Marijuana use by teenagers in the 10th and 12th grade increased from 14.2% and 18.8% in 2007 to 17.0% and 22.9% in 2012 respectively. A continued abuse of prescription and OTC drugs also continued to rise, especially on the use stimulants and pain relievers. While marijuana and medical drugs showed consistent and, other times, escalating use, other drugs of abuse such as inhalants, cocaine and MDMA (ecstasy) decreased in all. Alcohol use among teenagers, on the other hand, showed a slight increase in 2012. Cigarettes, though peaked around 1997, continued to decrease until now. Both cigarettes (17.1%) and marijuana (22.9%) showed significant decrease and increase respectively from 2007 data.
The significant rise in marijuana abuse was partly attributed to the decreased risk perception on marijuana owing to the recent news on medical marijuana and its legalization. Recent studies have shown that marijuana can also have beneficial effects especially in the treatment of acute pain. While the medical community vastly embraced this new use, legalization of medical marijuana paved the way to an increase in its medical and street use. More people, seeing a reduced risk in the use of marijuana due to its establishment as a “legal” drug, were reported to have shifted from other drugs of abuse to marijuana due to the decreased risk perception. If the medical benefits of marijuana were proven and life-altering compared to the other established drugs, then there is no harm in using it as treatment. Practitioners should, however, be reminded of its addictive properties and monitoring people to whom they have prescribed the drug. Presence of a prescription is important in order to separate those using it as treatment and those using it to relieve addiction.
According to NIDA, a combination of biological/genetic and environmental risk factors are determines whether a person will be addicted to drugs. Risk factors such as “early aggressive behavior, poor social skills, lack of parenteral supervision, peer substance abuse, drug availability and poverty” (NIDA, 2012) increases the likelihood of addiction, while “protective” factors such as “self-control, positive relationships, parental support and monitoring, academic competence, anti-drug use policies and strong neighborhood attachment” (NIDA, 2012), respectively, reduces the chances of it.
Illicit drugs, alcohol and tobacco use also greatly affect the brain, as much as the other parts of the body. Initially, drug addicts would detect a feeling of pleasure from the addiction due to a sudden surge of dopamine, which is directly or indirectly targeted by the drug. Dopamine is a neurotransmitter responsible for regulating cognition and behavior, and most significantly, feelings of pleasure, motivation and reward. The brain functions in such a way that activities become repetitive when associated with feelings of pleasure and reward. Since this is the main pathway in which drugs of abuse elicit their effect, people are eventually drawn to addiction. “Long term drug abuse (however) impairs brain functioning” (NIDA, 2012). With the sudden surge of dopamine in the brain, the brain counters by producing more and more dopamine receptors in the body. Eventually, large amounts of dopamine will be needed to generate the same extent of pleasure felt on first use of the drugs, a phenomenon known as tolerance. While this happens, normal brain interaction is heavily compromised, making a person incapable of self-control and at times sanity.
As discussed earlier, illicit drug use range from the common nicotine in tobacco and ethyl alcohol in liquors to the more obvious prescription medicines and illegal drugs. Nicotine, mainly found in cigarettes, is a natural liquid substance extracted from the leaves of tobacco plant. Its addiction mainly comes from its effect on stress relief and pleasure elevation, when taken in large amounts, nicotine has the capability to produce hypertension and tachycardia. Development of withdrawal symptoms is also common, which includes increased anxiety and irritability, depression, poor social skills, and cognitive impairment. Alcohol, on the other hand, is ethyl alcohol found in liquors, beers, and wines. It commonly gives the feeling of euphoria, relaxation, and pleasure. When taken in high doses, however, it can cause nausea, impaired visual and motor function, incoherent speech, and emotional instability. Alcoholics also tend to result to violence, which is viewed as a withdrawal symptom of the drug. (NIDA, 2011)
Aside from tobacco and alcohol, other drugs of abuse can be obtained from plants such as cannabinoids (i.e. marijuana), and opioids. Such pharmacological classes also have their synthetic derivatives (i.e. heroin), unlike tobacco and alcohol. Marijuana’s effects are attributed to its active constituent, ∆9-tetrahydrocannabinol (THC), with onset occurring in minutes and peaking at 1-2 hours. General effects include grandiosity, well-being and slow passage of time. It has also been proven as a relief for chronic pain, which is the basis of its use medically. Withdrawal symptoms include restlessness, insomnia, and cramping. (Katzung, 2009). While marijuana is natural, heroin, which is an opioid, is a synthetic derivative of the naturally-occurring morphine, more potent than the latter. It is used mainly as a painkiller with additional effects of euphoria. Toxic effects include confusion, difficulty of breathing, and a heavy feeling in the body. Heroin can develop strong tolerance and dependence leading to withdrawal such as dysphoria, muscle aching, rhinorrhea, mydriasis, sweating, diarrhea, and fever.
