1. No category

Novel Psychoactive Substances
and Other Drugs
May 2014
The Growing Alphabet…
E, K, G, BZP, 2CB, 5MeO-DIPT...
“Party Drugs” such as Ecstasy, Ketamine and
GHB have not gone away. However, there have
been significant changes to purity and
associated risks. As well, a proliferation of new
substances are quickly appearing.
What are some of the current substances being
used and the risk reduction messages we
should be sharing, particularly with today’s
youth?
Before we start…
• Why did you come?
• What are you interested in?
• Questions as we go:
– If we’re not sure about something we can look it up.
• What we know changes:
– New issues; new science.
• If you are going to take drugs:
– Do your homework.
– Treat drugs, and your body, with respect.
Overview
• Terminology
– Street Drugs  Rave Drugs  Club Drugs 
Party Drugs Novel Psychoactive
Substances
• Current Data & Trends
• Specific substances:
– What they are; How they work
– Immediate risks; Longer-term concerns
– Risk reduction strategies
• Websites
Order of information about
Specific Substances
• Bath Salts
• Research Chemicals
• MDPV; Mephedrone
• Phenethylamines
• Tryptamines
• Ecstasy
• Pills; MDMA; Molly
•
•
•
•
•
Cannabis
Synthetic Cannabinoids
Salvia
Cocaine
Methamphetamine
•Ketamine
•GHB
•Viagra
•Poppers(amyl nitrite)
•LSD
•Magic Mushrooms
•Cough Syrup
•Inhalants/Solvents
•Alcohol
•Opiates
•Other Pharmaceuticals
Note:
The drugs are ordered in the flow of a typical workshop discussion and are not
grouped by class, effect, or any particular categorization.
Disclaimer
• Information is presented on some of the more commonly
used and discussed substances and is collected from a
variety of sources, including trusted websites and from
people who have used these drugs.
• More information is available about certain substances
than others -this is not an exhaustive list or document.
• We have attempted to consolidate as much accurate
information as possible, but not all of it is scientifically
backed-up or proven.
• Substance use involves inherent risks and no
information provided here can eliminate all risks. Take
drugs with caution and consult healthcare professionals,
such as a doctor, before engaging in use.
What do I think of as
“Street Drugs”?
“Street Drugs”
• Heroin; Oxy; Crack Cocaine
– Including injection drug use
• Alcohol
– Including non-palatable
• “Meds” (psychiatric; opioids)
These stereotypical
images are used to
illustrate primary
Hep C / HIV
transmission
concerns and to
prompt discussion
about attitudes and
stigma.
What do I think of as
“Party Drugs”?
Rave Drugs / Club Drugs
• 1970’s - 1980’s:
– New York and Chicago discos
– Ibiza, Spain (UK Tourists)
• 1980’s - 1990’s:
– Underground Raves (U.K.); Warehouse Parties (New York,
Chicago, Detroit, Toronto); Gay Nightclubs
• 1990’s - 2000’s:
– Nightclubs (U.K.)
– Raves, Nightclubs, Gay Circuit Parties (North America)
• 2000’s:
– Nightclubs; Gay Clubs; all-ages-all-night events
– “Parties”
“Party Drugs”
• A generalized term for substances that have
historically been associated with raves and all
night dance-clubs.
• These drugs are used by many kinds of people
in all kinds of settings.
• Some of these drugs are illegal, some have no
classification
• Examples:
– Ecstasy, Ketamine, GHB, Acid, Cocaine, Crystal
Methamphetamine
– Newer Classes and Research Chemicals
“Party-Drugs”
• Ecstasy/MDMA
• Amphetamine / Methamphetamine
• GHB
• Ketamine
• Mushrooms / LSD
• Cannabis
• Nicotine
• Powdered Cocaine
• Poppers
• Viagra
• Energy Drinks
• Alcohol
• Research/unclassified chemicals
• Pharmaceuticals
• anti-depressants/anxiety; opioids
Research Chemicals/Legal Highs
• Popularized by “fringe scientist” and doctor, Alexander
Shulgin.
• Examples
– 2CI, 2CB, 2CT2, 2CT7, 5-meo-DiPT, 5-meo-AMT, BZP, TFMPP,
mephedrone
• Some are legal, many are increasingly scheduled.
• Have been easily obtained over the internet the last few
years.
• Often the ones with psychedelic properties are sought.
• Some mimic amphetamine type substances.
Novel Psychoactive Substances
What’s been happening over the last
decade?
• Molecular Chemistry Geeks
• “Psychonauts”
• Internet
• BAD DRUG POLICY
What are we actually seeing?
• Data is limited.
• Data is time delayed.
• Researchers and health/social services
aren’t asking the right questions and can’t
keep up.
Ontario Student Drug Use and
Health Survey
Survey of 10,272 Ontario students in grades 7 to
12 during the 2012-2013 school year.
http://www.camh.ca/en/research/news_and_publications/on
tario-student-drug-use-and-healthsurvey/Documents/2013%20OSDUHS%20Docs/2013OSD
UHS_Detailed_DrugUseReport.pdf
*Remember this survey is administered IN SCHOOL, so
does not represent all youth in Ontario, and likely under
reports use.
Are use of the following going up,
down, or staying the same?
•
•
•
•
Alcohol
Cigarettes
LSD (acid)
Crystal meth
OSDUHS 2013
DATIS – Drug Treatment Admission Data, Ontario
Drug Treatment Numbers
• Only reflect people that actually made it to
treatment:
– geography; housing; mental health; stigma; types or
treatment available
• Do people honestly report all use  stigma?
• More people in treatment does not necessarily
mean more people using.
– Long-term users presenting now?
• Are people voluntarily coming or being “forced”
(by courts/families)?
TRIP! survey data 2008
Trends (2008)
• Of greatest concern was the re-emergence of crystal meth
use over the past year. In 2007, only 15% of respondents
identified using this substance in the last year or month. In
2008, the number rose to 26%.
• Also of concern was the number of people using prescription
medication for psychoactive purposes. This question was not
asked in the previous survey and has not been a focus for
TRIP! in the past, but with more than 20 percent of people
using these substances, more work needs to be done to
address this in the coming year. Other than Oxycodone and
Codeine, respondents identified using Adderal, Ritalin,
Dexedrine, Diluadid, Concerta, Valium and Morphine.
Trends (2008)
• Small numbers of people indicated use of research
chemicals such as DOB, DOI, DOC, 2CE, 2CC,
2CB, 2CI, 5-MeO-MiPT, and AMT, nitrous oxide,
poppers, pcp, hasish, over the counter
disassociative DXM, a variety of plant based
hallucinogenics such as Kratom, Salvia, DMT,
morning glory seeds, Mugwort T. Peruvianus (a
cactus), and other amphetamines such as TMA,
BZP, and MDA.
“Bath Salts”
• Canadian Centre for Substance Abuse
– CCENDU Alert June 2012 – “Bath Salts”
http://www.ccsa.ca/2012%20CCSA%20Docu
ments/CCSA-CCENDU-Drug-Alert-BathSalts-2012-en.pdf
Specific Drugs
What should we talk about? Things I would
focus on:
• “Bath Salts”
• Ecstasy / “Molly”
• Cannabis
– Concentrates; Synthetics
• Pharmaceuticals
• Sizzurp
• GHB/Ketamine
Have you heard of MDPV?
• Mystery drug causing freakouts
Toronto Sun posted: January 19, 2012
http://www.torontosun.com/2012/01/19/mystery-drug-causing-freakouts
• Owen Sound, Ontario, Canada
“Four people have showed up at the hospital within a 24hour period suffering from extreme paranoia, vivid
hallucinations and thoughts of killing themselves after
smoking or injecting a mysterious brown powder…”
• In this case, lab analysis by Health Canada confirmed
the use of MDPV.
Miami Zombie Attack, May 2012
• May 26, Miami Florida
– Police shoot and kill a man who was attacking another person
and “chewing his face”. Police suspect the attacker was high on
“bath salts”.
• May 30
– Miami's 'Naked Zombie' Proves Need to Ban Bath Salts, Experts
Say
• http://www.usnews.com/news/articles/2012/05/30/miamis-nakedzombie-proves-need-to-ban-bath-salts-experts-say
• June 02
– Drug Linked To Cannibalism Case Hits Edmonton Streets
• http://www.huffingtonpost.ca/2012/06/02/bath-salts-drug-edmontoncannibalism_n_1565046.html?utm_hp_ref=rudy-eugene
June 28, 2012
• “No Bath Salts in Miami Case”
– Miami-Dade Medical Examiner, Bruce Hyma
"The department's toxicology laboratory has identified
the active components of marijuana... The laboratory
has tested for but not detected any other street drugs,
alcohol or prescription drugs, or any adulterants found
in street drugs. This includes cocaine, LSD,
amphetamines (Extasy, Meth and others),
phencyclidine (PCP or Angel Dust), heroin,
oxycodone, Xanax, synthetic marijuana (Spice), and
many other similar compounds."
“Bath Salts” in the media
• Numerous stories in the media of people acting
very bizarrely after suspected use of “bath salts”.
• Stories from the UK started 3-4 years ago and
over the last year or two in Canada and the
United States.
• Sometimes toxicology reports show that “bath
salts” were actually not ingested.
• The extreme cases are the ones reported; many
people have used the substances with no
problems at all.
“Bath Salts” and other newer drugs
• The next few slides provide information on
newer drugs that have come to market in the last
few years.
• The media has paid particular attention to “bath
salts”:
– Much of the reporting has been inaccurate and
sensationalized.
– However, there can be some serious side effects with
these new substances.
“Bath Salts”
• May refer to a number of compounds that are synthetic
substances based on the (cathinone) compounds that
exist in the Khat plant of East Africa.
– Examples: mephedrone, methylone, and MDPV
(methylenedioxypyrovalerone)
• Typically they have strong stimulant effects and require a
smaller dosage than drugs like methamphetamine or
cocaine.
• In higher doses, or with extended use, may cause strong
“psychiatric effects” (psychosis).
