Last partial update: July 2016 - Please read disclaimer before proceeding
Classification of illicit substances
Drugs that act on the brain (psychoactive drugs) can be classified into two broad groups; those that stimulate brain activity and those that depress it. The commonly used drugs in each group appear in the table below.
Stimulant drugs tend to make people more alert and excited and have effects on the body such as raising pulse rate and body temperature. These effects are exaggerated in stronger drugs or when an overdose is taken, and this can lead to anxiety, agitation, hallucinations, aggression, and psychotic episodes. (A psychotic episode occurs when the person losses touch with reality. As might be expected, hallucinations commonly occur as part of these episodes.)
Depressant drugs are the most commonly used group and tend to slow down the brain, giving a calm relaxed feeling. When these are taken to excess they can slow the brain down so much that the person goes into a coma and eventually stops breathing. (This is the cause of deaths that occasionally occur with a heroine overdose.)
Types of drug commonly used in Australia (Listed in approximate decreasing order of use in Australia) |
|
Stimulants |
Depressants |
Caffeine |
Alcohol |
Nicotine |
Cannabis / marijuana |
Amphetamines |
Heroine |
Ecstasy |
GBH (‘Fantasy’) |
Methamphetamine (‘Ice’) |
Ketamine |
Cocaine |
|
LSD |
|
Nervous system stimulants (psychostimulants)
Numerous stimulants are used in Australia. As a group they are used to induce euphoria, increase energy, social interaction, alertness, thinking and sexual arousal. Peer pressure and experimentation are also reasons for use. Depressants such as alcohol, cannabis, ketamine and GBH are sometimes used with them to decrease the negative effects, such as anxiety and aggitation.
Many of these drugs are associated with after effects in regular users. After a ‘binge’, a period characterised by sleepiness, overeating and irritability / anxiety can occur for up to several days. (This is commonly called a ‘crash’.) In chronic users a withdrawal occurs on stopping these drugs. The initial withdrawal phase, lasting up to a week, is charaterised by mood swings, intense cravings and aggression. This is followed by a prolonged period of depression, lethargy and cravings that can last for months. Many find these symptoms too difficult to deal with and relapse back into regular use.
Stimulants are the most common cause of presentation at hospital casualties with psychosis, a mental condition characterised by lost contact with reality. Such presentations are often accompanied by marked agitation, paranoia, hallucinations and aggression and, not surprisingly, these people are very difficult for casualty staff to manage.
Frequent users often suffer from anxiety and depression, aggressive behaviour, impaired relationships and occasionally violent injury. They are often unemployed and occasionally involved in criminal activity.
These drugs are most commonly used by people participating in the ‘party / dance club scene’ (about 25 per cent use Ecstasy or Ice), injecting drug users, homosexual men and, to a lesser extent, the senior high school and tertiary student populations.
The most commonly used psychostimulants in Australia are amphetamines and the related drugs, methamphetamine (‘Ice’) and Ecstasy, and to a lesser extent cocaine.
Caffeine
See section at the end of the topic, ‘Nutrition: an introduction’
Amphetamines (Speed)
Amphetamines are a group of drugs that stimulate the central nervous system (brain). They are taken either by sniffing them through the nose, by injection, or in tablet or capsule form and are being increasing used in Australia. About 500,000 Australians used amphetamines in 2004, with the average age of first use being 20 years of age. (It is now the most commonly injected drug in Australia.) The drug is not sold in a pure form; it is mixed with a variety of other substances that can have harmful effects.
There are three main types of users;
- Infrequent or experimental users
- Regular users who may be dependent and are more likely to experience harm
- People who take amphetamines for a specific purpose, such as truck drivers, night shift workers and (occasionally) people wishing to maintain a lower weight.
