412 CHAPTER 9
Other Abused Substances
This chapter has focused so far on stimulants and depressants because they are the
most commonly abused substances. However, they are not the only substances that
people abuse. In this section we briefl y review three classes of other substances
that are often abused: narcotic analgesics (such as codeine and heroin), hallucinogens
(such as marijuana), and dissociative anesthetics (such as ketamine).What Are Other Abused Substances?
By 1969, the Beatles had not performed for 3 years. In that year, they agreed to
perform and have their rehearsals fi lmed. They spent a month in a recording stu-
dio composing and arranging songs, learning their parts, and rehearsing the songs.
Rather than a true concert, however, the project culminated in a live, rooftop per-
formance that was fi lmed. Some of this arduous process and the fi nal concert were
captured in the fi lm Let It Be, which shows glimpses of the effects of John Lennon’s
heroin use. Lennon had diffi culty remembering his lines from hour to hour and day
to day, had trouble getting up each morning and arriving at the sessions on time, and
had diffi culty concentrating on writing and fi nishing songs (Spitz, 2005; Sulpy &
Schweighardt, 1984). Such problems are typical of heroin use in particular and of
the use of narcotic analgesics more generally.Narcotic Analgesics
Narcotic analgesicsare derived from the opium poppy plant or chemically related
substances; narcotic analgesics are sometimes referred to as opiates, or opioids.
To distinguish them from endogenous opioids, narcotic analgesics are some-
times referred to as exogenous opioids (exogenous means arising from an outside
source). Exogenous opioids include methadone and heroin (to be discussed in more
detail shortly), as well as codeine, morphine, and synthetic derivatives found in
prescription pain relief medications such as oxycodone (OxyContin), hydro-
codone (Vicodin), meperidine hydrochloride (Demerol), propoxyphene (Darvon),
andhydromorphone (Dilaudid). These drugs can be injected, snorted, or taken by
mouth. Legal but restricted narcotic analgesics are generally prescribed for persis-
tent coughing, severe diarrhea, and severe pain. However, some people abuse these
medications, taking them not for their medical effects but instead for the “high”
they produce (NIDA, 2008a).
All analgesics relieve pain, and people who take analgesics for recreational
purposes may temporarily experience pleasant, relaxing effects. However, this
category of drugs is highly addictive—their use rapidly leads to tolerance and
withdrawal and compulsive behavior related to procuring and taking the drug.
Narcotics depress the central nervous system, and can cause drowsiness and
slower breathing, which can lead to death if a narcotic analgesic is taken with a
depressant. Although users may experience euphoria after taking a narcotic anal-
gesic, that fades to apathy, unhappiness, impaired judgment, and psychomotor ag-
itation (the “fi dgets”) or psychomotor retardation (sluggishness). Users may also
experience confusion—as happened to John Lennon—as well as slurred speech,
sedation, or unconsciousness.
Withdrawal from a narcotic analgesic begins within 8 hours after the drug was
last used. Withdrawal symptoms peak within several days, but can last for a week
or more. Physical symptoms of withdrawal include nausea and vomiting, muscle
aches, tearing from the eyes, dilated pupils, sweating, fever, diarrhea, and insomnia;
many of the symptoms are similar to those of a bad case of the fl u. Depressed mood,
irritability, and a sense of restlessness are also common during withdrawal.Heroin
Heroin is one of the stronger opioids and is very addictive. Unfortunately, the con-
trast between the euphoria that the drug induces and the letdown that comes when
its effects wear off can drive some individuals to crave the euphoria, and so theyAlthough some narcotic analgesics are derived
from the opium poppy plant, others are synthetic
derivatives. Repeated use of any type of narcotic
analgesic rapidly leads to tolerance and
withdrawal—signs of dependence.Photodisc/Alamy