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The intent of this website is to provide general health resources and information. It is not intended to provide medical advice on personal health matters, which should be obtained directly from a healthcare provider. The material/references are offered solely in an educational context and are therefore designed to support, not replace, any relationship that may exist between a patient/site visitor and his/her existing physician. Please consult your doctor before starting, changing or discontinuing any medical treatment.
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Basic Addiction Books/Survey Texts
Brecher, E. Licit and Illicit Drugs. Consumers Union.
This book was published in the seventies by the same people that produce the magazine Consumer Reports. It attempted to cut through the propaganda and hysteria of the time and present consumers with a factual report on drugs and their use/abuse. Many of the finest experts of the time (and now) contributed to this book (and then they proceeded to catch hell for not hewing to Richard Nixon's hard-line War on Drugs message). The book is out of print now, but you can still find a used copy now and then on Amazon.com.
Brizer D, Castaneda R. Addiction and Recovery for Beginners. Writers and Readers Publishing.
This is a humorous and inexpensive comic book that covers all the important points of drug effects, addiction and treatment. Perhaps it was intended for young adults, but I found it an exceptionally accurate, comprehensive and very enjoyable book. It takes an hour to read and leaves the reader with a fine start on addiction knowledge.
Inaba, D, Cohen, W. Uppers, Downers, and All Arounders. CNS Publications.
An excellent pictorial textbook at the high school or college level about the history and pharmacology relating to drug use and addiction. Written by the CEO of the Haight-Ashbury Free Clinics.
Kuhn C, Swartzwelder S, Wilson W. Buzzed. Norton.
This is the most intellectually honest book I’ve ever read on the topic of drugs. The authors of this book are all pharmacists, and they present refreshingly balanced information about each class of drugs, their effects and consequences. If brave enough to use it, this is a very good text for high school and college teachers looking to go beyond the “Just Say No’ platitudes regarding drugs and their effects.
Liska K. Drugs and the Human Body. Prentice Hall.
This is a small and inexpensive college textbook of interesting and accurate information on drug effects, drug addiction, and how these have influenced the history and sociology surrounding drugs. A very good survey text about addiction.
Ruden RA. The Craving Brain. Harper Collins.
Probably the easiest book to read that describes addiction’s impact on midbrain survival systems. Dr. Ruden’s chapters on his “Biobalance Approach” are less useful, but the first part of the book is worth its price.
Schuckit M. Educating Yourself About Alcohol and Drugs. Perseus Books.
This is one of the best books containing information on classes of drugs, mechanisms of drug abuse and addiction, and theories on addiction’s origins. Dr. Schuckit is the world's expert on the genetic mechanisms of addiction.
Weil A, Rosen W. From Chocolate to Morphine. Houghton Mifflin.
This is an exceptionally enlightened and balanced survey text about drugs and their effects. Dr. Andrew Weil, a physician famous for combining holistic approaches and nutrition, is an intelligent guide through the morass of ideology surrounding drug use.
Medical Textbooks
Graham AW, Schultz TK, Wilford BB. Principles of Addiction Medicine. American Society of Addiction Medicine.
A large and expensive textbook best found at a medical school library. This book reflects more the philosophic orientation of the American Society of Addiction Medicine, a philosophy that leans heavily in favor of twelve-step programs. Still, it is an excellent sourcebook – second only to the Lowinson text – and has very good sections on pain relief in recovery.
Karch SB (Ed.). Drug Abuse Handbook. CRC Press.
An excellent reference text for a huge variety of information about drugs and drug abuse written from a forensic pathology/toxicology perspective
Lowinson J. ed. Substance Abuse: A Comprehensive Textbook. Williams and Wilkins.
This is one of the two main medical textbooks on addiction medicine (the other being the ASAM text). True to its title, it covers a wide range of topics from brain reward neurophysiology and the neurochemistry of individual drugs to the social and political issues concerning the treatment of addicts. At over one thousand pages, it is also an expensive book. The best place to read it without having to buy it is at a local medical school library.
