Drugfacts Inhalants

Inhalants

Many products readily found in the home or workplace—such as spray Definition paints, markers, glues, and cleaning Although other abused drugs can be fluids—contain volatile substances inhaled, the term inhalants is reserved that have psychoactive (mind- for the wide variety of substances— altering) properties when inhaled. including solvents, aerosols, gases, and People do not typically think of these nitrites—that are rarely, if ever, taken products as drugs because they were via any other route of administration. never intended for that purpose. (See below for a list of examples.) However, these products are sometimes abused in that way. They are especially (but not exclusively) may sniff or snort fumes from a con- abused by young children and adoles- tainer or dispenser (such as a glue cents, and are the only class of sub- bottle or a marking pen), spray aero- stance abused more by younger than sols (such as computer cleaning dust- by older teens. ers) directly into their nose or mouth,

or place a chemical-soaked rag in their High-School Students Reporng mouth. Abusers may also inhale fumes Having Ever Used Inhalants from a balloon or a plastic or paper bag. Although the high produced by 8th inhalants usually lasts just a few minutes, abusers often try to prolong 10th

Grade it by continuing to inhale repeatedly over several hours. 12th

0.00% 5.00% 10.00% 15.00% People tend to abuse different inhalant products at different ages. New Source: University of Michigan, 2011 Monitoring the users ages 12–15 most commonly Future Study. Survey data can be found at www.drugabuse.gov abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. New users How Are Inhalants Abused? ages 16–17 most commonly abuse nitrous oxide or “whippets.” Adults Abusers of inhalants breathe them in most commonly abuse a class of in- through the nose or mouth in a varie- halants known as nitrites (such as ty of ways (known as “huffing”). They amyl nitrites or “poppers”). Inhalants • September 2012 • Page 1 How Do Inhalants Affect the Brain? Products Abused as Inhalants Most abused inhalants other than nitrites depress the central nervous sys- Volatile solvents—liquids that vaporize at room tem in a manner not unlike alcohol. temperature: Industrial or household products, including The effects are similar—including paint thinners or removers, degreasers, dry- slurred speech, lack of coordination, cleaning fluids, gasoline, and lighter fluid euphoria, and dizziness. Inhalant Art or office supply solvents, including correc- tion fluids, felt-tip marker fluid, electronic con- abusers may also experience light- tact cleaners, and glue headedness, hallucinations, and delusions. With repeated inhalations, Aerosols—sprays that contain propellants and many users feel less inhibited and less solvents: Household aerosol propellants in items such as in control. Some may feel drowsy for spray paints, hair or deodorant sprays, fabric several hours and experience a linger- protector sprays, aerosol computer cleaning ing headache. products, and vegetable oil sprays

Gases—found in household or commercial prod- Unlike other types of inhalants, ucts and used as medical anesthetics: nitrites enhance sexual pleasure by Household or commercial products, including dilating and relaxing blood vessels. butane lighters and propane tanks, whipped cream aerosols or dispensers (“whippets”), and refrigerant gases Although it is not very common, ad- Medical anesthetics, such as ether, chloro- diction to inhalants can occur with re- form, halothane, and nitrous oxide (“laughing peated abuse. gas”)

Nitrites—used primarily as sexual enhancers: What Are the Other Health Effects Organic nitrites are volatiles that include cy- of Inhalants? clohexyl, butyl, and amyl nitrites, commonly known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When Chemicals found in different types of marketed for illicit use, organic nitrites are of- inhaled products may produce a vari- ten sold in small brown bottles labeled as “vid- ety of other short-term effects, such as eo head cleaner,” “room odorizer,” “leather nausea or vomiting, as well as more cleaner,” or “liquid aroma.” serious long-term consequences. The- se may include liver and kidney dam- person. High concentrations of inhal- age, hearing loss, or bone marrow ants may also cause death from suffo- damage. Effects may also include loss cation, especially when inhaled from a of coordination and limb spasms due paper or plastic bag or in a closed ar- to damage to myelin—a protective ea. Even when using aerosols or vola- sheathing around nerve fibers that tile products for their legitimate pur- helps nerves transmit messages in the poses like painting or cleaning, it is brain and peripheral nervous system. wise to do so in a well-ventilated Inhalants can also cause brain damage room or outdoors. by cutting off oxygen flow to the brain. Nitrites are a special class of inhalants Inhalants can even be lethal. Sniffing that are abused to enhance sexual highly concentrated amounts of the pleasure and performance. They can chemicals in solvents or aerosol be associated with unsafe sexual prac- sprays can directly cause heart failure tices that increase the risk of contract- within minutes. This syndrome, ing and spreading infectious diseases known as “sudden sniffing death,” can like HIV/AIDS and hepatitis. result from a single session of inhalant use by an otherwise healthy young Inhalants • September 2012 • Page 2 Learn More

For additional information on inhalants and inhalant abuse, please see http://www.drugabuse.gov/publicati ons/research-reports/inhalant-abuse

Inhalants • September 2012 • Page 3

Synthetic Cathinones (“Bath Salts”)

The term “bath salts” refers to an emerg- they are sold online and in drug para- ing family of drugs containing one or phernalia stores under a variety of brand more synthetic chemicals related to names, such as “Ivory Wave," "Bloom," cathinone, an amphetamine-like stimu- "Cloud Nine," "Lunar Wave," "Vanilla lant found naturally in the Khat plant. Sky," "White Lightning," and “Scarface.”

Reports of severe intoxication and dangerous health effects associated with use of bath salts have made these drugs a serious and growing public health and safety issue. The synthetic cathinones in bath salts can produce euphoria and increased sociability and sex drive, but some users experience paranoia, agitation, and hallucinatory delirium; some even display psychotic and violent behavior, and deaths have been reported in several instances. In Name Only

The synthetic cathinone products How Are Bath Salts Abused? marketed as “bath salts” to evade de-

tection by authorities should not be Bath salts are typically taken orally, in- confused with products such as Ep- haled, or injected, with the worst out- som salts that are sold to improve the comes being associated with snorting or experience of bathing. The latter have needle injection. no psychoactive (drug-like) properties. How Do Bath Salts Affect the Brain? Bath salts typically take the form of a white or brown crystalline powder and Common synthetic cathinones found in are sold in small plastic or foil packages bath salts include 3,4- labeled “not for human consumption.” methylenedioxypyrovalerone (MDPV), Sometimes also marketed as “plant mephedrone (“Drone,” “Meph,” or “Me- food”—or, more recently, as “jewelry ow Meow”), and methylone, but there cleaner” or “phone screen cleaner”— are many others. Much is still unknown “Bath Salts” • November 2012 • Page 1 nephrine can raise heart rate and blood An Evolving Threat pressure. Bath salts have been marketed When bath salts emerged at the as cheap (and until recently, legal—see end of the last decade, they rapidly Box) substitutes for those stimulants. A gained popularity in the U.S. and recent study found that MDPV—the Europe as “legal highs.” In October most common synthetic cathinone found 2011, the U.S. Drug Enforcement in the blood and urine of patients admit- ted to emergency departments after bath Administration placed three com- salts ingestion—raises brain dopamine mon synthetic cathinones under in the same manner as cocaine but is at emergency ban pending further in- least 10 times more potent. vestigation, and in July 2012, Presi-

dent Obama signed legislation The hallucinatory effects often reported permanently making two of them— in users of bath salts are consistent with mephedrone and MDPV—illegal, other drugs such as MDMA or LSD that along with several other synthetic raise levels of another neurotransmitter, drugs often sold as marijuana sub- serotonin. A recent analysis of the effects stitutes (“Spice”). in rats of mephedrone and methylone showed that these drugs raised levels of Although the new law also prohibits serotonin in a manner similar to MDMA. chemically similar “analogues” of the named drugs, manufacturers What Are the Other Health Effects of are expected to respond by creat- Bath Salts? ing new drugs different enough from the banned substances to Bath salts have been linked to an alarm- evade legal restriction. After ing surge in visits to emergency depart- mephedrone was banned in the ments and poison control centers across United Kingdom in 2010, for exam- the country. Common reactions reported ple, a chemical called naphyrone for people who have needed medical at- quickly replaced it, and is now be- tention after using bath salts include ing sold as “jewelry cleaner” under cardiac symptoms (such as racing heart, the brand name “Cosmic Blast.” high blood pressure, and chest pains) and psychiatric symptoms including about how these substances affect the paranoia, hallucinations, and panic at- human brain, and each one may have tacks. somewhat different properties. Chemi- cally, they are similar to amphetamines Patients with the syndrome known as (such as methamphetamine) as well as “excited delirium” from taking bath salts to MDMA (ecstasy). also may have dehydration, breakdown of skeletal muscle tissue, and kidney The energizing and often agitating ef- failure. Intoxication from several syn- fects reported in people who have taken thetic cathinones including MDPV, bath salts are consistent with other mephedrone, methedrone, and butylone drugs like amphetamines and cocaine has proved fatal in several instances. that raise the level of the neurotransmitter dopamine in brain circuits regulating Early indications are that synthetic cath- reward and movement. A surge in do- inones have a high abuse and addiction pamine in these circuits causes feelings potential. In a study of the rewarding of euphoria and increased activity. A and reinforcing effects of MDPV, rats similar surge of the transmitter norepi- showed self-administration patterns and