Amphetamines make the user more energetic, alert and excited, which can lead to feelings of aggression and anxiety / panic and increased risk taking behaviour. They also cause blood pressure to rise, an increase in heart rate, faster breathing, and problems with sleeping. These effects are maximal at about one to three hours after oral administration and 15 minutes after injection and can last from a few hours to a few days. Large amounts can lead to headaches, dizziness, shaking, feelings of power and hostility, and may even lead to psychosis, where the person may suffer delusions (seeing things or hearing voices that are not there).
Long term use may result in dependence, significant depression, repeated violent behaviour, and recurrent episodes of psychosis. Dependent people also have social problems related to relationships, finances and employment.
Harm can also be associated with the method of use. Injecting drug use has similar problems to those described with heroin use. (See above.) Nasal use can permanently damage the nose and the sinuses.
Overdose can happen to any person using the drug and even small amounts can cause overdose symptoms in sensitive people. It can result in psychosis, heart attack, stroke, a very high fever and rarely even death.
Regular users of amphetamines are also likely to use other drugs, including alcohol and tobacco, sedatives (e.g. ketamine & GHB), and hallucinogens (e.g. LSD) and they often have concurrent mental illness such a anxiety and depression, making treatment more difficult.
Withdrawals in dependent users are associated with cravings, tiredness and prolonged sleep, anxiety and significant depression. Such symptoms usually last for short periods.
Reducing harm from amphetamines
- People already suffering from mental illness, particularly anxiety, depression or schizophrenia, should not use this drug as it may make symptoms worse.
- People should take heed of advice from others regarding any deterioration in their behaviour when taking the drug and avoid further use.
- Amphetamines should not be mixed with other drugs as this practice increases the risk of overdose. Sleep is a particular problem for regular users and they often take other drugs such as alcohol and sedatives to help them sleep, initiating a perpetuating cycle of drug use.
- The method of administration can also cause harm. The dangers involved with injecting drug use and advice regarding their minimisation was covered in the section on heroin use. The effects of long term nasal use are difficult to prevent.
- Amphetamines should not be used during pregnancy as they increase the risk of miscarriage, premature births and low birth-weight babies. The baby may also suffer from drug withdrawal.
- Increased risk taking activity associated with using amphetamines means that the user should not drive, use machinery etc when taking the drug.
Ecstasy
The use of Ecstasy is increasing rapidly, especially by young people at dance clubs etc and Australia has the dubious honour of being the world’s highest per capita user of the drug. About 1.2 million Australians have tried Ecstasy at some time. Ecstasy is the street term for a number of substances related to 3,4-methylendioxymethamphetamine (MDMA), which act as central nervous system (brain) stimulants. It is available most commonly as tablets, although a powder form which can be snorted or, rarely, injected is also available. It is popular with young adults with about 20 per cent of people in the 20 to 29-year age group having used the drug at some time. Most use it irregularly, with use twice a month (one or two tablets at a time) being common. The main reason for this is that people get used to the positive effects quickly and the negative effects become more prominent with increased use.
Like amphetamines, Ecstasy tablets are generally not sold in a pure form and can contain a wide variety of substances including amphetamines and ephedrine, depending on the supplier’s whim and there is no way of knowing what is contained in any particular ‘brand’ of tablet. (The tablets often have ‘brand names’ imprinted on them, such a ‘Love Hear’, ‘Blue Dove’, ‘CK’, ‘Mitsubishi’ etc.) The contents of popular tablet ‘brands’ can vary as there are many pill making machines in the community and popular brands of tablets can easily and quickly be copied. (As stated previously, one study found that about 10 per cent of Ecstasy tablets contain no MDMA at all.)
Ecstasy is chemically related to the amphetamines and has similar effects on the body. Its affects begin about 30 to 60 minutes after oral ingestion and usually last up to six hours, although effects have been known to last much longer (up to 30 hours). It facilitates energetic, continuous activity which is why it is used in dance clubs. It also gives a feeling of closeness to others, sometimes allowing people to make friends with complete strangers; a sometimes risky activity that can be taken advantage of. It does not enhance sexual activity. Unwanted effects include sweating, body tingling, increased heart rate and blood pressure, dry mouth, feeling hot with a risk of overheating, dehydration which causes significant thirst (dry mouth), jaw clenching, nausea, anxiety and there is a possible link to liver damage.
