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7.  The Truth about Amphetamines, LSD, Ecstasy and the rest

Amphetamines and drug addiction - Pattern of use - Paranoia and other problems - Other effects - Tranquilizers and Barbiturates - Barbiturates and Benzodiazepine - Tranquilisers - Temazepam - Rohypnol - Ketamine - Steroids - Long term use - Poppers - Solvents - Hallucinogens : LSD, acid, microdots and ecstasy - Why people die from Ecstasy use - Special issues - Magic Mushrooms - Designer drugs of the future

The Truth about Drugs - book on drug addiction by Dr Patrick Dixon - published by Hodder 1998 Chapters: Acknowledgements - Definitions - Introduction - 1.The Size of the Drugs Problem - 2.The True Cost of Drug Addiction - 3.Addicted to Pleasure - 4.Caffeine, Alcohol and Tobacco - 5.Cannabis - 6. Cocaine addiction, Crack addiction and Heroin addiction - 7.Amphet amines, LSD, Ecstasy and the Rest - 8.Why Governments are Scared of Prevention - 9.Treatment of drug addiction works - 10.Legislation and Decriminalization; The Arguments over Marijuana - 11.Conclusions; What We Must Do - Appendices

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Amphetamines     (Return to Index)

Terms: Wizz, speed, sulph, billy, crystal, crank

Amphetamines are widely abused, addictive drugs. They are usually sniffed as powder or injected.The effects begin with a very intense "rush" and last around four to six hours.They make people hyper-alert and lively, hence the label "speed".In the short term they help concentration, but leave the user exhausted, typically staying awake for up to a day.During this time most users can neither eat nor sleep.Heart rate rises and pupils dilate, sweating increases with body tremors, dry mouth and lips, itchy nose and dizziness. High doses over a short period can cause delirium, panic, hallucinations and paranoia.

In the longer term, appetite falls and users become very anxious, jumpy and paranoid. Rebound depression, lethargy and intense hunger follows withdrawal.Amphetamines postpone the need for rest and food, replacing neither.

Amphetamines can be prescribed for medical purposes but are illegal to sell or give away. Amphetamine sulphate powder is the second most common illegally used drug in Britain after Marijuana.The drug is usually sniffed but may be swallowed with a drink.The usual dose for a beginner is less than half a gram but heavy users may need up to eight grams a day.For many users, injecting is the preferable route of consumption.

In one large survey, 10% of 15 - 29 year olds in Britain claimed that they had tried the drug at least once. A similar proportion of those asking for help with drugs problems said that amphetamine was the main drug they used.Over half this group were injectors, the highest percentage after heroin.

Those who like speed often use cycles of uppers (amphetamines) and downers (barbiturates or other depressants) to help them have a good day and then a good night.Tolerance develops rapidly.

One of the biggest problems doctors face among those using speed is paranoia.I have seen many people who have become acutely suspicious of those around them as a result of ampetamine abuse. "The milkman is poisoning my milk" or "My neighbour is a member of the MI5 secret intelligence services and is informing on me".Since paranoia is a well-recognised psychiatric condition it can be easy to miss the real cause.In serious cases, amphetamine users land up in hospital because of this, but the symptoms soon settle if the person is weaned off.

The trouble is that paranoia and other drugs affecting the brain, including alcohol, can be a heady mix.The result can be fights, attempted murders or worse as people respond to what they are convinced is the truth about those around them.The strains on neighbours and friends can be immense.

Judith is a warm, friendly and out-going person - in her right mind.With two daughters she lives in Birmingham in a new terrace of council housing.The trouble is that her neighbours get on with her when she is herself, but are terrified when she is taking drugs.She is unpredictable and can be extremely violent if she thinks someone is against her. On several occasions she has threatened one woman with an axe, ("I'll kill you"), but it's a close community, and police have limited powers - and anyway what would happen to the children if they took her away?Worst of all, no one dares inform on her in case someone gets butchered.

Amphetamines strain the heart and blood vessels, an added risk when linked with extreme exercise as in a club goer. Women can find amphetamines interfere with their menstrual cycle, and make contraceptive pills less effective.

Terms:Tranx, temazies, barbs, Valium, temazepam, jellies and sekkies

Tranquillisers and barbiturates are sedative and hypnotic, helping sleep and reducing anxiety.Many drugs are sedative at low doses and hypnotic at high doses.

Barbiturates are widely misused and therefore prescribed less now. Pills are swallowed, often with alcohol although they are sometimes injected after crushing and mixing the pills in water.This often leaves very small undissolved particles which can damage veins.