“Bath Salts” • November 2012 • Page 2 escalation of drug intake nearly identical Also, drug users who believe they are to methamphetamine. Bath salts users purchasing other drugs such as ecstasy have reported that the drugs trigger in- may be in danger of receiving synthetic tense cravings (or a compulsive urge to cathinones instead. For example, use the drug again) and that they are mephedrone has been found commonly highly addictive. Frequent consumption substituted for MDMA in pills sold as ec- may induce tolerance, dependence, and stasy in the Netherlands. strong withdrawal symptoms when not taking the drug. Learn More

The dangers of bath salts are compound- For additional information on bath salts, ed by the fact that these products may please see contain other, unknown ingredients that http://www.emcdda.europa.eu/publicat may have their own harmful effects. ions/drug-profiles/synthetic-cathinones

“Bath Salts” • November 2012 • Page 3 Cocaine

Cocaine is a powerfully addictive stimulant The intensity and duration of cocaine’s drug. The powdered hydrochloride salt form effects—which include increased energy, of cocaine can be snorted or dissolved in reduced fatigue, and mental alertness— water and then injected. Crack is the street depend on the route of drug administration. name given to the form of cocaine that has The faster cocaine is absorbed into the been processed to make a rock crystal, bloodstream and delivered to the brain, the which, when heated, produces vapors that more intense the high. Injecting or smoking are smoked. The term “crack” refers to the cocaine produces a quicker, stronger high crackling sound produced by the rock as it is than snorting. On the other hand, faster heated. absorption usually means shorter duration of action: the high from snorting cocaine How Is Cocaine Abused? may last 15 to 30 minutes, but the high from smoking may last only 5 to 10 minutes. In Three routes of administration are commonly order to sustain the high, a cocaine abuser used for cocaine: snorting, injecting, and has to administer the drug again. For this smoking. Snorting is the process of inhaling reason, cocaine is sometimes abused in cocaine powder through the nose, where it binges—taken repeatedly within a relatively is absorbed into the bloodstream through short period of time, at increasingly higher the nasal tissues. Injecting is the use of a doses. needle to insert the drug directly into the bloodstream. Smoking involves inhaling How Does Cocaine Affect cocaine vapor or smoke into the lungs, the Brain? where absorption into the bloodstream is as rapid as it is by injection. All three methods Cocaine is a strong central nervous system of cocaine abuse can lead to addiction and stimulant that increases levels of dopamine, other severe health problems, including a brain chemical (or neurotransmitter) increasing the risk of contracting HIV/AIDS associated with pleasure and movement, in and other infectious diseases. the brain’s reward circuit. Certain brain cells, or neurons, use dopamine to communicate.

Updated March 2010 Page 1 of 5 Normally, dopamine is released by a increases body temperature, heart rate, and neuron in response to a pleasurable signal blood pressure. It can also cause headaches (e.g., the smell of good food), and then and gastrointestinal complications such recycled back into the cell that released it, as abdominal pain and nausea. Because thus shutting off the signal between neurons. cocaine tends to decrease appetite, chronic Cocaine acts by preventing the dopamine users can become malnourished as well. from being recycled, causing excessive Different methods of taking cocaine can amounts of the neurotransmitter to build up, produce different adverse effects. Regular amplifying the message to and response intranasal use (snorting) of cocaine, for of the receiving neuron, and ultimately example, can lead to loss of the sense disrupting normal communication. It is this of smell; nosebleeds; problems with excess of dopamine that is responsible for swallowing; hoarseness; and a chronically cocaine’s euphoric effects. With repeated runny nose. Ingesting cocaine can cause use, cocaine can cause long-term changes severe bowel gangrene as a result of in the brain’s reward system and in reduced blood flow. Injecting cocaine other brain systems as well, which may can bring about severe allergic reactions eventually lead to addiction. With repeated and increased risk for contracting use, tolerance to the cocaine high also HIV/AIDS and other blood-borne diseases. often develops. Many cocaine abusers Binge-patterned cocaine use may lead report that they seek but fail to achieve to irritability, restlessness, and anxiety. as much pleasure as they did from their Cocaine abusers can also experience first exposure. Some users will increase severe paranoia—a temporary state of their dose in an attempt to intensify and full-blown paranoid psychosis—in which prolong the euphoria, but this can also they lose touch with reality and experience increase the risk of adverse psychological auditory hallucinations. or physiological effects. Regardless of the route or frequency of What Adverse Effects use, cocaine abusers can experience Does Cocaine Have on acute cardiovascular or cerebrovascular Health? emergencies, such as a heart attack or stroke, which may cause sudden death. Abusing cocaine has a variety of adverse Cocaine-related deaths are often a result effects on the body. For example, cocaine of cardiac arrest or seizure followed by constricts blood vessels, dilates pupils, and respiratory arrest.

Updated March 2010 Page 2 of 5 Added Danger: Cocaethylene cocaine and other forms of addiction remains one of NIDA’s top research Polydrug use—use of more than one priorities. Researchers are seeking to drug—is common among substance develop medications that help alleviate the abusers. When people consume two or severe craving associated with cocaine more psychoactive drugs together, such as addiction, as well as medications that cocaine and alcohol, they compound the counteract cocaine-related relapse triggers, danger each drug poses and unknowingly such as stress. Several compounds are perform a complex chemical experiment currently being investigated for their safety within their bodies. Researchers have found and efficacy, including a vaccine that would that the human liver combines cocaine sequester cocaine in the bloodstream and and alcohol to produce a third substance, prevent it from reaching the brain. Current cocaethylene, which intensifies cocaine’s research suggests that while medications are euphoric effects. Cocaethylene is associated effective in treating addiction, combining with a greater risk of sudden death than them with a comprehensive behavioral cocaine alone.1 therapy program is the most effective method to reduce drug use in the long term. What Treatment Options Exist? How Widespread Behavioral interventions—particularly, Is Cocaine Abuse? cognitive-behavioral therapy—have been Monitoring the Future Survey† shown to be effective for decreasing cocaine use and preventing relapse. According to the 2009 Monitoring the Treatment must be tailored to the individual Future survey—a national survey of 8th, patient’s needs in order to optimize 10th-, and 12th-graders—there were outcomes—this often involves a combination continuing declines reported in the use of †† of treatment, social supports, and other powder cocaine, with past-year usage services. levels reaching their lowest point since the early 1990s. Significant declines in Currently, there are no FDA-approved use were measured from 2008 to 2009 medications for treating cocaine addiction; among 12th-graders across all three survey thus, developing a medication to treat categories: lifetime use decreased from

Updated March 2010 Page 3 of 5 7.2 percent to 6.0 percent; past-year use National Survey on Drug Use and ††† dropped from 4.4 percent to 3.4 percent; Health (NSDUH) and past-month use dropped from 1.9 According to the 2008 National Survey percent to 1.3 percent. Survey measures on Drug Use and Health, the estimated showed other positive findings among percentage of persons aged 12 or older 12th-graders as well; their perceived risk who used cocaine in the past month (0.7 of harm associated with powder cocaine percent) was similar to the percentage in use increased significantly during the same 2007 and 2002. However, the percentage period. Additionally, survey participants of past-month crack users in 2008 (0.1 in the 10th grade reported significant percent of the population) was lower than changes, with past-month use falling from in 2007 and all other years going back 1.2 percent in 2008 to 0.9 percent in to 2002, with the exception of 2004. 2009. From 2002 to 2008, rates of past-month cocaine use among youth aged 12 to 17 Use of Cocaine by Students declined significantly, from 0.6 percent to 2009 Monitoring the Future Survey 0.4 percent. Past-month cocaine use also 8th Grade 10th Grade 12th Grade dropped significantly among young adults Lifetime 2.6% 4.6% 6.0% aged 18 to 25 during this time period, Past Year 1.6% 2.7% 3.4% from 2.0 percent to 1.5 percent. Past Month 0.8% 0.9% 1.3% Significant declines in the number or percentage of past-year cocaine initiates Crack Cocaine Use by Students were also estimated among several age 2009 Monitoring the Future Survey groups measured, including persons 12 8th Grade 10th Grade 12th Grade or older and those aged 18 to 25. The Lifetime 1.7% 2.1% 2.4% percentage of past-year initiates also Past Year 1.1% 1.2% 1.3% dropped significantly from 2007 to 2008 Past Month 0.5% 0.4% 0.6% for crack use among the 12–17 age group.

Updated March 2010 Page 4 of 5 Other Information Sources For street terms searchable by drug name, cost and quantities, drug trade, and drug For additional information on cocaine, please use, visit www.whitehousedrugpolicy. refer to the following sources on NIDA’s Web gov/streetterms/default.asp. site, www.drugabuse.gov:

• Cocaine: Abuse and Addiction— Research Report Series • Various issues of NIDA Notes (search by “cocaine” or “crack”)

Data Sources

† These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov.

†† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 877–643–2644.

Reference 1 Harris DS, et al. The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug Alcohol Depend 72(2):169–182, 2003.

