Introduction

So what do drugs do, how do they work….

When we talk about drugs, we are referring to ‘psychoactive’ drugs which is ‘a chemical entity used non-medically, self-administered for its psychoactive effect’ (WHO). When used, they alter a person’s mood, perception or brain function.

Our experience of a drug is influenced not only by the physiological effect of the drug on our body (usually the brain), but also by our expectations of the drug and the situation we use it in. The effects of the drug are thus not just the intrinsic property of the drug itself. Some drugs have several types of effects while others are unique in their properties. Some, like alcohol, can have a sedating effect on the brain function but this might be experienced in mood and behaviour as stimulating or disinhibiting.

Classification

We classify drugs according to their physiological effects and the effects they have on the Central Nervous System (CNS).

Watch the video for a good overview of this. 

Depressants

Depressant drugs don’t usually make a person feel depressed. Rather, they slow down (depress) the activity of the CNS and the messages going between the brain and the body. They affect someone’s concentration and coordination and slow down a person’s ability to respond to unexpected situations. In small quantities they can cause a person to feel more relaxed and less inhibited. In larger amounts they may cause things like drowsiness, vomiting, unconsciousness and death.

Depressant drugs include alcohol, cannabis, heroin, benzodiazepines, GHB, opioids and inhalants.

Stimulants

Stimulant drugs speed up the messages going between the brain and body. They can make a person feel more awake, alert, confident or energetic. Large quantities can “over-stimulate” a person, causing anxiety, panic, seizures, headaches, stomach cramps, aggression and paranoia. The effects can also be from using strong stimulants for a long period of time.

Stimulant drugs include caffeine, nicotine, methamphetamine, cocaine and ecstasy.

Hallucinogens

Hallucinogens distort a person’s perception of reality. People who take them may see or hear things that aren’t really there. Or what they see may be distorted in some way. The effects of hallucinogens vary greatly.

Hallucinogenic drugs include datura, ketamine, LSD, magic mushrooms, mescaline and PCP. Cannabis and ecstasy can also have hallucinogenic qualities.

How are drugs administered?

Once a drug has been administered, the human body uses the following mechanisms to deal wth it.

• Adsorption (will depend on the route of administration)
• Distribution (around the body and to the brain)
• Metabolism (as the drug exerts its effect)
• Excretion (out of the body)

How quickly and powerfully the effects are felt will depend on the route of administration (YSAS, 2001).

Oral Ingestion

This mode has the advantage of being non-invasive but the effectiveness of the drug is greatly reduced as it goes through the digestive tract. In the case of the stimulant drug cocaine, as much as 80% may be metabolised before reaching the receptor sites when ingested orally – therefore only 20% of the effects are felt. In view of the artificially inflated costs of illicit substances, young people will often seek routes of administration that offer better value for money. Consequently, the reduced effectiveness of a drug through oral administration is of great enough consequence to encourage the use of more high-risk routes such as injection (YSAS 2001).

Injection (Parenterally)

Drugs can be injected intravenously (via a vein), intramuscularly (via a muscle) or subcutaneously (under the skin) (NCETA 2004). Injection has the advantage of ensuring that a greater amount of the drug will arrive at the brains receptors in a shorter space of time. However injection drives a range of health harms specific to this route of administration including transmission of viral and bacterial diseases.

Insufflation (Sniffing or Snorting)

Insufflation refers to the sniffing or snorting of a drug. When drugs are self administered in this way, they are absorbed through the mucous membrane in the nose and into the blood stream.

Inhalation

Inhalation such as smoking cannabis or sniffing aerosols ensures blood from the lungs is pumped straight to the brain and the onset of drug action can often occur more rapidly than via intravenous injection.

Sublingual

Sublingual refers to placing a tablet (or wafer in the case of Suboxone) under the tongue where it is absorbed into the blood stream through the mucous membrane. Absorption is relatively rapid.

