Addictive Drugs, Drug Addiction, and Drug Treatment
Cocaine and Crack
Oxycontin, Vicodin, Fentanyl,
Morphine, Methadone, Demerol, Percocet, Tramadol,
Darvon and Heroin
Marijuana is one of the most controversial substances
of abuse at this time. It works because our brain makes its own substance
(anandamide) which normally fits into the receptors(called cannabinoid
receptors on nerve cells) that marijuana fits into. This endogenous cannabinoid
system works as a regulator of many nervous system functions. Receptors
are found throughout the brain. Tetrahydrocannibol is the major ingredient
of marijuana but there are other cannabinoids present in the plant.
Marijuana is an addictive drug with hallucinogenic properties, obtained
from the flowering tops, stems, and leaves of the hemp plant. Resins found
on the surface of the female plant are used to prepare the most potent
form of marijuana, hashish. Marijuana produces a dreamy, euphoric state
of altered consciousness, with feelings of detachment and gaiety. The
appetite is usually enhanced, while the sex drive may increase or decrease.
Just as opiates mimic our endorphin system, marijuana mimics our endogenous
cannabinoid system. And, just as morphine and other opiates have medical
uses, there is the risk of addiction.
People may be against medical marijuana or legalization of marijuana
or others may be for these things or undecided. Supporters of marijuana
emphasize its medical benefits such as in the treatment of glaucoma or
high Blood pressure or nausea due to cancer. Still as a medicine it has
some side effects especially related to an increase in anxiety in some
people, panic attacks, weight gain and increased appetite and importantly,
the potential for abuse and addiction. Tetrahydrocannabinol is a powerful
chemical that can interact with the brain cannabinoid receptors which
are distributed around the brain and may affect Memory, learning and emotions.
The use of Marijuana can create a picture similar to ADD(attention deficit
disorder). Studies show heavy Marijuana use negatively impacts learning
and social behavior. Studies show impaired attention, memory, and critical
thinking. Compared to the light users, heavy marijuana users made more
errors and had more difficulty sustaining attention, shifting attention
to meet the demands of changes in the environment, and in registering,
processing, and using information. These findings suggest that the greater
impairment among heavy users is likely due to an alteration of brain activity
produced by marijuana.
So whether you are with or against THC for medicinal purposes, remember
it has side effects.
All forms of Marijuana are mind-altering, changing the way the brain
works. This drug also affects the lungs causing daily cough and phlegm,
symptoms of chronic bronchitis, and more frequent chest colds. Continuing
to smoke marijuana can lead to abnormal functioning of lung tissue injured
or destroyed by marijuana smoke. It also causes problems with heart rate
and blood pressure. A marijuana user’s heart rate can increase
when using marijuana alone.
Marijuana is not a good treatment for either anxiety or depression.
Just as alcohol and other drugs may be taken by people trying to deal
with anxiety and depression, the suppression of these feelings, which
may stem from distress, grief or loss, will only lead to the person getting
emotionally sicker as these feelings are not dealt with or respected.
When a person is addicted to Marijuana they may find it hard to stop
its use despite their awareness of problems caused by Marijuana. Conversely,
the person may feel such a need for marijuana that they find it hard to
accept that Marijuana is causing problems which those around them see
to be directly related to Marijuana use.
For some people coming off Marijuana may be difficult. They may experience
an increase in anxiety and a difficulty with getting to sleep and craving
for Marijuana. Since Marijuana is a fat soluble molecule, it is stored
in the fat. When Marijuana is stopped, the fat will still release the
Marijauna that is stored there. Heavy Marijuana users may find that it
can take as long as a month for Marijuana to no longer be found in the
Recovery from Marijuana dependence begins with stopping the drug and
letting the body restabilize itself. The person reduces the risk of relapse
by participating in a structured program of recovery which includes a
12 step program. Structured programs help teach the person a different
way of reacting to life that does not need Marijuana as a coping tool
or as a way to enjoy life.
Adverse reactions are relatively rare, and most can
be attributed to adulterants frequently found in marijuana preparations.
