Behavior characteristics associated with substance abuse

• Abrupt changes in work or school attendance, quality of work, work output, grades, discipline.
• Unusual flare-ups or outbreaks of temper.
• Withdrawal from responsibility.
• General changes in overall attitude.
• Deterioration of physical appearance and grooming.
• Wearing of sunglasses at inappropriate times.
• Continual wearing of long-sleeved garments particularly in hot weather or reluctance to wear short-sleeved attire when appropriate.
• Association with known substance abusers.
• Unusual borrowing of money from friends, co-workers or parents.
• Stealing small items from employer, home or school.
• Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion such as frequent trips to storage rooms, restroom, basement, etc.

Signs characteristic of use of specific substances

• Alcohol
• Marijuana
• Stimulants
• Depressants
• Opiates
• Inhalants
• Hallucinogens
• PCP (Angel Dust)

Signs of Alcohol Abuse

• Odor on the breath.
• Intoxication.
• Difficulty focusing: glazed appearance of the eyes.
• Uncharacteristically passive behavior; or combative and argumentative behavior.
• Gradual (or sudden in adolescents) deterioration in personal appearance and hygiene.
• Gradual development of dysfunction, especially in job performance or schoolwork.
• Absenteeism (particularly on Monday).
• Unexplained bruises and accidents.
• Irritability.
• Flushed skin.
• Loss of memory (blackouts).
• Availability and consumption of alcohol becomes the focus of social or professional activities.
• Changes in peer-group associations and friendships.
• Impaired interpersonal relationships (troubled marriage, unexplainable termination of deep relationships, alienation from close family members).

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Signs of Marijuana Abuse

• Rapid, loud talking and bursts of laughter in early stages of intoxication.
• Sleepy or stuporous in the later stages.
• Forgetfulness in conversation.
• Inflammation in whites of eyes; pupils unlikely to be dilated.
• Odor similar to burnt rope on clothing or breath.
• Tendency to drive slowly - below speed limit.
• Distorted sense of time passage - tendency to overestimate time intervals.
• Use or possession of paraphernalia including roach clip, packs of rolling papers, pipes or bongs.
• Marijuana users are difficult to recognize unless they are under the influence of the drug at the time of observation. Casual users may show none of the general symptoms. Marijuana does have a distinct odor and may be the same color or a bit greener than tobacco.

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Signs of Stimulant Abuse

COCAINE, CRACK, CRANK, SPEED, AMPHETAMINES

• Dilated pupils (when large amounts are taken).
• Dry mouth and nose, bad breath, frequent lip licking.
• Excessive activity, difficulty sitting still, lack of interest in food or sleep.
• Irritable, argumentative, nervous.
• Talkative, but conversation often lacks continuity; changes subjects rapidly.
• Runny nose, cold or chronic sinus/nasal problems, nose bleeds.
• Use or possession of paraphernalia including small spoons, razor blades, mirror, little bottles of white powder and plastic, glass or metal straws

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Signs of Depressant Abuse

BARBITURATES, TRANQUILIZERS

• Symptoms of alcohol intoxication with no alcohol odor on breath (remember that depressants are frequently used with alcohol).
• Lack of facial expression or animation.
• Flat affect.
• Flaccid appearance.
• Slurred speech.

Note: There are few readily apparent symptoms. Abuse may be indicated by activities such as frequent visits to different physicians for prescriptions to treat "nervousness", "anxiety","stress", etc.

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Signs of Opiate Abuse

What are opiates?

Opiates, sometimes referred to as narcotics, are a group of drugs that are used medically to relieve pain, but also have a high potential for abuse. Some opiates come from a resin taken from the seedpod of the Asian poppy. This group of drugs includes opium, morphine, heroin, and codeine. Other opiates, such as meperidine (Demerol), are synthesized or manufactured. Opium appears as dark brown chunks or as a powder and is usually smoked or eaten. Heroin can be a white or brownish powder that is usually dissolved in water and then injected. Most street preparations of heroin are diluted, or "cut", with other substances such as sugar or quinine. Other opiates come in a variety of forms including capsules, tablets, syrups, solutions, and suppositories.

Which opiates are abused?

Heroin ("junk", "smack") accounts for 90 percent of the opiate abuse in the United States. Sometimes opiates with legal medicinal uses also are abused. They include morphine, meperidine, paregoric (which contains opium), and cough syrups that contain codeine [or a synthetic narcotic, such as dextomthorphan].

What are the effects of opiates?

