Drugspecific Negative Consequences

Discussion in this section is limited to the specific negative consequences of a few of the most prevalent illicit drugs: marijuana, cocaine, and heroin. Other illicit substances that could have been discussed here include LYSERGIC ACID DIETHYLAMIDE (LSD), PHENCYCLIDINE (PCP), and other ''alphabet'' or ''designer'' drugs (''ecstacy,'' etc.), Amphetamine, and Methamphetamine (and its smokable form, ''ice''). This discussion also could well include legal substances that are abused by inhalation, such as gasoline, airplane glue, and various solvents, which are mundane but widely used—especially in economically depressed areas of the United States and in developing nations. These are very harmful to lungs and brain cells, and are often deadly.

Marijuana. The smoking of marijuana, probably the most widely used illicit drug, may well have more serious acute and chronic consequences than once thought. Recent and continuing research is casting new light on the chronic health risks posed by marijuana smoking, contradicting the conventional wisdom that it is less harmful than either drinking alcoholic beverages or smoking tobacco. For example, it is reported that three times the tar is delivered (and four times more is deposited) to the mouth and lungs per puff from a marijuana joint than from a filter-tipped cigarette. Smoking marijuana also produces up to five times more carbon monoxide in the user's blood than does tobacco. Knowledge is also being accumulated regarding the specific health-damaging mechanisms from the 426 known chemicals contained in Cannabis sativa (which are transformed into over 2,000 when ignited).

Among the pertinent facts already established is that 70 of these chemicals are fat-soluble and accumulate in fatty body tissue, notably the brain, lungs, liver, and reproductive organs. This represents a persistence-of-residue effect in which portions of THC (delta-9-TETRAHYDROCANNABINOL), the most potent psychoactive chemical in marijuana, not only remain in the body (and are thus detectable) for several weeks following use, but also accumulate with repeated use. This THC buildup is particularly noteworthy when one considers that the potency (THC content) of marijuana has increased dramatically since the 1960s, when the average potency was about 0.2 percent.

Regular marijuana smoking can contribute to emotional and other behaviorally defined mental-health problems through degraded interpersonal relationships and arrested development. The mechanism for this seems to be a drug-induced perception of well-being and problem abatement that may not reflect reality and contributes to avoidance rather than coping with life situations.

Research findings from the 1980s and 1990s highlight a marijuana health risk that is largely unmeasured but may be much greater than gener ally considered. Researchers examined blood samples from over 1,000 individuals brought to a hospital trauma unit with severe injuries. Two-thirds of these individuals had accidental injuries associated with the operation of motor vehicles (drivers, passengers, and pedestrians injured by cars, trucks, or motorcycles). Using a blood test that normally ceases to detect THC around 4 hours after use, the researchers found about 34 percent of these accident victims had psychoactive levels of THC in their blood when they arrived at the hospital. A more recent study found that 45 percent stopped for reckless driving tested positive for marijuana. Given that there currently are no simple, legally recognized tests to detect marijuana use, the extent of marijuana-related vehicular injuries and deaths is an unknown but potentially sizable statistic.

Cocaine. Many readers undoubtedly have heard that Sigmund FREUD, the famous Viennese psychoanalyst, was an avid user and proponent of cocaine. The initial account of his observations of the drug's effects for himself and some of his patients indeed was glowing. It was translated from German and reprinted in an American medical journal in the mid-1880s, thus popularizing the drug in the United States and prompting its incorporation into products from patent medicines to soft drinks. Less well reported is the fact that Freud and his colleagues had discovered the significant negative effects of cocaine by the end of that same decade and had withdrawn their support for its applications in medical therapy.

Cocaine has had several periods of popularity in the United States as a drug of abuse, with the most recent beginning in the early 1980s. Touted as a safe, nonaddicting, recreational drug, cocaine hy-drochloride (in powder form) was ''snorted'' (inhaled) by millions who liked the absence of hypodermic needles, the lack of lung-cancer risk, and the rapid high, with its feelings of alertness, wit-tiness, and sexual prowess.

