DRUG TYPES

Stimulants

Stimulants are drugs that stimulate the Central Nervous System. These substances tend to increase alertness and physical activity. They include Amphetamines, Cocaine, Crack and some inhalants like Amyl or Butyl Nitrites. Caffeine (present in tea, coffee and many soft drinks) is also a mild stimulant drug.

Which stimulants are abused?

The most widely abused stimulants are cocaine, crack (a pure form of cocaine) and amphetamines. Cocaine has limited commercial use and its sale and possession are strictly controlled. Nevertheless there is a huge worldwide illicit network for the manufacture and supply of this drug in its various forms. Doctors sometimes prescribe pharmaceutical amphetamines and their availability makes them candidates for misuse but powdered amphetamine, manufactured in illicit laboratories, is the most common type of amphetamine to be abused in the UK. Inhalants such as amyl and butyl nitrates are legal at present. Because of their very short action time - the effect lasts approximately 1-2 minutes - they are usually only abused in certain settings, such as parties etc.

What do they look like?

Stimulants appear in many forms. Pharmaceutical amphetamines are usually produced as pills or capsules, whereas street amphetamines come in the form of a fine, white dull powder. Inhalants can be prescribed or purchased in small glass vials which are crushed to release the vaporising fluid inside, or in small bottles. Cocaine is a relatively fine, white crystalline powder. Crack is seen as cloudy white crystals that are irregular and fairly large (pea-sized).

What are the effects of stimulants?

Different stimulants act on the body in different ways. For example, nitrate inhalants cause the blood vessels to dilate (widen); cocaine and crack interfere with normal levels of the neurotransmitter serotin; amphetamines cause the release of adrenalin. Nevertheless, broadly speaking all these stimulants have a similar effect in that they cause either mental and/or physical stimulation in the user. This may be felt as apparent increased physical energy and/or apparent clarity and speed of thought.

A note on caffeine Caffeine is a mild stimulant that has the effect of making a person feel more awake and alert. Tea, coffee and soft drinks are the three major sources of caffeine, although it can also be purchased in tablet form. Each cup of coffee can provide approximately between 65mg to 115mg of caffeine, a cup of tea usually has about 60mg of caffeine in it and a soft drink contains between 30mg and 60mg of caffeine. Too much caffeine can cause anxiousness, headaches, the 'jitters' and may prevent sleep. Caffeine is also addictive and a person who abruptly stops drinking coffee may experience withdrawal symptoms.

Depressants

These are substances that slow down or depress the Central Nervous System. Depressant drugs include alcohol, barbiturates and tranquillisers. It's worth remembering that, although alcohol is a legal drug and can be purchased by any person over 18 years old, it can be a dangerous drug, particularly when abused.

Barbiturates and benzodiazepines are the two major categories of depressant drugs used as medicines. Often these drugs are referred to as sleeping pills and tranquillisers or sometimes just as sedatives. Some well-known barbiturates are secobarbital (Seconal) and pentobarbital (Nembutal). Benzodiazepines commonly in use are Diazepam (Valium), chlordiazepoxide (Librium) Nitrazepam (Mogodon) and Temazepam.

Which depressants are abused?

Alcohol is by far the most commonly abused drug in the UK. Abuse generally takes the form of under-age drinking, drinking in inappropriate situations, or drinking in excess. Its easy availablity and social acceptability may have enhanced this state of affairs. Although it is often perceived as a pleasant social drug (and for some drinkers this is the case), many people become either psychologically or physically dependent upon it.

Alcohol abuse is directly or indirectly responsible for many deaths through drunken driving, accidents and illness. It is also a major contributing factor in most incidents of domestic and other violence.

Barbiturates used to be common drugs of abuse in the 1950's and 1960's but because of their addictive properties and association with suicides and accidental deaths, their use as medicines has been reduced significantly since the 1970's. The illicit market in these drugs has become smaller because of their reduced availablity.

Unfortunately, benzodiazepines - which were originally developed to provide a safe alternative to barbiturates for the treatment of anxiety and insomnia - have now become a major category of abused drugs. Vallium, Librium and Temazepam are the most commonly abused tranquillisers and are often taken with alcohol as these two types of drug amplify each others effect.

What do they look like?

Depressants are usually manufactured as tablets or capsules, but some of these drugs are also available in liquid form. Alcohol is legally available in a multitude of forms.

What are the effects of depressants?

Their effects range from calming down anxious people to promoting sleep. Alcohol, tranquilizers and sleeping pills can have either effect, depending on how much is taken. At high doses or when they are abused, these type of drugs can cause unconsciousness and death.

Regular use of all depressants over a long period of time can result in tolerance, which means a person has to take larger and larger doses to get the same effects. This includes alcohol. When regular users stop using large doses of these drugs suddenly, they may develop physical withdrawal symptoms ranging from restlessness, insomnia and anxiety, to convulsions and death.

Analgesics

Analgesics are substances that provides relief from pain. Mild analgesics, such as the many brand-named preparations of aspirin or paracetemol, are relatively harmless. Analgesic drugs of abuse are far stronger than this and are all powerful pain killers. Some are refined from an extract obtained from opium poppies (Papaver somniferum) and are classed as "opiates" and some are produced by chemical synthesis.

Opiates include Opium itself, which is the resin obtained from the seed pod of the opium poppy, along with Morphine, Heroin and Codeine. These can all be produced from raw opium by fairly simple chemical processing. Synthetic analgesics are manufactured as powders, tablets or liquids. They include Methadone (usually as a syrup), Physeptone (a methadone tablet), Pethidine, Diconal and Palfium.

Which analgesics are abused?

Analgesics - particularly opiates - have a high potential for abuse. Heroin is the most widely abused opiate analgesic but morphine, paregoric (which contains opium) and cough syrups that contain codeine are also abused.

Many synthetic opiates are abused, usually by heroin users as an alternative to that drug. Methadone - prescribed as an alternative to heroin - has been much abused in recent years and is responsible for many deaths in the UK.

Diconal, Physeptone, Pethidine and palfium tablets are usually crushed up and injected by drug abusers. These tablets contain solids such as chalk, which can block veins when injected and lead to gangrene or a stroke. What do they look like?

Opium is a dark brown slightly sticky resin with the consistency of stiff putty and is usually smoked or eaten. Heroin is a white or brownish powder which is usually dissolved in water and then injected, although it can be smoked. Most street preparations of heroin are diluted, or 'cut' with other substances such as lactose or quinine.

Other analgesics, including all synthetics, come in a variety of forms including capsules, tablets, syrups, solutions and suppositories.

What are the effects of analgesics?

Opiate and synthetic analgesics tend to relax the user. When they are injected, the user feels an immediate 'rush' - that is a strong wave of pleasurable relaxation and relief from anxiety. Unpleasant effects may include restlessness, nausea, and vomiting. The user may go 'on the nod' - going back and forth from feeling alert to drowsy. With large doses, the user cannot be awakened and the skin becomes cold, moist and bluish in color. Breathing slows down and death may occur.

Where analgesics are taken as a syrup, tablets or capsules etc. the effects are similar to that after injection but are milder and without any immediate 'rush'.

Hallucinogens

Hallucinogens - or psychedelics - are drugs that affect a person's perception of sights, sounds, touch, smell etc. Some of the stronger hallucenogenics can exert a powerful effect on a drug users thinking and self-awareness.

A few hallucinogens come from natural sources, such as mescaline from the peyote cactus and psilocybin, which is the hallucinogenic agent in so-called magic mushrooms. Others, such as LSD, MDA (methylenedioxyamphetamine) and Ecstasy (methylenedioxymethamphetamine - or MDMA) are either entirely synthetic or semi-synthetic. For example, LSD is derived from a fungus that grows on rye grains but requires very substantial chemical processing to produce.

Which hallucinogens are abused?

Hallucinogens do not have any legal medicinal uses and are therefore all classed as drugs of abuse. The most commonly seen are LSD, Ecstasy and psilocybin (magic mushrooms). Other hallucinogenic substances such as mescaline and DMT are not widely available in the illicit drug market of the UK.

What do they look like?

Some of the naturally occuring hallucinogenic materials are most commonly seen either in their natural state or after minimal processing, such as drying. This includes all varieties of hallucinogenic fungi.

Where natural materials have been refined to a large degree, such as in the production of mescaline, the end product can take a variety of forms, including liquid, tablet or capsule.

Synthetic or semi-synthetic hallucinogens are produced as tablets, capsules or liquids (dropped on blotting paper, sugar cubes or gelatine sheets). When produced in tablet form, LSD - and particularly Ecstasy - are often manufactured with a coloured or impressed logo upon them. This can take the form of a cartoon character etc. - the better to appeal to young people. What are the effects of hallucinogens? The effects of hallucinogens vary a great deal according to their strength. Psilocybin for example is a relatively mild hallucinogen and its effects are usually confined to relaxation, a sense of well-being and mild visual distortion of colour and distance. LSD, in contrast, is far more potent (about 100 times stronger) and its effects can include very vivid visual and audible hallucinations - almost literally an out of body experience - combined with distortion of time, distance and personal integrity. This can be terrifying, as a user will be unable to control his or her thought processes and any unpleasant aspects of the 'trip' can lead to intense fear, anxiety and even psychosis. Hallucinogens such as MDA or MDMA (Ecstasy) are midway between these two extremes in terms of potency. Some distortion of vision and perception may occur but not in the intense and uncontrollable manner as can happen with LSD.

Alcohol

What is it?

Alcohol is the common name for ethyl alcohol. It's a Central Nervous System depressant and is one of the most widely used (and abused) drugs in our society. It's produced by the fermentation of fruits, vegetables or grains by yeasts which converts the carbohydrates (sugars) of these plants to ethyl alcohol. Alcoholic drinks consist mainly of various strength mixtures of water and ethyl alcohol.

Medicinal uses

Alcohol is sometimes used as an external local anaesthetic and sterilising agent.

How does it work?

Alcohol depresses parts of the central nervous system - it slows down some of our brain functions. Various parts of the central nervous system are depressed by alcohol, with all sorts of consequences. For example, when the brain's speech centres are inhibited, this causes slurred speech; when the vision centres are affected this produces distorted vision; when the co-ordination centres are depressed this results in loss of balance and limb control.

The strong depressant effect of alcohol lasts for a few hours after drinking, but alcohol also produces a weaker agitation (or irritation) of the nervous system that lasts much longer. This is the cause of the "morning after" hangover and shakiness. It's due to the irritation of the nervous system by alcohol drunk many hours before.

This effect often leads heavy evening drinkers to drink again the next morning, as the (very uncomfortable) agitation can be temporarily overcome by drinking more alcohol. Thus, a vicious circle is set in motion, which can play a large part in alcoholic drinking patterns.

What effect does it have? The impact of drinking alcohol depends on the state of the brain at the time, and this in turn depends on the drinking environment. In a quiet environment (little brain activity), perhaps at home in an armchair, an alcohol user will experience relaxation or drowsiness at low to moderate doses.

In a social setting, with lots of sights, sounds and social interaction (lots of brain activity) low doses of alcohol may feel stimulating. This is caused by depression of the higher brain centres, which produces apparent stimulation by reducing anxiety and self-consciousness. A drinker may become more talkative than normal and demonstrate increased self-confidence and loss of self-restraint. So alcohol can feel like a stimulant - but it's not - these effects are a result of the inhibition of normal brain activity.