Barbiturates depress the nervous system and last three to eight hours.A small dose makes someone relaxed as if they have had one or two drinks.Sedation occurs at larger doses, with slurred speech, lack of co-ordination, and sometimes confusion.

After several pills the user becomes clumsy and at risk of injury.There can be extreme and unpredictable emotional reactions. Barbiturates are very dangerous in overdose, with loss of consciousness and death from arrest of breathing.The amount needed to kill is not much higher than the therapeutic dose, so death from a deliberate overdose is a constant danger, increased if alcohol is used at the same time.

Psychological and physical dependence occurs.Withdrawal causes irritability, nervousness, lack of sleep, faintness, nausea, twitching and fits.Sudden, complete withdrawal can kill.Heavy users are more susceptible to bronchitis and pneumonia, through suppression of coughing and also to hypothermia. All these risks are far greater in those who inject.

Tranquilisers are also used to relieve anxiety and help sleep.Benzodiazepines are the commonest, e.g. temazepam and Valium.They are the most commonly prescribed drugs in Britain with one in seven adults taking them every year and 10% on a regular basis.66% of regular users are women and many are addicted.

Unfortunately medical mistakes have led to a generation of "therapeutic addicts" - people who are semi-permanently dependent on their usual medication just to get through life.A significant element of psychiatric consultations has been trying to wean such people off and onto less addictive substances.

When abused, these drugs are usually swallowed but temazepam is often injected. Temazepam is a short-acting benzodiazepine, used medically as a sleeping tablet.The effects are similar to alcohol with drowsiness, but also increased talkativeness, over-excitement and even aggression.Judgement is affected, with over-confidence and sometimes feelings of invincibility.

Temazepam withdrawal causes lack of sleep, panic attacks, loss of appetite, nausea, tremors and sometimes hallucinations.Sudden withdrawal from high doses can induce fits and is dangerous.Overdosing is more frequent in combination with other depressants such as heroin, alcohol or Valium.

Injectable temazepam has become a popular drug in Scotland and elsewhere.Production of the gel-form capsules has been illegal since 1995 because of the injuries caused.It became an illegal drug in any form for non-medical use in 1996.

Injecting temazepam can cause serious problems.For example, the gel inside the capsules can resolidify causing blockage of veins or arteries.If the person injects into an artery by mistake the result can be thrombosis with gangrene of a hand, leg or foot.

Fatal doses of benzodiazepines alone are almost unknown, unless combined with alcohol.Tolerance and withdrawal occur even at medically prescribed doses.Withdrawal effects last a long time: inability to sleep, anxiety, nausea, mental confusion and after high doses even fits.Psychological dependence is very common.

Terms: roofies, roche and "Quaalude of the 90s"

Rohypnol is prescribed in 64 countries for insomnia and as a preoperative anaesthetic, and is ten times as potent as valium.It is popular in clubs and at parties for giving a drunken-like high.However the serious problem is with rapists who spike the drinks of victims.The drug leaves the person helpless, and with little or no memory after the attack.To combat the problem, the manufacturer, Hoffman-La Roche has recently added a strong dye to the drug so that attempts to hide it in drinks are more obvious. Rohypno abuse is a rapidly growing problem: in 1990 there were just five seizures of 207 tablets in the US, but the figures were 81 of 140,000 pills by 1995.

Other drugs are commonly used by rapists - for example alcohol, Marijuana and cocaine.

Terms: K, special K, KitKat

Ketamine is a powerful anaesthetic used mainly by vets on farm animals.The liquid or white powder costs $10 and is snorted or swallowed as a powder or swallowed or injected as a liquid.It can also be injected - usually into muscle.

Ketamine makes the person feel disconnected from the body, and can cause hallucinations.Because it kills pain, the user may hurt himself without realising.In large doses the heart rate falls.Ketamine can cause loss of consciousness, vomiting and death. Tolerance is common but there are few studies of dependence.

Steroid use today is far commoner than most people realise.For example the Drug Dependants Anonymous centre in Nottingham found recently that over half their drug injectors were using steroids.These drugs can cause wild mood swings, including manic-like symptoms and withdrawal often leads to depression.Users may develop paranoid jealousy, extreme irritability, delusions and impaired judgement with feelings of invincibility.

2% of American high school seniors have tried using anabolic steroids at least once, 1.4% in the last year, and almost 1% in the last month.

Anabolic steroids are widely abused by those training in competitive sport, despite strict bans and drug testing. One problem is that steroids are eliminated from the body long before the body-building effects wear off, so that athletes are able to train hard with drugs and then continue to train without them in the weeks up to a major event. Since 1996 the supply but not the possession of these drugs has been made a Class C offence.

