Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1994-1998.
&quot;black tar,&quot; has also become increasingly available in the western United States. The color and consistency of black tar heroin results from the crude processing methods used to illicitly manufacture the substance in Mexico. Black tar heroin may be sticky, like roofing tar or hard like coal, and its color may vary from dark brown to black. It is often sold on the street in its tar-like state at purities ranging from twenty to eighty percent. This heroin is most frequently dissolved, diluted and injected. Red Rum Heroin - is a highly potent form of heroin that was recently responsible for the overdose death of a rock musician in New York. Red Rum and other brands like it, including Fire Express, Green Honey, and Laundromat, are much more potent than brands of heroin a decade ago. They are designed to deliver a strong high by snorting or smoking instead of injecting. According to New York City police, a sample of the Red Rum heroin tested at a purity level between 60 and 70 percent. Red Rum&apos;s origins are believed to be South American.
The typical heroin user today consumes more heroin than a typical user did just a decade ago, which is not surprising given the higher purity currently available at the street level. Until recently, heroin in the United States almost exclusively was injected either intravenously, subcutaneously (skin-popping), or intramuscularly. Injection is the most practical and efficient way to administer low-purity heroin. The availability of higher purity heroin has meant that users now can snort or smoke the narcotic. Evidence suggests that heroin snorting is widespread or increasing in those areas of the country where high-purity heroin is available, generally in the northeastern United States. This method of administration may be more appealing to new users because it eliminates both the fear of acquiring syringe-borne diseases such as HIV/AIDS and hepatitis, and the historical stigma attached to intravenous heroin use.
Howard Lotsof, a renowned researcher into ibogaine treatment of heroin addiction, has estimated that a &quot;low end analgesic dose of heroin would be about 1mg.&quot; Most users start with doses much higher than this. Insufflated doses of heroin probably start at between 5 and 20mg of pure heroin and intravenous doses probably start between 5 and 10 mg. As usage increases, however, the doses get much higher. Dr Lotsof wrote &quot;In close to twenty years of research and involvement with the treatment of opioid dependence with ibogaine the highest dose I personally saw used of heroin in Europe was 2 grams [per day], that is 2,000 mgs.&quot; 2 grams per day, however, is extremely high, much higher than most heroin addicts achieve. Heroin is very expensive and this dosage level would be fatal in most people who had not worked up their dosages slowly.When the Swiss government began allowing maintanence of heroin users, they were able to collect reliable data about exactly how much heroin was being used. The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg. of diacetylmorphine per day. One author writes &quot;I&apos;ve known people prescribed a full gram per day, but they were quite unusual, and such habits on the street are impossible except for relatively high level dealers. Remember, I&apos;m talking about pure pharmaceutical or number 4 if on the street. There are certainly cases of pain patients receiving larger equivalent dosages of opioids, but I&apos;ve never heard of one of these beating a 1000/1 ratio.&quot;The Swiss data was published in 1999 Prescription of Narcotics for Heroin Addicts: Main Results of the Swiss National Cohort StudyVolume One. Uchtenhagen, A;Dobler-Mikola, A.; Steffen, T; Gutzwiller, F.; Blattler, R; Pfeifer, S. Karger; Basel; 1999Page 20 states that the mean daily dose of heroin IV ( when used alone, without methadone on the side) was 491.7mg.Page 22 states &quot;A stable dose was achieved after 6 months at most; beyond this point, almost no further increases in dose were required
A dirty hit can result in a fairly quick and intense reaction or might take days or weeks to produce an effect. Symptoms often include sweating, headache, fever, and trembling. While the effects of a dirty hit may pass by themselves, you should seek medical attention if they are particularly strong or persistent. Shooting: IV Injection Skin Pooping: SQ injection Muscle Pooping: IM Chasing the dragon: Smoking (it&apos;s put on aluminum foil and heated from the bottom and allowed to run down the foil if possible while inhaling the smoke…) freebasing Dirty Hit: The result of a dirty process usually resulting in an abscess, cellulites, etc
Big in Ky, Fl, A new formulation would make it &quot;a lot more difficult to get a high&quot; from OxyContin, said Robin Hogen, executive director of public affairs for Purdue Pharma of Norwalk, Connecticut. The painkiller has become a popular street drug, delivering an instant high when crushed or dissolved and ingested. Hogen said the new drug would have to pass through clinical trials required by the Food and Drug Administration, which means it might be two to three years before it could be prescribed by doctors. Among the hurdles, Hogen said, are efficacy trials that would show how well the new formula handles pain relief.
This is the key to the heroin high: Nothing matters, hot or cold, fun or boring, big or small. When one is high on smack, one looks at the outside world and has only one thought: Who gives a fuck? You feel as if you&apos;ve been wrapped in the most pleasing, warm, and comfortable blanket in the world. At high doses, you fall in and out of consciousness, and getting this &apos;nod&apos; is what the veteran user prays for every time he shoots up; to sleep the sleep of angels is the ultimate goal of the heroin addict. ..from erowid.com
BLOOD POISONING (Septicemia) Blood poisoning (septicemia) is a bacterial infection of the bloodstream that can be caused by injecting with contaminated water, re-using old cottons, or failing to clean the skin prior to injection. Early symptoms include chills, fever, and extreme fatigue. If you experience these symptoms, seek medical attention. Septicemia can be fatal! ENDOCARDITIS Endocarditis is an infection of the heart lining that is caused by bacteria, fungi, and other infection-causing microbes that enter the bloodstream during injection and build up around the valves of the heart, weakening them as well as other parts of the heart muscle. Endocarditis can eventually cause a heart murmur, as well as fever, chest pains, fainting spells, shortness of breath, and heart palpitations. It can be treated with antibiotics if detected early, but can be fatal if it goes untreated. TETANUS tetanus spores enter a wound and release tetanus bacteria, usually after a scab has already formed. The bacteria then enter the bloodstream and cause an infection, which is characterized by muscle spasms or rigidity, especially in the neck and jaw (tetanus is commonly called &quot;lockjaw&quot;). Tetanus is fatal if not treated. Tetanus spores live in the soil and on rust, which is why a tetanus shot is recommended if you step on an old nail or other rusty object. If your needle, syringe, or other injection equipment is contaminated with tetanus spores due to dirt or rust, you could infect yourself. Skin-poppers and muscle-poppers are particularly susceptible to tetanus infection and should always use new, sterile equipment. NECROTIZING FASCIITIS (Flesh-Eating Disease) Associated w/ black tar Necrotizing fasciitis is a bacterial infection commonly known as &quot;flesh-eating disease&quot; that enters the body through broken skin and then affects the surrounding tissue and nearby muscle. It can be transmitted by the exchange of blood during needle sharing, and has recently been traced to &quot;black tar&quot; heroin on the West Coast. Symptoms of necrotizing fasciitis include increasing redness and swelling and extreme pain at the wound or injection site accompanied by a fever. The flesh around the site of infection begins to decay and looks as if it had been &quot;eaten&quot; away. Since this infection is fatal, early treatment with antibiotics is crucial to survival, although even appropriate therapy does not prevent death in all cases. Wounds must be kept impeccably clean. WOUND BOTULISMWound botulism is caused by a bacteria that produces a toxin on the skin where a puncture would is made and that eventually stops your breathing by paralyzing your muscles. Recent cases have been associated with the subcutaneous injection of &quot;black tar&quot; heroin on the West Coast. The source of the botulism could be the drug itself, a cut in the drug, dirty injection equipment, or contamination during the preparation process. Wound botulism can be prevented in the same ways as necrotizing fasciitisby following excellent sterile technique when preparing and injecting your drugs. Symptoms of wound botulism include droopy eyelids, blurred or double vision, and a dry, sore throat which may progress into difficulty speaking and swallowing, a weakness of the neck, arms, and legs, and difficulty breathing.