As the alcohol dose is increased, significant depression of brain activity can result in slurred speech, loss of limb co-ordination and loss of emotional control. High doses of alcohol can inhibit vital brain functions - this can produce deep sedation and slow down the breathing rate, which can result in coma or death.

Alcohol intake is measured in units. One unit is is roughly equal to half a pint of normal strength beer/lager/cider, a glass of wine or a pub measure of spirits. The list below shows the effect of drinking various amounts of alcohol and also indicates blood alcohol concentration (as mg alcohol per 100ml blood), as this determines whether an offence is committed by driving a motor vehicle. The current UK alcohol limit for driving is 80mg/100ml.

It's important to remember that the concentration of alcohol in the blood and its effects depend on a number of factors including body weight, type of drink, drinking environment, previous exposure to alcohol, stomach contents and sex of the drinker.

Alcohol has its strongest effect on women. This is because women's generally lower body weight means (for equal amounts drunk) they take in more alcohol per pound weight and also, as the female body contains less blood volume, the same amount drunk will produce a higher blood alcohol concentration in a woman than in a man.

After 1 to 2 units (0.5 to 1 pint of beer - or 20-50mg/100ml) there is not much effect, beside a slight intensification of mood.

After 3 to 4 units (1.5 to 2 pints of beer - or 50-80mg/100ml) there is usually a feeling of relaxation and mild sedation. There may be a slight impairment of steady movement. This is the legal limit for driving a vehicle, and in fact 4 units of alcohol could put some people over the 80 mg/100ml legal blood alcohol limit.

After 5 to 6 units (2.5 to 3 pints of beer - or 80-100mg/100ml) there is usually some loss of physical and mental co-ordination. Judgement and memory may be affected, particularly the ability to concentrate.

After 7 to 8 units (3.5 to 4 pints of beer - or 120-200mg/100ml) most people slur their speech and are likely to have some difficulty in standing or walking. This level of intoxication can result in irresponsible behaviour and euphoria.

After drinking 15 to 20 units (7 to 10 pints of beer - or 200-300mg/100ml) most people will have passed out.

Consequences of alcohol abuse

Most people will have some experience with alcohol. Many will experiment and stop, or continue to drink casually without significant adverse effects. Some people will use alcohol regularly, with varying degrees of physical, emotional and social problems. Some will develop a dependency and be destructive to themselves and others for many years. Some will die - and some will cause others to die.

As there is no certain way to predict which alcohol drinkers will develop serious problems, all alcohol use must be considered as potentially dangerous.

Alcohol Dependence

Alcohol drinkers may develop a physical or psychological dependence on alcohol. This can cause great harm to the drinker, in terms of physical and mental health, financial problems, employment difficulties etc. In addition, alcohol dependence is likely to cause great distress to partners, children or other family members, who may be directly or indirectly exposed to the consequences arising from compulsive alcohol consumption.

Physical dependence is often related to consistently heavy drinking. People who drink on a regular basis become tolerant to many of the unpleasant effects of alcohol and are able to drink more before suffering these effects. Many heavy drinkers may not appear to be drunk. Because they continue to work and socialize reasonably well, harm to their physical health can go unrecognised until severe damage develops - or until they are unable to drink for some reason and suddenly experience alcohol withdrawal symptoms. These symptoms range from jumpiness, sleeplessness, sweating, and poor appetite, to tremors (the "shakes"), convulsions, hallucinations and sometime death.

Deaths from suicide, accident and cirrhosis of the liver are very common among heavy drinkers. Psychological dependence upon alcohol may occur with regular use of even quite small daily amounts, such as a glass or two of sherry. It can also occur in people who drink alcohol only under certain conditions, such as before and during social occasions. This form of dependence results from a craving for alcohol's psychological effects, such as relief from anxiety, although the drinker may not consume amounts that produce serious intoxication. For psychologically dependent drinkers, lack of alcohol tends to make them anxious and prone to panic attacks.

Damage to health

The UK Government-recommended alcohol limits are presently 28 units per week for men (14 pints of beer) and 21 units per week for women (10.5 pints of beer). Sustained drinking in excess of this level increases the chance of damaging our health. This can take the form of liver disease, stomach ulcers, heart and circulation disorders - and in extreme cases brain damage.

25,000 people die in the UK each year from alcohol-related illnesses - this is 50 times the annual rate of death from all illicit drugs put together!

Family abuse

Excessive consumption of alcohol is commonly sited as a reason for difficulties within a family or within a marriage. These may range from drunken violence directed toward a spouse or children, to financial problems caused by compulsive purchase of alcohol or otherwise related to that.

It is difficult to over-emphasise just how much stress a person who abuses alcohol may cause within his or her immediate family. If a person continues to abuse alcohol over a period of time, his or her behaviour is likely to cause bitterness and resentment among relatives. While family members may love the alcohol abuser, they are likely to hate his or her behaviour. Eventually - the love dies.

Accidents

While a person is under the influence of alcohol he or she is far more likely to have an accident than while sober because alcohol adversely affects judgement and perception. Thirty percent of vehicle drivers killed in road accidents within the UK were found to have been drinking alcohol beforehand. Many of those who died in such a manner may well have caused the death or injury of other road users. What a waste.

Amphetamines

What are they?

Amphetamine, dextroamphetamine, and methamphetamine are collectively referred to as amphetamines. Their chemical properties and actions are very similar. These drugs stimulate the central nervous system - that is, they increase activity in the brain.

Medicinal uses

Amphetamine was first marketed in the 1930s as Benzedrine in an over-the-counter inhaler to treat nasal congestion. By 1937, amphetamine was available by prescription in tablet form. During World War II, amphetamine was widely used to keep soldiers alert and both dextroamphetamine (Dexedrine) and methamphetamine (Methedrine) became readily available.

Medical use of amphetamines was common in the 1950's and 1960's when they were widely used to combat mild depression and cause weight loss. However, due to their side effects and addictive properties they fell out of favour and the majority of brands were removed from the market. Doctors have now considerably reduced their prescription.

Used properly, amphetamines increase alertness and physical ability. They are prescribed to counter the effects of narcolepsy, a rare disorder marked by episodes of uncontrollable sleep, and to help children with attention deficit hyperactivity disorder.

Abuse of amphetamines

Prescription amphetamines (i.e. legally manufactured medicines) are sometimes stolen, acquired by obtaining false prescriptions forms or by conning a doctor into writing a prescription. These drugs then enter the black market in their tablet or capsule form. They have a number of slang names (often related to their appearance) such as 'black beauties', 'black bombers', 'black 'n whites', 'blues' etc. but are no longer common as a drug of abuse because of the reduced use of such medications in recent years.

The most widespread type of amphetamine on the street is a white powder called Amphetamine Sulphate. It's manufactured in illicit laboratories and then adulterated so the final product usually contains between 6% and 10% amphetamine. The other 90% can comprise of just about anything, from baking powder to laxatives. Amphetamine Sulphate costs between 5 and 10 pounds sterling a gram.

Amphetamine Sulphate can be swallowed, sniffed up the nose (snorted) or injected. Slang names include 'sulphate', 'wizz', 'speed', 'Billy Wiz' etc.

How do they work?

Amphetamines speed up the nervous system and cause adrenalin to be released. This increases the heart and respiration rates, increases blood pressure and decreases appetite.

In a sense, Amphetamines (by causing a release of adrenalin) mimic the "fight or flight response". This is a natural survival mechanism of man/womankind that operates in a dangerous situation - such as the approach of a hungry lion (or headmaster, police officer, tax inspector etc. - depending on your situation!). At such times the body will automatically go into 'fight or flight' mode. Adrenalin floods the system, this increases heart and respiration rates so that oxygenated blood can be rushed to the muscles. Mental alertness is increased. The digestive system shuts down to leave more blood for muscle use. The man or woman is now physically ready to fight the lion - or run like hell!

What effect do they have?

When injected, amphetamines take effect immediately. Swallowing or sniffing powdered amphetamines leads to onset of effects after 10-40mins. Prescription amphetamines may take effect after various lengths of time as some are designed as short-acting and some as time-release medicines. The effect of a single dose of amphetamines generally lasts about 3-6hrs, although that of pharmaceutical time-release capsules last for longer.

An amphetamine user may experience a temporary boost in self-confidence and feel far more energetic than usual.

It's common for users to talk a lot and they often display a lot of physical activity - repeatedly getting up, walking around etc. - hence the slang terms "speed" and "speeding" for the drug and its use. When under the influence of amphetamines, users find relaxation difficult and sleep impossible. They will have little or no appetite, although amphetamines simply postpone the need for rest and food, they do not replace it.

Side effects

As amphetamine users tend not to eat or sleep and burn off a lot of energy by physical activity, the body becomes exhausted - both physically and mentally - after a long period of amphetamine use. As a result users often feel fatigued and depressed for a few days after using amphetamines and may also feel irritable, anxious and restless.

Other side effects include blurred vision, sleeplessness, and dizziness.

Many women who use amphetamines find that their periods become irregular or even stop.

To maintain the desired effect, regular users have to take increasing doses. When they eventually stop they are likely to feel very depressed and lethargic. High doses, especially if frequently repeated, can produce delirium, panic attacks, hallucinations and feelings of paranoia.

Consequences of amphetamine abuse

Consequences for health

Amphetamines are psychologically addictive. Users often become dependent on the drug to avoid the depression experienced when the drug's effect wears off. This dependence can lead a user take larger doses of amphetamines - and more often - in order to maintain a "high". Of course, this can also lead to users taking other - more powerfull - drugs.

Regular amphetamine users who take high doses may develop delusions, hallucinations and feelings of paranoia. In addition, heavy amphetamine use can damage blood vessels and cause heart failure, especially among people with existing high blood pressure or heart trouble, or amongst those who over-exert themselves while using the drug.

Legal consequences

Amphetamines are Class B drugs under the Misuse of Drugs Act. It is illegal to produce, supply or possess them.

Barbiturates

What are they?

Barbiturates are central nervous system depressants. They act in a similar manner to alcohol and slow down many areas of the brain. Drugs of this class are known as sedative/hypnotics, in that they can be used as sedatives to calm people and also (at higher doses) as hypnotics to assist sleep.

Medicinal uses

Through the early 1900's barbiturates were prescribed widely for anxiety and insomnia and were also used in conjunction with amphetamines to treat depression. Prescription of barbiturates increased markedly in the late 1950's and 1960's, when up to 500,000 people in the UK were estimated to be taking them, with nearly one quarter of these patients dependent upon them. Their widespread availability resulted in many deaths through accidental overdose and they were a common agent for suicide.

Concern about the addiction potential of barbiturates and the ever-increasing numbers of fatalities associated with them led to the development of alternative medications. With the discovery of a 'safer' alternative - the benzodiazepines - (see Tranquillisers) the medicinal use of barbiturates for treating anxiety and insomnia has been greatly reduced since the 1970's. Nevertheless, phenobarbital is still widely used as an anti-convulsant to control Epilepsy and other barbiturates are occasionally used to treat depression.

Abuse of barbiturates

Unlike many other drugs of abuse, barbiturates are rarely produced in clandestine laboratories. Generally, legitimate pharmaceutical products are diverted to the illicit market through forged prescriptions etc., although many barbiturates are also illegally imported from foreign manufacturers.