Steroids are swallowed as pills or capsules or injected. Anabolic or androgenic steroids are almost identical to naturally occurring testosterone in the human body, with a wide range of properties including the encouragement of muscle formation and increased aggression, encouraging athletes to train hard.

They are very widely abused in the body-building world.Bodybuilders tend to use them in cycles of 4 to 12 weeks with rest periods. Steroids as drugs have been around since the 1940s but took off in the 60s and 70s, followed by a backlash in the 1980s when many athletes who abused steroids were stripped of titles.

Steroids cause many long term problems. They have androgenic-like effects,causing acne, so that female users develop smaller breasts and deep voices and have disrupted menstrual cycles, with an enlarged clitoris.Men may suffer from impotence, shrunken testicles, swollen breats and low sperm counts, due to the testicles shutting down their own testosterone production.Users may become bloated from water retention and suffer hair loss.

These effects take days or weeks to develop. Androgenic body changes can be semi-permanent and steroids can stunt adolescent growth. Long term use can cause liver, heart and kidney damage.Liver damage can be less if steroids are injected as oral doses pass straight to the liver after absorption. Heart damage is due to blocking of arteries and increased blood pressure. There are also all the usual risks from injecting, such as septicaemia and hepatitis.

This particular epidemic will never be controlled in major competitive sport until better testing regimes are introduced.Even that will not prevent mass-market adoption of steroids by teenagers and young adults keen to build up their physique, to look good.

Terms: poppers

Sniffing nitrites makes the user light headed, with a feeling of blood rushing to the head, a flush of heat and increased sensual awareness. The effects are extremely short, perhaps one to two minutes.Some users get a headaches afterwards, or feel sick or dizzy, or coughing.No sudden deaths have been reported.Tolerance occurs but there is no evidence of physical addiction.

Poppers have been particularly popular among the gay community because they cause relaxation of smooth muscle, helpful before attempting anal intercourse.

A huge number of commonly available carbon-based products can produce a high when inhaled.A report recently described a youth club which had identified and locked away over 100 "sniffable" items on the premises - only to find members sniffing other products the youth leaders were unaware of.Aerosols, adhesives, butane gas from cigarette lighters, paints, polishes, varnishes, fire extinguishers, dry cleaning fluids, petrol, cigarette lighter gas - the list goes on.

Some sniffers use a plastic bag placed over the head, which can easily cause death by suffocation as the vapour displaces normal air. This state of "drunkenness" usually lasts about half an hour. In the short term an overdose can cause loss of consciousness, and death through vomiting.The fumes replace oxygen in the lungs and can cause suffocation and heart failure.They are also toxic to the liver in the longer term, as well as to the kidneys and brain.

Solvents are rapidly absorbed through the lungs and reach the brain in seconds.Breathing and heart rate slow. In small doses the user feels drunk-like.In larger does there may be hallucinations, disorientation, loss of control and loss of consciousness. Most users recover rapidly, leaving a mild hangover, with headache, poor concentraion ad nausea, lasting perhaps a day.Heavy solvent use over years can cause brain damage.Aerosols and cleaning fluid abuse can cause liver and kidney damage. Tolerance can develop, but physical dependence is rare. Psychological dependence is also very unusual.

Sudden death usually happens through choking on vomit or suffocation.Some solvents directly damage the heart causing heart failure.Gases squirted directly into the back of the throat can cause severe cold damage and suffocation.

Hallucinogens have been know since ancient times but became prominent in the 1960s. The commonest hallucinogens are PCP (angel dust), LSD, mescaline, peyote and psilocybin (mushrooms).PCP is phencyclidine.

Terms:acid, trips

LSD is a chemical derived from a parasitic fungus: d-lysergic acid diethylamine. It is usually sold as stamps or blotters, in squares a quarter the size of a postage stamp, made by wetting the paper with alcohol containing a solution of LSD. The paper is usually covered with a printed design, for example "star wave", "om", "white dove" and "strawberry". Effects vary according to the situation and mood.They also vary according to dose which is difficult to regulate accurately because such tiny amounts are needed to induce a trip.

About an hour after taking LSD the user begins to feel a change, perhaps becoming giggly or anxious. Perception is distorted in this trip inside the mind, so that sense of time, colour, taste or sound is changed. You can see sounds and taste colours. A million years becomes a moment. The world can look and feel very strange.There is a sense of depersonalisation.Self-awareness alters, and the user may have mystical or ecstatic experiences. Hallucinations are very common.

