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Quit Marijuana The Complete Guide

This now famous guide has helped thousands of people overcome marijuana. None have had to spend another cent on marijuana, munchies, detox kits, rehab or therapy. Like thousands before you, quit weed the easy way! Defuse your psychological addiction very quickly. The one major sneaky secret that will banish your cravings for marijuana. How to get some sleep naturally, without smoking marijuana. What you will be feeling, thinking and struggling with, and some Real-Life solutions that will actually work for you. What you should never do when you first try to quit weed (you are probably already doing this right now!) Stop mental fogginess! Gain clarity, focus and motivation to upgrade your career or education. Lung Cleansing Course included! Cleanse your lungs and experience larger lung capacity, clearer breathing and an increased chest size! Finally get rid of that 'feeling' you get to smoke weed, (discover who the real you is and claim your life back!) Support Gain 24/7 personal email support or talk to other marijuana quitters in our forum. Instantly enhance your own natural conversation skills and social interaction. Warning This guide changes how you actually look at weed! Read more here...

Quit Marijuana The Complete Guide Summary


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Highly Recommended

The author has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Origins Sources and Manufacture of Cannabis

The plant material can be used as herbal material, once dried, e.g. marijuana. Low-quality products, which contain stalks, seeds, leaves and flowering tops, may be compressed into blocks (West African and Caribbean material), it may occur as loose herbal material (from Central and Southern Africa), or it may be rolled into a so-called 'Corn Bob', wrapped in vegetable fibre (again from Central and Southern Africa). Higher-quality materials, composed of fruiting tops and flowers alone, may also be encountered. If tied around bamboo sticks, this material is known as 'Buddha Sticks' or 'Thai Sticks', and arises from SouthEast Asia. A central bamboo cane is used, around which up to 2 g of herbal material can be tied. The materials can be seized in bundles of up to 20 sticks. An African equivalent is to wrap the material in a small roll of brown paper such rolls frequently contain less than 0.5 g of cannabis per roll. Sieved products may also be encountered. This process removes the stems...

Qualitative Identification of Cannabis

The methods used to identify cannabis products depend upon the nature of the products themselves. Herbal material can be identified on the basis of its morphological characteristics alone, provided that certain of these are present. Where they are not, and in the case of resin and hash oil, the identification is made on the basis of phytochemical identification and the proof of the presence of A9-THC (1), its precursor, cannabidiol (CBD) (3) and its breakdown product, cannabinol (CBN) (4). However, it should be remembered that the presence of the breakdown product, CBN, precludes the use of the sample for comparative purposes.

National Organization For The Reform Of Marijuana Laws

Since its founding in 1970, National Organization for the Reform of Marijuana Laws (NORML) has sought the repeal of marijuana prohibition so the responsible use of cannabis by adults is no longer penalized. During the 1970s, NORML led successful efforts to decriminalize minor marijuana offenses in 11 states and significantly lowered marijuana penalties elsewhere. Today NORML continues to lead the fight to reform state and federal marijuana laws, whether by voter initiative or through the legislatures. For more information, see Contact at

Duquenois Levine Reagent for Cannabis Products

Five drops of solution (1) are added to the material under investigation, which has previously had a drop of ethanol added to it to solubilize the cannabinoids, and the system shaken. Five drops of solution (2) are then added and after shaking again, 10 drops of solution (3) are added. The whole is then shaken thoroughly and the two phases allowed to separate. Cannabinoids rapidly form a blue complex which extracts into the chloroform layer. Beware, however of 'false positives' that can be confused with reactions from 'old' Cannabis products.

Comparison of Cannabis Samples

On occasion, it may be necessary to make comparisons between cannabis samples. There are a number of questions which need to be addressed in order to establish or otherwise that two or more samples of cannabis once formed the same batch. These include the following Figure 4.6 Gas chromatogram of cannabinoids from a herbal sample of cannabis after derivatization with N,O-BSA. Figure 4.6 Gas chromatogram of cannabinoids from a herbal sample of cannabis after derivatization with N,O-BSA. Figure 4.7 Mass spectrum of A9-tetrahydrocannabinol from a herbal sample of cannabis after derivatization with N,O-BSA. Physical Comparison of Cannabis Samples Plate 4.6 A low-power microscopic image of cannabis resin, illuminated to show raised areas on one common surface and the corresponding troughs on the opposite surface. Copyright Michael D. Cole, Anglia Polytechnic University, Cambridge, UK, and reproduced with permission. Plate 4.6 A low-power microscopic image of cannabis resin,...


Cannabis sativa is the hemp plant from which several drugs are produced including marijuana (pot, grass, joints, reefer, roaches, weed, Mary Jane), tetrahydro-cannabinol, hashish, and hashish oil. All are smoked or taken orally. Marijuana and Hashish The most commonly used illicit drug in the United States today, marijuana is a mixture of the dried and shredded leaves, stems, seeds, and flowers of the hemp plant. Hashish is made from marijuana resin found in the tops of a flowering marijuana plant where the level of marijuana's main ingredient, tetrahydro-cannabinol (THC), is most concentrated. Marijuana is much stronger and thereby more addictive today than it was 30 years ago when average THC levels were less than 1 . Today, THC levels range between 7 and 20 . Although marijuana is used medically to relieve pain and suffering from such disabling conditions as multiple sclerosis, glaucoma, and the side effects of chemotherapy, it is also used illicitly in many ways. Some users brew...


Marijuana is the number one illegal drug used in the United States. Its legal status remains controversial, with viewpoints polarized between critics who view marijuana as a possible gateway drug and advocates for its medicinal use for patients undergoing chemotherapy or with acquired immunodeficiency syndrome.138 For athletes, concern again rises for possible marijuana use among a population of risk takers. In a survey of U.S. high school students, Ewing139 found that male athletes used marijuana more than their nonathlete peers, but that female athletes used marijuana less than their nonathlete peers. Interestingly, a French study suggests that elite athletic participation by adolescents and young adults has a protective effect against marijuana use. Marijuana might provide a performance benefit at low doses through relaxation and a possible improvement in auditory and visual perception.130 However, persistent use of marijuana, which is often accompanied by increased use or abuse...

Marijuana Cannabis

Marijuana is the most widely used illicit drug. A recent survey by the National Institute on Drug Abuse found that more than 20 percent of high school seniors have used marijuana within the last 30 days Echoing the previous paragraph is the question of whether it's use affects student performance. Marijuana or the hemp plant (cannabis sativa) is often smoked or eaten to get high. A major active ingredient is delta-9-THC (tetrahydrocannabinol), but there are probably others such as cannabidiol. The strength or percent of the plant that is drug has increased over the past few decades, presumably because of selection. Several different strains of the plant are known. Dronabinol (synthetic THC, whose proprietary name is Marinol) is a marketed medication indicated for appetite stimulation and reduction of vomiting. Hashish, an extract of the plant that is a more pure form of the drug, is made of resinous secretions of the plants which are dried, compressed, and smoked. Delta-9-THC and...

