Regardless of how cocaine is used or how frequently, a user can experience acute cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke, which could result in sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest.
Health Hazards

Cocaine is a strong central nervous system stimulant that interferes with the reabsorption process of dopamine, a chemical messenger associated with pleasure and movement. The buildup of dopamine causes continuous stimulation of receiving neurons, which is associated with the euphoria commonly reported by cocaine abusers.

Physical effects of cocaine use include constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine’s immediate euphoric effects, which include hyperstimulation, reduced fatigue, and mental alertness, depends on the route of administration. The faster the absorption, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of time a user feels high and increases the risk of addiction.

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 full-blown paranoid psychosis, in which the user loses touch with reality and experiences auditory hallucinations.

Other 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. Because cocaine has a tendency to decrease appetite, many chronic users can become malnourished.

Different means of taking cocaine can produce different adverse effects. Regularly snorting cocaine, for example, 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 and other blood-borne diseases.

Added Danger: Cocaethylene
When people mix cocaine and alcohol consumption, they are compounding the danger each drug poses and unknowingly forming a complex chemical experiment within their bodies. NIDA-funded researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine’s euphoric effects, while potentially increasing the risk of sudden death.
Treatment

The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.

One of NIDA’s top research priorities is to find a medication to block or greatly reduce the effects of cocaine, to be used as one part of a comprehensive treatment program. NIDA-funded researchers are also looking at medications that help alleviate the severe craving that people in treatment for cocaine addiction often experience. Several medications are currently being investigated for their safety and efficacy in treating cocaine addiction.

In addition to treatment medications, behavioral interventions-particularly cognitive behavioral therapy-can be effective in decreasing drug use by patients in treatment for cocaine abuse. Providing the optimal combination of treatment and services for each individual is critical to successful outcomes.
Extent of Use

Monitoring the Future (MTF) Survey **
There were no significant changes from 2005 to 2006 in the proportion of students in 8th, 10th, and 12th grades reporting lifetime,*** past year, or past month use of powder cocaine; however, past year crack use among 10th-graders declined significantly, from 1.7 percent in 2005 to 1.3 percent in 2006.

Past year prevalence of powder cocaine use in 2006 among all three grades was not significantly different from 2001; however, significant declines in crack use were seen over the same time period among 8th- and 10th-graders.

Daily Facts

Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and, particularly in users who inject the drug, infectious diseases, including HIV/AIDS and hepatitis.

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 (”rush”) accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Long-term effects of heroin appear after repeated use for some period of time. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin’s depressing effects on respiration.

Heroin abuse during pregnancy and its many associated environmental factors (e.g., lack of prenatal care) have been associated with adverse consequences including low birth weight, an important risk factor for later developmental delay.

In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.
Tolerance, Addiction, and Withdrawal

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity of 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 (”kicking the habit”), 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 less dangerous than alcohol or barbiturate withdrawal.
Treatment

There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin (or other opiate) use and return to more stable and productive lives.

In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated effectively. The panel strongly recommended broader access to methadone maintenance treatment programs for people who are addicted to heroin or other opiate drugs; and the Federal and State regulations and other barriers impeding this access be eliminated. This panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services to enhance retention and successful outcomes in methadone maintenance treatment programs. The panel’s full consensus statement is available by visiting the NIH Consensus Development Program Web site at consensus.nih.gov.

Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates.

Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor’s office. Several other medications for use in heroin treatment programs are also under study.

For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. There is preliminary evidence that buprenorphine also is safe and effective in treating heroin dependence during pregnancy, although infants exposed to methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.

There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.
Extent of Use

Monitoring the Future (MTF) Survey *
According to the 2006 MTF, rates of lifetime** and past year heroin use were stable among all three grades surveyed. However, 8th-graders reported significant declines in past month use of heroin, from 0.5 percent in 2005 to 0.3 percent in 2006.

Recent peaks in past year heroin use were observed in 1996 for 8th-graders (1.6 percent), 1997-2000 for 10th-graders (1.4 percent), and 2000 for 12th-graders (1.5 percent). Past year use in 2006 was significantly lower than these peak years of use for all three grades.