Barbiturates are generally nicknamed "barbs" or "downers" by drug abusers - or called other names, often based on the colour of the capsule, such as "reds" or "yellows". Barbiturates that used to be very commonly abused included amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal). As they are not prescribed much these days, these drugs have only a limited presence in the illicit drug market, where they may be available as capsules and tablets or sometimes in a liquid form or suppositories.

Barbiturate sleeping pills are most often abused for their intoxicating effect. Abusers will usually swallow the drug, often with alcohol to increase the intoxicating effect. However, they are also sometimes injected by opening the capsules and dissolving the contents in water. Small particles of undissolved material used as 'bulk' within the capsules can block or damage veins.

How do they work?

Barbiturates work by enhancing the action of a brain neurotransmitter (a chemical messenger) that is in charge of inhibiting parts of the brain sometimes. For example, when we go to sleep, some areas of the brain are inhibited, as they are not needed. As barbiturates facilitates the activity of one of the main inhibiting neurotransmitters (Gamma ammino butyric acid - GABA), they have an impact on many aspects of the body including mood, locomotion, co-ordination and even breathing.

What effect do they have?

The effects of barbiturates are, in many ways, similar to the effects of alcohol. Small amounts produce calmness and relax muscles. This combination of sedation and reduced anxiety are features which made this type of drug popular as drugs of abuse.

Moderate doses will cause drowsiness, confusion, inability to concentrate, loss of co-ordination, tremors and slurred speech. These effects make it dangerous to drive a car or operate machinery as at these doses judgement is very seriously impaired.

Large doses of barbiturates produce depressed pulse rate, dilated pupils and shallow breathing. As vital life processes (such as heart and breathing rates) may be inhibited, such doses may easily cause unconsciousness and death.

Consequences of barbiturate abuse

Consequences for health

The use of barbiturates with other drugs that slow down the body, such as alcohol, multiplies their effects and greatly increases the risk of death. Overdose deaths can occur when barbiturates and alcohol are used together, either deliberately or accidentally.

Depending on the dose, frequency and duration of use, tolerance and/or physical and psychological dependence on barbiturates can develop very quickly.

As a user becomes tolerant to barbiturates, the margin of safety between an effective dose and a lethal dose becomes very narrow. So to obtain the same level of intoxication, a drug abuser who is tolerant to barbiturates may raise his or her dose to a level that can produce coma and death.

Dependence (or addiction) to barbiturates can occur within a very short time and long-term barbiturate users will require hospitalisation in order to safely undergo the withdrawal effects from such drugs.

Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a user takes one dose, becomes confused and unintentionally takes additional or larger doses. With barbiturates there is less difference between the amount that produces sleep and the amount that kills. Furthermore, barbiturate withdrawal can be more serious than heroin withdrawal.

Legal consequences

Barbiturates are Class B drugs under the Misuse of Drugs Act. It is illegal to produce, supply or possess them.

Cannabis

What is it?

Cannabis is a Central Nervous System depressant obtained from the plant Cannabis sativa, which grows in many parts of the world. It is available for use as a drug in three main forms: as the dried leaves and buds, known as grass or marijuana, as a solid resin (hashish or hash) which is collected from the buds and flower heads, and also as a thick liquid prepared from the flowers or resin (hash oil).

The main mind-altering (psychoactive) ingredient in cannabis is THC (delta-9-tetrahydrocannabinol), but more than 400 other chemicals are present in the plant.

Hashish is made by taking the resin from the leaves and flowers of the cannabis plant and pressing it into cakes or slabs. It is usually stronger than herbal cannabis and may contain five to ten times as much THC.

Cannabis resin found in the UK comes from a variety of sources. Slabs of hashish from India, Pakistan, Afghanistan and Nepal are usually dark brown or black and resinous, while traditional hashish from Morocco and Lebanon take the form of green/brown or red/brown slabs that are often dry and brittle. However, in recent years non-traditional forms of the drug have appeared, particularly from Morrocco, where it can now be found as a dark brown or black resin in smaller slabs than previously.

Hashish is often adulterated both within the producing country and also in Europe.

Herbal cannabis has become more popular in recent years. It is imported from many countries within Africa, Asia, South America and the Caribbean. Herbal cannabis as commonly sold in the UK includes nearly all parts of the plant (stalk, leaves, seeds, flowering parts) that are dried and then cut or crushed. It may be imported into the UK as compressed bales or blocks of various sizes.

In recent years 'home-grown' grass has become more common in the UK and Europe. This is partly due to the increased sophisticated of growing equipment and illicit producers and partly because more potent strains of C. sativa have been developed for home cultivation.

Strains of particularly strong grass are now often available, which have a far higher content of THC than was present say, in the 1960's or 1970's home-grown herbal cannabis market. 'Home-grown' herbal cannabis is usually seen as finely cut leaves, stalks etc. of the C. sativa plant that are sold loose, rather than in any compressed form.

Cannabis oil is extracted from the flowering parts of C. sativa or from cannabis resin by using some form of solvent (such as acetone, alcohol or petrol). The solvent is then evaporated off and the thick sticky liquid left behind is known as hash oil. This oil contains a high concentration of THC and is smoked in a similar fashion to the resin. Hash oil is not very common in the UK, mainly because it is difficult to weigh or to carry it, it's fiddly to prepare for smoking and it's more expensive than herbal or resinous cannabis.

Medicinal uses

Cannabis has been used as a herbal medicine in many countries of the world for a very long time. It has been used as a mild sedative or painkiller and for treatment of insomnia and gastric upsets. In the UK it was legally prescribed up until 1928.

The beneficial effects of cannabis as a mild analgesic and sedative, which may relieve the symptoms of multiple sclerosis, hypoglycaemia, and other disorders, is widely attested. In some cases it has found use as a medication for the terminally ill, where other treatments have failed to relieve distress. However its possession or use in the UK is nevertheless illegal at present and doctors are not able to prescribe cannabis in any form.

Cannabis use

Cannabis is the most widely used illicit drug in the UK, with up to 3 million consumers per year. It is most commonly smoked, usually by mixing it with tobacco and rolling it up with cigarette papers into a cannabis cigarette (called a 'spliff', 'joint', 'jay' etc.). However, it can also be smoked with or without tobacco in various forms of pipes or smoking devices such as 'bongs' or 'water pipes'. Smoking Cannabis produces fairly instant intoxication, the effects lasting from 1 to 3 hours depending on the potency of the drug and the amount used.

Cannabis can also be taken orally, either eaten direct or mixed with food preparations, such as cakes, biscuits (hence 'hash cookies') or hot drinks. Taking Cannabis orally means that the active ingredients are absorbed slowly into the bloodstream and take an hour or two to produce their strongest effect, which may then last for 2 to 6 hours, again depending on potency and amount ingested.

What effect does it have?

The effects of cannabis depend upon the amount used, its potency, the circumstances and the expectations/mood of the user.

The most common (and desired) effects are talkativeness, cheerfulness, relaxation and greater appreciation of sound and colour. Cannabis users frequently report perceiving an enhanced performance for tasks involving creativity (art, music etc.), although no scientific evidence indicates that the drug improves hearing, eyesight or skin sensitivity. Many users also experience a compulsion for binge eating (known as the 'munchies').

Some immediate physical effects of cannabis use include a faster heartbeat and pulse rate, bloodshot eyes, and a dry mouth and throat. Studies of cannabis's mental effects show that the drug can impair or reduce short-term memory, alter sense of time and reduce the ability to do things that require concentration, quick reactions and/or effective co-ordination.

A common bad reaction to marijuana is an acute anxiety attack. People describe this reaction as an extreme fear of "losing control," which causes panic. The symptoms usually disappear in a few hours.

High doses of cannabis can cause hallucinations and sensory distortions that can be very scary. Those who use the drug when anxious or depressed may find these conditions made worse. Panic and paranoia could then result.

Young cannabis users

Over the past few years there appears to have been an increase in cannabis use among young people. Several factors appear to be involved:

Public, government and media attention given to heroin, cocaine and ecstasy in recent years may have led some adults and young people to assume that cannabis is of less concern.

Many of today's parents may have experimented with cannabis earlier in their lives and could now be

uncomfortable about warning their children against its use. Some of those arguing for legalization have promoted the idea that cannabis is "no big deal," or that its use may even have some benefits.

Today's youth are often told that using drugs - including cannabis - is "cool" and they may come to believe that it's OK to "have a blow" - or whatever. These messages reach them from many sources, such as some rap and rock music videos, marijuana-emblem clothing and other products, and positive references to its use in various media.

Cannabis availability is at an all-time high.

Consequences of cannabis use

Health

There is no conclusive evidence at present that long-term use of cannabis causes lasting damage to physical or mental health. However, some recent studies have found that prolonged heavy cannabis use does cause physical damage to the brain and short-term memory loss has been reported in several investigations.

A long-term health risk arises from the common method of cannabis use. Smoking any substance over a long period of time is a bad idea and frequent inhalation of cannabis smoke can lead to bronchitis or other chest related disorders and may cause lung cancer.

Some women have found that heavy cannabis use can make their periods irregular, whilst cannabis smoked with tobacco during pregnancy produces the same risks to the mother and child as smoking cigarettes.

The fact that cannabis use does not represent an immediate serious risk to a persons health does not make this a harmless drug, or make the damage that can result from its use any less significant than harm caused by other illicit drugs.

Cannabis is a drug that impairs. It impairs co-ordination and may contribute to such potentially fatal events as accidents in the home, at work or while driving a motor vehicle.

It impairs attention and memory, reducing the user's ability to concentrate, solve problems, learn and retain new information.

It impairs development of healthy social relationships, possibly alienating and isolating young people from bonding with mentors and positive role models and peers.

It could also impair a young person's ability to make good decisions. Statistics show that young people who use cannabis are more likely than those who don't to use other illicit drugs or engage in other dangerous behaviour.

Dependence

Cannabis is not physically addictive but as with many other drugs, including alcohol, some cannabis users do develop a psychological dependence on the drug. They may have difficulty limiting their cannabis use or they may need more of the drug to get the same effect. These cannabis users may develop problems with their jobs and personal relationships that are directly attributable to their drug use. Obtaining and using the drug can become a central aspect of their lives.

Cannabis use may lead on to use of other drugs, including those that are physically addictive.

Among teenagers, those who smoke cigarettes are more likely to drink alcohol. Those who smoke and drink are more likely to use cannabis. And those who use all three are more likely to use other illicit drugs.

Long-term studies show that use of other illicit drugs among youth almost never occurs unless they have first used cannabis.

Using cannabis places youth in the company and influence of those who use and deal in illicit drugs and may encourage other dangerous and illegal activities.

Physical safety

Tests have clearly proved that, while under the influence of cannabis, users cannot perform tasks involving concentration and manual dexterity - such as driving a car - as well as normal. Driving whilst under the influence of cannabis is dangerous, both for the individual concerned and for other road users. Recent evidence has shown that 20% of car drivers killed in road accidents in the UK were under the influence of illicit drugs. As cannabis is by far the most commonly used illicit drug, it must play a role in these deaths.

Some estimates suggest that more road accidents are caused by cannabis use than by alcohol.

