Over the past decade, certain drugs of abuse have wielded a major blow to individuals and families. Hospitals and other healthcare facilities have seen the tremendous devastation of opioid abuse. Fortunately, state organizations, individuals, healthcare providers, and licensing boards are taking steps to keep the public educated about drugs of abuse to hopefully deter their use, and make help available to those who need it. Due to the opioid epidemic and abuse rates on other over the counter and recreational drugs, it is no wonder why such a topic would be included on the NCCAOM’s Biomedicine exam for acupuncturists seeking to obtain the coveted diplomat status. Healthcare providers in all specialties and fields are bound to, at one point or another in their professional tenure, encounter the ramifications of drugs of abuse. In this quick and helpful article, we break down the top 5 drugs of abuse that acupuncturists must know about to prepare for the NCCAOM Biomedicine exam.
Opioids
Opioids like OxyContin and Percocet are powerful prescription medications that are intended for pain management. However, they can be abused for their euphoric effects, which can lead to addiction and serious health consequences.
Opioid abuse can appear in various ways. Common ways opioids are abused are through:
Oral Ingestion
Some people abuse opioids by taking them orally, often in higher doses than prescribed. They may crush or chew the pills to experience a quicker onset of the drug’s effects.
Snorting
Abusers may crush opioids into a fine powder and then snort the powder. This method allows the drug to enter the bloodstream rapidly through the nasal membranes.
Injecting
Opioid pills can be dissolved in water and then injected intravenously. Injecting drugs carry with it a high risk of infection, and overdose.
Combining with Other Substances
Some individuals abuse opioids by combining them with other substances, such as alcohol or benzodiazepines, to enhance their effects. This practice can be extremely dangerous and increase the risk of overdose.
In other cases, people obtain multiple prescriptions for opioids by visiting multiple doctors and not disclosing their existing prescriptions, a practice referred to as “doctor shopping.” This is a form of abuse that can lead to a dangerous accumulation of opioids. People may steal opioids from family members, friends, or neighbors, who have legitimate prescriptions. This is a common source of opioids for non-medical use.
Opioids are sometimes purchased illegally, and sometimes these drugs may be diverted from legitimate sources or manufactured illicitly. Use of any opioid without a prescription medication is a form of abuse. Numerous health risks are associated with opioid abuse, including but not limited to overdose, addiction, contracting an infectious disease (if the route is intravenous), and/or respiratory depression. Negatively impact personal relationships, well-being, and mental health are also a consequence of opioid abuse.
Benzodiazepines
Benzodiazepines are a class of prescription drugs that are primarily used to treat conditions like anxiety, insomnia, and seizures. They work by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, leading to a calming and sedative effect. However, benzodiazepines can also be abused, often for their euphoric and sedating effects, which can lead to addiction and other health complications.
However, benzodiazepines can also be abused, often for their euphoric and sedating effects, which can lead to addiction and other health risks.
Benzodiazepines are abused in several ways:
Consuming larger doses than prescribed
Some individuals take more benzodiazepines than recommended by their healthcare provider to achieve a stronger sedative effect or to get high.
Combining benzodiazepines with other substances
Benzodiazepines are often used in combination with other drugs, such as alcohol, opioids, or stimulants. This can increase the risk of overdose and other health complications.
Obtaining benzodiazepines without a prescription
Some individuals acquire benzodiazepines from illegal sources.
Route of administration of benzodiazepines
In some cases, people may crush benzodiazepine tablets and snort the powder, or dissolve it and inject it. No matter the route of administration, abuse of benzodiazepines can have serious consequences, such as infection, or overdose.
Prolonged use and dependence
Extended use of benzodiazepines, even as prescribed, can lead to physical and psychological dependence. This can result in people taking higher doses or using them for longer than intended.
Abusing benzodiazepines can lead to various negative consequences, including addiction, withdrawal symptoms, impaired cognitive and motor functions, increased risk of accidents and injuries, and overdose, which can be fatal when combined with other substances. It’s essential to use these drugs only as prescribed by a healthcare professional and seek help if you or someone you know is struggling with benzodiazepine abuse or dependence.