Marijuana is a dry, shredded green/brown mix of flowers, stems, seeds,
and leaves of the plant Cannabis sativa, it usually is smoked as a cigarette
(joint, nail), or in a pipe (bong). It also is smoked in blunts, which
are cigars that have been emptied of tobacco and refilled with marijuana,
often in combination with another drug. It might also be mixed in food
or brewed as a tea. As a more concentrated, resinous form it is called
hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a
pungent and distinctive, usually sweet-and-sour odor. There are countless
street terms for marijuana including pot, herb, weed, grass, widow, ganja,
chronic, and hash, as well as terms derived from trademarked varieties
of cannabis, such as Bubble Gum, Northern Lights, Fruity Juice, Afghani
#1, and a number of Skunk varieties. The main active chemical in marijuana
is THC (delta-9-tetrahydrocannabinol). The membranes of certain nerve
cells in the brain contain protein receptors that bind to THC. Once securely
in place, THC kicks off a series of cellular reactions that ultimately
lead to the high that users experience when they smoke marijuana.
Effects of Marijuana
If the person uses cocaine at the same time, severe
increases in heart rate and blood pressure can occur. Research also shows
more anger and more regressive behavior (thumb sucking, temper tantrums)
in toddlers whose parents use marijuana than among the toddlers of non-using
As with any drug of abuse, a mother's health during pregnancy can be
affected, making it a time when expectant mothers should take special
care of themselves. Drugs of abuse may interfere with proper nutrition
and rest, which can affect good functioning of the immune system. Some
studies have found that babies born to mothers who used marijuana during
pregnancy were smaller than those born to mothers who did not use the
drug. In general, smaller babies are more likely to develop health problems.
A nursing mother who uses marijuana passes some of the THC to the baby
in her breast milk. Research indicates that the use of marijuana by a
mother during the first month of breast-feeding can impair the infant's
motor development (control of muscle movement).
A drug is addicting if it causes compulsive, often uncontrollable drug
craving, seeking, and use, even in the face of negative health and social
consequences. Animal studies suggest marijuana causes physical dependence,
and some people report withdrawal symptoms.
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Cocaine is a drug derived from coca leaves, producing
euphoria, hallucinations, and temporary increases in physical energy.
Prolonged use can cause nervous-system aberrations (including delusions),
general physical deterioration, weight loss, and addiction. Withdrawal
from the drug can produce severe depression.
Cocaine is a powerfully addictive stimulant that directly affects the
brain. Cocaine has been labeled the drug of the 1980s and 90s, because
of its extensive popularity and use during this period. However, cocaine
is not a new drug. In fact, it is one of the oldest known drugs. The pure
chemical, cocaine hydrochloride, has been an abused substance for more
than 100 years, and coca leaves, the source of cocaine, have been ingested
for thousands of years.
There are basically two chemical forms of cocaine: the hydrochloride
salt and the "freebase." The hydrochloride salt, or powdered
form of cocaine, dissolves in water and, when abused, can be taken intravenously
(by vein) or intranasally (in the nose). Freebase refers to a compound
that has not been neutralized by an acid to make the hydrochloride salt.
The freebase form of cocaine is smokable.
Cocaine is generally sold on the street as a fine, white, crystalline
powder, known as "coke," "C," "snow," "flake," or "blow." Street
dealers generally dilute it with such inert substances as cornstarch,
talcum powder, and/or sugar, or with such active drugs as procaine (a
chemically-related local anesthetic) or with such other stimulants as
Crack is the street name given to the freebase form of cocaine that
has been processed from the powdered cocaine hydrochloride form to a smokable
substance. The term "crack" refers to the crackling sound heard
when the mixture is smoked. Crack cocaine is processed with ammonia or
sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride.
Because crack is smoked, the user experiences a high in less than 10
seconds. This rather immediate and euphoric effect is one of the reasons
that crack became enormously popular in the mid 1980s. Another reason
is that crack is inexpensive both to produce and to buy.
Source: U.S. Department of Health and Human Services Department of
Health and Human Services. National Institute on Drug Abuse. (2002, February
18). NIDA Research Report Cocaine Abuse and Addiction (PHD813,
NIH Publication No. 99-4342) Washington, DC: U.S. Government Printing
Office. Retrieved October 03, 2002 from www.drugabuse.gov/ResearchReports/Cocaine/cocaine2.html#what
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Amphetamine, dextroamphetamine, methamphetamine,
and their various salts are collectively referred to as amphetamines.
In fact, their chemical properties and actions are so similar that even
experienced users have difficulty knowing which drug they have taken.