Transdermal

Transdermal modes of administration are those where the drug is absorbed through the skin, typically in ‘patch’ form (nicotine patches) or ointments.

Rectal


Commonly referred to as ‘shelving’ or ‘shafting’ the drug is made into a suppository and inserted into the rectum and absorbed into the blood stream that way.

 

Methamphetamines

Methamphetamine is a synthetic CNS stimulant drug – a more potent form of the drug amphetamine.

There are different forms of methamphetamine, generally distinguished by their appearance and perceived purity:

• Crystalline ('Ice' or 'Crystal-meth') is a highly purified form of methamphetamine with a crystal-like appearance
• Powder ('Speed')
• Some types of amphetamines are legally prescribed by doctors to treat medical conditions (e.g. ADHD)

Methamphetamine can be swallowed, snorted, smoked or injected. Ice is usually smoked or injected.

Depending on how methamphetamines are taken, the effects may be felt immediately (through injecting or smoking) or within 30 minutes (snorting) and approximately 20-30 minutes if swallowed.

Common effects of methamphetamine 

• Increased energy
• Faster reaction times
• Feeling more awake and alert
• Reduced need for sleep 
• Sense of euphoria and wellbeing
• Increased attention and alertness
• Increased talkativeness
• Feelings of confidence and motivation
• Increased libido
• Blurred vision
• Tremors
• Irregular breathing
• Loss of coordination
• Collapse
• Rapid pounding heart
• Violent or aggressive behaviour
• Hallucinations
• Methamphetamine psychosis

Overdosing on methamphetamine can cause:

• Psychosis
• Faster, irregular or weak heartbeat
• Heart attack
• Bleeding blood vessels in the brain (stroke)
• Very high fever
• Death

Withdrawal symptoms from methamphetamine can include:

• Strong cravings for methamphetamine
• Confusion and poor concentration
• Decreased energy
• Apathy and the limited ability to experience pleasure
• Irritability, anxiety, panic 
• Depression
• Extreme fatigue and exhaustion
• Headaches and general aches and pains
• Hunger and increased appetite
• Disturbed and restless sleep often interrupted by nightmares

Harm reduction - Methamphetamine

• Injecting increases the risk of infectious diseases - alternatives are to drink in water, snort, or “gum” (rub into the gums)
• Don’t share injecting equipment, and use carefully to avoid collapsed veins, abscesses and risk of diseases
• Have amphetamine-free days, rest and eat well
• Avoid mixing with alcohol or other drugs 
• Eat healthy food, even if not hungry
• Monitor mental health symptoms, and get support if necessary 

Cannabis

Cannabis is a depressant drug also known as Marijuana 

Cannabis is smoked in hand-rolled cigarettes called joints, or in a pipe or bong

Common effects of cannabis

Low - moderate doses:

• Euphoria
• Mild enhancement of senses (smell, taste, hearing)
• Subtle changes in thought and expression
• Talkativeness
• Drowsiness
• Increased appreciation of music
• Mild closed-eye visuals
• Anaesthesia
• Decreased nausea
• Increased appetite
• More pronounced visual hallucinations
• Altered sense of time

High doses: 

• Feel confused
• Vomiting
• Restlessness
• Change in perception of time, sound, sight, touch and distance
• See or hear things which are not there (hallucinations)
• Feel anxious or panicky
• ‘Black out’
• Feel distant or separate from reality

Overdose - Cannabis

There is no risk of overdose or death from cannabis use as there are few cannabis receptors in the brainstem which control vital functions.

Withdrawal from Cannabis

When people stop using cannabis after prolonged use (either because they cannot get any or because they are trying to quit) they may experience a variety of withdrawal symptoms including:

• Sleep difficulties including insomnia and strange dreams
• Mood swings/irritability
• Depression
• Anxiety/nervousness
• Restlessness/physical tension
• Reduced appetite
• Nausea
• Sweats
• Cravings to smoke cannabis

Whilst individual symptoms can be relatively mild, in combination they can still contribute to why a person keeps using cannabis and why they may relapse if trying to quit.

