Between Politics and Reason

  Appendix   A Brief Guide to Drug Effects

    Erich Goode — State University of New York, Stony Brook

For the purposes of this book, the definition of drugs that pivots on psychoactivity makes the most sense, since drugs that influence the mind are often used for the purpose of intoxication or getting high, and, in turn, many users who seek intoxication use substances that achieve that intoxicating effect frequently, compulsively, chronically, and in an abusive manner. To take the process a step further, publics have become concerned, and legislatures have attempted to curtail, such abuse. Legislation which attempts to control such abuse, and whether it represents a workable and wise approach, are the subjects of this book. Hence, my focus on psychoactivity.
    Different psychoactive drugs have very different sorts of effects on the human mind. Drugs are classified according to type, that is, according to the nature of their effects. Drugs are placed together in the same category, or put into different categories, because of the similarities and differences in these effects. To be more specific, since all drugs have multiple effects, a drug is classified according to the nature of its "main" or "principle" effect. (Side effects are those the classifier is less interested in than the "main" effect.) Below, I will summarize the effects of the most important of the psychoactive drugs, according to a commonly agreed-upon classification scheme. Following common practice, I capitalize trade or brand names (examples: Seconal, Dexedrine, Prozac) and use the lowercase letter for generic, general, or chemical names (barbiturate, amphetamine, morphine). For a more detailed, book-length, discussion of the effects of the drugs and drug types discussed here, see Goldstein (1994), Julien (1995), and Ray and Ksir (1993).
    Some drugs energize, speed up, or "stimulate" signals passing through the central nervous system (the CNS), that is, the brain and spinal column. They are called stimulants, and they include amphetamine, methamphetamine, and cocaine. A second category retards, slows down, or "depresses" signals passing through the CNS; they are referred to as depressants, and they include the sedatives (such as barbiturates) and alcohol. Tranquilizers or "antianxiety agents," such as Valium and Halcion, are closely related to the sedatives. A third category of drugs comprises those whose principal action is "obtunding" or suppressing pain; they are referred to as narcotics or analgesics, and they include the opiates, or the natural derivatives of opium (principally, opium, morphine, heroin, and codeine) and the opioids, or artificial narcotics. A fourth category includes drugs which induce profound alterations in perceptions of reality; they are referred to as hallucinogens or psychedelics; they include LSD, peyote and mescaline, and psilocybin. Marijuana's effects are so different from the others that it is usually placed in a category of its own. In addition, there are several other psychoactive drugs whose use is limited to psychiatry and medicine, that is, which are very rarely used recreationally, for the purpose of intoxication, and whose use almost never leads to abuse. They include the antipsychotics (Thorazine, Stelazine, Haldol) and the antidepressants (Prozac, Elavil, Nardil); they will not be discussed here, since hardly anyone is concerned with their legal status.

 

STIMULANTS

Someone taking low to moderate doses of stimulants will be more alert, aroused, and mentally acute; he or she will be able to focus on a given task with greater concentration than normally. In addition, stimulants generate a feeling of confidence, competence, and well-being, even a voluptuous sense of mastery. Stimulants generate the need to engage in physical activity. As we saw earlier, of all drugs, stimulants possess the greatest immediate sensual appeal. This means that when experimental subjects who are unaware of what they are taking are administered stimulants, they are more likely to say they enjoyed the effects of these drugs, and want to take them again, than any other drug or drug type. Amphetamine and cocaine are stimulants; methamphetamine ("crank," "crystal," "speed," or "ice") is closely related to, but somewhat more powerful than, amphetamine. "Crack" is a crystalline but impure form of cocaine. (Technically, nicotine is also a stimulant, except that it has too many side effects to fit comfortably into this category; caffeine is a stimulant, too, but its effects are mild and subeuphoric.) Stimulants, especially cocaine, are highly reinforcing, and a substantial proportion of users end up taking them frequently and abusively; that is, they become dependent on or "addicted" to these drugs. (Most are moderate in their use, however.) At higher, abusive, levels, a substantial proportion of users become irritable, anxious, compulsively focused on activities others regard as trivial, and even paranoid, psychotic, and violent. A very high proportion of persons who commit common street crimes, especially robbery, have cocaine in their system at the time of committing the crime for which they are arrested. Heavy, chronic abuse is accompanied by a strong craving for the drug, and abstinence will bring on withdrawal symptoms, including depression, anxiety, tremors, and even seizure.
    The effects of stimulants, as with all drugs, are highly dependent on route of administration, that is, how they are taken, as well as on dose, that is, how much of the drug is taken in a single episode of use. Cocaine and amphetamine are taken by four common routes of administration: first, intranasally, that is, by sniffing or "snorting"; second, by smoking or, to be more precise, by heating then inhaling the drug's vapors; and third, by injection; in addition, amphetamine may be taken orally, in the form of a capsule or tablet. Smoking is by far the quickest, most efficient means of using any drug, including the stimulants. With cocaine, including crack, smoking delivers a sudden, intense orgasm-like "rush" or jolt of pleasure directly to the brain within six to eight seconds of administration. Injecting the drug intravenously (IV), that is, directly into a vein, also generates an intense euphoric, ecstatic sensation, usually within 10 to 12 seconds. Typically, users who take stimulants by smoking or IV injecting will take fairly large quantities of the drug through this route, often 50 to 100 milligrams per "hit" or dose. Injecting directly into a muscle rather than a vein ("joy popping") produces a much slower and less intense high or intoxication. Intranasal administration (or "snorting") is an even slower, more inefficient means of getting high; for most users, its effects are voluptuously pleasurable, but less intensely so, slower to take effect, and more protracted, than is true for smoking and IV injection. The slowest, least efficient, and least intense means of getting high is oral administration, that is, by tablet or capsule, or by drinking the substance in liquid solution.