Methamphetamine is the most commonly abused.
Amphetamines are a class of powerful drugs that act as stimulants on
the central nervous system. Popularly known as "bennies," "speed," or "uppers," amphetamines
enhance mental alertness and the ability to concentrate; cause wakefulness,
talkativeness, and euphoria; and temporarily reverse the effects of fatigue.
They have been used to treat obesity, narcolepsy, and minimal brain dysfunction.
Some of the short-term effects of amphetamines are: hallucinations,
insomnia, feelings of exhilaration and energy, rapid breathing, increased
heart rate, elevated blood pressure, as well as such severe systemic disorders
as cardiac irregularities and gastric disturbances.
Long-term side effects of using amphetamines are tremors, loss of coordination,
irritability, anxiousness, restlessness, delirium, panic, paranoia, aggressiveness,
impulsive behavior, rapid or irregular heartbeat, reduced appetite, weight
loss, and even heart failure. The drugs are addictive and easily abused;
addiction can result in psychosis or death from over-exhaustion or cardiac
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Opioid dependence is one of the most common addictions in today’s
society and Santa Barbara is no different than any other community. This
category of addiction includes: prescriptions pain medication such as
Oxycontin, Vicodin,Fentanyl, Morphine, methadone, Demerol, Percocet, Tramadol,
and Darvon as well as illicit drugs such as heroin. Unfortunately, Opioid
Dependence does not differentiate between people because of socioeconomic
status or education and it is not uncommon to see patients with opioid
dependence who are professional successful people who have to struggle
with the secret of addiction. At Recovery Road Medical Center we have
physicians who are Board Certified in Addiction and are able to help the
patient with medical detox or withdrawal which always had been an obstacle
So what is opioid dependence
Opioid tolerance, dependence, and addiction are all
manifestations of brain changes result-
ing from chronic opioid abuse. The brain changes chemically to
adapt to the presence of the drugs and the drugs reward and strengthen brain
pathways and habits that lead to using the drug.
The opioid addict’s struggle for recovery is in great part a struggle to
overcome the effects of these changes. Medications such as buprenorphine, methadone,
and naltrexone act on the same brain structures and processes as addictive opioids,
but with protective or normalizing effects. Despite the effectiveness of medications
in stabilizing the imbalance caused by the drugs, they must be used in conjunction
with appropriate psychosocial treatments to help the addict’s brain learn
new ways of finding reward and feeling safe.
Why is it addictive
Brain changes resulting from chronic use of heroin,
oxycodone, and other morphine-derived drugs are
the underlying causes of opioid dependence (the need
to keep taking drugs to avoid a withdrawal syndrome)
and addiction (intense drug craving and compulsive use). Some of the biochemical
abnormalities that produce dependence, appear to resolve after detoxification,
within days or weeks, after opioid use stops. The adaptations and brain
pathways that produce addiction, however, are more wide-ranging, complex, and long-lasting.
They may involve an interaction of environmental effects, for example, stress,
the social context of opiate use, and psychological conditioning, and a predisposition
in the form of brain pathways that were abnormal even before
the first dose of opioid was
taken. Some of these brain pathways may be due to
genetics and others may be the result of how the
connections have developed since childhood. Such
brain changes can produce craving that leads to relapse
months or years after the individual is no longer
opioid dependent. At Recovery Road Medical Center we work on addressing
all the above mentioned factors.
ORIGINS OF DRUG LIKING
both individual and environmental, influence whether a particular person
who experiments with opioid drugs will continue taking them long enough
to become dependent or addicted. For individuals who do continue to use
the drugs, the opioids’ ability to provide intense
feelings of pleasure and/or a secure sense of safety are critical
reasons. When heroin, oxycodone, or any other opiate
travels through the bloodstream to the brain, the chemicals attach to
specialized proteins, called mu opioid receptors, on the surfaces of opiate-sensitive
neurons (brain cells). The linkage of these chemicals with the receptors
triggers the same biochemical brain processes that reward people with
feelings of pleasure when they engage in activities that promote basic
life functions, such as eating and sex or reduce a sense of alarm or terror such
as escaping danger and feeling secure. Opioids are prescribed therapeutically to relieve
pain, but when opioids activate these reward and safety processes, they
can motivate repeated use of the drug simply for pleasure or to feel safe.