Opiates tend to relax the user. When opiates are injected, the user feels an immediate "rush." Other initial and unpleasant effects include restlessness, nausea, and vomiting. The user may go "on the nod," going back and forth from feeling alert to drowsy. With very large doses, the user cannot be awakened, pupils become smaller, and the skin becomes cold, moist, and bluish in color. Breathing slows down and death may occur.

Does using opiates cause dependence or addiction?

Yes. Dependence is likely, especially if a person uses a lot of the drug or even uses it occasionally over a long period of time. When a person becomes dependent, finding and using the drug often becomes the main focus in life. As more and more of the drug is used over time, larger amounts are needed to get the same effect. This is called tolerance.

What are the physical dangers?

The physical dangers depend on the specific opiate used, its source, the dose, and the way it is used. Most of the dangers are caused by using too much of a drug, the use of unsterile needles, contamination of the drug itself, or combining the drug with other substances. Over time, opiate users may develop infections of the heart lining and valves, skin abscesses, and congested lungs. Infections from unsterile solutions, syringes, and needles can cause illnesses approximately 24-72 hours after they begin, and subside within 7-10 days. Sometimes symptoms such as sleeplessness and drug craving can last for months.

What are the dangers for opiate-dependent pregnant women?

Researchers estimate that nearly half of the women who are dependent on opiates suffer anemia, 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 withdrawal symptoms, which may last several weeks or months. Many of these babies die.

What treatment is available for opiate addiction?

The four basic approaches to drug abuse treatment are: detoxification (supervised withdrawal from drug dependence, either with our without medication) in a hospital or as an outpatient, therapeutic communities where patients live in a highly structured drug-free environment and are encouraged to help themselves, outpatient drug-free programs which emphasize various forms of counseling as the main treatment, and methadone maintenance which uses methadone, a substitute for heroin, on a daily basis to help people lead productive lives while still in treatment.

How does methadone treatment work?

Methadone, a synthetic or manufactured drug, does not produce the same "high" as illegal drugs such as heroin, but does prevent withdrawal and the craving to use other opiates. It often is a successful treatment for opiate dependence because it breaks the cycle of dependency on illegal drugs such as heroin. When patients are receiving methadone in treatment, they are not inclined to seek and buy illegal drugs on the street, activities that are often associated with crime. Patients in methadone maintenance programs also receive counseling, vocational training, and education to help them reach the ultimate goal of a drug-free normal life.

What are narcotic antagonists?

Narcotic antagonists are drugs that block the "high" and other effects of opiates without creating physical dependence of producing a "high" of their own. They are extremely useful in treating opiate overdoses and may prove useful in the treatment of opiate dependence.

Source: National Institute on Drug Abuse, 1986 Facts About...Opiates Synopsis:

The opioids include both natural opiates - that is, drugs from the opium poppy - and opiate-related synthetic drugs, such as meperidine and methadone.

The opiates are found in a gummy substance extracted from the seedpod of the Asian poppy, Papaver somniferum. Opium is produced from this substance, and codeine and morphine are derived from opium. Other drugs, such as heroin, are processed from morphine or codeine.

Opiates have been used both medically and non-medically for centuries. A tincture of opium called laudanum has been widely used since the 16th century as a remedy for "nerves" or to stop coughing and diarrhea. By the early 19th century, morphine had been extracted in a pure form suitable for solution. With the introduction of the hypodermic needle in the mid-19th century, injection of the solution became the common method of administration.

Heroin (diacetylmorphine) was introduced in 1898 and was heralded as a remedy for morphine addiction. Although heroin proved to be a more potent painkiller (analgesic) and cough suppressant than morphine, it was also more likely to produce dependence.

Of the 20 alkaloids contained in opium, only codeine and morphine are still widespread clinical use today. In this century, many synthetic drugs have been developed with essentially the same effects as the natural opium alkaloids.

Opiate-related synthetic drugs, such as meperidine (Demerol), hydro-codone, oxicodone, oxicontin and methadone, were first developed to provide an analgesic that would not produce drug dependence. Unfortunately, all opioids (including naturally occurring opiate derivatives and synthetic opiate-related drugs), while effective as analgesics, can also produce dependence. (Note that where a drug name is capitalized, it is a registered trade name of the manufacturer.)

Modern research has led, however, to the development of other families of drugs. The narcotic antagonists (e.g. naloxone hydrochloride) - one of these groups - are used not as painkillers but to reverse the effects of opiate overdose.