Jimson weed is Datura Stramonium, a member of the nightshade family. The active chemicals in Jimson include atropine, scopolamine, and hyoscamine. The buzz from this family of psychotropic plants is more like a dilerium with very strong hallucinations than anything else. Jimson is very poisonous, the buzz couldn&apos;t really be described as recreational, and I wouldn&apos;t try it, myself. If you decide to experiment with it, be *extremely* careful, because just a little too much could kill you. I have tried smoking a small amount of Datura Inoxia, and the buzz is interesting, but not overly pleasant. It has been reported that Datura Inoxia has been added to marijuana for extra effects, but I don&apos;t have any firsthand knowledge of this combination, It&apos;s possible that Datura Stramonium could be used in the same way, but I haven&apos;t heard or read of anyone trying this. Scopolamine: “Twilight Sleep” Chemically related to Atropine, it is an anticholenergic (wich has some hallucinatory properties at high doses) Strong potentiation with some hallucination. Also a component in “Jimson weed” Stedman&apos;s medical dictionary describes overdose symptoms as: &quot;Strange indescribable feelings with giddiness, yawning, staggering or falling on attempting to walk; dryness of mouth and throat, sense as of suffocation, swallowing difficult, voice husky; face at first pale later suffused with a scarlatiniform rash which extends to the body; pupils widely dilated; pulse, at first bounding and rapid, later becomes irregular and faint&quot;.
medical detoxification is usually accomplished by giving decreasing doses of a long-acting opiate like methadone. After a few weeks of this, the patient is usually opiate-free without having suffered any appreciable physical discomfort. Since a percentage of the methadone marketed for medical use finds its way into the streets, many addicts also detox themselves this way without formal medical help Still others detox &apos;cold turkey&apos;--without any pharmacological help at all. They simply tell their friends they have the flu, go to bed, and suffer in relative silence. A substantial portion of the physical symptoms of this stage seem to depend on the activity (previously suppressed) of a part of the brainstem called the locus coeruleus. The is believed responsible for the brain&apos;s fear-alarm system, and such hyperactivity would be consistent with the marked anxiety, hypertension, and agitation withdrawing addicts report.
The &quot;meth&quot; comes from the chemical name &quot;methyl&quot;. The chemical Methamphetamine is composed of an amphetamine molecule with an additional methyl group attached to its nitrogen (amine group). A methyl is one of the simplest atomic groups which can be added to a molecule: it is a single carbon atom with a set of (usually) 3 hydrogens.For many of the known psychoactives, adding a methyl group slightly alters the effects, duration, and/or potency. As you start to pay attention to other chemical names, you&apos;ll see &quot;meth&quot; show up in many names and this will almost always indicate that there is a methyl group on the molecule somewhere. For Methamphetamine, the methyl allows it a little better fat solubility and thus better penetration into the brain.
Jan 18, 1887-Amphetamine was first synthesized by German chemist L. Edeleano and originally named phenylisopropylamine 1932Amphetamines are first marketed as &apos;benzedrine&apos; in an over-the-counter inhaler to treat congestion. 1937Amphetamine is first available in tablet form by prescription for use in the treatment of narcolepsy and ADHD (attention deficit hyperactivity disorder). WWII Both Amphetamine and Methamphetamine are widely distributed to soldiers to help improve performance. This led to addiction problems in Japan after the war. 1942Dextro-amphetamine and methamphetamine become commonly available. 1960&apos;sMethamphetamine use rises in the United States. 1970Amphetamine becomes illegal with the passage of the &apos;U.S. Drug Abuse Regulation and Control Act of 1970&apos;. [ Late 1980&apos;sSmoked Methamphetamine becomes more popular
All of these substances are swallowed, snorted, smoked, and injected by users (in estimated order of frequency) and all can be dangerous in combinations with MAOIs, at high doses, or at high frequencies of use.monoamine oxidase inhibitors (MAOIs) Until recently, it was believed that the metabolites of Parnate were Amphetamine and Methamphetamine, which would fit the definition of &quot;sympathomimetic agonists&quot; Most research does not support the amphetamine metabolite theory. However, there is still a lot to learn about MAOI pharmacology.
&quot;Crystal&quot; has seven letters, &quot;crank&quot; only has five. A term once used mostly to distinguish down-and-dirty bootleg meth from its crystal-clean sibling, &quot;crank&quot; has become a generic nickname for all forms of speed. And that includes the tablets and capsules that find their way out of the local pharmacy and onto the street.
Chronic use can lead to what is called, resulting in paranoia, auditory and visual hallucinations, self-absorption, irritability, aggressive and erratic behavior, and picking at the skin. This can be magnified by lack of sleep which often accompanies heavy use of meth. Patients concomitantly ingesting dextromethoraphan, monoamine oxidase inhibitors, MDMA and other serotonergic agents may develop a &quot;serotonin syndrome.&quot; Characterized by agitation, hyperthermia, altered muscle tone and seizures. Occurs within 2 hours of ingestion of offending agent and resolves 6 -24 hours after discontinuing the agent.