Miller NS, Gold MS, Smith DE. Manual of Therapeutics for Addictions. Wiley-Liss.
A great handbook for medical and surgical residents to use in managing addicted patients in the hospital setting. Written by three superstars in the field of addiction medicine and the treatment industry.
Individual Drugs
Fernandez H. Heroin. Hazelden Press.
The best book I’ve found that compiles the history, effects and addiction process of this drug. It is a very good resource book, but to avoid triggers to relapse I recommend that newly sober heroin addicts avoid chapter five until further along in sobriety.
McCoy AW. The Politics of Heroin. Lawrence Hill Books.
An interesting but somewhat breathless investigation into the global traffic in heroin including the putative involvement of the CIA. Very good sections about the trafficking of heroin during the Vietnam War.
Streatfeild D. Cocaine: An Unauthorized Biography. St. Martin's Press.
A thorough and fascinating (if somewhat celebratory) examination of the history and politics surrounding the use of cocaine.
Process Addictions
Barthelme S, Barthelme F. Double Down: Reflections on Gambling and Loss. Houghton Mifflin.
A moving memoir by two brothers concerning their accelerating addiction to gambling.
Beattie M. Codependent No More. Hazelden Press.
Although the precise nature of “codependency” is debated in feminist psychology, this book is the best description of the phenomenon available. It’s possible to wear out a highlighter while reading this book - that’s how powerful the identification of the reader to the codependent process can be. This book has sold in huge numbers and is a standard in pop psychology. It is an excellent book for the spouse or parent of the addict in early recovery to read since it will provide explanations for past painful events and introduce Al-Anon as a method of support.
Boskind-White, M. Bulimia/Anorexia. W. W. Norton and Company.
Carnes, P. Out of the Shadows. Hazelden Press.
Dr. Carnes is the leading expert in the emerging (and highly sensitive) topic of sexual addiction. Written from a humane perspective, this book explains the dynamics of the sexual behaviors that are commonly paired with chemical addiction - especially cocaine and methamphetamine.
Galanter M. Cults: Faith, Healing and Coercion. Oxford University Press.
An important description of a form of addiction that can be perpetrated by many dysfunctional "faith-based" treatment centers onto drug addicted patients.
Treatments
Burns D. Feeling Good: the New Mood Therapy. Harper Collins
This is the easier-to-read version of Aaron Beck’s Cognitive Therapy of Substance Abuse. It explores the issues of faulty core beliefs that direct automatic thinking leading to intolerable feelings that trigger addictive behaviors. This is a good book for those in early recovery who are more rationally inclined and having trouble with the spiritual aspects of traditional recovery programs.
Coombs RH. Drug Impaired Professionals. Harvard University Press.
A compendium of the literature describing addiction in physicians, dentists, pharmacists, nurses, attorneys and airline pilots and the impaired professional programs run by most state licensing boards. This book is a good introduction to the concept of dealing with addiction from an occupational medicine perspective. Professional groups traditionally have very high success rates when carefully monitored in work settings, and lessons learned in this area of addiction medicine are important because they can be transferred to other addicts, regardless of their professional status.
Marlatt, GA. Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors. Guilford Press.
One of my all-time favorite books. This book explains the philosophy and research behind the highly controversial public health approach to addiction known as Harm Reduction - a view that seeks to work with addicts even if they are not ready to stop drugs. This view is anathema to the traditional abstinence-based treatment approaches currently used in the United States today. Although it is respected and effective in other countries (it is, for instance, the official government policy on drug abuse in Canada and much of Europe), the hostility toward Harm Reduction borders on rabid. Dr. Marlatt slices through the misrepresentations and articulates the ethical and practical arguments for this approach.
Marlatt GA, Gordon JR. Relapse Prevention. Guilford Press.
The definitive text on the dynamic of relapse and the techniques to prevent it. This expansive book is written for professionals.