Cannabis and Hashish

Cannabis (also known as marijuana, weed, pot, etc.), are the buds and leaves of the Indian hemp plant. THC is a psychoac-tive chemical which causes relaxation and reduced short-term memory. Continued use can result in increased anxiety and paranoia in some individuals. It is a milder form of intoxicant than hashish which is a hardened form ofcannabis that is eight times stronger. Cannabis was used as early as 3000 BC in Egypt. In the 1960s and 1970s marijuana became a commonly used drug as it still is today. The pot subculture includes hundreds of pop songs that praise grass. Stoner movies became a minor genre which included Up in Smoke starring Cheech and Chong, Pineapple Express and Harold and Kumar go to White Castle. Sean Penn became a star playing a stoner in Fast Times at Ridgemont High. Today some creative individuals such as comic Bill Maher and Willie Nelson publicly admit smoking cannabis regularly. It has reached acceptance to the point that President Barack Obama mentioned...

Cannabinol Marijuana

Marijuana is one of the most commonly abused drugs. It was used as early as 3000 bc in cultures as diverse as those found in the Middle East and Asia. The drug is known by a number of names, including hashish, ganja, and bhang. Low to moderate doses of the drug cause very few psychological and physiological symptoms. The pharmacologic actions and the long-term effects of chronic use are still unclear. Delta-tetrahydrocannabinol (THC) is derived from the marijuana plant, Cannabis sativa. The drug can be smoked, eaten, or taken intravenously. Its potency varies greatly. When smoked, the peak plasma level of the drug is reached within 10 minutes, although psychological effects do not develop until 20 to 30 minutes. The effects can last up to 3 hours. However, THC is absorbed and accumulates in tissues such as the testes and the brain.

Background to the Misuse of Drugs Act 1971

Historically, in the United Kingdom the Dangerous Drugs Act, 1951 simply controlled vegetable narcotics, such as Cannabis sativa (cannabis) and opium, and a few chemically related synthetic substances. This was superseded by the Dangerous Drugs Act, 1964, which organized the controlled drugs into three schedules based on internationally accepted principles. This was the first time that stimulants, used as anorectics, such as amphetamine and its analogues, were included in British Law. It also introduced some specific offences in relation to cannabis. In 1965, a new act, i.e. the Dangerous Drugs Act, 1965, combined the provisions of the Dangerous Drugs Act, 1951 with those of the Dangerous Drugs Act, 1964, as well as providing a more comprehensive definition of herbal cannabis as 'the fruiting and flowering tops of any plant of the genus Cannabis'. Since the forensic scientist still came across difficulties in discriminating fragmented plant parts which could still be a potent source...

The Provisions of the Misuse of Drugs Act 1971

Social harm, and Class C drugs the least. Class A drugs include cocaine, heroin, mescaline, morphine and opium, Class B includes amphetamine(s), and Class C the benzodiazepines. At the time of writing Cannabis is being reclassified. In addition, stereoisomers, salts, esters, ethers and certain preparations are also controlled groupwise, thus removing the need to name each of these individually. Associated with each class of drug are maximum penalties which may be prescribed. Those for Class A drug offences are more severe than those for Class C offences. For Class A drugs, some offences carry a maximum sentence of life imprisonment, for Class B 14 years in prison, and for Class C, five years in prison. With respect to each of the listed drugs, the Misuse of Drugs Act, 1971 is divided into several sections (Table 1.1), with each section relating to a specific type of offence under the Act which is prohibited. Cultivation of cannabis presence of a drug and on occasion, particularly in...

Current Status of Drug Analysis

At the present time, it is possible to carry out identification and quantification of a wide variety of drugs, ranging from those which are entirely herbal or fungal in origin (Cannabis and its products), through those which are semi-synthetic (cocaine and diamorphine), to those which are entirely synthetic (the amphetamines). A wide variety of techniques can be applied for their analysis and it is rare that an issue of sensitivity becomes apparent. In terms of drug identification and quantification, the drug analyst is in a particularly strong position. Much is known about sample preparation for comparison purposes in cases of the more commonly encountered materials, for example, heroin, and Cannabis and its products. However, considerably less information is available concerning the stabilities of the newer 'designer' drugs in the solvents used to prepare them, what the extraction efficiencies are for the different impurities, and whether, for example, artefacts are formed as a...

Analytical Sequence Bulk and Trace Sampling Procedures

Prior to the process of identifying whether or not a material contains cannabis or its products, a decision must be made as to whether the sample is a bulk or a trace sample. A bulk sample can be defined as anything that can be seen (herbal material, resin or oil), while a trace sample, in terms of cannabis, can be loosely defined as one which would easily be contaminated. Trace samples might be present, for example, on the surfaces of scales used to weigh cannabis materials, the surfaces of knives used to cut resinous blocks or the surfaces of paraphernalia associated with cannabis use. Bulk samples range from a few mg of plant, resin or hash oil, to kilogram and tonne seizures arising from intervention of law enforcement agencies in smuggling operations. Their analysis follows the sequence, physical description, presumptive test, thin layer chromatography and then instrumental analysis. The analytical sequence for trace samples involves a physical description of the item, followed...

Identification of Other Materials

If the morphological characteristics of Cannabis sativa are not all present, or if they have been destroyed, in, for example, resinous material or material that has been smoked (Plate 4.4), it is necessary to identify the material through its phytochemical content. Plate 4.4 Unicellular trichromes present in the remains of smoked cannabis material. Copyright Michael D. Cole, Anglia Polytechnic University, Cambridge, UK, and reproduced with permission. Plate 4.4 Unicellular trichromes present in the remains of smoked cannabis material. Copyright Michael D. Cole, Anglia Polytechnic University, Cambridge, UK, and reproduced with permission. Presumptive Tests for Cannabis Presumptive tests for cannabis products are used to test for the presence (or otherwise) of phenolic cannabinoids. The principle one that is used is the Duquenois-Levine test. An alternative which is available and can also be used is the Corinth IV salt test. Both involve a reaction between the cannabinoids and a...