Repeated administration of methamphetamine damages cells in the somatosensory cortex: overlap with cytochrome, by O&apos;Dell SJ, Marshall JFSynapse, Vol 37 (No 1) Jul 2000;32-7 Methamphetamine is also believed to be neurotoxic.It use causes damage to the neurons in the dopamine portions of the brain. : Up to 50% in relatively small doses over prolonged periods Lead Poisening had been documented in some chronic IV meth users, Meth is sometimes made with lead acetateLarge amounts of lead in can cause brain damage, mental retardation, behavior problems, anemia, liver and kidney damage, hearing loss, hyperactivity, developmental delays, other physical and mental problems, and in extreme cases, death. Chelation therapy is indicated in patients with blood lead levels between 45 and 70 mug/dL. clinical symptoms suggesting encephalopathy (eg, obtundation, headache, and persistent vomiting) Normally the brain&apos;s irreplaceable complement of 30-40 thousand odd dopaminergic cells tends to die off at around 13% per decade in adult life. This diminishes the quality and intensity of experience. It also saps what in more ontologically innocent times might have been called one&apos;s life-force. Eighty percent loss of dopamine neurons results in Parkinson&apos;s disease, often prefigured by depression.
Most pharmacological Detox is based on cocaine info, has met with little success in meth users. This combination can be particularly bad because the user is likely to have strong cravings for more meth, while at the same time being unable to reach a satisfactory high
Cocaine was soon sold over-the-counter. Until 1916, one could buy it at Harrods. Cocaine was widely used in tonics, toothache cures and patent medicines; and in chocolate cocaine tablets. Ryno&apos;s Hay Fever and Catarrh Remedy - &quot;for when the nose is stuffed up, red and sore&quot; - was 99.9 per cent pure cocaine. Prospective buyers were advised - in the words of pharmaceutical firm Parke-Davis - that cocaine &quot;could make the coward brave, the silent eloquent, and render the sufferer insensitive to pain&quot;. Coca-cola was introduced in 1886 as &quot;a valuable brain-tonic and cure for all nervous afflictions&quot;. Coca-cola was promoted as a temperance drink &quot;offering the virtues of coca without the vices of alcohol&quot;. The new beverage was invigorating and popular. Until 1903, a typical serving contained around 60mg of cocaine. Sold today, it still contains an extract of coca-leaves. The Coca-Cola Company imports eight tons from South America each year. Nowadays the leaves are used only for flavoring since the drug has been removed.
The reinforcing effects of cocaine and cocaine analogs correlate best with their effectiveness in blocking the dopamine transporter (Ritz et al, 1987). This blockade is believed to produce increased dopaminergic stimulation at critical brain sites. However cocaine also blocks both norepinephrine (NE) and serotonin (5HT) reuptake and chronic use of cocaine produces changes in these systems as measured by reductions in the neurotransmitter metabolites MHPG (3-methoxy-4 hydroxyphenethyleneglycol and 5-HIAA (5-hydroxyindoleacetic acid). Thus neurotransmitters other than dopamine may be involved. It blocks re-uptake of 5-HT similarly to SSRI (serotonin specific reuptake inhibiting) anti-depressants such as fluoxetine (Prozac), sertraline, and paroxetine. Agonist (stimulation rather than blocking) properties at the 5-HT2 receptor have been found to fairly universally be associated with &quot;classical&quot; psychedelic drugs such as LSD, psilocybin and mescaline. It is possible that some of MDMA&apos;s &quot;psychedelic&quot; effect occurs because of interactions with this receptor. The alpha-2 adrenergic receptor may be associated with some of the carciovascular effects of MDMA. MDMA also releases dopamine which may be central to both its psychological action and to its neurotoxicity in animal studies. Pre- treatment of an animal with a drug which blocks dopamine release will also block MDMA neurotoxicity. In summary, MDMA effects 5-HT similarly to the way that amphetamines effect dopamine, by inhibiting the reuptake and causing the release of 5-HT. This effect is somewhat similar to the effect that SSRI anti-depressant drugs have. It also effects the 5-HT2 (psychedelic) and alpha-2 adrenergic (cardiovascular) receptor sites. Also, its effects on dopamine appear, at this point, to be involved both with its neurotoxicity and psychological effects.
Low-potency cocaine differs from regular cocaine powder and crack in terms of its purity level, and how fast and thoroughly it alters brain chemistry. According to Weil, the coca leaf chewed by peasant farmers in Bolivia and Peru is half of 1 percent pure cocaine. Similar concentrations sold in gum and lozenges overseas Freebasing is an especially dangerous means of abusing cocaine because of the high concentrations of cocaine it introduces into the bloodstream. These high doses can overtax the cardiovascular system. Reports of sudden death while freebasing are not uncommon. freebase: mix about 1 g of coke in 10 ml of water in a small vial. Slowly add drops of ammonia to the solution. A white milky precipitate will form. Stop adding ammonia when additional drops no longer result in precipitation. Add 5 ml of ethyl ether, close vial, and shake. The precipitate (freebase) will dissolve in the ether. Siphon off the ether with a pipette (ether and water don&apos;t mix), and slowly drip it on a plate. As the ether evaporates, white crystals will form. This is the evil freebase. Crush the crystals and put under a heat lamp for at least 24 hrs to let the solvent evaporate. mix 2 parts ok coke HCL for 1 part baking soda in 20 ml of water. Heat solution gently until white precipitates form, and stop heating when precipitation stops. Filter and keep precipitate. wash precipitate once with water (this procedure usually omitted in street product). Dry 24 hours under heat lamp. Voila. The product is much less pure (there is lots of baking soda left) but the procedure is safer.
