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Student Notes for Drug Abuse
Substance (Drug) Abuse
PERIOD ONE
What is “Substance Abuse”?
Substance abuse’ ( 物 質 濫 用 ) is a very general term. It is too broad,
particularly in Chinese. People may have difficulties in grasping the meaning
and message. In this block, the discussion shall focus on certain
drugs/chemicals that affect behavior. These are the chemicals that are most
commonly abused in Hong Kong (HK).
Drug abuse is not confined to behavior-modifying drugs only. Other drugs
can be abused. For example, some people may take an aspirin or Panadol
to relief ‘general’ discomfort unrelated to pain and temperature, even though
they know very well that they are painkillers and antipyretics (fever-reducing
drugs).
Besides those mind-altering drugs/chemicals, there are at least two other
types of drugs that are often misused – steroids (particularly testosterones)
and ‘weight-reducing’ drugs. The former is mainly used by body-builders and
weight-lifters to enhance their performance through the increase of muscle
mass and strength. Such abuse may lead to unpredictable incidences of
uncontrolled aggressive behavior, or even heart attacks. Other alarming
and dangerous side effects may include feminization in men (such as
atrophy, or decreasing in size, of the testes), masculinization and temporary
infertility in women, liver damage and clogged arteries. Common features
of the female athlete using steroids are leathery skin, bulging muscles and
dense facial hair.
Recently, the use of weight-reducing drugs by ‘over-weight’ or ‘obese’
people to lose weight without exercise is a fashion in HK. Some of these
drugs achieve weight-reduction by facilitating water-excretion and/or
reducing appetite. Some even contain ‘illegal’ and/or harmful substances.
[Please note that the more effective ways of losing weight are to eat less
‘high-calorie’ foods and do more exercise, as described in other lectures of
this module. Also, these substances are very harmful when misused, and
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Student Notes for Drug Abuse
should be avoided. These two types of drugs/chemicals shall not be
discussed in this block because of time limit.]
[Also note that drugs prescribed by your doctors are normally used for
short-term only and this use does not usually cause abuse/addiction and
long-term harmful effects.]
Drug/chemical abuse is a worldwide problem. Among the drugs/chemicals
being abused, psychotropic substances/drugs are most commonly. The
table in the next slide shows the amount confiscated.
Psychotropic drug seizure in different region
Recently, psychotropic substance abuse has become a pandemic
(world-wide) issue. In the past, psychotropic substance abuse was mainly
confined to opiates (opium, morphine and heroin). From 1990’s onward, the
substances in the list include amphetamines (there are many types of
amphetamine), cocaine, marijuana, ketamine, sleeping pills (e.g., Valium [安
定], etc). The upward trend is most striking in Asia.
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Student Notes for Drug Abuse
Some reasons for studying drug abuse
Drug abuse is an important social problem:Causes heavy financial loss
in society. A large sum of money has to be spent to provide
treatments for addicts. Not to mention the loss in work production.
2. Rapid increase in drug abusers recently. Drug abusers usually have
poor family and peer relationships. This creates many social
problems.
3. Related to organized crime or triad society activities. Some triad
societies obtained their money supply by operating illegal drug
trades.
Scientific issues:
1. How do drugs affect behaviour? Behaviour is controlled by the
brain. In this block we shall briefly introduce some parts of the
brain that participate more actively in the regulation of behaviour.
2. What are the effects of drug abuse? We have been told that these
drugs are harmful, but why? And how do they produce these
effects? In this block, we shall introduce the mechanisms involved.
3. Why do some people use drugs? There are many reasons, and
some of the more important/common ones shall be discussed in
this block.
4.
Do abusers display any abnormal signs of habits? The answer is
“yes”. Some abusers have the false belief that no one will know
they take drugs as they do so in “secret places”. This is wrong.
Drug abusers have some easily recognizable signs.
[Try to think of other important reasons to supplement this part.]
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Student Notes for Drug Abuse
Number of people arrested for drug offences
This table below gives a recent picture of drug-related offences in HK.
Major offences: trafficking, possession of large quantity, manufacturing etc.
Minor offences: possession of small quantity, taking, etc
The point to be stressed is that drug abuse is still a problem in HK despite of
much government efforts.
The number of psychotropic drug abusers increased rapidly in recent years.
Two Major reasons: more young people attend rave parties and these drugs
are “readily available” in nightclubs and bars. [Some of these illicit drugs,
e.g., ice, ketamine and sleeping pills, are from Mainland China.]
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Student Notes for Drug Abuse
Reasons for Drug use
The table below provides some reasons for taking drugs.
Reasons for drug use
Reason
Percentage
Peer influence /to identify with peers
45.7
Avoid discomfort of its absence
45.7
Curiosity
27.5
To seek euphoria or sensory satisfaction
23.2
Relief of boredom/depression/anxiety
21.4
For self-medication
4.3
Under influence of the partner
1.4
Other reasons
2.5
(Central Registry of Drug Abuse)
[Can you think of some other important reasons?]
What is drug?
Definition. A drug is a chemical, other than food, used in the diagnosis,
prevention or treatment of diseases. This is a comprehensive description of
a drug. (For most people, drugs are medicines that can cure or arrest,
relieve symptoms, ease pain, and provide other medical benefits. Defined in
this way, the term ‘drugs’ include essential vitamins and minerals that may
be given to correct deficiency diseases.) The other parts of the definition are
to broaden students’ understanding of a drug.
[Can you tell the differences between a food and a drug?]
Drugs can be very simple and common compounds. For example, glucose
and sodium chloride can be used as drugs.
1. Diagnosis
(a) Glucose is used to diagnose diabetes. How? Patients are asked to
drink a cup of glucose solution then the amount of glucose in the
blood or urine will be determined after a certain period of time. If a
large amount of glucose is found in the blood or urine, the patient is
likely to be suffering from diabetes.
(b) Sodium chloride, with or without other salts, the solution is
administered to patients who lost a lot Student
of water Notes
(dehydration)
e.g.,
in
for Drug
Abuse
cases of diarrhea (di-ar-rhea) as a salt replacement.
2. Prevention
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An example that drugs used in the prevention of diseases is vaccination,
(e.g., BCG for tuberculosis). This part shall be discussed in the ”Treatment
& Disease” block.
3. Treatment
Aspirin and Panadol are common painkillers and antipyretics. Antibiotics
are effective drugs used to treat bacterial infections. This part shall be
discussed in the ”Treatment & Disease” block.
Concept map on types of drugs
Drugs
Medicinal
Abused
[Please see “Treatment
& Disease” for detail.]
Socially accepted
e.g. caffeine, alcohol,
nicotine (cigarette smoking)
Stimulants
e.g. cocaine, amphetamines,
caffeine, nicotine
Opiates
e.g. opium, morphine, heroin,
methadone
Hallucinogens
e.g. marijuana, LSD
Depressants
e.g. alcohol, barbiturates, sleeping pills,
ketamine
Side effects of drugs
In addition to their therapeutic effects, most drugs have one or more
undesirable effects, and they are:
1. Adverse effects of drugs
They are effects other than the aimed therapeutic effects:
Examples:
a. Aspirin is acidic and too much may cause stomach discomfort and
bleeding (ulcer)
b. Too much Panadol (more than 2 g per
day) may
result
liver Abuse
Student
Notes
forinDrug
damage.
c. Taking antibiotics indiscriminately may cause bacteria to become
resistant to antibiotics. (See “Treatment & Diseases for detail.)
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2. Overdosage toxicity
Examples:
Taking too much Panadol may cause damages to the liver. Another
example is too many sleeping pills may cause death because extremely
high doses may suppress brain functions and respiration.
3. Allergic reactions
Most drugs are “foreigners” and our body’s immune system may produce
antibodies to attack them, and one the most common reactions is the
appearance of rash over our body.
Examples:
Some people are allergic to penicillin. Why do some people develop an
allergic reaction after taking a drug while others don’t? It is likely that
some people are just more sensitive than others.
4. Tolerance
This is a situation developed where patients take a larger dose of a drug in
order to achieve the therapeutic effect. Why? It is likely people become
adapted to the dosage or effect of the drug. For example, after prolonged
(chronic) use of aspirin, some people may have to take a larger dosage in
order to have a painkilling (analgesic) effect.
5. Addiction
It is the misuse or harmful use of a drug especially for non-therapeutic
purposes. Certain drugs are often or generally misused because they alter
mood or behavior. Thus, an understanding of their properties is important
to an understanding of their abuse.
However, drug abuse does not depend entirely on the pharmacological
properties of a drug as NOT everyone uses the same drug to the same
extent. There are two major reasons for drug abuse: “habituation” and
“addiction”.
a. Habituation is mainly due to psychological dependence. Alcohol,
the most commonly misused drug, is abused because it is freely
available in our society. To some, it relieves anxiety and facilitates
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Student Notes for Drug Abuse
participation in social situations. Because of these and other
reasons, some people believe that alcohol abuse is mainly a “bad”
habit. However, prolonged use may lead to addiction and the
situation is – “alcoholism”.
b. Addiction develops because of tolerance and psychologic as well
as physical dependence.
Definition of Addiction: “Addiction” is a disease process characterized
by the continued use of a specific drug (particularly a psychotropic
substance) despite physical, psychological or social harm.
References:
http://mentalhealth.about.com/library/sci/0201/blgenedrug201.htmhttp://hom
eworktips.about.com/library/blantidrug.htm
http://www.addictionscience.net/ASNprimer.htm
Sequence leading to addiction
1. Experimental use. Most drug abuse begins with experimental or
exploratory use. After which the person may either reject the use of the
drug or progress to one of the patterns of use given below.
2.
Social use. Some drugs tend to be used with a group of “friends”.
Social users do so because individuals form attitudes and react as
members of the group. The attitudes and problems of their group will
condition their use of drugs and their reaction toward people who
choose to use drugs. One common example is alcohol. The danger of
social use of drugs is that it increases the chance of those individuals
who are vulnerable to a more serious and destructive pattern of misuse.
3.
Episodic abuse. This is a pattern where an excess amount of drugs is
used, either when the individual is with his/her friends or even alone.
The major difference between experimental use and social use is that
the amount of drug used is much larger.
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Student Notes for Drug Abuse
4.
Tolerance.
A person needs to increase the dosage of a medication
over time in order to receive the same therapeutic benefits. [Studies
show that the majority of people with anxiety disorders do not increase
their benzodiazepines (a kind of anti-anxiety/sleeping pill) dosages over
time; in fact, most lower their dosages. However, in drug abuse,
tolerance often develops. The point to be stressed that ‘proper medical’
use does not cause addiction.]
5.
Addiction. The major difference between this type of abuser and those
of above is that addicts (compulsive abusers) have difficulty giving up
their habits when given maximal assistance. Example: some smokers
cannot perform their jobs properly with a cigarette in hand. Also,
alcoholics don’t eat at all without alcohol.
Misconception of ‘hard’ and ‘soft’ drugs
1. These terms – ‘hard’ and ‘soft’ do not reflect their textures or forms.
2.
3.
4.
Drugs that are subject abuse were divided into ‘hard’ and ‘soft’. It was
believed that soft drugs were not or less harmful and addictive drugs.
These sayings are now considered to be wrong and unfound.
