• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Drugs and the Body
 

Drugs and the Body

on

  • 5,803 views

Learn how drugs work in the body!

Learn how drugs work in the body!

Statistics

Views

Total Views
5,803
Views on SlideShare
5,784
Embed Views
19

Actions

Likes
0
Downloads
68
Comments
0

2 Embeds 19

http://youthrise.org 16
http://www.youthrise.org 3

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Drugs and the Body Drugs and the Body Presentation Transcript

    • Drugs & Body Workshop
      TRIP! Outreach Training
      Spring 2011
      Nick Boyce: nboyce@ohsutp.ca
      Wende Wood: wendewood@hotmail.com
    • Before we start…
      All of us have different experiences and insights.
      Back to basics.
      Questions as we go.
      For some stuff, you will know more than us.
      If we’re not sure about something we can look it up later.
      What we know changes.
      New issues; new science.
      Do your homework!
    • Introductions
      Group Guidelines
      Safe Space & Confidentiality
      “I” statements
      Step up / Step back
      Cell phones
      Who you are
      Name; how long you have been “partying”; when you heard of/got involved with TRIP!
      Something you are hoping to take away from the training
      Specific drug(s) you want to find out/know more about?
      Can you think of a situation with yourself or a friend that presented a problem (e.g., bad trip; OD; wrong drugs; etc.)
    • Workshop Overview
      Drug: Set : Setting
      Things to think about
      Body & Brain:
      Effects of drugs on body
      Effects of body on drugs
      Neuro-Physiology
      Interactions
      Ways drugs are taken:
      How drugs get into the body
      Risks and benefits
      Where are people at?
      The continuum of use
    • Workshop Overview
      What are people saying?
      TRIP! Survey Data
      Specific substances:
      What they are
      How they work
      Immediate risks
      Longer-term concerns
      Risk reduction strategies
      Resources & Referrals
    • What are some…?
      Drugs…?
      Prescriptions…?
      Medications…?
    • Medications, Drugs, Pills…
      “The term ‘drug’ means one thing to politicians trying to get elected, another thing to high school students, and yet another to physicians.”
      - “Buzzed”, Chapter 14
      Drugs could be:
      • Mega doses of vitamins
      • Herbal medications from health food stores
      • Birth control pills
      • Over-the-counter cold remedies
      • Tylenol
      • Beer
      • Prescribed medicines
      • Recreational drugs
    • Medications, Drugs, Pills…
      SSRIs Ecstasy
      Prozac Cocaine
      Ritalin Crystal meth
      Zoloft Ephedrine
      Paxil Speed
      Wellbutrin GHB
      Effexor Ketamine
      Valium Alcohol
      Tylenol DMT
      Percocet Nicotine
      Codeine Salvia
      Oxycontin Psilocybin
      Insulin Cannabis
      Methadone Poppers
      ARVs Viagra
      : :
      SUBSTANCE USE
    • Drug : Set : Setting
      Three interrelated factors affecting a person’s experiences and risks:
      Drug
      The drug, medication, pill being consumed.
      Set
      The person taking the substance.
      Setting
      The context in which it is taken.
    • DrugWhat substance(s)?
      The specific pharmacology of the substance(s)
      Effects on physiology and neurochemistry.
      Half-life: How long does it take the body to eliminate it?
      How much is taken
      Potency.
      For some drugs you can take tiny amounts, others require a lot.
      How it is taken (route of administration) affects:
      How quickly the feeling “comes on”.
      How intense it feels.
      How long it lasts.
      Quality of illicit substances
      It may be hard to know what you’re getting; the ingredients can include anything. What are they cut with?
      A dealer may say a substance is one thing but sell something else.
      It may look like the stuff from last time but it might be stronger or weaker, or have different ingredients.
    • Classes of Substances(primarily illicit substances listed)
    • Prescription Medications
      Opioids include pain medications with active ingredients such as morphine, oxycodone and codeine.
      Tylenol 3s; Percocets; Oxycontin
      Tranquillizers are often prescribed to reduce stress and panic attacks.
      benzodiazepines such as diazepam (Valium®) and alprazolam (Xanax)
      Stimulants are often used to treat ADD/ADHD.
      dextroamphetamine (Adderall); methylphenidate (Ritalin)
    • Prescription Medications
      Antidepressant are used to alleviate mood disorders, such as major depression and dysthymia.
      selective serotonin reuptake inhibitors (SSRIs: Celexa; Zoloft; Prozac); serotonin-norepinephrine reuptake inhibitors (SNRIs: Effexor); monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs)…
      Barbiturates treat anxiety, sleep disorders and seizures
      pentobarbital sodium (Nembutal) and mephobarbital (Mebaral).
      Anitpsychotics are primarily used to manage psychosis particularly in schizophrenia and bipolar disorder:
      haloperidol (Haldol) olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and aripiprazole (Abilify)
    • SetWho’s taking the substance?
      Size and body weight.
      Physical, mental, psychological state.
      How tired they are.
      Their mood before they use.
      Their reason(s) for using.
      Genetics.
      How does their body metabolize drugs?
      Experiences with this or other substances.
      Tolerance; Habituation; Sensitization
      Expectation, or anticipation, of how the substance will feel or effect them.
      Did they eat recently if swallowing a drug?
      Are they using other substances at the same time?
    • SettingWhat’s the context?
      Where are they?
      Alone; with friends; with strangers?
      Indoors or outdoors?
      Quite setting or lots of people and noise?
      What time of day?
      What type of music is playing?
      Rules and regulations.
      Community and social attitudes towards certain substances or ways or taking them.
      The legal status of different substances.
    • Drugs and Body
      Classes of drugs
      Stimulants
      CNS Depressants
      Opioids
      Sedatives/Hypnotics
      Hallucinogens
      Dissociative Anaesthetics
      Entactogens
      Effects of drugs on body
      Effects of body on drugs
    • Drugs on Body
      Effects of drugs on body
      What is the high like?
      What receptors does it attach to?
      What physiological effects will it have?
      What psycho-behavioural effects will it have?
      What interactions will it have with other drugs and medications? (common receptors)
      What happens if you OD?
      Why do we get high anyway?
      Neurotransmitters
      Receptors
      Reuptake Pumps
    • Body on Drugs
      Effects of body on drugs
      Getting drugs in
      Routes of administration
      Getting drugs around
      Getting drugs out
      How long do they last?
