Maxfacts

A wide range of drugs, both prescription and non-prescription, are used for purposes they are not primarily intended for. In the case of alcohol, nicotine and caffeine it could be argued that they are used for their intended purpose, the problem is when they are used to excess, inappropriately or a dependence is formed.

Societies vary hugely in their attitudes to these drugs. For example, alcohol is freely available, taxed and forms part of culture in some countries whereas it is illegal in others.

Criminalisation of a health problem is seldom a successful strategy and in the UK excessive drug use and dependence is regarded as a health problem by formal medical representative bodies such as the BMA (British Medical Association). However, many regularly used drugs are illegal and criminalised despite a lack of evidence that this reduces the harm caused.

Some of the more common drugs that may influence your problems and/or treatment are:

Alcohol

Alcohol, or more specifically ethanol in beer, wine and spirits, is potentially highly addictive. It is well documented that excessive alcohol consumption causes physical (for example, liver disease), psychological and societal damage. In addition, excessive alcohol consumption hampers recovery and rehabilitation in oral and maxillofacial surgery. High alcohol intake is also associated with an increased risk of malignancies although alcohol is not necessarily causative in all cases.

Amphetamines

Amphetamine is a chemical which acts as a strong stimulant; its legal prescription use is in the treatment of narcolepsy. Relatively minor chemical modifications of the basic amphetamine molecular structure have resulted in many substances being classified as amphetamine-like substances. Their power, type of effect and mode of application vary per the specific compound but all are potent stimulants and all produce severe hangover-like effects. Some well-known examples include ecstasy, crystal meth and speed. Some of these drugs are highly addictive (for example, crystal meth), others are not addictive (for example, ecstasy). Most of them have not been assessed for safety and they are normally not produced under quality-controlled professional laboratory conditions (except for ‘military grade amphetamine’ being widely used in military forces since 1940). Accordingly, consumption of these street-bought drugs is inherently dangerous from either the effects of the drug substance itself, from dosage errors or from impurities.

Hormones, anabolic-androgenic steroids

Chemical messengers known as hormones play a role in the regulation of various bodily functions. Naturally occurring testosterone is the male sex hormone; its anabolic role is to increase muscle and bone mass, its androgenic role is a virilising effect, for example increasing the amount of body hair. Synthetic versions of chemicals with similar effects to testosterone are called anabolic-androgenic steroids. They lend themselves to cheating in sports such as weight lifting where unfair advantage can be had from increased muscle mass by taking anabolic steroids. Such overuse comes at a considerable risk of suffering harmful side effects such as dangerously increased blood pressure, or developing serious cardiovascular conditions or liver damage.

Another well-known example of a hormone with both performance enhancing effects and potentially lethal side effects is so called EPO (erythropoietin). EPO is a naturally occurring hormone that is synthesized in the kidneys and stimulates the production of red blood cells (erythrocytes) in bone marrow. This explains its medical use in treating some forms of anaemia. Higher levels of red blood cells are equivalent to improved oxygen-carrying capacity of blood, resulting in enhanced endurance. EPO has been used as ‘blood doping’ for a long time in various endurance sports and only recently has it become possible to identify EPO doping. EPO abuse is infamous in the tour de France and similar endurance events. Dangerous side effects of EPO overuse result from its effect on blood viscosity, including sudden deaths.

Stimulants, caffeine and cocaine

Found in tea, coffee, energy drinks and some non-prescription drugs, caffeine increases alertness and energy. Despite being a common drug, excessive consumption can result in undesirable effects ranging from dehydration to insomnia and heart palpitations.

Cocaine is an illegal stimulant, it is not particularly addictive but habit-forming and tolerance develops rapidly (there are well-functioning professionals who happen to be cocaine users). Cocaine causes local harm to nasal tissue from snorting it.