By contrast, cocaine smuggled in by traffickers is 50 percent to 60 percent pure. The effect of crack is even more intense because it is smoked and its chemicals reach the brain in seconds. Cocaine inhaled through the nose takes 30 minutes to be fully effective. Orally ingested cocaine in lozenges or gum takes an hour, according to Kleber. Freebasing is an especially dangerous means of abusing cocaine because of the high concentrations of cocaine it introduces into the bloodstream. These high doses can overtax the cardiovascular system. Reports of sudden death while freebasing are not uncommon. freebase: mix about 1 g of coke in 10 ml of water in a small vial. Slowly add drops of ammonia to the solution. A white milky precipitate will form. Stop adding ammonia when additional drops no longer result in precipitation. Add 5 ml of ethyl ether, close vial, and shake. The precipitate (freebase) will dissolve in the ether. Siphon off the ether with a pipette (ether and water don&apos;t mix), and slowly drip it on a plate. As the ether evaporates, white crystals will form. This is the evil freebase. Crush the crystals and put under a heat lamp for at least 24 hrs to let the solvent evaporate. mix 2 parts ok coke HCL for 1 part baking soda in 20 ml of water. Heat solution gently until white precipitates form, and stop heating when precipitation stops. Filter and keep precipitate. wash precipitate once with water (this procedure usually omitted in street product). Dry 24 hours under heat lamp. Voila. The product is much less pure (there is lots of baking soda left) but the procedure is safer.
Because cocaine hydrochloride will decompose if smoked directly, the hydrochloride must be converted back to a relatively pure base state (freebasing) before it is suitable for smoking. Freebasing was introduced as a way to smoke cocaine during the late seventies. The base is produced form the hydrochloride using volatile chemicals (generally ether) and elaborate paraphernalia such as acetylene or butane torches. The process is dangerous and cumbersome and has resulted in numerous explosions and burns to individuals. Unlike cocaine base manufactured in the traditional freebase process, crack (which is an off-white color resembling coagulated soap powder) is manufactured by converting hydrochloride back to base, primarily by using baking soda and water. Ammonia can also be substituted for the baking soda. This method of preparation does not involve the use of heated volatile substances and consequently, virtually eliminates the dangers of explosion and fire encountered in the conventional freebasing. After conversion, the product is sold in ready-to-smoke powder which can be sprinkled on cigarettes. The name &quot;crack&quot; may have developed because this form of drug resembles crackled paint chips or because it makes a crackling noise when smoked. Crack often is distributed in a &quot;rock&quot; form allowing the user to smoke the cocaine in a traditional glass pipe.
The effects of cocaine occur within the first few minutes, peak in 15-20 minutes and disappear in about 1- hours. The immediate effects are what make cocaine so addicting. The user is willing to endure the lows in order to experience the highs. The half-life of cocaine in plasma is about 50 minutes, but inhalant (crack) users typically desire more cocaine after 10 to 30 minutes. Intranasal and intravenous use also results in a high of shorter duration than would be predicted by plasma cocaine levels, suggesting that a declining plasma concentration is associated with termination of the high and resumption of cocaine seeking. The major route for cocaine metabolism involves hydrolysis of each of its two ester groups resulting in loss of pharmacological activity. Benzoylecgonine results from the loss of the methyl group and this represents the major urinary metabolite. Standard tests to detect cocaine use target this metabolite which can be found in the urine for two to five days after a binge. Heavy users have been found to have positive urines for up to 10 days and thus the urine test is only a marker of use, but not necessarily recent use.
Cocaine has been reported to produce a prolonged and intense orgasm if taken prior to intercourse. Thus its use is associated with sexual activity, often compulsive and promiscuous. However, long term cocaine use may result in reduced sexual drive and complaints of sexual problems are common among cocaine users presenting for treatment
Recurrent snorting of cocaine may result in ischemia, necrosis, and infections of the nasal mucosa, sinuses, and adjacent structures. Pulmonary complications of cocaine toxicity include pulmonary edema, pulmonary hemorrhages, pulmonary barotrauma, foreign body granulomas, cocaine related pulmonary infection, obliterative bronchiolitis, asthma, and persistent gas-exchange abnormalities &apos;Sterile infections&apos; can only occur after cocaine injections. These are infections which are not caused by bacteria but by dying dermis (true skin). A patient developed fever, bronchoconstriction, hypoxaemia, pulmonary infiltrates, and serum and bronchoalveolar lavage fluid eosinophilia on two occasions after inhaling crack cocaine. Transbronchial biopsy specimens showed normal lung parenchyma but a dense eosinophilic infiltrate within the bronchial wall. Both episodes resolved promptly after treatment with corticosteroids. Eosinophilic lung disease may be a steroid responsive complication of crack cocaine abuse.
Cocaine and heroin taken together is referred to as &quot;speed ball.&quot; It is thought that the two drugs enhance one another&apos;s effects. Heroin may also temper some of the unpleasant after effects of cocaine use. Stedman&apos;s medical dictionary describes overdose symptoms as: &quot;Strange indescribable feelings with giddiness, yawning, staggering or falling on attempting to walk; dryness of mouth and throat, sense as of suffocation, swallowing difficult, voice husky; face at first pale later suffused with a scarlatiniform rash which extends to the body; pupils widely dilated; pulse, at first bounding and rapid, later becomes irregular and faint&quot;.
Since cocaine withdrawal is generally mild, treatment of withdrawal symptoms is generally not required. The major problem in treatment is not stopping cocaine, but rather it is helping the patient to resist the urge to re-start compulsive cocaine use. There is evidence that rehabilitation programs involving individual and group psychotherapy based on the principles of Alcoholics Anonymous and behavioral treatments based on reinforcing cocaine free urine tests can result in significant improvement in the majority of cocaine users. Nevertheless, there is great interest in finding a medication that can aid in the rehabilitation of cocaine addicts.