      Half life
      Interactions with other drugs and medications? (metabolism)
      Adaptation; tolerance; withdrawal
    • Body Physiology
      Key organs and processes of the body
      Heart
      Kidneys
      Liver
      Brain
      Temperature
      Blood pressure
      Heart rate
    • Brain Physiology
      What does it do
      Major regions
      Neurotransmitters
      Neuroreceptors
      Reuptake Pumps
    • Neurotransmitters
      Amines
      Serotonin
      Dopamine
      Norepinephrine
      Epinephrine
      Acetylcholine
      Tyramine
      Octopamine
      Phenylethylamine
      Tryptamine
      Melatonin
      Histamine
      Pituitary Peptides
      Circulating Hormones
      Hypothalamic Releasing Hormones
    • Neural Pathways
    • Brain Physiology 101
      Neurons: brain signals and messages
      axon dendrite
    • Brain Physiology 101
      Synapse: site of communication
    • Brain Physiology 101
      Synapse: normal communication
    • Brain Physiology 101
      Synapse: under the influence
    • Brain Physiology 101
      Synapse: after the influence - reuptake
    • Brain Physiology 101
      Synapse: site of communication
    • Brain Physiology 101
      Synapse: normal communication
    • Brain Physiology 101
      Synapse: under the influence
    • OVERDOSE RISK
      DEPRESSANTS
      CNS Depression, respiratory depression, coma
      Highest risk with opioids (heroin, oxycontin), barbiturates, alcohol, GHB
      Benzodiazepines in high doses especially combined with alcohol &/or other depressants
      STIMULANTS
      unpredictable
      dehydration, overheating, cardiovascular problems, seizure
      paranoia, agitation, hallucinations
      HALLUCINOGENS
      Not much direct risk from overdose per se, however psychiatric effects can lead to dangerous situations (i.e. a “bad trip”), or trigger underlying disorder
    • Interactions
      When two or more substances are taken at or near the same time an interaction may occur
      This may create new effects that are different than those from either drug taken alone
      They may:
      Act independently of each other
      Enhance each other's effects
      Potentiation: multiplying the effects of two drugs rather than simply doubling the dose
      Have an antagonistic effect
      some drugs block the effects of other
    • Drug interactions may occur when combining recreational drugs with:
      Other recreational drugs
      Prescribed psychotropic medications
      Other prescribed drugs (including medications prescribed for medical conditions)
      Over-the-counter medications
      Herbal and natural products
      Alcohol
      Tobacco
    • Anticipating Interactions - Challenges
      Drug potency, strength, dose
      Drug purity – contaminants, adulterants
      Research studies lacking, inconclusive, unethical
      Drug interaction information based on unproven theories or case reports with incomplete data
      Person not forthcoming or doesn’t know all that they have taken
      Over-the-counter drugs, herbal products and grapefruit juice not often reported
    • Anticipating Interactions….
      DEPRESSANTS
      2 bottles Oxycontin
      12 Vicodin (hydrocodone + acetaminophen)
      2 bottles of Nyquil (doxylamine, pseudoephedrine, acetaminophen, DM)
      18 chlorpheniramine antihistamines
      10sleeping pills (benzodiazepines?)
      Vodka
      STIMULANTS
      6 Ritalin (methylphenidate)
      20 clenbuterol (beta-2-agonist used as diet pill)
      18 herbal uppers (ephedra?)
      energy drink (caffeine?)
      GI MEDS
      8 antacid reflux tabs
      1 bottle of stomach upset mixture PeptoBismol
      10 Zantac (ranitidine) tablets
    • Dave
      Started his night at friend’s drinking vodka cranberry. Before they left for the party he did a couple lines of blow. At the party he dropped a pill, did some shots and drank a Vodka Redbull. Later, he took a cap of MDMA and did some bumps of K. Becoming nauseous, he left the party and went to a friend’s to chill. Feeling better, he crushed some speed and they each did a rail before heading home to crash. He couldn’t find any G, so said he might knock himself out with some Ativan, or a couple of Gravols and a joint.
    • John
      Has been partying nearly every weekend for over a year, since moving to Toronto from a small town. His partying usually involves late nights including some drinking, 1-2 ecstasy pills each weekend, and some K once or twice a month when sketching at home. He has maintained a job in retail, has been going to the gym 3 times a week and seeing his friends on weekdays to hangout and have dinners. For the three months he has been trying to quit smoking and has been taking Zyban on and off. Six weeks ago he went to his doctor and said he was feeling down; he was prescribed him Celexa. For the last two weeks he has missed several days of work, has not gone to the gym and has only seen his friends out clubbing.
    • Kate
      Does not like to drink but smokes weed occasionally. She had never done any party drugs but recently she was introduced to Ketamine and enjoys snorting it at home with a couple of friends. She likes the feeling and enjoys K-holing. Last week, after people left her place, she found a baggie of powder on the coffee table. Assuming it was K she snorted a big line and hoped to K-out. Instead she felt a rush of energy and was very anxious for about an hour.
    • Ways drugs are taken…
      Different methods of administration affect how quickly you get high, the intensity and duration of the high, and pose different advantages and risks.
      • Smoking / Inhaling
      • Injecting
      Intra-venous
      Intra-muscular
      Subcutaneous
      • Snorting (up the nose) / Hooping (up the bum or vagina)
      • Sublingual (under the tongue)
      • Transdermal (through the skin)
      • Swallowing / Ingesting
      • Placebo effect / Contact high
    • Smoking / Inhaling
      Concerns:
      • Burns to lips and mouth (with certain drugs e.g., crack).
      • Damage to lungs and airways.
      • Quick ‘come-on’ can increase the ‘rush’ and potentially makes using more addictive.
      Advantages:
      • Easier to titrate dose.
      • Effects felt rapidly.
    • Injecting
      Concerns:
      • Infection through re-using or sharing equipment.
      • Abscesses.
      • Easier to overdose.
      • Finding a safe space.
      Advantages:
      • More “bang for buck”.
      • (More intense high.)
    • Snorting / Hooping
      Concerns:
      • Sharing straws, bills and bumpers can transmit all types of germs from the common cold and flu to Hepatitis C.
      • Damage to nasal/anal passages.
      Advantages:
      • Quicker and easier to administer.
    • Swallowing
      Concerns:
      • Harder to measure dose.
      • Drugs are absorbed more slowly through the gut therefore the positive and negative effects of the drugs tend to be less extreme; however, they tend to last longer.
      Advantages:
      • The risk of getting HIV or Hepatitis C is greatly reduced (almost no risk) from swallowing a drug.
    • Routes of Administration(e.g., crystal meth)
      Effects FeltDuration
      Inject < 1 min 3-7 hrs
      Smoke < 1 min 3-7 hrs
      Snort / rectal 5-10 mins 4-10 hrs
      Swallow 20-60 mins 5-12 hrs
      Intensity of high /
      “Euphoric Rush”
      Image source: learn.genetics.utah.edu/content/addiction/drugs/delivery.html
    • Continuum of use
      • No Use - the person does not use particular substances.
      • Experimental Use - the person tries a substance and may or may not use it again.
      • Social or Occasional Use - the person uses the substance in an amount or frequency that is not harmful (e.g., drinks on a social occasion; ceremonial use).
      • Medication (prescribed) - the person uses a medication as directed, under medical supervision. Risks are minimized.
      • Problematic Use - the person experiences negative consequences from using a substance (e.g., health, family, school, work, financial, legal problems).
      • Dependence - the person is psychologically and/or physically dependent on a substance and continues using, despite experiencing serious problems. Withdrawal symptoms may exhibit if use stops.
    • Notes about the Continuum of Use
      • People do not automatically move along the continuum.
      • Some people may stay social users for their entire lives.
      • Some people can move around the continuum over time.
      • People can be at different points of the continuum for different substances.
      • Where a person is on the continuum, does not necessarily impact her/his ability to manage and minimize risks. For example:
      • Someone that is “heavily addicted” may still use new equipment every time.
      • A long time cocaine user may overdose.
      • A social user may overdoes or spend too much.
      • For people struggling with dependency, not using for a while, then using again (sometimes referred to as “relapse”) is the norm.
      • The reason(s) people start to use are not always the reason(s) they continue to use.
    • Reasons Why People Use Drugs
      TRIP! survey data 2008.
      Participants were asked to rate how much a set of questions described them on a scale of 1-5.
      1 2-3 4-5
      They help me relax when I feel stressed 25% 35% 40%
      They are fun, I feel happy/excited 10% 30% 60%
      They help me feel confident with friends 35% 65% - %
      To get a different view on life 15% 20% 65%
      To help me work/study 45% 45% 10%
      Spiritual growth/meditation 10% 15% 75%
      Makes music/dancing more enjoyable 15% 30% 55%
      Makes me feel better when depressed 45% 35% 15%
      Helps me sleep 55% 30% 15%
      Keep going on nights out 30% 50% 20%
      Forget problems/worries 65% 25% 10%
    • Signs of “Problematic Use”
      Some risks are acute; others are chronic
      Psychological / physical dependency
      CAGE
      Have you ever felt you should cut down on your use?