High doses can produce hallucinations, irrational behaviour, vomiting, insomnia and convulsions. Deaths have occurred due to over heating and dehydration, which are side effects of the active component, MDMA. Strokes also rarely occur and there is evidence that long-term use causes permanent brain damage. Cravings occur in chronic regular users when not taking the drug. Ecstasy can also produce a hang over effect with symptoms such as insomnia and muscle aches, and depression can occur with chronic users. About 10 per cent of users have suicidal thoughts.
About 25 per cent of users take prescription medication to improve the effect of the drug or lessen the withdrawal symptoms. Commonly used drugs include SSRI depressants, benzodiazepines and sildenafil (Viagra).
Reducing harm from Ecstasy
The harm reduction strategies are similar to those for amphetamines described above. There are, however, a few issues specific to Ecstasy use.
- Dehydration is a common problem and it is important to keep sipping water to prevent dehydration. However, drinking too much water has led to serious fluid overload in some people. To prevent problems with dehydration, a reduced dose (quarter of a tablet) should be used initially in people not used to the drug and the person should be accompanied by a non-user. Adverse reactions should be treated urgently in hospital emergency departments, not by friends of the user, as delay can have serious consequences. Occasional deaths occur with this drug. (Writing an ‘E’ on the hand of a user lets doctors know that they have been using Ecstasy and allows quicker treatment.)
- Preventing complications associated with administration is an issue with injecting users.
2CB
This drug (4-bromo-2,5-dimethoxyphenethylamine) is similar in structure to Ecstasy and has similar effects. It is relatively new to Australia and is taken in tablet form.
'Ice' (methamphetamine)
'Ice' is stimulant drug called crystal methamphetamine, which is available generally in a relatively pure form (80% purity); making it very powerful. It is similar to amphetamine but much stronger and much more addictive, with about two thirds of users becoming addicted. Its other names are 'crystal', 'rave', shabu, ox-blood, tina and 'meth'.
While less pure forms of methamphetamine have been used for some time in Australia and are not increasing, its availability in the more pure (and dangerous) ‘Ice form’ is increasing. (It is used twice as commonly as heroine.)
Like amphetamine, the drug acts to stimulate the central nervous system (brain); but it is much more potent than amphetamines. The drug increases self-confidence, making the user feel invincible and gives feelings of sexual power. The effects start from 5 minutes to 30 minutes after an oral dose is taken. (Effects come on more quickly with snorting or inhaling the drug. It is also often smoked in a glass pipe.) The effects are maximum at about one to three hours after oral administration and 15 minutes after injection and usually last about 6 to 8 hours (occasionally up to 12 hours) with a single dose but can last days with recurrent doses.
It is sold as a fine white powder or as clear, almost liquid-like rice grains. Unfortunately it can be fairly easily produced in 'make-shift' laboratories. Use can be via injection, swallowing, snorting, anally and by inhaling / smoking it through a glass pipe. Smoking delivers high levels to the brain very quickly.
Problems with metamphetamine use
As can be seen from the problems associated with its use described below, methamphetamine is a dangerous drug and should be avoided.
Psychological: Psychological symptoms include euphoria (a sense of well-being), insomnia (difficulty sleeping), irritability, nervousness, aggressiveness that can lead to violent behaviour, and in higher doses, confusion, severe anxiety and paranoia. Aggressiveness and hostility are particularly common, occurring in about 50 per cent of users. Psychosis, where the person using the drug experiences hallucinations, can last for several days and is a relatively common occurrence. (Feeling that there are 'bugs crawling under the skin' is an example.) The combination of hostility and hallucinations makes people very difficult to handle when under the effects of the drug. It is more common with high blood levels of the drug (such as with smoking) and is associated with both long- and short-term use of the drug. It usually stops within a week of ceasing the drug but symptoms can last for longer. (This can occur with any 'amphetamine-like drug.)