Those ‘soft’ drugs are so called possibly because some of them are
prescription drugs e.g., diazepam (a sleeping pill), so, the false belief
arose that they were less harmful. [Note that long-term use of a drug in
large quantity can lead to addiction.] Also, the penalties for possessing
‘soft’ drugs are less harsh than those of ‘hard’ drugs, e.g., morphine or
heroin.
Besides being classified as ‘hard’ and ‘soft’, drugs are often categorized
into ‘socially acceptable’ and ‘socially unacceptable’, ‘legal’ and ‘illegal’,
‘pharmaceutical’ and ‘recreational’. Depending on their use, some drugs
may fall into a number of categories.
What are club/party drugs?
Besides the unscientific classification of drugs into ‘hard’ and ‘soft’, some
drugs are called club/rave drugs. They are relatively trendy terms. They are
drugs mainly used in parties, bars and entertainment places.
What are they?
Most of them are mind-altering drugs.
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Student Notes for Drug Abuse
Why are they abused?
These people believe that they can produce ‘high’ feelings. Because most of
the people attending these events/functions are teens and young adults, and
they are the group of people who are likely to seek something ‘new’ and
excitement - ‘high feeling’. Also, these drugs are usually in pill or powder
forms so they can be easily carried to these places and that they dissolve in
drinks readily.
Examples:
GHB, Valium (a sleeping pill), and ketamine are predominantly central
nervous system depressants. In low doses, they can suppress shyness. Ice,
ecstasy and cocaine are stimulants, and people become more talkative after
taking these drugs.
Some characteristics of those drugs:
 Colorless
 Tasteless
 Odorless
 Can add to beverages and ingested unknowingly
Some of them are called “date rape drugs” because they have the above
characteristics.
How are psychoactive substances taken?
The main purpose is that by knowing the routes/ways of abuse one can tell
whether some one is a drug abuser.
1.
Like most drugs, psychoactive substances are taken orally.
Examples: amphetamines, sleeping pills, cough syrups, etc.
2.
Morphine, heroin and other clinically used psychotropic substances are
usually taken by injection. This route of administration gives a very
quick response to the drug(s) administered. However, this route is also
the most dangerous one as it readily causes overdose toxicity or even
death. Why? This is because most of the street-drugs (a) contain
impurities; and (b) package dosages vary with sources, illegal supply
and price. Moreover, it is also the major cause of AIDS and hepatitis (a
serious inflammation of the liver) as well as other dangerous infectious
diseases.
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3.
Inhaling or sniffing is used for taking marijuana, cocaine, nicotine
(smoking), paint thinner, model glue etc. This is also elicits fast
responses, as soon as substances are inhaled, they enter the blood
stream through the lungs then travel to the brain. This route of taking
drugs may cause damage to the nose, respiratory tract and lungs.
4.
Substances that are fat-soluble, e.g. paint thinner can be absorbed
through skin contact. The amount absorbed through this route is very
small and the response generated is very mild. This route is rarely
used.
5.
Regardless of the routes of administration/taken, these substances
finally enter the brain to exert their mind-altering affects. This is the
reason why an understanding of structure and function of the brain is
essential.
The central nervous system
The figure below describes the structure and function of the central nervous
system (CNS). The CNS is composed of the brain and the spinal cord. The
point to be remembered is that the brain or the central nervous system is the
most important organ in our body that controls our behavior.
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Student Notes for Drug Abuse
Function of the brain
Some of the major functions of the nervous system are:
1. Organize and direct behaviour – speech, reflex, etc
2. Minot the outside world – with our eye, ears, nose, etc.
3. Learning and memory – improve our quality of life, survival, etc
4. Thinking – generates ideas, develops personality, etc.
The major point to be remembered is that “different areas of the brain
perform different functions”.
The concept that different brain areas perform different function is important
for you to understand why certain psychoactive substances have multiple
effects on behavior. The answer is that these substances can affect one or
more neurotransmitter system(s) in different areas of the brain.
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Student Notes for Drug Abuse
Functions of Neurons
This part introduces the basic concept of (chemical) neurotransmission, i.e.,
how are signals from one neuron passed to another by using chemicals
known as neurotransmitters. The reason for including this is to inform
students that psychoactive substances affect neurotransmission to achieve
behavioral changes.
Neuron is one of the major cell types in the nervous system. The other is
glial cell. Glial cells may be considered as supporting cells in the nervous
system as they do not participate directly in neurotransmission.
Unlike liver cells and red blood cells, neurons have many shapes.
[Please consult a senior form biology textbook for diagrams and details.]
Their function is to transmit signals. They do so by using different
neurotransmitters. Neurotransmitters are chemical ‘mail carriers.’ At present,
there are at least 50 neurotransmitters known.
Structures of a neuron
The figure below is a schematic drawing of a neuron.
Schematic drawing of a neuron
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Student Notes for Drug Abuse
The major points to be noted are:
1.
2.
3.
At one end (left-hand side), the cell body where the nucleus is, the
nerve cell (neuron) serves as an antenna. It receives signals from
adjacent neurons. At the terminal (right-hand side), the signal is relayed
to the other adjacent nerve cell. The axon is just a cable where signals
pass from one end (cell body) to the other (the nerve terminal).
The two adjacent neurons are NOT in direct contact with one another.
This leads to the question of how signals pass from one neuron to
another or neurotransmission.
The process involved is known as ‘chemical neurotransmission’. Briefly,
signals pass from one neuron to another by causing neurotransmitter
4.
5.
release at the nerve terminal, the neurotransmitter released at the
synaptic cleft binds to specific receptors situated on the plasma
membrane of the postsynaptic cell. Repeating the above processes
would enable signals to pass to another neuron.
At present, there are more than 50 neurotransmitters known. For
simplicity, you may equate ‘neurotransmission’ to the ‘mail delivery
system’, and ‘neurotransmitters’ to ‘letters’ delivered to different
addresses written on the envelope. As the contents in the letters are
different, the messages delivered are also different.
If this mail delivery system goes astray, the situation will become
chaotic. Mind-altering drugs affect brain functions by interfering the mail
delivery system – neurotransmission, in the brain.
Psychotropic drugs
What are psychotropic drugs?
Psychotropic drugs are substances that possess the ability to alter mood,
anxiety, behavior, cognitive processes or mental tension.
Commonly abused mind-altering drugs may be arbitrarily and broadly
divided into three groups:
1. Therapeutic drugs, i.e., drugs with clinical applications (e.g.
benzodiazepines, ketamine, morphine, etc)
2. Socially accepted drugs/chemicals (e.g. alcohol and tobacco)
3. Drugs of abuse, i.e. drugs with little or no clinical applications (e.g.
heroin, amphetamines, cocaine, LSD and marijuana).
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Student Notes for Drug Abuse
In this block, these drugs are classified in a more scientific way into five
categories, according to their clinical applications, actions and effects.
1.
2.
3.
4.
5.
Narcotic analgesics
Depressants
Stimulants
Hallucinogens
Antipsychotics
Some examples and how they affect the central nervous system are
described later in this block.
Commonly abused drugs of all people in Hong Kong
The most commonly abused drug in Hong Kong is still heroin. It had been so
for many years. This may be related to the history that opium was the first
mood-altering drug used in HK in the Ching Dynasty. At present, most of the
heroin abusers are older than 21, and the number of heroin abusers are
decreasing compared to a few years ago. One of the reasons may be due to
the effectiveness of the Government’s anti-drug campaign and rehabilitation
programmes.
On the other hand, psychotropic drug abuse is becoming more popular.
Psychotropic substance abuse has been on the rising trend in North America
and Europe in recent years, and perhaps HK people are just following.
Amongst the drugs, ketamine, ice, sleeping pills and ecstasy are some
‘popular’ drugs.
Commonly Abused Drugs by Persons of All Ages in HK (2001)
Drugs
Percent*
71.8
Heroin (海洛英)
15.7
Ketamine (氯胺酮)
14.5
Ecstasy (忘我)
6.3
Cannabis (大麻)
5.4
Ice (冰)
*Total > 100% as some abusers use more than one type of drug
Source: Central Registry of Drug Abuse 48 th Report (2001), Narcotics Division,
HKSAR
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Student Notes for Drug Abuse
Commonly abused drugs by person under 21 in Hong Kong
Abuse of psychotropic drugs in HK is getting more popular in persons under
21. The reason is not very clear. One possible reason may be due to
American and European influence. Another possible reason might be due to
the misconception that they are ‘soft’ drugs and this creates the false belief
that they are less harmful.
In HK, the most ‘popular’ drugs are ecstasy and ketamine. These and other
psychotropic drugs are easily available in the black market or certain
entertainment places.
Commonly Abused Drugs by Persons Under 21 in HK (2001)
Drugs
Percent*
56.6
Ecstasy (忘我)
56.4
Ketamine (氯胺酮)
14.3
Cannabis (Marijuana, 大麻)
14.2
Heroin (海洛英)
10.6
Ice (冰)
*Total > 100% as some abusers use more than one type of drug
Source: Central Registry of Drug Abuse 48 th Report (2001), Narcotics Division,
HKSAR
Sources of drugs in Hong Kong
As drugs are neither planted nor manufactured in HK, all illicit drugs
(chemicals) seized locally are smuggled into HK.
Smuggling by land is the means by which most heroin and ice reach HK.
Heroin, which is produced in the Golden Triangles, is infiltrated into the
Mainland via its land borders, stored in Guangdong Province then shipped to
HK. Ice is similarly conveyed to HK across the land border.
Bulky drugs, e.g., cannabis, are smuggled by maritime routes.
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Student Notes for Drug Abuse
Sources of Drugs in Hong Kong






Heroin: Golden Triangle  Mainland China* HK
MDMA (Ecstasy): Europe  HK
Methylamphetamine (Ice): Mainland China*  HK
Cannabis (Marijuana): Golden Triangle & Cambodia  Mainland
China* HK
Cocaine: South America  HK
Benzodiazepines (sleeping pills) & ketamine: Local dispensary
operators, medicine brokers & unscrupulous medical
practitioners*Mainly through Guangdong Province
End of Period 1
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Student Notes for Drug Abuse
PERIOD TWO
Narcotics analgesics (Opiates)
Definition: Opiates are compound that have clinical properties similar to
morphine, i.e., they have analgesic effects.
There are four major forms of opiates:
1. Heroin
2. Morphine
3. Opium
4. Codeine (found in cough syrups)



Heroin is processed from morphine, a naturally occurring substance
extracted from the seedpod of the poppy plant Papaver somniferum
(this Latin name means “the poppy that makes you sleep”.
Among them, heroin (diacetylmorphine) is the most potent and highly
addictive opiate, and is the major abused substance in HK. The
presence of the two acetyl groups make heroin more fat-soluble and
thus enters the brain more readily.
In the manufacturing of heroin, acetic anhydride is required to convert
morphine to heroin (diacetylmorphine). This explains why possession of
acetic anhydride is unlawful.
Street/Other namesHeroin is typically sold in the black market as a white or
brownish powder. Street names for heroin include ‘smack’, ‘H’, ‘skag,’ and
‘junk’, •白粉, 粉, 灰,四仔, 港紙 (純度約 15-65%), 美金 (純度約 7090%)
Codeine : MB, 高甸, 止咳水, 囉囉攣
Methadone: 美沙酮, 蜜瓜汁
Most street heroin is “cut” (diluted) with other drugs or with substances such
as sugar, starch, powdered milk, acetaminophen ( 必 理 痛 ) or quinine.