Miller W, Rollnick S. Motivational Interviewing. Guilford Press.
In my opinion, the most important addiction medicine book currently in print for professionals. Miller and Rollnick's approach marks an important shift away from the traditional, punitive tactics used in many treatment centers in the United States. The book is the jewel in the crown of addict/patient advocacy, and contains withering arguments against the concepts of denial and aggressive intervention. Whenever I am depressed about the things I see done to patients in treatment centers, I read the first chapter of this book - it never fails to inspire me. IT IS IMPORTANT TO NOTE that the authors have removed much of the revolutionary tone in their second edition (I think someone got to them), but you can still find the first edition used on Amazon.com.
Politics/History/Ethnography
Acker CJ. Creating the American Junkie. Johns Hopkins University Press.
An extremely important book. Dr. Acker chronicles the development of the - today unchallenged - idea that addicts are criminally-minded, disease-spreading sociopaths and demonstrates that this portrait of addicts was very consciously and carefully created during the period surrounding the enactment of the Harrison Narcotics Act in 1914. Dr. Acker's withering account of the complicity of psychoanalysts in stereotyping addicts as deviants is an absolute must-read for counselors, therapists and physicians before they practice confrontational therapies to "break down" the ego of addicted patients.
Baum, D. Smoke and MirrorsSmoke and Mirrors. Little, Brown and Company.
An excellent by a journalist for the Wall Street Journal about the escalation of the War on Drugs from the Nixon to the Clinton Administrations.
Gray, J. Why Our Drug Laws Have Failed and What We Can Do About It. Temple.
An analysis of the social and legal problems created by the Zero Tolerance/War On Drugs approach to addiction written by an Orange County Superior Court Judge.
Gray, M. Drug Crazy. Random House.
This book is a fascinating account of the attitudes of the individuals who established United States drug laws. It contains exceptionally interesting anecdotes about the history of drug policy in the United States.
Hentoff N. A Doctor Among the Addicts. Grove Press.
If you want to read about a true hero in addiction medicine, read Mr. Hentoff's book about Dr. Marie Nyswander. She talks about addicts as people, as patients and as valuable human beings - high or sober. And it's important to remember that this book was written in 1968! Dr. Nyswander and her colleague Dr. Robert Dole were two of a very small handful of doctors who were willing to bring heroin addicts into hospitals and treat them with dignity and kindness. Both of these pioneers are gone now, but I refer back to Hentoff's book for inspiration and a glimpse of what addiction medicine could be if only we followed Dr. Dole's and Dr. Nyswander's ideas.
Hodgson B. Opium: A Portrait of the Heavenly Deamon. Chronicle Books.
This is a beautiful pictorial of the history of opium use, but it might be too romantic for people in early recovery. It is a good book for the heroin addict on your Christmas list who already has ten years sober.
Lenson D. On Drugs, University of Minnesota Press.
This book is one of my favorites. Lenson analyses drug use and addiction from a phenomenological basis – through the experience of the addict. He deliberately avoids the standard neurophysiological, psychological, evangelical, confessional and literary approaches to the subject of drug use and addiction that make books in this genre so boring. His analysis of addiction as a pathology of consumerism is exciting and important.
Massing M. The Fix. University of California Press.
Extremely readable and insightful account of the origins of the Office of National Drug Control Policy under President Nixon and the formation of the cabinet position known as the “Drug Czar.” This book reveals the politics behind much of the United States’ policy toward addicts.
Musto, D. The American Disease: Origins of Narcotic Control. Oxford Press.
This book is an exhaustive review of the history and evolution of the legal sanctions and moral philosophy in the United States. Dr. Musto is the senior authority in this subject, making this a very important work. The book is commonly must-read in college courses about the sociology and history of American drug laws.
Musto, D. Drugs in America: A Documentary History. New York University Press.
An excellent anthology of primary source historical material relating to drug use and drug addiction in the United States over the last three hundred years.