One of the brain circuits that is activated by opioids
is the mesolimbic (midbrain) reward system. This
system is deep in the primitive survival brain and
generates signals in a part of the brain called the ventral tegmental
area (VTA) that result in the release of the chemical dopamine (DA) in
another part of the brain, the nucleus accumbens (NAc) (also called the
Reward Center). This release of DA into the NAc causes feelings of pleasure.
Other areas of the brain create a lasting record or memory that associates
these good feelings with the circumstances and environment in which they
occur. These memories, called conditioned associations, often lead to
the craving for drugs when the addict re-encounters those persons, places,
or things, and they drive the user to seek out more drugs in spite of
many obstacles. Particularly in the early stages of abuse, the opioid’s stimulation of the brain’s
reward system or its ability to provide a feeling of safety are the primary
reasons that some people take drugs repeatedly.
At Recovery Road Medical Center we are proud of providing our comprehensive
service in Santa Barbara starting by having the patient see a specialist
within 24 hours from the phone call and if the patient is in need of detox,
the specialist will contact the Doctor the same day. Once the addiction
is stabilized, then the program works to help retrain the person’s
reactions to internal and external cues that produce craving for the drugs.
Medications used for treatment of opioid dependence
When a person comes for treatment for opiate dependence, the doctor
reviews with them the choice of detoxing off opiates and restabilizing
their nervous system off opiates or stabilizing the nervous system with
long acting opiates that do not trigger the reward systems in the same
way as the opiates the person was using, but provide relief from craving
and allow the person to begin the process of retraining without having
Some medications are used to help the nervous system detoxify from opiates.
These medications are often given in a hospital setting and the person may
require a week or so of this treatment to effectively go through the acute
withdrawal. Subacute withdrawal symptoms may be treated by other medications
as an outpatient. For many patients however, this approach has not been
effective due to the severity of the addiction, and it is better
to put the patient on long acting opiates that have been shown to stabilize
withdrawal but do not produce euphoria. These long-term pharmacotherapies
use medications that attach to the same receptors as the other opiates
but stimulate them in a different way so that the memory records the experience
in a different way.
The physicians at Recovery Road Medical Center are able to assist patients
with both detoxification in the hospital as well
as outpatient detoxification or medication stabilization.
Both medical directors were two of the first physicians in Santa Barbara
to prescribe Suboxone. They are certified to prescribe Suboxone for detoxification
or maintenance treatment.
Buprenorphine’s action on the mu opioid receptors elicits two
different therapeutic responses within the brain cells. The drug binds
to the mu-receptors very tightly. This binding is much tighter than
morphine or heroin, but it doesn’t stimulate the receptors as strongly
as these drugs. Because of this dual action, Buprenorphine can relieve
craving and withdrawal but does not produce the rewarding effects of heroin
or other opiates. It also has the advantage that when one is on buprenorphine,
other opiate drugs such as heroin or morphine, can’t get to the
mu-receptor because the buprenorphine sticks to the receptor much more
tightly. Hence if a person tries to use opiates while on buprenorphine,
the other opiates don’t work. Buprenorphine also has an additional
safety measure in that it has a ceiling on suppressing
breathing. Most opiates, as the dose goes up, will suppress breathing
more. At low doses there is some slowing of breathing with buprenorphine,
but at higher doses of the drug, it does not suppress breathing more.
For the above reasons the FDA approved buprenorphine for the treatment
of opiate addiction in 2002. Several clinical trials have shown that when
used in a comprehensive treatment program with psychotherapy, buprenorphine
is an effective treatment for opiate dependence with results showing decreased
drug use, improvement in work, health and relationships, and a reduction
in legal problems.
Buprenorphine is available in 2 mg and 8 mg tablets.
The most common way that buprenorphine is prescribed
is as a combination tablet (Suboxone) which combines buprenorphine
with naloxone. Naloxone is an opiate blocking drug which is only active
if injected. It was added to negate the reward a user would feel if he
or she were to inject the medication. This is an added safety advantage
of Suboxone. The average dose used according to the manufacturer is 16
mg/day. The maximum dose approved by the FDA is 32 mg.
Methadone is a long-acting opioid medication. Unlike morphine,
heroin, oxycodone, and other addictive opioids that remain in the brain
and body for only a short time, methadone has effects that last for days.
Methadone causes dependence, but, because of its steadier influence on
the mu opioid receptors it alleviates craving and compulsive drug use.