• TRIP! Info: www.tripproject.ca/trip/?q=node/1939
“Bath Salts”
The next few slides are adapted from:
• “Characterization of Methylenedioxypyrovalerone
(MDPV) and Mephedrone in “Legal High” Products by
Chemical Color Tests, Microcrystalline Tests, with
Confirmation by LC/MS”
• Emmi Slivka
• The Center for Forensic Science Research and Education
Willow Grove, PA
Mephedrone and MDPV
• Structurally related to cathinone, an illegal
stimulant drug extracted from the khat plant
Mephedrone
•
•
•
•
Mephedrone, 4-MMC, Meow, M-Cat, Bubbles
2-Methylamino-1-p-tolylpropan-1-one
Stimulant; Euphoriant
A synthetic stimulant with empathogenic effects
that some people report being a “cross between
ecstasy and cocaine”.
• Between 2007 and 2009, it became available for
purchase online, was used increasingly in
Europe, Australia, and New Zealand, associated
with several deaths, and then controlled in some
countries as a result.
Mephedrone
• Duration of 2 to 3 hours, depending on the
quality of the drug as well as the user;
comedown is said to last an hour but some
users have reported not be able to sleep for
several hours.
• It is a stimulant:
– Some users report heart palpitations and irregular or
racing heartbeat which may last for quite some time
after taking the drug.
– Be careful mixing with other stimulants (e.g., energy
drinks)
How are they used?
• Routes of administration:
– Snorting and swallowing (in gel caps or “parachuting”)
– Less common methods include smoking, rectal
administration and intravenous use
• Common Doses:
– MDPV: Range from 5mg-25mg
– Mephedrone
• Snorting- 25 to 75mg; >90mg considered high dosage
• Oral- 150 to 250mg
Pharmacology
Mephedrone:
• Promotes the release of monoamine
neurotransmitters as well inhibiting their
reuptake
– norepinephrine, serotonin and dopamine
MDPV:
• Increases levels of dopamine and
norepinephrine
– Reuptake inhibitor
Effects of Mephedrone and MDPV
• Desired Effects
–
–
–
–
–
–
Euphoria
Sociability
Elevated Mood
Hallucinations
Increased Insight
Increased Energy
• Adverse Effects
-
High Heaet Rate
High Blood Pressure
Arrhythmia
Seizures
Paranoia
Agitation
UK Mephedrone Ban May Have
Done More Harm Than Good
• http://whyprohibition.ca/blogs/jesse-wentzloff/uk-mephedrone-banmay-have-done-more-harm-good
• The ban, which came after mephedrone had been linked
to a number of deaths, which were later found not to be
attributable to the drug, could be driving demand for
other new drugs.
• The ban comes after recent research revealed that 40
new synthetic drugs have flooded into the UK during the
past year.
"One of the dangers of the approach that
has been taken is that if we ban every new
drug without a balanced view, then people
will keep making more new drugs to
replace them and eventually they will make
something that is extremely toxic which,
when kids take it, they will die.”
-
Professor David Nutt, Independent Scientific Committee on Drugs
“Bath Salts”
• The term “Bath Salts” is problematic:
– So many different substances
– No standard definition
– Creates false sense of safety
– Confusion with other substances such as
solvents like hair spray and nail polish
• Better to use terms like “Research
Chemicals” or “Novel Psychoactive
Substances”
“Bath Salts” and other
Research Chemicals
• As with all substances, these newer drugs have
inherent risks.
• Generally, it is probably better to encourage
people to avoid “bath salts” and stick to
substances they are already familiar with.
• However, if people are going to use them, they
should be careful with dosing, the
unpredictability of the effects, and be aware that
nothing is really known of the long-term
consequences.
Research Chemicals
• Popularized by fringe scientist and doctor,
Alexander Shulgin.
• 2CI, 2CB, 2CT2, 2CT7, 5-MeO-DiPT. 5-meoAMT, BZP, TFMPP, mephedrone.
• Some are legal; many are increasingly are
scheduled.
• Can easily be obtained over the internet.
• Typically the ones with psychedelic and/or
stimulant properties are sought.
Research Chemicals
• Typically white crystalline powder sold in plastic
baggies or gel capsules.
• Often sold in packages marked “not for human
consumption” and labelled “Bath Salts” or “Plant
Food” to deceive customs.
• Common Product Names:
– Meow Meow; Tranquility; Blue Silk; Cloud 9; Bolivian
Bath; Ivory Wave; Bliss; Lunar Wave
Research Chemicals - Concerns
•
•
•
•
•
Mislabelling
Bad batches
Dosage
Long-term effects unknown
False sense of security
Research Chemicals
• Come in “waves” through the “dance music
scene”… and now other communities or social
networks.
• Scheduling of these substances (making them
illegal) causes “blow-out sales” by manufacturers,
who want to get rid of them quickly:
– Easy to sell through the internet;
– Easy to buy if you have a credit card;
– Bulk sales to dealers:
• who re-package for end user, sometimes selling as traditionally
known drugs such as “Ecstasy”, or now, “Molly”.
Research Chemicals
• Little is known of these substances,
particularly regarding their long-term
effects and potential contraindications with
medications and other drugs.
• Not a very high “success rate”:
– With many substances, 50% of users will get
the desired high, the other 50% will have
vomiting and diarrhea.
Research Chemicals - Safety
• “There really is no safe way – it’s all a
gamble...”
• What exactly are you taking?!
– Mass spectrometry (cost prohibitive)
– Home test reagent kits (not definitive)
– User reports (subjective)
– One person try sub-threshold dose before
everyone else (guinea pig)
Phenethylamines
• A family of chemicals structurally similar to the
amphetamines that are naturally occurring plant
and animal enzymes. Synthetic phenethylamines
are also made by chemists.
• Examples
– 2C-I, 2C-B, 2C-T-2, 2C-T-7, mescaline and others
– MDMA, mephedrone
• http://www.tripproject.ca/trip/?q=node/65
2C-* Effects
•
•
•
•
•
Visuals
Stimulation
Sensory and Tactile Effects
Synaesthesia
Memory Flooding and Thought CrossReferencing
Phenethylamines: 2-CB
•
•
•
•
•
•
•
•
•
White powder or tablet
$30 per dose
MDMA/LSD effect
Open and closed eye visuals
Mild stimulant and mood enhancer
Can cause cramps and diarrhoea
Lasts 4 to 6 hours
“Life altering”
Tolerance develops quickly
Phenethylamines: 2-CT-7
•
•
•
•
•
•
Powder or tablet
7 mg tabs sometimes sold as “E”
Change in perception & time
Increased sociability
Dissociative effect
May cause anxiety, confusion or panic
attacks
• Nausea and vomiting
• Has resulted in death
2C-* Risk Reduction
•
•
•
•
•
•
Although each phenethylamine has its own distinct signature, there are
some general concerns.
Dosages for each (most are around 10mg) are very small and as powder it
cannot be ‘eyed’ out accurately. Weigh it out on a milligram scale.
Dosing more than 20milligrams can get really intense. Every few milligrams
over 25 will double the intensity, but will most likely just increase the
unwanted effects and any toxicity.
Don’t snort any 2Cs! Death and OD cases seem to all have come when
users snorted 2C-T-7 or 2C-B, and in any case it burns so badly that most
of the your first hour high will be in pain and tears. Not good for sinuses!
The first time, any of the 2Cs will be extra-intense; try a half dose by itself at
home or somewhere safe.
Wait at least 2 weeks or a month between trips. Frequent 2C trips will get
less interesting even with increasing the dosage. Higher dosages often lead
to more side-effects than wanted effects.
2C-* Risk Reduction
•
•
•
•
•
•
Phenethylamines are prone to causing mystical or life-changing
experiences. Make sure that you are in a comfortable environment
(mentally and physically) and have everything you’ll need with you.
The onset of 2Cs can vary widely. On an empty stomach and swallowed as
powder out of the capsule or dissolved in a drink, the onset will be quick
(15-45 minutes.) Left inside the capsule or as a pill, or if taken on a full
stomach, the onset will be delayed, sometimes up to 3 hours!
That said, don’t take more if you aren’t high. You may still be coming up 3
hours after dosing.
2C-B has a rather brief duration, usually entirely over within 5 or 6 hours but
other 2Cs will keep you up all night like E or speed.
2C compounds can be dangerous in combination with MAO inhibitors such
as syrian rue/harmaline or certain antidepressants (MAOIs and otherwise)
Be careful! Very little is known about these compounds. Make sure
someone knows exactly what you’re taking when you dose in case you
need help. (medical or otherwise!)
Tryptamines
• A family of chemicals that are found in animals, plants
and fungi.
• Neurotransmitters serotonin and melatonin are
tryptamine-based structures.
• Can be synthesized in laboratories
– Foxy, LSD and melatonin sleeping pills have all come from the
human imagination
• Examples
– AMT, DMT, “Foxy” (5-meo DIPT), “Moxy” (5-MeO-MIPT)
• http://www.tripproject.ca/trip/?q=node/44
Tryptamines: AMT
• (Alpha-methyltryptamine)
–
–
–
–
–
–
–
–
–
Lasts 16 hours
Effect like combining MDMA & LSD
Wide range of experiences
Comes in a white powder
Can be swallowed, snorted or smoked
$20 – 25
Only a small amount needed
Narrow dose range 10 – 15 mg.
Can cause unpleasant trips
Tryptamines: 5-MeO-DiPT
• 5-MeO-DiPT  Foxy Methoxy  “Foxy”
• Synthetic tryptamine first developed by Alexander
Shulgin in 1980.
• It may be sold as a small amount of loose powder in a
gel cap, or as a pressed pill.
• Effects are wide-ranging and last 4 - 8 hours.
“Foxy” 5-MeO-DIPT
•
•
•
•
White powder or tablet
Dose: 5 – 12 mg
$30 – 40 per dose (? Toronto 2011)
Causes body buzz, mood lift, euphoria,
increased sex drive, and enhanced visuals
• Long lasting
• Can cause acute vomiting, long come down
(12 hours), diarrhoea, a widely varied
experiences.