Peele S, Brodsky, AM. The Truth About Addiction and Recovery. Fireside Books.
Written by a notorious opponent of the addiction treatment industry, Dr. Peele summarizes the strongest arguments against the "Disease Model" conceptualization of Addiction and the ideology of the recovery movement that claims it. Dr. Peele writes in the same style as Thomas Szasz and other anti-psychiatry libertarians, and denounces the “zealotry” and “coercive tactics” used by addiction treatment centers. I think this is an exceptionally important book for all addiction medicine clinicians to read. Peele's arguments are very strong and should be addressed. The addiction treatment industry ignores Peele at its own peril. Fortunately, good counter-arguments do exist to Peele’s positions.
Shavelson L. Hooked: Five Addicts Challenge Our Misguided Drug Rehab System. The New Press.
This book, written by a physician and photojournalist in Northern California, accurately describes the abusive tactics of the therapeutic community model of treatment to which addicts who cannot afford traditional treatment centers (i.e. Hazelden, Betty Ford) are exposed. It is an important documentation of this injustice, and a telling account of why it fails as a treatment method. Shavelson follows several addicts as they go through the addiction/treatment/relapse process and explores the reasons for their lack of success. He makes intelligent recommendations at the end of the book to change this pattern in the addict who is poor or mentally ill by changing the punitive aspects of treatment available to them.
Szasz T. Ceremonial Chemistry. Learning Publications.
Thomas Szasz is the intellectual father of the anti-psychiatry, libertarian movement against the addiction treatment industry and the Disease Model of addiction. Szasz claims that mental illness is a cultural construct more than a pathologic process (see his additional work The Myth of Mental Illness) and advocates for the elimination of drug laws entirely in favor of allowing addicts to “mature out” of their destructive behavior.
White, W. Slaying the Dragon. Chestnut Health Systems.
This book chronicles the evolution of early alcoholism treatment in the United States from patent medicine cures, mutual aid societies and inebriate asylums as well as the formation of Alcoholics Anonymous.
Help with Early Recovery
Dement, W. The Promise of Sleep. Living Planet Press.
A good book for patients in and out of recovery experiencing problems with sleep disorders. Written by the head of Stanford University's sleep lab, Dr. William Dement, who is arguably the leading expert on the subject. Explores in detail the elements of Sleep Hygiene which is used in addiction treatment centers as a non-pharmacological approach to insomnia in early sobriety.
Gorski TT. Staying Sober. Herald House/Independence Press.
The second book I would recommend to the addict in early recovery (the first being the Alcoholics Anonymous basic text). Gorksi combines the material from Marlatt and Gordon’s standard clinical text on relapse prevention with his own valuable insights. This book contains an excellent description of Post-Acute Withdrawal Syndrome as well as strategies to cope with it.
Gorski TT. Getting Love Right: Learning the Choices of Healthy Intimacy. Fireside Press.
Although frowned upon as a relapse trigger, romantic relationships in early recovery are common. If a relationship is going to happen, this book is probably the best way the help the recovering addict learn ways to avoid disaster. It is also a good book for long-established relationships with one or both members in early recovery.
AA/Philosophy/Spirituality
Cheever S. My Name is Bill. Simon and Schuster.
A reverent but honest look into the life of William G. Wilson, the co-founder of Alcoholics Anonymous.
Kurtz E. Not God. Hazelden Press.
This is a semi-objective account of the origins of Alcoholics Anonymous from an academic historical approach. It explores the philosophical concepts at work in the twelve steps, and the significance of the twelve-step movement as a response to modernism.
Information about Addiction and Treatment
Center for Substance Abuse Treatment
http://csat.samhsa.gov/
CSAT provides a library of Treatment Improvement Protocols which are publications designed to standardize understanding and management of common problems in addiction treatment. TIPs cover a range of subjects such as Substance Abuse Treatment for Persons with Co-Occurring Disorders (TIP 42) and Treatment of Adolescents with Substance Use Disorders (TIP 32). It is possible to build a fine addiction medicine library for free by downloading these TIPs and their accompanying TAPs (Technical Assistance Publications).
