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Health Effects

Drugs of Abuse

Emerging Drugs

Get more information on K2/Spice, Salvia and Bath Salts. NIDA will update this page with the latest research findings on these and other emerging drugs as they develop.

Commonly Abused Drugs

Cannabis (Marijuana)
Health Effects
Greenish-gray mixture of the dried, shredded leaves, stems, seeds, and/or flowers of Cannabis sativa or cannabis indica—the hemp plant
Acute	Heightened sensory perception; euphoria, followed by drowsiness/relaxation; impaired short-term memory, attention, judgment, coordination and balance; increased heart rate; increased appetite
Long-term	Addiction: About 9 percent of users; about 1 in 6 of those who started using in their teens; 25 to 50 % of daily users Mental disorders: May be a causal factor in schizophreniform disorders (in those with a pre-existing vulnerability); is associated with depression and anxiety Smoking related: Chronic cough; bronchitis; lung and upper airway cancers is undetermined
In combination with alcohol	Magnified tachychardia and effect on blood pressure; amplified impairment of cognitive, psychomotor, and driving performance
Withdrawal symptoms	Irritability, difficulty sleeping, strange nightmares, craving, and anxiety
Associated Special Vulnerabilities/Populations
Youth	Almost 44 percent of teens have tried marijuana by the time they graduate from high school (MTF, 2010).
Treatment options
Medications	There are no FDA-approved medications to treat marijuana addiction.
Behavioral Therapies	Cognitive-behavioral therapy (CBT) Contingency management, or motivational incentives Motivational Enhancement Therapy (MET) Behavioral treatments geared to adolescents (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

Cocaine
Health Effects
White crystalline powder that can be snorted, injected or smoked
Acute	Dilated pupils; increased body temperature, heart rate, and blood pressure; nausea; increased energy, alertness; euphoria; decreased appetite and sleep High doses: Erratic and violent behavior, panic attacks
Long-term	Addiction, restlessness, anxiety, irritability, paranoia, panic attacks, mood disturbances; insomnia; nasal damage and difficulty swallowing from snorting; GI problems; HIV
In combination with alcohol	Greater risk of overdose and sudden death than either drug alone
Withdrawal symptoms	Depression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation
Associated Special Vulnerabilities/Populations
Pregnancy	Premature delivery, low birth weights, and smaller for gestational age
Treatment options
Medications	There are no FDA-approved medications to treat cocaine addiction.
Behavioral Therapies	Cognitive-behavioral therapy (CBT) Community reinforcement approach plus vouchers Contingency management, or motivational incentives The matrix model 12-Step facilitation therapy (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

Prescription Stimulants (Abuse)
Health Effects
Amphetamine (Dexedrine, Adderall), Methylphenidate (Ritalin, Concerta)
Acute	Increased alertness, attention, energy; irregular heartbeat, dangerously high body temperature, potential for cardiovascular failure or seizures
Long-term	High doses, or alternate routes of administration (e.g., snorting, injecting): Anxiety, hostility, paranoia, psychosis; addiction
In combination with alcohol	Masks the depressant action of alcohol, increasing risk of alcohol overdose; may increase blood pressure; jitters
Withdrawal symptoms	Depression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation
Associated Special Vulnerabilities/Populations
Female adolescents	Unlike some illicit drugs and alcohol, stimulants are used at equal or greater frequency by young females vs. males. Use is often to lose weight, stay awake to study, or perform better on exams.
Mixing with antidepressants or OTC cold medicines	May enhance adverse effects; cause blood pressure to become dangerously high or lead to irregular heart rhythms
Treatment options
Medications	There are no FDA-approved medications to treat stimulant addiction.
Behavioral Therapies	Behavioral therapies that have proven effective for treating addiction to illicit stimulant drugs, such as cocaine and methamphetamine, may be useful in addressing prescription stimulant addiction. (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

Methamphetamine
Health Effects
White, odorless, bitter-tasting crystalline powder that is easily dissolved in water or alcohol; can be ingested orally, intranasally, injected, or smoked
Acute	Enhanced mood; increased heart rate, blood pressure, body temperature, energy and activity; decreased appetite; dry mouth; increased sexuality; jaw-clenching
Long-term	Addiction, memory loss; weight loss; impaired cognition; insomnia, anxiety, irritability, confusion, paranoia, aggression, mood disturbances, hallucinations, violent behavior; liver, kidney, lung damage; severe dental problems; cardiac and neurological damage; HIV, Hepatitis
Withdrawal symptoms	Depression, anxiety, fatigue, and intense craving for the drug
Associated Special Vulnerabilities/Populations
Pregnancy	Increased risk of premature birth, placental abruption, fetal growth retardation, and heart and brain abnormalities
Treatment options
Medications	There are no FDA-approved medications to treat methamphetamine addiction.
Behavioral Therapies	Cognitive-behavioral therapy (CBT) Contingency management, or motivational incentives The matrix model 12-Step facilitation therapy (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