      Have people annoyed you by criticizing your use?
      Have you ever felt bad or guilty about your use?
      Have you ever used first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
      Physical / mental health, spiritual, emotional, financial, social, driving, legal consequences…
    • 5 Risk Reduction Tips
      Self-directed harm reduction strategies to help avoid overdosing, bad highs, missing work, dehydration, or other consequences after use:
      Rationing
      Rules for selecting and mixing
      Controlling quality
      Maintaining a healthy lifestyle
      Following guidelines during use
      Adapted from: “Greenspan, N.R., et al. “It’s not rocket science, what I do”: Self-directed harm reduction strategies among drug using ethno-racially diverse gay and bisexual men. International Journal of Drug Policy (2010), doi:10.1016/j.drugpo.2010.09.004”
    • Rationing
      Limiting or regulating the quantity and/or frequency of use in a particular setting, or over a given time period.
      “I limit myself to two pills a night.”
      “I don’t party every weekend.”
      “I need time to recover before work on Monday.”
    • Rules for selecting and mixing
      Which drugs you will use.
      Certain characteristics maybe reasons to choose or avoid specific drugs:
      “It doesn’t leave me hung-over.”; “I can afford it.”
      “I won’t do that because it’s illegal.”; “I don’t like speedy drugs.”
      How you will take them.
      Method of consumption can be a deterrent:
      “I would never stick anything up my nose.”
      Which drugs you can use at the same time.
      Physical harms are often reason to avoid specific drugs or combinations:
      “If I mix these two I could pass out.”
      “This drug won’t mix well with my prescription.”
    • Controlling quality
      To ensure, as best you can, the quality of drugs used.
      Obtaining drugs from a “reliable source”
      Get to know your dealer
      Using drugs that have been (safely) used by others
      Ask around: “Peer Reviews”
      Trial & error and inspection
      Get to know how drugs look, taste, smell
      Become familiar with how they feel in the body and how long the effects last
    • Maintaining a healthy lifestyle
      Eating, resting, sleeping
      Drinking water
      Not sharing water bottles
      Taking vitamins and other supplements
    • Following guidelines during use
      Drinking water when partying
      Especially in hot environments or when physically exerting yourself
      Using with people you trust and have experience
      They can help if you have a problem
      Not sharing drug use equipment
      To avoid HIV and Hep C but even common cough and cold viruses
      Watch out for your drinks
      To prevent deliberate or accidental contamination
    • Rave Drugs / Club Drugs
      1970’s - 1980’s:
      New York and Chicago discos
      Ibiza, Spain (UK Tourists)
      1980’s - 1990’s:
      Underground Raves (U.K.); Warehouse Parties (New York, Chicago, Detroit, Toronto); Gay Nightclubs
      1990’s - 2000’s:
      Nightclubs (U.K.)
      Raves, Nightclubs, Gay Circuit Parties (North America)
      2000’s:
      Nightclubs; Gay Clubs; all-ages-all-night events
      “Parties”
    • “Party Drugs”
      A generalized term for substances that have historically been associated with raves and all night dance-clubs.
      These drugs are used by many kinds of people in all kinds of settings.
      Some of these drugs are illegal, some have no classification
      Examples:
      Ecstasy, Ketamine, GHB, Acid, Cocaine, Crystal Methamphetamine
      Newer Classes and Research Chemicals
    • “Party-Drugs”
    • TRIP! survey data 2008
    • Trends
      Of greatest concern was the re-emergence of crystal meth use over the past year. In 2007, only 15% of respondents identified using this substance in the last year or month. In 2008, the number rose to 26%.
      Also of concern was the number of people using prescription medication for psychoactive purposes. This question was not asked in the previous survey and has not been a focus for TRIP! in the past, but with more than 20 percent of people using these substances, more work needs to be done to address this in the coming year. Other than Oxycodone and Codeine, respondents identified using Adderal, Ritalin, Dexedrine, Diluadid, Concerta, Valium and Morphine.
    • Trends
      Small numbers of people indicated use of research chemicals such as DOB, DOI, DOC, 2CE, 2CC, 2CB, 2CI, 5-MeO-MiPT, and AMT, nitrous oxide, poppers, pcp, hasish, over the counter disassociative DXM, a variety of plant based hallucinogenics such as Kratom, Salvia, DMT, morning glory seeds, Mugwort T. Peruvianus (a cactus), and other amphetamines such as TMA, BZP, and MDA.
    • Drugs to talk about…
      Alcohol
      Amphetamine-type substances
      MDMA; Ecstasy Pills; Speed; Meth; Dexedrine; Ritalin
      Hallucinogens
      Phenylethamines; LSD; Mushrooms; Ketamine
      Benzos
      Atavan; Xanax; Clonazepam
      Opiates
      Oxies; percs; T3s
      Marijuana
      GHB
      Cocaine
    • Alcohol
      Neurotransmitters:
      GABA (inhibits brain activity)
      Alcohol stimulates GABA receptors, making them more inhibitory and further inhibiting brain activity
      Glutamate (brain’s general purpose excitatory transmitter)
      Binds to glutamate receptors preventing glutamate from exciting the cell
      Alcohol particularly effects areas involved in memory formation, decision making and impulse control
    • Alcohol Risk Reduction
      Alcohol does not mix well with many substances.
      Be cautious, and better to avoid, the following:
      Alcohol + Benzos
      Alcohol + Ketamine
      Alcohol + Opiates
      Alcohol + GHB
      This can be a particularly dangerous combination
    • Alcohol Risk Reduction
      Eat something before drinking
      Pace yourself
      Hydrate as you drink
      Prearrange transportation; leave car keys behind
      Take only the money you intend to spend
      Make your own drinks
      Only accept drinks from people you trust
      Monitor how often you’re drinking; take breaks
      “Liquor before beer, you’re in the clear; beer before liquor, never been sicker”
      (Nearly all liquor is quality and potency assured)
    • Non-palatable alcohol
      • Initiate a non-judgmental, factual discussion about the harms of using these substances.
      • Encourage the use of safer alcohols – beer, wine and liquor.
      • Discuss the use of less harmful, non-palatable alcohols (e.g., mouthwash rather than hand sanitizer).
      • Discuss options to reduce the amount of non-palatable alcohol consumed, and other strategies to reduce the potential for harm,
    • Ecstasy
      E, X, pills, disco biscuits
      Specific pills named based on colour, size, shape, stamp/logo
      Can come as powder in a gel cap
      $5-$20 a pill (Toronto 2009)
      Predominately swallowed
      Pills may be crushed in to powder and snorted
      Rarely hooped or smoked
    • Ecstasy
      Main neurotransmitter: Serotonin
      Though with adulterated pills others maybe effected (e.g., more dopamine if methamphetamine is in pills)
      Primarily stimulant effects; “upper”
      Though overwhelming sense of “bliss” may leave you feeling lethargic
      Physical effects:
      Increases in heart rate, body temperature and energy
      Jaw clenching/tightening, dilated pupils, nausea
      Psycho/behavioural effects:
      +ve: empathy, openness, peace, caring, open-hearted communication
      –ve: anxiety, paranoia, “bad mood”
    • Ecstasy
      Immediate risks:
      Not knowing what you get
      Ecstasy pills are one of the most adulterated illicit substances
      Dehydration; overheating; stroke
      Particularly when used in hot nightclubs and parties
      Say or do something you regret
      Tendency to talk openly and “feel connected” may not last the next day
      Rough comedown
      Can be hard to fall asleep
      You may feel sad, blue, and easily irritated for a couple of days after
    • Ecstasy
      Longer-term concerns:
      Tolerance
      Many longer-term users report taking more to get a similar effect (e.g., “½ a pill used to get me high, now I take 2 in a night”).