Treatment Improvement Protocols can be found here:
http://www.kap.samhsa.gov/products/manuals/tips/index.htm
And Technical Assistance Publications can be found here
http://www.kap.samhsa.gov/products/manuals/taps/index.htm
National Institute of Drug Abuse
http://www.nida.nih.gov/
The U.S. government-sponsored research arm of the National Institutes of Health. Although it often is influenced by the political agenda of the Executive Branch, the research funded by NIDA is of excellent quality - especially regarding neurophysiology and brain imaging.
National Institute on Alcohol Abuse and Alcoholism
http://www.niaaa.nih.gov/
Nature Neuroscience
http://www.nature.com/neuro/index.html
Nature Neuroscience is the pre-eminent publication for the latest research on the brain. The Nov 2005 issue was devoted entirely to addiction and can be found here: http://www.nature.com/neuro/journal/v8/n11/index.html
Science Daily (regular updates on addiction topics)
http://www.sciencedaily.com/news/mind_brain/addiction/
General Information on Drugs and Medications
Erowid
http://www.erowid.org/
Erowid is a beautiful library of information about psychoactive plants and chemicals. It is just about the best reference section on common drugs of abuse available on the internet (even if it does somewhat romanticize drugs).
Addiction Science Research and Education Center University of Texas, Austin
http://www.utexas.edu/research/asrec/addiction.html
This is an excellent source of information and serves as the home site for Dr. Carlton Erickson, a popular lecturer on the neurophysiologic basis of addiction.
Professional Organizations
American Society of Addiction Medicine
http://www.asam.org/
The national professional society for medical doctors who practice addiction medicine. Also a good source for new treatments for addiction and legislative efforts for humane treatment of addicts.
California Society of Addiction Medicine
http://www.csam-asam.org/
The California state professional society for medical doctors who practice addiction medicine. A good source for new treatments for addiction and legislative efforts for humane treatment of addicts.
National Association of Addiction Treatment Providers
http://www.naatp.org/home.php
Addiction and Recovery Advocacy Groups
Faces and Voices of Recovery
http://www.facesandvoicesofrecovery.org/
The political action committee for Americans in recovery. An excellent site to keep up to date on the latest news regarding legislation regarding addiction and its treatment.
Join Together
http://www.jointogether.org/
An excellent source of current information on new treatments for addiction, legislative efforts in public health, and reports about conflicts regarding the rights of addicted patients.
Amphetamines
Phenylethylamine
Ephedrine
Pseudroephedrine
Methamphetamine
Crystal Methamphetamine
“Ice”
“Glass”
Phentermine
Methylphenidate
Ritalin
Concerta
Adderal
Amphetamine is the prototype drug for a large class of major CNS stimulants that share a basic Phenylethylamine structure. Phenylethylamine-type molecules include not only many amphetamine-related stimulant drugs, but the catecholamine neurotransmitters (epinephrine, norepinephrine and dopamine), entactogen drugs (MDMA, or “Ecstasy”), and the anti-depressants venlafaxine (Effexor) and buproprion (Wellbutrin). Because of their structural relation to the catecholamines, phenylethylamine drugs like amphetamines are sympathomimetic – meaning they stimulate the “fight-or-flight” sympathetic nervous system.
Amphetamines have a long history in medicine. Originally their sympathomimetic properties were employed for bronchodialation in asthmatic patients. Drugs such as methamphetamine also possess this property, one reason for the instantaneous cough on injection experienced by intravenous methamphetamine users. Amphetamine drugs have also been used in the treatment of obesity due to their ability to suppress appetite (anorectic), and for the treatment of attention-deficit disorder, as well as severe cases of narcolepsy.