Depression: Feelings of intense sadness can follow the highs associated with using this drug.
Physical symptoms: Physical symptoms including increased physical activity, sweating, tremors, decreased appetite (which can lead to significant weight loss with long-term use), nausea and vomiting, stomach cramps, increased breathing rate, palpitations, shaking, dry mouth, an increase in body temperature and high blood pressure. 'Ice' can also cause liver and kidney damage. In addicted users, weight loss and nutrient deficiencies due to poor eating habits are common. Occasional deaths have occurred due to heart attacks, strokes, convulsions and high body temperature (hyperthermia). These deaths are more likely when methamphetamine is used in combination with another drug or drugs, especially heroin, alcohol and marijuana, and such use should especially be avoided.
Smoking 'ice' causes lung damage and its associated high blood levels increase the risk of overdose.
Sexually transmitted diseases: The feelings of sexual power associated with its use increases the tendency to engage in unsafe sexual practices, increasing the risk of HIV/AIDS, Hepatitis B, and other sexually transmitted diseases. Many new cases of HIV/AIDS in the USA (and probably Australia) have been associated with using this drug.Infection with HIV can also occur when the drug is administered intravenously.
Addiction: Addiction is common and occurs quickly. The drug can dominate people's lives, causing adverse changes in behaviour and personality that seriously affect both work, home and social life. Its use has been associated with an increased incidence of violent crime.
People who use Ice commonly use other illicit drugs also.
Reducing harm from methamphetamine
The harm reduction strategies are similar to those for amphetamines described above. However, this is a particularly dangerous drug and it really should be avoided altogether. Any one who chooses to use the medication should do so in as safe a manner as possible. This includes being sure that there is a competent person with the person using the drug who is able (i.e. not using any drug) and willing to help seek obtain medical help if needed.
Counselling from an experienced drug counsellor is the best form of treatment.
Cocaine
Cocaine is a central nervous system (brain) stimulant. There are different forms that are usually taken nasally, by injecting or rarely by smoking. Cocaine is used infrequently in Australia compared to other drugs, although injected use is increasing amongst users of other injected drugs. Peak effects occur about 5 to 10 minutes after injection and about 60 minutes after nasal administration. It has a short life and effects can diminish within an hour, which leads to repeated use and, in injecting users, an increased risk of blood borne infections such as HIV and hepatitis C.
As with many other drugs, it is not sold pure and is mixed with a variety of other substances, some of which are harmful. Its effects include becoming more excited, alert, confident and aggressive, all of which can lead to increased risk taking. The user’s heart rate becomes faster and he or she moves more quickly. Larger doses can cause dizziness, headaches, violent behaviour, difficulty concentrating, convulsions (fits), heart attacks and psychosis (imagining things such as voices). Long term use can lead to dependence, aggressiveness, and home, financial and work related problems. Other drug use is not uncommon, especially drugs such as sedatives, alcohol and marijuana, all of which help with the insomnia caused by cocaine.
Overdosage can cause breathing problems, heart failure, strokes and even death and is more likely with multiple drug use. Dependence and withdrawal symptoms occur in some people. These symptoms are usually short-lived and include cravings, nausea and vomiting, shaking, tiredness, hunger, depression and even feelings of suicide.
Reducing harm from cocaine
- Problems associated with drug injecting use need to be avoided (see section on heroin).
- Cocaine should not be used during pregnancy as it increases the risk of miscarriage, premature births and low birth-weight babies. The babies may also suffer from withdrawals.
- Increased risk taking means that the person should not drive or operate machinery etc when using the drug.
Hallucinogens
Hallucinogens are a group of drugs that work on the brain to cause hallucinations i.e. seeing, hearing, smelling and tasting things that are not there. These substances occur naturally in trees, fungi (‘magic mushrooms’) etc or can be made synthetically, an example being LSD. Some other drugs, such as ecstasy and cannabis, can cause hallucinations when taken in high doses.
