Alcohol (ethanol) | Depressant; 10 g/drink Drink: 12-oz beer, 4-oz wine, 1½-oz liquor; one drink increases blood level by approximately 0.025 g/dL (varies by weight) | Legal: 0.05–0.1 g/dL (varies by state) Mild (< 0.1 g/dL): disinhibition, euphoria, mild sedation, and impaired coordination Moderate (0.1–0.2 g/dL): impaired mentation and judgment, slurred speech, ataxia Severe: > 0.3 g/dL: confusion, stupor > 0.4 g/dL: coma, depressed respiration | Mild: headache, tremors, nausea and vomiting (“hangover”) Severe: fever, sweaty, seizure, agitation, hallucination, hypertension, tachycardia Delirium tremens (chronic use) | Hepatitis, cirrhosis, cardiac disease, Wernicke encephalopathy, Korsakoff syndrome |
Marijuana (cannabis) | THC; 4%–6% in marijuana; 20%–30% in hashish | Low: euphoria, relaxation, impaired thinking. High: mood changes, depersonalization, hallucinations Toxic: panic, delusions, paranoia, psychosis | Irritability, disturbed sleep, tremor, nystagmus, anorexia, diarrhea, vomiting | Cough, gynecomastia, low sperm count, infertility, amotivational syndrome, apathy |
Cocaine | Stimulant; releases biogenic amines; concentration varies with preparation and route of administration | Hyperalert, increased energy, confident, insomnia, anxiety, paranoia, dilated pupils, tremors, seizures, hypertension, arrhythmia, tachycardia, fever, dry mouth Toxic: coma, psychosis, seizure, myocardial infarction, stroke, hyperthermia, rhabdomyolysis | Drug craving, depression, dysphoria, irritability, lethargy, tremors, nausea, hunger | Nasal septum ulceration, epistaxis, lung damage, intravenous drug use |
Opioids (heroin, morphine, codeine, methadone, opium, fentanyl, meperidine, propoxyphene) | Depressant; binds central opioid receptor; variable concentrations with substance | Euphoria, sedation, impaired thinking, low blood pressure, pinpoint pupil, urinary retention Toxic: hypotension, arrhythmia, depressed respiration, stupor, coma, seizure, death | Only after > 3 wk of regular use: drug craving, rhinorrhea, lacrimation, muscle aches, diarrhea, anxiety, tremors, hypertension, tachycardia | Intravenous drug use: cellulitis, endocarditis, embolisms, HIV |
Amphetamines | Stimulant; sympathomimetic | Euphoria, hyperalert state, hyperactive, hypertension, arrhythmia, fever, flushing, dilated pupils, tremor, ataxia, dry mouth | Lethargy, fatigue, depression, anxiety, nightmares, muscle cramps, abdominal pain, hunger | Paranoia, psychosis |
MDMA (ecstasy) | Stimulant, psychedelic; releases serotonin, dopamine, and norepinephrine; inhibits reuptake of neurotransmitters; increases dopamine synthesis; inhibits MAO | Enhanced empathy, euphoria, increased energy and self-esteem, tachycardia, hypertension, increased psychomotor drive, sensory enhancement, illusions, difficulty concentrating and retaining information, headaches, palpitations, flushing, hyperthermia Toxic: frank psychosis, coma, seizures, intracranial hemorrhage, cerebral infarction, asystole, pulmonary edema, multisystem organ failure, acute renal or hepatic failure, ARDS, DIC, SIADH, death | None | Paranoid psychosis |
GHB (liquid ecstasy) | Depressant, endogenous CNS transmitter; influences dopaminergic activity, higher levels of GABA-B activity | 10 mg/kg: sleep 30 mg/kg: memory loss 50 mg/kg: general anesthesia Toxic: CNS and respiratory depression, aggressiveness, seizures, bradycardia, apnea | Only after chronic use with dosing every 3 h. Early: mild tremor, tachycardia, hypertension, diaphoresis, moderate anxiety, insomnia, nausea, vomiting Progressive: confusion, delirium, hallucinations, autonomic instability, death | Wernicke-Korsakoff syndrome |
Sedative-hypnotics (barbiturates, benzodiazepines, methaqualone) | Depressant | Sedation, lethargy, slurred speech, pinpoint pupils, hypotension, psychosis, seizures Toxic: stupor, coma, cardiac arrest, seizure, pulmonary edema, death | Only after weeks of use: agitation, delirium, psychosis, hallucinations, fever, flushing, hyper-/hypotension, death | Paranoia |
Hallucinogens (LSD, peyote, mescaline, mushrooms, nutmeg, jimson weed) | Inhibition of serotonin release | Illusions, depersonalization, hallucination, anxiety, paranoia, ataxia, dilated pupils, hypertension, dry mouth Toxic: coma, terror, panic, “crazy feeling” | None | Flashbacks |
Phencyclidine | Dissociative anesthetic | Low dose (< 5 mg): illusions, hallucinations, ataxia, hypertension, flushing Moderate dose (5–10 mg): hyperthermia, salivation, myoclonus High dose (> 10 mg): rigidity, seizure, arrhythmia, coma, death | None | Flashbacks |
Inhalants (toluene, benzene, hydrocarbons, and fluorocarbons) | Stimulation progressing to depression | Euphoria, giddiness, impaired judgment, ataxia, rhinorrhea, salivation, hallucination Toxic: respiratory depression, arrhythmia, coma, stupor, delirium, sudden death | None | Permanent damage to nerves, liver, heart, kidney, brain |
Nicotine | Releases dopamine, 1 mg nicotine per cigarette | Relaxation, tachycardia, vertigo, anorexia | Drug craving, irritability, anxiety, hunger, impaired concentration | Permanent damage to lung, heart, cardiovascular system |
Anabolic steroidsa | Bind steroid receptor Stacking: use many types simultaneously Pyramiding: increase dosage | Increased muscle bulk, strength, endurance, increased drive, hypogonadism, low sperm count, gynecomastia, decreased libido, virilization, irregular menses, hepatitis, early epiphysial closure, aggressiveness | Drug craving, dysphoria, irritability, depression | Tendon rupture, cardiomyopathy, atherosclerosis, peliosis hepatis (orally active C17 derivatives of testosterone are especially hepatotoxic) |