 

DEPRESSANTS

Depressants retard the activity of a wide range of organs and functions of the body. As a consequence, they reduce anxiety, release inhibition, and bring on sleep. In larger doses, they can induce unconsciousness and coma. An overdose of a sedative drug results from an inhibition of the breathing mechanism and, hence, deprives the brain of oxygen. Depressants also produce ataxia, or discoordination, and a lowering of an awareness of one's surroundings. In addition, they are highly addicting: If enough of any one of the depressants is taken over a long enough period of time and then use is discontinued, painful, life-threatening withdrawal symptoms will ensue—nausea, vomiting, chills, muscular spasms, and intense bodily aches and pains. With alcohol, these are known as "the DTs"—delirium tremens. Alcohol and barbiturates are known to cause brain damage if taken in sufficient doses over an extended period of time. Historically, alcohol and, in the first half of the twentieth century, barbiturates were used for a wide range of medical and psychiatric ailments, including insomnia and anxiety; however, as a result of the generality of their action, their addicting properties, the medical damage associated with their use, and their overdose potential, for the most part, this has been discontinued. Today, the number of legitimate medical uses for barbiturates is extremely limited. Methaqualone (Quaalude, or "'ludes"), a popular sedative of the 1970s, is no longer prescribed at all. At one time a popular street drug, in a sufficient dose, barbiturates produce a stuporous, dazed, half-conscious sensation—similar to being drunk—often accompanied by irritability and belligerence. Such use has declined sharply since the 1970s. At sufficiently large doses, antianxiety agents or tranquilizers have effects that are remarkably similar to the sedatives.

 

NARCOTICS

The narcotic drugs "obtund" or reduce the mind's sensation of pain; hence, they have been used for thousands of years as analgesics, or painkillers. (Aspirin, acetaminophen, or Tylenol, and ibuprofen are weak analgesics, but they have none of the other properties of the narcotics including intoxication.) Narcotics generate an intense, voluptuous, orgasm-like "rush" upon IV administration; produce a strong dependency or addiction; and can precipitate death by overdose in only 10 times the dose that generates a high or intoxication. Opium, which is derived from the opium poppy, has been smoked for millennia for both ecstasy and analgesia. Morphine, first isolated in the early 1800s, is derived from opium; it is even more effective both as an intoxicant and as a painkiller Heroin, in turn, is derived from morphine, and it produces a quicker and more intense high. The narcotic drugs that are derived from opium are generally referred to as "opiates." There are a number of synthetic or chemically produced narcotics ("opioids") as well, with effects very similar to the natural opiates—methadone, Demerol, fentanyl, and Dilaudid. All are addicting, produce an intense high, and can produce death by overdose. Heroin is the drug of choice among street narcotic addicts and abusers, but any of the other narcotic drugs will be substituted in the absence of a heroin supply. Until the late 1980s, the principal means by which street heroin addicts administered narcotic drugs was IV injection. However, recently, a new generation of abusers is taking heroin by means of smoking and snorting, often in conjunction with cocaine or crack cocaine.