Inhalants
Health Effects
Volatile solvents, Aerosols, Gases, Nitrites (Poppers): Effects depend on properties of chemical; inhalation common route of abuse
Acute	Confusion; nausea; slurred speech; lack of coordination; euphoria; dizziness; drowsiness; disinhibition, lightheadedness, hallucinations/ delusions; headaches; suffocation; convulsions/seizures; hypoxia; heart failure; coma; sudden sniffing death (butane, propane, and other chemicals in aerosols) Nitrites: Systemic vasodilation; increased heart rate; brief sensation of heat and excitement; dizziness; headache
Long-term	Myelin break down leading to muscle spasms, tremors and possible permanent motor impairment; liver/kidney damage Addiction: A minority inhale on a regular basis, but among those, some report symptoms of addiction (need to continue using, despite severe adverse consequences). Nitrites: HIV/AIDS and hepatitis; lipoid pneumonia
In combination with alcohol	Nitrites: Increased risk of adverse cardiovascular effects; Alcohol may increase the blood-vessel relaxant effect of organic nitrates (such as amyl nitrite) and result in dangerously low blood pressure.
Withdrawal symptoms	With Long-Term Abuse: Mild withdrawal syndrome (e.g., irritability, restlessness, insomnia, headaches, poor concentration)
Associated Special Vulnerabilities/Populations
Youth	Abused mostly by younger (8th graders) rather than older teens (10th and 12th graders) Nitrites: Linked to high risk sexual behaviors and HIV transmission; because of vasodilating actions on anal sphincter, frequently used to facilitate anal intercourse by men who have sex with men
Pregnancy	Although rigorous studies have not been conducted, data from occupational exposure to abused solvents like toluene suggest increased spontaneous abortion and fetal malformations.
Treatment options
Medications	There are no FDA-approved medications to treat inhalant addiction
Behavioral Therapies	There are no published reports of behavioral approaches for the treatment of inhalant abuse.

Prescription Sedatives, sleeping pills*, or anxiolytics (Abuse)
Health Effects
Central nervous system depressants include barbiturates (e.g., Nembutal) and benzodiazepines (e.g., Valium, Xanax)
Acute	Drowsiness, relaxation; overdose
Long-term	Tolerance, physical dependence, addiction
In combination with alcohol	Slows both heart rate and respiration, which can be fatal
Withdrawal symptoms	Discontinuing prolonged use absent a physician’s guidance can lead to serious withdrawal symptoms, including seizures. For barbiturates, abrupt cessation can be life-threatening.
Treatment options
Medications	Addicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered.
Behavioral Therapies	Behavioral therapies, such as cognitive behavioral therapy, that have proven effective for treating addiction to other illicit substances may be useful in addressing addiction to prescription sedatives. (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

* Although newer (non-benzodiazepine) sleep medications are thought to have less abuse/addiction liability, ER visits associated with their nonmedical use have been increasing, so these may also present a risk for patients taking them other than as prescribed.

Hallucinogens
LSD
LSD, PCP, MDMA (Ecstasy), Psilocybin, Salvia, Ketamine
Acute	Elation, depression, arousal, paranoia or panic; impulsive behavior, rapid shifts in emotions; distortions in perception. Increased body temperature, heart rate, blood pressure; nausea; loss of appetite; jaw-clenching; numbness; sleeplessness; dizziness, weakness, tremors High doses: Panic, paranoia, feelings of despair, fear of insanity and death
Long-term	Frightening flashbacks, Hallucinogen Persisting Perception Disorder (HPPD), low addictive potential; however, tolerance possible
PCP
Acute	Low Doses: Shallow, rapid breathing, increase in heart rate and blood pressure; nausea, blurred vision, dizziness; numbness; slurred speech; confusion; loss of coordination; muscle contractions; analgesia; altered perceptions; feelings of being separated from one’s body High Doses: Feelings of invulnerability and exaggerated strength; seizures, coma, hyperthermia
MDMA (Ecstasy)
Acute	Euphoria; increased energy, alertness, tactile sensitivity, empathy; decreased fear, anxiety; increased/irregular heartbeat; dehydration; chills; sweating; impaired cognition and motor function; reduced appetite; muscle cramping; teeth grinding/clenching; in rare cases—hyperthermia, rhabdomyolysis, and death
Long-term	Impulsiveness; irritability; sleep disturbances; anxiety addiction
Psilocybin
Acute	Low doses: Relaxation; altered sensory perception; increased energy, heart rate; decreased appetite High doses: Effects similar to LSD, including visual hallucinations, altered perceptions; nervousness, confusion, panic, paranoia
Long-term	Low addictive potential, however may produce tolerance
Salvia
Acute	Short-lived, but intense hallucinations, altered visual perception, mood, body sensations; emotional swings, feelings of detachment from one’s body; highly modified perception of external reality and self; sweating
Long-term	Unknown addictive potential
Ketamine (similar to PCP)
Acute	Anxiety; agitation; insomnia; euphoria; excitement; slurred speech; blurred vision; irregular heartbeat Low Doses: Nausea; elevated blood pressure; sedation; analgesia; impaired attention; memory and motor function Higher Doses: Immobility; distortions of auditory and visual perceptions; feelings of being separated from one’s body and environment; hallucinations; memory problems
Long-term	Cognitive impairment, including verbal and short-term memory; blurred vision; loss of coordination
In combination w/alcohol	Increased risk of adverse effects
Treatment options
Medications	There are no FDA-approved medications to treat addiction to hallucinogens.
Behavioral Therapies	There is no evidence base for treating abuse of or addiction to hallucinogens specifically.