Updated March 2010 Page 5 of 5 Heroin

Heroin is an opiate drug that is synthesized automatic processes critical for life, such as from morphine, a naturally occurring breathing (respiration), blood pressure, and substance extracted from the seed pod of arousal. Heroin overdoses frequently involve a the Asian opium poppy plant. Heroin usually suppression of respiration. appears as a white or brown powder or as a black sticky substance, known as “black tar After an intravenous injection of heroin, users heroin.” report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing How Is Heroin Abused? of the skin, heaviness of the extremities, and Heroin can be injected, snorted/sniffed, or clouded mental functioning. Following this smoked—routes of administration that rapidly initial euphoria, the user goes “on the nod,” deliver the drug to the brain. Injecting is an alternately wakeful and drowsy state. the use of a needle to administer the drug Users who do not inject the drug may not directly into the bloodstream. Snorting experience the initial rush, but other effects is the process of inhaling heroin powder are the same. through the nose, where it is absorbed into the bloodstream through the nasal tissues. With regular heroin use, tolerance Smoking involves inhaling heroin smoke into develops, in which the user’s physiological the lungs. All three methods of administering (and psychological) response to the drug heroin can lead to addiction and other decreases, and more heroin is needed to severe health problems. achieve the same intensity of effect. Heroin users are at high risk for addiction—it is How Does Heroin Affect estimated that about 23 percent of individuals the Brain? who use heroin become dependent on it. Heroin enters the brain, where it is converted to morphine and binds to receptors known as What Other Adverse Effects opioid receptors. These receptors are located Does Heroin Have on in many areas of the brain (and in the body), Health? especially those involved in the perception Heroin abuse is associated with serious of pain and in reward. Opioid receptors are health conditions, including fatal overdose, also located in the brain stem—important for spontaneous abortion, and—particularly

Updated March 2010 Page 1 of 5 in users who inject the drug—infectious drug and typically subside after about 1 diseases, including HIV/AIDS and hepatitis. week. Some individuals, however, may Chronic users may develop collapsed show persistent withdrawal symptoms for veins, infection of the heart lining and months. Although heroin withdrawal is valves, abscesses, and liver or kidney considered less dangerous than alcohol or disease. Pulmonary complications, including barbiturate withdrawal, sudden withdrawal various types of pneumonia, may result by heavily dependent users who are in poor from the poor health of the abuser as well health is occasionally fatal. In addition, as from heroin’s depressing effects on heroin craving can persist years after drug respiration. In addition to the effects of cessation, particularly upon exposure to the drug itself, street heroin often contains triggers such as stress or people, places, toxic contaminants or additives that can and things associated with drug use. clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent Heroin abuse during pregnancy, together damage to vital organs. with related factors like poor nutrition and inadequate prenatal care, has been Chronic use of heroin leads to physical associated with adverse consequences dependence, a state in which the body including low birthweight, an important risk has adapted to the presence of the drug. factor for later developmental delay. If the If a dependent user reduces or stops mother is regularly abusing the drug, the use of the drug abruptly, he or she may infant may be born physically dependent on experience severe symptoms of withdrawal. heroin and could suffer from serious medical These symptoms—which can begin as complications requiring hospitalization. early as a few hours after the last drug administration—can include restlessness, What Treatment Options muscle and bone pain, insomnia, diarrhea Exist? and vomiting, cold flashes with goose A range of treatments exist for heroin bumps (“cold turkey”), and kicking addiction, including medications and movements (“kicking the habit”). Users also behavioral therapies. Science has taught us experience severe craving for the drug that when medication treatment is combined during withdrawal, which can precipitate with other supportive services, patients are continued abuse and/or relapse. Major often able to stop using heroin (or other withdrawal symptoms peak between 48 opiates) and return to stable and productive and 72 hours after the last dose of the lives.

Updated March 2010 Page 2 of 5 Treatment usually begins with medically • Buprenorphine is a more recently assisted detoxification to help patients approved treatment for heroin addiction withdraw from the drug safely. Medications (and other opiates). Compared with such as clonidine and buprenorphine can methadone, buprenorphine produces less be used to help minimize symptoms of risk for overdose and withdrawal effects withdrawal. However, detoxification alone and produces a lower level of physical is not treatment and has not been shown dependence, so patients who discontinue to be effective in preventing relapse—it is the medication generally have fewer merely the first step. withdrawal symptoms than those who stop taking methadone. The development Medications to help prevent relapse include of buprenorphine and its authorized use the following: in physicians’ offices give opiate-addicted • Methadone has been used for more patients more medical options and extend the reach of addiction medication. Its than 30 years to treat heroin addiction. accessibility may even prompt attempts It is a synthetic opiate medication that to obtain treatment earlier. However, not binds to the same receptors as heroin; all patients respond to buprenorphine— but when taken orally, it has a gradual some continue to require treatment with onset of action and sustained effects, methadone. reducing the desire for other opioid drugs while preventing withdrawal symptoms. • Naltrexone is approved for treating Properly administered, methadone is not heroin addiction but has not been widely intoxicating or sedating, and its effects do utilized due to poor patient compliance. not interfere with ordinary daily activities. This medication blocks opioids from Methadone maintenance treatment binding to their receptors and thus is usually conducted in specialized prevents an addicted individual from opiate treatment programs. The most feeling the effects of the drug. Naltrexone effective methadone maintenance as a treatment for opioid addiction is programs include individual and/or usually prescribed in outpatient medical group counseling, as well as provision settings, although initiation of the of or referral to other needed medical, treatment often begins after medical psychological, and social services. detoxification in a residential setting. To prevent withdrawal symptoms, individuals

Updated March 2010 Page 3 of 5 must be medically detoxified and opioid- individual or group counseling; contingency free for several days before taking management, which uses a voucher-based naltrexone. system where patients earn “points” based on negative drug tests—these points can • Naloxone is a shorter-acting opioid be exchanged for items that encourage receptor blocker, used to treat cases of healthy living; and cognitive-behavioral overdose. therapy, designed to help modify a patient’s expectations and behaviors related to drug For pregnant heroin abusers, methadone abuse, and to increase skills in coping with maintenance combined with prenatal various life stressors. care and a comprehensive drug treatment program can improve many of the How Widespread Is Heroin detrimental maternal and neonatal Abuse? outcomes associated with untreated heroin † abuse. Preliminary evidence suggests Monitoring the Future Survey that buprenorphine may also be a safe According to the Monitoring the Future and effective treatment during pregnancy, survey, there was little change between although infants exposed to either 2008 and 2009 in the proportion of 8th- methadone or buprenorphine prenatally and 12th-grade students reporting lifetime,†† may still require treatment for withdrawal past-year, and past-month use of heroin. symptoms. For women who do not want or There also were no significant changes in are not able to receive pharmacotherapy past-year and past-month use among 10th- for their heroin addiction, detoxification graders; however, lifetime use increased from opiates during pregnancy can be significantly among this age group, from accomplished with medical supervision, 1.2 percent to 1.5 percent. Survey measures although potential risks to the fetus and the indicate that injection use rose significantly likelihood of relapse to heroin use should be among this population at the same time. considered. Use of Heroin by Students There are many effective behavioral 2009 Monitoring the Future Survey treatments available for heroin addiction— 8th Grade 10th Grade 12th Grade usually in combination with medication. Lifetime 1.3% 1.5% 1.2% These can be delivered in residential Past Year 0.7% 0.9% 0.7% or outpatient settings. Examples are Past Month 0.4% 0.4% 0.4%

Updated March 2010 Page 4 of 5 National Survey on Drug Use and Other Information Sources ††† Health (NSDUH) For additional information on heroin, please According to the 2008 National Survey refer to the following links on NIDA’s Web on Drug Use and Health, the number of site, www.drugabuse.gov: current (past-month) heroin users aged 12 • Heroin Abuse—Research Report Series or older in the United States increased from • Various issues of NIDA Notes (search by 153,000 in 2007 to 213,000 in 2008. “heroin” or “opiates”) There were 114,000 first-time users of heroin aged 12 or older in 2008. For street terms searchable by drug name, cost and quantities, drug trade, and drug use, visit www.whitehousedrugpolicy. gov/streetterms/default.asp.

Data Sources

Updated March 2010 Page 5 of 5

MDMA (“Ecstasy”)

MDMA (3,4-methylenedioxy- How Does MDMA Affect the Brain? methamphetamine), popularly known as ecstasy, is a synthetic, psychoactive drug MDMA acts by increasing the activity of that has similarities to both the stimu- three neurotransmitters, serotonin, do- lant amphetamine and the hallucinogen pamine, and norepinephrine. The emo- mescaline. It produces feelings of in- tional and pro-social effects of MDMA creased energy, euphoria, emotional are likely caused directly or indirectly by warmth and empathy toward others, and the release of large amounts of seroto- distortions in sensory and time percep- nin, which influences mood (as well as tion. other functions such as appetite and sleep). Serotonin also triggers the re- MDMA was initially popular among lease of the hormones oxytocin and vas- White adolescents and young adults in opressin, which play important roles in the nightclub scene or at “raves” (long dance parties), but the drug now affects Is MDMA Addictive? a broader range of users and ethnicities. Research thus far on MDMA’s addictive properties has shown varying re- How Is MDMA Abused? sults, but we do know that some users report symptoms of dependence, MDMA is taken orally, usually as a capsule including continued use despite or tablet. Its effects last approximately 3 to knowledge of physical or psychologi- 6 hours, although it is not uncommon for cal harm, tolerance (or diminished users to take a second dose of the drug as the effects of the first dose begin to fade. It response), and withdrawal effects. is commonly taken in combination with other drugs. For example some urban gay The neurotransmitter systems target- and bisexual men report using MDMA as ed by MDMA are the same as those part of a multiple-drug experience that in- targeted by other addictive drugs. Ex- cludes cocaine, GHB, methamphetamine, periments have shown that animals ketamine, and the erectile-dysfunction drug will self-administer MDMA—an im- sildenafil (Viagra). portant indicator of a drug’s abuse potential—although the degree of self-administration is less than some other drugs of abuse such as cocaine.