Because heroin abusers do not know the actual strength of the drug or its
true contents, they are at risk of overdose or death.
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Student Notes for Drug Abuse
Clinical uses of Opiates
Opiates and their synthetic counterparts (commonly called synthetic opiates)
are used in modern medicine to relieve acute pain suffered as a result of
disease, surgery, or injury; in the treatment of some forms of acute heart
failure; and in the control of moderate to severe coughs (codeine) or
diarrhea. Among them, morphine is commonly used for relief of severe pain
in the care of the terminally ill.
How is it abused?
1. Heroin is usually injected, sniffed/snorted or smoked.
2. Intravenous injection provides the greatest intensity and most rapid
3.
4.
5.
6.
euphoria. This is because it enters the brain most rapidly and
completely.
Intramuscular injection produces a slower onset of euphoria and that of
sniffing and smoking is slower.
Like other street psychoactive substances, purities and concentrations
of heroin from different black market sources create dangerous
problems that can be fatal.
Opium appears either as dark brown chunks or in powder form, and is
generally eaten or smoked.
Researchers have confirmed that all forms of opiate when used
regularly and in large doses are addictive.
Short-term effects
1. After an injection of heroin, the user reports feeling a surge of euphoria
("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy
extremities. Following this initial euphoria, the user goes into an alternately
wakeful and drowsy state.
2. Mental functioning becomes clouded due to the depression of the central
nervous system. Morphine and other opiates have depressive effects on
respiration. At high doses of opiates, respiration may become so slow or
irregular as to be life threatening and result in death. Pupil constriction and
constipation are some common symptoms of opiate abuse.
3. Heroin addicts are at very high risk for contracting AIDS, hepatitis and
other infectious diseases. This is because heroin addicts may share or reuse
injection needles and syringes with infected individuals.
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Student Notes for Drug Abuse
4. In addition to the effects of the drug itself, street heroin may have
additives that do not readily dissolve and result in clogging the blood vessels
that lead to the lungs, liver, kidneys, or brain. This can cause infection or
even death of small patches of cells in vital organs.
Long-term effects
1. Long-term effects of heroin appear after repeated use for some period of
time. Chronic users may develop collapsed veins, infection of the heart lining
and valves, abscesses, cellulitis (inflammation of connective tissues), and
liver disease.
2. Pulmonary complications, including various types of pneumonia, may
result from the poor health condition of the abuser, as well as from heroin's
depressing effects on respiration.
3. With regular heroin use, tolerance develops. This means the abuser must
use larger doses of heroin to achieve the same intensity or effect. As higher
doses are used over time, physical dependence and addiction develop. With
physical dependence, the body has adapted to the presence of the drug and
withdrawal symptoms may occur if use is reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few hours
after the last administration, produces drug craving, restlessness, muscle
and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose
bumps ("cold turkey"), kicking movements ("kicking the habit"), and other
symptoms. Sudden withdrawal by heavily dependent users who are in poor
health is occasionally fatal.
Effects on pregnancy
Heroin abuse can cause serious complications during pregnancy, including
miscarriage and premature delivery. Children born to addicted mother are at
greater risk of suffering from ‘sudden infant death syndrome.
Treatment:
There is a broad range of treatment options for heroin addiction, including
medication as well as behavioral therapies.
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Student Notes for Drug Abuse
Methadone, a synthetic opiate medication that blocks the withdrawal effects
of heroin for about 24 hours, has a proven record of success when
prescribed at a high enough dosage level for people addicted to heroin.
References:
http://www.nida.nih.gov/ResearchReports/Heroin/Heroin.html
http://www.nlm.nih.gov/medlineplus/heroinabuse.html
Depressants/Sedative hypnotic compounds
These substances can depress central nervous system (CNS) neuronal
activities and are capable of inducing sedation, sleep (hypnosis) and
behavioral alterations, so they are known as ‘depressants’ or ‘sedative
hypnotic’ compounds.
Some of them are prescribed to treat insomnia (sleeping pills), anxiety
(benzodiazepines) and epilepsy (barbiturates) [For simplicity, these drugs
are grouped under “depressants” in this block.]
What are CNS Depressants?
Depressants are chemicals (or drugs) that can slow down normal brain
function. Clinically, some depressants are useful drugs in the treatment of
anxiety and sleep disorders.
Depressants to be discussed include alcohol, Inhalants (organic solvents &
cigarette lighter fluid), gamma hydroxybutyrate (GHB), ketamine and Valium.
The last three are used clinically.
In this block, psychoactive substances belonging to this class are simply
called (CNS) depressants. Alcohol and inhalants are general depressants as
they slow all nerve activities in our body, while others exert their actions
mainly in the brain, therefore known as CNS depressants.
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Student Notes for Drug Abuse
A. Ethyl alcohol
Ethyl alcohol is a nonselective CNS depressant because it affects all parts of
the CNS. Alcohol and cigarette are the most commonly abused chemicals.
Frequently Asked Questions
A. Does food slow alcohol absorption?
Yes. Food in the stomach slows alcohol absorption for two reasons:
1. By diluting the alcohol and covering some of stomach membranes
through which alcohol would be absorbed.
2. By prolonging the emptying time. Thus, blood levels of alcohol
will increase much faster in an individual who has fasted than in
someone who has just eaten a heavy meal. However, in either
case, the alcohol will be completely absorbed; it is only that the
absorption is delayed in the well-fed individual.
B. What is ‘wood alcohol’? Why is it toxic?
Methyl alcohol (wood alcohol; sometimes found as an adulterant in
illegal liquors) is toxic. The lethal dose is 2-8 oz (~60-220 ml).
1. Methyl alcohol enters the brain more rapidly than ethyl alcohol.
Upon metabolism (in the liver), it is converted to formic acid and
2.
3.
4.
5.
formaldehyde.
Formic acid causes acidosis (decrease in body pH and this can be
fatal).
The optic nerve (the nerve that connects the eye to the brain) is
most sensitive to acidosis and this may result in blindness,
[Blindness or impaired vision may be permanent.]
Other effects include: headache, dizziness and nausea.
One treatment for methyl alcohol toxicity is to give ethyl alcohol.
The rationale is that both methyl and ethyl alcohol use the same
set of metabolic enzymes, thus taking ethyl alcohol would reduce
the formation of formic acid and formaldehyde.
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Student Notes for Drug Abuse
Relationship between blood alcohol concentrations & pharmacological
effects
The table below provides an idea that the severity of alcohol intoxication
increases with the amount of alcohol ingested.
Blood alcohol
(mg/100mL)
50
60
80
100-150
200-300
300-350
355-600
Effects
Euphoria and minor motor disturbances
Nystagmus and increase errors on simple teat
Impaired driving ability and brain wave changes
Gross motor incoordination
Amnesia for experience
Coma
May cause death
Blood alcohol concentrations (BACs) and driving:
Blood alcohol concentration (BAC) is the amount of alcohol in the
bloodstream. It is measured in percentages. For example, having a BAC of
0.10 percent means that a person has 1 part alcohol per 1,000 parts blood in
the body.
The drink driving legislation was first introduced in Hong Kong in December
1995. The prescribed legal limit of BAC was 0.08% (80 mg of alcohol per
100 ml of blood). In response to the community's concern over drink driving
and having reviewed the effectiveness of the legislation, the HKSAR
tightened the legal limit of BAC in October 1999 from 80 to 50 mg of alcohol
per 100 ml of blood (i.e. 0.05 percent), same as in places like Germany,
Australia and Japan.
Major reasons for lowering the legal limit of BAC are based on studies of
alcohol-related traffic accidents, reaction time, tracking ability, concentrated
attention ability, divided attention performance, information process
capability, visual functions, perceptions, and psychomotor performance.
Impairment in all these areas was significant at blood concentrations of 0.05
percent. These studies found that impairment first appeared in many of
these important areas of performance at BAC of 0.02 percent, substantially
below the legal limit in the HKSAR. Note that deterioration in driving skills
progresses rapidly with rising BAC.
Student Notes for Drug Abuse
Effects on alcohol
93
Depending on the amounts ingested, alcohol can cause various effects.
1. Psychomotor performance (see information listed above).
2. Malnutrition. Chronic use and in large amount, alcohol replaces a
part or most of the normal diet. The calories derived from alcohol are
unaccompanied by vitamins and protein and this results in
malnutrition.
3. Chronic use causes degenerative changes in the nervous system
that is characterized by poor memory in recent events.
4. Chronic use and large consumption causes permanent liver damage.
For example, fatty liver because alcohol ingested is converted to fat
which deposits in the liver. The fatty changes are reversible, but they
may lead to hepatitis and liver cirrhosis.
B. Inhalants
What are inhalants?
Inhalants are volatile substances that producing chemical vapors that can be
inhaled to induce psychoactive, or mind-altering, effects. [Although other
abused substances can be inhaled, the term "inhalants" is used to describe
a variety of substances whose main common characteristic is that they are
rarely, if ever, taken by any route other than inhalation.]
Inhalant abuse refers to the intentional breathing of gas or vapors with the
purpose of reaching a high feeling.
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Student Notes for Drug Abuse
Because there are a large number of chemicals that can produce vapors at
room temperature, a precise categorization of inhalants is difficult. One
classification system lists four general categories of:
1.
2.
3.
4.
Volatile solvents (see below for details)
Aerosol, e.g., spray paints, deodorant and hair sprays
Gases, e.g., medical anesthetics (ether, chloroform, halothane, and
nitrous oxide, commonly called "laughing gas.")
Nitrites-based on the form in which they are often found in
household, industrial, and medical products.
[Nearly all inhalants are highly inflammable substances and misuses can
easily cause fire hazard. Abuse of aerosols, gases and nitrites-based
inhalants are rather uncommon in HK, and their abuses will not be further
discussed.]
Volatile solvents
 Volatile solvents are liquids that vaporize at room temperatures.
 They are found in a multitude of easily available products used for
common household and industrial purposes.
 These include:
1
2
3
4
5
6
7
8
Paint thinners and removers,
Dry-cleaning fluids,
Degreasers,
Gasoline,
Glues,
Correction fluids,
Felt-tip marker fluids, and
Cigarette lighter fuel.
How are inhalants used?
Inhalants are usually taken by sniffing.
Short-term effects
At low doses, inhalants produce disinhibition (high feeling, euphoria etc.) at
early stage. The reason is that low concentrations of inhalants inhibit the
inhibitory neurons in the nervous system.
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Student Notes for Drug Abuse
At high doses, they depress most neuronal activities, vital organ functions
and in severe cases, death. In most cases, respiration is slowed.
Long-term effects
Inhalant abuse has been shown to cause liver, kidney and brain damage
and these harmful effects can also occur in the fetus. They cause these
long-term effects, as inhalants are fat-soluble substances so they can stay in
the body for a relatively long time.
Effects on pregnancy
Similar to other substances of abuse, inhalants also affect the developing
fetus because they dissolve and accumulate in fatty tissues.
Moreover, a "fetal solvent syndrome" can occur has been suggested.
Because of their potential serious effects, pregnant women should avoid
exposure to solvents.
