Terminology

Some chemicals actually manifest both stimulant and depressant effects. For example, alcohol is really a central nervous system (CNS) depressant, although initially it appears to be a stimulant because it first depresses the higher brain centers used for judgment or the inhibitory neurons.

Abused drugs are also classified by source. They include legally prescribed medications. These include but are not limited to: tranquilizers or sedatives that are prescribed and used long after the need for them has passed, medications shared with another person, prescriptions acquired from several sources, and medications combined with other substances such as alcohol or nonprescription drugs to achieve the desired effect. The surge in drug deaths has recently been fueled by increased availability and abuse of prescription painkillers (such as OxyContin) and antianxiety drugs. Prescribed drugs that are considered more addictive or dangerous are restricted by government agencies and are available only for research or with a signed written prescription without refill provisions. Heroin and morphine are regulated this way, as are stimulants such as those prescribed for attention deficit hyperactivity disorder.

Many psychoactive substances are readily available without restrictions, such as sleep-inducing or wake-up pills; cough syrups; spray paints; decongestants; alcohol-based hair lotions; or glues, nail polish removers, aerosols, and solvents for sniffing or inhaling. These generally provide a short “high” followed by depression and disorientation. Such substances are frequently misused and have been responsible for a number of suicides and accidental deaths. As a result, substances of this type are kept behind the counter in stores and must be requested.

Illegal or street drugs are widely available and are both costly and more dangerous for the user because their content is unpredictable. Such usage often leads to overdose or toxic effects caused by adulterating substances. Many street drugs are better known by their common names than by their medical or chemical names. For example, “speed” or “uppers” is the term used for amphetamines, “angel dust” for phencyclidine (PCP), and “snow” or “powder” for cocaine. Methamphetamine is a highly addictive, easily manufactured stimulant, and is known as “crank,” “ice,” or “crystal.” It can be sniffed, injected, smoked, or taken orally. It stimulates the body by increasing dopamine levels in the brain, but subsequently damages dopamine-producing neurons in the brain. A high dose causes elevated body temperature and seizures. Heroin is commonly known on the street as “blow.” “Ecstasy” or MDMA, a stimulant, is a designer drug, chemically modified to provide special effects and avoid legal restrictions. Ecstasy imparts a feeling of euphoria and energy. A high dose leads to hyperthermia and heart failure. It is commonly known as “X,” “K,” or “Special K.”

The market for illegal drugs has become a matter of concern both economically and socially because of the increased criminal activity and violence associated with drug trafficking. Many street drugs are easily manufactured from inexpensive chemicals in simple “laboratories.” Regulations to restrict access to the precursor chemicals required to produce the popular street drugs have been enacted in many countries, in an effort to control the source of street drugs. Street drugs are often diluted with contaminants that may be toxic; this practice is done to increase profits and or to make the substance more marketable on the street. It is important that screening for both the primary compound as well as known contaminants is done when treating a drug-induced emergency.

Discussion continues about the medical benefits compared with the abuse potential, and the legal versus illegal status of marijuana. An active ingredient, dronabinol (Marinol), or delta-9-tetrahydrocannabinol, is available for the controlled treatment of nausea, vomiting, and wasting associated with cancer chemotherapy or AIDS. It is not effective in all patients. Other less definitive areas involve tobacco smoking and the social use of alcohol, in which the concepts of addiction and health risks are not well defined.

Individuals who abuse substances such as alcohol often crave risk or excitement and participate in activities that are inherently dangerous. Driving under the influence or in an impaired state is an example of such behavior. 40% of all traffic related deaths are related to alcohol use/abuse. Social limits on behavior are often dampened by the depressive effects of many chemicals leading to impaired judgment and difficulty controlling feelings of anger. Interaction with law enforcement or emergency medical personnel may be unpredictable and carry increased danger to first responders.