MDMA (“Ecstasy”) • December 2012 • Page 1 love, trust, sexual arousal, and other so- build up in the body if it is taken repeat- cial experiences. This may account for edly within short periods of time. the characteristic feelings of emotional closeness and empathy produced by the Compounding the risks of ecstasy use is drug; studies in both rats and humans the fact that other potentially harmful have shown that MDMA raises the levels drugs (including synthetic cathinones, of these hormones. the psychoactive ingredients in “bath salts”) are sometimes sold as ecstasy. The surge of serotonin caused by taking These drugs can be neurotoxic or pose MDMA depletes the brain of this im- other unpredictable health risks. And ec- portant chemical, however, causing neg- stasy tablets that do contain MDMA may ative aftereffects—including confusion, contain additional substances such as depression, sleep problems, drug crav- ephedrine (a stimulant), dextrome- ing, and anxiety—that may occur soon thorphan (a cough suppressant), keta- after taking the drug or during the days mine, caffeine, cocaine, or methamphet- or even weeks thereafter. amine. The combination of MDMA with one or more of these drugs may be haz- Some heavy MDMA users experience ardous. Users who intentionally or un- long-lasting confusion, depression, sleep knowingly combine such a mixture with abnormalities, and problems with atten- additional substances such as marijuana tion and memory, although it is possible and alcohol may be putting themselves that some of these effects may be due to at even higher risk for adverse health ef- the use of other drugs in combination fects. with MDMA (especially marijuana). Additionally, the closeness-promoting ef- What Are the Other Health Effects of fects of MDMA and its use in sexually MDMA? charged contexts (and especially in com-

MDMA can have many of the same phys- Does MDMA Have Therapeu- ical effects as other stimulants like co- tic Value? caine and amphetamines. These include MDMA was first used in the 1970s, increases in heart rate and blood pres- not as a recreational drug but as an sure, which are particularly risky for people with circulatory problems or aid in psychotherapy—although heart disease. MDMA users may experi- without the support of clinical trial ence other symptoms such as muscle research or FDA approval. In 1985, tension, involuntary teeth clenching, the Drug Enforcement Administra- nausea, blurred vision, faintness, and tion labeled MDMA a Schedule I chills or sweating. substance, or a drug with high abuse potential and no recognized In high doses, MDMA can interfere with medicinal use. Some researchers the body’s ability to regulate tempera- remain interested in its potential ture. On rare but unpredictable occa- therapeutic value when adminis- sions, this can lead to a sharp increase in tered under carefully monitored body temperature (hyperthermia), conditions. It is currently in clinical which can result in liver, kidney, or car- trials as a possible pharmacothera- diovascular system failure or even death. py aid to treat post-traumatic stress MDMA can interfere with its own me- disorder (PTSD) and anxiety in ter- tabolism (breakdown within the body), minal cancer patients. causing potentially harmful levels to

MDMA (“Ecstasy”) • December 2012 • Page 2 bination with sildenafil) may encourage Learn More unsafe sex, which is a risk factor for contracting or spreading HIV and hepatitis. For additional information on MDMA, please see http://www.drugabuse.gov/publication s/research-reports/mdma-ecstasy- abuse

MDMA (“Ecstasy”) • December 2012 • Page 3 Methamphetamine

Methamphetamine is a central nervous How Does Methamphetamine system stimulant drug that is similar in Affect the Brain? structure to amphetamine. Due to its high Methamphetamine increases the release and potential for abuse, methamphetamine blocks the reuptake of the brain chemical (or is classified as a Schedule II drug and neurotransmitter) dopamine, leading to high is available only through a prescription levels of the chemical in the brain—a common that cannot be refilled. Although mechanism of action for most drugs of abuse. methamphetamine can be prescribed by a Dopamine is involved in reward, motivation, doctor, its medical uses are limited, and the the experience of pleasure, and motor doses that are prescribed are much lower function. Methamphetamine’s ability to release than those typically abused. Most of the dopamine rapidly in reward regions of the methamphetamine abused in this country brain produces the intense euphoria, or “rush,” comes from foreign or domestic superlabs, that many users feel after snorting, smoking, or although it can also be made in small, illegal injecting the drug. laboratories, where its production endangers the people in the labs, neighbors, and the Chronic methamphetamine abuse significantly environment. changes how the brain functions. Noninvasive How Is Methamphetamine human brain imaging studies have shown Abused? alterations in the activity of the dopamine system that are associated with reduced Methamphetamine is a white, odorless, motor skills and impaired verbal learning.1 bitter-tasting crystalline powder that easily Recent studies in chronic methamphetamine dissolves in water or alcohol and is taken abusers have also revealed severe structural orally, intranasally (snorting the powder), by and functional changes in areas of the brain needle injection, or by smoking. associated with emotion and memory,2,3 which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers.

Updated March 2010 Page 1 of 4 Repeated methamphetamine abuse can display a number of psychotic features, also lead to addiction—a chronic, relapsing including paranoia, visual and auditory disease characterized by compulsive drug hallucinations, and delusions (for example, seeking and use, which is accompanied the sensation of insects crawling under the by chemical and molecular changes in the skin). brain. Some of these changes persist long after methamphetamine abuse is stopped. Transmission of HIV and hepatitis B and C Reversal of some of the changes, however, can be consequences of methamphetamine may be observed after sustained periods of abuse. The intoxicating effects of abstinence (e.g., more than 1 year).4 methamphetamine, regardless of how it is taken, can also alter judgment and inhibition What Other and can lead people to engage in unsafe Adverse Effects Does behaviors, including risky sexual behavior. Methamphetamine Among abusers who inject the drug, HIV/ Have on Health? AIDS and other infectious diseases can be spread through contaminated needles, Taking even small amounts of syringes, and other injection equipment methamphetamine can result in many that is used by more than one person. of the same physical effects as those Methamphetamine abuse may also worsen of other stimulants, such as cocaine or the progression of HIV/AIDS and its amphetamines, including increased consequences. Studies of methamphetamine wakefulness, increased physical abusers who are HIV-positive indicate that activity, decreased appetite, increased HIV causes greater neuronal injury and respiration, rapid heart rate, irregular cognitive impairment for individuals in this heartbeat, increased blood pressure, and group compared with HIV-positive people hyperthermia. who do not use the drug.5,6 Long-term methamphetamine abuse has many negative health consequences, What Treatment Options including extreme weight loss, severe Exist? dental problems (“meth mouth”), Currently, the most effective treatments anxiety, confusion, insomnia, mood for methamphetamine addiction are disturbances, and violent behavior. Chronic comprehensive cognitive-behavioral methamphetamine abusers can also interventions. For example, the Matrix

Updated March 2010 Page 2 of 4 Model—a behavioral treatment approach reporting that crystal methamphetamine was that combines behavioral therapy, family easy to obtain has dropped to 14 percent, education, individual counseling, 12-step down from 19.5 percent 5 years ago. support, drug testing, and encouragement for nondrug-related activities—has Use of Methamphetamine by Students been shown to be effective in reducing 2009 Monitoring the Future Survey methamphetamine abuse.7 Contingency 8th Grade 10th Grade 12th Grade management interventions, which provide Lifetime 1.6% 2.8% 2.4% tangible incentives in exchange for Past Year 1.0% 1.6% 1.2% engaging in treatment and maintaining Past Month 0.5% 0.6% 0.5% abstinence, have also been shown to be effective.8 There are no medications at this time approved to treat methamphetamine National Survey on Drug Use and ††† addiction; however, this is an active area of Health (NSDUH) research for NIDA. According to the 2008 National Survey on Drug Use and Health, the number of past- How Widespread Is month methamphetamine users age 12 and Methamphetamine Abuse? older decreased by over half between 2006 Monitoring the Future Survey† and 2008. Current (past-month) users were numbered at 731,000 in 2006, 529,000 Methamphetamine use among teens in 2007, and 314,000 in 2008. Significant appears to have dropped significantly in declines from 2002 and 2008 also were recent years, according to data revealed noted for lifetime and past-year use in this by the 2009 Monitoring the Future survey. age group. The number of high-school seniors reporting †† past-year use is now only at 1.2 percent, From 2002 to 2008, past-month use of which is the lowest since questions about methamphetamine declined significantly methamphetamine were added to the survey among youths aged 12 to 17, from 0.3 in 1999; at that time, it was reported at 4.7 percent to 0.1 percent, and young adults percent. Lifetime use among 8th-graders aged 18 to 25 also reported significant was reported at 1.6 percent in 2009, down declines in past-month use, from 0.6 percent significantly from 2.3 percent in 2008. In in 2002 to 0.2 percent in 2008. addition, the proportion of 10th-graders

Updated March 2010 Page 3 of 4 Other Information Sources For street terms searchable by drug name, cost and quantities, drug trade, and drug For more information on the effects of use, visit www.whitehousedrugpolicy. methamphetamine abuse and addiction, gov/streetterms/default.asp. visit www.drugabuse.gov/ drugpages/methamphetamine.html.