Daily Facts

What is Marijuana?

Call it pot, grass, weed, or any one of nearly 200 other names, marijuana is, by far, the world’s most commonly used illicit drug—and far more dangerous than most users realize. So, there is just cause for alarm when adolescent marijuana use increases, as it did in the mid-1990’s, and the age at which youngsters first experiment with pot starts to drops.

Marijuana has been around for a long while. Its source, the hemp plant (cannabis sativa), was being cultivated for psychoactive properties more than 2,000 years ago. Although cannabis contains at least 400 different chemicals, its main mind-altering ingredient is THC (delta-9-tetrahydrocannabinol).The amount of THC in marijuana determines the drug’s strength, and THC levels are affected by a great many factors, including plant type, weather, soil, and time of harvest. Sophisticated cannabis cultivation of today produces high levels of THC and marijuana that is far more potent than pot of the past. THC content of marijuana, which averaged less than 1 percent in 1974, rose to an average 4 percent by 1994.

For the highly popular form of marijuana called Sinsemilla (from the Spanish “without seeds”), made from just the buds and flowering tops of female plants, THC content averages 7.5 percent and ranges as high as 24 percent. As for hashish, a resin made from flowers of the female plant, THC levels may be five to ten times higher than crude marijuana’s.

How is it Used?

Marijuana and other cannabis products are usually smoked, sometimes in a pipe or water pipe, but most often in loosely rolled cigarettes known as “joints.” Some users will slice open and hollow out cigars, replacing the tobacco with marijuana, to make what are called “blunts.” Joints and blunts may be laced with other substances, including crack cocaine and the potent hallucinogen phencyclidine (PCP), substantially altering effects of the drug.

Smoking, however, is not the sole route of administration. Marijuana can be brewed into tea or mixed in baked products (cookies or brownies).

How Does it Affect You?

A mild hallucinogen, marijuana has some of alcohol’s depressant and disinhibiting properties. User reaction, however, is heavily influenced by expectations and past experience, and many first-time users feel nothing at all.

Effects of smoking are generally felt within a few minutes and peak in 10 to 30 minutes. They include dry mouth and throat, increased heart rate, impaired coordination and balance, delayed reaction time, and diminished short-term memory. Moderate doses tend to induce a sense of well-being and a dreamy state of relaxation that encourages fantasies, renders some users highly suggestible, and distorts perception (making it dangerous to operate machinery, drive a car or boat, or ride a bicycle). Stronger doses prompt more intense and often disturbing reactions including paranoia and hallucinations.

Most of marijuana’s short-term effects wear off within two or three hours. The drug itself, however, tends to linger on. THC is a fat-soluble substance and will accumulate in fatty tissues in the liver, lungs, testes, and other organs. Two days after smoking marijuana, one-quarter of the THC content may still be retained. It will show up in urine tests three days after use, and traces may be picked up by sensitive blood tests two to four weeks later.

The Impact on the Mind

Marijuana use reduces learning ability. Research has been piling up of late demonstrating clearly that marijuana limits the capacity to absorb and retain information. A 1995 study of college students discovered that the inability of heavy marijuana users to focus, sustain attention, and organize data persists for as long as 24 hours after their last use of the drug. Earlier research, comparing cognitive abilities of adult marijuana users with non-using adults, found that users fall short on memory as well as math and verbal skills. Although it has yet to be proven conclusively that heavy marijuana use can cause irreversible loss of intellectual capacity, animal studies have shown marijuana-induced structural damage to portions of the brain essential to memory and learning.

The Impact on the Body

Chronic marijuana smokers are prey to chest colds, bronchitis, emphysema, and bronchial asthma. Persistent use will damage lungs and airways and raise the risk of cancer. There is just as much exposure to cancer-causing chemicals from smoking one marijuana joint as smoking five tobacco cigarettes. And there is evidence that marijuana may limit the ability of the immune system to fight infection and disease.