Foxy - Effects
• Audio distortions
– Your own voice might sound strange, as will others; music you
know may seem unfamiliar or different
• Tactile sensitivity
– Your skin may seem extra-sensitive; response to touch may
range from feeling very good not so good, or just plain odd
• Enhancement of visual textures
– Brightening of colours, trails and visual distortions
• Nausea, diarrhoea, or an uneasy feeling
Tryptamines – Risk Reduction
• Recreational use of Tryptamines requires only minute
amounts of the substance, making it impossible to
eyeball’ out doses.
– Differences of 5 or 10mg between small lines of powder are
impossible to judge. The difference between a good trip and bad
time relies on DOSAGE.
– Use a scale to measure doses.
– (MDMA, a phenethylamine, dose is typically ~100mg).
• Use the buddy system and have a sober ‘sitter’.
• Tryptamines aren’t necessarily party drugs; better to use
at home.
Tryptamines – Risk Reduction
• Avoid mixing tryptamines with any other drugs such as
downers, amphetamines or other stimulants.
• MAOIs seriously potentiate their effects, and generally
should be avoided when using tryptamines.
• Most doctors and medics have no idea these drugs even
exist, let alone what to do in an overdose situation. In
case of an overdose, let the medics know exactly what
has been ingested as well as any info like websites.
• Tryptamines should be treated with a great deal of
respect and only called on when your mind is clear
before diving into the depths of your psyche.
Ecstasy takers in
hospital
CBC News Posted:
Apr 8, 2011
http://www.cbc.ca/ne
ws/canada/novascotia/story/2011/04/
08/ns-ecstasyhalifax.html
The pills in this case
were analysed in a
lab and contained
Foxy.
Unfortunately no
information is
provided regarding
the appearance of
the pills (not the ones
pictured).
Ecstasy
• E, X, pills, disco biscuits
“White Happy Face”
– Specific pills named by colour,
size, shape, stamp/logo
– Sometimes powder in a gel cap
• Newest term “Molly”
• Price per pill or capsule:
–
–
–
–
$5-10 (Toronto 2013)
$5-20 (Toronto 2009)
$10-20 (Toronto 2005)
$20 “E” pill / $30 MDMA capsule
(Toronto 1999)
“Green Mercedes”
Ecstasy
• Predominately swallowed
– Pills may be crushed into powder and snorted
– Rarely hooped or smoked
• Main neurotransmitter: Serotonin
– Though with adulterated pills others maybe effected (e.g., more
dopamine if methamphetamine is in pills)
• Primarily stimulant effects; “upper”
– Though overwhelming sense of “bliss” may leave you feeling
lethargic (affecting serotonin)
• Physical effects:
– Increases in heart rate, body temperature and energy
– Jaw clenching/tightening, dilated pupils, nausea
• Psycho/behavioural effects:
+ve: empathy, openness, peace, caring, open-hearted
communication
–ve: anxiety, paranoia, “bad mood”
Ecstasy
• Immediate risks:
– Not knowing what you get
• Ecstasy pills are one of the most adulterated illicit substances
– Dehydration; overheating; stroke
• Particularly when used in hot nightclubs and parties
– Say or do something you regret
• Tendency to talk openly and “feel connected” may not last
the next day
– Rough comedown
• Can be hard to fall asleep
• You may feel sad, blue, and easily irritated for a couple of
days after
Ecstasy
• Longer-term concerns:
– Tolerance
• Many longer-term users report taking more to get a similar
effect (e.g., “½ a pill used to get me high, now I take 2 in a
night”).
– Psychological Dependency
• If you have always taken ecstasy when going out dancing, it
may be hard to not think about using when going out, even
though your body isn’t physically needing it.
– Depression
• What goes up, must come down. Serotonin, one of the
neurotransmitters ecstasy effects, is part of your eat/sleep
patterns and mood cycles - it may be depleted after use.
– Anxiety & panic attacks
• Stimulant drugs can create a sense of urgency or paranoia in
some people, especially with the more you take or the longer
you stay high.
Ecstasy: Pills vs. MDMA
• MDMA
– 3,4-methylenedioxy-N-methylamphetamine
•
•
•
•
Historically found pressed into a pill form.
Pills are usually “cut” with other drugs.
Never know what you are getting!
Each pill is different, even if it looks the
same.
- Duration of high: 4-6hrs (pure MDMA), 210 hrs (Ecstasy pills)
Ecstasy Pills
• Observations and conversations with partiers
and clubbers using E, show a wide variety of
experiences.
• Toronto, 2004:
– 7 of 21 Ecstasy users showed methamphetamine in
hair samples.
• BC Centre for Excellence in HIV/AIDS and UBC
Dept. of Health Care and Epidemiology, 2004:
– 94 pills tested: 44 (47%) contained methamphetamine
• Case Report: Halifax, N.S. 2011
– Ectasy pills contain “Foxy”
Ecstasy Pills
• The Pink Heart or the Orange Pig?
– Ketamine; DXM; Caffeine; Crystal Meth; BZP
Ecstasy – Before You Use
• Remember, ecstasy is illegal and has tough penalties for
possession.
– You can also be charged for trafficking if you buy for friends.
• Ask around… Try to get the latest buzz on good and bad
E’s circulating.
– Pill websites and pill testing may help be useful.
• Buy from someone you know, or someone whose pills
you’ve tried and like.
• Be careful if you are feeling down before using.
• Be very careful if you are using anti-depressants; better
to avoid using.
• Be cautious if mixing with other drugs.
• Eat and sleep lots before and after partying.
Ecstasy – When You Use
• It’s nearly impossible to know the purity
and quality of the pill until after you take it.
– Kicks in, 20-60 mins (swallowed) – wait to get high!
– Start with half a pill. Wait about 45 minutes after
you’ve dosed before deciding to do more.
• Less is more. You will likely feel worse,
after using, if:
– You do more at one time (e.g., 2 ½ pills vs. 1 pill)
– You stay high longer (e.g., 20 hrs vs. 7 hrs)
Ecstasy – When You Use
• If you are physically exerting yourself
(dancing; sex) take breaks and chill out.
• Stay hydrated:
– YES: water; Gatorade;
– NO: alcohol; energy drinks
– Don’t overhydrate:
• Drink more if you are sweating a lot and your pee is dark in
colour
• Drink less if you are peeing a lot.
• You still need energy, even though you
may not be hungry. Eat!
– Fruits (esp. bananas), protein shakes, juices, yogurt,
are all good (and easier) to eat.
• Don’t overhydrate.
• U.K. case of
Leah Betts:
http://en.wikipe
dia.org/wiki/Le
ah_Betts
What goes up, must come down…
• Lack of sleep. Lack of food. Physically
exhausted.
– Accept the comedown; chill out with friends.
• Depressed; irritable; cranky
– Need time for recovery
– Eat! Sleep!
• Spread out the partying… not every
weekend.
– Serotonin takes a few weeks to be replaced.
• Good to see the variety of pill contents.
• Cost prohibitive.
• Lots of local reports.
• Subjective experiences can vary – be careful!
• Similar looking pills can vary.
Canadian results from ecstasydata.org
Most recent tests from ecstasydata.org
(not all Canadian results)
MDMA Purity
• New substances are being developed all the
time – some of these are easier to make than
MDMA; some are easy to acquire through the
internet; and some are not illegal, though can be
quite harmful.
• Increased global restrictions on the pre-cursor
chemicals used in the synthesis of MDMA are
making production more difficult and, therefore,
people are turning to new substances as
substitutes for MDMA, or mixing them with poor
quality MDMA to achieve more potent results.
Home Testing Kits
Home testing kits do NOT
demonstrate an accurate
picture of what is in pills and
capsules. They only serve to
indicate the SUSPECTED
presence, or non-presence,
of certain chemicals. The kits
do not show a complete
chemical picture and in no
way show the quantity (or
dose) or any ingredients.
• www.dancesafe.org (US)
• www.eztest.com (Europe)
Mandelin Reagent Test
• http://youtu.be/cmGNMA6sRyY
Home testing results of capsules sold as MDMA in Toronto
• Acquisition dates: #1 (June 2010); #2-5 (May-June 2011)
• From left: 1, 3 & 4 +ve for MDMA; 2 not tested; 5 not +ve for MDMA
(possibly DXM)
1
2
3
4
5
Home testing kits do NOT demonstrate an accurate picture of what is in pills and
capsules. They only serve to indicate the SUSPECTED presence, or non-presence,
of certain chemicals. The kits do not show a complete chemical picture and in no
way show the quantity (or dose) or any ingredients.
Canadian Test Kit Supplier
www.testkitplus.ca
Of Particular Concern
• PMA/PMMA (para-Methoxyamphetamine/paraMethoxymethamphetamine)
• These mimic the effects of MDMA but are more
potent and take longer to “kick-in”; people end
up double or triple dosing resulting in overdosing
and often death as a result of increased body
temperature.
• Linked to a number of deaths over the years
including several in British Columbia in
2011/2012.
Methylone
• bk-MDMA
• Structurally similar to MDMA
• Similar effects; novice users may not
differentiate
• Higher heart rate and body temp
• Increased jaw clenching
• Confirmed seizures in Toronto (2013)
• Confirmed home test results (2013)
Methylone
• "[Methylone] has almost the same potency
of MDMA, but it does not produce the
same effects. It has an almost
antidepressant action, pleasant and
positive, but not the unique magic of
MDMA.“ - Schulgin
• MOLLY: EVERYTHING BUT THE GIRL
• http://www.mixmag.net/words/features/dru
g-molly-everything-but-the-girl
Pure Pillz
• Piperazine class of drugs.
• Combination of BZP and TFMPP.
• First popularized as “Social Tonics” in New Zealand and
marketed as a “harm reduction” alternative to street
laced ecstasy pills.
• Were available in Canada online and in Toronto storefronts around 2007/2008.
• Did not become too popular as decent quality MDMA
was widely available and Pure Pillz only crudely mimic
effects of MDMA.
• BZP and TFMPP often show up in lab analysis of current
ecstasy pills.