To find publicly funded treatment facilities by state, visit www.findtreatment. samhsa.gov.

Data Sources † These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. Questions about crystal methamphetamine were added to the 12th-grade and followup surveys in 1990, and questions about methamphetamine were added to the study for all three grades in 1999. The latest data are on line at www.drugabuse.gov. †† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey. ††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 877–643–2644.

References 1 Volkow ND, Chang L, Wang GJ, et al. Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. Am J Psychiatry 158(3):377–382, 2001. 2 London ED, Simon SL, Berman SM, et al. Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers. Arch Gen Psychiatry 61(1):73–84, 2004. 3 Thompson PM, Hayashi KM, Simon SL, et al. Structural abnormalities in the brains of human subjects who use methamphetamine. J Neurosci 24(26):6028–6036, 2004. 4 Wang GJ, Volkow ND, Chang L, et al. Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence. Am J Psychiatry 161(2):242–248, 2004. 5 Chang L, Ernst T, Speck O, Grob CS. Additive effects of HIV and chronic methamphetamine use on brain metabolite abnormalities. Am J Psychiatry 162(2):361–369, 2005. 6 Rippeth JD, Heaton RK, Carey CL, et al. Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc 10(1):1–14, 2004. 7 Rawson RA, Marinelli-Casey P, Anglin MD, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction 99(6):708–717, 2004. 8 Roll JM, Petry NM, Stitzer ML, et al. Contingency management for the treatment of methamphetamine use disorders. Am J Psychiatry 163(11):1993–1999, 2006.

Updated March 2010 Page 4 of 4

Prescription and Over-the-Counter Medications

Some medications have psychoactive stimulants for treating Attention Deficit (mind-altering) properties and, because Hyperactivity Disorder (ADHD), such as of that, are sometimes abused—that is, Adderall, Concerta, or Ritalin; and cen- taken for reasons or in ways or amounts tral nervous system (CNS) depressants not intended by a doctor, or taken by for relieving anxiety, such as Valium or someone other than the person for Xanax.1 The most commonly abused OTC whom they are prescribed. In fact, pre- drugs are cough and cold remedies con- scription and over-the-counter (OTC) taining dextromethorphan. drugs are, after marijuana (and alcohol), the most commonly abused substances People often think that prescription and by Americans 14 and older. OTC drugs are safer than illicit drugs, but that’s only true when they are taken ex- actly as prescribed and for the purpose Past-Year Use of Illicit Drugs and Pharmaceucals among 12th Graders intended. When abused, prescription and OTC drugs can be addictive and put Marijuana/Hashish 36.4% abusers at risk for other adverse health 11.3% Synthec Marijuana effects, including overdose—especially Adderall 7.6% Vicodin 7.5% when taken along with other drugs or al- Cough Medicine 5.6% cohol. Tranquilizers 5.3% Hallucinogens 4.8% How Are Prescription Drugs Abused? Sedaves 4.5% Salvia 4.4% OxyConn 4.3% Prescription and OTC drugs may be MDMA (Ecstasy) 3.8% abused in one or more of the following Inhalants 2.9% Illicit Drugs ways: Cocaine (any form) 2.7% Pharmaceucal Ritalin 2.6% Taking a medication that has been pre-

SOURCE: University of Michigan, 2012 Monitoring the Future Study scribed for somebody else. Unaware of the dangers of sharing medications, people often unknowingly contribute to this The classes of prescription drugs most commonly abused are: opioid pain relievers, such as Vicodin or Oxycontin; 1 These are proprietary names of particular drug products. Generic versions may also exist. Prescription and Over-the-Counter Medications • December 2012 • Page 1 form of abuse by sharing their unused the same way cocaine does—by boosting pain relievers with their family mem- the amount of the neurotransmitter dopamine. Opioid pain relievers like Ox- Most teenagers who abuse pre- yContin attach to the same cell receptors scription drugs are given them targeted by illegal opioids like heroin. for free by a friend or relative. Prescription depressants produce sedating or calming effects in the same man- bers. ner as the club drugs GHB and rohypnol, Taking a drug in a higher quantity or in by enhancing the actions of the neuro- another manner than prescribed. Most transmitter GABA (gamma-aminobutyric prescription drugs are dispensed orally acid). When taken in very high doses, in tablets, but abusers sometimes crush dextromethorphan acts on the same glu- the tablets and snort or inject the pow- tamate receptors as PCP or ketamine, der. This hastens the entry of the drug producing similar out-of-body experi- into the bloodstream and the brain and ences. amplifies its effects. When abused, all of these classes of Taking a drug for another purpose than drugs directly or indirectly cause a prescribed. All of the drug types men- pleasurable increase in the amount of tioned can produce pleasurable effects at dopamine in the brain’s reward path- sufficient quantities, so taking them for way. Repeatedly seeking to experience the purpose of getting high is one of the that feeling can lead to addiction. main reasons people abuse them. ADHD drugs like Adderall are also often abused What Are the Other Health Effects of by students for their effects in promoting Prescription and OTC Drugs? alertness and concentration. Stimulants can have strong effects on the cardiovascular system. Taking high doses of a stimulant can dangerously raise body temperature and cause irregular heartbeat or even heart failure or seizures. Also, taking some stimulants in high doses or repeatedly can lead to hos- tility or feelings of paranoia.

Opioids can produce drowsiness, cause constipation, and—depending upon the How Do Prescription and OTC Drugs amount taken—depress breathing. The Affect the Brain? latter effect makes opioids particularly dangerous, especially when they are Taken as intended, prescription and OTC snorted or injected or combined with drugs safely treat specific mental or other drugs or alcohol. physical symptoms. But when taken in different quantities or when such symp- CNS depressants slow down brain activi- toms aren’t present, they may affect the ty and can cause sleepiness and loss of brain in ways very similar to illicit drugs. coordination. Continued use can lead to physical dependence and withdrawal For example, stimulants such as Ritalin symptoms if discontinuing use. increase alertness, attention, and energy

Prescription and Over-the-Counter Medications • December 2012 • Page 2 Dextromethorphan can cause impaired All of these drugs have the potential for motor function, numbness, nausea or addiction, and this risk is amplified when vomiting, and increased heart rate and they are abused. Also, as with other blood pressure. On rare occasions, hy- drugs, abuse of prescription and OTC poxic brain damage—caused by severe drugs can alter a person’s judgment and respiratory depression and a lack of oxy- decisionmaking, leading to dangerous gen to the brain—has occurred due to behaviors such as unsafe sex and the combination of dextromethorphan drugged driving. with decongestants often found in the medication. Learn More Deaths from Opioid Pain Relievers Exceed Those from All Illegal Drugs For more information on prescription and OTC drugs, visit Opioid pain relievers Illegal drugs 12 10.4 http://www.drugabuse.gov/publication 10 8.3 s/research-reports/prescription-drugs 7.1 8 6 5.3 5 6 4.4 3.7 4 2.2 2.5 1 2 0.3 0

Deaths per 100,000 populaon 15-24 25-34 35-44 45-54 55-64 ≥65 Age Group Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011.