Research began by the CIA in the 50’s, by the 60’s the CIA realized that an adversary intelligence service could employ LSD &quot;to produce anxiety or terror in medically unsophisticated subjects unable to distinguish drug-induced psychosis from actual insanity&quot;. The only way to be sure that an operative would not freak out under such circumstances would be to give him a taste of LSD (a mind control vaccine?) before he was sent on a sensitive overseas mission. Such a person would know that the effects of the drug were transitory and would therefore be in a better position to handle the experience. CIA documents actually refer to agents who were familiar with LSD as &quot;enlightened operatives&quot;. Included in this group are LSD and hallucinogens derived from plants such as mescaline from peyote cactus, psylocybin from mushrooms, dimethyltryptamine (DMT) from seeds and myristicin from nutmeg. LSD is similar to compounds found in ergot, a fungus that grows on rye. Albert Hofmann, a scientist for Sandoz Pharmaceutical Laboratories in Basel, Switzerland found LSD while working on a series of ergot compounds. Lysergic acid was similar in structure to a compound called nikethamide, a stimulant. Hofmann was attempting to create a similar chemical that might be used for medicinal purposes. Some of the compound he had created was on his hands when he ate a sandwich. The resulting effects led to further experimentation. See page 341 in the text. LSD has been used experimentally in treatment of alcoholism, autism, paranoia, schizophrenia and various other mental illnesses with no particular success. Therapeutic use has been limited by the legal aspects and by difficulty in finding the pure substance. Impurities in LSD cause adverse reactions. The use of LSD declined after the 1960s and began to increase in the 1990s. Peer pressure and approval plus lack of understanding of potential problems resulting in use have led to increased use. Several students have suggested that the individuals imprisoned for production of LSD are being released and are making it again resulting in increased use. LSD is synthesized in laboratories, but the process is not simple. Producing it takes approximately a week. An illegal operation in San Francisco is the primary source of LSD. The amount of LSD needed to produce the desired effect is extremely small. Therefore a very small amount can satisfy the demand and can be easily hidden. In its purified form, LSD is colorless, odorless and tasteless making detection difficult. Due to the small amount needed to produce a reaction, it is sold in microdots (tablets approximately one tenth the size of aspirin), in liquid or in the form of &quot;panes&quot; (absorbent paper impregnated with LSD). One gram of LSD can provide 10,000 individual doses and is valued on the street at $50,000.00. The typical dose in the 1990s is 20 to 30 micrograms compared with a typical dose of 150 to 300 micrograms in the 1960s. Severe side effects with current use are fairly rare. A lethal dose is estimated to be five milligrams per kilogram of body weight (approximately half the pound weight). When taken into the body, LSD readily crosses all body tissues. It readily passes the BBB and the placenta. The brain receives approximately 1% of the total dose. In the brain, LSD concentrates in the hypothalamus, the limbic system and the auditory and visual reflex areas. Electrodes placed in the limbic system indicate and &quot;electrical storm&quot; or a massive increase in neural activity that might correlate with the overwhelming flood of sensations and the phenomenon of synesthesia. LSD also activates the sympathetic nervous system shortly after ingestion. Body temperature, heart rate and blood pressure rise. Sweating occurs along with increased salivation and nausea. Half of the LSD is cleared from the body within three hours and more than 90% is excreted in 24 hours. Tolerance develops rapidly and lasts longer than tolerance to other substances. Repeated doses lead to tolerance that might relate to the inability of the neurons to be altered to any greater extent. There are no withdrawal symptoms for LSD and addiction is thought to be psychological rather than physiological. Tolerance wears off in a matter of days after use is discontinued. The stages of the LSD experience have been described as Heightened, exaggerated senses Altered sense of time Perception of objects, colors, sounds altered Loss of control Flashbacks Self reflection User becomes aware of thoughts and feelings long hidden, forgotten or repressed Loss of identity and sense of cosmic merging Skin ceases to be a boundary between self and others Behavioral Effects include feelings of Being more creative – creative projects done while under the influence of LSD do not support this belief. being more insightful – new insights are short-lived, behavior does not change and answers achieved while under the influence are not &quot;earth-shattering&quot; Psychotic adverse reaction or &quot;freakout&quot; – this experience is referred to as a bad trip. Persons using LSD in an unfavorable setting or who have mental problems prior to use are most likely to have this experience. Flashback is now referred to as Post Hallucinogenic Perceptual Disorder (PHPD). Flashbacks might take the form of reoccurrence of body sensations, a distressing thought or emotion or altered visual perceptions. The most disturbing aspect of PHPD is that it comes on unexpectedly. The individual feels out of control and is concerned about safety of self or others. Treatment consist of reassurance that the condition will go away. Most such experiences occur within weeks or months of using LSD. Occasionally there is a report of five years after using a hallucinogen. LSD &quot;freakout&quot; is an intense, nighmarish experience with loss of emotional control. The individual susceptible to suggestions might have a syndrome resulting in being easily controlled, experience of paranoid delusions, hallucinations, panic attacks, psychosis and catatonic seizures. In rare instances some of these reactions are prolonged, lasting days. Varying degrees of tension, anxiety, fear, depression and despair might also occur, but are not as intense as the &quot;freakout&quot;. These symptoms are more likely to occur when taken in unfavorable setting, a person having psychological problems or a strong need to be in conscious control. Genetic damage and birth defects are not proven. Individuals who use hallucinogens are likely to also use other substances that might cause birth defects or problems with the pregnancy. Adulterants in the LSD might also cause problems in pregnancy. In the 1950s, the U. S. government and military experimented with LSD and gave it to humans without consent. Participants were coerced into taking the drug or not told that it was being given. The legal consequences of the LSD studies are ongoing. Large cash settlements have been awarded to families surviving persons who committed suicide as a result of taking LSD.
Drug Slang Terms (NB: many of these refer to the carrier, ie, &quot;Blotter&quot; or &quot;Sugar Cubes&quot;. Often the local names will refer to patterns printed on the blotter, eg, &quot;Blue unicorn&quot;.): Acid, &apos;Cid, Sid, Bart Simpsons, Barrels, Tabs, Blotter, Heavenly blue, &quot;L&quot;, Liquid, Liquid A, Lucy in the sky with diamonds, Microdots, Mind detergent, Orange cubes, Orange micro, Owsley, Hits, Paper acid, Sacrament, Sandoz, Sugar, Sugar lumps, Sunshine, Tabs, Ticket, Twenty-five, Wedding bells, Windowpane, etc.