Treatment
The general treatment of withdrawal from solvents is similar to that for
alcohol - calm reassurance in an area of low-level sensory stimuli, and drug
treatment is not usually required.
Detoxification from solvents, however, takes much longer than from alcohol:
short term detoxification requiring from 2 weeks to 30 days. This is because
they are rather fat-soluble and can accumulate in fatty tissues.
For details, see: http://corp.aadac.com/drugs/beyond/Solvents.asp
C. Ketamine
What is ketamine?
Ketamine is a depressant and an anaesthetic, which has hallucinogenic
action.
Ketamine abuse grew through the 1980s and 1990s, and recently ketamine,
together with GHB (gamma hydroxybutyrate) and Valium (a kind of sleeping
pill), are ‘popular 'date rape’ drugs in the US. In Hong Kong, it is one of the
popular 'club drugs'.
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Student Notes for Drug Abuse
Street/Other namesSlang terms of ketamine include, ‘K’, ‘Special K’,
‘Ketaset’, ‘Ketalar’, ‘Vitamin K’, ‘Lady K’, ‘Super K’, ‘OK’, ‘KO’,
‘Ket Kat’,‘Make-Her-Mine’, 氯胺酮/K 仔 etc.
‘Kid Rock’,
Appearance
In undiluted form it looks like an off-white powder, in diluted form it looks like
slightly cloudy water.
Clinical usesKetamine is an anaesthetic used primarily in surgery.
How is it used?Although it is manufactured as an injectable liquid, in illicit
use ketamine is generally evaporated to form a powder that is snorted or
compressed into pills.
Ketamine is used recreationally primarily as a snorted white powder and for
therapeutic and psychedelic use it is often injected intra-muscularly.
Ketamine is odorless and tasteless, so it can be added to beverages without
being detected, and it induces amnesia (loss of short-term memory).
Because of these properties, the drug is sometimes given to unsuspecting
victims and used in the commission of sexual assaults referred to as "drug
rape."
Short-term effects
The most common effects include:
 Hallucinations
 Confusion
 Euphoria
 Increased sociability
 Clumsy, or 'robotic' movement (which lead to delayed reaction time,
irrationality, violent or aggressive behavior).
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Student Notes for Drug Abuse
Negative physical effects can include:




Dry mouth
Depressed respiration
Racing heart.
Nausea and/or vomiting (a common problem when taking an
anesthetics or sedatives).
With larger doses, it can lead to oxygen starvation of the brain and muscles.
An overdose can also cause the heart to stop and death.
Long-term effectsKetamine has the potential to be both physically and
psychologically addicting. Individuals who use it regularly may find it difficult
to stop.
Effects on pregnancy
In humans, safety in pregnancy and lactation has not been established.
However, studies with rats showed that ketamine, PCP (phencyclidine,
another dissociative anesthetics having similar effects as ketamine), and
alcohol trigger widespread cell death in the brains of developing rats.
(For details see:
http://www.drugabuse.gov/NIDA_Notes/NNVol15N2/Ketamine.html)
Treatment
Little is known conclusively about the treatment of ketamine abuse and
counseling appears to be a useful approach.
References:
http://www.nbcd.gov.tw/prop/prop_1-11.asp (Chinese)
http://www.greencross.org.tw/drugabuse/ketamine.htm (Chinese)
http://www.erowid.org/chemicals/ketamine/ketamine.shtml
End of Period 2
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Student Notes for Drug Abuse
PERIOD THREE
D. Benzodiazepines (Sleeping pills)
The term ‘benzodiazepines’ or ‘sleeping pills’ shall be used, instead of other
clinical terms, to describe different drugs belong to this group.
What are benzodiazepines?
Benzodiazepines are CNS depressants or sedative hypnotic compounds
and they are the most common minor tranquilizers and sleeping pills.
Commonly abused/prescribed benzodiazepines include:
 Valium [安定; 羅氏五號; 羅氏十號]

Librium [利眠寧; 綠豆仔]
In the following discussion, Valium is used as an example to illustrate the
actions and effects of benzodiazepines.
In Hong Kong, unscrupulous medical practitioners, drug store operators and
medicine brokers supply most of the benzodiazepines and related drugs in
the black market.
Street/Other names
 In Hong Kong’s black market, there are about 100 different types of
benzodiazepines and related pills that come in different forms and
colours.
 Slang terms for this group include Roach, Roofies, Run-Trip-and-Fall,
R-2, Mexican Valium, Rohypnol, Rib, and Rope.
[Surf the web to download their pictures.]
Clinical uses
Benzodiazepines are used as sedatives and anti-anxiety agents and taken
orally.
How is it abused?
Most of the drugs in this group are colorless, odorless and flavorless; they
can be slipped into drinks unnoticed. This is one reason why these drugs are
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Student Notes for Drug Abuse
so dangerous. People may consume it without knowing it. It dissolves
quickly and takes effect in 20-30 minutes.
Short-term effects
At low doses (doses prescribed by a doctor), Valium acts as a sedative and
reduce psychomotor responses, anxiety; reduce respiration, reduce blood
pressure, reduce heart rate and induce sleep.
At high doses, Valium can actually increase some types of behavior and act
like a stimulant. These effects are caused by depression of inhibitory brain
circuits. In other words, they can produce amnesia (memory loss) and
muscle relaxation and make people lower their inhibitions. [An inhibition is
when you feel like you can't do something. When inhibitions are lowered,
people feel as if an obstacle has been removed. Therefore, they can talk
more freely and feel less shy.]
Overdoses of Valium can lead to excessive sedation and cause anesthesia,
coma and even death. Overdoses may occur because the effective dose of
these drugs is not too far away from the lethal dose.
Long-term effects:
Long-term uses of large doses of Valium and related drugs can lead to
addiction. This is because both may lead to tolerance and dependence.
What are ’tolerance’ and ‘ dependence’?
Tolerance occurs when a greater and greater amount of the drug is required
to get the desired effect. For example, if a large dose of Valium is used to
help a person sleep, over time, a greater dose of the drug will be needed to
get the person to sleep.
Dependence occurs when a person feels like he or she must use the drug
and withdrawal symptoms occur when the person stops using the drug.
Withdrawal symptoms of Valium addiction:
 Headache
 Muscle pain
 Confusion
 Hallucinations
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Student Notes for Drug Abuse

Convulsions
Valium, when taken along with other drugs (in particular heroin) or alcohol,
are a common cause of overdose toxicity and overdose related deaths.
Effects of pregnancy
Long-term use of Valium in large dose is addictive to both the mother and
the baby. The baby is less able to cope with this type of drug than the
mother. It is recommended that the use of Valium and related drugs be
avoided during pregnancy, as they can be harmful if taken continuously or in
high doses.
Valium can produce withdrawal symptoms in newborn babies.
Withdrawal symptoms of newborn babies include:
 Breathing problems
 Poor body temperature control
 Poor muscle tone
 Difficult sucking
The babies can appear floppy or limp and this poor muscle tone can last for
a number of months, although the babies do eventually recover.
Treatment
There is no effective medical treatment for abuse of Valium and related
drugs, and the most effective treatment is counseling.
References:
http://faculty.washington.edu/chudler/barb.html
http://faculty.washington.edu/chudler/roof.html
http://www.hon.ch/Dossier/MotherChild/preg_drugs/benzodiazepines.html
http://womenshealth.about.com/library/bldaterapedrugfaq.htm?terms=Treat
ment+Rohypnol
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Student Notes for Drug Abuse
E. GHB
What is GHB?
Gamma-hydroxybutyrate (GHB) [G 水、迷暈水] is both a metabolite and
precursor of the nhibitory neurotransmitter GABA (gamma-aminobutyric acid,
or gamma-aminobutyrate). It is a naturally occurring component of human
cells. GHB is a constituent of some wine, and it has been speculated that
GHB may be responsible for the soporific (a substance causing sleep)
effects of wine.
Street/Other names
GHB, G, Liquid X, Liquid E, GBH, Gamma-oh, Blue Verve G 水、迷暈水, etc
It is called a “date rape drug” because it is believed to improve sex
performance, but this is arguable.
Clinical uses
GHB was developed in the early 60s as a human anaesthetic, but was
discontinued due to unwanted side effects.
During the 1980s, GHB was widely available over-the-counter in health-food
stores, purchased largely by body-builders for its ability to stimulate growth
hormone release which aids in fat reduction and muscle building. [It may
cause a "protein sparing" effect which reduces the rate at which the body
breaks down its own proteins.]
One of the major concerns with GHB is that the recreational dosage range is
narrow and even small overdoses can cause temporary unconsciousness
and large overdoses (poisonings) can be life threatening.
GHB was banned from over-the-counter sale by the Food and Drug
Administration, USA in 1990, and it is illegal to possess this drug in Hong
Kong.
How is it abused?
GHB commonly comes as a colorless, odorless, bitter or salty-tasting liquid
usually sold in the black market in small bottles or vials. It also comes as a
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Student Notes for Drug Abuse
crystal powder. It is mostly taken orally, however, there have been reports of
people injecting the drug.
Short-term effects
Effects of small doses may include:
 Sense of well-being and relaxation
 Increased confidence and sociability
 Enhanced sense of touch
 Drowsiness, induced sleep, nausea, dizziness, and headache
An increase in the amount or strength of GHB used, may result in the initial
feelings of euphoria being replaced by effects including:
 Impaired movement and speech
 Extreme drowsiness
 Hallucinations
 Disorientation
 Difficulties in respiration
 Amnesia
Whatever side effects may be noted, they are often much more severe when
GHB is combined with other central nervous system depressants such as
alcohol or central nervous system depressants, such as ketamine, heroin
and benzodiazepines (sleeping pills), as these drugs help to further
suppress respiration.
Adding alcohol on top of GHB will highly and rapidly increase the possibility
of respiratory collapse, coma and possibly death.
The effects of GHB can generally be felt within five to twenty minutes after
ingestion. Determining the ideal dose is probably the trickiest aspect of
abusing GHB. The amount required for a given level of effect will vary from
person to person, and the dose-response curve is fairly steep.
Because GHB generally comes in liquid form and thus the concentration is
difficult to determine, thus, there is a real danger of overdose toxicity.
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Student Notes for Drug Abuse
Long-term effects
There has been little research conducted on the effects of long-term use of
GHB. Apart from the potential to develop physical and psychological
dependence, the health and social consequences of long-term use are
largely unknown.
Withdrawal symptoms include a strong desire to take GHB or other
psychotropic substances, difficulty sleeping, vertigo, and worrisome chest
pains.
Effects on pregnancy
Like other abused drugs, GHB use during pregnancy is not recommended.
Drug use during pregnancy can increase the incidence of premature labour,
resulting in low birth weight babies. If the mother continues to use GHB while
breastfeeding, it is possible that the drug will be present in the mother's milk
and possibly cause adverse affects to the baby.
Treatment
There is no effective medical treatment for GHB abuse and counseling is the
method of choice.
References:
http://www.adf.org.au/drughit/facts/ghb.html
http://www.ceida.net.au/tools_for_workers/drugs/ghb.htm
http://www.emedicine.com/emerg/topic848.htm
Stimulants
What are stimulants?