Identification of Herbal Material

Botanically, Cannabis sativa can be identified on the basis of its gross morphological features and, more importantly, by the presence of microscopic structures on the surface of the plant, namely the trichomes. At the macro-morphological level, it has a square stem, with four corners, and has palmate leaves with serrated edges. These are the characteristics with which most people are familiar. Microscopically, three types of trichome are observed, namely the glandular tri-chomes (Plate 4.1), unicellular trichomes (Plate 4.2) and cystolithic trichomes (Plate 4.3). Plate 4.1 Glandular trichromes found on the surface of Cannabis sativa. Copyright Michael D. Cole, Anglia Polytechnic University, Cambridge, UK, and reproduced with permission. Plate 4.1 Glandular trichromes found on the surface of Cannabis sativa. Copyright Michael D. Cole, Anglia Polytechnic University, Cambridge, UK, and reproduced with permission. Plate 4.2 Unicellular trichromes found on the surface of Cannabis sativa....

Impurity Extraction and Sample Comparison

Each route of synthesis will result in an impurity profile which can be analysed. Unlike cannabis, heroin and cocaine, the impurities are present in very low concentrations and need to be extracted from the amphetamine matrix. Liquid-liquid extraction (LLE) and solid-phase extraction (SPE) have been most frequently applied for this purpose 13-16 . Of these, LLE is currently the most widely used technique. In addition, there are attempts being made to develop the method so that it can be optimized to allow data exchange between different laboratories (in different countries) 17 .

Learning from the past

Images produced by a variety of drugs, focusing on such varied dimensions of these images as color, movement, action, and form. Siegel's subjects were trained to use an image classification system prior to the drug sessions. There were baseline and placebo sessions for comparative purposes. With regard to reported images, the amphetamine (a stimulant) and pheno-barbitol (a sedative) sessions did not differ from placebo sessions. However, the sessions with mescaline, LSD, psilocybin, and a synthetic compound based on the active ingredients in marijuana produced similar images. In the psychedelic drug sessions, for example, complex images did not appear until well after there was a shift to lattice tunnel forms memory images emerged in the later stages of the appearance of complex imagery. Noting that hypnagogic and hypnopompic images were accompanied by theta and low-frequency alpha brain waves, other researchers used biofeedback to teach subjects how to enter these states. There was...

Abused Substances and Their Effects

Part I describes drugs that are frequently abused opiates, depressants, stimulants, cannabis, hallucinogens, inhalants, steroids (anabolic-androgenic) and designer drugs. An easy-to-use reference table of these psychoactive drugs covers their common name, pharmaceutical name, street names, medical uses, methods of administration, indices of misuse, health consequences (both short- and long-term effects), overdosing, withdrawal symptoms, and physical and psychological dependency. The Control Schedules for Abused Drugs describes the five schedules that are controlled and monitored by the U.S. Drug Enforcement Administration (DEA). ABUSED DRUGS Opiates Depressants Stimulants Cannabis Hallucinogens Inhalants

I2 Drug Discoverya Historical Perspective

In early times, there was no possibility of understanding the biological origin of a disease. Of necessity, progress in combating disease was disjointed and empirical. The use of opium, ephedra, marijuana, alcohol, salicylic acid, digitalis, coca, quinine, and a host of others still in use, long predates the rise of modern medicine. These natural products are surely not biosynthesized by plants for our therapeutic convenience we believe they have survival value to the plants in dealing with their own ecological challenges.

Animal Model Extended

In fact, most drug abusers and addicts have stopped or tried to stop taking drugs, only to eventually relapse. So at any given time, most drug abusers are in fact relapsers. Therefore, it is important to study relapse itself, and this is nicely done in a variant of the self-administration model, as mentioned previously. It works by allowing the animal to learn to self-administer a drug, such as cocaine, until the lever pressing is stable. Then, the drug is withdrawn, and, as expected, the animal gradually tires of lever pressing without a reward and the lever pressing behavior is extinguished. This animal is now an experienced drug user, much like most humans who have used drugs but have stopped. A human in this condition likely thinks about the drug, and when stressed or reminded of the drug, perhaps by some cue, craves the drug and perhaps starts looking for a drug. The cue can be the sight of friends who use drugs, the crack house, or even some...

Visual Hallucinations

Illicit drug use (cocaine, lysergic acid diethylamide LSD , marijuana), medications (digoxin, anticholinergics, and dopaminergics), and parasympatholytic eye drops (atropine) may also be responsible for visual hallucinations. A psychotic psychiatric disorder is suggested when complex visual hallucinations are accompanied by occasional auditory hallucinations. y Normal people may experience both formed and unformed visual images upon wakening (hypnopompic) or upon going to sleep (hypnagogic). A number of degenerative neurological diseases (Parkinson's disease, progressive supranuclear palsy), in the setting of medication use (levodopa, dopamine agonists, monoamine oxidase MAO inhibitors, and anticholinergics) can make visual hallucinations a common clinical disorder. Other disorders such as diffuse Lewy body disease may have visual hallucinations as a primary symptom as well.

Inference and Relational Generalization

Early work by Schustack and Anderson (1979) provided evidence that people sometimes falsely report that analogical inferences were actually presented as facts. Blanchette and Dunbar (2002) performed a series of experiments designed to assess when analogical inferences are made. They had college students (in Canada) read a text describing a current political issue, possible legalization of marijuana use, which served as the target analog. Immediately afterward, half the students read, The situation with marijuana can be compared to . . . , followed by an additional text describing the period early in the twentieth century when alcohol use was prohibited. Importantly, the students in the analogy condition were not told how prohibition mapped onto the marijuana debate, nor were they asked to draw any inferences. After a delay (1 week in one experiment, 15 minutes in another), the students were given a list of sentences and were asked to decide whether each sentence had actually been...

The role of other neurotransmitters in LTD

Non-glutamatergic receptors may be involved in the regulation of LTD induction. As in the case of LTP, the role of different neurotransmitters on modulating LTD is potentially complex. There are far fewer reports of a role for non-glutamatergic receptors in LTD than for LTP. However, beta-adrenergic receptors play a role in CA1 LTD (Katsuki et al., 1997) and in prefrontal cortex LTD requires coactivation of dopamine and mGluRs (Otani et al., 1999). Also, in a similar way to the previously described agonist-induced mGluR-LTD in CA1, pharmacological activation of mAChRs (Kirkwood et al., 1999 Massey et al., 2001) or noradrenergic receptors (Kirkwood et al., 1999) induces a form of NMDAR-independent and stimulation-independent LTD in visual and perirhinal cortex. A topic of current investigation is that of cannabinoids in synaptic plasticity and memory cannabinoid receptors have been shown to be essential for certain types of synaptic depression (Ronesi et al., 2004).