Harm Reduction - Cannabis

Eating cannabis (cakes or cookies) instead of smoking.

When marijuana is burned it releases toxins (poisonous fumes) which are then inhaled when smoking. If the person eats the cannabis instead the risk of contracting respiratory (breathing) illnesses is significantly reduced. However, it takes a lot longer to feel the effects after eating cannabis than it does with smoking. This can make it difficult to judge the dose and people can become a lot more stoned than they anticipated. It's also worth keeping in mind that more time will be needed for the drug to wear off, which may be important when it comes to driving or other tasks.

Avoid tobacco

When smoking cannabis in cigarettes (joints) It is common for people to mix it with tobacco. This poses some problems as tobacco is highly addictive and will make it harder for the cannabis user to cut down or stop. Mixing tobacco with cannabis also increases the risk of lung cancer and other respiratory (breathing) problems. It also raises the risk of heart disease. It is therefore better not to mix the two.

When smoking cannabis in water pipes (bongs)

• Don't inhale deeply and don't hold the smoke in. Approximately 95% of the THC is absorbed within seconds of inhalation. The smoke is forced further down into the lungs increasing the surface area for lung cancer and other respiratory illnesses. Take small, shallow puffs.
• Regularly clean the water pipe and replace the water. Unclean bongs and water are breeding grounds for germs and viruses.
• Use a screen (filter) in the 'cone' or 'down pipe' - this prevents inhalation of small particles and contamination of the water.
• Monitor the water level in the chamber - should be at least 20cm below the rim of the mouthpiece. This will minimise the risk of leakage and water vapour entering the lungs. Water vapour (droplets) accumulating in the lungs can cause lung infection.
• Avoid using bongs made out of wood, aluminium or plastic (including those made out of drink containers or garden hoses). Toxic fumes can be released when smoking through these types of bongs. It's less harmful to use bongs made out of glass, stainless steel or brass.

Avoid mixing drugs together

Avoid using other drugs while taking cannabis. If they are mixed, the effects may be more powerful or more unpredictable, and the chance you will have a bad reaction is increased. Mixing drugs (or what is called 'polydrug' use) can result in you feeling more paranoid, anxious or panicky and/or nauseous (leading to vomiting).

Alcohol

Alcohol is a legal, depressant drug 

Common effects of alcohol

At low doses a person may experience the following:

• Disinhibition - reduces shyness or anxiety
• Mental relaxation and  reduced stress
• Reduced concentration
• Inhibits memory (useful for survivors of trauma)
• Relaxes the muscles
• Dulls pain
• Slower reflexes

At moderate doses a person may experience the following:

• Fewer inhibitions and more confidence
• Reduced coordination and slurred speech
• Intensified mood

Signs of overdose of alcohol:

• Disorientation
• Loss of coordination
• Vomiting
• Seizures
• Irregular or slow breathing (less than eight breaths a minute)
• Blue-tinged or pale skin
• Low body temperature (hypothermia)
• Stupor (being conscious but unresponsive)
• Unconsciousness (passing out)

Withdrawal from Alcohol

If a dependent person stops drinking alcohol, they may experience withdrawal symptoms because their body has to get used to functioning without the drug.

Withdrawal symptoms usually start about 4-12 hours after the last drink and can last 4-5 days. These symptoms include: shaking, sweating, tremors, weakness, anxiety, headache, nausea, vomiting. Withdrawal from alcohol carries the risk of seizures or fits. Medical assistance may be required to help the person get through withdrawal safely.

Harm reduction - Alcohol

• Have one or two alcohol-free days a week, and avoid binge-drinking
• Don’t participate in shouts or drinking games
• Buy your own drinks, and never leave your drink unattended (to avoid drink spiking)
• Eat before you plan to drink, and make every second drink a non-alcoholic drink
• Check the interaction of medications and alcohol if you are prescribed medications 

Inhalants 

Inhalants (or 'volatile substances') are depressant drugs and refer to a range of products that produce vapours which, when inhaled, may cause the person to feel intoxicated or 'high'. Common names include chroming, glue, sniff, and huff. 