CNS stimulants are chemicals that can increase the activities of the brain
Types of stimulants
In here, stimulants are divided into two types: socially accepted (caffeine and
nicotine) and unaccepted (amphetamines and cocaine).
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Student Notes for Drug Abuse
A. Caffeine
Caffeine-containing beverages are used habitually in different cultures. Fox
example, Chinese, Japanese, Indians and Britain have the habit of drinking
tea while South and North Americans drink coffee. In Hong Kong, many
people, young and old, like to drink Pepsi Cola, Coca Cola and other cola
drinks.
Coffee has the most caffeine with 47-164 milligrams per 150 mL serving.
The caffeine content depends on how the coffee is brewed -- fresh drip has
the highest level, instant has the lowest. Caffeine-free coffer contains about
3-6 mg per cup. A single serving of black tea (150 mL) can have anywhere
from 25 to 110 milligrams of caffeine, while a single serving of Coca-Cola
(350 mL) measures in with 46 milligrams. However, when you break it down
to caffeine per mL, tea handily beats Coke.
Chocolates also contain caffeine because they contain cocoa (dark brown
powder make from crushed cocoa seeds).
(Visit http://ask.yahoo.com/ask/20001018.html to find out how much caffeine
in chocolates.)
The various effects of caffeine are given below:
1.
2.
3.
4.
5.
Slightly  pulse rate (1 cup/day).
Alertness and Fatigue (1 cup or more).
 Loss of calcium in the urine (5 cups/day). [Caffeine increases
water excretion.]
A possible human teratogen (>6 mg/kg body weight). [A teratogen
is a chemical that causes abnormal fetus development.]
 Calorie intake. [This is because most of these drinks contain
sugar.]
Affects sleep patterns
Withdrawal symptoms: Headaches, gastrointestinal effects and
diarrhea.
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Student Notes for Drug Abuse
B. Nicotine (Tobacco smoking)
Apart from caffeine, nicotine is the most widely used stimulant in our society.
Nicotine is an alkaloid found in tobacco.
Comments on the effects
Nicotine is an extremely potent stimulant exerting powerful effects on the
nervous system, the heart and various other body structures. It exerts its
various effects by stimulating acetylcholine receptors that are widely
distributed in our bodies. [Acetylcholine is a neurotransmitter.]
Chronic smoking results in a smoker’s syndrome characterized by difficulty
in breathing, wheezing, chest pain lung congestion and increasing
susceptibility to infections of the respiratory tract.
Cigarette smoking impairs ventilation and greatly increases the risk of
emphysema (a form of irreversible lung damage).
There is a strong correlation between smoking and lung cancer. However,
lung cancer is believed to be caused by tars and other chemicals in tobacco
rather than nicotine.
There is also evidence that smoking has harmful effects on the developing
foetus. Cigarette smoking increases the rates of spontaneous abortion,
stillbirths and early postpartum death of infants. Thus, pregnant women are
advised to quit smoking.
C. Amphetamine and related compounds
What are they?
This group includes amphetamine: methylene dioxymethamphetamine
(MDMA, ecstasy) and methamphetamine (Ice). They have chemical
structures similar to those of amphetamine, and they act as stimulants in the
nervous system. Stimulants can create a sense of well-being and higher
energy, sometimes a release of social inhibition, and feelings of “cleverness”,
“competence” and “power”. But these are unreal.
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Student Notes for Drug Abuse
They are popular rave party drugs in Hong Kong and elsewhere. Because
‘Ice’ is odorless and has a colorless smoke, users of the drug may go
virtually unnoticed. Significant abuse of the drug began to be seen in the
United States in the 1960s and in Hong Kong since the late 1990s.
Street/Other names
Methamphetamine (Ice, 冰) or Dextroamphetamine is also known as “Meth”,
‘crystal meth’, ‘speed’, ‘ice’, ‘black beauties’, ‘bennies’, ‘dexies’, ‘beans’,
‘crank’, etc.
“Ice" is a concentrated form of methamphetamine that resembles tiny chunks
of translucent glass (it is also called ‘glass’. It is very potent crystal
methamphetamine in a form that can be "smoked" rather than injected.
Because the “Ice” is vaporized and inhaled, and not actually burned, the
term "smoking" is technically incorrect.
Another very popular synthetic amphetamine is ecstasy (亞甲二氧基甲基安
非他明, 狂喜, 忘我 ), commonly known as MDMA, short for methylene
dioxymethamphetamine. It acts simultaneously as a stimulant and a
hallucinogen. Users sometimes take ecstasy for the sense of well-being, the
sensory distortions caused by the drug, or to stay awake. [One of the
primary problems with MDMA is the low quality of street ecstasy. Street
ecstasy, especially pressed pills, is often mixed with a wide variety of
adulterants that can cause a variety of negative side effects both unpleasant
and dangerous.]
Clinical uses
Amphetamines first were synthesized in 1887, but were not used medically
until about 1930. Between 1930 and the early 1960s, amphetamines were
used to treat childhood hyperactivity, obesity and narcolepsy (day sleep), a
rare disorder in which persons are overcome by sudden attacks of deep
sleep.
How is it abused?
Ecstasy is most often found in tablet, capsule, or powder form and is usually
consumed orally, although it can also be injected. Other amphetamine drugs
are used in similar manner. Ecstasy is sometimes packaged in capsules or
generic tablets to imitate prescription drugs.
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Student Notes for Drug Abuse
(For other details see:
http://parentingteens.about.com/library/fs/blsldicamph.htm?terms=Ampheta
mine+.)
Ice is usually consumed by smoking or orally.
Short-term effects
Physical effects:
 Loss of appetite
 Involuntary teeth clenching
 Blurred vision
 Increased heart rate and blood pressure



Chills and sweating
Tremors
Deaths have occurred because users don’t drink enough water and
become overheated.
Psychological difficulties can include the following symptoms:
 Confusion
 Depression
 Sleep problems
 Drug craving (an addiction behaviour)


Severe anxiety
Paranoia - during and sometimes weeks after taking MDMA.
Amphetamine-induced psychosis is a paranoid state that may develop after
ingestion or the injection of large doses of amphetamines.
Long-term effects
Research links MDMA use to long-term damage to those parts of the brain
critical to thought and memory possibly by destroying and producing
neurons in the brain. [Damage to these neurons is the underlying cause of
the motor disturbances seen in Parkinson's disease. Symptoms of this
disease begin with lack of coordination and tremors and can eventually
result in a form of paralysis.]
Long-term heavy use of amphetamines may lead to malnutrition
(amphetamine reduces appetite), skin disorders, ulcers and diseases
resulting from vitamin deficiencies. Regular use may contribute to lack of
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Student Notes for Drug Abuse
sleep and weight loss. Intravenous users are at risk for serious,
life-threatening diseases such as AIDS, lung and heart disease and other
cardiovascular diseases. Frequent use of large amounts of amphetamines
may eventually result in mental illness, suicide or violent death.
Effects on pregnancy
 Pregnant women who take ecstasy, ice and other
amphetamine-related drugs may increase the chances of their
babies developing birth defects.
(For details see: http://news.bbc.co.uk/1/hi/health/481775.stm and
http://mdma.net/prenatal/pregnancy.html)
 Pregnant women who take ecstasy increase their risk of an
abnormal baby by up to seven times.
(For details see:
http://www.erowid.org/chemicals/mdma/references/journal/1999_mc
elhatton_lancet_1/1999_mcelhatton_lancet_1_media1.shtml.)
Treatment
There is no effective medical treatment for abuse of amphetamines and
counseling appears to be a very useful mean.
References:
http://substanceabuse.about.com/library/weekly/aa040700.htm (kills brain
cell)
http://substanceabuse.about.com/library/weekly/aa040700.htm
http://www.nida.nih.gov/infofax/ecstasy.html
http://drugabuse.gov/ResearchReports/methamph/methamph.html
http://www.erowid.org/chemicals/mdma/references/journal/1999_mcelhatton
_lancet_1/1999_mcelhatton_lancet_1_media1.shtml
http://faculty.washington.edu/chudler/mdma.html
http://weber.Im.flu.edu.tw/~swduh/sociology_of_drug/amphetamine_1.htm
(Chinese)
http://www.greencross.org.tw/drugabuse/amph_withdraw.htm (Chinese)
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Student Notes for Drug Abuse
D. Cocaine
General information
Cocaine, a stimulant, is one of the most addictive psychotropic substances.
The other is heroin.
It is one of the oldest known drugs. The pure chemical, cocaine
hydrochloride, has been an abused substance for more than 100 years, and
coca leaves, the source of cocaine, have been ingested for thousands of
years particularly in South American countries for example, Peru and Bolivia.
It was used as tonics/elixirs to treat a wide variety of illnesses. Because of its
powerful addictive effect, this usage has been abandoned.
The major sources of cocaine are some South American countries. There
are two chemical forms of cocaine: the hydrochloride salt and the
"freebase“ (not neutralized by an acid). The hydrochloride salt, or powdered
form of cocaine, dissolves in water and, when abused, can be taken
intravenously (by injection) or intranasally (sniffing). The freebase form of
cocaine is smokable.
Street names or other names
Cocaine is generally sold on the street as a fine, white, crystalline powder,
known as "coke," "C," "snow," "flake," "blow," 可卡因, 可可精 or 古柯鹼.
Street dealers generally dilute it with such inert substances such as corn
starch, talcum powder, and/or sugar, or with such active drugs like procaine
(a local anesthetic) or with such other stimulants such as amphetamines.
Cocaine abuse and addiction continues to be a major problem in Europe and
North and South Americas. For example, an estimated 1.5 million Americans
age 12 and older were chronic cocaine users in 1997. However, the number
of cocaine abusers in Hong Kong remains small. One reason may be
because cocaine in the local black market is very expensive.
Short-term effects
Cocaine's effects appear almost immediately after a single dose, and
disappear within a few minutes or hours.
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Student Notes for Drug Abuse
In small amounts (up to 100 mg), cocaine usually makes the user feel
euphoric, energetic, talkative, and mentally alert, especially to the sensations
of sight, sound, and touch. (These are common effects of CNS stimulants.) It
can also temporarily decrease the need for food and sleep.
Some users find that the drug helps them to perform simple physical and
intellectual tasks more quickly, while others can experience the opposite
effect.
The short-term physiological effects of cocaine include:

Dilated pupils


Increased body heat sensation
Increased heart rate and blood pressure (constricted blood
vessels).
Larger amounts (several hundred milligrams or more) intensify the user's
high, but may also lead to bizarre, erratic, and violent behavior. These users
may experience tremors, vertigo, muscle twitches, paranoia, or, with
repeated doses, a toxic reaction closely resembling amphetamine poisoning.
Some users of cocaine report feelings of restlessness, irritability, and
anxiety.
In rare instances, sudden death can occur on the first use of cocaine or
unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac
arrest or seizures followed by respiratory arrest.
Long-term effects
Cocaine is a powerfully addictive drug. Once having tried cocaine, an
individual may have difficulty predicting or controlling the extent to which he
or she will continue to use the drug.
An appreciable tolerance to cocaine's high may develop, with many addicts
reporting that they seek but fail to achieve as much pleasure as they did
from their first experience. Some users will frequently increase their doses to
intensify and prolong the euphoric effects.