Unlike the other major stimulant cocaine, which acts solely as a dopamine re-uptake inhibitor, amphetamines have multiple mechanisms of action. Like cocaine, amphetamines are also dopamine re-uptake inhibitors. They also cause the release of dopamine itself from pre-synaptic neurons, as well as the newly-synthesized pools of norephinephrine and (to a lesser degree) serotonin in brain neurons. Additionally, amphetamines in high doses also inhibit the enzyme Mono-Amine Oxidase (MAO), which ordinarily breaks down those same three catecholamine neurotransmitters. These different mechanisms combine to produce a powerful potentiation of the catecholamine-based sympathetic nervous system. The rewarding effects of amphetamines are due primarily to the exaggerated release of dopamine in the mesolimbic reward circuit of the brain.
LOW DOSES OF AMPHETAMINES
Exhiliration/Euphoria
Arousal (often sexual in nature)
Curiosity
Gregariousness
Increased Attention and Task Performance
Increased Motility
Increased Heart Rate
Increased Blood Pressure
Increased Body Temperature
Bronchodialation
Diaphoresis (Perspiration)
Mydriasis (Dilated Pupils)
MODERATE DOSES OF AMPHETAMINES
Hedonic Instability (variable and unpredictable drug reward)
Widened Sexual Repertoire
Suspiciousness
Socially Inappropriate Behavior (fight-seeking)
Repetitive Assembling and Disassembling Objects (“Projects”)
Psychomotor Agitation
Tachycardia
Hypertension
Pyrexia
HIGH DOSES OF STIMULANTS
Hedonic Dysregulation (anhedonia)
Hypersexuality (genital injury, unsafe situations)
Paranoia
Social Withdrawal, Violence
Hypervigilence, Stereotypies
Rhabdomyolysis (breakdown of muscle, release of proteins into bloodstream)
Cardia arrhythmias
Hypertensive Crisis
Severe Dehydration
TOXIC/FATAL DOSES OF STIMULANTS
Severe psychosis
Suicide, “Death by Cop”
Ventricular Fibrillation
Myocardial Infarction
Cerebrovascular Accident (stroke)
Renal Failure
Malignant Hyperthermia
A withdrawal phenomenon is observed in patients who suddenly stop taking amphetamines. Although not as life-threatening as the withdrawal from sedative/hypnotic medications, the patient can experience severe depression, hypersomnia (oversleeping), extreme hunger and craving for amphetamines.
Methamphetamine is synthesized when an extra methyl group is added to the amphetamine molecule. This makes the methamphetamine molecule more lipid soluble and thus increases its effects in the central nervous system over amphetamine. Methamphetamine was first synthesized in Japan in 1893 from ephedrine, a chemical found in the Chinese herb Ma-huang. Ephedrine has is a bronchodialator and was once sold over the counter as asthmatic inhalers. Like most amphetamine-like molecules, the “L” enantiomer of ephedrine is a less powerful sympathomimetic drug known as Pseudoephedrine (L stands for Levo-rotatory, for its ability to rotate polarized light to the left when passed through the molecule). L-ephedrine is sold over-the-counter as a nasal decongestant. It can be used to synthesize L-methamphetamine via a relatively easy process known as “cooking meth.” The purified, crystalline “L” enantiomer of methamphetamine has a wide vaporization phase and is therefore smokable. This form of crystal methamphetamine is often known as “ice” or “glass.”
Other phenylethylamine stimulants can be used as appetite-supressants (or “anorectics”). Phentermine and Fenfluramine used to be prescribed together as “Phen-Fen” in outpatient clinics (sometimes set up exclusively for that purpose). Because of the propensity for these moderate stimulants to produce pulmonary hypertension, their use is controversial for the purpose of weight loss. Phen-Fen was pulled from the market in the late 1990s.
Psychostimulants such as amphetamine and other phenylethylamines are also used for the treatment of Attention-Deficit Disorder. The most common drug prescribed for this purpose is methylphenidate (Ritalin, Concerta).