The drug is inhaled through the nose or mouth. It may be sprayed into a plastic bag, poured into a bottle or soaked into a cloth or sleeve before being inhaled. Some drugs are inhaled directly from the container. Sometimes they are even sprayed directly into the mouth or nose. This can be very dangerous and cause suffocation.

Common effects of inhalants

The effects of inhalants may start to be felt immediately and can last for 45 minutes, and include:

• Lowered inhibitions 
• Feeling of wellbeing 
• Excitement or euphoria 
• Decreased social anxiety
• Feeling disoriented
• Decreased coordination
• Visual distortions
• Nausea, vomiting and diarrhoea
• Headaches
• Bloodshot eyes
• Increased confidence leading to risky behaviour
• Hallucinations
• Blackout 
• Convulsions and coma

Signs of overdose of inhalants:

• Hallucinations
• Drowsiness 
• Coma

Some inhalant-related deaths are thought to have been caused by a condition called ‘sudden sniffing syndrome’. This is a type of heart failure that can strike if the user attempts any physical exertion after inhaling. Users have also been accidentally killed by engaging in risky behaviours, such as jumping off high buildings while under the influence.

Withdrawal from Inhalants

If a dependent individual ceases using inhalants, they may experience mild withdrawal symptoms as they get used to functioning without inhalants. Withdrawal symptoms begin 24-48 hours after last use and may last 2-5 days.

Symptoms may include: hangover effects, headache, nausea, stomach pain, feeling tired, feeling shaky, tremors, muscle cramps, hallucinations, visual disorders (seeing spots).

Harm Reduction - Inhalants

Harm reduction strategies for inhants:

• Know which inhalants are more harmful than others
• Do not use alone or in dangerous places
• Do not put plastic bags over your head
• Use smaller bags to reduce the risk of suffocation
• Don't smoke around inhalants as they are flammable
• Avoid alcohol or other drugs while intoxicated with inhalants as this increases the chance of accidents and overdose
• Dial 000 in an emergency

Heroin

Heroin is a CNS depressant from a group of drugs known as opioids. It is manufactured from morphine which comes from the opium poppy.

Other opioids include opium, morphine, codeine, pethidine, oxycodone, buprenorphine and methadone.

Heroin can range from a fine white powder to off-white granules. It has a bitter taste but no smell and is usually packaged in “foils” [aluminium foil] or small, coloured balloons. Opiate/opioid painkillers are medicines with effects similar to opium. They act by stimulating opioid receptors in the brain and nervous system.

Heroin is mostly injected into veins (intravenous). It is also smoked, known as “chasing the dragon”, snorted, or added to cannabis or tobacco cigarettes. Depending on how heroin is taken, the effects may be felt within 7-8 seconds (injecting) or within 10-15 minutes (snorting or smoking). The effects of heroin can last for approximately 3-5 hours.

Common effects from using heroin or other opioids  

Low - moderate doses

• Feelings of intense pleasure
• Strong feelings of well-being
• Pain relief
• Reduced stress and emotional pain
• Confusion
• Constricted pupils
• Lowered cough reflex 
• Reduced sexual urges
• Drowsiness
• Slurred and slow speech
• Reduced coordination
• Dry mouth
• Decreased heart rate and blood pressure
• Slow breathing rate
• Nausea and vomiting
• Reduced appetite

High doses

A high dose of heroin can cause an individual to overdose. This means that an individual has taken more heroin than the body can cope with. The risk of overdose increases if the strength or purity of the heroin is not known. Injecting heroin also increases the risk of overdose due to large amounts of the drug entering the blood stream and quickly travelling to the brain.

