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Alternative Names
Heroin abuse; Substance abuse; Marijuana abuse; Illicit drug abuse; Narcotic abuse; Cocaine abuse; Hallucinogen abuse; PCP abuse; LSD abuse.

About 2 in 5 Pakistanis have used marijuana (also called “grass,” “pot,” “reefer,” “joint,” “hashish,” “cannabis,” “weed,” and “Mary Jane”) at least once. Approximately 10% of the population uses it on a regular basis. Next to tobacco, and alcohol in some areas, marijuana is the most popular substance young people use regularly.

Because the effects are felt almost immediately by the smoker, further inhalation can be stopped at any time to regulate the effect. In contrast, those eating marijuana experience effects that are slower to develop, cumulative (they add up), longer-lasting, and more variable, making unpleasant reactions more likely.

The primary effects of marijuana are behavioral, because the drug affects the central nervous system (CNS). Popular use of marijuana started because of its effects of euphoria (feeling of joy), relaxation, and increased visual, auditory (hearing), and taste perceptions that may occur with low-to-moderate doses. Most users also report an increase in their appetite (“the munchies”).

Unpleasant effects that may occur include depersonalization (inability to distinguish oneself from others), changed body image, disorientation, and acute panic reactions or severe paranoia.

Marijuana has specific effects that may decrease one”s ability to perform tasks requiring a great deal of coordination (such as driving a car). Visual tracking is impaired, and the sense of time is typically prolonged.

Learning may be greatly affected because the drug reduces one”s ability to concentrate and pay attention. Studies have shown that learning may become “state-dependent,” meaning that information acquired or learned while under the influence of marijuana is best recalled in the same state of drug influence.

Other marijuana effects may include:
• Blood-shot eyes
• Increased heart rate and blood pressure
• Bronchodilatation (widening of the airways)
• In some users, bronchial (airway) irritation leading to bronchoconstriction (narrowing of the airways) or bronchospasm (airway spasms, leading to narrowing of the airways)
• Pharyngitis, sinusitis, bronchitis, and asthma in heavy users

Possible serious effects on the immune system Regular users, upon stopping marijuana use, may experience withdrawal effects. These may include agitation, insomnia, irritability, and anxiety. Because the metabolite (the substance formed when the body breaks down the drug) of marijuana may be stored in the body”s fat tissue, evidence of marijuana may be found in heavy users through urine testing up to 1 month after discontinuing the drug.

It is difficult to estimate the current use of phencyclidine (PCP, “angel dust”) in Pakistan, because many individuals do not recognize that they have taken it. Other illicit substances (such as marijuana) can be laced with PCP without the user being aware of it.

Ketamine, a compound related to PCP, has grown in popularity in recent years. It is commonly referred to as Special K.

In addition to PCP, other commonly abused hallucinogens include LSD (lysergic acid diethylamide), psilocybin (mushrooms, “shrooms”), and peyote (a cactus plant containing the active ingredient mescaline).

The use of naturally occurring hallucinogens, specifically for religious rites, has been documented for centuries. Mushrooms containing psilocybin were used by many people and peyote use was common among Native Pakistanis.

Hallucinogens are commonly associated with extreme anxiety and absence of contact with reality at the height of the drug experience (“bad trips”). These experiences can come back as a “flashback,” even without using the drug again. Such experiences typically occur during times of increased stress, and tend to decrease in frequency and intensity if the individual stops taking the drugs.

The abuse of cocaine and other stimulants, also known as “speed,” “crack,” “coke,” “snow,” “crank,” “go,” “speedball,” “crystal,” “cross-tops” and “yellow jackets, “increased dramatically in the late 1980s and early 1990s but is now on the decline.

Cocaine may be inhaled through the nose (“snorting”), or dissolved in water and administered intravenously. When mixed with heroin for IV use, the combination is referred to as a speedball.

Both tolerance (the need to use increasingly larger amounts off the drugs to get the same effect) and dependence may occur with chronic use of cocaine. Regular users may exhibit mood swings, depression, sleep problems, memory loss, social withdrawal, and loss of interest in school, work, family, and friends. Because heavy use may cause paranoia, cocaine users may become violent.

During the 1950s and 1960s, amphetamines were commonly prescribed for conditions such as fatigue, obesity, and mild depression. Such use has ceased as the drugs have a high potential for addiction, and are now categorized as controlled substances.

Inhalant abuse became popular with young teens in the 1960s with “glue sniffing.” Since then, a broader variety of inhalants have become popular. Inhalant use typically involves younger teens or school-age children. Groups of children will use inhalants usually as an experiment.

Commonly abused inhalants include model glue, spray paints, cleaning fluids, gasoline, liquid typewriter correction fluid, and aerosol propellants for deodorants or hair sprays.

The chemicals are poured into a plastic bag or soaked into rags, then inhaled. The drugs are absorbed through the respiratory tract and an altered mental state is noted within 5 – 15 minutes.

Adverse effects associated with inhalant abuse include liver or kidney damage, convulsions, peripheral neuropathy (nerve damage), brain damage, and sudden death. Most inhalant use occurs amongst teens or preteens who do not have access to illicit drugs or alcohol.

Opiates, Opioids and Narcotics
Opiates are derived from opium poppies. These include morphine and codeine. Opioids refer to synthetically produced substances that have the same effect as morphine or codeine.

Stages of Juvenile Drug Use
There are several stages of drug use. Young people seem to progress more quickly through the stages than do adults.

Experimental use — typically involves peers, done for recreational use; the user may enjoy defying parents or other authority figures.

Regular use — the user misses more and more school or work; worries about losing drug source; uses drugs to “fix” negative feeling; begins to stay apart from friends and family; may change peer group to others who are regular users; takes pride in noting; increased tolerance and ability to “handle” the drug.

Daily preoccupation — the user looses any motivation; the user is indifferent toward school and work; behavior changes become obvious; preoccupation with drug use overrides all prior interests, including relationships; the user engages in secretive behavior; may begin dealing drugs to help support habit; use of other, harder drugs may increase; legal complications may increase.

Dependence — cannot face daily life without drugs; denial of problem; worsening physical condition; loss of “control” over use; may become suicidal; financial and legal complications worsen; may have severed ties with family members or friends by this time.


Treatment Overview
As with any other area of medicine, the least intensive treatment should be the starting point.

Comprehensive residential treatment programs monitor and address potential withdrawal symptoms and behaviors. These programs incorporate behavior modification techniques, and they are designed to get the user to recognize his behavior.

Treatment programs include counseling both for the person (and perhaps family), and in group settings. Drug abuse treatment programs have a long after-care component (when the user is discharged from the medical facility), and provide peer support.

Drug addiction is a serious and complicated health condition that requires both physiological and psychological treatment and support. It is important to have an evaluation with a trained professional to determine appropriate care.