      Psychological Dependency
      If you have always taken ecstasy when going out dancing, it may be hard to not think about using when going out, even though your body isn’t physically needing it.
      Depression
      What goes up, must come down. Serotonin, one of the neurotransmitters ecstasy effects, is part of your eat/sleep patterns and mood cycles - it may be depleted after use.
      Anxiety & panic attacks
      Stimulant drugs can create a sense of urgency or paranoia in some people, especially with the more you take or the longer you stay high.
    • Ecstasy: Pills vs. MDMA
      MDMA = “pure” Ecstasy.
      Historically found pressed into a pill form.
      Pills are usually “cut” with other drugs.
      Never know what you are getting!
      Each pill is different, even if it looks the same.
      • Duration of high: 4-6hrs (pure MDMA), 2-10 hrs (Ecstasy pills)
    • Ecstasy Pills
      Observations and conversations with partiers and clubbers using E, show a wide variety of experiences.
      Toronto, 2004:
      7 of 21 Ecstasy users showed methamphetamine in hair samples.
      BC Centre for Excellence in HIV/AIDS and UBC Dept. of Health Care and Epidemiology, 2004:
      94 pills
      44 (47%) contained methamphetamine
    • Ecstasy Pills
      The Pink Heart or the Orange Pig?
      Ketamine; DXM; Caffeine; Crystal Meth; BZP
    • Ecstasy – Before You Use
      Remember, ecstasy is illegal and has tough penalties for possession.
      You can also be charged for trafficking if you buy for friends.
      Ask around… Try to get the latest buzz on good and bad E’s circulating.
      Pill websites and pill testing may help be useful.
      • Buy from someone you know, or someone whose pills you’ve tried and like.
      Be careful if you are feeling down before using.
      Be very careful if you are using anti-depressants; better to avoid using.
      Be cautious if mixing with other drugs.
      Eat and sleep lots before and after partying.
    • Good to see the variety of pill contents.
      Cost prohibitive.
      • Lots of local reports.
      • Subjective experiences can vary – be careful!
      • Similar looking pills can vary.
    • Ecstasy – When You Use
      It’s nearly impossible to know the purity and quality of the pill until after you take it.
      Kicks in, 20-60 minutes when swallowed – wait to get high
      Start with half a pill. Wait about 45 minutes after you’ve dosed before deciding to do more.
      Less is more. You will likely feel worse after using if:
      You do more at one time (e.g., 2 ½ pills vs. 1 pill)
      You stay high longer (e.g., 20 hrs vs. 7 hrs)
      Stay hydrated:
      YES: water; Gatorade
      NO: alcohol; energy drinks
      If dancing, take breaks and chill out for a while.
      Fruits (esp. bananas), protein shakes, juices, yogurt, are all good (and easier) to eat.
    • What goes up, must come down…
      Lack of sleep. Lack of food. Physically exhausted.
      Accept the comedown; chill out with friends.
      Depressed; irritable; cranky
      Need time for recovery
      Eat! Sleep!
      Spread out the partying… not every weekend.
      Serotonin takes a few weeks to be replaced.
    • Cocaine (powder)
      Coke, Blow, Charlie, Whitney
      White to cream chunks or powder
      $40 ½ gram; ~$240 8-ball [3.5 grams] (Toronto 2011)
      Typically snorted up the nose
    • Cocaine (powder)
      Main neurotransmitter: dopamine
      Stimulant
      Physical effects:
      Increase in heart rate, body temperature, blood pressure
      Numbs tissues it touches (nose, gums, lips)
      Jaw grinding, dilated pupils, upset stomach
      Psycho/behavioural effects:
      +ve: increased wakefulness; confidence; chatty
      -ve: cravings; anti-social; anxious; “edgy”
       or  sex drive
    • Cocaine biochemistry
      Peak blood cocaine levels in approximately:
      30 to 45 minutes (snorted)
      5 minutes (smoked)
      Almost instantly (injected)
      Duration of action: 45 to 90 minutes
       Short half life (1-2 hours)
      Short high… Quick come down  desire to do more and to keep going
    • Cocaine biochemistry
    • Cocaine
      Immediate risks:
      Stroke; heart attack (esp. with high concentrations from high doses or extended “runs”)
      Anxiety / panic attacks
      Dehydration
      Push boundaries and take unintended risks
      Spend more than you intend
      Disease (esp. with snorting)
    • Cocaine
      Longer-term concerns:
      Tolerance
      Psychological / physical dependency
      Sinus infections
      Weight loss or gain
      Finances
    • Cocaine Risk Reduction
      Use a new straw
      Don’t snort with dirty dollar bills and keys.
      Avoid sharing straws or bumpers.
      Try colour coding or marking your straws when using with other people.
      Having a nasal spray of clean water, that you could use shortly after snorting each line.
      This can help reduce the damage to your nose.
      Leave money and bank cards at home.
    • Cocaine (crack)
      Rock; Free base cocaine;
      Powdered cocaine dissolved and boiled in a mix of ammonia or baking soda.
      Looks like rocks or chunks
      Price: varies by region; 1 hit for <$5
      Smoked or injected
      Makes a cracking sound when burned
    • Cocaine (crack)
      Taken from erowid.org
    • Crack Risk Reduction
      Use your own equipment:
      Pipes, needles, cookers, filters, tourniquets… etc.
      Find a safe space to use.
      Carry condoms / lube.
      Moisturize lips with non-oil based products.
    • Safer Crack Kit
      • Alcohol swabs
      • Pyrex-glass pipe
      • Rubber mouth piece
      • Heat resistant metal screens
      • Chopstick
      • Helps prepare screens
      • (Lip Balm)
      Video: Step-by-step demonstration of safer crack smoking: http://hepcinfo.ca/videoplayer_e/safer_smoking_e.flv
    • Cocaine – New Concerns
      Cocaine is notoriously cut with adulterants; it is rarely good quality.
      Recently an adulterant known as Levamisole is showing up in many samples throughout North America.
      This is of particular concern for people who are already susceptible to autoimmune disorders:
      Levamisole can significantly reduce the number of white blood cells in the body, a condition called agranulocytosis.
      Symptoms include fever, swollen glands, painful sores in the mouth and anus, and an infection that won't go away.
      Because many of the symptoms of the illness are the same as the flu, it is important that people who are using cocaine be aware that they aren't sick with something more serious than influenza.
    • Cocaine – New Concerns
      If you use cocaine watch out for:
      High Fever
      Chills
      Painful anal, oral sores
      Skin abscess / lung infection that appears to be developing more rapidly than usual.
      Seek Medical Attention Immediately!
    • Mephedrone
      Mephedrone, 4-MMC, Meow, M-Cat, Bubbles
      2-Methylamino-1-p-tolylpropan-1-one
      Stimulant; Euphoriant
      A synthetic stimulant with empathogenic effects that some people report being a “cross between ecstasy and cocaine”.
      Between 2007 and 2009, it became available for purchase online, was used increasingly in Europe, Australia, and New Zealand, associated with several deaths, and then controlled in some countries as a result.
    • UK Mephedrone Ban May Have Done More Harm Than Good
      http://whyprohibition.ca/blogs/jesse-wentzloff/uk-mephedrone-ban-may-have-done-more-harm-good
      The [ban], which came after mephedrone had been linked to a number of deaths, which were later found not to be attributable to the drug, could be driving demand for other new drugs.