LSD
LSD (Lysergic Acid Diethylamide) is the most commonly used hallucinogen. It is taken orally, usually as a tablet. Effects occur about 30 minutes after ingestion and can last up to 12 hours. Visual hallucinations are quite common, such as colours becoming very bright and distortions of space. Other effects include floating sensations, emotional swings from intense happiness to profound sadness, strange body sensations and changed thoughts. Sometimes the hallucinations can be frightening (‘bad trips’) and cause extreme anxiety or fear, paranoia, panic attacks and feelings of losing control. Aggression and self harm can very occasionally accompany these episodes. A long lasting LSD psychosis (lasting up to months) can rarely occur, usually when large, cumulative doses are taken in susceptible individuals.
There are no long term side effects although flash backs of sensations experienced during use can occur for months to even years after taking the drug. They are more common in regular users, can last up to several minutes and may occur without warning. Addiction to LSD is very rare and there are no withdrawal symptoms.
Reducing harm from LSD
- People who have not used the drug frequently should not take it alone. They should have a non-using friend with them to help them through possible ‘bad trips’. Ways to help a friend having a bad trip include:
- Changing the environment by moving to another room or changing the lighting and music. (These people are often paranoid and thus should not be forced to do things.)
- Do not leave them.
- Reassure them and help them relax. e.g. by breathing with them.
- Users should not drive, operate machinery or perform other similar tasks.
- Adverse reactions need to be treated in hospital emergency departments.
- People with an existing mental illness or a family history of schizophrenia should not take LSD.
- Pregnant women should not take LSD as it causes contractions of the uterus (womb).
Further reading
Teenagers, Alcohol and Drugs What your kids really want and need to know about alcohol and drugs. by Paul Dillon. Published by Allen & Unwin, 2009.
Further information
Alcohol and Drug Information Service in your state.
This service will provide information and/or advice regarding problems. They can also refer callers to health professionals that can help them personally regarding alcohol and other drug problems.
ACT Ph 6205 4545; NSW Ph 9361 8000 or 1800 422 599: NT 8981 8030 or 1800422 599; Qld Ph 3236 2414 or 1800 177 833; SA Ph 1300 131 340; Tas 1800 811 994; Vic Ph 9416 1818 or 1800 136 385; WA Ph 9442 5000 or 1800 198 024) Check directory assistance if these numbers have changed.
Australian Drug Information Network www.adin.com.au
Information about alcohol, tobacco and other drugs.
Australian Drug Foundation www.adf.org.au.
Another good general site regarding drug use; easy to access information about most types of drugs.
Family Drug Support 24 hour hotline www.fds.org.au
Ph 1300 368 186 (throughout Australia)
National Health and Medical research Council National Guidelines on Responsible Drinking https://www.nhmrc.gov.au/health-topics/alcohol-guidelines
National Cannabis Information and Prevention Centre https://ncpic.org.au
Brief Intervention: the Drink-less package (University of Sydney) http://sydney.edu.au/medicine/addiction/drinkless/index.php
This site the very helpful and commonly used alcohol reduction program ‘Drink-less’. It can be downloaded free or orders can be taken from the site.
Information for doctors
Specialist advice for doctors regarding drug and alcohol problems (24 hour service)
NSW: Drug and Alcohol Specialist Advisory Service: Ph: 1800 023 687 or (02) 9361 8006
Vic, Tas, NT: Drug and Alcohol Specialist Advisory Service. Ph: 1800 812 804 or (03) 9416 1818
ACT: Alcohol and Drug Program. Ph: (02) 6205 4545
WA: Dept of Health Clinical Advisory Service. Ph 1800 688 847 or (08) 9442 5042
Qld: Alcohol and Drug Information Service. Ph: (07) 3636 7098 or (07) 363607599