Prescription and Over-the-Counter Medications • December 2012 • Page 3 Salvia

Salvia (Salvia divinorum) is an herb than 1 minute and lasting less than 30 common to southern Mexico and Central minutes. They include psychedelic-like and South America. The main active changes in visual perception, mood and ingredient in Salvia, salvinorin A, is a potent body sensations, emotional swings, feelings activator of kappa opioid receptors in the of detachment, and importantly, a highly brain.1,2 These receptors differ from those modified perception of external reality and activated by the more commonly known the self, leading to a decreased ability to opioids, such as heroin and morphine. interact with one's surroundings.5 This last effect has prompted concern about the Traditionally, S. divinorum has been dangers of driving under the influence of ingested by chewing fresh leaves or by salvinorin. The long-term effects of Salvia drinking their extracted juices. The dried abuse have not been investigated leaves of S. divinorum can also be smoked systematically. Recent experiments in as a joint, consumed in water pipes, or rodents demonstrated deleterious effects of vaporized and inhaled. Although Salvia salvinorin A on learning and memory.6 currently is not a drug regulated by the Controlled Substances Act, several States Extent of Use and countries have passed legislation to NIDA’s Monitoring the Future Survey of th th th regulate its use.3 The Drug Enforcement 8 , 10 , and 12 graders asked about salvia Agency has listed Salvia as a drug of abuse for the first time in 2009—5.7 percent concern and is considering classifying it as a of high school seniors reported past year use Schedule I drug, like LSD or marijuana. (greater than the percent reporting ecstasy use). And according to the latest MTF Health/Behavioral Effects figures the use of Salvia reported by 8th People who abuse salvia generally graders remained unchanged from 2011 to experience hallucinations or 2012 at 1.4 percent. Among 10th and 12th “psychotomimetic” episodes (a transient graders there was a decline–2.5 percent of experience that mimics a psychosis).4,5 10th graders and 4.4 percent of 12th graders reported past year abuse. Subjective effects have been described as intense but short-lived, appearing in less Although information about this drug is 4 Roth, B.L., et al. Salvinorin A: a potent limited, its abuse is likely driven by drug- naturally occurring non-nitrogenous kappa related videos and information on Internet opioid selective agonist. Proc Natl Acad Sci. 99:11934–11939, 2002. sites.3 Because of the nature of the drug’s effects—its use may be restricted to 5 Gonzalez, D., et al. Pattern of use and individual experimentalists, rather than as a subjective effects of Salvia divinorum among social or party drug5 recreational users. Drug Alcohol Depend. 85:157–162, 2006. Learn More 6 Braida D, Donzelli A, Martucci R, Capurro V, Sala M. Learning and memory impairment For more information on the effects of induced by salvinorin A, the principal ingredient hallucinogenic drugs, see NIDA’s Research of Salvia divinorum, in wistar rats. Report on Hallucinogens and Dissociative Int J Toxicol. 2011 Dec;30(6):650-61. Drugs at www.nida.nih.gov/ResearchReports/hallucin ogens/hallucinogens.html. About the Survey For more information on Salvia divinorum Since 1975, the MTF survey has measured and the Controlled Substances Act, visit drug, alcohol, and cigarette use and related http://www.deadiversion.usdoj.gov/drugs_c attitudes among 12th graders, nationwide. oncern/salvia_d.pdf. In 1991, 8th and 10th graders were added Complete MTF survey results are available at to the survey. Survey participants report www.monitoringthefuture.org. For more their drug use behaviors across three time information on the survey and its findings, periods: lifetime, past year, and past month. also visit www.drugabuse.gov/related- Overall, 44,449 students from 395 public topics/trends-statistics/monitoring-future. and private schools in the 8th, 10th, and 12th grades participated in the 2012 survey. Citations The survey is funded by NIDA and 1 Chavkin, C., Sud, S., Jin, W. et al. Salvinorin A, conducted by the University of Michigan. an active component of the hallucinogenic sage Results from the survey are released each Salvia divinorum is a highly efficacious kappa- opioid receptor agonist: structural and December. functional considerations. J Pharmacol Exp Ther. 308:1197–203, 2004.

2 Harding, W.W., et al. Salvinicins A and B, new neoclerodane diterpenes from Salvia divinorum. Organic Letters. 7:3017–3020, 2005.

3 http://www.deadiversion.usdoj.gov/drugs_conc ern/salvia_d.pdf. Accessed September 24, 2007.

Spice (Synthetic Marijuana)

“Spice” refers to a wide variety of herbal found in Spice as Schedule I controlled mixtures that produce experiences simi- substances, making it illegal to sell, buy, lar to marijuana (cannabis) and that are or possess them. Manufacturers of Spice marketed as “safe,” legal alternatives to products attempt to evade these legal re- that drug. Sold under many names, in- strictions by substituting different chem- cluding K2, fake weed, Yucatan Fire, icals in their mixtures, while the DEA Skunk, Moon Rocks, and others—and la- continues to monitor the situation beled “not for human consumption”— and evaluate the need for updating the these products contain dried, shredded list of banned cannabinoids. plant material and chemical additives that are responsible for their psychoac- Spice products are popular among young tive (mind-altering) effects. people; of the illicit drugs most used by high-school seniors, they are second only to marijuana. (They are more popular False Advertising among boys than girls—in 2012, nearly twice as many male 12th graders report- Labels on Spice products often claim ed past-year use of synthetic marijuana that they contain “natural” psycho- as females in the same age group.) Easy active material taken from a variety access and the misperception that Spice of plants. Spice products do contain products are “natural” and therefore harmless have likely contributed to their dried plant material, but chemical popularity. Another selling point is that analyses show that their active in- the chemicals used in Spice are not easily gredients are synthetic (or designer) detected in standard drug tests. cannabinoid compounds. Past-Year Use of Illicit Drugs by High School Seniors (percent) For several years, Spice mixtures have Marijuana/Hashish been easy to purchase in head shops and 36.4 Synthec Marijuana gas stations and via the Internet. Be- 11.3 Hallucinogens 4.8 cause the chemicals used in Spice have a Salvia high potential for abuse and no medical 4.4 MDMA (Ecstasy) 3.8 benefit, the Drug Enforcement Admin- Cocaine istration (DEA) has designated the five 2.7 active chemicals most frequently 0 20 40 SOURCE: University of Michigan, 2012 Monitoring the Future Study

Spice (Synthetic Marijuana) • December 2012 • Page 1 How Is Spice Abused? Spice, however, bind more strongly to those receptors, which could lead to a Some Spice products are sold as “in- much more powerful and unpredictable cense,” but they more closely resemble effect. Because the chemical composition potpourri. Like marijuana, Spice is of many products sold as Spice is un- abused mainly by smoking. Sometimes known, it is likely that some varieties al- Spice is mixed with marijuana or is pre- so contain substances that could cause pared as an herbal infusion for drinking. dramatically different effects than the user might expect.

What Are the Other Health Effects of Spice?

Spice abusers who have been taken to Poison Control Centers report symptoms that include rapid heart rate, vomiting, agitation, confusion, and hallucinations. Spice can also raise blood pressure and cause reduced blood supply to the heart (myocardial ischemia), and in a few cas- K2, a popular brand of “Spice” mixture. es it has been associated with heart at- tacks. Regular users may experience

withdrawal and addiction symptoms. How Does Spice Affect the Brain?

We still do not know all the ways Spice Spice users report experiences similar to may affect human health or how toxic it those produced by marijuana—elevated may be, but one public health concern is mood, relaxation, and altered percep- that there may be harmful heavy metal tion—and in some cases the effects are residues in Spice mixtures. Without fur- even stronger than those of marijuana. ther analyses, it is difficult to determine Some users report psychotic effects like whether this concern is justified. extreme anxiety, paranoia, and hallucina-

tions. Learn More

So far, there have been no scientific stud- For additional information on Spice, see ies of Spice’s effects on the human brain, http://www.emcdda.europa.eu/attache but we do know that the cannabinoid ments.cfm/att_80086_EN_Spice%20The compounds found in Spice products act matic%20paper%20— on the same cell receptors as THC, the %20final%20version.pdf primary psychoactive component of ma-

rijuana. Some of the compounds found in

Spice (Synthetic Marijuana) • December 2012 • Page 2

Inhalants

Grade it by continuing to inhale repeatedly over several hours. 12th

For additional information on inhalants and inhalant abuse, please see http://www.drugabuse.gov/publicati ons/research-reports/inhalant-abuse

Inhalants • September 2012 • Page 3 Club Drugs (GHB, Ketamine, and Rohypnol)

Club drugs are a pharmacologically • Ketamine is a dissociative anesthetic, mostly heterogeneous group of psychoactive drugs used in veterinary practice. that tend to be abused by teens and young adults at bars, nightclubs, concerts, and How Are Club Drugs parties. Gamma hydroxybutyrate (GHB), Abused? Rohypnol, ketamine, as well as MDMA • GHB and Rohypnol are available in (ecstasy) and methamphetamine (which are odorless, colorless, and tasteless forms featured in separate InfoFacts) are some of that are frequently combined with alcohol the drugs included in this group. and other beverages. Both drugs have been used to commit sexual assaults (also GHB (Xyrem) is a central nervous system known as “date rape,” “drug rape,” (CNS) depressant that was approved by “acquaintance rape,” or “drug-assisted” the Food and Drug Administration (FDA) in assault) due to their ability to sedate 2002 for use in the treatment of narcolepsy and incapacitate unsuspecting victims, (a sleep disorder). This approval came preventing them from resisting sexual with severe restrictions, including its use assault. only for the treatment of narcolepsy, and the requirement for a patient registry • GHB is usually ingested orally, either in monitored by the FDA. GHB is also a liquid or powder form, while Rohypnol metabolite of the inhibitory neurotransmitter is typically taken orally in pill form. gamma-aminobutyric acid (GABA). It exists Recent reports, however, have shown that naturally in the brain, but at much lower Rohypnol is being ground up and snorted. concentrations than those found when GHB • Both GHB and Rohypnol are also abused is abused. for their intoxicating effects, similar to other • Rohypnol (flunitrazepam) use began CNS depressants. gaining popularity in the United States in • GHB also has anabolic effects (it stimulates the early 1990s. It is a benzodiazepine protein synthesis) and has been used by (chemically similar to sedative-hypnotic bodybuilders to aid in fat reduction and drugs such as Valium or Xanax), but it muscle building. is not approved for medical use in this • Ketamine is usually snorted or injected country, and its importation is banned. intramuscularly.