In addition to the side effects of heroin and opioids already listed, an individual may experience:

• Impaired concentration
• Going “on the nod”
• Shallow and slow breathing
• Nausea and vomiting
• Increased sweating and itching
• Urge to pass urine but difficulty doing so
• Drop in body temperature
• Irregular heartbeat
• Unconsciousness
• Death

Overdose signs (heroin):

• Shallow breathing
• No breathing
• Slow and difficult breathing
• Extremely small pupils, sometimes as small as the head of a pin ("pinpoint pupils")
• Low blood pressure
• Weak pulse
• Bluish-colored nails and lips

Overdose signs (other opioids): 

• Awake, but unable to talk
• Body is very limp
• Face is very pale or clammy
• Fingernails and lips turn blue or purplish black
• For lighter skinned people, the skin tone turns bluish purple, for darker skinned people, it turns grayish or ashen
• Breathing is very slow and shallow, erratic, or has stopped 
• Pulse (heartbeat) is slow, erratic, or not there at all
• Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
• Vomiting
• Loss of consciousness
• Unresponsive to outside stimulus

Withdrawal from Heroin

Heroin withdrawal begins within 6-24 hours after last use, symptoms peak at 24-48 hours and subside within 5-10 days.

Symptoms include: increased sweating, runny eyes & nose, urinary frequency, diarrhoea, abdominal cramps, nausea, vomiting, muscle spasm, headaches, back aches, cramps, twitching, joint pain, goose bumps, pupillary dilatation, elevated blood pressure, tachycardia, anxiety, irritability, dysphoria (low mood), disturbed sleep, increased cravings for heroin. 

Although heroin withdrawal is extremely unpleasant, it is not life threatening to users with no medical complications.

Harm Reduction - Heroin  

• If you haven’t used drugs such as heroin for a while, be aware that your tolerance is likely to be a lot lower than it was before – it would be best to use a smaller amount
• If using illegal drugs from an unknown source or of unknown purity, have a smaller amount at first
• Try to avoid using alone – let someone know where you are and what you are doing or have a friend with you
• Don't share injecting equipment 

Benzodiazepines

Benzodiazepines are legal depressant drugs. Also known as ‘minor tranquillisers’, benzodiazepines are commonly prescribed by doctors to relieve stress and anxiety and to help people sleep.

Some people use benzodiazepines to become intoxicated or to come down from the effects of stimulants such as amphetamines. Benzodiazepines are known by their chemical names or their brand names.  Benzodiazepines usually come in the form of tablets and capsules, in a range of colours and designs. They are generally stamped with their name and milligram quantity. They are commonly referred to as benzos, tranx, sleepers, downers, serras [Serepax ®]; moggies [Mogadon®]; normies [Normison®], Xanax.

Benzodiazepines are usually swallowed. Some individuals also inject them; however this method carries significant risk of harms such as collapsed veins, damage to organs, stroke and even death.

Common effects of benzodiazepines

The effects of benzodiazepines may start to be felt within an hour.

Low – moderate doses

• Disinhibition
• Feelings of euphoria
• Very effective anti-anxiety medications
• Slow heart rate
• Relax muscles/spasms
• Aid sleep
• Eases social anxiety and diminishes social isolation

High doses

• Drowsiness
• Over-sedation and sleep
• Confusion
• Dizziness
• Jitteriness/excitability
• Slurred speech
• Loss of coordination
• Impaired judgement
• Difficulty in thinking clearly
• Memory loss
• Mood swings and aggressive behaviour

Signs of overdose - Benzodiazepines

It is unusual to overdose on benzodiazepines alone but if you use them with other drugs such as alcohol, heroin or methadone it is very easy to overdose and die. Symptoms of overdose are: person is unable to be 'roused' or woken, coma, very slow breathing, slow heartbeat, cold clammy skin, lips may appear bluish. Call '000' if concerned.