Marijuana also affects hormones. Regular use can delay the onset of puberty in young men and reduce sperm production. For women, regular use may disrupt normal monthly menstrual cycles and inhibit ovulation. When pregnant women use marijuana, they run the risk of having smaller babies with lower birth weights, who are more likely than other babies to develop health problems. Some studies have also found indications of developmental delays in children exposed to marijuana before birth.

Marijuana as Medicine

Although U.S. law classifies marijuana as a Schedule I controlled substance (which means it has no acceptable medical use), a number of patients claim that smoking pot has helped them deal with pain or relieved the symptoms of glaucoma, the loss of appetite that accompanies AIDS, or nausea caused by cancer chemotherapy. There is, however, no solid evidence that smoking marijuana creates any greater benefits than approved medications (including oral THC) now used to treat these patients, relieve their suffering, or mitigate the side effects of their treatment. Anecdotal assertions of beneficial effects have yet to be confirmed by controlled scientific research.

Teens and Marijuana
Although dangers exist for marijuana users of all ages, risk is greatest for the young. For them, the impact of marijuana on learning is critical, and pot often proves pivotal in the failure to master vital interpersonal coping skills or make appropriate life-style choices. Thus, marijuana can inhibit maturity.

Another concern is marijuana’s role as a “gateway drug,” which makes subsequent use of more potent and disabling substances more likely. The Center on Addiction and Substance Abuse at Columbia University found adolescents who smoke pot 85 times more likely to use cocaine than their non–pot smoking peers. And 60 percent of youngsters who use marijuana before they turn 15 later go on to use cocaine.

But many teens encounter serious trouble well short of the “gateway.” Marijuana is, by itself, a high-risk substance for adolescents. More than adults, they are likely to be victims of automobile accidents caused by marijuana’s impact on judgment and perception. Casual sex, prompted by compromised judgment or marijuana’s disinhibiting effects, leaves them vulnerable not only to unwanted pregnancy but also to sexually transmitted diseases (STDs).

Marijuana Dangers

• Impaired perception
• Diminished short-term memory
• Loss of concentration and coordination
• Impaired judgement
• Increased risk of accidents
• Loss of motivation
• Diminished inhibitions
• Increased heart rate
• Anxiety, panic attacks, and paranoia
• Hallucinations
• Damage to the respiratory, reproductive, and immune systems
• Increased risk of cancer
• Psychological dependency

Daily Facts

Marijuana is the most commonly abused illicit drug in the United States. A dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis sativa, it usually is smoked as a cigarette (joint, nail), or in a pipe (bong). It also is smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug. It might also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor. There are countless street terms for marijuana including pot, herb, weed, grass, widow, ganja, and hash, as well as terms derived from trademarked varieties of cannabis, such as Bubble Gum, Northern Lights, Fruity Juice, Afghani #1, and a number of Skunk varieties.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). The membranes of certain nerve cells in the brain contain protein receptors that bind to THC. Once securely in place, THC kicks off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana.

Extent of Use

In 2005, 14.6 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed, which is similar to the rate in 2004. About 6,000 people a day in 2005 used marijuana for the first time–2.1 million Americans. Of these, 59.1 percent were under age 18. As a percentage of those who had not used marijuana prior to the past year, youth marijuana initiation declined significantly, from 5.8 percent in 2004 to 5.2 percent in 2005.

Lifetime* use of marijuana/hashish among 10th-graders declined significantly from 2005 (34.1 percent) to 2006 (31.8 percent)⁽²⁾. Past year marijuana use was reported by 11.7 percent of 8th-graders, 25.2 percent of 10th-graders, and 31.5 percent of 12th-graders in 2006. Past year prevalence of use has fallen significantly since 2001; it has dropped by 24 percent among 8th-graders, 23 percent among 10th-graders, and 15 percent among 12th-graders. Perceived risk of harm from smoking marijuana regularly remained stable for all three grades from 2005 to 2006, but perceived availability of marijuana fell significantly among 10th-graders, from 72.6 percent in 2005 to 70.7 percent in 2006.

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