While tolerance to the high can occur, users can also become more
sensitive (sensitization) to cocaine's anesthetic and convulsant effects,
111
without increasing the dose taken. This increased sensitivity may explain
some deaths occurring after apparently low doses of cocaine.
112
Student Notes for Drug Abuse
Reference:
http://www.drugabuse.gov/ResearchReports/Cocaine/cocaine2.html#what
Effects and danger of taking multi-drugs
A. Do not take psychoactive drugs together with alcohol!
The brain compartment is separated from the circulatory (blood) system by a
filter, called the blood-brain barrier. [This protects the brain from sudden
changes in chemical composition in the blood, for example after a meal.]
This filter prevents most substances from entering the brain freely. To
compensate this ‘defect’, there are specialized carrier system to carry
substances, e.g., glucose (a must fuel for the brain) and others, into the
brain to allow the brain to perform its normal functions. Interestingly,
fat-soluble substances do not have to enter the brain by carriers and they do
so by diffusion because they can dissolve in the lipid components of a cell
membrane then enter a cell.
Most, if not all, psychoactive drugs are fat-soluble substances and they
dissolve readily in alcohol (a good solvent for fat-soluble substances), so
these mood-altering drugs can pass through the blood brain barrier more
rapidly by diffusion. Thus, taking these drugs with alcohol would cause a
sudden and sharp rise of the drug(s) in the brain. This may cause overdose
toxicity in the brain and explains why taking psychoactive drugs with alcohol
is extremely dangerous.
The point to be remembered is “Do not use drugs with alcohol!”
B. Effects of taking multi-drugs are unpredictable!
Some abusers believe that taking a depressant together with a stimulant will
cancel out each other’s effects. This is Wrong! It is a misconception. The
real answer could be ‘fatal’.
This false belief was developed simply because some abusers think
depressants equate to ‘minuses’, while stimulants ‘pluses’, and they have
the false belief that (-1) + (+1) should equal to 0 (zero) mathematically,
therefore the false belief that taking both together should have no harmful
effect(s).
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Student Notes for Drug Abuse
This is wrong because:
1.
2.
3.
Depressants and stimulants are very different drugs and they affect
different neurotransmitter systems.
They affect different areas of the brain. [At the beginning of this block,
we discussed the concept that different brain areas perform different
functions.
The fact is taking different kinds of psychoactive drugs together could
be fatal. This is because more neuronal systems and more brain areas
are affected at the same time.
End of Period 3
114
Student Notes for Drug Abuse
PERIOD FOUR
Hallucinogens
What are hallucinogens?
Hallucinogens are also called ‘psychedelics’. They are substances that
induce sensory (vision, sound, smell, etc.) sensitivities of the brain. Under
the influence of hallucinogens, people see images, hear sounds, and feel
sensations that seem real but do not exist. These are called ‘psychedelic’
sensations. These drugs can disrupt a person's ability to think and
communicate rationally, or even to recognize reality, sometimes resulting in
bizarre or dangerous behavior.
The two commonly abused hallucinogens in HK are LSD and marijuana.
[Note that although ketamine is classified as a depressant in this block, it
can distort perceptions of sight and sound and produces feelings of
detachment - dissociation - from the environment and self. The details of
ketamine will not be repeated here.]
A.
LSD
What is LSD?
LSD (lysergic acid diethylamide) is a hallucinogen that causes emotions to
swing wildly and from real-world sensations to assume unreal, sometimes
frightening aspects.
LSD is the hallucinogen most widely used in this class of drugs. Recently,
LSD and ketamine are becoming more widely used at entertainment places
and all-night rave parties by older teens and young adults in Hong Kong.
Herbal hallucinogens
In addition to LSD and marijuana, there are other hallucinogens, in the forms
of hallucinogenic plants that had been used in many cultures. These include
cactus, which grow in Mexico and the Southwest United States, 'magic
mushrooms' and Star Jasmine.
Of this group, however, LSD is by far the most potent. Abuse of these plant
hallucinogens is not common in HK, probably because of lack of supply.
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Student Notes for Drug Abuse
History of LSD
LSD was synthesized in 1938 by German chemist Albert Hofmann. He
accidentally ingested a small amount and experienced a series of frightening
sensory effects.
Properties of LSD
LSD is a clear or white, odorless, water-soluble material synthesized from
lysergic acid, a compound derived from a rye fungus. LSD is the most
potent mood- and perception-altering drug known: oral doses as small as 30
micrograms (mg) can produce effects that last 6 to 12 hours.
The most common form of LSD is called "blotter acid" - sheets of blotting
paper soaked in LSD. Drug distributors often apply LSD to colored paper,
making it difficult for a buyer to determine the drug's purity or dosage. (Purity
of this street drug is an issue of concern in substance abuse.)
Street/Other names
Acid, angel dust, and vitamin K
Clinical uses
Most hallucinogens, including LSD, which are intended for illegal uses, have
no accepted medical use.
How is it used?
LSD is usually taken orally, but is sometimes inhaled or injected.
Short-term effects
Short-term effects appear soon after a single dose and disappear within a
few hours or days.
Physical effects include:
 Increased blood pressure and heart rate
 Increased body temperature and sweating
 Impaired motor skills and coordination
 Nausea; dizziness, loss of appetite
 Dry mouth
 Affect emotion and sensory (major effects of hallucinogens)
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Student Notes for Drug Abuse
After the physical effects, dramatic changes in perception, thought, and
mood occur. These may include:
 Vivid, usually visual, "pseudo-hallucinations" that the user is aware
are not real.
 Distorted perceptions of: time (minutes seem like hours)
 Distorted distance perception (hazardous if operating motor vehicles
or standing near balcony edges)
 Space between oneself and one's environment (for some, a feeling of
oneness with the universe, for others, a feeling of terror)
 Fusion of the senses (music is “seen,” colors “heard”) is experienced.
Long-term effects
LSD users quickly develop a high degree of tolerance for the drug's effects.
After repeated use, they need increasingly larger doses to produce similar
effects. This may result in addiction.
Two long-term effects are “psychosis” and “perception disorder”.
Psychosis is the disorganization of a person's capacity to recognize reality,
think rationally, or communicate with others. These effects of LSD may last
for years and can affect people who have no history or other symptoms of
psychological disorder.
Perception Disorder consists of episodes of spontaneous, repeated,
sometimes continuous, recurrences of some of the sensory distortions
originally produced by LSD. The experience may include hallucinations, but
it most commonly consists of visual disturbances such as seeing false
motion on the edges of the field of vision, bright or colored flashes, and
halos or trails attached to moving objects. This condition is typically
persistent and in some cases remains unchanged for years after individuals
have stopped using the drug. Chronic LSD use may result in prolonged
depression and anxiety.
Effects on pregnancy
There appears to be a higher risk of spontaneous abortion and congenital
abnormalities in babies born to women who regularly used LSD during
pregnancy.
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Student Notes for Drug Abuse
Treatment
There is no effective medical treatment for LSD abuse, and counseling
appears to be the method of choice.
References:
http://www.drugabuse.gov/ResearchReports/Hallucinogens/hallucinogens.ht
mlhttp://www.erowid.org/plants/peyote/peyote.shtml (Mescaline/peyote)
http://www.erowid.org/plants/mushrooms/mushrooms.shtml (Psilocybin and
magic or hallucinogenic mushrooms)
http://www.erowid.org/chemicals/ibogaine/ibogaine.shtml (Ibogaine)
B. Marijuana
What is marijuana?
Marijuana (Marihuana) is a green, brown or grey mixture of dried, shredded
leaves, stems, seeds and flowers of the hemp plant (Cannabis sativa). It is a
mind-altering substance.
Street/Other names
大 麻 , 草 , ‘Pot’, ‘herb’, ‘weed grass’, ‘boom’, ‘Mary Jane’, ‘gangster or
chronic’, ’grass’ and hashish (‘hash’ for short). Hashish is the stronger form
of marijuana.
Clinical uses
Marijuana in its smoked form has no commonly accepted medical use. THC
(delta-9-tetrahydrocannabinol; te-tra-hydro-can-na-bin-nol), the active
ingredient in marijuana, has been used by some medical practitioners to
treat nausea and vomiting that occur with certain cancer treatments and to
help AIDS patients eat more to keep up their weight. However, further
studies are needed to determine its therapeutic value and consequence of
regular use.
How is it abused?
Marijuana is usually smoked as a cigarette (called a ‘joint’ or a ‘nail’), or in
pipe.
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Student Notes for Drug Abuse
Short-term effects
Distorted perceptions including sights, sounds, time and touch. This is
because it is a hallucinogen. Other effects are: trouble with thinking and
problem-solving ability, loss of coordination (athletes could find their
performance is off; timing, movements and coordination), and increased
heart rate and anxiety.
Long-term effects
Tolerance and addiction are common effects.
Marijuana contains some, or even more, of the cancer-causing chemicals,
e.g., tars found in cigarette smoke. [Studies found that someone who
smokes 5 joints per week may have taken in as much cancer-causing
chemicals as someone who smokes a full pack of cigarettes every day.]
Thus, long-term marijuana abusers have much higher risk of lung and other
cancers. Development of the same kinds of breathing problems that
cigarette smokers have: coughing and wheezing as well as emphysema.
Animal studies have found that THC can damage cells of the immune
system.
Abusers of marijuana are at higher risk of becoming addicted to other drugs,
such as cocaine and amphetamine-related drugs.
Effects on pregnancy
Marijuana, like other drugs of abuse, can affect a mother's health during
pregnancy, making it a time when expectant mothers should take special
care of themselves. Drugs of abuse may interfere with proper nutrition and
rest, which can affect good functioning of the immune system and have a
detrimental effect on the development of the fetus.
Babies born to marijuana users were shorter, weighed less and had smaller
head sizes. [Head size, or circumference, is an indicator of brain
development during infancy.] Smaller babies are more likely to develop
health problems. Also, Children born to women who abused marijuana
have trouble concentration.
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Student Notes for Drug Abuse
A nursing mother who uses marijuana passes some of the THC to the baby
in her breast milk. Research indicates that the use of marijuana by a mother
during the first month of breast-feeding can impair the infant's motor
development (e.g., control of muscle movement).
Treatment
There are currently no medications for treating marijuana addiction
effectively. Treatment programmes focus on counseling and group support
systems
are
quite
effective.
See
also:
http://www.health.org/reality/articles/2000/youth.asp
References
http://www.nida.nih.gov/MarijNroch/MarijparentsN.htmlhttp://www.nida.nih.go
v/Infofax/marijuana.html
http://www.health.org/reality/articles/2001/birthdefects.asp
Signs of taking club drugs
The information given below describes some common observable signs in
club drug abusers.
Signs of drug abuse
1.
2.
4.
5.
6.
7.
8.
Problems remembering things they recently said or did (amnesia)
Loss of appetite & body weightLoss of muscle coordination,
dizziness, fainting
Depression
Confusion
Sleep problems
Chills or sweating (for no medical reasons)
Slurred speech
The main point is that drug abuse can be identified, and that the belief that
misuse of club drugs can be hidden is false. So, stay away from drugs.
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Student Notes for Drug Abuse
Some major effects of drug abuse
Addiction and withdrawal
1. Affects heart, kidney and liver functions
2. Affects brain function by interfering with neuronal transmissionMay
cause death because of:
a.
b.
c.