      It comes after recent research revealed that 40 new synthetic drugs have flooded into the UK during the past year
    • "One of the dangers of the approach that has been taken is that if we ban every new drug without a balanced view, then people will keep making more new drugs to replace them and eventually they will make something that is extremely toxic which, when kids take it, they will die.”
      • Professor David Nutt, Independent Scientific Committee on Drugs
    • Methamphetamine
      Crystal, Meth, Jib, Crank, Ice, Tina
      Price = $ 50-60 / bag (0.25 – 0.3 gram)
      White to off white powder; crystal shards (like glass)
    • Methamphetamine
      It can also look like…
    • Methamphetamine
      Strong stimulant; “upper”
      Releases dopamine, serotonin, norepinephrine (adrenalin)
      Long half-life (12 hours)
      Physical effects:
      Increase in heart rate, body temperature; decreased appetite and sleep; dry mouth; loss of erection
      Psycho/behavioural effects:
      Increase in alertness, confidence, euphoria
      Paranoia; anxiety; decreased self control / inhibitions
    • The Role of Dopamine
      While all stimulants release some dopamine, crystal meth releases much larger amounts:
      Cocaine releases 400% more dopamine
      Crystal meth releases almost 1500% more dopamine
    • Methamphetamine
      Immediate risks:
      Dehydration
      Lack of food / sleep
      Loss of inhibitions
      Paranoia / psychosis
    • Methamphetamine
      Longer-term risks:
      Physical/psychological dependency
      Weight loss
      Tooth decay
      Strains on heart
      Depression
      Loneliness
      Loss of friends, school, job
    • Methamphetamine Risk Reduction
      Plan ahead before partying; you may need a few days to recover.
      Try to eat something while you're high
      Protein shakes or fruit juices with healthy supplements are better than nothing. Feed your body the fuel it needs.
      Limit what you buy.
      The longer you party the rougher you’ll feel.
      Use extra lube if having sex.
      Lack of sleep. Lack of food. Physically exhausted.
      Accept the comedown
      Spread out the partying… not every week.
      Dopamine and all those other neurotransmitters take time to be replaced.
    • GHB
      G, GHB
      Price = ~ $10 / vial
      Clear liquid with slight “chemically” smell and taste which can easily be masked in a drink
    • GHB
      Sedative; depressant; “downer”
      Lower dose:
      similar effect to alcohol… relaxed, happy sociable
      Higher dose:
      dizzy, sleepy, vomiting, muscle spasms, loss of consciousness (“G-d out”), depressed breathing
      Duration of high: 1-4 hours
    • GHB
      Immediate risks:
      Very dose dependant
      Can be extremely dangerous when mixed with alcohol
      Vomit pass out  aspiration
      Coma
      Longer-term risks:
      Psychological dependency
      Physical dependency
    • GHB Risk Reduction
      Store liquid G in a container that could never be mistaken for drinking water.
      Colour the mixture BLUE using food colouring, so as to avoid it being mistaken for water, juice or alcohol.
      Shake that bottle!
      GHB is heavier than water.
    • Ketamine
      Special K, K, kitty
      Price: $20 - $30 / vial
      White powder
      Looks similar to table salt or a fluffy powder
      Typically snorted
      Can be smoked or injected (IM)
    • Ketamine
      Source: wikipedia
    • Ketamine
      Anesthetic; “downer”
      Lower dose:
      mild, dreamy effect; numbness in extremities
      Higher dose:
      difficult to move; hallucinogenic effect: out of body feeling; separation of mind and body (“K-hole”)
      Duration of high: 30-60 minutes (K-hole) but after effects last longer
    • Ketamine
      Immediate risks:
      Falling (breaking a limb)
      Assault
      Nausea (aspiration)
      Disease (esp. with snorting)
    • Ketamine
      Longer-term risks:
      Tolerance
      Psychological/physical dependency
      Sinus infections (if snorting)
      Bladder infections
      Kidney problems
      “k-pains”
    • Ketamine Risk Reduction
      Caution should be exercised when measuring doses.
      It is best to start with very small doses, working your way toward the desired levels.
      Caution with eating before using.
      Anesthetics often make people throw-up.
      Avoid mixing with alcohol.
      Many users report getting sick this way.
    • Viagra
      Sildenafil®
      Tablets come in doses of 25, 50 and 100 mg.
      Other similar substances:
      Levitra, Cialis,
      Physical effects:
      Blood vessels relax; erection; lowered blood pressure
      Immediate risks:
      Stroke / heart attack
      Duration high:
      drug lingers in body for several hours
    • Viagra
      Symptoms of Viagra, Cialis or Levitra toxicity:
      Chest or jaw pain
      Irregular heartbeat
      Nausea
      Respiratory problems
      Visual disturbances (blue colour)
      Prolonged erection > 4 hours
      Get to emergency room!
    • Viagra Risk Reduction
      Use the smallest dose necessary
      Be extra cautious if using blood pressure medications
      Don’t take with grapefruit juice
      Be careful when - or try to avoid - mixing with poppers
      If erection lasts longer than 4 hours, go to emergency room
    • Viagra
    • Viagra?
      Off-prescription “Viagra”, Fall 2007, Toronto, Canada
    • Poppers
      bolt, climax, poppers, rush, Zbest, and others
      Butyl / amyl nitrite; vapor inhaled
      Physical effects:
      Relaxation of blood vessels and smooth muscle tissue
      Drop in blood pressure; flushed face
      Psychological effects:
      +ve: head rush; horny; less inhibited
      -ve: anxiety; nausea
      Duration high: 30-60 seconds
    • Poppers
      Immediate risks:
      Flammable; chemical burns
      Nausea; headaches
      Stroke (esp. mixed with other substances that lower blood pressure such as Viagra)
      Long-term risks:
      Psychological addiction; carcinogenic?
    • Alcohol
      Neurotransmitters:
      GABA (inhibits brain activity)
      Alcohol stimulates GABA receptors, making them more inhibitory and further inhibiting brain activity
      Glutamate (brain’s general purpose excitatory transmitter)
      Binds to glutamate receptors preventing glutamate from exciting the cell
      Alcohol particularly effects areas involved in memory formation, decision making and impulse control
    • Alcohol Risk Reduction
      Alcohol does not mix well with many substances.
      Be cautious, and better to avoid, the following:
      Alcohol + Benzos
      Alcohol + Ketamine
      Alcohol + Opiates
      Alcohol + GHB
      This can be a particularly dangerous combination
    • Alcohol Risk Reduction
      Eat something before drinking
      Pace yourself
      Hydrate as you drink
      Prearrange transportation; leave car keys behind
      Take only the money you intend to spend
      Make your own drinks
      Only accept drinks from people you trust
      Monitor how often you’re drinking; take breaks
      “Liquor before beer, you’re in the clear; beer before liquor, never been sicker”
      (Nearly all liquor is quality and potency assured)
    • Cannabis
      Marijuana, pot, weed.
      Commonly smoked or eaten.
      Concentrated resinous form called hashish, and as a sticky black liquid called hash oil.
      Synthetic (pharmaceutical) versions.
      Three distinct species
      Cannabis sativa, Cannabis indica, and Cannabis ruderalis
      The term 'hemp' is generally used to describe low-THC varieties of cannabis which are grown for industrial uses.
    • Cannabis
      Price = ~ $40 for 1/8 ounce (a “half quarter”, 3.5 grams)
      Green leaf plant with buds, with orange/brown fibers and sometimes coated in crystals.
    • Cannabis
      The active ingredients are called cannabinoids
      THC (Delta-9-tetrahydrocannabinol) is thought to be responsible for most of the psychoactive effects.