Hallucinogens

The broad term hallucinogen covers a range of substances that cause disruption to the central nervous system: the user’s perception of reality is distorted resulting in effects such as hallucinations and wild mood swings. These hallucinations are largely a sensory amplification and distortion; some of us growing up in the 1960ies may well remember ‘Deep Purple’, or ’tangerine dreams’, and so on. Ketamine and LSD (‘acid’) are examples of synthetic hallucinogenic substances. Synthetic hallucinogens are not addictive but individual experiences from taking them may vary widely. Magic mushrooms (for example, mescaline as the active component) occur naturally and have been used in all kinds of rituals for thousands of years.

Inhalants

A variety of volatile substances found in glues, aerosols, ‘poppers’ and ‘whippets’ may be inhaled to induce a high, usually only a short-lasting effect. Dosage of gaseous substances is difficult to control without some technical equipment such as a flowmeter. Hence usage can be dangerous irrespective of the number of times taken (for example, collapse caused by dangerously lowered blood pressure). The classical examples of inhalants are ether and nitrous oxide, N₂O (also known as ‘laughing gas’), causing dizziness and a degree of euphoria. More recently, a variety of volatile alkylnitrites (‘poppers’) have found use as recreational drugs, often in combination with other drugs. Most, if not all, of these substances are easily accessible owing to their multiple alternative legal uses.

Nicotine

As a highly addictive, harmful and yet legal drug, nicotine continues to cause more damage than all illegal drugs combined. Nicotine has traditionally been consumed through tobacco leaves in a variety of ways such as smoking, chewing and snuff, although more recent methods such as vaping supply nicotine more directly, in water vapour. Smoking is considered the most harmful way of nicotine consumption due to the hundreds of harmful chemicals and particles contained in the inhaled smoke. The significantly increased risk of smokers to develop lung diseases and/or cardiovascular conditions is well documented. Whatever the method of intake, the harmful effects are augmented through combination with alcohol. In the context of oral and maxillofacial conditions it is especially the combination of smoking with alcohol consumption that has been shown to be strongly correlated with an increased risk of developing head and neck malignancies.

Opioids

Opioids represent a vast category of drugs that are all chemically related to one another. Many opioids such as codeine and morphine are used legally as analgesics, or methadone is used as a substitute in the management of heroin addiction, and even the active component of cannabis (tetrahydrocannabinol, THC) can be prescribed for clinical purposes in treating chronic pain. The many different substances in this category are addictive to variable degrees. Overdosing of opioids can, and does, produce catastrophic effects such as respiratory arrest (breathing stops). The highly addictive nature of many opioids can result in criminality to fund the dependence. Opioid addiction has fuelled long standing debates in many societies on how best to deal with the issue. More recently the debate also includes findings that widely prescribed analgesics such as tramadol can (and do) lead to dependence even if used per prescription, and in consequence add to a flourishing illegal black market of legal drugs.

Tranquilizers

Similarly, to the opioids above, tranquilizers incorporate a broad range of drugs, some of which are legally used as prescription drugs. Major tranquilizers act as antipsychotics whereas minor tranquilizers such as gamma-hydroxybutyrate (GHB) and diazepam induce relaxation, calmness or sleep. Minor tranquilizers are more likely to cause dependencies and abuse. Within the class of minor tranquilizers further subcategories exist such as barbiturates, benzodiazepines and the so-called Z-drugs (zopiclone, zolpidem). Widespread prescription, in particular of the latter, has also resulted in their appearance on the illegal drug market, similar to the illegal trade of prescription opioids. In high dosage and when combined with other drugs, particularly with alcohol, most tranquilizers can have dangerous effects.

The above list of drugs that find recreational use, legal or illegal, is by no means exhaustive but illustrates how wide the field of recreational drug use is. Various problems can arise from the different categories of drugs in the short and/or long term; some having a negative impact on the prognosis of treatment. Understanding the ways in which these drugs work can help in reducing or preferably stopping their usage, therefore improving the outcome of treatment. The legality of drugs should not lead one to conclude that legality is equal to a low, or no, destructive potential; for example, the destructive potential of the legal drugs alcohol and nicotine vastly outweighs that of the illegal recreational drugs.

In the UK, many institutions and charities offer support in non-judgmental ways with the management of addictions as well as offering help with attempts to terminate substance abuse.