• Sildenafil (Viagra) is a synthetic piperazine derivative.
Pure Pillz
Health Canada Advisory – Pure Pillz
Cannabis
• Price = ~ $40 for 1/8 ounce (a “half quarter”, 3.5 grams)
• Green leaf plant with buds, with orange/brown
fibers and sometimes coated in crystals.
Cannabis
• Marijuana, pot, weed.
• Commonly smoked or eaten.
• Concentrated resinous form called hashish, and
as a sticky black liquid called hash oil.
• Synthetic (pharmaceutical) versions.
• Three distinct species
– Cannabis sativa, Cannabis indica, and Cannabis
ruderalis
• The term 'hemp' is generally used to describe
low-THC varieties of cannabis which are grown
for industrial uses.
Source: flipper.diff.org/app/items/info/6025
Cannabis
Joints. Pipes. Bongs.
Cannabis Risk Reduction
• Vaporizers offer and alternative to smoking.
• Cannabis is heated to the point THC vaporizes but the
plant material is not burned.
Cannabis before (left) and
after (right) vaporization.
This vaporizer relies on convection
rather than conduction.
Vaporizers
Vaporizer vs. Smoking
• Vaporizer after 2 months use (left)
• Pipe after 2 weeks use (right)
Concentrates
Cannabis
• Butane Honey Oil (BHO); Wax; Dabs
– Cannabinoids extracted with gasses such as butane
or carbon dioxide.
• Concerns:
– High Concentrations of Cannabinoids (+ve / -ve)
• Think hard liquor vs. beer
– Left over contaminants
– Production dangers (explosive chemicals)
– http://www.hightimes.com/read/dab-or-not-dab
Cannabis
• The active ingredients are called cannabinoids
– THC (Delta-9-tetrahydrocannabinol) is thought to be
responsible for most of the psychoactive effects.
• Effects
– Onset: When smoked, the effects of cannabis begin
almost immediately. When eaten the effects can take
1 to 2 hours to manifest.
– Duration: Effects of smoked cannabis peak after
about 20 minutes and last for 1-2 hours. When eaten,
the effects will peak more slowly and primary effects
may last for 3-4 hours.
Cannabis Experience
• Primary effects with recreational use:
– Euphoria, relaxation, and changes in perception.
– Effects vary depending on dosage.
• Low doses:
– Sense of well-being, mild enhancement of senses
(smell, taste, hearing), subtle changes in thought and
expression, talkativeness, giggling, increased
appreciation of music, increased appetite, and mild
closed-eye visuals.
• Higher doses:
– Visuals may become more prominent, sense of time is
altered, attention span and memory are frequently
affected, and thought processes and mental
perception may be significantly altered.
Cannabis Experience
• Primary reasons for medicinal use:
– Appetite stimulation
– Pain reduction
– Many other benefits reported for a wide variety
of conditions.
• Can get a federal permit:
– To possess
– To grow
– To be a designated grower
Cannabis Concerns
• Negative effects can include:
– Paranoia, dry mouth, respiratory problems and
nervousness/racing heart.
– Reduced ability to concentrate, impaired
memory, tiredness, and confusion.
– Side effects tend to increase with lifetime use.
Cannabis Concerns
• Relative potential for dependency:
– Regular use can lead to psychological habituation
making it difficult to quit.
– Most people do not experience signs of physical
addiction.
– Withdrawal somewhat difficult but in no way
dangerous.
– Benzodiazepines can be used to treat withdrawal.
Cannabis Concerns
• Long Term Health Problems:
– Smoking: lung and throat problems: coughing;
increased throat and lung infections; reduced
lung capacity; carcinogenic effects.
– Amotivational syndrome.
– Not (or slightly) toxic to the liver, but…
• Increasing concern around heavy/chronic use and
HepC.
Cannabis Concerns
• Heart Issues:
– Because cannabis increases heart rate, it
could potentially increase risks of heart
problems in those at risk of heart disease.
• Mental Illness:
– Can precipitate neuroses or psychoses in
those who are already at risk.
Cannabis Risk Reduction
• Know your source.
• Be careful about mould and bacteria.
• Eating poses lowest health risks, though harder to titrate (manage)
dose.
• Use with people you trust.
• Be mindful of smoking public spaces.
• Avoid getting high and driving.
• Smoking increases risks of pulmonary disease.
– Try a vaporizer instead of smoking.
A marijuana infused
lollipop found in Toronto
(2013).
Media report with several
misleading statements
and no mention of the
cannabis psychosis
connection!
http://www.ctvnews.ca/video
?clipId=162909&playlistId=1
.1232631&binId=1.810401&
playlistPageNum=1
Cannabis
• In March 2013 a teenager presented to a
Toronto area Emergency Room hallucinating
and very tachycardic. He had been consuming
an “MJ Lollipop”. Analysis revealed the lollipop
contained only marijuana and a comprehensive
urine screen showed only marijuana in his
system.
Teenagers really should try to avoid marijuana
until later in life and this is why...
http://www.cbc.ca/documentaries/natureofthings/
2010/downsideofhigh/
Synthetic (prescription) THC
• Synthetic THC, available on prescription
– Cesamet (nabilone); Marinol (dronabinol)
• Reduced psychoactive effects.
Have you heard of “Izms”?
Synthetic Cannabinoids
• Contain synthetic cannabinoids JWH-018, JWH-073 and
JWH-122.
• Produce effects similar to tetrahydrocannabinol (THC),
the primary active ingredient in marijuana.
• Resembles crushed marijuana, except it’s brown in
colour and smells fruity instead of skunk-like
• Health Canada says these are “controlled substances”
and therefore illegal.
• Little is known about short or long-term effects, so
probably safer to avoid using these substances.
Salvia
• Salvia divinorum is a soft-leaved green plant,
native to Southern Mexico,
• Contains a powerful psychoactive chemical
“Salvinorin”.
• Many species and varieties within the genus
'Salvia'
– Plants commonly found in garden stores are almost
certainly not S. divinorum unless specifically labeled.
• Traditionally used by chewing pairs of leaves.
• Strong effects can be difficult to attain from
smoking dried leaf, but extracts and potencybred leaves can cause dramatic, sometimes
frightening, psychedelic mind-states.
• Many people choose not to repeat the
experience.
Salvia
• Depending on dosage, the experience can vary from a
subtle to a full-blown psychedelic experience.
– At higher doses users report dramatic time distortion, vivid imagery,
encounters with beings, travel to other places, planets or times, living
years as the paint on a wall or experiencing the full life of another
individual.
– These can be extremely powerful experiences and should only be
attempted with a sitter.
• When smoked, the first effects are noticed between 2060 seconds, increasing to peak effects within 1-2
minutes. The high is short with primary effects lasting 515 minutes and a 20-40 minute comedown.
• On Feb 19, 2011, a Notice to Interested Parties
proposing that Salvia divinorum and Salvinorin A be
controlled in Canada was published.
Salvia Risk Reduction
• Many people that have tried Salvia say they will never do it again.
• Do not operate heavy machinery. Do not drive.
• Use a Sitter.
– Some users will attempt to stand up and move around while in a completely
dissociated state. Having a sitter present can reduce the chances of injury or
other problems.
• People with existing emotional or psychological concerns should be
careful about choosing to use strong psychoactives.
• Individuals with a family history of schizophrenia or early onset
mental illness should be extremely careful; strong psychoactives
have been known to trigger psychological and mental health
problems.
• Salvia is unlikely to be physically addicting or likely to cause
psychological dependence.
Cocaine (powder)
• Coke, Blow, Charlie,
Whitney
• White to cream chunks or
powder
• $40 ½ gram; ~$240 8-ball
[3.5 grams] (Toronto
2011)
• Typically snorted up the
nose
Cocaine (powder)
• Main neurotransmitter: dopamine
• Stimulant
• Physical effects:
– Increase in heart rate, body temperature, blood
pressure
– Numbs tissues it touches (nose, gums, lips)
– Jaw grinding, dilated pupils, upset stomach
• Psycho/behavioural effects:
+ve: increased wakefulness; confidence; chatty
-ve: cravings; anti-social; anxious; “edgy”
 or  sex drive
Cocaine biochemistry
• Peak blood cocaine levels in
approximately:
– 30 to 45 minutes (snorted)
– 5 minutes (smoked)
– Almost instantly (injected)
• Duration of action: 45 to 90 minutes
• Short half life (1-2 hours)
– Short high… Quick come down  desire to
do more and to keep going
Cocaine biochemistry
Cocaine
• Immediate risks:
– Stroke; heart attack (esp. with high
concentrations from high doses or extended
“runs”)
– Anxiety / panic attacks
– Dehydration
– Push boundaries and take unintended risks
– Spend more than you intend
– Disease (esp. with snorting)
Cocaine
• Longer-term concerns:
– Tolerance
– Psychological / physical dependency
– Sinus infections
– Weight loss or gain
– Finances
Cocaine Risk Reduction
• Use a new straw
– Don’t snort with dirty dollar bills and keys.
– Avoid sharing straws or bumpers.
– Try colour coding or marking your straws when using
with other people.
• Having a nasal spray of clean water, that you
could use shortly after snorting each line.
– This can help reduce the damage to your nose.
• Leave money and bank cards at home.
Cocaine (crack)
• Rock; Free base cocaine;
• Powdered cocaine dissolved and boiled in
a mix of ammonia or baking soda.
• Looks like rocks or chunks
• Price: varies by region; 1 hit for <$5
• Smoked or injected
• Makes a cracking sound when burned
Cocaine (crack)
Taken from erowid.org
Crack Risk Reduction
• Use your own equipment:
– Pipes, needles, cookers, filters, tourniquets… etc.
• Find a safe space to use.
• Carry condoms / lube.
• Moisturize lips with non-oil based products.
Safer Crack Kit
• Alcohol swabs
• Pyrex-glass pipe
• Rubber mouth
piece
• Heat resistant
metal screens
• Chopstick
• Helps prepare
screens
• (Lip Balm)
Video: Step-by-step demonstration of safer crack smoking:
http://hepcinfo.ca/videoplayer_e/safer_smoking_e.flv
Cocaine – New Concerns
• Cocaine is notoriously cut with adulterants; it is rarely
good quality.