In spite of the impressive degree of prior problems noted in many of these patients, there are occasional reports of severe and prolonged reactions occuring in basically well adjusted individuals. In the same vein, there are many instance of faily poorly adapted individuals who suffer _no_ ill effects from repeated psychedelic drug use. In fact, it has been hypothesized that some schizophrenics do not suffer adverse reactions because of their familiarity with such acute altered states. Another possibility is that there individuals may be &quot;protected&quot; by possible &quot;down- regulation&quot; of the receptors for LSD, bu the (over-)production of some endogenous compound. _Individual_ prediction of adverse reactions, therefore, is quite difficult... Hensala et al. compared LSD-using and non-LSD-using psychiatric inpatients. They found that this group of patients was generally of a younger age and contained more characteristically disordered individuals than the non- LSD-using group. Patients with specific diagnoses with or without LSD histories were not compared. Based on their observations, they concluded that LSD was basically just another drug of abuse in a population of frequently hospitalized individuals in the San Francisco area, and that it was unlikely that psychedelic use could be deemed etiological in the development of their psychiatric disorders
The effect sets in after 30 to 90 minutes and gen- erally lasts 5 to 12 hours. However, intermittent distur- bances of affect may occasionally persist for several days. 1973: &quot;Of 189 samples of LSD quantitatively analyzed, the average dose was 67.25ug LSD. Useful dose is 50-200 mcg, with “Transcending doses as high as 500 mcg
LSD acts to preferentially inhibit serotonergic cell firing and seems to spare postsynaptic serotnergic receptors. This preference is shared by other simillar hallucinogens but in a limited fashion. Nonhallucinogenic analogs of LSD show no preference. These results suggest that there are two different steric conformation of serotonergic receptors, one of which has higher affinity for LSD than the other. In general, 5-ht is an inhibitory transmitter; thus, when its activity is decreased, the next neuron in the chain is freed from inhibition and becomes more active. blocks re-uptake of 5-HT similarly to SSRI (serotonin specific reuptake inhibiting) anti-depressants such as fluoxetine (Prozac), sertraline, and paroxetine. Agonist (stimulation rather than blocking) properties at the 5-HT2 receptor have been found to fairly universally be associated with &quot;classical&quot; psychedelic drugs such as LSD, psilocybin and mescaline.
Since serotnergic systems appear to be intimately involved int eh control of sensation, sleep, attention, and mood, it may be possible to explain the actions of LSD and other hallucinogens by their disinhibition of these critical systems. There is also evidence for interaction with dopaminergic systems. These include an oxytocic action and constriction of the blood vessels of isolated vascular beds. In intact animals LSD causes a fall in blood pressure, but its adrenergic blocking potency is low. LSD causes mydriasis in man and other species. It also causes hyperglycaemia and mydriasis, has a hyperthermic action and causes piloerection. These effects are sympathetic in nature and are abolished by ganglion blocking or adrenergic blocking agents. Parasympathetic effects include salivation, lachyrmation, vomiting, hypotension, and brachycardia. Low doses stimulate respiration but larger doses depress it. (NB: mydriasis = pupillary dilation) The &quot;speedy&quot; quality of unadulterated LSD is due to the pharmacological actions of LSD itself, and not necessarily due to decomposition or impurities. LSD typically causes early adrenergic effects such as sweating, nervousness, jaw grinding and insomnia which are easily confused with the side effects of amphetamine. Actually, I think the fact that PharmChem analyzed something on the order of 2,000 LSD samples between 1972 and 1979 and never found one with strychnine in it would be better. I&apos;m going over all their data with a toothpick and I&apos;ll get back to you on exactly what I find. It looks like the percent of LSD with strychnine in it is, however, at least under .05%. More a little later. The reported LD50 values for LSD are 46, 16.5, 0.3 mg/kg I.V. for mice, rats, and rabbits, respectively. Again, it&apos;s hard to accurately translate these numbers to oral values. Note that an average human dose is 0.001 mg/kg, ie, 1 microgram/kg, ie, 1 part per billion by weight.
Insomnia occurs frequently after the trip. A mild, over-the-counter sleeping aid can help, and these antihistamines do not produce adverse interactions. Also, some people like to consume a small amount of alcoholic beverage to &quot;smooth the jitteries&quot;. The usual precautions about sleeping aids if alcohol has been consumed apply of course.
ADDICTION POTENTIAL: Zero physical addiction potential. Not something that makes you want to do it again immediately. Essentially zero psychological addiction potential. Rarely people use it to escape in a negative way or as part of &quot;polydrug abuse&quot; behavior or pattern of behavior. Usually in this case other drugs are causing more harm, and the fundamental problem is a personal difficulty; the escapism/distraction is a symptom. The mental effects of Delysid can be rapidly reversed by the i.m. administration of 50 mg. chlorpromazine. Literature available on request. SANDOZ LTD., BASLE, SWITZERLAND 9792*-Z1540 e.-sp./d.-fr. Printed in Switzerland. ..... ~From: An Introduction to Pharmacology 3rd edition, JJ Lewis, 1964 (p 385) Peripheral Actions
Street drugs part 1
Street Drugs Part 1
Street Drugs every medic should
We will review some common principles of caring
for the “Pharmacologically gifted”
We will discuss some of the “standard” street
drugs that every paramedic should know.
There is no way we can be all inclusive in an hour
so bear with me.
And if you think this is going to be boring…try
Drugs we will cover
Hyper dynamic Drugs
Meth and derivatives
We will focus on Heroin. There are others similar
drugs in this class as well:
Heroin - First synthesized from
morphine (derived from the
poppy plant) in 1874, was not
extensively used in medicine
until the beginning of this
Commercial production of the
new pain remedy was first
started in 1898. While it
received widespread acceptance
from the medical profession,
physicians remained unaware
of its potential for addiction for
It’s abuse was a major cause of
the Harrison Narcotic Act of
One survey in 1999 saw
2% of HS students had
used heroin, most (1.1%)
under the age of 16. Use is
mainly growing in the 30-
40 age group (those w/
There is some indication
that heroin use is slowly
increasing to levels seen
in the 60’s and 70’s.
Pure heroin is a white powder with a bitter taste. Most
illicit heroin is a powder form which may vary in color
from white to dark brown because of impurities left from
the manufacturing process or the presence of additives.
Pure heroin is rarely sold on the street.. This heroin may be
"black tar," has also become increasingly available in the
western United States. It is often sold on the street in its
tar-like state at purities ranging from twenty to eighty
percent. This heroin is most frequently dissolved, diluted
A "bag" --slang for a single dosage unit of
heroin--may contain 100 mg of powder, only a
small portion of which is heroin. The remainder
could be sugars, starch, powdered milk, or
quinine. Traditionally the purity of heroin in a
"bag" has ranged from one to ten percent. More
recently, heroin purity has ranged from one to
ninety-eight percent, with a national average of
“ chippers" that being the term for non-addicts
who use addictive drugs in a controlled fashion
Homicide, Polo, Super
Scopolamine or Coke)
Methods of use
Low Purity: almost
injected either IV, SQ,
Higher purity: snort or
smoke the narcotic.
