| Greenish-gray mixture of the dried, shredded leaves, stems, seeds, and/or flowers of Cannabis sativa or cannabis indica—the hemp plant | |
| Health Effects | |
|---|---|
| Acute | Heightened sensory perception; euphoria, followed by drowsiness/relaxation; impaired short-term memory, attention, judgment, coordination and balance; increased heart rate; increased appetite |
| Long-term | Addiction: 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 alcohol | Magnified tachychardia and effect on blood pressure; amplified impairment of cognitive, psychomotor, and driving performance |
| Withdrawal symptoms | Irritability, difficulty sleeping, strange nightmares, craving, and anxiety. |
| Associated Special Vulnerabilities/Populations | |
| Youth | Almost 44 percent of teens have tried marijuana by the time they graduate from high school (MTF, 2010) |
| Treatment options | |
| Medications | There are no FDA-approved medications to treat marijuana addiction. |
| Behavioral Therapies |
|
| 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-term | Addiction, restlessness, anxiety, irritability, paranoia, panic attacks, mood disturbances; insomnia; nasal damage and difficulty swallowing from snorting; GI problems; HIV |
| In combination with alcohol | When combined, there is a greater risk of overdose and sudden death than either drug alone. |
| Withdrawal symptoms | Depression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation |
| Associated Special Vulnerabilities/Populations | |
| Pregnancy | Premature delivery, low birth weights, and smaller for gestational age. |
| Treatment options | |
| Medications | There are no FDA-approved medications to treat cocaine addiction. |
| Behavioral Therapies |
|
| Amphetamine (Dexedrine, Adderall), Methylphenidate (Ritalin, Concerta) | |
| Health Effects | |
|---|---|
| Acute | Increased alertness, attention, energy; irregular heartbeat, dangerously high body temperature, potential for cardiovascular failure or seizures. |
| Long-term | High doses especially, or alternate routes of administration (e.g., snorting, injecting) can lead to anxiety, hostility, paranoia, psychosis; addiction. |
| In combination with alcohol | Masks the depressant action of alcohol, increasing risk of alcohol overdose. May increase blood pressure; jitters. |
| Withdrawal symptoms | Depression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation |
| Associated Special Vulnerabilities/Populations | |
| Female adolescents | Unlike 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 medicines | May enhance adverse effects; cause blood pressure to become dangerously high or lead to irregular heart rhythms. |
| Treatment options | |
| Medications | There are no FDA-approved medications to treat stimulant addiction. |
| Behavioral Therapies | Behavioral 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.) |
| White, odorless, bitter-tasting crystalline powder that is easily dissolved in water or alcohol; can be ingested orally, intranasally, injected, or smoked | |
| Health Effects | |
|---|---|
| Acute | Enhanced mood; increased heart rate, blood pressure, body temperature, energy and activity; decreased appetite; dry mouth; increased sexuality; jaw-clenching |
| Long-term | Addiction, 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 symptoms | Depression, anxiety, fatigue, and intense craving for the drug. |
| Associated Special Vulnerabilities/Populations | |
| Pregnancy | Increased risk of premature birth, placental abruption, fetal growth retardation, and heart and brain abnormalities |
| Treatment options | |
| Medications | There are no FDA-approved medications to treat methamphetamine addiction. |
| Behavioral Therapies |
|
| Volatile solvents, Aerosols, Gases, Nitrites (Poppers). Effects depend on the properties of the chemical, but inhalation is the common route of abuse | |
| Health Effects | |
|---|---|
| Acute | Confusion; 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-term | Myelin 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 alcohol | Nitrites – 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 symptoms | A mild withdrawal syndrome (e.g., irritability, restlessness, insomnia, headaches, poor concentration) can occur with long-term inhalant abuse. |
| Associated Special Vulnerabilities/Populations | |
| Youth | Abused 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. |
| Pregnancy | Although rigorous studies have not been conducted, data from occupational exposure to abused solvents like toluene suggest increased spontaneous abortion and fetal malformations. |
| Treatment options | |
| Medications | There are no FDA-approved medications to treat inhalant addiction |
| Behavioral Therapies | There are no published reports of behavioral approaches for the treatment of inhalant abuse. |
| Central nervous system depressants include barbiturates (e.g., Nembutal) and benzodiazepines (e.g., Valium, Xanax) | |
| Health Effects | |
|---|---|
| Acute | Drowsiness, relaxation; overdose |
| Long-term | Tolerance, physical dependence, addiction |
| In combination with alcohol | Slows both heart rate and respiration, which can be fatal |
| Withdrawal symptoms | Discontinuing 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 | |
| Medications | Addicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered. |
| Behavioral Therapies | Behavioral 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.
| LSD, PCP, Psilocybin, Salvia, Ketamine | |
| LSD | |
|---|---|
| Acute | Elation, 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-term | Frightening flashbacks, Hallucinogen Persisting Perception Disorder (HPPD). Low addictive potential; however, tolerance does develop |
| Psilocybin | |
| Acute | Low 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-term | Low addictive potential, however may produce tolerance |
| Salvia | |
| Acute | Short-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-term | Unknown addictive potential |
| PCP | |
| Acute | Low 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) | |
| Acute | Anxiety; 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-term | Cognitive impairment, including verbal and short-term memory; blurred vision; loss of coordination |
| In combination w/alcohol | Increased risk of adverse effects |
| Treatment options | |
| Medications | There are no FDA-approved medications to treat addiction to hallucinogens. |
| Behavioral Therapies | There is no evidence base for treating abuse of or addiction to hallucinogens specifically. |
| Health Effects | |
|---|---|
| Acute | Euphoria; 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-term | Impulsiveness; irritability; sleep disturbances; anxiety addiction. |
| 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 | |
|---|---|
| Acute | Euphoria; warm flushing of skin; dry mouth; heavy feeling in extremities; clouded thinking; alternate wakeful and drowsy states; itching; nausea; depressed respiration |
| Long-term | Addiction; physical dependence; collapsed veins; abscesses; infection of heart lining and valves; arthritis/other rheumatologic problems; HIV; Hepatitis C |
| In combination with alcohol | Dangerous slowdown of heart rate and respiration, coma, or death |
| Withdrawal symptoms | Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. |
| Associated Special Vulnerabilities/Populations | |
| Pregnancy | Spontaneous abortions; low birth weight |
| Treatment options | |
| Medications |
|
| Behavioral Therapies |
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| 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-term | Tolerance, addiction |
| In combination with alcohol | Dangerous slowing of heart rate and respiration, coma, or death |
| Withdrawal symptoms | Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. |
| Associated Special Vulnerabilities/Populations | |
| Youth | 8-10% of high school seniors have used Vicodin nonmedically in the past year; ~5% have abused OxyContin |
| Pregnancy | Spontaneous abortions; low birth weight |
| Older Adults | The 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 |
|
| Behavioral Therapies | Behavioral 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.) |
| 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 | |
|---|---|
| Acute | Headaches, 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-term | Liver 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 alcohol | May be synergistic in precipitating impulsive violent behavior. (more research is needed) |
| Withdrawal symptoms | Mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, and depression—sometimes leads to suicide attempts. |
| Associated Special Vulnerabilities/Populations | |
| Males | Shrunken testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer and striae distensae when injected |
| Females | Facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice, circumscribed hypertrichosis |
| Adolescents | Stunted growth due to premature skeletal maturation and accelerated puberty changes |
| Treatment options | |
| Medications | Some 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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