Unfortunately, cocaine users often progress from casual to compulsive patterns of use. The grandiose perceptions of heightened mental and physical abilities inevitably wane (typically within 20 minutes following use), and the resulting dysphoria (opposite of euphoria) is so marked in contrast that it resembles depression. Trying to relieve the depression and regain the euphoria, cocaine abusers repeat this cycle over long periods (called binges) until their supplies, resources, and/or stamina are exhausted. In the study of reckless drivers noted earlier, 25 percent tested positive for cocaine.

The risk of infection with HIV and other sexually transmitted diseases is high among compulsive cocaine users, particularly female crack users. Often forsaking socially acceptable means of earning income, they live an existence that revolves around crack use. Many maintain their crack supply by repeatedly selling or trading their sexual services, with each unprotected sexual contact increasing the chance that they will have an HIV-infected partner.

Other manifestations of negative effects of cocaine abuse include hyperstimulation; digestive disorders, nausea, loss of appetite and weight; tooth erosion; nasal mucous membrane erosion, including perforations of the nasal septum (holes in the membrane separating the nostrils); cardiac irregularities; stroke (from vascular constriction); convulsions (especially among individuals prone to seizure disorders); and paranoid psychoses and delusions of persecution. Cocaine is a notoriously fickle drug—some experts say it behaves as though it belongs in other pharmacological categories besides stimulant. A highly publicized case was the 1986 cocaine-induced death of the athlete Len Bias, who reportedly was a first-time user of a small amount. In addition, research indicates that the concurrent use of cocaine and alcohol (a common practice) produces a new, liver-and brain-accumulating and -damaging drug (COCA-ETHYLENE) within the user's body. It is implicated in puzzling low-dosage ''excited delirium'' fatalities and increased mortality risks for individuals with existing heart problems.

Some of the fetal damage from maternal cocaine use occurs because cocaine is a vasoconstrictor, a useful characteristic for topical application in delicate medical procedures, such as eye surgery, but a decided negative as it concerns the placenta of a pregnant woman. The restriction of blood flow through the placenta limits nutrients and oxygen to the fetus, leading to retarded growth and development of vital organs. Heavy cocaine use during pregnancy also can cause spontaneous abortion, and anecdotal reports of cocaine being used intentionally for this purpose are not uncommon. Premature separation of the placenta from the uterus, another common medical complication among cocaine-using pregnant women, results in either a premature birth or a stillbirth. Surviving infants usually have low (sometimes very low) birth-

weights, and low birthweight itself increases risk for a variety of problems. Cocaine-exposed underweight newborns have been documented to be at greater risk for stroke and respiratory ailments, and at much greater risk for sudden infant death syndrome (SIDS or crib death). Research studies are being conducted to confirm anecdotal and preliminary studies that indicate higher rates of retarded emotional, motor, and cognitive development, including ATTENTION DEFICIT DISORDERS, among such children entering school.

Heroin. Paradoxically, the negative direct physiological consequences to the user that are attributable to heroin itself are less than from the use of tobacco, alcohol, cocaine, or many prescription drugs. This does not mean that heroin is a drug whose use is without negative consequences, however. Heroin is highly addictive, and once its central nervous system depressive effects wear off, (typically in 4 to 6 hours), users tend compulsively to seek sources and means for another ''hit.'' This often leads to socially unproductive, self-neglectful lifestyles, not uncommonly involved with income-producing crime committed to maintain the addiction. Fetuses exposed to heroin from their mothers' use during pregnancy suffer many of the same negative effects as those exposed to cocaine.

In addition, heroin users frequently experience negative reactions and overdoses because of TOLERANCE effects, since the drug purity and type of filler may vary widely among dealers. Often, they are unknown with certainty by the user. However, the greatest threat to current heroin users' health and lives undoubtedly stems from the risks of hepatitis and HIV infection from sharing contaminated hypodermic syringes and needles. Their risks of infection with HIV and other diseases through sexual activity are elevated in ways similar to those described for cocaine users. The risks of fetal HIV infection among pregnant heroin-using women is also increased because of their own needle use and the likelihood that they have had at least one intravenous-drug-using sexual partner.

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