The effects last up to twelve hours, and are greatly shaped by what else is going on around the person.LSD exaggerates whatever the person might normally be feeling - for example insecurity, fear, loneliness or comfort and safety.In the short term, normal mental processes are impossible and reactions are slowed. Crossing the road, driving, swimming or other activities can be dangerous. Accidents are common, including drowning, burns, falls, car crashes and other tragedies.

A "bad trip" can be very upsetting with reactions lasting days.Users may feel depressed, disorientated and anxious. LSD can trigger acute mental illness.Flashbacks can also occur years later, with a return of the altered mental state in the absence of the drug. Tolerance develops but not physical dependency.With larger doses there is a risk of convulsions, coma, heart failure and death (110 deaths from LSD in the US in 1991). Another cause of death is accidents as a result of users misunderstanding what is going on - climbing out of a window to fly or "swimming" across a busy road for example.

LSD fell out of fashion from 1970 to the early 1990s. However interest in LSD is growing again as part of the rave scene and as part of the quest for self-enlightenment in new age consciousness. National surveys suggest that 10 - 15% of 15 - 16 year olds have tried the drug

Terms:E, MDMA, MDA, MDEA, pills, X,and a wide variety of other terms depending on the appearance of the tablets or capsules (doves, birds etc)

Methylene-dioxymethamphetamine (MDMA) is just one of a large family of phenethylamines including MDA, MDEA and MDBD, all of which are abused.They lie halfway between LSD and amphetamines. However much that passes for Ecstasy is not.Fake ecstasy is widely sold as a mixture of drugs such as ketamine, caffeine and ephedrine.In fact only one on four of Ecstasy tablets tested in one survey contained any MDMA. Ecstasy is available under more than 100 brand names including "Dennis the Menace", "Doves" and "Apples".They change with great rapidity.

Ecstasy use by tens of thousands of young people as part of the club / rave scene may have helped acceptability of other drugs such as Marijuana, LSD and amphetamines as well as newer drugs such as ketamine, GHB and amyl nitrite.

Ecstasy is expensive: - £7 - 20 a time compared to £2.50 for LSD or £1.80 for a pint of beer.It is swallowed as a pill or capsule. In small doses the effect is not unlike LSD, but in higher doses more like amphetamine.

In the short term, users lose inhibitions, feel euphoria, and are struck by an initial rush of energy, "butterflies" in the stomach and tingling, followed by a warm euphoric glow with increased empathy towards others. Users feel "in tune" with people around them and with what is going on.Early effects include sweating, with dry mouth and throat, dilated pupils and raised blood pressure. Later on sweating may fall. However effects may be greatly altered by the combination of other drugs in the capsule - for example ketamine.

Effects peak in two hours and last around three to four.In the longer term, ecstasy may cause panic and confusion, anxiety and depression or paranoia, and there is some evidence that the liver may be damaged.It is hard to tell what is caused by Ecstasy and what is caused by additives which vary, however "E" itself can inhibit orgasm and prevent erection in some men.

A small number of people have negative experiences and flashbacks can occur.Psychological addiction can develop.Tolerance builds up very quickly with higher doses needed for the same effect.

Since 1988 there have been around 70 reported deaths in the UK associated with the use of Ecstasy in the rave and club scene.These deaths have not been caused by toxic effects, but from three other factors: heat-stroke, fluid overload and heart failure.

Most deaths have been from heat-stroke.The drug induces hyperactivity so the user dances to the point of exhaustion without feeling tired, generating huge amounts of body heat in an atmosphere which may be very hot and humid, reducing the effectiveness of sweating as a cooling mechanism.Body temperature can rise above 40 degrees centigrade, resulting in convulsions, dilated pupils, a collapse in blood pressure and rapid heart rate.The drug triggers massive clotting reactions (disseminated intravascular coagulation) blocking blood vessels to vital organs and the person dies.

Every self-respecting club in Britain has now introduced air conditioning, which is often set to very low levels, to help prevent overheating.In addition dancers have been encouraged by massive publicity to wear loose clothes, "chill out" regularly and drink plenty.However, at least three people have died from severe metabolic disturbances caused by drinking litres of water, far more than the recommended half a litre an hour.

Over-drinking of water or other non-alcoholic beverages causes body fluids to become less salty.Water finds its way inside every cell, causing severe disturbances of normal cell activity. Ecstasy appears to make matters worse by telling the kidneys to stop making urine.Early symptoms of water poisoning include dizziness and disorientation before collapse and coma as the brain begins to swell.