Caffeine
Coffee
Tea
Chocolate
Cola-flavored drinks
Energy drinks
Pain relievers
CLASS: MINOR STIMULANT
EXAMPLE: CAFFEINE
THERAPEUTIC EFFECTS: REDUCED FATIGUE, INCREASED ALERTNESS, AND FLUIDITY OF THOUGHT, IMPROVED COORDINATION
SIDE EFFECTS: IRRITABILITY, WITHDRAWAL HEADACHES
OVERDOSE: TACHYCARDIA, ANXIETY
LONG-TERM HEALTH EFFECTS: GENERALLY CONSIDERED SAFE FOR MOST PATIENTS
Caffeine is the most widely consumed psychoactive substance and been used by humans since pre-historic times. Caffeine is produced in the leaves, fruit and beans of over sixty different plants where it acts as a natural pesticide.
It is an ingredient in many beverages such as coffee, tea, chocolate, cola-flavored drinks, and in larger quantities in increasingly popular energy drinks.
Caffeine acts a minor CNS stimulant to produces alertness, ward off drowsiness, and increase the speed and clarity of thought. Caffeine works by blocking the neurotransmitter adenosine in the central nervous system, and by increasing the amount of cyclic-AMP in cells.
Caffeine content in foods & drugs (source: Center for Science in the Public Interest)
Starbucks Drip Coffee (grande): 320 mg
Starbucks Latte (grande): 150mg
Starbucks Espresso: 75mg
Tea (brewed): 50mg
Coca-cola: 35mg
Diet Coke: 47mg
Pepsi: 38mg
Mountain Dew: 40mg
Monster Energy: 160mg
Red Bull: 80mg
Rockstar: 80mg
Ben & Jerry’s Coffee Ice Cream: 68mg
Hershey’s Chocolate Bar: 9mg
NoDoz & Vivarin (1 tablet): 200mg
Excedrin (2 tablets): 130mg
Cannabinoids
Cannabinoid receptors
Cannabindoid receptor antagonists
tetrahydrocannabinol
Marijuana
Marinol
Rimonibant
CLASS: CANNABINOIDS
EXAMPLES: MARIJUANA, HASHISH, HASHISH OIL
THERAPEUTIC EFFECTS: RELAXATION, DECREASED MUSCLE SPASTICITY, DECREASED INTRAOCULAR PRESSURE
SIDE EFFECTS: IMPAIRED JUDGEMENT AND MEMORY, INCREASED HEART RATE AND APPETITE
DESIRED ABUSE EFFECTS: ELEVATED MOOD, MILD STIMULATION FOLLOWED BY SEDATION, DECREASED ANXIETY, LAUGHTER, CONTEMPLATION
OVERDOSE: HALLUCINATIONS, PARANOIA, PSYCHOSIS IN SOME PATIENTS, COMA IN CHILDREN
LONG-TERM HEALTH EFFECTS: AGGREVATION OF PULMONARY DISEASE, IMMUNE SYSTEM DYSFUNCTION
Cannabinoids are a large class of molecules similar in their structure to tetrahydrocannabinol, the active ingredient in cannabis (marijuana) and hashish. Upon burning cannabis leaves, a wide variety of cannabinoid compounds are liberated, most of which have psychoactive properties through their interaction with cannabinoid receptors in the central nervous system.
For many years, marijuana was considered to be psychologically addicting, not physically addicting the way alcohol and heroin. Since the discovery of physical cannabinoid receptors in the central nervous system, this distinction has lost its meaning. It appears that in many users, marijuana can in fact produce tolerance and a clinically observable withdrawal phenomenon. Also, due to individual differences, perhaps with a genetic basis, the response of some patients to marijuana can be distinctive, up to and including psychosis.