Updated July 2010 Page 1 of 4 How Do Club Drugs Affect withdrawal reactions have been reported the Brain? among patients presenting from an overdose of GHB or related compounds, • GHB acts on at least two sites in the especially if other drugs or alcohol are brain: the GABA receptor and a specific B involved.3 GHB binding site. At high doses, GHB’s sedative effects may result in sleep, • Like other benzodiazepines, chronic coma, or death. use of Rohypnol can produce tolerance, physical dependence, and addiction. • Rohypnol, like other benzodiazepines, acts at the GABAA receptor. It can • There have been reports of people produce anterograde amnesia, in which binging on ketamine, a behavior that is individuals may not remember events they similar to that seen in some cocaine- or experienced while under the influence of amphetamine-dependent individuals. the drug. Ketamine users can develop signs of tolerance and cravings for the drug.4 • Ketamine is a dissociative anesthetic, so called because it distorts perceptions of What Other Adverse sight and sound and produces feelings of detachment from the environment and Effects Do Club Drugs Have self. Ketamine acts on a type of glutamate on Health? receptor (NMDA receptor) to produce Uncertainties about the sources, chemicals, its effects, which are similar to those of and possible contaminants used to the drug PCP.1,2, Low-dose intoxication manufacture many club drugs make it results in impaired attention, learning extremely difficult to determine toxicity ability, and memory. At higher doses, and associated medical consequences. ketamine can cause dreamlike states Nonetheless, we do know that: and hallucinations; and at higher doses • Coma and seizures can occur following still, ketamine can cause delirium and use of GHB. Combined use with other amnesia. drugs such as alcohol can result in nausea and breathing difficulties. GHB and two Addictive Potential of its precursors, gamma butyrolactone • Repeated use of GHB may lead to (GBL) and 1,4 butanediol (BD), have withdrawal effects, including insomnia, been involved in poisonings, overdoses, anxiety, tremors, and sweating. Severe date rapes, and deaths.

Updated July 2010 Page 2 of 4 • Rohypnol may be lethal when mixed with • Patients with a ketamine overdose are alcohol and/or other CNS depressants. managed through supportive care for acute symptoms, with special attention to • Ketamine, in high doses, can cause cardiac and respiratory functions.5 impaired motor function, high blood pressure, and potentially fatal respiratory How Widespread Is Club problems. Drug Abuse? What Treatment Options Monitoring the Future Survey† Exist? MTF has reported consistently low levels of There is very little information available in abuse of these club drugs since they were the scientific literature about treatment for added to the survey. For GHB and ket- persons who abuse or are dependent upon amine, this occurred in 2000; for Rohypnol, club drugs. 1996. According to results of the 2009 MTF survey, 0.7 percent of 8th-grade and • There are no GHB detection tests for 1.1 percent of 12th-grade students reported use in emergency rooms, and as many past-year†† use of GHB, a statistically sig- clinicians are unfamiliar with the drug, nificant decrease from peak-year use of 1.2 many GHB incidents likely go undetected. percent in 2000 for 8th-graders and 2.0 According to case reports, however, percent for 12th-graders in 2004. GHB use patients who abuse GHB appear to among 10th-grade students was reported present both a mixed picture of severe at 1.0 percent, an increase from 2008 (0.5 problems upon admission and a good percent), and statistically unchanged from response to treatment, which often peak use of 1.4 percent in 2002 and 2003. involves residential services.3

• Treatment for Rohypnol follows accepted Past-year use of ketamine was reported by protocols for any benzodiazepine, which 1.0 percent of 8th-graders, 1.3 percent may consist of a 3- to 5-day inpatient of 10th-graders, and 1.7 percent of 12th- detoxification program with 24-hour graders in 2009. These percentages also intensive medical monitoring and represent significant decreases from peak management of withdrawal symptoms, years: 2000 for 8th-graders (at 1.6 percent) since withdrawal from benzodiazepines and 2002 for 10th- and 12th-graders (at can be life-threatening.3 2.2 and 2.6 percent, respectively).

Updated July 2010 Page 3 of 4 For Rohypnol, 0.4 percent of 8th- and Other Information Sources 10th-graders, and 1.0 percent of 12th- For more information about club drugs, graders reported past-year use, also down visit www.clubdrugs.gov, www. from peak use in 1996 for 8th-graders teens.drugabuse.gov, and www. (1.0 percent), 1997 for 10th-graders (1.3 backtoschool.drugabuse.gov; or percent), and 2002 and 2004 for 12th- call NIDA at 877-643-2644. For street graders (1.6 percent). terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit http://www. whitehousedrugpolicy.gov/ streetterms/default.asp.

† † “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

Resources 1 Anis NA, Berry SC, Burton NR, Lodge D. The dissociative anaesthetics, datamine and phencyclidine, selectively reduce excitation of central mammalian neurons by N-methyl-aspartate. Br J Pharmacol 79(2): 565–575, 1983.

2 Kapur S, Seeman P. NMDA receptor antagonists ketamine and PCP have direct effects on dopamine D2 and serotonin 5-HT2 receptors – Implications for models of schizophrenia. Molecular Psychiatry 7: 837–844, 2002.

3 Maxwell JC, Spence RT. Profiles of club drug users in treatment.Subst Use Misuse 40(9–10):1409–1426, 2005.

4 Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: A review of problem use and dependence. J Psychoactive Drugs 33(2):151–158, 2001.

5 Smith KM, Larive LL, Romanelli F. Club Drugs: Methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and γ–hydroxybutyrate. Am J Health-Syst Pharm 59(11):1067–1076, 2002.

Updated July 2010 Page 4 of 4

Marijuana

Marijuana is a dry, shredded green and brown mix of leaves, flowers, stems, and seeds from the hemp plant Cannabis sa- tiva. In a more concentrated, resinous form, it is called hashish, and as a sticky black liquid, hash oil. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol, or THC.

Marijuana is the most common illicit drug used in the United States. After a period of decline in the last decade, its How Does Marijuana Affect the Brain? use has generally increased among young people since 2007, corresponding When marijuana is smoked, THC rapidly to a diminishing perception of the drug’s passes from the lungs into the blood- risks. More teenagers are now current stream, which carries the chemical to the (past-month) smokers of marijuana than brain and other organs throughout the of cigarettes, according to annual survey body. It is absorbed more slowly when data. ingested in food or drink.

How Is Marijuana Used? However it is ingested, THC acts upon specific molecular targets on brain cells, Marijuana is usually smoked in hand- called cannabinoid receptors. These re- rolled cigarettes (joints) or in pipes or ceptors are ordinarily activated by chem- water pipes (bongs). It is also smoked in icals similar to THC called endocanna- blunts—cigars that have been emptied of binoids, such as anandamide. These are tobacco and refilled with a mixture of naturally occurring in the body and are marijuana and tobacco. Marijuana smoke part of a neural communication network has a pungent and distinctive, usually (the endocannabinoid system) that plays sweet-and-sour, odor. Marijuana can al- an important role in normal brain devel- so be mixed in food or brewed as a tea. opment and function.

The highest density of cannabinoid receptors is found in parts of the brain that

Marijuana • December 2012 • Page 1 influence pleasure, memory, thinking, marijuana heavily in their teens lost as concentration, sensory and time percep- much as 8 points in IQ between age 13 tion, and coordinated movement. Mari- and age 38; importantly, the lost cogni- juana overactivates the endocannabinoid tive abilities were not restored in those system, causing the high and other ef- who quit smoking marijuana as adults. fects that users experience. These in- (Individuals who started smoking mari- clude distorted perceptions, impaired juana in adulthood did not show signifi- coordination, difficulty with thinking and cant IQ declines.) problem solving, and disrupted learning and memory. What Are the Other Health Effects of Marijuana? Effects on Life Research clearly demonstrates that Marijuana use can have a variety of ad- marijuana has the potential to cause verse, short- and long-term effects, espe- problems in daily life or make a per- cially on cardiopulmonary and mental son's existing problems worse. In fact, health.

heavy marijuana users generally re- Marijuana raises heart rate by 20-100 port lower life satisfaction, poorer percent shortly after smoking; this effect mental and physical health, relation- can last up to 3 hours. In one study, it ship problems, and less academic and was estimated that marijuana users have career success compared to their a 4.8-fold increase in the risk of heart at- peers who came from similar back- tack in the first hour after smoking the grounds. For example, marijuana use drug. This may be due to increased heart is associated with a higher likelihood rate as well as the effects of marijuana of dropping out from school. Several on heart rhythms, causing palpitations studies also associate workers' mariju- and arrhythmias. This risk may be great- ana smoking with increased absences, er in older individuals or in those with tardiness, accidents, workers' com- cardiac vulnerabilities. pensation claims, and job turnover.

Marijuana and Driving Research has shown that, in chronic us- Because it seriously impairs judgment ers, marijuana's adverse impact on and motor coordination, marijuana al- learning and memory persists after the so contributes to accidents while driv- acute effects of the drug wear off; when ing. A recent analysis of data from marijuana use begins in adolescence, the several studies found that marijuana effects may persist for many years. Re- use more than doubles a driver’s risk search from different areas is converging of being in an accident. Further, the on the fact that regular marijuana use by combination of marijuana and alcohol young people can have long-lasting nega- is worse than either substance alone tive impact on the structure and function with respect to driving impairment. of their brains.