 

HALLUCINOGENS

A group of drugs produces profound alterations in the user's perceptions of the material world. These drugs are often referred to as "hallucinogens," although this term is not entirely appropriate, since users are typically aware that these alterations are not literally or concretely "real"; in fact, true hallucinations are rare and take place only at very high doses. The term "psychedelic" is often used to refer to these drugs; it means that the mind works best (or is "made manifest") under their influence. Again, this designation is not altogether accurate either, since some perceptions of the world are reduced or distorted, while others are much more intense. There is no single term that is entirely appropriate for this drug type. LSD is the best known of the hallucinogens or psychedelics. Closely related to LSD in its effects are the peyote cactus, mescaline (the psychoactive ingredient in peyote), psilocybin (the so-called magic mushroom, or "'shrooms"), morning-glory seeds, and DMT. Some experts include Sernyl (PCP, or "angel dust") as a hallucinogen. But although some users of PCP experience hallucinations, the drug produces none of the profound alterations of perceptions of reality associated with the true psychedelics. It is best classified as a sedative and an analgesic with contradictory side effects. Likewise, MDMA, or "ecstasy," is often seen as a hallucinogen. Here, too, we observe none of the perceptual alterations associated with the true hallucinogens. Some observers prefer to refer to ecstasy as an "empathogen," or an agent which facilitates closeness with others.
    Psychedelic drugs have an extremely long duration of action; with LSD, the effects can last up to eight hours. Different sets of perceptions are likely to take place at different periods or phases of the experience. Perceptual alterations and distortions are extremely common in a psychedelic drug "trip." Colors will seem extremely vivid; solid objects are often seen as unstable, dynamic, in motion; time is said to stand still or lose meaning; the senses will blend or translate into one another, so that one will "hear" color or "taste" sounds (this is referred to as "synesthesia"); boundaries between oneself and the world and between disparate phenomena in the world will seem to dissolve; mental associations will tumble one after the other, seemingly uncontrollably; one will perceive parts of one's body, and the bodies of others, in a profoundly different way—skin will seem to turn green, for instance, or hair will seem to be made of snakes; emotional intensity or exaggeration is common; one will often have the sense that one's thoughts are momentous, extraordinary, profound; great swings in mood, from ecstasy to despair, are typically reported. The "psychotic episode," or extreme panic reaction—an emotional disturbance so serious that it requires professional attention—seems to be quite rare. Likewise, "flashbacks," or the uncontrollable return of psychedelic drug effects in the absence of having taken a drug, have been reported in a significant proportion—a minority—of users. In the 1960s, it was thought that LSD damaged chromosomes and produced birth defects in the children of mothers who took the drug. This proved to be a false alarm; the drug produces no such effects.

 

MARIJUANA

The effects of marijuana are so different from those of all other types of drugs that it is most often placed in a category of its own. One expert refers to it as "a unique sedative-euphoriant-psychedelic drug" (Julian, 1995, p.330). Very, very few users report the sorts of profound visual and perceptual transformations with marijuana that are common with the psychedelic experience; even then, they occur only at extremely high doses. Marijuana is a natural product of the hemp or cannabis plant; its psychoactive ingredient is tetrahydrocannabinol, or THC. Most marijuana contains the flowering tops and some leaves of the cannabis plant; hashish contains only the resin of the female plant. Most commercial-grade marijuana sold on the street in the United States is 2 to 5 percent THC; hashish can be as much as 10 to 15 percent. Some specially cultivated marijuana products, such as sinsemilla (cultivated "without seeds") contain as much THC as potent hashish, or more. In the United States, marijuana is most often smoked; its effects rarely last longer than three or four hours, and they typically begin to tail off or decrease gradually after a half hour to an hour after smoking. Since THC is not soluble in water, it is stored in the fat or lipid cells of the body, including the liver. Hence, metabolites of THC can be found in the body more than a week after one's last episode of use. This has caused some experts to fear that chronic marijuana use may produce an accumulation of THC over a period of time, which could prove to be harmful.
    Marijuana does not produce a "rush," or an intense, orgasm-like sensation, upon administration. Hence, it is not strongly dependency-producing, or "addicting." Users report feeling relaxed, peaceful, pleasant, mildly euphoric, lethargic, and drowsy. Intellectual and motor skills decline under the influence; short-term memory is temporarily impaired. Under the influence, users often report feeling hungry and finding many more things amusing than normally. Many of these effects fit in well with a variety of recreational activities, such as socializing with friends, listening to music, and making love. Most experts believe that death as a result of a marijuana "overdose" is next to impossible. Psychotic reactions seem to be extremely rare, especially considering the huge number of episodes of use. Most of the medical ravages of marijuana that were reported in the 1970s and early 1980s have not been confirmed by later research, with the exception of a decline in the efficiency and effectiveness of the lungs. The use of marijuana is associated with a decline in ambition and the motivation to succeed (the "amotivational syndrome"); it is not clear whether this is a direct effect of the drug or is an accompaniment of the characteristics of the persons who use it.

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