Nevertheless, and perhaps to the dismay of many parents, cannabinoids are considered one of the safer drug of abuse - at least by the pharmacologic definition of safety in which the effective dose of a drug is far less than the lethal dose of the drug (the lethal dose of marijuana has yet to be determined). This “pharmacologic” safety should not be confused with the overall safety of marijuana, which is quite real due to its effects on memory and its current classification by the Department of Justice as a Schedule I drug – defined as a drug so dangerous that it cannot be prescribed safely even by a doctor, and therefore has no legitimate medical use.
The issues surrounding the concept of “medical marijuana” are complex and nearly impossible to divorce from political and personal considerations. The active ingredient in marijuana, tetrahydrocannabinol, is available as a Schedule II medication, but its efficacy appears to be far less than smoked marijuana cigarettes. This may be due to some process in the pyrolysis (burning) of cannabis leaves that cannot be reproduced when the medication is in tablet form. The clinical evidence for marijuana’s effectiveness over other available medications for conditions such as glaucoma, nausea secondary to chemotherapy, and wasting syndrome due to HIV/AIDS is equivocal and highly contested. Marijuana does have demonstrated efficacy over other medications in the treatment of spastic muscular disorders such as muscular dystrophy and neurological disorders such as multiple sclerosis. The effort at the state level to legislate “compassionate use” of marijuana ignores the prevailing enforcement authority of the federal government, which recognizes no such utility.
Cannabinoids can be classified as either exogenous – those coming from plants and often self-administered for recreational purposes, or endogenous – those peptides manufactured by the body that have activity at CB (cannabinoid) receptors. The main endogenous cannabinoid is named Anandamide (“ananda” being the Sanskrit word for “bliss”).
The presently known cannabinoid receptors are divided into two classes, CB1 and CB2. CB1 receptors are found primarily in the brain. CB1 agonists produce the mood altering and anti-convulsant effects usually associated with marijuana. CB2 receptors have been found in the spleen and throughout the immune system and may be responsible for the anti-inflammatory effects of marijuana.
There are a number of synthetic cannabinoids used in medicine for their analgesic, anti-emetic (nausea) and appetite-stimulating effects. Dronabinol (Marinol) is a Schedule III cannabinoid mediction used in the treatment of cancer pain and nausea and anorexia associated with chemotherapy. Rimonibant is a cannabinoid receport antagonist that blocks the CB1 receptor and initially showed some promise as an anti-obesity drug. Its association with suicide in patients taking the medication has delayed its FDA approval for this purpose.
Cocaine
Coca leaves
Erythroxylon coca
Erythroxylon novogranatense
Coca paste
Cocaine salt
Cocaine hydrochloride
Free base cocaine
Crack cocaine
Monoamines
Bioavailability
Route of administration
Cocaine vaccination
Baclofen
Disulfiram
CRF-antagonists
Along with the amphetamines, cocaine is a major stimulant – as opposed to the two minor stimulants, nicotine and caffeine. Cocaine is produced by two Central and South American shrubs: Erythroxylon coca, and Erythroxylon novogranatense. The vast majority of the world’s cocaine comes from Erythroxylon coca. There is a long history of cocaine use in South America in the form of chewing coca leaves drinking coca leaf tea. Leaves are chewed with a pinch of an alkaline substance – usually lime – to liberate the cocaine from the leaves. Among the Incas, the use of coca leaves was limited to royalty.
During the 1800s, organic chemists succeeded in extracting alkaloids from plant products such as opium and coca leaves. In the United States, cocaine was mass-produced and sold as a key ingredient in many “health tonics” – including
It was soon recognized as a severely addictive drug. Today, cocaine is used only rarely as a local anesthetic for the upper respiratory tract (nose, sinuses, pharynx). It is no longer used for anesthesia during eye surgery due to its tendency to produce corneal ulcerations. Cocaine is a key ingredient in Brompton Cocktail, a combination of cocaine, morphine and alcohol given to cancer patients in the final hours of their life to elevate their mood and provide some last minute sociability with family and friends before death. Tod