Legal consequences

Cannabis is a Class B drug - except cannabis oil, which is sometimes considered to be a Class A drug. It is illegal to grow, produce, supply or possess cannabis, except under special UK Home Office licence. It is also an offence to allow any premises to be used for growing, producing, supplying or using cannabis. Although a first offence possession of a small amount of cannabis is sometimes only given a police caution these days, it is nevertheless a criminal offence and the maximum punishment is 5 years imprisonment and/or an unlimited fine.

The act of supplying cannabis - and this may involve nothing more than giving the drug to a friend - is a more serious offence and the maximum punishment is 14 years imprisonment and/or an unlimited fine.

Cocaine

What is it?

Cocaine is a powerful Central Nervous System stimulant. It's a chemical derived from the leaf of the Erythroxylon coca bush, which grows primarily in Colombia, Peru and Bolivia.

Medicinal uses

Cocaine was first extracted and identified in the mid-19th century and was then used in patent medicines and tonics to treat a wide variety of symptoms - real or imagined. Because of its stimulating effect, many people in the late 19th century took cocaine, even though some doctors recognized that users quickly became dependent. It later found common usage as a local anaesthetic for minor surgery but this role today is fairly limited as synthetic anaesthetics are more widely used. Cocaine has no other medicinal application.

Abuse of Cocaine

In the 1970's and 1980's the high cost of cocaine and its rarity in the illicit marketplace meant that it was regarded as a drug of wealthy people such as rock stars or film stars. In the 1990's it has become relatively inexpensive and easier to buy. The street price of cocaine in the UK is (as of mid-1999) as low as 40 Pounds Sterling per gram and its low cost, easy availability and (false) reputation as a non-addictive drug has led to widespread use among young people, where 9% of those aged 20-24 who were asked in 1998 said they had taken it.

Cocaine is generally sold on the street as cocaine hydrochloride - a fine, white crystalline powder, soluble in water, known by slang names such as "coke", "C", "Charlie" etc. It is often cut with inert substances such as talcum powder or fine sugar; with other local anaesthetics such as procaine and benzocaine, or other stimulants such as amphetamines. Nevertheless, street cocaine has become purer in recent years and today averages around 60% or more pure.

Cocaine in powder form is usually sniffed, or "snorted", up the nose through a rolled-up bank note or any other similar type of tube, after a line of the powder (about the size of a large matchstick) has been spread out on a smooth surface - commonly a mirror. To experience cocaine's effects more rapidly and to heighten their intensity, some users inject the drug directly into their veins.

Crack cocaine

Pure cocaine is a chemical 'base'. A base can combine with an acid - in this case hydrochloric acid - to form a salt. Cocaine hydrochloride is a salt of cocaine. This powdered form of cocaine is soluble in water and so can be snorted, where it dissolves into the blood system via small capillaries in the nostrils, or injected into a vein.

The cocaine hydrochloride salt can be changed back into its base form by a fairly simple chemical process. This is called 'free basing' and is potentially dangerous because the solvents used are highly flammable. The resulting form of cocaine is called 'free base' - or crack - and takes the shape of relatively large crystals. It's pure cocaine (i.e. without the hydrochloride) and as it is not soluble in water, it must be smoked in order to be taken. It's called 'Crack' because it makes a crackling noise as it is smoked.

Crack is absorbed into the body much faster than when cocaine powder is snorted and therefore it takes effect very quickly. It's a very powerful form of cocaine and is highly addictive. It has become fairly common in the UK since the mid 1980's.

How does it work?

Cocaine - like most drugs - acts on neurotransmitters in the body. These are chemical messengers that send signals between one nerve cell and an adjacent one. Some neurotransmitters switch nerve cells on - or speed them up, some switch nerve cells off - or slow them down. If any chemical - such as a drug - interferes with these neurotransmitters, this can have all sorts of consequences.

Cocaine interfers with the normal action of at least two neurotransmitters, one is Seretonin and the other is Dopamine. When cocaine is taken - in any form - brain activity speeds up, as does heart rate and breathing rate.

Blood pressure increases and so does body temperature. Physical symptoms of cocaine use may include chest pain, nausea, blurred vision, fever, and muscle spasms. These symptoms result from an overworked heart and high blood pressure.

What effect does it have?

Generally, cocaine produces feelings of mental well-being, and exhilaration. A user may feel energetic, talkative and mentally alert - especially to sensations of sight, sound, and touch. At the same time cocaine inhibits appetite and the desire for sleep. In some respects the effect of cocaine is grossly similar to that of amphetamines and like those drugs, cocaine use can produce anxiety or panic attacks. The after-effects of cocaine can include tiredness and depression. Excessive doses can sometimes cause death from heart failure.

Short-term effects

When cocaine is snorted, its euphoric effects appear soon after it is taken, peak in about 15-30 minutes and disappear completely within one half to two hours. As the 'high' is short lasting, this often encourages users to repeat the dose in order to maintain the effect. It's common for cocaine users to take cocaine again after about half an hour or so after they last took some. Many repeated doses taken over a short period can lead to extreme states of agitation, anxiety or paranoia.

The compulsion to repeat cocaine use is even more evident when the drug is taken as crack. The effects of crack cocaine occur and peak immediately the drug is smoked and begin to fade shortly afterwards. Crack users commonly repeat the dose at short intervals in an attempt to maintain the 'high'.

When large amounts of cocaine are taken (several hundred milligrams or more) the 'high' is intensified up to a point, but such doses can also lead to bizarre, erratic and violent behaviour. These users may experience severe tremors, vertigo, muscle twitches and paranoia.

Longer-term effects

If cocaine is taken over a period of time, users experience the drug's long-term effects. The euphoric 'high' is gradually replaced by restlessness, extreme excitability, insomnia, and paranoia - and eventually hallucinations and delusions. These conditions are very similar to amphetamine psychosis and paranoid schizophrenia, although they disappear in most cases after cocaine use is ended.

While many of the physical effects of heavy continuous use are essentially the same as those of short-term use, the heavy user may also suffer from mood swings, loss of interest in sex, weight loss and insomnia.

Tolerance

Tolerance to any drug exists when it becomes necessary to take higher doses to achieve the same effects once reached with lower doses. At present there is no evidence to suggest tolerance to cocaine's stimulant effect occurs.

Users may keep taking the original amount over extended periods and still experience the same euphoric effects.

However, some users do increase their dosage in an attempt to intensify and prolong the effects.

Consequences of cocaine use

Physical dependence

At present, it's unclear if physical dependence upon cocaine hydrochloride can occur. However, when some regular heavy users stop taking the drug, they experience a powerful negative reaction, which may indicate physical dependence.

Crack cocaine does produce a strong physical dependency. With regular heavy use increasingly unpleasant symptoms occur. Euphoria is replaced by restlessness, over-excitability and nausea. With continued use this can lead to paranoid psychosis. Regular users may appear chronically nervous, excitable and paranoid. Confusion as a result of exhaustion, due to lack of sleep, is common.

Psychological dependence

Psychological dependence exists when a drug is so central to a person's thoughts, emotions, and activities that it becomes a craving or compulsion. Among heavy cocaine users, an intense psychological dependence can occur; they suffer severe depression when the supply of cocaine runs out, which lifts only when they take it again.

Experiments with animals have suggested that cocaine is perhaps the most powerful drug of all in producing psychological dependence.

When not taking cocaine, many regular users complain of sleep and eating disorders, depression and anxiety, and the mental craving for the drug often compels them to take it again.

Consequences for health

Death from a cocaine overdose can occur from convulsions, heart failure, or the depression of vital brain centres that control breathing.

Chronic cocaine snorting often causes stuffiness, runny nose and eczema, and commonly damages the nasal membranes and the structure separating the nostrils.

Severe respiratory tract irritation has been noted in some heavy users of crack cocaine.

Users who inject the drug not only risk overdosing but also getting infections from unsterile needles and hepatitis or AIDS from needles shared with others.

The risk to mental health of using cocaine is high. As mentioned above, regular use can lead to anxiety, paranoia and psychosis - which can sometimes produce permanent mental health problems.

Legal consequences

Cocaine in any form is a Class A drug. It is illegal to produce, supply or possess it. It is also illegal to allow premises to be used for the supply, production or consumption of cocaine. Penalties are high.

Cocaine is not a cheap drug and it is expensive to maintain a regular intake. Many regular users resort to crime of one kind or another to fund their drug use. Obviously, such behaviour can result in a criminal record or imprisonment.

Ecstasy

What is it?

Ecstasy is an hallucinogenic stimulant. It is a man-made drug with both hallucinogenic and amphetamine-like properties. The chemical name for ecstasy is 3,4 Methylenedioxymethylamphetamine - or MDMA in short form. It's chemically similar to two other synthetic drugs, MDA and methamphetamine.

Medicinal uses

None.

Use of Ecstasy

Ecstasy has only been used as a drug of abuse in the UK since the mid 1980's. It is now very common and is taken regularly by many thousands of people. It's mainly associated with the dance culture or disco scene and so is often perceived as a 'party' drug, or a 'weekend' drug, unlike for example heroin or amphetamines, which are usually taken more regularly.

This perception can give rise to a false understanding that ecstasy is safe to use. This is simply not true - as the long term effects are largely unknown.

Ecstasy is seen in tablet or capsule form, or very rarely as a powder. Slang jargon includes 'E', 'Eccies', 'Love Doves', 'Disco biscuits' etc., although tablets are sold under a variety of so-called 'brand names' and are often embossed with a logo. A single dose costs 10-15 Pounds Sterling.

The type of tablets available changes from week to week, and counterfeit tablets are common. According to police analysis, half of all Ecstasy tablets seized contained no MDMA (the active ingredient). Some tablets contained LSD, amphetamine, MDA, and Ketamine, others had no drug content whatsoever.

How does it work?

Ecstasy interferes with the concentration and action of seretonin in our brains. Serotonin is a 'messenger substance' or neurotransmitter that affects the peripheral and central nervous systems. It acts through 'receptors' that are located on the outside walls of cells. Amongst other things it's involved in the regulation of mood, sleep, sexual behaviour, temperature and appetite.

Ecstasy acts to increase the natural level of seretonin. The result is a change of mood, repression of libido and appetite, mental stimulation and increased body temperature.

What effect does it have?

Ecstasy produces a relaxed, euphoric state without marked hallucinations.

It takes effect 20-40 minutes after taking a tablet and wears off after about 3-4 hours. The peak effects are felt 60 to 90 minutes after taking the drug.

A user first feels rushes of exhilaration that can be accompanied by nausea.

Sensations of sight, sound and touch are enhanced. Music - particularly when it contains a strong repetitive rhythm - exerts a powerful influence on the user.

Users report that the experience is very pleasant and highly controllable. Even at the peak of the drug's effect, people can easily bring themselves down to deal with an important matter.

The effect that makes Ecstasy different from other drugs is the sensation of understanding and accepting others (it should be remembered that this is a drug-induced sensation and does not correspond to reality!). Users feel as though interpersonal barriers have disappeared and are likely to feel uninhibited.

Side effects

Many of the side effects users encounter with Ecstasy are similar to those found with the use of amphetamines and cocaine. They include increases in heart rate and blood pressure, nausea, blurred vision, faintness, chills and sweating. Psychological problems such as confusion, depression, insomnia, severe anxiety, paranoia, and psychotic episodes can occur.