Another group of drugs possesses both morphine-like and naloxone-like properties (e.g. pentazocine, or Talwin) and are sometimes used for pain relief because they are less likely to be abused and to cause addiction.

Nevertheless, abuse of pentazocine in combination with the antihistamine tripelennamine (Pyribenzamine) was widely reported in the 1980's, particularly in several large cities in the United States. This combination became known on the street as "Ts and blues." The reformulation of Talwin, however, with the narcotic antagonist nalaxone has reportedly reduced the incidence of Ts and blues use.

Appearance

Opium appears either as dark brown chunks or in powder form, and is generally eaten or smoked. Heroin usually appears as a white or brownish powder, which is dissolved in water for injection. Most street preparations of heroin contain only a small percentage of the drug, as they are diluted with sugar, quinine, or other drugs and substances. Other opiate analgesics appear in a variety of forms, such as capsules, tablets, syrups, clixirs, solutions, and suppositories. Street users usually inject opiate solutions under the skin ("skin popping") or directly into a vein or muscle, but the drug may also be "snorted" into the nose or taken orally or rectally.

Effects

The effects of any drug depend on several factors:

• the amount taken at one time
• the user's past drug experience
• the manner in which the drug is taken
• the circumstances under which the drug is taken (the place, the user's psychological and emotional stability, the presence of other people, simultaneous use of alcohol or other drugs, etc.)

Short-term effects appear soon after a single dose and disappear in a few hours or days. Opioids briefly stimulate the higher centers of the brain but then depress activity of the central nervous system. Immediately after injection of an opioid into a vein, the user feels a surge of pleasure or a "rush". This gives way to a state of gratification; hunger, pain, and sexual urges rarely intrude.

The dose required to produce this effect may at first cause restlessness, nausea, and vomiting. With moderately high doses, however, the body feels warm, the extremities heavy, and the mouth dry. Soon, the users go "on the nod," an alternately wakeful and drowsy state during which the world is forgotten.

As the dose is increased, breathing becomes gradually slower. With very large doses, the user cannot be roused; the pupils contract to pinpoints; the skin is cold, moist, and bluish; and profound respiratory depression resulting in death may occur.

Overdose is a particular risk on the street, where the amount of a drug contained in a "hit" cannot be accurately gauged. In a treatment setting, the effects of a usual dose of morphine last three to four hours. Although pain may still be felt, the reaction to it is reduced, and the patient feels content because of the emotional detachment induced by the drug.

Long-term effects appear after repeated use over a long period. Chronic opiate users may develop endocarditic, an infection of the heart lining and valves as a result of unsterile injection techniques.

Drug users who share needles are also at a high risk of acquiring AIDS (acquired immune deficiency syndrome) and HIV infection (human immune deficiency virus) and Hepititus C. Unsterile injection techniques can also cause abscesses, cellulitis, liver disease, and even brain damage. Among users with a long history of subcutaneous injection, tetanus is common. Pulmonary complications, including various types of pneumonia, may also result from the unhealthy lifestyle of the user, as well as from the depressant effect of opiates on respiration.

Tolerance and Dependence

With regular use, tolerance develops to many of the desired effects of the opioids. This means the user must use more of the drug to achieve the same intensity of effect. Chronic users may also become psychologically and physically dependent on opioids.

Psychological dependence exists when a drug is so central to a person's thoughts, emotions, and activities that the need to continue its use becomes a craving or compulsion.

With physical dependence, the body has adapted to the presence of the drug, and withdrawal symptoms occur if use of the drug is reduced or stopped abruptly. Some users take heroin on an occasional basis, thus avoiding physical dependence.

Withdrawal from opioids, which in regular users may occur as early as a few hours after the last administration, produces uneasiness, yawning, tears, diarrhea, abdominal cramps, goose bumps, and runny nose. These symptoms are accompanied by a craving for the drug.

Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after a week. Some bodily functions, however, do not return to normal levels for as long as six months. Sudden withdrawal by heavily dependent users who are in poor health has occasonally been fatal. Opioid withdrawal, however, is much less dangerous to life than alcohol and barbiturate withdrawal.

Opioids and Pregnancy

Opioid-dependent women are likely to experience complications during pregnancy and childbirth. Among their most common medical problems are anemia, cardiac disease, diabetes, pneumonia, and hepatitis. They also have an abnormally high rate of spontaneous abortion, breech delivery, caesarian section, and premature birth. Opioid withdrawal has also been linked to a high incidence of stillbirths.