• Recently an adulterant known as Levamisole is showing
up in many samples throughout North America.
• This is of particular concern for people who are already
susceptible to autoimmune disorders:
– Levamisole can significantly reduce the number of white blood
cells in the body, a condition called agranulocytosis.
– Symptoms include fever, swollen glands, painful sores in the
mouth and anus, and an infection that won't go away.
– Because many of the symptoms of the illness are the same as
the flu, it is important that people who are using cocaine be
aware that they aren't sick with something more serious than
influenza.
Cocaine – New Concerns
• If you use cocaine watch out for:
–
–
–
–
High Fever
Chills
Painful anal, oral sores
Skin abscess / lung infection that
appears to be developing more rapidly
than usual.
• Seek Medical Attention Immediately!
Methamphetamine
• Crystal, Meth, Jib, Crank, Ice, Tina
• Price = $ 50-60 / bag (0.25 – 0.3 gram)
• White to off white powder; crystal shards
(like glass)
Methamphetamine
It can also look like…
Methamphetamine
• Strong stimulant; “upper”
• Releases dopamine, serotonin, norepinephrine
(adrenalin)
• Long half-life (12 hours)
• Physical effects:
– Increase in heart rate, body temperature; decreased
appetite and sleep; dry mouth; loss of erection
• Psycho/behavioural effects:
– Increase in alertness, confidence, euphoria
– Paranoia; anxiety; decreased self control / inhibitions
The Role of Dopamine
• While all stimulants release some dopamine,
crystal meth releases much larger amounts:
– Cocaine releases 400% more dopamine
– Crystal meth releases almost 1500% more
dopamine
Methamphetamine
• Immediate risks:
– Dehydration
– Lack of food / sleep
– Loss of inhibitions
– Paranoia / psychosis
Methamphetamine
• Longer-term risks:
– Physical/psychological dependency
– Weight loss
– Tooth decay
– Strains on heart
– Depression
– Loneliness
– Loss of friends, school, job
Methamphetamine Risk Reduction
• Plan ahead before partying; you may need a few days to
recover.
• Try to eat something while you're high
– Protein shakes or fruit juices with healthy supplements are better
than nothing. Feed your body the fuel it needs.
• Limit what you buy.
– The longer you party the rougher you’ll feel.
• Use extra lube if having sex.
• Lack of sleep. Lack of food. Physically exhausted.
– Accept the comedown
• Spread out the partying… not every week.
– Dopamine and all those other neurotransmitters take time to be
replaced.
Ketamine
• Special K, K, kitty
• Price: $20 - $30 / vial
• White powder
– Looks similar to table
salt or a fluffy powder
• Typically snorted
– Can be smoked or
injected (IM)
• Currently a lot of K is
actually MXE
(Methoxetamine)
Ketamine
Source: wikipedia
Ketamine
• Anesthetic; “downer”
• Lower dose:
– mild, dreamy effect; numbness in extremities
• Higher dose:
– difficult to move; hallucinogenic effect: out of body
feeling; separation of mind and body (“K-hole”)
• Duration of high: 30-60 minutes (K-hole) but
after effects last longer
Ketamine
• Immediate risks:
– Falling (breaking a limb)
– Assault
– Nausea (aspiration)
– Disease (esp. with snorting)
Ketamine
• Longer-term risks:
– Tolerance
– Psychological/physical dependency
– Sinus infections (if snorting)
– Bladder infections
– Kidney problems
– “k-pains”
Ketamine Risk Reduction
• Caution with eating before using.
– Anesthetics often make people throw-up.
• Caution should be exercised when measuring doses.
– Best to start with small doses, working your way toward the
desired levels.
• Mixing with alcohol often results in nausea, vertigo, and
"the spins“.
• K often “over-powers” the high (but not necessarily the
physical effects) of other drugs.
• Better to use your own straws and bumpers.
Ketamine Risk Reduction
• Be careful using in public environments (e.g., nightclubs)
so that you don’t “K-out”.
– Tell friends you are doing K and try to have a sober friend that
can help if you do too much.
• Anaesthesia-levels of ketamine (K-holes) in certain
settings could lead to serious accidents, such as falling
from a balcony or bathtub drowning.
• If someone passes out lay them on their side in case
they vomit.
• Tolerance builds quickly; take breaks from use to bring it
back down.
• Bladder/urinary tract infections and damage from
excessive/extended use.
Ketamine
Injecting
GHB
• G, GHB
• Price = ~ $10 / vial
• Clear liquid with slight
“chemically” smell and
taste which can easily
be masked in a drink
GHB
• Sedative; depressant; “downer”
• Lower dose:
– similar effect to alcohol… relaxed, happy
sociable
• Higher dose:
– dizzy, sleepy, vomiting, muscle spasms, loss
of consciousness (“G-d out”), depressed
breathing
• Duration of high: 1-4 hours
GHB
• Immediate risks:
– Very dose dependant
– Can be extremely dangerous when mixed
with alcohol
– Vomit pass out  aspiration
– Coma
• Longer-term risks:
– Psychological dependency
– Physical dependency
GHB Risk Reduction
• Store liquid G in a container that could
never be mistaken for drinking water.
• Colour the mixture BLUE using food
colouring, so as to avoid it being mistaken
for water, juice or alcohol.
• Shake that bottle!
– GHB is heavier than water.
“Hard-Ons”
• Sildenafil®
• Tablets come in doses of 25, 50 and 100 mg.
• Other similar substances:
– Levitra
– Cialis (the “weekender”; longer half life)
• Physical effects:
– Blood vessels relax; erection; lowered blood pressure
• Immediate risks:
– Stroke / heart attack
• Duration high:
– drug lingers in body for several hours
Viagra
Symptoms of Viagra, Cialis or Levitra toxicity:
• Chest or jaw pain
• Irregular heartbeat
• Nausea
• Respiratory problems
• Visual disturbances (blue colour)
• Prolonged erection > 4 hours
– Get to emergency room!
Viagra Risk Reduction
• Use the smallest dose necessary
• Be extra cautious if using blood pressure
medications
• Don’t take with grapefruit juice
– Absorption of Viagra increased by 23% when taken with
grapefruit juice instead of water. Grapefruit juice also delayed
the absorption of Viagra. (Jetter A, et al. Clinical Pharmacology
and Therapeutics 2002; 71:21-29.)
• Be careful when - or try to avoid - mixing
with poppers (amyl nitrite)
• If erection lasts longer than 4 hours, go to
emergency room
Viagra
Viagra?
Off-prescription “Viagra”, Fall 2007, Toronto, Canada
Poppers
• bolt, climax, poppers, rush, Zbest, and others
• Butyl / amyl nitrite; vapor inhaled
• Physical effects:
– Relaxation of blood vessels and smooth muscle
tissue
– Drop in blood pressure; flushed face
• Psychological effects:
+ve: head rush; horny; less inhibited
-ve: anxiety; nausea
• Duration high: 30-60 seconds
Poppers
• Immediate risks:
– Flammable; chemical burns
– Nausea; headaches
– Stroke (esp. mixed with other substances that
lower blood pressure such as Viagra)
• Long-term risks:
– Psychological addiction; carcinogenic?
LSD
(d-lysergic acid diethylamide)
• Potent hallucinogen
• White crystalline powder that dissolves in water,
is odourless, and has a slightly bitter taste.
• An effective dose is too small to see. (20 - 80
micrograms)
• It is usually packaged in squares of LSD soaked
papers (blotters) or miniature powder pellets
called microdots
• Usually taken by mouth and held on the tongue
or swallowed
LSD
Examples of LSD
blotter paper
colourful designs
often added to mask
impurities
street names may
vary according to
blotter designs
LSD
•
•
•
•
LSD trips are unpredictable
Produces vivid visual effects
Affects your senses, mood and thoughts
People can become paranoid and feel a
loss of control which can lead to a state of
panic
• Judgement is affected and people may put
themselves in danger
LSD
• Alters the persons perception of reality.
• Can vividly distort the senses.
• “Trip” - perceptual changes, altered time
sense, feeling detached from self,
synesthesia (“hearing” colours), dizziness,
“pins and needles”
• Not addictive
• Can cause flashbacks
• Some “acid blotter” being sold now is
actually 25I-NBOMe, a derivative of the
substituted phenethylamine 2C-I.
Psilocybin
Street names: Magic Mushrooms, shrooms
• Hallucinogen, similar to LSD
• Mushrooms or in powder capsules
• Sniffed, smoked or injected, or ingested
orally
• Onset 1/2 hour
• Effects last 4 to 5 hours
Effects of Psilocybin
• Sensations of relaxation or fatigue;
separation from surroundings;
heaviness or lightness
• Perceptual distortions, visual
hallucinations, dizziness, shivering
• Can cause tension and anxiety shortly
after ingestion
Is Psilocybin Dangerous?
• One danger is misidentification, as some
mushrooms are poisonous
• PCP and LSD are often sold as psilocybin
• Can impair judgement
• Can trigger underlying mental health
problems and cause schizophrenic-type
symptoms
• User can have “bad trips”
Sizzurp / Purple Drank
• Ingredients:
– Promethazine w/Codeine syrup
– Any fruit flavored soda
– A jolly rancher
The codeine is mainly responsible for the euphoria felt after drinking
sizzurp. Promethazine causes motor skill impairment, lethargy, and
extreme drowsiness.
DXM is not a component of sizzurp, although it may produce vaguely
similar effects to the above recipe in doses ranging from 150 - 250 mg.
DXM
• Dextromethorphan is found in over-thecounter cough and cold medicines.
• In high doses it acts as a "dissociative
anaesthetic" like ketamine or PCP. May
feel very spacey and "out of it“. May
lose motor control (your legs may feel
wobbly or at very high doses you won't
be able to move much).
• It can also produce audio and visual
hallucinations, and can sometimes
cause nausea and itchy skin.
• It can also be quite dangerous. Watch
Out!