Street Opioids (Heroin, Opium)
Health Effects
Processed from poppy plants; white or brownish powder or black sticky substance known as “black tar heroin;” Usually smoked or injected, could be taken orally (opium)
Acute	Euphoria; warm flushing of skin; dry mouth; heavy feeling in extremities; clouded thinking; alternate wakeful and drowsy states; itching; nausea; depressed respiration
Long-term	Addiction; physical dependence; collapsed veins; abscesses; infection of heart lining and valves; arthritis/other rheumatologic problems; HIV; Hepatitis C
In combination with alcohol	Dangerous slowdown of heart rate and respiration, coma, or death
Withdrawal symptoms	Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements
Associated Special Vulnerabilities/Populations
Pregnancy	Spontaneous abortions; low birth weight
Treatment options
Medications	Methadone Buprenorphine Naltrexone (short and long-acting formulations)
Behavioral Therapies	Contingency management, or motivational incentives 12-Step facilitation therapy (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

Prescription Opioids (Abuse)
Health Effects
Hydrocodone, Oxycodone, Codeine
Acute	Pain relief, drowsiness, nausea, constipation, euphoria—in some When taken by routes other than as prescribed (e.g., snorted, injected), increased risk of depressed respiration, leading to coma, death; CDC reports marked increases in unintentional poisoning deaths since late the 1990s, due mainly to opioid pain reliever overdose (often in combination with alcohol or other drugs).
Long-term	Tolerance, addiction
In combination with alcohol	Dangerous slowing of heart rate and respiration, coma, or death
Withdrawal symptoms	Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements
Associated Special Vulnerabilities/Populations
Youth	8-10% of high school seniors have used Vicodin nonmedically in the past year; ~5% have abused OxyContin
Pregnancy	Spontaneous abortions; low birth weight
Older Adults	The higher prevalence of pain in this population renders a greater number of prescriptions written for opioid medications. Unintentional misuse or abuse could have more serious health consequences for elderly patients because of comorbid illnesses (and multiple prescriptions), potential for drug interactions, and age-related changes in drug metabolism.
Treatment options
Medications	Methadone Buprenorphine Naltrexone (short and long-acting)
Behavioral Therapies	Behavioral therapies that have proven effective for treating addiction to illicit opioid drugs, such as heroin, may be useful in addressing prescription opioid addiction. (For more information on these treatments, please see NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide - Behavioral Therapies.)

Androgenic Anabolic Steroids (Abuse)
Health Effects
Synthetic substances related to testosterone; promote growth of skeletal muscle (anabolic) and development of male sexual characteristics (androgenic); taken orally or by injection in doses much higher than would be prescribed
Acute	Headaches, acne; fluid retention (especially in the extremities), gastrointestinal irritation, diarrhea, stomach pains, and an oily skin, jaundice, and hypertension; infections possible at injection site
Long-term	Liver damage; CVD: high blood pressure; increases in LDL (“bad” cholesterol); and decreases in HDL (“good” cholesterol); cardiac hypertrophy, atherosclerosis Addiction: Different from other drugs since abuse is not driven by euphoric effects. Nevertheless, individuals often continue abuse despite adverse physical/social consequences. Currently, few users of anabolic-androgenic steroids (AAS) seek substance abuse treatment, but those that present with AAS addiction display a distinctive pattern of comorbid psychopathology, overlapping with that of individuals with other forms of substance dependence
In combination with alcohol	May be synergistic in precipitating impulsive violent behavior (more research is needed)
Withdrawal symptoms	Mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, and depression—sometimes leads to suicide attempts
Associated Special Vulnerabilities/Populations
Males	Shrunken testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer and striae distensae when injected
Females	Facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice, circumscribed hypertrichosis
Adolescents	Stunted growth due to premature skeletal maturation and accelerated puberty changes
Treatment options
Medications	Some medications that have been used for treating steroid withdrawal restore the hormonal system after its disruption by steroid abuse. Other medications target specific withdrawal symptoms—for example, antidepressants to treat depression and analgesics for headaches and muscle and joint pains.
Behavioral Therapies	Some patients require assistance beyond pharmacological treatment of withdrawal symptoms and are treated with behavioral therapies. Physicians have found that supportive therapy is sufficient in some cases.

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