Infants born to heroin-dependent mothers are smaller than average and frequently show evidence of acute infection. Most exhibit withdrawal symptoms of varying degrees and duration. The mortality rate among these infants is higher than normal.

Who Uses Opioids

Opiates and their synthetic counterparts are used in modern medicine to relieve acute pain suffered as a result of disease, surgery, or injury; in the treatment of some forms of acute heart failure; and in the control of moderate to severe coughs or diarrhea. They are not the desired treatment for the relief of chronic pain, because their long-term and repeated use can result in drug dependence and side effects (such as constipation and mood swings). They are, however, of particular value in control of pain in the later stages of terminal illness, where the possibility of dependence is not a significant issue.

A small proportion of people for whom opioids have been medically prescribed become dependent; they are referred to as "medical addicts." Even use of non-prescription codeine products, if continued inappropriately, may get out of control. Medical advice should be sought, since withdrawal symptoms may result from abrupt cessation of use after physical dependence has been established. Because members of the medical and allied health professions have ready access to opioids, some become dependent.

The largest proportion of non-medical use, however, falls into the street-use category. Currently, heroin is the most popular opiate among street users; these users are also prone to heavy use of other psychoactive drugs, such as cocaine, alcohol, certain sedative/hypnotics, and tranquillizers.

During the past few years, synthetic opioids such as hydrocodone, hydromorphone, oxycodone, and meperidine have gained prominence as drugs of dependence. Users sometimes urge physicians to write them prescriptions for the opioid of preference. These opioids are also frequently stolen from pharmacies and sold on the street. Today, illicit use of such opioid-based medicines as Percodan, Dilaudid, and Novahistex is common.

Opioids and the Law

The federal Narcotic Control Act regulates the possession and distribution of all opioids. The act permits individual physicians, dentists, pharmacists, and veterinarians, as well as hospitals, to keep supplies of certain opioids. Members of the general public must obtain these drugs for such authorized sources.

Although the act also permits the prescribing of methadone in the treatment of opioid dependence, permission is given only to specially licensed physicians, and use is governed by specific guidelines. If tried by summary conviction, a first offence for opioid possession carries a maximum penalty of a $1,000 fine and six months imprisonment. For subsequent offences, the maximum penalty is a $2,000 fine and 12 months imprisonment. If tried by indictment, opioid possession carries a maximum penalty of seven years imprisonment.

Importing, exporting, trafficking, and possession for the purposes of trafficking are all inditable offences and carry a maximum penalty of life imprisonment. Cultivation of opium is also an indictable offence and carries a maximum penalty of seven years imprisonment.

It is illegal to obtain a prescription for opioids or any other "narcotic" from health care professionals without notifying them that you have obtained a similar prescription through another practitioner within the preceding 30 days.

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Signs of Inhalant Abuse

GLUE, VAPOR PRODUCING SOLVENTS, PROPELLANTS

• Substance odor on breath and clothes.
• Runny nose.
• Watering eyes.
• Drowsiness or unconsciousness.
• Poor muscle control.
• Prefers group activity to being alone.
• Presence of bags or rags containing dry plastic cement or other solvent at home, in locker at school or at work.
• Discarded whipped cream, spray paint or similar chargers (users of nitrous oxide).
• Small bottles labeled "incense" (users of butyl nitrite).

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Signs of Hallucinogen Abuse

LSD, MESCALINE

• Extremely dilated pupils.
• Warm skin, excessive perspiration and body odor.
• Distorted sense of sight, hearing, touch; distorted image of self and time perception.
• Mood and behavior changes, the extent depending on emotional state of the user and environmental conditions.
• Unpredictable flashback episodes even long after withdrawal (although these are rare).

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Signs of PCP Abuse

ANGEL DUST

• Unpredictable behavior; mood may swing from passiveness to violence for no apparent reason.
• Symptoms of intoxication.
• Disorientation; agitation and violence if exposed to excessive sensory stimulation.
• Fear, terror.
• Rigid muscles.
• Strange gait.
• Deadened sensory perception (may experience severe injuries while appearing not to notice).
• Pupils may appear dilated.
• Mask like facial appearance.
• Floating pupils, appear to follow a moving object.
• Comatose (unresponsive) if large amount consumed. Eyes may be open or closed.

Note: PCP has stimulant, depressant, hallucinogenic and analgesic effects. Which of these will be most pronounced is unpredictable and depends on users personality, psychological state and the setting at time of use.

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