      Effects
      Onset: When smoked, the effects of cannabis begin almost immediately. When eaten the effects can take 1 to 2 hours to manifest.
      Duration: Effects of smoked cannabis peak after about 20 minutes and last for 1-2 hours. When eaten, the effects will peak more slowly and primary effects may last for 3-4 hours.
    • Cannabis Experience
      Primary effects with recreational use:
      Euphoria, relaxation, and changes in perception.
      Effects vary depending on dosage.
      Low doses:
      Sense of well-being, mild enhancement of senses (smell, taste, hearing), subtle changes in thought and expression, talkativeness, giggling, increased appreciation of music, increased appetite, and mild closed-eye visuals.
      Higher doses:
      Visuals may become more prominent, sense of time is altered, attention span and memory are frequently affected, and thought processes and mental perception may be significantly altered.
    • Cannabis Experience
      Primary reasons for medicinal use:
      Appetite stimulation
      Pain reduction
      Many other benefits reported for a wide variety of conditions.
      Can get a federal permit:
      To possess
      To grow
      To be a designated grower
    • Cannabis Concerns
      Negative effects can include:
      Paranoia, dry mouth, respiratory problems and nervousness/racing heart.
      Reduced ability to concentrate, impaired memory, tiredness, and confusion.
      Side effects tend to increase with lifetime use.
    • Cannabis Concerns
      Relative potential for dependency:
      Regular use can lead to psychological habituation making it difficult to quit.
      Most people do not experience signs of physical addiction.
      Withdrawal somewhat difficult but in no way dangerous.
      Benzodiazepines can be used to treat withdrawal.
    • Cannabis Concerns
      Long Term Health Problems:
      Smoking: lung and throat problems: coughing; increased throat and lung infections; reduced lung capacity; carcinogenic effects.
      Amotivational syndrome.
      Not (or slightly) toxic to the liver, but…
      Increasing concern around heavy/chronic use and HepC.
    • Cannabis Concerns
      Heart Issues:
      Because cannabis increases heart rate, it could potentially increase risks of heart problems in those at risk of heart disease.
      Mental Illness:
      Can precipitate neuroses or psychoses in those who are already at risk.
    • Cannabis Risk Reduction
      Know your source.
      Be careful about mould and bacteria.
      Eating poses lowest health risks, though harder to titrate (manage) dose.
      Use with people you trust.
      Be mindful of smoking public spaces.
      Avoid getting high and driving.
      Smoking increases risks of pulmonary disease.
      Try a vaporizer instead of smoking.
    • Cannabis Risk Reduction
      Vaporizers offer and alternative to smoking.
      Cannabis is heated to the point THC vaporizes but the plant material is not burned.
      Cannabis before (left) and
      after (right) vaporization.
      This vaporizer relies on convection rather than conduction.
    • Vaporizer vs. Smoking
      Vaporizer after 2 months use (left)
      Pipe after 2 weeks use (right)
    • Synthetic (prescription) THC
      Synthetic THC, available on prescription
      Cesamet (nabilone); Marinol (dronabinol)
      Reduced psychoactive effects.
    • LSD (d-lysergic acid diethylamide)
      Potent hallucinogen
      White crystalline powder that dissolves in water, is odourless, and has a slightly bitter taste.
      An effective dose is too small to see. (20 - 80 micrograms)
      It is usually packaged in squares of LSD soaked papers (blotters) or miniature powder pellets called microdots
      Usually taken by mouth and held on the tongue or swallowed
    • LSD
      • Examples of LSD blotter paper
      • colourful designs often added to mask impurities
      • street names may vary according to blotter designs
    • LSD
      LSD trips are unpredictable
      Produces vivid visual effects
      Affects your senses, mood and thoughts
      People can become paranoid and feel a loss of control which can lead to a state of panic
      Judgement is affected and people may put themselves in danger
    • LSD
      Alters the persons perception of reality.
      Can vividly distort the senses.
      “Trip” - perceptual changes, altered time sense, feeling detached from self, synesthesia (“hearing” colours), dizziness, “pins and needles”
      Not addictive
      Can cause flashbacks
    • PsilocybinStreet names: Magic Mushrooms, shrooms
      Hallucinogen, similar to LSD
      Mushrooms or in powder capsules
      Sniffed, smoked or injected, or ingested orally
      Onset 1/2 hour
      Effects last 4 to 5 hours
    • Effects of Psilocybin
      Sensations of relaxation or fatigue; separation from surroundings; heaviness or lightness
      Perceptual distortions, visual hallucinations, dizziness, shivering
      Can cause tension and anxiety shortly after ingestion
    • Is Psilocybin Dangerous?
      One danger is misidentification, as some mushrooms are poisonous
      PCP and LSD are often sold as psilocybin
      Can impair judgement
      Can trigger underlying mental health problems and cause schizophrenic-type symptoms
      User can have “bad trips”
    • Tryptamines - AMT
      (Alpha-methyltryptamine)
      Lasts 16 hours
      Effect like combining MDMA & LSD
      Wide range of experiences
      Comes in a white powder
      Can be swallowed, snorted or smoked
      $20 – 25
      Only a small amount needed
      Narrow dose range 10 – 15 mg.
      Can cause unpleasant trips
    • Tryptamines 5-MEO-DIPT
      Foxy-methoxy
      White powder or tablet
      5 – 12 mg. Dose
      $30 – 40 per dose
      Causes body buzz, mood lift, euphoria, increased sex drive, and enhanced visuals
      Long lasting
      Can cause acute vomiting, long come down (12 hours), diarrhoea, a widely varied experiences.
    • Tryptamines - 2CB
      White powder or tablet
      $30 per dose
      MDMA/LSD effect
      Open and closed eye visuals
      Mild stimulant and mood enhancer
      Can cause cramps and diarrhoea
      Lasts 4 to 6 hours
      Life altering
      Tolerance develops quickly
    • Tryptamines - 2CT7
      Powder or tablet
      7 mg tabs sometimes sold as “E”
      Change in perception & time
      Increased sociability
      Dissociative effect
      May cause anxiety, confusion or panic attacks
      Nausea and vomiting
      Has resulted in death
    • Research Chemicals
      Substances used in medical research
      Popularized by fringe scientist and doctor, Alexander Shulgin
      2CI, 2CB, 2CT2, 2CT7, 5-meo-DiPT. 5-meo-AMT, BZP, TFMPP, mephedrone
      Many are legal, some are scheduled substances
      Can easily be obtained over the internet
      The ones with psychedelic properties are sought
    • Research Chemicals
      Scheduling of these substances causes ‘blow-out sales’ by manufacturers, who are eager to get rid of them to anyone with a credit card
      Come in ‘waves’ through the dance music scene
    • Research Chemicals
      Little is known of these substances, their long-term effects, potential contraindications with medications and other drugs
      Not a very high success rate: with several of the substances, only 50% of users will get the desired high, the other 50% will have vomiting and diarrhea
    • Opiates
      • Heroin
      • Opium
      • Fentanyl
      • Morphine (& MS-Contin) (“peelers”)
      • Hydromorphone (Dilaudid, Hydromorph-Contin)
      • Oxycodone (Percocet, Percodan)
      • Codeine
      • Hydrocodone (Hycodan)
      • Meperidine (Demerol)
      • Substitute: Methadone
      • All are downers
      • Slow breathing and heart rate
    • Heroin
      • Poppy derivative
      • Mainly administered IV
      • Also snorted and smoked
      • ± $50 a point (1/10 of a gram)
      • Intense feeling of euphoria and well-being
      • Sedation, analgesia
      • Tolerance builds and ceasing use may result in withdrawal symptoms
    • Opiates - Canada
      • Heroin use has become an increasingly marginal form of drug use among illicit opioid users in Canada, particularly outside of Vancouver and Montréal.