Common types of benzodiazepines include:
- Alprazolam (Xanax) – used to treat anxiety and panic disorders.
- Diazepam (Valium) – used for alcohol withdrawal, anxiety, seizures.
- Lorazepam (Ativan) – used to treat seizure disorders, such as epilepsy. It can also be used before surgery and medical procedures to relieve anxiety.
- Clonazepam (Klonopin) – to control certain types of seizures, or relieve panic attacks.
- Temazepam (Restoril) – used to treat insomnia.
- Chlordiazepoxide (Librium) – commonly used to treat tremors, withdrawal symptoms, and anxiety.
- Oxazepam (Serax) – used to manage anxiety associated with depression.
- Bromazepam (Lexotan) – used to manage anxiety.
- Triazolam (Halcion) – used for the treatment of insomnia.
- Flurazepam (Dalmane) – a sedative used to treat difficulty sleeping.
Alcohol
Alcohol is unique in that it is a legal substance in many parts of the world, and its widespread availability contributes to its high rates of use and abuse.
Drinking and Driving
Operating a vehicle under the influence of alcohol is a severe form of abuse that endangers the individual, passengers, and others on the road.
Using Alcohol to Cope
Some individuals abuse alcohol as a way to cope with stress, emotional problems, or mental health issues. This is often referred to as self-medication and can lead to a cycle of dependence.
Binge Drinking
Binge drinking is the consumption of a large amount of alcohol within a short period, often with the goal of getting intoxicated quickly. This pattern of drinking can lead to serious health risks and accidents. Consistently drinking large amounts of alcohol over an extended period can lead to alcohol abuse. This may involve daily or near-daily consumption of alcohol in quantities that exceed recommended limits.
Mixing alcohol with other substances
Combining alcohol with other drugs, whether they are legal medications or illicit substances, can be dangerous and is a form of alcohol abuse. The interaction between alcohol and other substances can have unpredictable and potentially harmful effects.
Ignoring Responsibilities
Neglecting work, school, family, or other important responsibilities due to alcohol consumption can be a sign of abuse.
Legal Problems
Getting into legal trouble due to alcohol-related incidents, such as public intoxication, DUIs, or alcohol-related violence, is another indication of alcohol abuse.
Social and relationship Issues
Alcohol abuse can lead to strained relationships with friends and family, as well as social isolation.
Physical and mental health consequences
Over time, alcohol abuse can result in a range of health problems, including liver disease, heart issues, cognitive impairment, and mental health disorders.
Tolerance and Dependence
Developing tolerance (needing more alcohol to achieve the same effects) and dependence (experiencing withdrawal symptoms when not drinking) are signs of an escalating alcohol abuse problem.
Allergy and Cold Medications
Over-the-counter allergy and cold medications, when combined with alcohol, can intensify drowsiness and affect motor skills.
Medication Interactions with Alcohol
Allergy and Cold Medications: Over-the-counter allergy and cold medications, when combined with alcohol, can intensify drowsiness and affect motor skills.
Pain Relievers (Opioids): Alcohol can enhance the sedative effects of opioids, increasing the risk of respiratory depression and overdose.
Sedatives and Benzodiazepines: Combining alcohol with drugs like Valium, Xanax, or Ativan can lead to excessive sedation, impaired coordination, and an increased risk of accidents.
Antidepressants: Alcohol can reduce the effectiveness of many antidepressant medications and may worsen symptoms of depression.
Antipsychotic Medications: Alcohol can interact with antipsychotic drugs, leading to increased sedation and impaired motor skills.
Antibiotics: Some antibiotics can interact with alcohol and cause adverse reactions, such as nausea, vomiting, headache, and potential liver toxicity.
Antihistamines: Combining alcohol with over-the-counter or prescription antihistamines can lead to increased drowsiness and impaired coordination.
Anti-Anxiety Medications: Medications like buspirone may have reduced effectiveness when taken with alcohol.
Blood Pressure Medications: Alcohol can affect blood pressure, and combining it with medications used to control blood pressure may interfere with the medication’s effectiveness.
Diabetes Medications: Alcohol can affect blood sugar levels, potentially leading to hypoglycemia (low blood sugar) when taken with medications like insulin or oral hypoglycemic drugs.