With short acting drugs such as heroin or morphine the blood levels drop
down to zero in a matter of a few hours. With methadone it usually takes
over 30 hours for ½ of the medication to be metabolized. This allows the brain
level to be stable and hence it allows the patient’s moods to remain
stable and not be in a constant flux due to the level of the drug going
up and down. It also moderates the exaggerated cortisol stress response
that increases the danger of relapse in stressful situations. Methadone
treatment reduces relapse rates, facilitates behavioral therapy, and enables
patients to concentrate on life tasks such as maintaining relationships
and holding jobs. Pioneering studies by Dole, Nyswander, and Kreek in
1964 to 1966 established methadone’s efficacy. As a Drug Enforcement
Administration schedule II controlled substance, the medication by law
may only be administered for the treatment of opiate dependence in federally
regulated methadone programs, where careful monitoring of patients’ urine
and regular drug counseling are critical components
of rehabilitation. Patients are generally started on a daily dose of 20
mg to 30 mg, with increases of 5 mg to 10 mg until a dose of 60 mg to100
mg per day is achieved. The higher doses produce full suppression of opioid
craving and, consequently, opioid-free urine tests. Patients generally
stay on methadone for 6 months to 3 years, some much longer. Relapse is
common among patients who discontinue methadone after only 2 years or
less, and many patients have benefited from lifelong methadone maintenance.
At Recovery Road Medical Center we do not prescribe methadone for maintenance
but we do accept patients who are receiving Methadone.
Naltrexone is used to help patients avoid relapse after they have
been detoxified from opioid dependence. Its main therapeutic action is to monopolize
mu opioid receptors in the brain so that addictive
opioids cannot link up with them and stimulate the brain’s reward system.
Naltrexone clings to the mu opioid receptors 100 times more strongly than opioids
do, but it does not stimulate the receptor and therefore
does not promote the brain processes that produce feelings of pleasure.
An individual who is adequately dosed with naltrexone
does not obtain any pleasure from addictive opioids
and is less motivated to use them. Before naltrexone
treatment is started, patients must be fully detoxified from all opioids,
including methadone, otherwise, they will be at risk for severe withdrawal.
Naltrexone is given at 50 mg per day or up to 200 mg twice weekly. Patients’ liver
function should be tested before treatment starts, as some patients may experience
increases in liver enzymes with the medication. This is not a common problem,
but the testing is done as a precaution, especially since many patients who
have used iv drugs have contracted hepatitis B and/or
C. Unfortunately, medication compliance is a critical problem with naltrexone,
because unlike methadone or suboxone, naltrexone does not itself calm the nervous
system down or reduce craving. Many patients who have been detoxified from opiates,
still have a very reactive nervous system and have
a lot of craving. Poor compliance limits naltrexone’s utility to only
about 15 percent of heroin addicts.
Opioid dependence and addiction are most appropriately understood
as chronic medical disorders, like hypertension, schizophrenia, and diabetes.
As with these other disorders there are genetic and
environmental risk factors for the illness, and changes in the body as a result
of these illnesses.
With addiction, the effect of a drug on the reward
centers is dependent upon the person’s genetic make up, how the
nervous system has developed since childhood and
the current state of the nervous system at the time
of use. With repeated experience of the drug, the nervous system adapts
biochemically to the presence of the drug and the reward and safety circuits
of the brain begin to be trained that the drug is necessary for survival.
These circuits become strengthened and more automatic with repetition.
These changes then lead to both physical dependence and to addiction.
As with those other diseases, a simple cure for drug addiction is unlikely, and
relapses can be expected; but long- term treatment can limit the disease’s
adverse effects and improve the patient’s day-to-day functioning. The mesolimbic
reward system appears to be central to the development of the direct clinical
consequences of chronic opioid addiction, including tolerance, dependence,
and addiction. Other brain areas and neurochemicals, including cortisol,
also are relevant to dependence and relapse. Pharmacological interventions
for opioid addiction are one part of the treatment; however, given the
complex biological, psychological, and social aspects of the disease,
they must be accompanied by appropriate psychosocial treatments. At
Recovery Road Medical Center we are aware of the neurobiological basis
of opioid dependence and we look forward to assisting each patient in
helping to reverse the effects of these drugs on the patient’s brain
and on their lives.
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