Maintaining Wellness Exercise Identifying Triggers For Alcohol And Drug Abuse Your Responses To Those Triggers And The

List the type of alcohol or the drug you use most frequently (examples beer, wine, marijuana, cocaine). In other words, think of drinking or drug use as one event in a sequence of events rather than a singular, isolated act. Then you'll be in a position to think about changing this sequence. For example, Amy learned to avoid certain situations and people who, she believed, made her drink more. Earl, who smoked marijuana heavily, learned to plan things for times of the day when he was most likely to get high (typically late afternoons after he finished his classes). Bethany learned to challenge her belief that alcohol alleviated her depressions. When she systematically evaluated the results of her drinking, she concluded that she felt better at first but more irritable and depressed later. She began to think of alcohol as a cause rather than an effect of her mood problems.

Maintaining Friendships While Avoiding Alcohol or Drugs

What if your social circle is one that relies heavily on alcohol or drugs Dispensing with alcohol, marijuana, or hard drug use can indeed have negative social implications. For example, some people find it hard to go out with their friends without drinking (this was the case for Amy). Some say that their friends devalue their efforts to stay sober. If these problems apply to you, consider discussing your dilemma with one or more trusted friends. Do they understand about your disorder and the likely impact of alcohol or drug use

State Dependent and Congruent Memory Processes

First, state-dependent learning has frequently been demonstrated with animals as well as with humans (Overton, 1984). In such research, drugs that act on the central nervous system are employed to demonstrate that if learning occurs or attention given during a particular drug state, when the subjects are reintroduced to that same drug state later, they will have a better memory of what was learned than if recall is attempted in a nondrugged or a different drug state. This state-dependent memory retrieval has been demonstrated with such well-known drugs as alcohol and marijuana, as well as with a wide range of others, including various anesthetics, narcotics, anxiolytics, and stimulants. Even nicotine was recently employed to show state dependency (Peters & McGee, 1982). Early theorizing about this phenomenon centered on particular brain mechanisms, but more recent ideas have focused on the conditioning of stimulus contextual cues (cf. Tulving & Thompson, 1973) arising from the...

Direction the viva may take

Cannabinoids (nabilone and dronabinol) Sedation is common, and the drugs may sometimes exert psychotomimetic effects similar to those induced by the parent compounds. Dry mouth and postural hypotension may also occur. Corticosteroids (methyl prednisolone and dexamethasone) The list of acute side effects includes steroid psychosis, which is related to sudden increase in plasma levels of corticoids, and metabolic disturbance including hyperglycaemia, fluid retention and hypokalaemia. Short courses of high-dose steroids may cause peptic ulceration.

Radiochemical Techniques

This technique is useful in the fields of drugs, phy-tochemistry, food additives, and other natural and synthetic organic compounds. Many organic constituents of drug-containing plants were detected by this technique. Examples are constituents of essential oils, purines (e.g., caffeine), narcotics from drugs or tobacco, marijuana constituents, mescaline from Mexican narcotic fungi, organic contituents of fossil fuels, and oil-shales.

What Constitutes An Appropriate Evaluation For The Epilepsy Patient With Psychiatric Symptoms

A critical part of the history is a thorough review of past and current substance use, including frequency, amount, effects, and related complications or problems (such as legal or medical complications). Substances to inquire about include tobacco, caffeine, alcohol, marijuana, cocaine, stimulants, depressants, hallucinogens, prescription medications, over-the-counter medications, and intravenous drugs.

Additional Resources

Two kinds of tests are commonly used (1) immediate outcome drug tests (e.g., home drug testing kits that test marijuana, cocaine, amphetamines, morphine opiates, PCP, alcohol, and nicotine) that provide immediate results and are economical and easy to use, and (2) confirmation tests sent to a lab to determine test accuracy and reliability. To minimize errors such as contamination, clerical error, improper execution, or cross-reactivity, select a sophisticated laboratory with a proven track record.

Historical Background To Aromatherapy

Incense smoke from resinous plant material provided a more sacrosanct atmosphere for making sacrifices, both animal and human, to the gods. The incense was often mixed with narcotics like cannabis to anesthetize the sacrificial animals, especially with humans (Devereux, 1997). The frankincense extract in oils (citrusy odor) was entirely different to that burnt (church-like) in chemical composition (Arctander, 1960), and therefore would have entirely different functions.

Child Sexual Abuse And Multicultural Considerations

Research consistently indicates that sexual abuse has numerous and profound effects. Specifically, sexually abused boys and girls tend to display more behavioral problems, emotional problems, academic difficulties, suicidal tendencies, disordered eating behaviors, substance use, and sexual risk taking than their nonabused peers.24,1,17,20 In a study examining the gender differences in outcomes of male and female teenagers who self-reported a history of sexual abuse, Chandy et al.24 found male adolescents with a history of sexual abuse tended to report performing below average and had a high or very high dropout risk when compared to female adolescents, were at higher risk than females in delinquent activities (e.g., beating up another person, group fights, running away from home, stealing), sexual risk taking (e.g., frequency of intercourse, use of contraception), and marijuana use. On the other hand, female adolescents showed higher risk for suicidal involvement (e.g., attempts,...

Constraints on Metaphorical Creativity

Much of the creativity in metaphoric language arises from turning familiar, established metaphoric ideas and expressions and twisting them to create something new, but with an echo to the past. For example, the metaphorical proverb Different strokes for different folks originated in the 1950s reflects the cultural ideal of people's need for mutual acceptance. Creative forms of this proverb over the years include Different spokes for different folks (from a book on bicycles), Different smokes for different folks (from a cartoon showing a picture of a businessman smoking a cigar and a hippie smoking a marijuana cigarette), Different slopes for different folks (from an Air Canada ad promoting ski vacations in Canada), and Different Volks for different folks (from a Volkswagon ad highlighting that it sells cars other than the Beetle). In each case, people appear to recognize the allusion to the original proverb, and find humor in the slight twist on that old piece of wisdom so blatantly...

What do you do now

The RCVS syndrome most often affects young women, especially during the puerperium, but also occurs at menopause and is found at all ages. Many of the patients have had a history of migraine. Some patients have developed this syndrome after carotid endarterectomy. The use of serotonin reuptake inhibitors prescribed for depression, and cannabis especially smoked in a binge can provoke the syndrome. Drugs such as phenylpropanolamine, cocaine, and amphetamines can also precipitate identical syndromes.

Teens Abusing Substances

Substance abuse continues to afflict American teenagers, with a dangerous trend toward use of marijuana and other illegal drugs at earlier ages. The National Half of adolescents have attended parties where drugs and alcohol were available. One third have attended a party at which alcohol, marijuana, cocaine, ecstasy, or prescription drugs were available while a parent was present.