• High doses of DXM have contributed to
numerous cases of rave-related
heatstroke.
Inhalants / Solvents
Inhalants / Solvents
• Inhalants are a diverse group of volatile substances
whose chemical vapors can be inhaled to produce
psychoactive (mind-altering) effects.
• While other classes of substances can be inhaled, the
term “inhalants” is used to describe substances that are
rarely, if ever, taken by any other route of administration.
• Inhalants are either chemicals in gaseous form or volatile
solvents (liquids) that becomes gas at the time of use,
which are inhaled by people for their psychoactive
effects.
• A variety of products common in the home and
workplace contain substances that can be inhaled to get
high: Gasoline; Acetone; Mineral Spirits; Freon;
Computer Duster; Glue
Inhalants generally fall into the
following categories:
• Volatile solvents: liquids that vaporize at room temperature
•
•
Industrial or household products, including paint thinners or removers, degreasers, drycleaning fluids, gasoline, and lighter fluid
Art or office supply solvents, including correction fluids, felt-tip marker fluid, electronic contact
cleaners, and glue
• Aerosols: sprays that contain propellants and solvents
•
Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric
protector sprays, aerosol computer cleaning products, and vegetable oil sprays
• Gases: found in household or commercial products or medical
anesthetics
•
•
Household or commercial products, including butane lighters and propane tanks, whipped
cream aerosols or dispensers (whippets), and refrigerant gases
Medical anesthetics, such as ether, chloroform, halothane, and nitrous oxide (“laughing gas”)
• Nitrites: a special class of inhalants that are used primarily as
sexual enhancers
•
Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly
known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When
marketed for illicit use, organic nitrites are often sold in small brown bottles labeled as “video
head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.”
Inhalants / Solvents
• Inhalants can be breathed in through the nose or mouth
in a variety of ways (known as “huffing”), such as sniffing
or snorting fumes from a container, spraying aerosols
directly into the nose or mouth, or placing an inhalantsoaked rag in the mouth. Users may also inhale fumes
from a balloon or a plastic or paper bag that contains an
inhalant.
• The intoxication produced by inhalants usually lasts just
a few minutes; therefore, users often try to extend the
“high” by continuing to inhale repeatedly over several
hours.
Inhalants / Solvents
• Immediate Effects:
– May include slurred speech, lack of coordination,
euphoria, lightheadedness, and dizziness.
– With repeated inhalations some people feel less
inhibited and less in control. Some may also
experience hallucinations, and delusions.
– Some users may feel drowsy for several hours and
experience a lingering headache.
– Chemicals found in different types of inhaled products
may produce a variety of additional effects, such as
confusion, nausea, or vomiting.
Inhalants / Solvents
• Immediate Risks:
– Sniffing highly concentrated amounts of the chemicals in
solvents or aerosol sprays can directly induce heart failure and
death within minutes of a session of repeated inhalation.
– This syndrome, known as “sudden sniffing death,” can result
from a single session of inhalant use by an otherwise healthy
young person.
– Sudden sniffing death is particularly associated with the abuse of
butane, propane, and chemicals in aerosols.
– Some solvents have effects at a cellular level, increasing the
susceptibility to HIV infection.
– Nitrites are sometimes used to enhance sexual pleasure and
performance and maybe associated with unsafe sexual
practices, increasing the risk of HIV or other STI transmission.
Hypoxia
• By displacing air in the lungs, inhalants deprive the body
of oxygen, a condition known as hypoxia.
• Hypoxia can damage cells throughout the body, but the
cells of the brain are especially sensitive to it.
• The symptoms of brain hypoxia vary according to which
regions of the brain are affected: for example, the
hippocampus helps control memory, so someone who
repeatedly uses inhalants may lose the ability to learn
new things or may have a hard time carrying on simple
conversations.
Solvents
• All have the ability to cause asphyxia, arrhythmias,
cardiovascular depression, neurologic dysfunction, and
mucosal, pulmonary, and skin irritation following acute
exposure and permanent neurologic damage with
chronic exposure. The acute effects of alkyl halides and
alkyl nitrites also include carbon monoxide poisoning and
hepatorenal toxicity, and methemoglobinemia,
respectively. Chronic exposure to aromatic hydrocarbons
and ketones can result in liver, kidney, and bone marrow
injury; myopathy, rhabdomyolysis, metabolic acidosis,
and electrolyte abnormalities are further complications of
chronic aromatic hydrocarbon inhalation.
– Emerg Med Clin North Am (1990 Aug) 8(3):559-78
Inhalants / Solvents
• Longer term risks:
– Long-term inhalant use can also break down
myelin, a fatty tissue that surrounds and
protects some nerve fibers. Myelin helps
nerve fibers carry their messages quickly and
efficiently, and when damaged, can lead to
muscle spasms and tremors or even
permanent difficulty with basic actions such
as walking, bending, and talking.
Alcohol
• Neurotransmitters:
– GABA (inhibits brain activity)
• Alcohol stimulates GABA receptors, making them more
inhibitory and further inhibiting brain activity
– Glutamate (brain’s general purpose excitatory
transmitter)
• Binds to glutamate receptors preventing glutamate from
exciting the cell
– Alcohol particularly effects areas involved in memory
formation, decision making and impulse control
Alcohol Risk Reduction
Alcohol does not mix well with many substances.
Be cautious, and better to avoid, the following:
• Alcohol + Benzos
• Alcohol + Ketamine
• Alcohol + Opiates
• Alcohol + GHB
– This can be a particularly dangerous combination
Alcohol Risk Reduction
•
•
•
•
•
•
•
•
•
Eat something before drinking
Pace yourself
Hydrate as you drink
Prearrange transportation; leave car keys behind
Take only the money you intend to spend
Make your own drinks
Only accept drinks from people you trust
Monitor how often you’re drinking; take breaks
“Liquor before beer, you’re in the clear; beer before
liquor, never been sicker”
• (Nearly all liquor is quality and potency assured)
Non-palatable alcohol
• Initiate a non-judgmental, factual
discussion about the harms of
using these substances.
• Encourage the use of safer
alcohols – beer, wine and liquor.
• Discuss the use of less harmful,
non-palatable alcohols (e.g.,
mouthwash rather than hand
sanitizer).
• Discuss options to reduce the
amount of non-palatable alcohol
consumed, and other strategies to
reduce the potential for harm,
Opiate Based Substances
• Illicit: Heroin; Opium (derived from the poppy plant)
• Pharmaceutical (prescription or street):
• Codeine (e.g., Tylenol 3)
• Oxycodone (e.g., Percocet)
• Oxycontin (time release oxycodone)
• Morphine
• Hydromorphone (e.g., Dilaudid)
• Hydrocodone (e.g., Hycodan)
• Meperidine (e.g., Demerol)
• Fentanyl (transdermal patch)
• Substitutes:
• Methadone
• Bubrenorphine/Suboxone
Opioids
• All are “downers”
• Primary risks are slowed breathing and heart rate.
• High potential for addiction with many.
• Heroin use has become an increasingly marginal form of
drug use among illicit opioid users in Canada, particularly
outside of Vancouver and Montréal.
• Most of the pharmaceuticals are prescribed for pain
management but have increasingly become the predominant
form of illicit opioid use.
• “Opioid-rich" environment:
• Canada is a world per capita consumer of a number of
pharmaceutical opioids.
Ontario Student Drug Use and Health Survey 2009
Heroin
•
•
•
•
•
Poppy derivative
Mainly administered IV
Also snorted and smoked
± $50 a point (1/10 of a gram)
Intense feeling of euphoria and wellbeing
• Sedation, analgesia
• Tolerance builds and ceasing use may
result in withdrawal symptoms
Oxycontin
• OxyContin contains oxycodone in a controlled-release tablet
(5 mg, 10 mg, 20 mg, 40 mg, and 80 mg)
• 12-hour pain relief.
• In Canada, OxyContin was manufactured by Purdue
Pharma.
• Introduced in 1996; Oxycodone-based products have been
used illicitly for the past 30 years.
• When used illicitly, OxyContin can be taken in pill form, or
crushed and then ingested, snorted, or injected, delivering
the whole time released dose at once.
• In 2012, Oxycontin was discontinued and replaced by
OxyNEO.
• OxyNEO is still Oxycodone but in a supposedly harder to
tamper with pill.
Fentanyl
• Extremely potent pain medication.
• Usually prescribed as a trans-dermal, time
release patch.
• 5 strengths with 1.25, 2.5, 5.0, 7.5, 10 mg.
• Delivers 12, 25, 50, 75, 100 mcg/hr for 72 hours.
• When used off prescription, people may
scrape the patch and inject the fentanyl.
• One patch can give about 10 injections.
• People can easily inject too much and
overdose.
“Underground Economy”
South East LHIN – North Hastings
Percocet 5 mg tabs
$5
Oxycocet 5 mg tabs
$3
Morphine 30 mg tabs
$4
Morphine 100 mg tabs
$8
Oxycontin 10 mg tabs
$7-8
Oxycontin 40 mg tabs
$20-30 ($20 Renfrew Cty)
Oxycontin 80 mg tabs
$45-60 ($40 Renfrew Cty)
Fentanyl 50 mcg patch $30
From presentation: “Below the Radar: Exploring Substance Use In Rural Ontario”. Kathy Hardill and Sean Lee-Popham
(North Hastings Harm Reduction Network), Canada Harm Reduction 2011 Conference , Ottawa
*In Northern Ontario, in some First Nation’s communities, 80mg pills can be sold for $200-$500.
Opiate Risk Reduction and Treatment
• Basic risk reduction strategies, particularly using new equipment when
injecting.
• Be cautious when using after periods of abstinence, as tolerance may
have dropped and risk of overdose is increased.
• Naloxone may be used in cases of overdose to provide temporary
relief but person should still be taken to hospital.
• Snorting and injecting opioid painkillers can result in a quicker and
stronger effect.
• These methods can be dangerous as they release several hours
worth of opioid painkillers into your body at once.
• Mixing with other substances, particularly depressants such as alcohol
and narcotics, can be dangerous.