Impurities/toxic substances found in the drug
Overdose [Concentrations vary in packages]
Poly-drug use [Remember that different drugs affect different
brain areas and different neurotransmitter systems]
Summary of effects of psychoactive drug abuse on different organs
The figure below summarizes the effects of different drugs on different
organs in our body. One very important point to be remembered is that these
drugs also affect other vital organs in our body.
Some suggested ways to say “No” to drugs
These are some suggested ways to say “No!” to drugs.
Some means to say “No” to drugs
1. Avoid places where drug-uses are likely
2. Keep ‘suspected’ abusers at arm’s length
3. When offered drugs:
a. Say “No” decisively, and tell them the harmful effects of drugs
b. Change the subject or excuse yourself and leave the place
121
Student Notes for Drug Abuse
c.
Accept the offer, and tell them that you would like showing it to
d.
your teachers/social worker at school/friends
Other appropriate means
Can you think of other good ways to refuse drugs?
Penalties of drugs-related crimes
The figure below summaries the penalties in HK and neighboring place.
The point to be noted is that possession/trafficking of some of these drugs is
illegal and the penalty is very heavy. For example, in Singapore, possession
of 15 grams of heroin can result in the death penalty.
Maximum penalties for drug-related crimes
Places
Penalty
Hong Kong
Life imprisonment and confiscation of properties
Mainland China
Death or life imprisonment and confiscation of properties
Macau
Long prison terms
Singapore
Death >15 grams of heroin
End of Period 4 and this block
122
Suggested activities
Suggested Activities
1. Group discussion
Divide students in a group of 4-5, and each takes turn to explain the
following to fellow students in their group why the following is NOT true:
(a)
Drinking alcohol does no harm to our body because many
people do drink.
(b)
Drinking beer is less harmful than taking heroin
(c)
Smoking is less harmful than inhaling organic solvents
(d)
Taking sleeping pills prescribed by doctors do not cause
addiction.
2. Data Analysis and information search
Show the slide below and ask the students visit public libraries or surf the
web to find information related to this slide, e.g.:
(a) What are drug-related ‘major offences’ and ‘minor offences’ in HK?
Suggested answer: Possession or trafficking of large quantity of
drugs, making heroin, etc are major offences, while possession of
small quantity and taking heroin, etc are minor.
(b) What could be the causes for the rise in drug-related offenders in
1994-1996?
Suggested answer: HK was used as a drug-transit place between
Mainland China and Golden Triangle and other countries. The drop
in 1997and onward was possibly due to stepped up cooperation
between Mainland and HK authorities to reduce the supply of drugs
and join efforts of the law enforcing agencies in HK.
(c) Name some government departments/agencies that are responsible
for enforcing drug-related laws.
Suggested answer: Hong Kong Police, Custom and Excise,
Department of Health, Correctional Services and the Narcotics
Division of the Security Bureau. Government departments and
agencies that play active role in drug-prevention education include:
Education Department, Social Welfare Department, Hospital
Authority and the Narcotics Division of the Security Bureau.
123
Suggested activities
3. Discussion and information searching:
(a). The table below, taken from the PowerPoint file, shows reasons why
young people in HK take drugs. Find some means to help them to stay
away from drugs.
(b). Hemp seeds [火麻仁] and poppy seeds [罌粟籽] are used in Chinese
medicine and recipes, respectively. Do you think taking these seeds would
cause addiction? Explain.
124
Suggested activities
If you find out that your good friend is a frequent rave partygoer and is
addicted to ketamine, what would you do?
4. Knowing the drugs (Worksheet)
(a) Below is a list of drugs/chemicals. Try to classify them by writing them
correctly in the boxes provided.
Drugs/Chemicals: ecstasy, heroin, marijuana, ice, morphine, organic
solvents, codeine, amphetamines, ketamine, LSD, opium, paint thinner,
butane, caffeine, 綠豆仔, 羅氏五號, 羅氏十號 etc.
Analgesics
Stimulants
Depressants
Hallucinogens
b) The diagram below shows a human body. In the boxes provided, name a
drug that affects the organ.
125
Suggested activities
5. Debate
Arrange a debate (after school) on one of the following topics:
(a) Pop stars are suitable beat-drug ambassadors; or
(b) Taking heroin is more harmful than alcohol/cigarette smoking.
References:
http://debate.uvm.edu/
http://residence.educities.edu.tw/tranemac/
http://hkpuedt.tripod.com/
6. Visit
Arrange a visit to a drug-related agency, for example, Drug Information
Center (to be open in late 2002), a non-government drug-counseling center,
etc
7. Interview
Arrange a visit to a rehabilitation center and students can interview/talk to
drug addicts or ex-drug abusers to understand why they take drugs.
8. Design/Creative writing/Independent study
(a) Design a brochure/poster to warn or educate young people of
the adverse effects of drug abuse.
(b) Imagine you were a drug: What would you do to bring a
potential abuser under you control?
(c) Imagine you were a foetus and you could talk to your mother.
How would you persuade her to stop smoking/drinking/taking
ecstasy?
(d) Construct a website at your school’s website to hyperlink sites
that are related to drug abuse.
(e) Write a play on the following situation: if you were a
parent/teacher/student and discovered your child/student/friend
is a frequent rave party goer and taking ketamine occasionally.
In the script include the following characters: a drug trafficker
who is eager to sell ketamine; a youngster who is desperate for
money; a youngster who is seeking for “high” sensation; a
worried parent who suspects something fishy going on with his
child; a very helpful social worker and a undercover policeman
watching at the party.
126
Review Questions/Quizzes/Food for thought
Review Questions/quizzes/food for thought
Quizzes for students
1. What is the most commonly used “drug” in Hong Kong?
a) Heroin
b) Cocaine
c) Alcohol
d) Marijuana
e) Amphetamine
2.
Name the two “legal drugs” most commonly used by teenagers in Hong
Kong.
3.
Which drug is associated with the most traffic deaths?
4.
Ecstasy obtained at rave parties is a particularly dangerous drug
because:
a) it is too cheap
b) it is readily available
c) it is highly addictive
d) it contains impurities
e) both (c) and (d)
5.
Fumes from which of the following can be inhaled to produce a high
feeling:
a) paint thinner
b) model glue
c) nail polish remover
d) freon
e) all of the above
6.
Students who have not used alcohol and other drugs before they
graduate from secondary school
a) should be good citizens after graduation
b) are “book-worms”
c) have lower risk of becoming chemically dependent after graduation.
d) have an increased risk of becoming chemically dependent after
graduation.
127
Review Questions/Quizzes/Food for thought
7.
Which of the following drug combinations is more likely to induce an
addiction?
a) Cocaine and heroin
b) Coffee and cigarette smoking
c) Sleeping pills and alcohol
d) Amphetamines and alcohol
e) Cigarette smoking and alcohol
8.
How much alcohol can a pregnant woman safely consume?
a) 100 ml (a glass) of red wine with dinner.
b) Two cans of beer each day.
c) 100 ml (a glass) of rice wine a week.
d) 100 ml (a glass) of red wine a week.
e) None
9.
Young people smoke because
a) they believe it is a symbol of adulthood.
b) they are attracted by advisements that link smoking to maturity,
social status, etc.
c) they are curious.
d) they want to cover up their weakness or shortcomings.
e) all of the above
10. Most people continue to smoke because
a) of psychological effects. They feel that smoking relieves tension and
boredom.
b) it has become a habit.
c) they become addicted.
d) both a) and c).
e) all of a), b) and c).
11. Smoking increases the risk of
a) lung cancer.
b) chronic bronchitis.
c) emphysema.
d) (coronary) heart disease.
e) all of the above.
128
Review Questions/Quizzes/Food for thought
12. Name some substances, not discussed in this block, but you consider
being drugs.
Explain
13. Why is psychotropic drug abuse more common in youth in Hong Kong?
129
Review Questions/Quizzes/Food for thought
Answers
1. (c) Because it is legal for adults and widely accepted in our culture,
alcohol is the drug most often used in Hong Kong.
2. Alcohol and tobacco. These are the "gateway" drugs, drugs that
children are first exposed to and whose use often precedes use of
other drugs.
3. Alcohol. (Activity: ask students to find out the number of people died
and injured in alcohol-related traffic accidents in last year.)
4. (e) Ecstasy is highly addictive and ecstasy of dubious origin may
contain poisonous impurities. In fact, cases of death due to
consumption of street drugs had been reported.
5. (e) Virtually anything that emits fumes or comes in aerosol form
contains inhalant(s) and they all can produce a high feeling. (It should
be noted that solvent inhaling is extremely dangerous and may be
fatal. (For detail see:
http://corp.aadac.com/drugs/beyond/Solvents.asp.)
6. (d) Early use of alcohol and other drugs - often by age 15 or less - is
strongly associated with drug-related problems such as addiction.
7. (a) Both cocaine and heroin are highly addictive substances.
(However, it does not imply that the others are not addictive.)
8. (e) It is generally recommended these days that expectant mothers
consume no alcohol at all during pregnancy to be on the safe side.
(For detail see: http://www.aerc.org.uk/alcohol_insights/Insert08.pdf .)
9. (e). Recent survey results in HK indicate that all are causes why young
people smoke.
10. (e). All are causes of smoking.
11. (e). Smoking increases the risk of all the disorders mentioned.
12. Any substances that fit the definition given in the PowerPoint/Notes
are considered to be correct.
13. Any reasonable answers.
For questions that require high order of thinking skill, please refer to
130
activities below
131
Tips for teachers
Tips for Teachers
Suggested Assessment Questions
Please refer to Suggested activities: 1, 3, 4 and 5.
Points to be noted
 The materials in this block are quite detailed because the authors
wish to provide a more complete picture of drug abuse in HK.
Users are requested to use their discretions and judgments to
select topics that are most suitable for their students.

The teaching materials described in this module take both a
biological/medical and a social science approach. However, some
users may consider content to be lacking the depth required for a
science course. Some simplification has been used so as not to
burden students with difficult scientific terms/names. Users may find
more advanced materials from the reference websites cited to
complement the deficiencies.

The simple description of the structures and functions of the
central nervous system and a neuron are included to provide
users/students with a brief idea of the actions of different
psychoactive chemicals. [Please note that teaching of
neuroanatomy/neuroscience is not intended.] The message to be
given to students is “different areas of the brain perform different
functions’. The point on neurotransmission is to inform students that
these chemical messengers carry different messages to
surrounding neurons, like postmen/couriers delivering different
letters to different addressees. The idea is to explain to students
how these chemicals affect neurotransmission instead of just
informing students that ‘these chemicals affect functions of the
brain’. It is hoped that this section will arouse students’ interest in
this topic. Also, this section attempts to provide a scientific
explanation for the dangers of taking multiple psychoactive
substances, or taking psychoactive substance(s) with alcohol.
132

Tips for teachers
The classification of drugs adopted in this block is based both on
the pharmacological (mechanisms of action of drugs) and medical
aspects of the drugs or chemicals.
Users may find the
classification different from those used by other drug-abuse
agencies. One of the reasons is that some of the drugs described in
this block have multiple effects.
For example, ketamine is
classified by some drug-abuse agencies as a hallucinogen because
it induces hallucination and is abused for its mind-altering effects.
