiction to prescription sedatives.

(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

* Although newer (non-benzodiazepine) sleep medications are thought to have less abuse/addiction liability, ER visits associated with their nonmedical use have been increasing, so these may also present a risk for patients taking them other than as prescribed.   
Hallucinogens
LSD, PCP, Psilocybin, Salvia, Ketamine
LSD
AcuteElation, depression, arousal, paranoia or panic; impulsive behavior, rapid shifts in emotions; distortions in perception. Increased body temperature, heart rate, blood pressure; nausea; loss of appetite; sweating; dry mouth; jaw-clenching; numbness; sleeplessness; dizziness, weakness, tremors.
High doses:  Panic, paranoia, feelings of despair, fear of insanity and death.
Long-termFrightening flashbacks, Hallucinogen Persisting Perception Disorder (HPPD). Low addictive potential; however, tolerance does develop
Psilocybin
AcuteLow doses: Relaxation; altered sensory perception; increased energy, heart rate; decreased appetite
High doses: Effects similar to LSD, including visual hallucinations, altered perceptions;  nervousness, confusion, panic, paranoia
Long-termLow addictive potential, however may produce tolerance
Salvia
AcuteShort-lived, but intense hallucinations, altered visual perception, mood, body sensations; emotional swings, feelings of detachment from one’s body; highly modified perception of external reality and self; sweating 
Long-termUnknown addictive potential
PCP
AcuteLow Doses: shallow, rapid breathing, increase in heart rate and blood pressure; nausea, blurred vision, dizziness; numbness; slurred speech; confusion; loss of coordination; muscle contractions; analgesia; altered perceptions; feelings of being separated from one’s body
High Doses:  Feelings of invulnerability and exaggerated strength; seizures, coma, hyperthermia
Ketamine (similar to PCP)
AcuteAnxiety; agitation; insomnia; euphoria; excitement; slurred speech; blurred vision; irregular heartbeat
Low Doses: Nausea; elevated blood pressure; sedation; analgesia; impaired attention; memory and motor function
Higher Doses:  Immobility; distortions of auditory and visual perceptions; feelings of being separated from one’s body and environment; hallucinations; memory problems
Long-termCognitive impairment, including verbal and short-term memory; blurred vision; loss of coordination
In combination w/alcoholIncreased risk of adverse effects
Treatment options
MedicationsThere are no FDA-approved medications to treat addiction to hallucinogens.
Behavioral TherapiesThere is no evidence base for treating abuse of or addiction to hallucinogens specifically. 
MDMA (Ecstasy)
Health Effects
AcuteEuphoria; increased energy, alertness, tactile sensitivity, empathy; decreased fear, anxiety; increased/irregular heartbeat; dehydration; chills; sweating; impaired cognition and motor function; reduced appetite; muscle cramping; teeth grinding/clenching; in rare cases—hyperthermia, rhabdomyolysis, and death.
Long-termImpulsiveness; irritability; sleep disturbances; anxiety addiction.
Street Opioids (Heroin, Opium)
Processed from poppy plants; a white or brownish powder or black sticky substance known as “black tar heroin.” Usually smoked or injected, could be taken orally (opium).
Health Effects
AcuteEuphoria; warm flushing of skin; dry mouth; heavy feeling in extremities; clouded thinking; alternate wakeful and drowsy states; itching; nausea; depressed respiration
Long-termAddiction; physical dependence; collapsed veins; abscesses; infection of heart lining and valves; arthritis/other rheumatologic problems; HIV; Hepatitis C
In combination with alcoholDangerous slowdown of heart rate and respiration, coma, or death
Withdrawal symptomsRestlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements.
Associated Special Vulnerabilities/Populations
PregnancySpontaneous abortions; low birth weight
Treatment options
Medications
  • Methadone
  • Buprenorphine
  • Naltrexone (short and long-acting formulations)
Behavioral Therapies
  • Contingency management, or motivational incentives
  • 12-Step facilitation therapy
(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)
Prescription Opioids (Abuse)
Hydrocodone, Oxycodone, Codeine
Health Effects
Acute
Pain relief, drowsiness, nausea, constipation, euphoria—in some.
When taken by routes other than as prescribed (e.g., snorted, injected), increased risk of depressed respiration, leading to coma, death. CDC reports marked increases in unintentional poisoning deaths since late the 1990s, due mainly to opioid pain reliever overdose (often in combination with alcohol or other drugs).
Long-termTolerance, addiction
In combination with alcoholDangerous slowing of heart rate and respiration, coma, or death
Withdrawal symptomsRestlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements.
Associated Special Vulnerabilities/Populations
Youth8-10% of high school seniors have used Vicodin nonmedically in the past year; ~5% have abused OxyContin 
PregnancySpontaneous abortions; low birth weight
Older AdultsThe higher prevalence of pain in this population renders a greater number of prescriptions written for opioid medications.  Unintentional misuse or abuse could have more serious health consequences for elderly patients because of comorbid illnesses (and multiple prescriptions), potential for drug interactions, and age-related changes in drug metabolism. 
Treatment options
Medications
  • Methadone
  • Buprenorphine
  • Naltrexone (short and long-acting)
Behavioral TherapiesBehavioral therapies that have proven effective for treating addiction to illicit opioid drugs, such as heroin, may be useful in addressing prescription opioid addiction.
(For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)
Androgenic Anabolic Steroids (Abuse)
Synthetic substances related to testosterone. Promote growth of skeletal muscle (anabolic) and the development of male sexual characteristics (androgenic) Taken orally, or by injection in doses much higher than would be prescribed.
Health Effects
AcuteHeadaches, acne; fluid retention (especially in the extremities), gastrointestinal irritation, diarrhea, stomach pains, and an oily skin, jaundice, and hypertension.  Infections can develop at the injection site.
Long-termLiver damage; CVD: high blood pressure; increases in LDL (“bad” cholesterol); and decreases in HDL (“good” cholesterol). Cardiac hypertrophy, atherosclerosis.
Addiction—different from other drugs since abuse is not driven by euphoric effects.  Nevertheless, individuals often continue abuse despite adverse physical/social consequences.  Currently, few users of anabolic-androgenic steroids (AAS) seek substance abuse treatment, but those that present with AAS addiction display a distinctive pattern of comorbid psychopathology, overlapping with that of individuals with other forms of substance dependence
In combination with alcoholMay be synergistic in precipitating impulsive violent behavior. (more research is needed)
Withdrawal symptomsMood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, and depression—sometimes leads to suicide attempts.
Associated Special Vulnerabilities/Populations
MalesShrunken testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer  and striae distensae when injected
FemalesFacial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice, circumscribed hypertrichosis
AdolescentsStunted growth due to premature skeletal maturation and accelerated puberty changes
Treatment options
MedicationsSome medications that have been used for treating steroid withdrawal restore the hormonal system after its disruption by steroid abuse. Other medications target specific withdrawal symptoms—for example, antidepressants to treat depression and analgesics for headaches and muscle and joint pains.
Behavioral Therapies
Some patients require assistance beyond pharmacological treatment of withdrawal symptoms and are treated with behavioral therapies. Physicians have found that supportive therapy is sufficient in some cases. *

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