Anticoagulants (Blood Thinners): Alcohol can increase the risk of bleeding when combined with blood-thinning medications like warfarin.
Sleep Medications: Combining alcohol with sleep aids or medications for insomnia can lead to excessive drowsiness and impaired cognitive function.
Seizure Medications: Alcohol can reduce the effectiveness of seizure medications and increase the risk of seizures.
Mood Stabilizers: Alcohol can interfere with the effectiveness of mood-stabilizing medications used in the treatment of bipolar disorder.
Migraine Medications: Some medications used to treat migraines can have an increased sedative effect when combined with alcohol.
Over-the-counter Cold Medicine
Several over-the-counter (OTC) cold and cough medicines can be abused, primarily due to the presence of active ingredients that can produce psychoactive effects when taken in large doses. The two main classes of OTC cold medicines that are commonly abused are antihistamines and cough suppressants. These medications are generally safe when used as directed, but taking them in excessive quantities can lead to a range of negative effects, including hallucinations, dissociation, and in some cases, addiction. Some of the specific OTC cold medicines that are frequently abused include:
- Diphenhydramine: Found in brands like Benadryl, diphenhydramine is an antihistamine that can produce hallucinogenic effects when taken in high doses. This is sometimes referred to as “Benadryl tripping.”
- Promethazine: Found in medications like Phenergan with Codeine, promethazine is an antihistamine that, when combined with codeine, can be abused for its sedative and euphoric effects.
- Dextromethorphan (DXM): DXM is a cough suppressant found in many OTC cold medicines, such as Robitussin, NyQuil, and Coricidin HBP Cough & Cold. When taken in excessive amounts, DXM can produce dissociative and hallucinogenic effects.
- Pseudoephedrine: While primarily used as a decongestant, pseudoephedrine can be used illicitly in the production of methamphetamine. For this reason, there are legal restrictions on the sale of products containing pseudoephedrine.
Abusing these OTC cold medicines can be dangerous and lead to a range of side effects and health risks, including dizziness, rapid heartbeat, nausea, vomiting, hallucinations, seizures, and, in some cases, death. It’s essential to use these products only as directed and to be aware of the potential for abuse when they are not taken as intended. If you suspect someone is abusing OTC cold medicines, it’s important to seek help or intervention to prevent further harm.
Cocaine
Cocaine is a powerful stimulant drug that is commonly abused when individuals seek its euphoric and stimulating effects. Cocaine abuse can take various forms, and the methods of abuse can include:
- Snorting: This is one of the most common ways cocaine is abused. The drug is typically in the form of a fine white powder, and users snort it through their nostrils. The drug is absorbed through the nasal mucosa and enters the bloodstream relatively quickly, producing a rapid high.
- Injecting: Some individuals dissolve cocaine powder in water and inject it into their bloodstream using a syringe, which has the risk of causing infections and vein damage.
- Smoking: Cocaine can be converted into a freebase form (known as “crack cocaine”) or into a crystal form (known as “crystal meth” or “ice”), which can be smoked. Smoking cocaine can be addictive and carry a high risk of lung and respiratory complications.
- Oral Ingestion: While less common, some users may ingest cocaine orally, either by mixing it with food or drinks or by swallowing it in its powdered form. This method has a slower onset of effects compared to snorting, smoking, or injecting.
Cocaine is known for its short-lived high, which typically lasts only a few minutes to half an hour, leading many users to seek repeated doses in a pattern known as a “binge.” This cycle of use can lead to dependence, addiction, and a range of physical and mental health problems.
Cocaine abuse can have serious consequences, including cardiovascular issues (e.g., heart attacks and high blood pressure), respiratory problems (when smoking), mental health issues (e.g., anxiety, paranoia, and hallucinations), and a high risk of addiction. Additionally, the purity and potential adulteration of street cocaine can introduce further health risks.
It’s important to note that cocaine abuse is illegal in most countries and can have severe legal consequences. If you or someone you know is struggling with cocaine abuse, seeking help from a healthcare professional or addiction specialist is advisable to address the problem and find appropriate treatment options.