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Monday, August 11, 2025

Illicit (street) drugs


1. Definition and Overview

  • Illicit (street) drugs are substances prohibited by law for production, possession, distribution, or use due to their high potential for abuse, addiction, and harm.

  • Include banned psychoactive substances and controlled prescription drugs obtained and used without a prescription.

  • Commonly sold or distributed in unregulated street markets, making purity and composition unpredictable.

  • Carry significant legal, health, and social risks.

2. Classification by Primary Effect

A. Stimulants

  • Increase central nervous system (CNS) activity, alertness, and energy.

  • Examples:

    • Cocaine (powder, crack).

    • Methamphetamine (“crystal meth,” “ice”).

    • Amphetamine (non-prescription misuse).

  • Mechanism: Enhance release/inhibit reuptake of dopamine, norepinephrine, serotonin.

  • Risks: Cardiovascular stress, psychosis, seizures, addiction.

B. Depressants

  • Slow CNS activity, producing sedation and relaxation.

  • Examples:

    • Illicit alcohol production in prohibited regions.

    • Benzodiazepines obtained illegally (e.g., alprazolam, diazepam).

    • GHB (gamma-hydroxybutyrate) – also a date-rape drug.

  • Mechanism: Potentiate GABAergic inhibition in CNS.

  • Risks: Respiratory depression, coma, dependence, fatal overdose.

C. Opioids

  • Strong analgesics with high addictive potential.

  • Examples:

    • Heroin (diacetylmorphine).

    • Illicit fentanyl and analogues.

    • Street-prepared opium.

  • Mechanism: Bind μ-opioid receptors → analgesia, euphoria, sedation.

  • Risks: Respiratory arrest, fatal overdose, severe withdrawal, infectious diseases (HIV, hepatitis).

D. Hallucinogens

  • Alter perception, mood, cognition.

  • Examples:

    • LSD (lysergic acid diethylamide).

    • Psilocybin (“magic mushrooms”).

    • Mescaline (peyote cactus).

  • Mechanism: Primarily serotonergic (5-HT2A receptor agonists).

  • Risks: Psychosis, flashbacks, panic reactions, impaired judgment.

E. Dissociative Anesthetics

  • Distort perception, induce detachment from self and environment.

  • Examples:

    • PCP (phencyclidine).

    • Ketamine (illicit use).

  • Mechanism: NMDA receptor antagonism.

  • Risks: Aggressive behavior, hallucinations, amnesia, accidents.

F. Cannabis and Synthetic Cannabinoids

  • Cannabis: THC-containing plant material (marijuana, hashish).

  • Synthetic cannabinoids (“Spice,” “K2”): laboratory-made compounds.

  • Mechanism: CB1/CB2 receptor agonists.

  • Risks: Anxiety, psychosis, cardiovascular effects; synthetics may be more toxic.

G. New Psychoactive Substances (NPS)

  • Designer drugs created to mimic effects of controlled drugs while evading legal restrictions.

  • Examples: Synthetic cathinones (“bath salts”), novel benzodiazepines, synthetic opioids.

  • Risks: Unknown potency/toxicity, unpredictable interactions.

3. Pharmacological Considerations

  • Many act on neurotransmitter systems (dopamine, serotonin, norepinephrine, GABA, glutamate).

  • Street formulations often contain adulterants (e.g., levamisole in cocaine, fentanyl in heroin) that increase harm.

  • High risk of poly-drug use, enhancing toxicity and complicating medical management.

4. Health Risks and Complications

Acute Risks

  • Overdose (respiratory depression, arrhythmia, seizures).

  • Acute psychosis, hallucinations, agitation.

  • Accidents and injuries due to impaired judgment.

Chronic Risks

  • Addiction and dependence.

  • Cardiovascular disease, liver and kidney damage.

  • Infectious disease transmission (needle sharing).

  • Neurological and cognitive impairment.

  • Mental health disorders (depression, anxiety, psychosis).

5. Withdrawal and Dependence

  • Physical and psychological withdrawal syndromes vary by drug type.

  • Opioids: flu-like symptoms, cravings, dysphoria.

  • Stimulants: depression, fatigue, intense cravings.

  • Depressants: seizures, anxiety, insomnia, potentially life-threatening.

6. Legal and Social Impact

  • Criminal charges for possession, trafficking, or manufacturing.

  • Social stigma, job loss, family disruption.

  • Economic burden on healthcare and legal systems.

7. Management of Acute Toxicity

  • Stabilization of airway, breathing, circulation (ABC).

  • Use of specific antidotes where available:

    • Naloxone for opioid overdose.

    • Flumazenil for benzodiazepine overdose (with caution).

  • Activated charcoal for recent ingestion of certain substances.

  • Psychiatric evaluation for self-harm risk.

8. Harm Reduction Strategies

  • Needle and syringe programs to reduce infection risk.

  • Supervised consumption facilities in some jurisdictions.

  • Drug-checking services to identify adulterants.

  • Public health campaigns on overdose prevention (e.g., naloxone distribution).

9. Treatment Approaches for Dependence

  • Opioid use disorder: Methadone, buprenorphine, naltrexone maintenance.

  • Stimulant use disorder: Behavioral therapies (contingency management, CBT).

  • Depressant dependence: Gradual tapering under medical supervision.

  • Support programs: 12-step groups, residential rehabilitation, outpatient counseling.

10. Emerging Concerns

  • Proliferation of potent synthetic opioids (e.g., carfentanil) with extreme overdose risk.

  • Rapid evolution of NPS to evade regulation.

  • Increase in poly-substance fatalities involving opioids, stimulants, and alcohol.



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