Principles of Treatment

The first principle is that no single treatment is good for all individuals. What a counselor would do for a college student who gets stoned on marijuana a lot, and whose grades are falling is different from what a doctor would do for a sixty-year-old alcoholic who has imbibed every day for years and years and is on the verge of liver failure. Importantly, if treatment does not seem to be working, consider another type or source of treatment. A life might be at stake

Mania And Substance Misuse

In the Aesop sample eleven subjects denied any present history of illicit drug use although two of these subjects had tried cannabis on one occasion in the past. Eight subjects were regular users of cannabis or a particularly strong form of the drug termed ''skunk weed'' in the United Kingdom. One subject had used cocaine on seven occasions in the past but not in the year of presentation. Of these eight patients, three admitted to consuming excess amounts of cannabis in the period immediately preceding the onset of manic symptoms and one subject took Ecstasy tablets for the first time prior to symptoms emerging. Although the role of drugs in the aetiology and presentation of psychosis remains controversial, all the patients in this sample fulfilled ICD-10 criteria for manic disorder and the duration of the symptoms exceeded a time period where they could not be explained by the use of drugs alone.

Evidencedbased Practice

That it is impossible to compare between trials. Patients who are recruited from inner city areas are unlikely to be free of recreational drug use. A small consumption of cannabis may not affect the therapy efficacy, but it is not clear whether any use of class A drugs affects the therapeutic effect of psychological treatment. A more recent trial has been designed to test the efficacy of CBT and family intervention to treat dual diagnosis patients (those diagnosed as suffering from schizophrenia and substance abuse) in which the substance abuse is thought to increase the risk of poor outcomes in the primary disorder.18 In this case severe substance abuse was an entry criterion.

Best Treatment Is Prevention

Prevention includes the policies and actions taken to prevent new or continuing drug abuse in a target population. If we can prevent the non-drug-using population from becoming drug users, then we can greatly reduce the burden of drug abuse. The idea is to prevent the damage before it occurs. Anti-tobacco and antidrug advertising are examples of prevention efforts. Prevention works For example, two educational programs in schools, Life Skills Training (LST) and the Strengthening Families Program (SFP),6 that are aimed at prevention of drug use have reduced marijuana smoking and alcohol use. The cost of these programs can be just one tenth of a year of outpatient treatment. The youth of this country are not stupid. When told about the problems with drugs, many listen. Figure 13-1 shows a reduction in drug use by youths after being told about the dangers of drugs. Marijuana Marijuana

Substance abuse issues

Bombadier et al. (2002) noted a similar finding to the previously mentioned three studies with high rates of alcohol-related problems before injury. One third of the group (142 of 156 consecutive admissions to a rehabilitation unit) were intoxicated at the time of the injury. Fifty-nine percent were considered at-risk drinkers with high levels of preinjury alcohol use, while 49 self-reported significant alcohol problems. Thirty-four percent reported recent illicit drug use and 37 featured positive toxicological results for illicit drugs. Forty percent of the sample had positive toxicological results for marijuana, cocaine, or amphetamine within three months of their injury, with marijuana accounting for more than half of the illicit drug use.

Distribution Of Drugrelated Problems In Space And Time

Problems are distributed in time as well as space (e.g., see Musto, 1987 Courtwright, 2001). For example, since the middle of the twentieth century, the people of Japan and the western Pacific seem to have been more affected by dependence on the psychostimulant amphetamine drugs than by other drugs, although in recent years problems associated with marijuana and other cannabis products (e.g., hashish) have become more prominent in Japan and elsewhere around the globe (Hughes

Demographic Risk Indicators Sex and

In conclusion, it appears that male-female differences in prevalence of drug dependence may be determined in part by differences in risk of experiencing opportunities to try drugs. Other plausible sources of variation, not yet contradicted by evidence, include sex-linked differences in risk of becoming drug dependent (e.g., with respect to drugs such as marijuana and cocaine), and by differences in duration of drug dependence. among adults aged 35 years and older, perhaps as a sign that drug-taking patterns acquired in adolescence and young adulthood are being carried over into middle-age (e.g., see United States Substance Abuse and Mental Health Services, 1993, 2000). Johnson and Gerstein (1998) have drawn attention to some impressive differences that can be seen in the illegal drug experiences of different cohorts within the United States since World War II Golub and Johnson (2001) have stressed more recent birth cohort experiences, and also draw attention to subgroup variation in...

Race as a Determinant of Risk for Drug Dependence

It also may be important to note that the profiles of risk-influencing conditions and processes may not be the same, once self-designated race has been used to form population subgroups. A simplifying assumption might be that all subgroups will benefit equally from preventive interventions directed toward the same conditions and processes. Ellickson and Morton (1999) recently offered prospectively gathered evidence that this assumption might not hold. With respect to the use of drugs such as cocaine and heroin, the profile of risk-influencing conditions observed for self-designated white and non-Hispanic subgroups in the longitudinal study sample was not entirely the same as the profile observed for other subgroups (Black, Asian, Hispanic). Indeed, they found that low parental educational attainment was associated with increased risk of drug involvement for white non-Hispanic youths, but was associated with reduced risk of drug involvement for Hispanic and black youths. Consistent...

The Sociological And Psychological Dimensions Perceiving Reality

Case 9 ''In most Western countries, a large proportion of those using soft drugs like marijuana will end up as addicts of hard drugs like heroin. We should therefore prevent the use of soft drugs like marijuana, even if in themselves they are much less dangerous than accepted drugs like alcohol or nicotine, to prevent further steps to the more dangerous and addictive drugs.''

General Approach to Treatment

Including serotonin receptor antagonists, cannabinoids, dexamethasone, or olanzapine may be used.6 For those in any risk group who experience anticipatory nausea and vomiting, the addition of lorazepam for prophylaxis and breakthrough is recommended, for its antiemetic and antianxiety properties. Table 99-3 lists the doses of the antiemetic agents for prophylaxis and breakthrough use.

Patient Encounter Part 2 Medical History Physical Exam Laboratory Exam

FH Father was an alcoholic and died at 55 years of age of cirrhosis. Mother is alive, has an anxiety disorder and emphysema. Brother was incarcerated for attempted murder and drug trafficking. Sister has an anxiety disorder and self-medicates with marijuana. SA Hx In late teens into mid-20s, heavy abuse of stimulants, barbiturates, and alcohol. Currently smokes marijuana three times per week and states it calms me down and helps me sleep. Occasionally drinks beer on weekends.