• Some opioid painkillers (such as codeine and hydrocodone) also
contain acetaminophen, which can cause liver toxicity with regular use
and high doses.
• Medications (Methadone; Buprenorphine) can assist with detoxification,
in combination with other therapeutic interventions.
Methadone Maintenance Programs
Some people struggling with opioid dependence are unable to
maintain a state of abstinence. Prolonged methadone
treatment can lead to:
• A decrease and often the cessation of opioid use.
• A decrease in the use of other substances.
• A substantial decrease in crime and prostitution.
• Improved health.
• An improvement in living conditions.
• Better conditions for the continuation of pregnancy.
Methadone Maintenance Programs
What is methadone?
Methadone is an effective and legal substitute for opioid drugs such as
heroin, codeine, morphine, Dilaudid® and Percodan®. Methadone is a longacting opioid drug. This means it acts more slowly in the body, for a longer
period of time, than most other opioids. By acting slowly it can prevent
withdrawal and eliminate or reduce drug cravings, without causing a person
to get high. People who are dependent on opioid drugs can take methadone
to help stabilize their lives and to reduce the harms related to their drug use.
It has been used in treatment programs since the early 1960s. Methadone is
available through specialized drug treatment clinics or it may be prescribed
by family physicians and dispensed by community pharmacists, in
accordance with Canadian regulations. Only physicians who have received
an exemption under Section 56 of the Controlled Drugs and Substances Act
are allowed to prescribe methadone.
Methadone Maintenance Programs
How does it work?
Methadone can be used to replace the opioid drug that a
person is dependent on. It prevents withdrawal symptoms and
cuts down on the person’s drug cravings. It does not alter
someone’s ability to work, go to school or care for their family.
Users usually need one dose every 24 hours. When
methadone is diluted in juice, it does not have a euphoric effect
or interfere with a person’s thinking, however, it does block the
euphoric effect of heroin and other opioid drugs, so it makes
the idea of using those drugs much less attractive. Methadone
works best when it is combined with drug counseling.
Methadone Maintenance Programs
Is methadone safe?
When taken as prescribed, methadone is very safe and will not cause damage to the body or
mind, even if it is taken daily for many years. On the other hand, methadone is a powerful drug
and can be extremely dangerous if not taken properly.
How is methadone taken?
Your doctor will give the pharmacy a prescription for your methadone. This prescription must be
renewed regularly by your doctor. He or she will determine how often you come for
appointments, depending on your needs and progress. Your dose of methadone is usually
mixed with orange juice. When you first start on methadone, you will be asked to go to your
pharmacy each day to drink the medication. After two months you may be able to begin to take
home some doses. These are called “carries.”
How long do people stay on methadone?
People stay on methadone as long as they need to. Some health care providers promote shortterm methadone detoxification, where the dependent person is stabilized on methadone and
then tapers off using it over the next one to six months. Others may stay on it for up to twenty
years. Whether short-term or long-term, research has shown that methadone maintenance is
the most effective treatment for opioid dependence.
Methadone Maintenance Programs
Given the costs of untreated opioid dependence, methadone maintenance treatment
offers significant benefits to society, which far outweigh the costs of providing
treatment. American researchers have found:
• The annual costs of methadone maintenance treatment are much lower than the
annual costs of either untreated heroin use, incarceration or drug-free treatment
programs;
• Criminal activities related to heroin use resulted in social costs that were four times
higher than the cost of methadone maintenance treatment;
• For every dollar spent on methadone maintenance treatment there is a savings to
the community of between US$4-$13.
Similar cost benefits are being identified in Canada. In Toronto, the average social
cost of an untreated person who is dependent on illicit opioids has recently been
estimated to be $44,600 per year. According to an estimate from the Centre for
Addiction and Mental Health in Toronto, methadone maintenance treatment can be
provided for approximately $6,000 per year. (2000)
In Canada, methadone maintenance has increased five-fold since the mid-1990s.
Methadone and HIV
• Some HIV meds decrease the strength of
methadone, which means you could go
into methadone withdrawal.
• Not a lot is known about how HIV meds
interact with substances - it’s a good idea
to talk with your doctor, nurse or
pharmacist about what is known so you
can stay as healthy as possible.
205
Methadone Interactions
• Viramune:  methadone up to 60%
• Sustiva:  methadone up to 60%
• Rescriptor: Not studied
Methadone Interactions
• Crixivan: None
• Norvir: Decreases methadone levels
• Invirase/ Fortovase: Minimal effects on
methadone
• Agenerase: Decreases methadone by 13%
• Viracept:  methadone 35-45%
– ( NFV 50%)
• Kaletra:  methadone up to 50%
Buprenorphine/Suboxone
• Buprenorphine hydrochloride is one of the first new treatment options
for opioid dependence since methadone was introduced in Canada
over 40 years ago.
• Physicians do not have to obtain a section 56 methadone exemption1
from Health Canada in order to prescribe buprenorphine.
• While international clinical evidence indicates that buprenorphine is a
much safer drug than methadone, it is important to keep in mind that
the opioid-dependent patient population presents special risks and
challenges.
• Two formulations of buprenorphine – Subutex® and Suboxone® –
have been approved by Health Canada for use in treating opioid
dependence.
Buprenorphine
• Is efficacious as substitution therapy in the treatment of opioid dependence.
• Is an alternative to, but not a substitute for, methadone maintenance treatment.
• Is considered safer in overdose than methadone, although if combined with other
CNS depressant drugs (e.g., benzodiazepines) respiratory depression can occur.
If clinical symptoms of overdose occur it may require higher doses of naloxone or
other measures for treatment.
• May have a lower potential for abuse and dependence than pure agonists such as
morphine, although abuse does occur.
• Can be titrated to an effective dose within days, in contrast to methadone which
typically may take weeks to achieve.
• May induce withdrawal in patients dependent on opioids if administered too soon
after last use of full opioid agonists.
• May be easier to taper from than methadone.
• May be associated with less stigma than methadone.
• Suboxone (Buprenorphione plus Naloxone) is a sub-lingual tablet, available in two
different doses. The Naloxone is intended to deter injection.
• Coverage for Suboxone is currently not universal in Ontario.
Source: (CAMH 2008)
Prescription Medications
• Opioids include pain medications with active ingredients
such as morphine, oxycodone and codeine.
– Tylenol 3s; Percocets; Oxycontin
• Tranquillizers are often prescribed to reduce stress and
panic attacks.
– benzodiazepines such as diazepam (Valium®) and alprazolam (Xanax)
• Stimulants are often used to treat ADD/ADHD.
– dextroamphetamine (Adderall); methylphenidate (Ritalin)
Prescription Medications
• Antidepressant are used to alleviate mood disorders,
such as major depression and dysthymia.
– selective serotonin reuptake inhibitors (SSRIs: Celexa; Zoloft; Prozac);
serotonin-norepinephrine reuptake inhibitors (SNRIs: Effexor);
monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants
(TCAs)…
• Barbiturates treat anxiety, sleep disorders and seizures
– pentobarbital sodium (Nembutal) and mephobarbital (Mebaral).
• Anitpsychotics are primarily used to manage psychosis
particularly in schizophrenia and bipolar disorder:
– haloperidol (Haldol) olanzapine (Zyprexa), quetiapine (Seroquel),
risperidone (Risperdal), and aripiprazole (Abilify)
Pharmaceutical Drugs
• The following few slides come from:
not4me.org
• We have divided the pharmaceutical facts
into three common categories:
• Opioid Painkillers
• Stimulants
• Tranquilizers, Barbiturates
Pharmaceutical
Opioid Painkillers
•
•
•
•
•
What it is
Category: Opioid analgesic
Examples of generic names (and their respective trade names) include:
codeine (Tylenol III), meperidine (Demerol), hydrocodone (Vicodin),
oxycodone (OxyContin, Percocet) and morphine.
Pharmaceutical painkillers are usually prescribed medically for the purposes
relieving pain, but they are also used recreationally or outside of their
prescribed use. Most opioid painkillers that are used recreationally are
diverted from prescription use, rather than being illegally manufactured.
Most come in pill form in various dosages, which can be taken orally,
ground up and snorted nasally or diluted into a liquid and injected. Snorting
and injecting result in a quicker and stronger effect (though these methods
can be very dangerous as they release several hours worth of opioid
painkillers into your body at once).
Pharmaceutical
Opioid Painkillers
•
•
•
•
•
•
•
•
•
What will likely happen *Reactions and experiences may vary dramatically from person to
person.*
Effects on brain:
Short term: Opioid painkillers activate opioid receptors in the brain, increasing the release of the
neurotransmitter dopamine, interfering with the transmission of pain signals to the brain and
causing feelings of intense happiness, warmth and pleasure.
Effects on body:
Short term: Possible immediate effects include (pain relief), sleepiness, constricted pupils,
sweating, loss of appetite, constipation, nausea, vomiting, dizziness, headache, itchiness, dry
mouth, fatigue, weakness, insomnia, fever, diarrhea, difficulty urinating, abdominal pain, rash,
difficulty breathing and convulsions. When snorted, nasal discomfort or damage can occur.
Long term: Possible long term effects include physical addiction and withdrawal symptoms if drug
use is stopped. Some opioid painkillers (such as codeine and hydrocodone) also contain
acetaminophen, which can cause liver toxicity with regular use and high doses.
Effects on behaviour:
Short term: Possible immediate effects include improved mood, euphoria, feelings of relaxation,
unfocused thoughts, confusion, and nervousness.
Long term: Possible long-term effects include cravings for more opioid painkillers and decreased
interest in sex.
Pharmaceutical
Opioid Painkillers
• Dependency
• Addiction: Opioid painkillers can be both physically and
psychologically addictive. The addictive potential is strong in
recreational users as well as in medical users, especially if the drug
is used on a daily basis.
• Tolerance: Tolerance to opioid painkillers can develop over a
matter of weeks, with higher doses needed to achieve the same
desired effect (both recreationally and medically).