Consequences of ecstasy use

Consequences for health

Ecstasy is not physically or psychologically addictive. However, the drug can often take on great importance in the lives of users.

A major risk to health from taking ecstasy is hyperthermia - or heatstroke. Some people who have died after taking this drug died as a result of the body overheating, which can cause failure of vital organs.

Overheating is particularly likely to occur when the drug is taken at a music venue or disco, where the user is dancing. The stimulant effect of ecstasy can enable people to dance vigorously for long periods, leading to exhaustion and heatstroke. When an ecstasy user dances to music with a repetitive rhythm, it seems that the person can 'lock in' to that repetition and simply go though the same movements over and over again for hours. This is a bit like Pavlov's dog - a reflex reaction. It is particularly dangerous as the user may be unaware of impending heatstroke.

Although many discos provide 'chill-out' rooms for dancers to cool off in, the availability of such facilities does not make the act of taking ecstasy safe. Some users have died from drinking fluid in excess to combat the overheating caused by ecstasy and made worse by dancing.

A few ecstasy users have died from brain haemorrhages, which have been caused by the increased blood pressure and heart rate associated with this drug. Some others have died from unknown reasons after taking ecstasy.

The long-term effects of ecstasy use are not yet known. Ecstasy's chemical cousin, MDA, destroys cells that produce serotonin in the brain. These cells help to regulate aggression, mood, sexual activity, sleep, and sensitivity to pain. Methamphetamine, also similar to Ecstasy, damages brain cells that produce dopamine. It is quite possible that ecstasy can also damage brain cells.

Scientists have found that ecstasy makes the brain's nerve branches and endings degenerate. It also makes them re-grow abnormally - failing to reconnect with some brain areas and connecting elsewhere with the wrong areas.

These reconnections may be permanent, resulting in damage to various brain functions, changes in emotion, learning or memory.

Legal consequences

Ecstasy is a Class A drug under the Misuse of Drugs Act. It is illegal to produce, supply or possess it. The offence of supply - in the eyes of the law - can be committed by giving a single tablet to another person. Penalties are high.

GHB

What is it?

GHB or as it is often known 'GBH' has an anaesthetic effect. Its chemical name is Gamma Hydroxybutyrate. It's usually seen as a colourless, odourless, salty-tasting liquid.

Medicinal uses

GHB has been used in Europe as a general anesthetic, a treatment for insomnia and narcolepsy (a daytime sleeping disorder), an aid to childbirth (increasing strength of contractions, decreasing pain and increasing dilation of the cervix) and a treatment for alcoholism and alcohol withdrawal syndrome.

Prior to 1990 GHB was available as an over-the-counter pill or powder in the USA, sold mostly in health food stores. It was banned as such in 1990 by the FDA because of deaths or serious illnesses related to its use, and is now illegal for any person to produce or sell GHB in the USA.

GHB is not prescribed or made available in the UK because of its side effects.

How does it work?

GHB is found naturally in every cell in the human body. Some scientists believe it acts as a neurotransmitter, although the jury is still out on this. It is very similar to another natural chemical in our brains called Gamma Amino Butyric Acid, or GABA. GABA is a neurotransmitter in our brain that slows down or inhibits certain activities. GHB is thought to act like GABA, perhaps indirectly affecting the same receptors.

Abuse of GHB

GHB is easily made from fairly common chemicals and it's often manufactured in 'kitchen-sink laboratories'. As such, the potency varies, since it will be home made to various strengths. It's sometimes available as a powder or in a capsule, but most commonly seen as a liquid. In this form, GHB is sold in small bottles (30-40ml), which would be enough for about two or three doses. Bottles cost between 10 and fifteen pounds sterling. It is usually drunk although rarely it is injected.

GHB first appeared on the UK club scene in 1994, starting with London gay venues and is now becoming more generally available in discos and raves etc.

Body builders have also been known to use the drug, as it is supposed to assist the production of muscle-building growth hormones by the body, but there is no evidence to support this claim.

What effect does it have?

The effects of GHB can generally be felt within five to twenty minutes after ingestion. They usually last no more than one and a half to three hours, although they can be indefinitely prolonged through repeated dosing. The effects of GHB are very dose-dependent. Small increases in the amount taken lead to significant intensification of the effect.

The effect of GHB at lower doses are a cross between alcohol and the hypnotic sedative Methaqualone Hydroxide (mandrax) that was popular in the 1970's but is no longer prescribed. Inhibitions are lowered in a similar fashion to moderate doses of alcohol.

Most users find that low doses of GHB induce a pleasant state of relaxation and tranquillity. Frequent effects are placidity, sensuality, mild euphoria and a tendency to talk. Anxieties and inhibitions tend to dissolve into a feeling of emotional warmth, wellbeing and pleasant drowsiness. The 'morning after' effects of GHB appear to lack the unpleasant characteristics associated with alcohol and other relaxation-oriented drugs.

At higher doses this mild sedative effect gives way to the anaesthetic action of GHB and users experience giddiness, loss of emotional control and interference with mobility and verbal coherence.

Consequences of using GHB

Consequences for health

The foremost risk to health with using this drug is that you never know what you are getting. Too much GHB can be deadly. Most of it is made at home by amateur chemists and may or may not be pure. Toxic compounds left behind by kitchen sink chemistry can - at best - burn mouths and throats.

Although it's an anaesthetic, at low to moderate doses GHB works as a sedative rather than a painkiller. It is the sedative effect that drug abusers are looking for. The problem is, the amount of GHB you need to take to feel the sedative effect is very close to the amount needed for anaesthesia - and this is very close to the amount that can cause seizures or coma. Also, as it's a homemade drug, purity will vary and a user could easily take a higher dose than he or she intended. It's a risky business.

Physical side effects and possible damage to health occur mainly when GHB is taken in a dose sufficient for the anaesthetic properties of the drug to start to operate. This can cause nausea, drowsiness, amnesia, vomiting, loss of co-ordination, respiratory problems and occasionally unconsciousness. After excessive use, seizures and coma can occur.

It is not yet clear if users can become tolerant to GHB or become psychologically or physically dependent upon it.

However, it seems probable that tolerance and/or psychological dependence could occur in some individuals and a withdrawal syndrome has been reported that may last 3-12 days including insomnia, anxiety and tremor. Little is known of the drug's long term effects on physical health or emotional well-being.

As a sedative drug, there is a very serious risk of overdose or damage to health if GHB is taken with other depressants - such as alcohol. Drinking alcohol with GHB could easily lead to respiratory failure or coma.

Legal Consequences

In the UK, GHB is classed as a medicine, and the Medicines Act regulates its manufacture. The manufacture of GHB by unlicensed persons is illegal. A conviction for illegal manufacture of a medicine carries a maximum sentence of two years imprisonment and a fine of two thousand pounds.

It is not illegal to possess or use GHB in the UK as of mid 1998. However, this situation is likely to change in the near future as efforts are underway to place this drug within the remit of the Dangerous Drugs Act.

Heroin

What is it?

Heroin is an opiate. Pure heroin is a white powder with a bitter taste that is made from the milky 'sap' of the opium poppy (see right). This plant is grown as an illicit crop in countries across the Middle East, Asia and South America.

Heroin is a powerful painkiller that depresses the Central Nervous System. This produces a feeling of relaxation, security and well-being.

Medicinal uses

Although opium has been known and used as a sedative and intoxicant in some cultures for several thousand years, heroin is a relatively new substance. It was first synthesized from morphine in 1874 in Germany and given the name heroisch - meaning 'powerful'.

Heroin was not extensively used in medicine until around the beginning of this century. At that time it then received widespread acceptance from the medical profession as a sedative and anaesthetic. Physicians remained unaware of its potential for addiction.

When the dangers of heroin came to be appreciated many governments around the world took steps to control its manufacture and it came under very strict prescription controls.

Today heroin does not have many legitimate medical applications, as synthetic sedatives and anaesthetics have replaced the opium-based compounds that were used in the past.

Abuse of Heroin

Illicit heroin comes in the form of a powder that may vary in colour from white to dark brown because of impurities left from the manufacturing process or the presence of adulterants. The powder can be sniffed or dissolved in water and injected. It can also be smoked by mixing with tobacco or heating on tin foil and inhaling the fumes, or swallowed after being wrapped in paper.

Heroin on the streets is usually diluted with other substances - ranging from lactose to paracetemol. However, the amount by which the drug is 'cut' varies from purchase to purchase or day to day and so its purity in any particular locality can vary enormously - depending pretty much on the mood of the dealers. Many deaths have resulted from overdosing on a batch of unusually pure heroin.

A few years ago powders sold as illicit heroin only actually contained 1 to 10 percent of the drug. In recent years street supplies have become stronger and the UK national average purity of heroin is now around 40 percent, although it can range from 1 to 98 percent (hence the likelihood of accidental overdose).

Along with an increase in purity, the cost of heroin has fallen. A gram of the drug now costs around 60 Pounds Sterling on the street.

Until recently, most heroin users took the drug by injection - either into a vein, under the skin or into a muscle. This is the most practical and 'efficient' way to take impure heroin.

The availability of higher purity heroin has meant that more users can now snort or smoke the drug and still achieve the desired effect. Smoking and sniffing of heroin appears to be on the increase in the UK as of 1997/8.

Although this may seem like 'good' news, as sniffing or smoking heroin eliminates the health risks associated with injecting drugs, it has a downside. Many people that may try heroin by sniffing or smoking may not have tried the drug if they had to inject it.

Sniffing or smoking heroin is likely to be more appealing to new users because it eliminates both the fear of acquiring syringe-borne diseases such as HIV/AIDS and hepatitis, and the initial distaste regarding self-injection.

It would certainly be a cause for concern if the reduction in the cost of heroin and increase in its purity leads to the drug becoming more acceptable to young people.

What effect does it have?

All opiates tend to relax the user and kill pain to some degree. Heroin is the most powerful opiate and when it is injected, the user feels an immediate 'rush' of relaxation and well-being. Physical pain is completely removed - and so is emotional pain.

It can be hard for non-users to understand the attraction of drugs - particularly heroin - but a major reason why any individual may feel drawn to use heroin again after an initial experience is that it produces such a powerful sense of security and tranquillity. It produces a state of mind where all cares and worries seem far removed. Nothing matters. Perhaps it's like being in the womb.

The best description this writer has ever found is:

"But with heroin, ahhh. You can just sit in a sewer all day and be soooo happy and feel soooo good"

("Junk" - Melvin Burgess, 1996 Penguin Books)

Of course, these pleasant sensations have nothing to do with reality. No matter how good a user may feel, the reality is the sewer - or whatever other situation exists - and this is usually quite unpleasant - hence the need to escape from it.

Side effects from heroin use - particularly for new users - include restlessness, nausea and vomiting. The user may go 'on the nod' or 'gouch out' - going back and forth from appearing fairly alert to almost falling asleep. The pupils of the eye are reduced to pinpricks.

Tolerance

If heroin is used regularly over a period of time then a tolerance to the drug builds up. It makes no difference what method of taking heroin a person may employ - and regularly can mean using many times each day, or only two or three times each week.