Availability of high
quality heroin is
Chasing the dragon:
Methods of use: Oxycontin / MS
Time released capsules, some may have more than 100 mg
Often crushed and snorted, eliminating the “time release”
May be crushed, diluted, and injected like traditional heroin
S/S OF AN OVERDOSE
Pin Point Pupils
Aspiration and Hypoxia
Other s/s? Think poly-
Cotton balls, Cig Filters
Spoons w/ residue
The bottom of a soda pop
can is commonly used as a
"spoon" to dissolve the
heroin in because it is
curved inward like a
spoon. The bottom is torn
off of a can as close to the
bottom as possible.
Slow admin of Narcan, just enough to make them
Narcan 0.4 mg-2 mg traditional, may need higher doses
High doses may be needed if drug is synthetic
Watch for re-sedation due to Narcan’s short
Due to the multiple drug combinations
possible, full ALS is advised (unforeseen
drug reactions-speed ball, homicide, etc)
Long Term problems
BLOOD POISONING (Septicemia) “Cotton
NECROTIZING FASCIITIS (Flesh-Eating
Disease) Associated w/ black tar
TRACKING AND BRUISING
CONSTIPATION, BOWEL OBSTRUCTION
Cocaine: AKA: Speedball
Heroin is thought to mask/temper some of cocaine's
“Homicide”, “Super Buick” Heroin, coke, scopolamine-
Causes tachycardia, anticholinergic toxicity (remove the
heroin via Narcan and the adrenergic and
anticholinergic effects combine uninhibited)
This is why its very important to give just enough
Narcan to regain respiratory function
Some weird things that have been
done with a Heroin OD by Junkies
Injected someone with salt water. This is an old
junky myth sometimes still used.
Injected someone who overdosed on heroin
with cocaine or speed, or vice versa. Another old
Narcan Used PTA of EMS- Narcan is becoming
more and more common among junkies for
“emergencies” (some trials are being done in
Seattle and Europe)
Put ice on their genitals (down their pants) .
Dependence, Detox, and Withdrawal
medical detoxification is usually accomplished
by giving decreasing doses of a long-acting
opiate like methadone.
While not truly physically addictive, Heroin
withdrawal is clearly extremely uncomfortable
The previously suppressed Locus Coeruleus is
believed responsible for most of the clinical
problems: anxiety, HTN, agitation
TAKE HOME INFORMATOIN
Beware of the
Slow minimal Narcan
Hyper-dynamic Drugs: Drugs with severe
cocaine (in several forms)
Other drugs that would be similar are Ecstasy,
and PMA which are discussed elsewhere.,
Background- Meth and other
“Meth" is methamphetamine, which is a type of
The chemical Methamphetamine is composed
of an amphetamine molecule with an additional
methyl group attached to its nitrogen (amine
For Methamphetamine, the methyl allows it a
little better fat solubility and thus better
penetration into the brain.
How Long has Meth and other
Amphetamines been around?
Jan 18, 1887-Amphetamine was first
synthesized by a German chemist
1919- Methamphetamine is first synthesized (in
WWII -Both Amphetamine and
Methamphetamine (by the Japanese mostly)are
widely distributed to soldiers to help improve
performance. This led to addiction problems in
Japan after the war.
Methamphetamine is a synthetic stimulant commonly
used as a recreational drug. It is legally prescribed as a
treatment for ADD under the brand name Desoxyn, for
both children and adults.
On the street, it is generally found as an odorless, white
or off-white, bitter-tasting powder, though it is also
found in pills, capsules and larger crystals.
Methamphetamine production is a relatively simple
process, especially when compared to many other
Nazi method: a method of quick cooking
Methamphetamine: meth, crystal meth,
speed, ice, crank, glass, uppers, yaba, shabu
shabu, tweak, go-fast, Hitler's Drug, Crazy
Speed : any amphetamine
Jacked: on speed
Bump: a snorted hit (average 2-4 “bumps”)
An intentional binge: with some heavy
users injection as much as a gram every 2-4
hours to keep things going
What is the difference between crystal and
“Crystal" has seven letters, “Crank" only has
Methods of use
It is frequently snorted, but is also used orally,
smoked, and injected.
Oral use takes about half an hour to produce
effects. When smoked, effects are almost
instantaneous, and nearly as quick when snorted.
S/S OF AN OVERDOSE
High last about 6-24 hours. 50% of meth is
remains in body at 12 hours. Most effects are from
the over stimulation of release of dopamine.
Jaw clenching, Agitation, Paranoia
Hyperthermia (lethal levels), DIC, Seizures
Visual, Auditory and tactile hallucinations
ALS (EKG, IV)
Benzo’s for sedation and seizures
2.5-10 mg Valium
Haldol also an option for just combativeness.
Note: Unresponsive meth users should have
a temp checked when feasible for early
detection and intervention
Active cooling for profound hyperthermia
Long term effects
Methamphetamine is an anorexant, This is considered a
benefit for many light users, but in regular or heavy users
can lead to malnutrition.
Methamphetamine is also believed to be neurotoxic.It’s
use causes damage to the neurons in the dopamine portions
of the brain.
Some possible effect on the serotonin producing parts of
the brain is also suspected.
The most commonly (and ambiguously) documented
warning of amphetamines (and ecstasy, PMA)is with the
use of Monoamine Oxidase Inhibitors (MAOI’s)
can be dangerous in combinations with MAOIs, at high
doses, or at high frequencies of use.
monoamine oxidase inhibitors (MAOIs)
Until recently, it was believed that the metabolites of
Parnate were Amphetamine and Methamphetamine, which
would fit the definition of "sympathomimetic agonists"
Recent research does not support the amphetamine
metabolite theory. However, there is still a lot to learn
about MAOI pharmacology.
Dependence, Detox, and Withdrawal
Methamphetamine causes significant tolerance, as
well as psychological dependence
strong cravings for more meth, while at the same
time being unable to reach a satisfactory high
Withdrawal from high doses can produce severe
depression, called the “Crash”
Everybody loves cocaine
“…Woe to you my Princess, when I come, I will
kiss you quite red and feed you till you are
plump. And if you are forward, you shall see
who is the stronger, a gentle little girl who
doesn't eat enough or a big wild man who has
cocaine in his body."