A recent study of marijuana users who Marijuana smoke is an irritant to the began using in adolescence revealed a lungs, and frequent marijuana smokers profound deficit in connections between can have many of the same respiratory brain areas responsible for learning and problems experienced by tobacco smok- memory. And a large prospective study ers, such as daily cough and phlegm pro- (following individuals across time) duction, more frequent acute chest ill- showed that people who began smoking Marijuana • December 2012 • Page 2 ness, and a heightened risk of lung infec- nonsmokers, mainly because of respira- tions. One study found that people who tory illnesses. smoke marijuana frequently but do not smoke tobacco have more health prob- A number of studies have shown an as- lems and miss more days of work than sociation between chronic marijuana use and mental illness. High doses of mariju- Is Marijuana Medicine? ana can produce a temporary psychotic Although many have called for the le- reaction (involving hallucinations and galization of marijuana to treat condi- paranoia) in some users, and using marijuana can worsen the course of illness in tions including pain and nausea patients with schizophrenia. A series of caused by HIV/AIDS, cancer, and other large prospective studies also showed a conditions, the scientific evidence to link between marijuana use and later date is not sufficient for the marijuana development of psychosis. This relation- plant to gain FDA approval, for two ship was influenced by genetic variables main reasons. as well as the amount of drug used and the age at which it was first taken— First, there have not been enough clin- those who start young are at increased ical trials showing that marijuana’s risk for later problems. benefits outweigh its health risks in patients with the symptoms it is Associations have also been found be- meant to treat. The FDA requires care- tween marijuana use and other mental fully conducted studies in large num- health problems, such as depression, bers of patients (hundreds to thou- anxiety, suicidal thoughts among adoles- sands) to accurately assess the bene- cents, and personality disturbances, in- fits and risks of a potential medication. cluding a lack of motivation to engage in typically rewarding activities. More re- Also, to be considered a legitimate search is still needed to confirm and bet- medicine, a substance must have well- ter understand these linkages. defined and measureable ingredients that are consistent from one unit Marijuana use during pregnancy is asso- (such as a pill or injection) to the next. ciated with increased risk of neurobe- This consistency allows doctors to de- havioral problems in babies. Because termine the dose and frequency. As THC and other compounds in marijuana mimic the body’s own cannabinoid-like the marijuana plant contains hundreds chemicals, marijuana use by pregnant of chemical compounds that may have mothers may alter the developing endo- different effects and that vary from cannabinoid system in the brain of the plant to plant, its use as a medicine is fetus. Consequences for the child may in- difficult to evaluate. clude problems with attention, memory, and problem solving. However, THC-based drugs to treat pain and nausea are already FDA ap- Finally, marijuana use has been linked in proved and prescribed, and scientists a few recent studies to an increased risk continue to investigate the medicinal of an aggressive type of testicular cancer properties of cannabinoids. For more in young men, although further research information, see is needed to establish whether there is a http://www.drugabuse.gov/publicatio direct causal connection. ns/drugfacts/marijuana-medicine Is Marijuana Addictive?

Marijuana • December 2012 • Page 3 stinent. Behavioral interventions, includ- Contrary to common belief, marijuana is ing cognitive-behavioral therapy and addictive. Estimates from research sug- motivational incentives (i.e., providing gest that about 9 percent of users be- vouchers for goods or services to pa- come addicted to marijuana; this num- tients who remain abstinent) have prov- ber increases among those who start en to be effective in treating marijuana young (to about 17 percent, or 1 in 6) addiction. Although no medications are and among daily users (to 25-50 per- currently available, recent discoveries cent). Thus, many of the nearly 7 percent about the workings of the endocanna- of high-school seniors who (according to binoid system offer promise for the de- annual survey data) report smoking ma- velopment of medications to ease with- rijuana daily or almost daily are well on drawal, block the intoxicating effects of their way to addiction, if not already ad- marijuana, and prevent relapse. dicted (besides functioning at a sub- optimal level all of the time). Learn More Long-term marijuana users trying to quit report withdrawal symptoms including For additional information on marijuana irritability, sleeplessness, decreased ap- and marijuana abuse, please see petite, anxiety, and drug craving, all of http://www.drugabuse.gov/publication which can make it difficult to remain ab- s/research-reports/marijuana-abuse

Rising Potency The amount of THC in marijuana samples confiscated by police has been increasing steadily over the past few decades. In 2009, THC concentrations in marijuana averaged close to 10 percent, compared to around 4 percent in the 1980s. For a new user, this may mean exposure to higher concentrations of THC, with a greater chance of an adverse or unpredictable reaction. Increases in potency may account for the rise in emergency department visits involving marijuana use. For experienced users, it may mean a greater risk for addiction if they are exposing themselves to high doses on a regular ba- sis. However, the full range of consequences associated with marijuana's higher potency is not well under- stood, nor is it known whether experienced marijuana users adjust for the increase in potency by using less.

Marijuana • December 2012 • Page 4

Is Marijuana Medicine?

The use of marijuana to treat various medical conditions—or “medical mariju-‐ ana”—is a controversial topic and has been for some time. Some people have argued that marijuana’s reported benefi-‐ cial effects on a variety of symptoms jus-‐ tify its legalization as a medicine for cer-‐ tain patients. Often the potential harm of marijuana use is not considered in these arguments, although risk is part of what THC's chemical structure is similar to the brain chem-‐ ical anandamide. Similarity in structure allows drugs the U.S. Food and Drug Administration to be recognized by the body and to alter normal (FDA) assesses when deciding whether brain communication. to approve a medicine.

Under Federal law, -‐ only FDA approved CBRs are part of a vast communication medications are legal to prescribe—and network known as the endocannabinoid marijuana is not one of those. Still, more system (ECS), which plays a role in nor-‐ than a dozen States have approved its mal brain development and function. What use to Does alleviate Marijuana a Do variety to the Body of symptoms. ? They cluster in brain areas that influence pleasure, memory, thinking, concentra-‐ tion, movement, coordination, and sen-‐ sory and time perception. Many of marijuana’s effects (including its artificially psychoactive or mind-‐altering proper-‐ When someone smokes marijuana, THC ties) stem from an ingredient called de l-‐ stimulates the CBRs , disrupt-‐ ta-‐9-‐tetrahydrocannabinol (THC), which ing function of the natural . cannabinoids resembles a chemical that the body and An overstimulation of these receptors in brain make naturally (see figure). THC key brain areas produces the marijuana attaches to specialized proteins, called "high" as well as its other effects on men-‐ cannabinoid receptors (CBRs), to which tal processes. the body’s natural chemicals (e.g., anan-‐ damide) normally bind.

Marijuana Used for Medical Purposes July 2012 Page 1 Why Isn’t Marijuana an FDA-‐approved Medicine? even though some of marijuana’s specific ingredients may offer benefits.

In fact, THC is an FDA -‐approved medica-‐ Finally, marijuana has certain adverse tion. It was shown in carefully controlled health effects that also must be taken in-‐ clinical trials to have therapeutic benefit to account. Because it is usually smoked, for relieving nausea associated n-‐ with ca marijuana can cause or worsen respira-‐ cer chemotherapy and stimulating appe-‐ tory symptoms (e.g., bronchitis, chronic tite in patients with wasting syndrome cough). It also impairs short-‐term (severe weight loss) that often accompa-‐ memory and motor coordination; slows nies AIDS. the scientific evidence to date reaction time; alters mood, judgment, is not sufficient for the marijuana and decision-‐making; and in some peo-‐ plant However, to gain FDA approval And ple can marijuana cause is severe addictive anxiety (paranoia) or psychosis (loss of touch . with reality) , and there —about 4.5 are a number of reasons why: million people in this country meet clini-‐ cal criteria marijuana for abuse or de-‐ First, there have not been enough clinical pendence.Misperceptions of S afety trials showing that marijuana’s benefits Growing acceptance of medical marijuana outweigh its risks in patients with the symptoms it is meant to treat. The FDA may be influencing how young people requires carefully conducted studies in perceive the harm associated with mariju-‐ large numbers of patients (hundreds to ana use generally. Research shows that as thousands) to accurately assess the ben-‐ high school seniors’ perception of mariju-‐ efits and risks of a potential medication. ana’s risks goes down, their marijuana use

Second, o t be considered a legitimate goes up, and vice versa (see graph). Sur-‐ medicine, a substance must have -‐ well veys show significant recent increases defined and measureable ingredients among 10th-‐ and th 12 -‐graders for daily, that are consistent from one unit (such current, and past-‐year marijuana use, now as a pill or injection) to the next. This surpassing cigarette smoking. consistency allows doctors to determine the What’s dose the and frequency difference . between High School Seniors’ Past-‐Year Marijuana medical and “street” marijuana? Use and Perceived Risk of Marijuana There is no difference between “medi-‐ Use, 1975–2010 60 cal-‐grade” marijuana and “street” mari-‐ Past-‐Year Use 50 juana. The marijuana sold in dispensaries Perceived Risk as medicine is the same quality and car-‐ 40 ries the same health risks as marijuana 30 Percent sold on the street. 20

0 Along with THC, the marijuana plant 1975 1980 1990 2000 2010 contains over 400 other chemical com-‐ pounds, including other cannabinoids Source: University of Michigan, 2011 Monitoring the Future Study that may be biologically active and vary from plant to plant. This makes it diffi-‐ cult to consider it Marijuanas use as Used a for Medical medicine Purposes July 2012 Page 2 Could Marijuana Be Used in C the rea-‐ tion of FDA-‐Approvable Medicines?

Yes. Research continues on the possible therapeutic uses of marijuana and its ac-‐ tive ingredients. Resulting medications show promise for treating neuropathic pain, addiction , multiple sclerosis, obesity, irritable bowel syndrome , and other con-‐ Learn ditions. More

For more information on i-‐ medical mar juana, visit http://www.drugabuse.gov/publication s/research-‐reports/marijuana-‐abuse/

Marijuana Used for Medical Purposes July 2012 Page 3