Ecstasy is a stimulant and causes the heart rate to rise as well as the blood pressure.This can push an undiagnosed heart condition to the limits, resulting in a sudden but rare death.Deaths have occurred after between one and five tablets.

The big issue with Ecstasy is whether to classify it as a relatively safe or dangerous drug.The truth is that the number of serious problems from Ecstasy use are very small considering the number of people taking it every week.While tragic deaths have occurred, they are far less significant in numbers terms than - say - deaths in which alcohol is involved including drink-driving.

UK deaths per year

·     Tobacco 0.9%

·     Alcohol 0.5%

·     Ecstasy 0.002%

As the Economist recently remarked, "flying in a civil airliner is 1.5 times as dangerous as dropping an "E"."And most of those deaths are avoidable in users who are well educated about how to behave when taking it. However, as soon as someone says the drug is relatively safe, the message becomes whiter than white, giving the impression that the drug has an (almost) clean bill of health.

Unfortunately, one of the greatest hazards of Ecstasy is that, as with Marijuana, it gets a young generation used to the idea of breaking the law to buy and use an illegal drug, which makes them feel good and caused very little harm.As with Marijuana, it lowers the threshold for further experimentation.It is also still far too early to be sure about the longer term side effects.

Terms: shrooms, liberty caps, fly-agaric

Hallucinogenic mushrooms have been used for thousands of years.They can be eaten cooked, heated with water or in added to tea, soup or some other dish just like any other ingredient.The usual "dose" is around 25-50 small mushrooms. Effects begin after 10-40 minutes and lasts six to twelve, with some disorientation the following day.The user can feel relaxed or "stoned" as with Marijuana, or may experience hallucinations. Physical effects are few apart from increase in blood pressure.

The commonest psychodelic mushroom in Britain is the psilocybe semilanceata. These mushrooms grow wild on well manured grassland and are often found on the grassy edges of bridal paths.They are also found in woods. They are gathered in the Autumn. However mistakes can be made in picking poisonous mushrooms and the psilocybin content can vary. Other mushrooms can be extremely toxic and mushroom poisoning can be a terrible way to die.Often the person is unwell and then recovers temporarily only to be rushed to hospital a couple of days later.

As with other drugs, mushrooms can amplify how you are feeling - up or down.

There are already growing numbers of so-called designer drugs, produced in laboratories, similar to other compounds.An example is the synthetic opiate fentanyl which is 80 - 100 times a powerful as heroin.Fentanyl acts very fast (one to four minutes and last 30-90 minutes.Another synthetic opiate is meperidine.There are also dozens of synthetic amphetamines.

We will see hundreds of new designer drugs in the next millennium acting not only on the brain but also on other parts of the body, for example to prolong sexual prowess and pleasure, or to block the symptoms of a hangover or to enhance memory and intelligence.Expect big controversy over memory enhancing substances, and their use in preparing students for exams, and a huge black-market in prescription-only sex-drive enhancers.

All designer drugs will work by targeting known pleasure mechanisms in the brain, looking to maximise pleasure and minimise side effects.Of course, the drug company and illegal drug manufacturer have very different aims.For example their attitude to addiction may be very different.Highly addictive properties may kill the health sector market but create a large illicit one.

So then, a very wide range of substances are being abused with new kinds of drugs becoming available.Each has its own characteristics and cultural associations.While users tend to have their favourites, in practice many will take whatever s available.Hence there is often a mixed picture.

Having looked at the extent of addiction and abuse, the costs to society, the nature of addictive behaviour and at particular drugs, we now need to look at solutions.Prevention is better than cure, but why are governments so sacred of prevention?

Amphetamines - Pattern of use - Paranoia and other problems - Other effects - Tranquilizers and Barbiturates - Barbiturates and Benzodiazepine - Tranquilisers - Temazepam - Rohypnol - Ketamine - Steroids - Long term use - Poppers - Solvents - Hallucinogens : LSD, acid, microdots and ecstasy - Why people die from Ecstasy use - Special issues - Magic Mushrooms - Designer drugs of the future

Chapters: Acknowledgements - Definitions - Introduction - 1.The Size of the Drugs Problem - 2.The True Cost of Addiction - 3.Addicted to Pleasure - 4.Caffeine, Alcohol and Tobacco - 5.Cannabis - 6. Cocaine, Crack and Heroin - 7.Amphet amines, LSD, Ecstasy and the Rest - 8.Why Governments are Scared of Prevention - 9.Treatment Works - 10.Legislation and Decriminalization; The Arguments over Marijuana - 11.Conclusions; What We Must Do - Appendices

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