While marijuana and heroin/morphine use has long been established, there were also newer drugs of abuse that made its way to the market. Metamphetamine (a.k.a. meth, ice) belongs to the stimulant family and is a synthetic, indirect-acting sympathomimetic drug which also acts to increase feelings of pleasure and reward. When taken in large amounts, it can accelerate body processes and lead to tachycardia, hypertension, hyperthermia, anxiety and tremors (NIDA, 2011). Withdrawal symptoms include dysphoria, drowsiness, and general irritability (Katzung, 2009). Together with amphetamine, club drugs such as MDMA or methylenedioxymethamphetamine (a.k.a. ecstasy) also produces feelings of pleasure, lowered inhibition and empathy. However, ecstasy is notorious for its hallucinogenic effects and the development of hyperthermia and dehydration, which can be fatal. Withdrawal symptoms of ecstasy are characterized by a long-lasting depression up to several weeks.
Other drugs of abuse do not cause dependence and addiction per se. Examples of this would be phencyclidine (a.k.a. angel dust), belonging to the dissociative drug class. General effect reported was psychedelic effect lasting for an hour. Toxic effects, on the other, hand include feelings of being from the body and environment, hallucinations and, in extreme cases, permanent psychosis (NIDA, 2011). Lysergic acid diethylamide or LSD (a.k.a. yellow sunshine) is a hallucinogenic drug which is capable of altering one’s perception. LSD is neurotoxic and oxytocic, which can induce abortion. (Katzung, 2009) There are no withdrawal symptoms due to absence of addiction capability.
As much as illegal drugs are being abused, people also report using prescription drugs for nonmedical use. In 2010, roughly 5.1 and 2.6 million Americans reported the use of pain relievers and sedatives for nonmedical purposes. These pain relievers usually include acetaminophen preparation, Vicodin®, and dextroamphetamine preparation, Adderall®. (NIDA, 2011) As part of the health care team, we also have the responsibility to detect addiction to these prescription medicines and consult them of such habit. It is also necessary to monitor patient medication use to ensure that medicines are properly prescribed by a physician and are properly administered for the right reasons.
Recently, we saw the rise in popularity of newer types of drugs such as bath salts, salvia, and spice. Spice is synthetic marijuana, which is the second-most used drug of abuse by high school seniors due to ease of access and false advertising (NIDA, 2012). Like MJ, it produces effects in the brain such as stress relief, elevated mood, and altered perception, which is mainly because it binds in the same cell receptors as marijuana does. Salvia, on the other hand, is an herb found in Central America, which is a powerful stimulant of the kappa opioid receptors in the brain different from the ones activated by heroin and morphine. This receptor is famous for its psychotomimetic effects (i.e. psychotic-like experiences). Last but not the least, bath salts is a relatively new drug of abuse related to cathinone, which is an amphetamine-like stimulant. As per recently seen incidents, bath salts can produce extreme euphoria, hallucination, and aggressive behavior. They contain several synthetic cathinones such as MDPV and mephedrone. (NIDA, 2012) People are drawn to these drugs mainly due to its increase in popularity and capability to generate curiosity.
Clinicians usually do screening and assessment first of a patient in order to determine presence of substance use disorder. There are many types of screening instruments and tools used in order to achieve this. Examples of which are the AUDIT or Alcohol Use Disorder Identification Test developed in 1989 by Babor and Grant, which consists of 10 questions related to alcohol consumption, and the CAGE test which assess lifetime use of alcohol and drug consumption, which involves yes or no questions. One disadvantage of the CAGE questionnaire is its tendency to be gender- and race-insensitive such that a modified version, CAGE Adapted to Include Drugs (CAGE-AID) was established. Other instruments were developed to tackle special populations such as pregnant women (e.g. TWEAK, T-ACE) and to screen for specific diseases such mental disorder (e.g. MINI, MSHF-III). (Center for Substance Abuse Treatment, 2009)
References
Katzung, B.G., Masters, S.B., Trevor, A.J. (Eds.). (2009). Basic and Clinical Pharmacology. 11th ed. China: The McGraw-Hill Companies, Inc.
Center for Substance Abuse Treatment. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women. (Treatment Improvement Protocol (TIP) Series, No. 51.) Chapter 4: Screening and Assessment. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK83253/
Center for Medical Cannabis Research. (2010). News & Information. Retrieved from http://www.cmcr.ucsd.edu/index.php?option=com_content&view=frontpage&Itemid=1
Grant I, Atkinson JH, Gouaux B. (2012). Research on medical marijuana. Am J Psychiatry, 169(10):1119-20. DOI: 10.1176/appi.ajp.2012.12060791.
National Institute on Drug Abuse. (2012). DrugFacts: Spice (Synthetic Marijuana). Retrieved from http://www.drugabuse.gov/publications/drugfacts/spice-synthetic-marijuana
National Institute on Drug Abuse. (2012). DrugFacts: Salvia. Retrieved from www.drugabuse.gov/publications/drugfacts/salvia
National Institute on Drug Abuse. (2012). DrugFacts: Synthetic Cathinones (Bath Salts). Retrieved from http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
National Institute on Drug Abuse. (2012). DrugFacts: High School and Youth Trends. Retrieved from http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends
National Institute on Drug Abuse. (2011). Commonly Abused Drugs Chart. Retrieved from http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-drugs-chart
National Institute on Drug Abuse. (2011). Commonly Abused Prescription Drugs Chart. Retrieved from http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-prescription-drugs-chart
National Institute on Drug Abuse (2010). Drugs, Brains, Behavior: The Science of Addiction. USA: NIDA. Retrieved from http://www.drugabuse.gov/sites/default/files/sciofaddiction.pdf