Users have to take larger amounts of heroin in order to get the same effect as previously. Tolerance can build up quite quickly - over a matter of weeks - although it continues to increase as long as a user takes heroin regularly.

If a person is abstinent from heroin for a time, their tolerance to the drug decreases. If they should use heroin again in the same amounts as previously, an overdose could easily occur.

Consequences of heroin use

Risks to physical health

One of the most obvious risks of taking heroin is that of overdose. This can occur whatever method is used to take the drug, although intravenous injection is most dangerous in this respect as the whole dose is delivered directly into the blood system.

Heroin is a Central Nervous System depressant and when it's taken vital functions such as higher brain activity, breathing and heart rate are inhibited - or slowed down. If a large dose is taken - or the heroin is exceptionally pure - the user may become comatose and the skin feel cold and clammy. Breathing becomes shallow and intermittent and death may occur.

Other physical health risks related to heroin use are associated with the means of taking the drug. Users who inject heroin might often employ contaminated needles or syringes. This can lead to severe blood infection and damage the heart.

Injecting heroin - or any drug - in situations where shared needles are used, perhaps accidentally, leaves the users open to infection from the HIV virus that causes AIDS. Hepatitis B or C, both of which are serious infections, can be spread in this way and are common among intravenous heroin users.

Another immediate physical danger associated with heroin use exists if the drug is combined with other substances. Other depressant drugs, such as alcohol, benzodiazepines and barbiturates are particularly dangerous as they are all CNS depressants. As heroin is also a powerful CNS depressant, the combined effect of mixing these drugs can depress breathing or heart rate to such an extent as to cause respiratory failure or heart failure.

Dependence

Physical and psychological dependence upon heroin is likely to occur, especially if a person uses a lot of the drug or even uses it occasionally over a long period of time. The method of taking heroin makes no difference here - a person who sniffs or smokes heroin can become dependent on the drug just as easily as a person who injects it.

Heroin use can result in a powerful physical addiction.

Coming off the drug can be very difficult because withdrawal symptoms - although lasting for only a few days - are fairly severe. Abstinence can bring on symptoms such as chronic diarrhoea, muscle cramps, vomiting, insomnia, sweating, anxiety, and tremors. The prospect of going through such a painful withdrawal puts many heroin users off the idea of trying to stop using the drug.

Once the physical withdrawal is over, a craving for the drug may still persist for a long time and relapses are common. Generally speaking, a heroin user who wishes to stop using the drug completely needs a strong support network to help him or her overcome the craving for the drug.

Social consequences

It costs a lot of money to maintain a regular intake of heroin. Many regular users resort to crime of one kind or another to fund their drug use. This has serious implications for our society, as the social costs of drug-related crime are enormous. The UK Home Office provided an estimate of the size of the problem in research in 1997, which found that 20 percent of all people arrested in Britain were on heroin.

Effect on pregnant women

Researchers estimate that nearly half of the women who are dependent on heroin suffer anaemia, heart disease, diabetes, pneumonia or hepatitis during pregnancy and childbirth. They have more spontaneous abortions, breech deliveries, caesarean sections, premature births and stillbirths.

Infants born to these women often have heroin withdrawal symptoms which may last several weeks or months. Many of these babies die.

Legal consequences

Heroin is a Class A drug. It is illegal to supply or possess it. Penalties are high.

Drugs similar to heroin, such as morphine, opium, methadone, dipapanone and pethidine are also Class A drugs.

Codeine and dihydrocodeine (DF118) are Class B drugs unless they are prepared for injection when they become Class A drugs.

Inhalants

What are they?

Inhalants are chemicals that produce mood-altering vapors. Many people don't usually think of inhalants as drugs because most of them were never meant to be used that way. There are more than a thousand different commercial products that can be abused for their mood-altering properties.

They can be divided into three main categories:

Volatile gases and solvents:

Such as cigarette lighter gas, cleaning fluids, spray paint, paint thinner, correction fluid, nail polish remover, petrol and glues.

Aerosols:

Such as hair spray, deodorants and other spray products that are abused more for the propellant gas, than for the contents.

Nitrates:

Such as Amyl nitrite, which has medical applications for heart patients and Butyl nitrite, which is used in room deodorizers.

Medicinal uses

Amyl nitrite was widely used in the past as a treatment for angina in heart patients and for diagnostic purposes. It is now rarely prescribed as a medicine as more effective compounds have been developed. Its availability to the public is controlled within the UK.

None of the other commonly abused inhalants, such as those examples listed above, have any medicinal application.

Abuse of inhalants

Young people are particularly likely to abuse inhalants because they are easily available, inexpensive and their abuse carries no criminal penalties. These factors make inhalants, for some young people, one of the first substances to be abused.

Inhalant vapours can be sniffed or sucked in directly from an open container or aerosol, or from a rag soaked in the substance and held to the face. Alternatively, the open container, substance or soaked rag can be placed in a paper or plastic bag and the vapours inhaled from that.

Some sniffers strengthen the effect by sniffing from inside a plastic bag placed over the head. This is very dangerous because the user may suffocate and become unconcious or even die.

Once inhaled, the large surface of the lungs allows rapid absorption of the vapour into the bloodstream. The effect of inhalants on the brain is so fast that sniffing these substances can provide an 'instant high' - in a similar fashion to that of intravenous injection of other drugs.

A note on nitrates

Amyl nitrite was first prescribed for use in small sealed ampoules. When these were broken, they made a snapping sound and illicit users nicknamed these ampoules 'snappers' or 'poppers'. This slang is often used today.

Amyl and butyl nitrites are sometimes abused by nightclub customers who inhale the fumes for the rush whilst dancing. They are also popular as a sex drug, sometimes said to be used for its muscle relaxant properties, but more often for added stimulation at the time of orgasm. The purchase of Amyl nitrite is controlled but Butyl nitrite can be bought from sex and other speciality shops, or in clubs.

How do they work?

Although different in makeup, nearly all of the commonly abused inhalants produce effects similar to that of anaesthetics, which act to slow down the body's functions. In general terms they are Central Nervous System depressants.

Various parts of the central nervous system are depressed by inhalants, with all sorts of consequences. For example, when the brain's speech centres are inhibited, this causes slurred speech; when the vision centres are affected this produces distorted vision; when the co-ordination centres are depressed this results in loss of balance and limb control.

The exceptions to this are Amyl and Butyl nitrites. These compounds widen blood vessels and make the heart beat faster. They exert a very short-lasting stimulant effect.

What effect do they have?

The effects of abusing inhalants such as solvents, glue and aerosols etc. resemble the effects of drinking alcohol. At low doses users may feel slightly stimulated - in a similar fashion to the alcohol user after, say two or three pints of beer. This is caused by depression of the higher brain centres, which produces an apparent stimulation by reducing anxiety and self-consciousness. An inhalant abuser may demonstrate increased self-confidence and loss of self-restraint.

So inhalants can feel stimulating - but they're not - these effects are a result of the inhibition of normal brain activity.

At high doses, an inhalant abuser can lose consciousness as the brain activity that controls vital functions such as breathing and heartbeat becomes inhibited.

The effects of inhalants occur very quickly and disappear after a short time - say 15 to 30 minutes later. This means that an inhalant abuser is likely to keep repeating the inhalation in an attempt to maintain the 'high'. This can lead to near-continuous use, with possible serious health risk or life-threatening consequences.

Inhalants cause distortion in perceptions of time and space. Many users experience headache, nausea or vomiting, slurred speech, loss of motor coordination and problems with breathing.

A characteristic 'glue sniffer's rash' around the nose and mouth is often seen on individuals who abuse inhalants. Clothes, skin and breath may smell of paint or solvents.

Nitrates

Sniffing nitrites makes the user light headed and giddy and produces a feeling of blood rushing to the head, a flush of warmth and heightened sensual awareness. These effects last only one minute or so at most. For this reason, Amyl and Butyl nitrites are regarded as 'party' or 'nightclub' drugs, rather than drugs of everyday abuse.

Some people get a bad headache after using nitrates. Repeated sniffing can cause the user to become dizzy or to possibly pass out. Some side effects include headaches, nausea, coughing and dizziness.

Consequences of inhalant abuse

Consequences for health

There is no safe way of abusing inhalants. People have died at the first sniff, or after using them for some time.

Short-term, sniffing solvents or aerosol sprays can cause heart failure and instant death. Sniffing can cause death the first time or any time. Inhalants can cause death from suffocation by displacing the oxygen in the lungs. Inhalants can also cause death by depressing the central nervous system so much that breathing slows down until it stops.

Death from inhalants usually results from sniffing a very high concentration of inhalant fumes - i.e. sniffing from a bag where the vapours have been allowed to collect. Deliberately inhaling from a paper bag greatly increases the chance of suffocation.

When a person is under the influence of inhalants, sudden exertion can cause a muscle spasm in the throat or heart. This can cause death.

Inhaling gases straight from aerosols may freeze the back of the throat causing death through suffocation. The gases may also be toxic. In 1995 abuse of volatile substances caused 68 deaths - of these, more than 40 were caused by abuse of gas lighter fuel refills.

Long-term abuse of inhalants can cause weight loss, skin problems, bronchitis, muscle fatigue, memory impairment, mood swings and loss of concentration.

Repeated sniffing of strong vapours over a number of years can cause permanent damage to the nervous system. In addition, long-term abuse of certain inhalants can damage the liver, kidneys, blood, and bone marrow. Glue and paint thinner sniffing in particular produce kidney abnormalities, while the solvents toluene and trichloroethylene (trike) cause liver damage.

Tolerance, which means the sniffer needs more and more each time to get the same effect, is likely to develop from most inhalants when they are used regularly.

Legal Status

Amyl nitrite can only be issued by pharmacists, but it is not illegal to possess this drug.

Butyl nitrite and all other inhalants referred to above - such as glues, paint thinners, aerosols etc. are freely available for sale to adults. However, it is an offence to sell some substances that can be used for intoxication - such as solvents, glues etc. - to people under 16 years old in the UK. In early 1998 the UK Government announced its intention to extend this ban to cigarette lighter gas refills.

Such bans apply to shopkeepers etc. and are intended to prevent young people buying products that can be abused as inhalants. They are not easy to enforce and in any case many of the substances that can be used for inhalant abuse are present in every home.

It is not an offence for any person - of any age - to possess inhalants.

LSD

What is it?

LSD (Lysergic Acid Diethylamide) is a powerful hallucinogen. It's a drug which alters a persons perception of sights, sounds, touch etc., to the extent where hallucinations can occur - that is, where the user sees or hears things that don't, in reality, exist.

LSD is a semi-synthetic drug derived from lysergic acid that is found in ergot - a fungus that grows on rye and other grains. In its pure form it is a white, odourless crystalline powder that is soluble in water.

Medicinal uses

LSD has no applications as a medicine, although it has been suggested that it may have some uses in the treatment of certain mental illnesses.

Use of LSD

LSD is commonly known as 'Acid'. It was popular in the UK during the late 1960's and early 1970's and also again in the late 1980's with the rise of 'acid house parties'. Its popularity has declined with the appearance of Ecstasy and LSD now has a relatively limited number of users when compared to that drug.

It is manufactured for the street market in illicit laboratories, mostly in Europe and North America.