      • Prescription opioids are the predominant form of illicit opioid use.
      • “Opioid-rich" environment - a world per capita consumer of a number of opioids.
    • Ontario Student Drug Use and Health Survey 2009
    • Oxycontin
      • OxyContin contains oxycodone in a controlled-release tablet (5 mg, 10 mg, 20 mg, 40 mg, and 80 mg)
      • 12-hour pain relief.
      • In Canada, OxyContin is manufactured by Purdue Pharma.
      • Introduced in 1996; Oxycodone-based products have been used illicitly for the past 30 years.
      • When used illicitly, OxyContin can be taken in pill form, or crushed and then ingested, snorted, or injected
    • Fentanyl
      • Extremely potent pain medication
      • Usually prescribed as a trans-dermal time release patch
      • 5 strengths with 1.25, 2.5, 5.0, 7.5, 10 mg
      • Delivers 12, 25, 50, 75, 100 mcg/hr for 72 hours
      • People will scrape the patch and inject the fentanyl
      • One patch can give about 10 injections
      • People can easily inject too much and overdose
    • Opiate Risk Reduction and Treatment
      • Basic risk reduction strategies, particularly using new equipment.
      • Medications can assist with detoxification in combination with other therapeutic interventions.
      • In Canada, methadone maintenance has increased five-fold since the mid-1990s
      • Methadone; Buprenorphine; Naloxone; Suboxone
    • Methadone Maintenance Programs
      Some heroin addicts are unable to maintain a state of abstinence. Prolonged methadone treatment can lead to:
      • A decrease and often the cessation of heroin use.
      • A decrease in the use of other substances.
      • A substantial decrease in crime and prostitution.
      • Improved health (except for preexisting infections).
      • An improvement in living conditions.
      • Better conditions for the continuation of pregnancy.
    • Buprenorphine
      Buprenorphine hydrochloride is one of the first new treatment options for opioid dependence since methadone was introduced in Canada over 40 years ago.
      Physicians do not have to obtain a section 56 methadone exemption1 from Health Canada in order to prescribe buprenorphine.
      While international clinical evidence indicates that buprenorphine is a much safer drug than methadone, it is important to keep in mind that the opioid-dependent patient population presents special risks and challenges.
      Two formulations of buprenorphine – Subutex® and Suboxone® – have been approved by Health Canada for use in treating opioid dependence.
      Suboxone was introduced to the Canadian market in fall 2007.
    • Pharmaceutical Drugs
      The following few slides come from: not4me.org
      We have divided the pharmaceutical facts into three common categories:
      Opioid Painkillers
      Stimulants
      Tranquilizers, Barbiturates
    • Pharmaceutical Opioid Painkillers
      What it is
      Category: Opioid analgesic
      Examples of generic names (and their respective trade names) include: codeine (Tylenol III), meperidine (Demerol), hydrocodone (Vicodin), oxycodone (OxyContin, Percocet) and morphine.
      Pharmaceutical painkillers are usually prescribed medically for the purposes relieving pain, but they are also used recreationally or outside of their prescribed use. Most opioid painkillers that are used recreationally are diverted from prescription use, rather than being illegally manufactured.
      Most come in pill form in various dosages, which can be taken orally, ground up and snorted nasally or diluted into a liquid and injected. Snorting and injecting result in a quicker and stronger effect (though these methods can be very dangerous as they release several hours worth of opioid painkillers into your body at once).
    • Pharmaceutical Opioid Painkillers
      What will likely happen *Reactions and experiences may vary dramatically from person to person.*
      Effects on brain:
      Short term:Opioid painkillers activate opioid receptors in the brain, increasing the release of the neurotransmitter dopamine, interfering with the transmission of pain signals to the brain and causing feelings of intense happiness, warmth and pleasure.
      Effects on body:
      Short term: Possible immediate effects include (pain relief), sleepiness, constricted pupils, sweating, loss of appetite, constipation, nausea, vomiting, dizziness, headache, itchiness, dry mouth, fatigue, weakness, insomnia, fever, diarrhea, difficulty urinating, abdominal pain, rash, difficulty breathing and convulsions. When snorted, nasal discomfort or damage can occur.
      Long term: Possible long term effects include physical addiction and withdrawal symptoms if drug use is stopped. Some opioid painkillers (such as codeine and hydrocodone) also contain acetaminophen, which can cause liver toxicity with regular use and high doses.
      Effects on behaviour:
      Short term: Possible immediate effects include improved mood, euphoria, feelings of relaxation, unfocused thoughts, confusion, and nervousness.
      Long term: Possible long-term effects include cravings for more opioid painkillers and decreased interest in sex.
    • Pharmaceutical Opioid Painkillers
      Dependency
      Addiction: Opioid painkillers can be both physically and psychologically addictive. The addictive potential is strong in recreational users as well as in medical users, especially if the drug is used on a daily basis.
      Tolerance: Tolerance to opioid painkillers can develop over a matter of weeks, with higher doses needed to achieve the same desired effect (both recreationally and medically).
      Withdrawal Symptoms: Symptoms can occur when regular pharmaceutical painkiller use is stopped, and include insomnia, restlessness, muscle spasms, muscle aches, tremors, sweating, fever, nausea, vomiting, diarrhea and anxiety.
    • Pharmaceutical Opioid Painkillers
      If you choose to use... Harm Reduction Tips
      Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.
      Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body have more fully developed before using substances can have long term health and mental benefits.
      Opioid painkillers have very strong addictive potential! Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Opioid painkillers are prescribed only for individuals who need it, and can have adverse and dangerous effects on individuals for whom they are not prescribed.
      Similarly, if you have been prescribed opioid painkillers, avoid taking more than the prescribed dosage. Always talk to your doctor or a health professional before taking prescribed painkillers with other substances.
      Some of the negative effects of opioid painkillers can be alleviated by lying down. Negative side effects generally increase with higher doses.
    • Pharmaceutical Opioid Painkillers
      Some opioid painkillers (such as codeine and hydrocodone) also contain acetaminophen, which can cause liver toxicity with regular use and high doses.
      If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe exchange, a pharmacy, or your local health department. If you can’t get new needles, try snorting instead. Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.
      Regular injection can cause abscesses, collapsed veins, infections and other complications.
      Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a hole in the cartilage wall between nostrils.
      Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis C and HIV
      Snorting and injecting opioid painkillers can result in a quicker and stronger effect. These methods can be very dangerous as they release several hours worth of opioid painkillers into your body at once.
      Avoid using opioid painkillers with other substances, particularly depressants such as alcohol and narcotics.
    • Pharmaceutical Stimulants
      What it is
      Category: Stimulants
      Examples of chemical names (and their respective trade names) include: amphetamine (Adderall) and methylphenidate (Ritalin, Concerta). Pharmaceutical stimulants are most commonly prescribed in the treatment of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD), but they have also been used in the treatment of narcolepsy and mild depression. Pharmaecutical stimulants are also used recreationally or outside of their prescribed use by many individuals.
      For more information about amphetamines, click here.
    • Pharmaceutical Stimulants
      What will likely happen *Reactions and experiences may vary dramatically from person to person.*
      Effects on brain:
      Short term: Stimulants cause an increased release of the neurotransmitter dopamine which causes increased feelings of pleasure.
      Long term: can cause permanent changes to some areas of the brain, though the brain is quite adept at rewiring and compensating for changes
      Effects on body:
      Short term: Possible immediate effects include sweating, dilated pupils, decreased appetite, difficulty sleeping, tremors, increased heart rate, increased blood pressure, narrowing of blood vessels causing decrease in blood flow and flow of oxygen to the heart.