Beliefs about Drinking Drug Abuse and Bipolar Disorder

I've heard people with bipolar disorder claim that marijuana or cocaine is just as effective as a mood stabilizer such as Depakote in controlling their mood states. They argue that alcohol calms them down, or reduces their anxiety, or improves their depression they argue that marijuana boosts their mood when they are depressed. One patient said, For me, alcohol is like the ropes that keep the hot air balloon from going up . and on the other side is like a disguise covering over the depression. Marijuana, although perhaps not as toxic for bipolar persons as alcohol, can also be detrimental to your mood stability. In Strakowski and colleagues' study (2000), marijuana use was associated with manic symptoms, whereas alcohol use was associated with depressive symptoms. One patient put it this way Marijuana makes me think and think and think, and then it keeps me from sleeping. It's like a catalyst for something in me. Marijuana can also interfere with your attention and concentration as...

Pratyusha Tummala Narra

Lorna enjoyed attending school, as she felt that this gave her a break from her home life. She excelled academically and studied dance for several years. At the same time, she experienced difficulty with fitting in socially with the other children at school. She described herself as shy and feeling as though she was different because of her Chinese background. While school felt like a place of respite in some ways, Lorna continued to feel lonely. In college, she developed a few close friendships and attempted to create an identity that was separate from her parents and from other Chinese Americans. After graduating from college, Lorna worked in a bank for several years and then decided to pursue a graduate degree. During her years of working at the bank, she began to use marijuana regularly to cope with her feelings of loneliness, depression, and anxiety. The substance use increased in frequency after she had been raped. She eventually decided to seek help from a therapist to address...

Substance Induced Mood Disorder

Manic or depressive episodes may result from medications, alcohol or drugs of abuse, or toxic agents. DSM-IV-TR specifies that the mood disturbance, either manic or depressive, must have developed within 1 month of substance intoxication or withdrawal that the substance (or medication) must be etiologically related to the disturbance and that these clinical conclusions must be based on the medical history, physical examination, or laboratory findings (see Table 6-11). Alcohol, cannabis, opiates, cocaine, stimulants, sedatives, and anabolic steroids are commonly associated with depressive symptoms in adolescents with manic symptoms.

Concepts of Addiction The US Experience

The League of Nations assumed responsibility for the Hague Convention in 1920. In 1924 the First Geneva Opium Conference addressed the gradual suppression of opium smoking. This was soon followed by the Second Geneva Opium Conference, which expanded international control over drugs by establishing a system of import and export certificates, creating the Permanent Central Opium Board (PCOB) to oversee the new provisions, and adding coca leaves and cannabis to the list of controlled substances. The United States, because it did not recognize the League, relinquished leadership of the international movement, and went so far as to walk out of the Second Geneva Opium Conference because, in its view, the other nations were unwilling to take meaningful steps to curb opium production and refused to ban the manufacture of diacetyl-morphine, more commonly known by its generic name, heroin. Heroin had been introduced by the Bayer Company in 1898 as a cough suppressant and within two decades had...

Presenting Clinical Features And Case Definitions

Our most recent epidemiological studies have suggested a substantial drug-specific variation in estimates of this type, as well as possible differences associated with studying the experience of different birth cohorts and different periods of time. As shown in Figure 1, with evidence from a nationally representative survey of 15-54 year old household residents in the United States, the estimated elapsed time from first extra-medical use until occurrence of dependence is substantially shorter for users of cocaine than for users of either alcohol or marijuana. Depicted in the inset figure for Figure 1, instantaneous risk of cocaine dependence peaked within 1 -3 years after first cocaine use, whereas the peaks for alcohol and marijuana were later (Wagner and Anthony, in 2002a). Figure 1. Estimated risk of developing DSM-III-R dependence upon cocaine, marijuana, and beverage alcohol, plotted in relation to the number of elapsed years since the age at first use of the drug. From data...

Supportive Laboratory Findings

Adolescents do not have mature brains (see Figure 12-1) because they continue to develop throughout adolescence. This development continues particularly in the frontal regions that are so critical for judgment and making appropriate decisions.5 Not only are frontal brain regions poorly developed in adolescents, continued drug use disrupts normal frontal cortex function, and both of these significantly contributes to being an addict. In the chapter on vulnerability, it was stated that the earlier in life that drug use begins, the greater the chance of becoming an addict in later life (see Chapter 8, Could I Become An Addict , Figure 8-3). Some children and adolescents appear to be at greater risk for drug abuse because of various factors that include genetics, family history of drug use, personality factors, birth defects, and co-existing emotional problems such as conduct disorder. Adolescents abuse a number of drugs, and marijuana is the most often used illicit drug in this age...

Primary Care of SUD Patients

Cocaine and other stimulants can cause myocardial infarction and stroke, raise blood pressure, and make essential hypertension resistant to treatment. Crack cocaine use, inhaled methamphetamines, and marijuana can lead to lung injury, chronic obstructive pulmonary disease, fibrosis, and pulmonary hypertension. Seizures can stem from stimulant use, benzodiazepine withdrawal, ecstasy and other club drug intoxication (Ries et al., 2009).

Effectiveness of research in routine clinical practice

Trouble for patients involved of meeting raters, the risk to them of receiving an ineffective control treatment, and an aversion, in principle, of involvement in research. It is probable that patients who are more severely ill are less likely to participate in studies, or to drop out of them, and so their results may have limited application. In practice, the studies cited below have been quite wide-ranging in their recruitment, and treatment and follow-up has been assertively offered in patients' homes where necessary. Exclusion criteria can also have effects, e.g. patients with dual diagnosis, especially of substance misuse, have been excluded from the studies cited below although many of the patients were abusing cannabis or amphetamines to some degree. Pilot studies in this group using motivational interviewing followed by CBT have, however, been successfully completed (Barrowclough et al., 2001).

Th Grade 10lh Grade12th Grade

The association of substance abuse with emergency department (ED) visits in the United States is reported by the Drug Abuse Warning Network (DAWN). This survey notes ED visits that are due to a condition induced by or related to drug use. Included in the data, are ED visits associated with alcohol, alone and in combination with other substances of abuse including cocaine, heroin, marijuana, and major stimulants. Figure 36-2 presents 2006 data depicting the number of ED visits per 100,000 people in the population that are associated with illicit drugs. Alcohol in combination with oth

Patient Encounter 2

Aprepitant, an NK1 receptor antagonist, prevents PONV however, it does not appear to be more effective than other available agents and is costly.9 Conversely, met-oclopramide, ginger, and cannabinoids have been shown to be of limited utility for PONV and are not recommended.9

Putting the History and Physical Examination Together

Substance abuse A 40-pack-year (2 packs a day for 20 years) history of smoking stopped smoking after first heart attack marijuana on rare occasions in past drinks alcohol ''socially'' but also admits to feeling the need for a drink as the day goes on (CAGE score, 1) denies use of other street drugs.