• Withdrawal Symptoms: Symptoms can occur when regular
pharmaceutical painkiller use is stopped, and include insomnia,
restlessness, muscle spasms, muscle aches, tremors, sweating,
fever, nausea, vomiting, diarrhea and anxiety.
Pharmaceutical
Opioid Painkillers
•
•
•
•
•
•
If you choose to use... Harm Reduction Tips
Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing
pharmaceuticals without a prescription from your doctor, or exchanging, buying or selling them, it
can result in criminal charges.
Drug use affects the developing mind and body differently than developed ones. Waiting until your
mind and body have more fully developed before using substances can have long term health and
mental benefits.
Opioid painkillers have very strong addictive potential! Do not assume that a drug prescribed by a
doctor to a friend will be safe for you to take as well. Opioid painkillers are prescribed only for
individuals who need it, and can have adverse and dangerous effects on individuals for whom
they are not prescribed.
Similarly, if you have been prescribed opioid painkillers, avoid taking more than the prescribed
dosage. Always talk to your doctor or a health professional before taking prescribed painkillers
with other substances.
Some of the negative effects of opioid painkillers can be alleviated by lying down. Negative side
effects generally increase with higher doses.
Pharmaceutical
Opioid Painkillers
•
•
•
•
•
•
•
Some opioid painkillers (such as codeine and hydrocodone) also contain acetaminophen, which
can cause liver toxicity with regular use and high doses.
If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean
the area you are planning to inject with soap and water or an alcohol pad. You can get clean
injection supplies from a syringe exchange, a pharmacy, or your local health department. If you
can’t get new needles, try snorting instead. Cleaning needles and works is not risk-free; it’s a last
resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.
Regular injection can cause abscesses, collapsed veins, infections and other complications.
Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus
infections, nose bleeds and developing a hole in the cartilage wall between nostrils.
Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of
Hepatitis B, Hepatitis C and HIV
Snorting and injecting opioid painkillers can result in a quicker and stronger effect. These methods
can be very dangerous as they release several hours worth of opioid painkillers into your body at
once.
Avoid using opioid painkillers with other substances, particularly depressants such as alcohol and
narcotics.
Pharmaceutical
Stimulants
• What it is
• Category: Stimulants
• Examples of chemical names (and their respective trade names)
include: amphetamine (Adderall) and methylphenidate (Ritalin,
Concerta). Pharmaceutical stimulants are most commonly
prescribed in the treatment of Attention Deficit Disorder (ADD) and
Attention Deficit Hyperactive Disorder (ADHD), but they have also
been used in the treatment of narcolepsy and mild depression.
Pharmaecutical stimulants are also used recreationally or outside of
their prescribed use by many individuals.
• For more information about amphetamines, click here.
Pharmaceutical
Stimulants
•
•
•
•
•
•
•
•
•
•
What will likely happen *Reactions and experiences may vary dramatically from person to
person.*
Effects on brain:
Short term: Stimulants cause an increased release of the neurotransmitter dopamine which
causes increased feelings of pleasure.
Long term: can cause permanent changes to some areas of the brain, though the brain is quite
adept at rewiring and compensating for changes
Effects on body:
Short term: Possible immediate effects include sweating, dilated pupils, decreased appetite,
difficulty sleeping, tremors, increased heart rate, increased blood pressure, narrowing of blood
vessels causing decrease in blood flow and flow of oxygen to the heart.
Long term: Possible long term effects include weight loss, insomnia, exhaustion, heart problems,
seizures, physical addiction and withdrawal symptoms is drug use is stopped.
Effects on behaviour:
Short term: Possible immediate effects include increased concentration, panic, anxiety,
aggression, hostility, violence and paranoia.
Long term: Possible long-term effects include paranoia, aggression, panic, hostility, violence and
triggering of underlying psychological problems.
Pharmaceutical
Stimulants
•
•
•
•
Dependency
Addiction: Physical and psychological addiction can occur.
Tolerance: can develop tolerance
Withdrawal Symptoms: Withdrawal symptoms occur when
stimulant use is stopped and include, depression, loss of appetite,
difficulty sleeping.
Pharmaceutical
Stimulants
•
•
•
•
•
•
•
•
•
If you choose to use... Harm Reduction Tips
Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a
prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.
Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body
have more fully developed before using substances can have long term health and mental benefits.
Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Pharmaceutical
stimulants are prescribed only for individuals who need it, and can have adverse and dangerous effects on
individuals for whom they are not prescribed.
Similarly, if you have been prescribed pharmaceutical stimulants, avoid taking more than the prescribed dosage.
Always talk to your doctor or a health professional before taking prescribed stimulants with other substances.
Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis
C and HIV
If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are
planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe
exchange, a pharmacy, or your local health department. If you can’t get new needles, try smoking or snorting
instead.
Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds,
then clean water 3 times.
Regular injection can cause abscesses, collapsed veins, infections and other complications. Regular snorting can
cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a
hole in the cartilage wall between nostrils.
Pharmaceutical
Tranquilizers, Barbiturates
• What it is
• Category: Sedative, tranquilizer
• Examples of generic names (and their respective trade names)
include: diazepam (Valium), lorazepam (Ativan), alprazolam
(Xanax), clonazepam (Klonopin), amobarbital (Amytal) and
pentobarbital (Nembutal).
• Pharmaceutical tranquilizers and barbiturates are usually prescribed
medically for the purposes of treating anxiety, sleep problems,
muscle spasms and seizures, but they are also used recreationally
or outside of their prescribed use. Most tranquilizers and
barbiturates that are used recreationally are diverted from
prescription use, rather than being illegally manufactured.
• Most come in pill form in various dosages, which can be taken
orally, ground up and snorted nasally or diluted into a liquid and
injected.
Pharmaceutical
Tranquilizers, Barbiturates
•
•
•
•
•
•
•
•
•
What will likely happen *Reactions and experiences may vary dramatically from
person to person.*
Effects on brain:
Short term: Pharmaceutical tranquilizers and barbiturates increase the activity of the
neurotransmitter GABA, resulting in decreased brain activity and causing feelings of
calmness and drowsiness.
Effects on body:
Short term: Possible immediate effects include dilated pupils, drowsiness, slurred
speech, loss of coordination, fatigue, irregular breathing, decreased heart rate,
decreased blood pressure.
Long term: Possible long term effects include slower reflexes, chronic tiredness,
problems with vision, difficulty sleeping, sexual dysfunction, respiratory difficulties and
liver damage.
Effects on behaviour:
Short term: Possible immediate effects include feelings of calmness and relaxation,
lowered inhibitions, impaired judgment and paranoia.
Long term: Possible long-term effects include mood swings and aggression.
Pharmaceutical
Tranquilizers, Barbiturates
•
•
•
•
Dependency
Addiction: Pharmaceutical tranquilizers and barbiturates can be both
physically and psychologically addictive. The addictive potential is strong in
recreational users as well as in medical users, especially if the drug is used
on a daily basis.
Tolerance: Tolerance to pharmaceutical tranquilizers and barbiturates can
develop very quickly, for both medical and recreational use, particularly
when taken on a daily basis.
Withdrawal Symptoms: Withdrawal symptoms do occur when regular use
or high doses are stopped and include restlessness, insomnia, anxiety,
depression and delirium. One severe withdrawal symptom is brain activity
rebound, as the tranquilizers or barbiturates wear off, resulting in the brain
racing out of control. This can sometimes cause seizures.
Pharmaceutical
Tranquilizers, Barbiturates
•
•
•
•
•
•
•
•
•
•
If you choose to use... Harm Reduction Tips
*Disclaimer! Nothing you do can make using unprescribed pharmaceuticals completely safe. All drug use has
inherent risks and dangers. The suggestions in this section can only help you reduce some of the associated risks.
The best way to avoid the harms related to drug use is to not take the drug at all.*
Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a
prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.
Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body
have more fully developed before using substances can have long term health and mental benefits.
Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis
C and HIV
If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are
planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe
exchange, a pharmacy, or your local health department. If you can’t get new needles, try snorting instead.
Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds,
then clean water 3 times.
Regular injection can cause abscesses, collapsed veins, infections and other complications. Regular snorting can
cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a
hole in the cartilage wall between nostrils.
Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Tranquilizers and
barbiturates are prescribed only for individuals who need it, and can have adverse and dangerous effects on
individuals for whom they are not prescribed.
Similarly, if you have been prescribed tranquilizers or barbiturates, avoid taking more than the prescribed dosage.
Always talk to your doctor or a health professional before taking prescribed medications with other substances.
Pharmaceutical Risk Reduction
• Harm Reduction Guide to Coming Off
Psychiatric Drugs:
– http://theicarusproject.net/downloads/ComingOffPsyc
hDrugsHarmReductGuide1Edonline.pdf
Resources
•
•
•
•
•
•
•
General:
www.erowid.org/psychoactives/psychoactives.shtml (all about every drug)
www.tripproject.ca (Toronto based “party drug” harm reduction)
www.not4me.org (Fear and abstinence only drug education?
It's not enough 4 me.)
www.torontovibe.com (AIDS Committee of Toronto’s party drug info page)
www.dancesafe.org (U.S. based “party drug” harm reduction info)
www.cssdp.org (Canadian Students for Sensible Drug Policy)
•
•
•
•
Ecstasy:
www.ecstasy.org
www.ecstasydata.org (chemical analysis of pills)
www.pillreports.com (qualitative user reports of pills)
•
•
•
Crystal Meth: (gay/bi men focused)
www.himynameistina.com
www.tweaker.org / www.crystalneon.org
www.knowcrystal.org
What should I tell my kids about drugs?
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Alcohol and tobacco are drugs.
All drugs can potentially cause harm.
Tell your kids about drugs from an early age.
Never inject.
Don’t use solvents.
Don’t drink and take drugs at the same time.
A criminal record can ruin your career.
Find good sources of advice.
If you do drugs, be clear why.
If you do get into trouble with drugs, get help quickly.
If you use drugs, don’t let them interfere with school.
Contact Us
Nick Boyce, Director
[email protected]
CC Sapp, Trainer
[email protected]
Website
www.ohsutp.ca
Presentations
http://www.slideshare.net/OHSUTP/presentations