LSD is an almost unbelieveably potent drug. An average dose taken for a 'trip' would be around 200 micrograms. That is one fifth of a milligram - or one five-thousandths of a gram. A single heaped tea spoonful of LSD would contain something like 20-25,000 doses!

Because a single dose of LSD is so small, the pure drug is usually diluted to a great extent and then a single drop containing enough for one dose is placed onto blotting paper, sugar cubes etc. Blotting paper is a popular medium for the drug as it can be cut into squares, representing single doses, that can be decorated with cartoon characters and suchlike (see illustrations at top of page). Alternatively, the drug can be added to gelatine sheets or made into tablets or capsules.

LSD tablets can be very small. An example is that commonly called a 'microdot', which is about the side of a pinhead. This can be very strong because of the difficulty in accurately measuring and preparing the tiny quantities necessary for an effective dose.

A single dose - or 'trip' - costs between 3 and 5 Pound Sterling.

What effect does it have?

The effects of LSD are unpredictable. Like any other drug, its effects depend on the amount taken, the user's personality, mood and expectations, past experience of the drug and the surroundings in which the drug is taken.

These factors are particularly important with LSD because its hallucinogenic properties can be so strong. If anything in the immediate environment is perceived as - say - oppressive or threatening, under the influence of LSD the 'normal' reaction of mild anxiety can take the form of totally overwhelming fear.

It is difficult - if not impossible - to predict the effects of LSD on any person, even if they have taken the drug before.

Usually, the user feels the first effects of the drug 30-90 minutes after taking it. The hallucinogenic effects reach a plateau after about 1-2 hours, with repeated peaks of intensity.

LSD causes dramatic changes in perception, thoughts and mood. This can include:

Vivid 'pseudo-hallucinations' - i.e. where a part of the user's conscious thought is aware that the hallucinations of sight, sound, smell and touch are not real. Distorted perceptions of time, where minutes can seem like hours. Distorted perception of distance, perspective and colour. Small objects may seem huge, and large objects small. A close object may seem to be very distant and a distant object very close.

Amplification of the relationship between the user and his/her surroundings - for some this may be a feeling of oneness with the universe, for others a feeling of terror and loneliness.

Apparent fusion of the senses, where sounds are 'seen', colours 'heard' and smells 'felt'.

Loss of control over thought processes, which can result in insignificant thoughts or objects taking on an importance out of proportion to their status. Mental/emotional experiences of a mystical, religious, or cosmic nature - or that's how they may appear to the user. The validity of such experiences is questionable.

Many regular users experience unpleasant reactions to LSD sooner or later - or this can happen the first time a person takes the drug. These 'bad trips' can occur anytime with any user. They often take the form of very intense feelings of fear, anxiety or depression. Users may feel that they have lost their identity, their place in the world and that there is no reality to hold on to. It is difficult for anyone who has not experienced this to appreciate just how terrifying it can be - when all perceptions are amplified.

In 'bad trips', pseudo-hallucinations can give way to terrifying true hallucinations, sometimes resulting in very erratic behaviour. In some cases, this psychotic state lasts several days or even longer.

Physical effects

The physical effects of taking LSD include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors. These usually pass unnoticed by the user as the mental/emotional effects of the drug are far stronger.

Tolerance

Tolerance to LSD's effects develops rapidly, making larger amounts of the drug necessary to produce the same effects. Often, within a few days of consecutive daily doses, no amount of the drug will produce the desired effect.

After several days of abstinence the hallucinatory effects are again felt.

Consequences for Physical Health

LSD appears to have few direct effects on the physical health of a user. No deaths caused by an LSD overdose have ever been reported and there is no physical dependence on the drug, as no withdrawal symptoms occur when a user stops taking it.

However, LSD can exert a profound indirect effect on physical health. Cases of suicide have occurred after taking LSD and the drug can induce violent or hazardous behaviour, resulting in death or injury to the user or others.

Driving a motor vehicle, walking near traffic or being near vertical drops while under the influence of LSD can all result in serious or fatal accidents. Irrational behaviour is common under the influence of the drug and a user may run onto a busy road or attempt to fly etc. Similarly, the distorted perception of time and distance and other vivid hallucinations caused by LSD make driving a motor vehicle absolute madness - yet an LSD user would have no real appreciation of the dangers.

Mental Health

Repeated use of LSD may result in prolonged depression and anxiety. The drug may reveal deep seated mental or emotional problems that were previously unknown to the user.

Heavy users sometimes develop signs of organic brain damage, such as impaired memory and attention span, mental confusion and difficulty with abstract thinking. It is not yet known whether such mental changes are permanent or if they disappear when LSD use is stopped.

'Flashbacks' can occur, where a person experiences LSD's effects for a short time without taking the drug. These can occur up to two years after the last time LSD was taken and may be very frightening.

A small minority of regular LSD users become psychologically dependent on the drug and the need to keep taking it becomes a compulsion.

Legal consequences

LSD is a Class A drug under the Misuse of Drugs Act. It is illegal to produce, supply or possess it. The offence of supply - in the eyes of the law - can be committed by giving a single dose to another person.

Methadone

What is it?

Methadone is a synthetic opiate. It was first synthesised by German scientists during World War II because of a shortage of the morphine that was used as a painkiller. It produces similar effects to heroin or morphine.

Medicinal uses

Although it was originally developed for use as an analgesic, methadone is mainly used today as a substitute for heroin in an attempt to relieve some of the problems associated with heroin addiction. It is usually prescribed as a liquid syrup to be swallowed but it is also manufactured as tablets and ampoules for injection.

Methadone mimics many of the effects of opiates such as heroin. Methadone maintenance programmes are intended to reduce the risks associated with heroin addicts who use illicit sources for their drugs. It is presumed that these risks - such as heroin overdose, HIV or hepatitis infection from shared syringes and risks associated with the need for criminal activity to fund illicit drug use - are reduced if addicts receive a daily supply of methadone as a substitute for illicit heroin. It is also presumed that - given a regular supply of a prescribed drug - addicts will be able to lead a more stable life, as they will no longer suffer from repeated heroin withdrawal.

The effects of methadone last far longer than those of heroin or morphine. They can last up to 24 hours, which allows an opiate addict to take methadone only once a day in methadone maintenance programmes without experiencing withdrawal symptoms.

The effectiveness of methadone maintenance programmes has come under question in recent years and this remains a controversial practice.

Methadone can also be used for a short period to help addicts get through the physical and psychological trauma of opiate withdrawal in detoxification programmes.

What effect does it have?

Methadone has a similar effect to that of opiates but not as intense. The fact that it is a slow-action drug that is usually prescribed as liquid syrup means the pleasurable feelings derived from methadone are far milder than those produced by - say - injection of heroin.

Although methadone produces a mild sense of well-being and relief of stress similar to that of heroin, this does not mean that methadone is a weak alternative to that drug. For it to work effectively, methadone needs to be as powerful as heroin and many addicts have stated that withdrawal from methadone is worse.

Abuse of methadone

Abuse of methadone can take several forms:

- conning a doctor into prescribing a higher dosage than is required;

- taking more than the recommended dosage;

- taking methadone in combination with other drugs, including alcohol;

- using methadone as a 'top up' drug while continuing to take heroin;

- selling prescribed methadone in order to buy heroin.

A serious problem with much of the methadone prescription in the past was that heroin addicts were often given sufficient methadone to last one week - or even one month. As a result, addicts commonly sold their prescribed methadone in the illicit drug market. Schoolchildren have been found in possession of this drug and several have died. It is more common practice today to require addicts on methadone maintenance programmes to collect their prescription from a clinic or pharmacy daily - and to swallow this under observation. This is to prevent methadone from entering the illicit market.

In 1996 more than twice as many people died in the UK from methadone-related causes than died from taking heroin. This casts doubt on the usefulness of methadone maintenance programmes and illustrates the danger inherent in its abuse.

Consequences of methadone use and abuse

Consequences for health

If methadone is taken as intended by the prescribing doctor it causes no damage to the physical health of the user, apart from minor symptoms such as constipation, small pupils, sweating and itchy skin. The dangers to health associated with illicit heroin or morphine - such as HIV or hepatitis infection, overdose or poisoning are not present.

Taking extra methadone above the recommended dose or mixing it with other depressants such as temazepam, alcohol or even heroin is very dangerous. This can - and does - commonly result in overdose and death of the user.

Withdrawal symptoms occur when a regular dosage of methadone is halted. Although these develop more slowly and are less severe than those associated with morphine and heroin withdrawal, they are more prolonged and in many respects more unpleasant.

Dependence

Tolerance to methadone, (where more and more of the drug must be taken to achieve the same effect) and physical/psychological dependence on the drug may occur. Anecdotal evidence appears to suggest that methadone is equally as addictive as heroin, although the attraction of injecting a 'fix' (a large part of psychological addiction) is not present.

Legal consequences

Methadone is a class A drug and it is only legal for a person to possess methadone if it has been prescribed for that individual. If prescription for an individual involves drinking the methadone syrup within the clinic or pharmacy dispensing it, possession of the drug outside of those premises would constitute an offence - it would be unlawful possession.

The maximum sentence for unlawful possession of methadone is 7 years imprisonment and an unlimited fine. The maximum sentence for supplying methadone (including giving some to a friend) is life imprisonment and an unlimited fine.

Methadone maintenance programmes

Methadone maintenance is commonly used as a form of treatment for opiate addiction in the UK because it could break the cycle of dependence on illicit drugs like heroin. Although methadone does not produce the same 'high' as heroin, it does prevent withdrawal symptoms and (hopefully) reduces the craving to use other opiates.

The underlying rationale of methadone maintenance is that if patients are receiving methadone, they are not inclined to seek out and buy illegal drugs on the street, or engage in criminal activities to fund illicit drug use. Also, the health risks associated with injection of illicit drugs are removed.

This approach to heroin addiction is often referred to as 'harm reduction' or 'harm minimisation' as its primary aim is not so much to encourage addicts to stop using drugs but simply to attempt to reduce the damage that such use causes to addicts and society.

It has been demonstrated that the probability of a methadone maintenance programme helping a heroin addict to become abstinent from all drugs - or at least find a stable lifestyle - is increased if other help, such as counselling, advice and support is also accepted.

Problems associated with methadone maintenance

Methadone has been accused of acting only as a palliative to the problem of heroin addiction and simply prolongs drug addiction within any individual. Prescription of a substitute for heroin offers no incentive to abstain from using drugs and many addicts simply use it as a free 'top up' to their existing illicit drug consumption.

While methadone prescription for a short period to counteract the symptoms of heroin withdrawal must have a place in addiction treatment, its widespread use could increase the number of chemically dependent individuals.

Abuse of methadone maintenance programmes is common, particularly when the drug is dispensed on a weekly basis rather than daily. Prescribed methadone is frequently encountered on the illicit market and has recently been associated with a greater number of overdose deaths than has heroin. As previously mentioned, many addicts have stated that it is physically more difficult for addicts to stop using methadone than it is to stop using heroin.

While methadone maintenance does represent a low-cost form of treatment for opiate addicts (and this may be its main attraction), it offers little or no incentive for an addict to stop taking drugs.

'Magic' Mushrooms

What are they?

Many species of fungi possess psychedelic properties and about a dozen of these grow wild in the UK. The most common is the Liberty Cap - Psilocibe semilanceata, which is commonly referred to as a 'Magic mushroom'.