Causes of Erectile Dysfunction

There are many other reasons for erectile dysfunction. People with diabetes are at increased risk of developing erection problems. Several studies suggest that almost half the people suffering from diabetes develop erectile dysfunction. High blood pressure can lead to progressive thickening of the arteries of the penis and is associated with erection problems. Smoking cigarettes, excessive use of alcohol, and abuse of substances such as marijuana and cocaine are also associated with erection problems. Automobile and motorcycle accidents causing fracture of the pelvis can very often interrupt the blood supply or the nerve supply of the penis, leading to erection problems.

What Is a Drug

When talking about drugs that can be abused, there are about seven different groups of substances. These are nicotine sedatives such as alcohol, barbiturates, benzodiazepines, and inhalants such as fumes from glue opiates such as heroin and morphine psychostimulants such as cocaine, amphetamine, and methamphetamine marijuana hallucinogens and caffeine. Prescription drugs that are abused comprise many of the previous classes and are shown in the following list Marijuana Marijuana

Creative Climax

The Beatles had been taking drugs since their days in Hamburg, when the waiters provided pills to keep their energy up during performances. At the time of the Help album they dropped the pills and drink and moved on to marijuana, and by Sgt Pepper, LSD was commonly used. The Beatles realized that drugs undermined the quality of their performance. A recording session affected by drugs needed to be redone at a later date, so they made a point of staying clean while recording. In terms of composition, drugs provided subject matter for songs such as Day Tripper and Got to Get You into My Life, but in the long term this probably had a detrimental effect. John Lennon, who took the greatest quantities of LSD and at times used heroin, experienced a significant drop off in output. By contrast, Paul McCartney, who largely restricted himself to marijuana continued to excel. Drugs may have also affected Lennon's ability to function in the group. About this time John's personality was changing and...


The mental health consultant is also bound by legal and ethical codes. The consultant who fails to disclose information that would allow the parents to protect the child may be held liable if the child is harmed. The consultant's decision to maintain adolescent confidentiality or disclose risk-taking behaviors to a parent is often a difficult one. For example, if a teen is drinking or smoking marijuana without the parents' knowledge, he or she may accuse the care provider of a privacy violation if the parents are informed. Such sharing may also lessen the likelihood of honest communication between the patient and therapist, undermine the therapeutic relationship, or cause the patient to withdraw. If, however, the patient's life or limb is in danger, or the behavior and its consequences are serious and predictable, the parent needs to be informed and the patient notified. Jurisdictions generally permit disclosure if the child's safety is at risk. The consultant should always attempt to...

Urine Drug Screens

The standard urine drug screen in a clinical setting is a panel of immunoassays designed to detect common drugs of abuse. The panel can include the five drugs required by federal workplace testing amphetamines, cocaine, opiates, marijuana, and PCP. Other drugs that are prevalent in the community can be added to the panel, including benzodiazepines and barbiturates. Point-of-care testing kits can be ordered for office use that are individualized to the need of the practice. These point-of-care tests provide results in minutes and have generally good sensitivity. The manufacturers recommend follow-up testing with a different laboratory technique to confirm positive tests. Generally, drugs and their metabolites are detectable in urine tests for about 3 days after use. A notable exception is marijuana, which can be present in the urine for weeks after heavy use. Urine drug screens have significant limitations, which are not always recognized. For example, most immunoassays for opiates are...

Type 2social Users

Although those at Stage 5 (i.e., people that are psychologically as well as physically dependent on substances) often regard themselves as social drinkers users, they cannot, like social users, ingest their drug-of-choice intermittently, go long periods without it, or quit at any time. By contrast, social users may enjoy social events that offer psychoactive substances as part of the fare but are not preoccupied with drugs or getting high. Although clients may use alcohol or even marijuana regularly, they are in control of their consumption and experience few, if any, significant adverse consequences at home, work, in social settings or with law enforcement personnel. There is still considerable debate whether people can experiment with certain mind-altering drugs (e.g., marijuana, methamphetamine, crack, or heroin) without escalating into misuse (Type 3) or dependency (Types 4 and 5). With some drugs, like alcohol, most people seem to be able to continue indefinitely as social users...

Drug Use and Abuse

But a deeper look at the issue raises serious questions about the relationship between drugs and creativity. First, while the deviancy necessary for drug use and creativity is often mentioned as a reason for suspecting the existence of a relationship, it is worth noting that the use of many drugs, especially nicotine and alcohol, is quite common and thus not dramatically deviant. Second, much of the evidence supporting the presence of a positive effect of drug use on creativity is anecdotal in nature indeed, empirical research generally does not support a strong, positive, causal relationship between creativity and drug use. On the contrary, long-term use of alcohol, marijuana, and other drugs appears to have a negative effect on creativity. Even in studies which partially confirm disinhibiting effects, other factors appear to hinder the degree to which individuals capitalize on the production of disinhibited ideas.

Substance Abuse

Cannabis on more than 15 occasions were six times more likely to develop schizophrenia than less frequent users and nonusers (Andreasson et al., 1987). On the other hand, the opposite interpretation of the data is equally plausible namely, that preschizophrenic individuals were more likely to abuse cannabis. As Jones and Cannon (1998) argue, given the increase in consumption of cannabis over the past three decades, one would expect to see an increase in schizophrenia if cannabis played a causal role in the etiology of schizophrenia, and this has simply not occurred. In general, the epidemiologic evidence suggests that certain drugs, such as cannabis, can exacerbate symptoms of schizophrenia (Hall and Degenhardt, 2000). This raises the issue about whether patients with schizophrenia who have comor-bid substance abuse are clinical different from those without such comorbidity. Many clinical investigators report that patients with both schizophrenia and substance abuse are more difficult...

Secondary Agents

Presumably by inhibiting spinal polysynap-tic pathways, oral cannaboids have reduced spasms in patients with MS.200 Marijuana has altered spasticity in some paraplegics after SCI. Epidural and intrathecal opioids have also reduced the frequency of spasms, presumably by acting on lumbar multisynaptic reflexes mediated by A-delta and C-fibers.201 The phenoth-iazines may inhibit the discharge of fusimotor fibers to reduce spasticity or, more likely, to act at dopaminergic sites and in the brain stem reticular formation.170


The models studied here are destined to be regularly updated, at the level of the estimation period, on the one hand, and of the integration of new risk factors, on the other. Even if the authors face obvious measurement problems, new explanatory variables could be dreamed up to build in the effects linked to the consumption of drugs such as cannabis, which is reported to be a factor in around 16 of personal injury accidents occurring in France13, or to the growing use of mobile telephones at the wheel, which is estimated to increase the accident risk by a factor of four14. It would be equally interesting to know the impact on road risk of the active and passive safety features of vehicles.