-- Sigmund Freud, On Coca
Cocaine is an alkaloid found in leaves of the South
American shrub Erythroxylon coca . It is a
powerfully reinforcing psychostimulant.
The drug induces a sense of exhilaration in the
user primarily by blocking the reuptake of the
neurotransmitter dopamine in the midbrain.
Doctors dispensed cocaine as an antidote to
morphine addiction. Unfortunately, some of their
patients made a habit of combining both.
Until 1916, one could buy it at Harrods.
Cocaine was widely used in tonics, toothache
cures and patent medicines; and in chocolate
Ryno's Hay Fever and Catarrh Remedy - "for
when the nose is stuffed up, red and sore" -
was 99.9 per cent pure cocaine.
Prospective buyers were advised - in the
words of pharmaceutical firm Parke-Davis -
that cocaine "could make the coward brave,
the silent eloquent, and render the sufferer
insensitive to pain".
Cocaine Hydrochloride is available on the
street generally at 30% to 40% purity and
retails at prices ranging from $10.00 to
$50.00 per quarter gram.
Cocaine metabolites are excreted in the
urine and can be detected for between 2 to 4
days after the drug has been consumed.
Types of Cocaine
Freebasing: “freebase” either injected or heated and its
fumes inhaled through a pipe. Very Elaborate, very
Smoked: Crack converted to smoke via direct flame
Chasing the dragon –as for heroin
Snorting:"snorted into the nose. This results in rapid
inhalation of the powder and cutting agents. Cocaine is
absorbed rapidly via the mucous membranes into the blood
Dabbing:a licked finger is coated with the powder and then
placed on the tongue or gums is an alternative method.
Freebasers Hall of Fame
Pregnant cocaine users may experience
premature labor and abruptio placenta
Just FYI: Cocaine has been reported to
produce a prolonged and intense orgasm if
taken prior to intercourse…in case you
Standard therapy for
respiratory problems (from
steroids very helpful for the
Treat CONFIRMED MI’s per
thrombo’s with caution
ACLS –EP recommends
spacing out EPI to 5-10
minutes in arrest
Lidocaine with caution
Mag for Dysrhythmias
Haldol for combativeness
Benzo’s for sedation and
seizures, AND HTN
2.5-10 mg Valium
Use anti-Hypertensives with
caution as they may worsen
Alpha specific blockers for
Beta Blockers are falling out of
favor (may leave alpha effects
Long term effects
Multiple Respiratory problems from smoking (COPD)
Recurrent snorting of cocaine may result in ischemia,
necrosis, and infections of the nasal mucosa, sinuses, and
MI’s, Cardiovascular Damage
Vascular damage from HTN
Irritability and increased risk of violence are found among
heavy chronic users
When combined with alcohol, the cocaine alkaloid
yields a further potently reinforcing compound,
now known to be cocaethylene
alcohol plus cocaine produces more stimulatory l
behavior in mice than either drug alone
The combination appears to exert more
cardiovascular toxicity than either drug alone in
Alcohol appears to potentiate cocaine
hepatotoxicity in both humans and mice.
Interactions- Heroin and
Heroin is thought to mask/temper some of cocaine's
“Homicide”, “Super Buick” Heroin, coke, scopolamine-
Causes tachycardia, anticholinergic toxicity (remove the
heroin via Narcan and the adrenergic and
anticholinergic effects combine uninhibited)
This is why its very important to give just enough
Narcan to regain respiratory function
Dependence, Detox, and
Since cocaine withdrawal is generally mild,
is mainly psychological in nature.
Tolerance to Cocaine builds quickly, thus
larger and larger doses are used.
Treatment of withdrawal symptoms is
generally not required.
Depression, bradycardia, sleepiness,
fatigue, cocaine craving
Take Home information about Hyper-
Betablockers falling out of favor
Benzos for HTN, sedation, SZ
Adrenergic blockers with alpha effects as well as
Beware of the poly pharm OD
Beware of the malignant hyperthermia
Discovered by Dr. Albert Hofmann in
Extensive study, use, and abuse by the
government in the late 40’s. 50’s, and
60’s. (OSS/CIA, US Navy)
Some documented cases of CIA
Operatives taking it to “Immunize” them
selves to its effects in the 60’s.
Now that’s job satisfaction!
Many names refer to the carrier or “brand”(image
printed on blotter)
Blotter, Sugar, Sugar Cube, “cid, Acid
Bart Simpsons, Barrels, Tabs, Blotter,
Heavenly blue, "L", Liquid, Liquid A, Lucy in
the sky with diamonds, Microdots, Mind
detergent, Orange cubes, Orange micro,
Owsley, Paper acid, Sacrament, Sandoz,
Sunshine, Tabs, Ticket, Twenty-five, Wedding
bells, Windowpane, etc.
Body Kinks- Unexpected physical side effects I.e.
nausea, jitters, etc
Bad trip- A person on LSD who becomes
depressed, agitated, or confused may
experience these feelings in an overwhelming
manner that grows on itself.
LSD psychosis: The effects of LSD
exacerbate pre-existing psychological
problems for several days.
Usually taken Sublingually or orally on
The solution may also be injected s.c.
or i.v.(RARE) The effect is identical
with that of oral administration but sets
in more rapidly.
Usual dose is 50-200 mcg, with
“Transcending doses” as high as 500
How does it work?
Similar to other drugs that give hallucinations:
It affects the re-uptake of 5-HT similarly to SSRI
(serotonin specific reuptake inhibiting) anti-
depressants such as fluoxetine (Prozac), sertraline,
Agonist (stimulation rather than blocking)
properties at the 5-HT2 receptor have been found
to fairly universally be associated with other
psychedelic drugs such as psilocybin and
mescaline, and somewhat in MDMA
S/S OF AN OVERDOSE
Vivid Auditory, tactile, and
Mild drops in B/P
May exacerbate pre-existing
Mild stimulatory effects
After trip effects
proven and disproven in
Benzo’s for severe agitation (rare)
Dependence, Detox, and withdrawal
No documented physical
A rapid tolerance is built
up (about 3-5 days) that
just as rapidly disappears
Take Home Information
Facilitate a low key trip, and all is well
The patients respond to your actions as much as
we respond to them
Very little clinical problems from drug, just
actions resulting from altered behavior