The original 'magic mushroom' is in fact another, not so common hallucinogenic fungi seen in the UK called Fly Agaric (Amanita muscaria). This is easily recognisable as a red toadstool with white warts, often depicted in cartoons as the cute red and white spotted variety from 'Alice In Wonderland'.

Medicinal uses

None in modern medicine. Although fungi of various sorts have been used as medicines and for ceremonial/spiritual purposes in cultures across the world for thousands of years.

As far as can be judged, their use was largely restricted to shamans etc. who may have used hallucinogenic fungi to enter a trance or see visions in order to fulfil a role within their community.

Use/abuse of mushrooms

Psilocybe mushrooms grow after rain in late summer and autumn in the UK. They are often found on cowpats in cattle grazing areas - which may or may not say something about their 'magical' value.

Fly Agaric grow in or near woodland.

Those who chose to ingest mushrooms eat them fresh - immediately after picking - or preserve them by drying to be eaten later. Some people brew a 'tea' made from them or use them in cooking.

Mushrooms were popular as an hallucinogenic drug in the 'hippie' culture of the late 1960's and 1970's. They have retained their popularity partly because they are seen as a 'natural' high and also because they cost nothing to obtain.

How do they work?

The primary active ingredients of Psilocybe mushrooms are psilocybin and psilocin - and to a lesser extent baeocystin and norbaeocystin. These chemicals bear a close resemblance to the neurotransmitter serotonin and the hallucinogenic effect of psilocybe mushrooms is probably caused by their interference with the normal actions of brain seretonin.

It's likely that LSD (which is synthesised from ergot - a fungus that grows on grains) works in a similar fashion.

Fly Agaric contains mycoatropine and muscarine, together with two other less poisonous compounds, muscimol and ibotenic acid. These are seriously nasty chemicals that basically irritate the brain and have an hallucinogenic effect. They also induce sweating and can cause delerium and coma.

What effect do they have?

Psilocybe

The effects of Psilocybe mushrooms are similar to a mild LSD 'trip', that is, they alter the perception of sight, sounds etc. and change the feelings and thoughts of the user. They take effect after about 30-45 minutes, peaking after about 3 hours, and last for around 4 or 5 hours altogether.

At low doses, euphoria, a sense of well being and a feeling of detachment occur, along with some mild distortion of perception. There is less dissociation than occurs with LSD and so less chance of a 'bad trip' as the user still has some control over his or her thought processes. Nevertheless, the effect of psilocybe mushrooms is unpredictable and depends on the setting in which they are taken and the mental or emotional state of the user.

At high doses visual distortions and vivid hallucinations can take place.

Most mushrooms containing psilocybin cause some nausea and other physical symptoms before the mental effects take over.

Fly Agaric

This hallucinogenic agents in this fungus are more toxic that those found in psilocybe and the intensity of the experience is higher. After the mushroom is eaten, individuals often vomit and may have a severe headache for a short time. The heart rate speeds up and the pupils dilate.

The mental effects resemble a state similar to extreme alcoholic intoxication, with the added complication of vivid hallucinations. Bizarre behaviour of users is common, ranging from non-stop talking or shouting to complete unawareness of their surrounding.

The duration of the hallucinogenic experience depends on the amount of mushrooms eaten and can range from 7-8 hours to 2 days. The user usually then falls into a deep sleep and on waking will not remember his or her behaviour while 'high'.

The 'magic' myth

'Magic mushrooms' haven't got any magic! In fact, their alarming effects are the nasty, brutish - and sometimes not so short - result of disruptive, chemical interference with the body's nervous system.

Consequences of using mushrooms

The idea that - because fungi are living things - they provide a 'natural high' is crazy. The active constituents of these mushrooms are dangerous chemicals. Opium is a natural substance - it's highly addictitve. Belladonna (Deadly nightshade) is natural - it can kill.

Natural does not mean harmless.

Risk to physical health

Philocybe

Philocybe mushrooms are not poisonous in the sense that they can kill and no lethal dose is known. However, some people react to them with vomiting, nausea and stomach pains. No serious long-term physical damage to health has been reported although it must be noted that no research has been carried out to assess the effects of frequent use.

The main risk to health from eating philocybe mushrooms comes from mistaken identity - collecting and eating poisonous varieties of mushrooms instead of the ones possessing the desired hallucinogenic properites. Some of these other fungi can cause death or permanent liver damage within hours of ingestion. Distinguishing hallucinogenic mushrooms from poisonous ones can be very difficult and sometimes almost impossible.

Risks to physical safety are likely to result from an individual's behaviour while under the influence of psilocybin. This may include irresponsible behaviour which could lead to an accident or injury.

Fly Agaric

Fly Agaric is poisonous as well as being hallucinogenic. Its toxicity is mainly due to the presence of mycoatropine, which causes disorders of mental activity. The content of another poisonous agent, muscarine, is relatively small. Eating them can cause permanent physical damage, or even death.

Fly Agaric itself is moderately toxic, but it should be remembered that species from the Amanita genus cause 95 percent of all deaths from mushroom poisoning. Fly Agaric's closest relatives are Amanita virosa (Destroying Angel) and Amanita phalloides (Death Cap) - the names say it all.

So, consuming Fly Agaric can be very dangerous for an individual's physical safety as so much depends on correct identification of the fungi. If a person is collecting mushrooms to eat for their hallucinogenic properties, one mistake could be their last mistake. Death by Amanita poisoning is reportedly an excruciating way to die. Even more horrifying is that the fatal symptoms only start to appear 2-3 days after eating the mushrooms - and by then it's too late.

Tolerance and Dependence

As with LSD, tolerance to the active ingredients in hallucinogenic mushrooms develops quickly and the day following a mushroom 'trip' it may take twice the original dose to produce the same effect.

There are no significant withdrawal symptoms from hallucinogenic mushrooms and no physical dependence appears to take place. There may be a strong desire to repeat the experience, which could be indicative of some degree of psychological dependence.

Legal consequences

The possession and use of hallucinogenic mushrooms in their natural form is not illegal in the UK. However, if they are prepared in any way, i.e. dried, crushed, cooked or brewed into tea, they then become a Class A drug. The penalties for possession or supply of a Class A drug are severe.

Tranquillisers

What are they?

Tranquillisers are synthetic drugs that are intended to reduce anxiety and help people to sleep. Benzodiazepines are the most commonly prescribed of these drugs, which include the well known brands such as Valium and Temazepam.

Medicinal uses

Benzodiazepines are frequently prescribed for the treatment of anxiety and insomnia. They are also used as sedatives before some surgical and medical procedures and for the treatment of some seizure disorders and alcohol withdrawal.

Because they are considered to be safer and more effective, benzodiazepines have largely replaced barbiturates in the treatment of both anxiety and insomnia.

The first benzodiazepine to be produced was chlordiazepoxide, commonly known as Librium. Diazepam (Valium) was the next to be developed and until the early 1980s this was the most widely prescribed tranquillizer in the world. Now, newer benzodiazepines such as Lorazepam (Ativan) account for most tranquillizer prescriptions.

Use and abuse of tranquillisers

Benzodiazepines are the most commonly prescribed drugs in Britain. Twice as many women take them as men and, where they have been prescribed over a long period of time, many patients have become dependent upon them.

The easy availability of tranquillisers has made them common as drugs of abuse. Some drug abusers take tranquillisers to bring them down after using stimulants such as ecstasy or cocaine. Others take them to 'enhance' the effect of alcohol. They are also used as replacement drugs when an addict's drug of first choice - such as heroin - is not available.

Tranquillisers are not generally injected but Temazepam capsules, known as 'jellies' or 'eggs' became a very popular injected drug among addicts in the late 1980's and early 1990's. Because of this they were banned in 1996, although the tablet form is still available.

What effect do they have?

Tranquillisers act as sedatives to lower anxiety and as hypnotics to assist sleep. Many tranquillisers have both effects, often having a sedative effect at low doses and a hypnotic effect at high doses.

A prescribed dose of tranquillisers will usually exert a mild calming effect. Larger doses may cause drowsiness, lethargy dizziness and lack of co-ordination.

Any Benzodiazepine in a high enough dose can act as a hypnotic and induce sleep. The hypnotic effects can last for 3 to 6 hours but this depends on the type of drug used.

If tranquillisers are mixed with other depressant drugs their effect is amplified. For example, drug abusers commonly take tranquillisers with alcohol as tranquillisers exaggerate the effect of drink. Such a combination can cause irrational or aggressive behaviour and is a common cause of injury or death.

Consequences of tranquilliser abuse

Consequences for health

Generally speaking, a low dosage of tranquillisers prescribed for a short time only is unlikely to pose any greater risk to health than the symptoms, such as anxiety and insomnia, they are intended to relieve.

A prescribed dose of tranquillisers is generally well tolerated and has a wide margin of safety, so a fatal overdose of these drugs alone is very rare. Nevertheless, overdoses - either accidental or intentional - do happen. While death rarely results from tranquillizer overdose alone, these drugs can be fatal when used in combination with alcohol, heroin or other depressant drugs.

Tranquillisers inhibit mental activity and alertness and impair driving and similar skills that require concentration.

Death or injury can easily occur where tranquillisers are mixed with other drugs without appreciation of the dangers. For example, alcohol can 'magnify' the effect of tranquillisers two or threefold. Driving a vehicle would then be very hazardous indeed, even when the individual doses of tranquillisers and alcohol are small.

Tranquillisers can sometimes release aggression by lowering the inhibitions of any user. This can result in violent or irrational behaviour that can pose a risk of injury or death to the user or others.

Dependence

Research has suggested that physical dependence on tranquillisers occurs even with a medically prescribed dose, as the patient's body adapts to the presence of the medication. This is demonstrated when a patient suddenly stops taking a prescribed tranquillizer - particularly a high dose regimen - as withdrawal symptoms occur. These symptoms can be unpleasant and long-lasting. They include an inability to sleep, sweating, anxiety, loss of appetite, nausea and sometimes convulsions and mental confusion.

The risk of physical dependence increases if tranquillisers are taken regularly for more than a few months, especially at higher than normal doses. However, problems have been reported after shorter periods of use.

A physician may decide to taper off the dosage of a tranquilliser prescription over a period of time to allow a patient to relinquish tranquillisers without suffering too much in the way of withdrawal. This may be particularly necessary where the patient has been taking tranquillisers for a long period.

Psychological dependence is common in users with a long-term tranquilliser prescription. There may be great fear concerning the thought of living without the drug. After they have stopped using tranquillisers, patients may be confused, irritable and anxious and unable to carry on with their normal routine.

Where illicit users, i.e. those who have acquired the drug on the black market, abuse tranquillisers, the risk of dependence is high as they are likely to take a far higher dosage than is normally prescribed.

Legal consequences

All tranquillisers are drugs that are legally available only to members of the public who have a valid doctor's prescription.

Benzodiazepines (e.g. Temazepam) are classified as Class C drugs under the Misuse of Drugs Act 1971. It is an offence to possess them without a doctor's prescription. It is an offence to supply them to another person. However, if Temazepam is illicitly prepared for injection, then it becomes a Class A drug under the 1971 Act. Penalties for possession and/or supply of Class A drugs are very high.

Prepared by Paul Roberts in UK