      Long term: Possible long term effects include weight loss, insomnia, exhaustion, heart problems, seizures, physical addiction and withdrawal symptoms is drug use is stopped.
      Effects on behaviour:
      Short term: Possible immediate effects include increased concentration, panic, anxiety, aggression, hostility, violence and paranoia.
      Long term: Possible long-term effects include paranoia, aggression, panic, hostility, violence and triggering of underlying psychological problems.
    • Pharmaceutical Stimulants
      Dependency
      Addiction: Physical and psychological addiction can occur.
      Tolerance: can develop tolerance
      Withdrawal Symptoms: Withdrawal symptoms occur when stimulant use is stopped and include, depression, loss of appetite, difficulty sleeping.
    • Pharmaceutical Stimulants
      If you choose to use... Harm Reduction Tips
      Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.
      Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body have more fully developed before using substances can have long term health and mental benefits.
      Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Pharmaceutical stimulants are prescribed only for individuals who need it, and can have adverse and dangerous effects on individuals for whom they are not prescribed.
      Similarly, if you have been prescribed pharmaceutical stimulants, avoid taking more than the prescribed dosage. Always talk to your doctor or a health professional before taking prescribed stimulants with other substances.
      Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis C and HIV
      If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe exchange, a pharmacy, or your local health department. If you can’t get new needles, try smoking or snorting instead.
      Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.
      Regular injection can cause abscesses, collapsed veins, infections and other complications. Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a hole in the cartilage wall between nostrils.
    • Pharmaceutical Tranquilizers, Barbiturates
      What it is
      Category: Sedative, tranquilizer
      Examples of generic names (and their respective trade names) include: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin), amobarbital (Amytal) and pentobarbital (Nembutal).
      Pharmaceutical tranquilizers and barbiturates are usually prescribed medically for the purposes of treating anxiety, sleep problems, muscle spasms and seizures, but they are also used recreationally or outside of their prescribed use. Most tranquilizers and barbiturates that are used recreationally are diverted from prescription use, rather than being illegally manufactured.
      Most come in pill form in various dosages, which can be taken orally, ground up and snorted nasally or diluted into a liquid and injected.
    • Pharmaceutical Tranquilizers, Barbiturates
      What will likely happen *Reactions and experiences may vary dramatically from person to person.*
      Effects on brain:
      Short term: Pharmaceutical tranquilizers and barbiturates increase the activity of the neurotransmitter GABA, resulting in decreased brain activity and causing feelings of calmness and drowsiness.
      Effects on body:
      Short term: Possible immediate effects include dilated pupils, drowsiness, slurred speech, loss of coordination, fatigue, irregular breathing, decreased heart rate, decreased blood pressure.
      Long term: Possible long term effects include slower reflexes, chronic tiredness, problems with vision, difficulty sleeping, sexual dysfunction, respiratory difficulties and liver damage.
      Effects on behaviour:
      Short term: Possible immediate effects include feelings of calmness and relaxation, lowered inhibitions, impaired judgment and paranoia.
      Long term: Possible long-term effects include mood swings and aggression.
    • Pharmaceutical Tranquilizers, Barbiturates
      Dependency
      Addiction: Pharmaceutical tranquilizers and barbiturates can be both physically and psychologically addictive. The addictive potential is strong in recreational users as well as in medical users, especially if the drug is used on a daily basis.
      Tolerance: Tolerance to pharmaceutical tranquilizers and barbiturates can develop very quickly, for both medical and recreational use, particularly when taken on a daily basis.
      Withdrawal Symptoms: Withdrawal symptoms do occur when regular use or high doses are stopped and include restlessness, insomnia, anxiety, depression and delirium. One severe withdrawal symptom is brain activity rebound, as the tranquilizers or barbiturates wear off, resulting in the brain racing out of control. This can sometimes cause seizures.
    • Pharmaceutical Tranquilizers, Barbiturates
      If you choose to use... Harm Reduction Tips
      *Disclaimer! Nothing you do can make using unprescribed pharmaceuticals completely safe. All drug use has inherent risks and dangers. The suggestions in this section can only help you reduce some of the associated risks. The best way to avoid the harms related to drug use is to not take the drug at all.*
      Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.
      Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body have more fully developed before using substances can have long term health and mental benefits.
      Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis C and HIV
      If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe exchange, a pharmacy, or your local health department. If you can’t get new needles, try snorting instead.
      Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.
      Regular injection can cause abscesses, collapsed veins, infections and other complications. Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a hole in the cartilage wall between nostrils.
      Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Tranquilizers and barbiturates are prescribed only for individuals who need it, and can have adverse and dangerous effects on individuals for whom they are not prescribed.
      Similarly, if you have been prescribed tranquilizers or barbiturates, avoid taking more than the prescribed dosage. Always talk to your doctor or a health professional before taking prescribed medications with other substances.
    • Pharmaceutical Risk Reduction
      Harm Reduction Guide to Coming Off Psychiatric Drugs:
      http://theicarusproject.net/downloads/ComingOffPsychDrugsHarmReductGuide1Edonline.pdf
    • Interactions with HIV meds
      Many recreational drugs may be dangerous when combined with HIV medications, based on individual case reports, and what we know about how the body processes these drugs. Most interactions between recreational drugs and HIV medications have not been scientifically studied, nor are they likely to be, given that most are illegal substances. However, people have shown through experience that “safer partying” is possible, and there are some specific tips that can help make drug use safer and healthier.
      Drug Interaction Tables
      Immunodeficiency Clinic
      Toronto General Hospital
      www.hivclinic.ca/main/drugs_interact.html
    • Resources
      General:
      www.erowid.org/psychoactives/psychoactives.shtml (all about every drug)
      www.tripproject.ca (Toronto based “party drug” harm reduction)
      www.not4me.org (Fear and abstinence only drug education?It's not enough 4 me.)
      www.torontovibe.com (AIDS Committee of Toronto’s party drug info page)
      www.dancesafe.org (U.S. based “party drug” harm reduction info)
      www.cssdp.org (Canadian Students for Sensible Drug Policy)
      Ecstasy:
      www.ecstasy.org
      www.ecstasydata.org (chemical analysis of pills)
      www.pillreports.com (qualitative user reports of pills)
      Crystal Meth: (gay/bi men focused)
      www.himynameistina.com
      www.tweaker.org / www.crystalneon.org
      www.knowcrystal.org
    • Existing Supports
      Detox, pre-treatment, treatment, post-treatment, complementary approaches
      DART (info about treatment)
      www.dart.on.ca
      1.800.565.8603
      24 hrs; anonymous; confidential
      Centre for Addiction and Mental Health (CAMH)
      Assessment: 416.535.8501 X 6616
    • Existing Supports
      YSAP – Youth Substance Abuse Program at YMCA
      Counselling and Education
      http://www.ymcatoronto.org/en/who-we-work-with/educators/substance-abuse/index.html
      Mississauga151 City Centre Drive, Suite 800905-276-9322
      Brampton8 Nelson Street, Suite 306905-450-9001
      Toronto485 Queen Street West, 3rd Floor 416-504-1710
      Scarborough230 Town Centre Court416-296-9907 ext. 401
    • LGBT Resources
      Prevention and safer using info for gay men
      • www.himynameistina.com
      • www.knowcrystal.org
      - www.tweaker.org
      - www.crystalneon.org
      - www.torontovibe.com
      Rainbow Services – CAMH (LGBT addictions counselling)
      Weekly meetings; 3 week sessions; 416.535.8501 x 6784
      AIDS Committee of Toronto Counselling Staff
      Primarily if concerned about behaviour but not looking to change use