Withdrawal from benzodiazepines

Some of the withdrawal symptoms that may be experienced include:

• Headaches 
• Tremor 
• Faintness or dizziness
• Sweating 
• Nausea, vomiting and stomach pains
• Insomnia or bizarre dreams 
• Anxiety and irritability
• Aching or twitching muscles
• Fatigue, difficulty concentrating
• Altered perceptions, heightening of the senses
• Delirium, delusions and hallucinations, paranoia
• Seizures, death

Individuals who have been using benzodiazepines for longer than a month should not suddenly stop taking them, as it is possible to experience severe withdrawal symptoms, such as seizures.

To decrease the severity of withdrawal symptoms, a slow decrease or tapering of dose is recommended.

Harm Reduction - Benzodiazepines

• Don’t mix with another drug, especially another CNS depressant
• Don’t take other people’s prescribed medications
• Avoid injecting as benzos can cause vein damage and infections

General Harm Reduction

Further down this page are harm reduction strategies which apply to specific drugs, however there are some general harm reduction strategies that can be applied to all substance use:

• Don’t use alone
• Use somewhere safe
• Keep your phone charged in case you need help
• Don’t hesitate to call an ambulance (many young people will be concerned about getting in trouble by assuming that the police will attend with an ambulance or their information will get shared. Police do not attend with ambulances unless there is risk of violence)

Poly Drug Use

People will use more than one drug at the same time to:

• Heighten the effect from one particular drug
• Reduce the effects of withdrawal
• Bypass the negative effects of coming down from a substance used earlier
• Obtain multiple concurrent drug effects (the effects of this are complex and one drug will not negate the effects of another)

Some examples of this may be:

1. The combinations of a large dose of benzodiazepines and alcohol may be fatal 
2. When ecstasy is used with alcohol, health risks increase because alcohol impairs body temperatures regulation and increased dehydration
3. Using more than one stimulant, including energy drinks, can lead to sympathetic hyperactivity that may result in impaired body temperature regulation and cardiac functioning.

Always remind young people to think about any medications they may be on, particularly for mental health, and to understand that alcohol is a drug and if mixed with other depressants will multiple the effects, increasing the risk of negative effects. This often gets forgotten.

Problems arising from drug use (by classification) – what to do

There are some particular problems that can arise generally for young people when taking drugs, which are related to the drugs classification as a depressant, stimulant or hallucinogen. While, in most cases these do not occur and young people use quite safely and without problems, it is useful to be aware of the problems that can arise.

Depressants

The main two concerns with depressants drugs are the risk of overdose (from opiates and benzodiazepines, especially in combination with alcohol) and the risk of misadventures due to a young person’s judgement being impaired.

Things to keep an eye on if a young person appears heavily substance affected by depressants:

• Regularly check responsiveness or state of consciousness and if changing or diminishing, call ‘000’
• Observe breathing and pulse and if slow or slowing call ‘000’ 
• Where the young person is in a public place or unsafe environment, or with unhelpful people, try to move the young person to a safer environment, or at least a monitored environment 

Stimulants

Often problems arising from stimulant use are related to behaviour, especially erratic or hallucinating (through sleep deprivation) presentations. Major health concerns can also occur, such as stroke, heart arrhythmia or organ failure.

Where a young person is very agitated, jumpy, easily upset or distracted it can be useful to know if they are drug affected and by which drug. Someone who has been drinking too much caffeine may be able to reduce their agitation by simple eating, talking calming with a carer or doing some exercise.

Whereas if the effects are from methamphetamine, ensuring the young person is contained in a safe environment and is not of risk to themselves or others is probably more important. Consider medical intervention in extreme situations where there are hallucinations, overheating, racing pulse or violence.

Hallucinogens

The main concerns is the young person’s safety as they may respond to stimuli in unexpected ways, so a calm and safe environment is important. If the young person has become distressed (e.g. ‘bad trip’) it may reduce the risk of self-injuring or erratic response if a caring person sits with them and keeps calming and reassuring them. If the fear or paranoia becomes a concern, medical intervention should be sought.