Summary Overview

Recent estimates for the lifetime prevalence of drug dependence indicate a broad range from under 1 in some countries (e.g., Korea, Puerto Rico) to above 3 in other locales (e.g., Christchurch, New Zealand Edmonton, Canada Los Angeles, CA). The proportion of drug users who develop drug dependence seems to vary considerably from one drug category to another and most likely is determined by factors such as drug availability as much as by the reinforcing functions served by these drugs. For example, among alcohol users, the proportion who had become cases of alcohol dependence and or abuse has been estimated to be 15 -20 , not too distant from that observed for users of cocaine but slightly greater than the proportion observed for cannabis users. For users of tobacco and users of heroin, the proportion appears to be higher, sometimes approaching or exceeding 30 (e.g., see Anthony et al., 1994). In the United States, the 1-year prevalence of drug dependence is between 1.4 and 2.2 active...


Traditional and newer man-made prescription drugs have contributed to a situation where substance dependence and abuse have become widespread. The US Department of Health and Human Services Substance Abuse and Mental Health Services Administration survey mentioned in the introduction indicated that in 2008 4.2 million people representing 1.7 of the population were dependent on marijuana or hashish. 1.7 million on pain relievers, and 1.4 million cocaine. Hallucinogens, inhalants, and heroin had lower levels of use.

Opium and Heroin

Charles Baudelaire, the French poet, and Alexander Dumas, belonged to The Club des Hashischins where hashish was taken every month at seances. Baudelaire clearly had addiction problems with alcohol and opium as well as hashish that may have contributed to his death. Coleridge is alleged to have written the Kubla Kahn under the influence of opium. Other famous opium users include Elizabeth Barrett Browning, Sir Walter Scott, and W. B. Yeats.


It's impossible to accurately measure the level of drug use because, aside from the question of legality, some writers might be afraid their reputations would suffer if they publicly admitted they used drugs. As times change, writers' use of alcohol and drugs may change. Recent studies challenge the popular notion that creatively successful individuals lead excessive life styles. A survey of 22 writers, 27 artists, 12 musicians, and 25 controls about use of cocaine, marijuana, alcohol, etc. found no significant difference in the use of most substances between groups. However, a high rate of heavy use (23 ), a small sample, and an even smaller control group preclude any definitive conclusions.

Subject Index

Abused drugs cannabis, 9-10 control schedules, 15-30 controlled substance analogues, 32 depressants, 4-7 designer drugs, 13-15 five control schedules, 30-32 government decision making, 32 hallucinogens, 10-12 inhalants, 12-13 opiates, 2-3 prescribing drugs, 30 prescription opiates, 3-4 stimulants, 7-9 Academic and professional journals alcohol, 327-330 all addictions, 314-327 eating disorders, 330-332 gambling, 332-333 nicotine, 333-334 sex, 334-336 Academy of Eating Disorders, 286 Academy of Organizational and Occupational Psychiatry, 286 Addiction characteristics of, 39-41 compulsive use, 39-40 continued use despite adverse

Illustrative Case

Yeah, I have an older brother who's fine. He's 31. Do you use any recreational drugs Marijuana about once or twice a month. Anything else No. He is single and lives with his girlfriend of 8 months and always uses condoms for sexual protection. He uses marijuana about one or twice a month. He does not use any other recreational drugs. He works now as a legal clerk.


People use recreational drugs to alter their mood. The main types of drug are classified according to the usual mood change that they cause, but often they have a mixture of effects. Stimulants, such as cocaine, increase mental and physical activity relaxants, such as marijuana and heroin, produce a feeling of calm intoxicants, such as glue, make users feel giggly and dreamy and hallucinogens, such as lysergic acid diethylamine (LSD), alter perception and cause hallucinations (seeing or hearing things that do not exist).

Outpatient care

As an outpatient, times were difficult with concerns about excessive noise from his TV, and occasional abusive debates with neighbours. He also continued to have problems with the police through minor incidents of theft. Although these went to court, conditions of treatment and probation had usually resulted. He was much less thought disordered and having much less medication. He tolerated discussions of his misdemeanours without leaving abruptly. He professed to be using cannabis occasionally but no other illicit substances, with some lapses when friends come to stay.

Types Of Antiemetic

Dexamethasone and cannabinoids (e.g. nabilone, dronabinol) are effective against chemotherapy-induced emesis. The efficacy of cannabinoids for PONV is uncertain but there is increasing evidence that dexamethasone is effective. Antagonists at the NK-1 receptor are antiemetic also and their site of action is probably in the brain stem where there is an abundance of these receptors. They are presently undergoing clinical trials.


Phencyclidine (PCP) was developed initially as an anesthetic. However, a large number of patients developed postoperative psychosis after its administration. These occurrences stopped its use for this purpose in humans. Significantly, PCP affects all neurotransmitter systems. During the 1970s PCP was sold as angel dust, and its use was rampant. At present, PCP is mainly used by lower middle class white men in a very few localities. It can be injected, snorted, smoked, or eaten, and has been found in samples of LSD, amphetamines, and marijuana. PCP has been sold as mescaline or as one of the hallucinogens.

Pregnant Women

Approximately 5.1 of pregnant women age 15 to 44 were current users of illicit substances in 2008. Compared with nonpregnant women, the rate of drug use is significantly lower for all age groups, with the exception of adolescent women 15 to 17 years old. The rate of illicit substance use was higher among pregnant adolescents age 15 to 17 compared to same-age nonpregnant adolescents (21.6 vs. 12.9 ). Use of cocaine, heroin, methamphetamine, marijuana, MDMA, inhalants, and nicotine during pregnancy has been associated with adverse outcomes such as intrauterine growth retardation, delayed cognitive development, and difficulty with attention and learning. Effects vary by substance ingested, quantity and frequency of ingested drug or drugs, and stage of fetal development when ingestion occurs. Currently, methadone maintenance is the treatment of choice for opiate dependency during pregnancy, although buprenorphine has been used when methadone is not available. Newborns are monitored for...

Other Drugs

Table 51-6 lists the signs and symptoms of intoxication and withdrawal of other drugs. There are no specific antidotes or reversal agents for the remaining drug classes. Care of the overdose patient is largely supportive and aimed at treating the medical effects of the particular overdose, such as treatment of myocardial ischemia resulting from cocaine overdose. Currently, no FDA-approved medications are available for stimulant (including cocaine and methamphetamine), marijuana, hallucinogen (e.g., LSD, PCP), or club drug (e.g., MDMA) withdrawal. Behavioral therapies are the mainstay of treatment.

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