However, it is classified as a depressant in here because it
depresses neuronal activities and is used clinically as an
anaesthetic. Pharmacologically, it is classified as an anaesthetic
(CNS depressant). Also, drugs that depress nerve activities are
simply grouped under ‘depressants’ and they are not divided into
‘CNS depressants’ and ‘tranquilizers’. [To sub-divide them into
these two classes requires some detailed medical/pharmacological
discussion, which is outside the scope of this course.] This
hopefully will ease students’ burden.

The materials on the effects of different psychoactive substances
are quite substantial, though not extensive; the main objective is to
illustrate the dangers as well as the diverse actions of these
chemicals. Users are advised not to ask students to memorize all
of them. Just the major ones should be acceptable. In delivering
this part, users are advised to bring out the following messages
clearly:
(a) Psychoactive drugs/substances are dangerous;
(b) Their effects are unpredictable;
(c) Street drugs contain impurities, some even contain
toxic substances;
(d) Drugs must not be mixed with alcohol and that taking
(e)
(f)
two or more drugs at the same time is extremely
dangerous and can be fatal;
Most of these drugs are odorless and tasteless, and
students should be very careful when they attend
parties;
The information on ‘Signs of an abuser’ is designed to
guide students, teachers and parents in identifying
possible abusers and to remind students that although
133
Tips for teachers
abusers may take drugs in clandestine places, there
are signs that can be recognized.

Most of the references cited are electronic ones. This is because
they are very informative and readily available than suitable
textbooks. Students are encouraged to find more sites to appreciate
the diversities and harmful effects of these substances so as to
reinforce their understanding of this subject. Teachers are
requested to help students to appreciate the scientific merits of
these sites.
Users may find photographs and figures provided in this block insufficient
due to copyright issues. Users can amend these shortcomings and enrich
the content by downloading appropriate, copyright-cleared pictures from
textbooks, newspapers, magazines, websites and other sources.
134
Glossary
Glossary
[The simple definitions or explanations given below are in the context of
substance abuse, to enhance users’ understanding of the terms used in this
module. They are NOT exhaustive but they serve as references for students
and teachers who would like to learn more. They should NOT be treated to
indicate the depth and breadth of teaching.]
Acid: Common street name for LSD (see below).
Addiction: A chronic, relapsing disease characterized by compulsive drug
seeking and use. The mechanism is believed due to neurochemical and
molecular changes in the brain.
Amnesia: Loss of memory.
Analog: a chemical compound that is similar to another drug in its effects
but differs slightly in its chemical structure.
Anaesthetic (Anesthetic): An agent that causes insensitivity to pain and
other sensations.
Angel dust: Common street name for PCP (phencyclidine).
Anterograde amnesia: Individuals may not remember events they
experienced while under the effects of the drugs.
Antidepressants: A group of drugs used in treating depressive disorders.
Antipsychotic drugs: Drugs used to treat schizophrenia, a mental disorder.
Benzodiazepines: drugs that relieve anxiety or are prescribed as sedatives;
the most widely prescribed medications include Valium, Librium and
Rohypnol.
Blood-brain barrier (BBB): A barrier that prevents direct contact between
blood and the brain. Its major function is to protect the brain from toxic
substances. This means that a substance entering the brain has to pass
through this barrier. [For example, 1. Selectively permeable- lipid soluble
substances pass through easily because they dissolve through
membranes (some of these substances are nicotine, opiates-heroin,
cannabinol); water-soluble molecules are retarded, as they are unable to
pass through fatty membranes readily. 2. Important substances, such as
glucose, are actively transported through capillary walls by special
transport carrier proteins]
Central nervous system (CNS): the brain and spinal cord.
Cerebral cortex: Region of the brain responsible for cognitive functions
including reasoning, mood, and perception of stimuli.
Club drugs: Although tobacco and alcohol are the most common
135
Glossary
substances found on the club scene, other substances such as ecstasy,
herbal ecstasy, Rohypnol, GHB, ketamine, and LSD have gained
popularity with young people in recent years. Typically, nightclubs, bars,
parties, and raves attract teenagers and young adults who may risk their
health in the interest of a good time. They are also known as ‘Rave party
drugs’.
Coca: The plant, Erythroxylon, from which cocaine is derived. Also refers to
the leaves of this plant.
Crack: Short term for a smokeable form of cocaine.
Craving: A powerful, often uncontrollable desire for drugs.
Date rape drugs: In recent years a new kind of rape threat has occurred at
parties, on campuses and in nightclubs in the form of "date rape" drugs.
Technically speaking, any substance that renders you incapable of saying
no or asserting yourself and your needs can be used to commit rape.
This includes things like alcohol, marijuana or other street drugs,
designer or club drugs like ecstasy, over-the-counter sleeping pills and
antihistamines, even cold medications. However, the term "date rape
drug" usually applies to the drugs Rohypnol, gamma hydroxybutyrate
(GHB) and ketamine. There are many factors that make these drugs
desirable to sexual predators. The drugs are virtually undetectable; they
are tasteless, odorless and colorless. Date rape drugs are easily slipped
into drinks and food and are very fast acting. They render the victim
semi-conscious but responsive with little or no memory of what happens
while the drug is active in their system. The drugs also make the victim
act without inhibition, often in a sexual or physically affectionate way. Like
most drugs, date rape drugs render a person incapable of thinking clearly
or of making appropriate decisions. This makes for a very passive victim,
one who is still able to play a role in what is happening but who will have
no clear memory of what happened afterwards. Without any memory of
events the victim is often unaware that they have even been raped, and if
they are aware or have suspicions they make very poor witnesses. If you
suspect that you have been given a date rape drug you need to get to a
hospital quickly and you must request that you be properly tested. The
drugs can be found in your system if you act quickly. If you suspect that
you have been raped using any one of these drugs go to a hospital and
request a preliminary rape exam with testing for date rape drugs. This is
the only way to know for sure.
136
Glossary
Dementia: A condition of deteriorated mentality. One hallmark is inability to
remember things or events, especially things that happened recently.
Dissociative anesthetic: A compound, such as phencyclidine (PCP) or
ketamine that produces an anesthetic effect characterized by a feeling of
being detached from the physical self or the environment.
Detoxification: a process of allowing the body to rid itself of a drug while
managing the symptoms of withdrawal; often the first step in a drug
treatment program.
Dopamine: A neurotransmitter present in regions of the brain that regulate
movement, emotion, motivation, and the feeling of pleasure.
DXM: Common street name for dextromethorphan.
Endorphin: A peptide produced by the brain that has pill-killing activity.
Compared to enkephalins, endorphin is a longer peptide.
Emphysema: A lung disease, often caused by smoking, in which tissue
deterioration results in increased air retention and reduced exchange of
gases. The result is difficult breathing and shortness of breath. This
condition is incurable and terminal.
Enkephalin: A peptide produced by the brain that has pill-killing activity.
Euphoria: A pleasurable feeling experienced by a user after taking
psychoactive/psychotropic substances (drugs). [Synonym: rush.]
GABA: (gamma-Aminobutyric acid): an inhibitory neurotransmitter
substance in the brain. Inhibitory neurotransmitters modulate (slow down)
the actions of stimulatory (excitatory) neurotransmitters in the brain.
GHB: (gamma-hydroxybutyrate):
GHB is both a metabolite and
precursor of the inhibitory neurotransmitter GABA (above). It is a
depressant that is abused as a club drug. It is also one of the ’date rape’
drugs.
Glutamate: A (excitatory) neurotransmitter associated with pain, memory,
and response to changes in the environment.
Hallucination: A condition where a person experiences profound distortions
in his perceptions of reality. Under the influence of hallucinogens, people
see images, hear sounds and feel sensations that seem real but do not
exist.
Hallucinogen: A compound that causes hallucination.
Ketamine: A dissociative anaesthetic abused for its mind-altering effects and
sometimes used to facilitate sexual assault.
Locus ceruleus: Region of the brain that receives and processes sensory
signals from all areas of the body.
137
Glossary
LSD: Lysergic acid diethylamide, a very potent hallucinogen.
Insomnia: Inability to sleep in the absence of impediments, such as noise, a
bright light, etc., during the period when sleep should normally occur.
Neurotransmitter: A chemical compound that acts as a messenger to carry
signals or stimuli from one nerve cell to another.
Magic mushroom: A type of mushroom that contains psilocybin, a
hallucinogen.
Narcolepsy: a disorder characterized by uncontrollable attacks of deep
sleep even during the day.
Neonatal abstinence syndrome: A clinical condition that occurs in infants
due to intrauterine exposure to addictive substances, e.g., heroin,
cocaine, LSD, etc. Onset of symptoms varies according to which drug is
being used by the mother, the quantity, frequency, and duration of
intrauterine exposure, and the timing of the withdrawal (last dose prior to
delivery). Symptoms include: CNS irritability (decreased duration of sleep
between feedings), CNS motor activities (tremors, increased muscle tone,
[myoclonic] jerks, etc), respiratory distress, vague autonomic symptoms
(fever, sweating, mottling, etc.) and other effects such as decreased birth
weight and increased weight loss during early neonatal period.
Neuron: A nerve cell in the brain. It is the basic building block of the nervous
system.
Nicotine: An alkaloid derived from the tobacco plant that is responsible for
smokers’ psychoactive and addictive effects; is toxic at high doses but
can be safe and effective as medicine at lower doses.
Opiates: Compounds derived from morphine or compounds that have
actions similar to morphine
Paranoia: A severe mental disorder characterized by the presence of
delusions such as being followed, poisoned or harmed by other means, in an
otherwise personality.
PCP: Short for phencyclidine, a hallucinogen.
Physical dependence: An adaptive physiological state that occurs with
regular drug use and results in a withdrawal syndrome when drug use is
stopped; usually occurs with tolerance. (Physical dependence occurs
when a person's body becomes used to functioning with the drug present;
if the person suddenly stops their drug use, withdrawal symptoms are
experienced. A sign of psychological dependence is when the use of a
drug becomes increasingly important in a person's life and the drug use
may take priority over other activities and responsibilities.)
138
Glossary
Poly-drug user: An individual who uses more than one drug e.g., ecstasy
and ketamine together.
Psychosis: a mental disorder characterized by symptoms such as delusions
or hallucinations that indicate an impaired conception of reality.
Rave party drugs: See ‘Clubs drugs’.
Rush: A surge of pleasure that rapidly follows administration of some drugs.
(Synonym: euphoria.)
Sedative hypnotic compounds: They are drugs that are capable of
inducing not only behavioral sedation or hypnosis (sleep) but also
behavioral alterations, ranging from (at low doses) relief from anxiety to
sedation, release from inhibition, sleep, and finally (at high doses) death
as a result of the depression of the respiratory center in the CNS (the
medulla).
Serotonin: A neurotransmitter that causes a very broad range of effects on
perception, movement, and the emotions by modulating the actions of
other neurotransmitters in most parts of the brain.
Teratogen: A chemical that can cause abnormal fetal development.
Teratogenesis: Interference with normal fetal development.
Tetrahydrocannabinol (THC): The active ingredient found in marijuana.
Tobacco: A plant widely cultivated for its leaves, which are used primarily for
smoking; the tabacum species is the major source of tobacco products.
Tolerance: A condition in which higher doses of a drug are required to
produce the same effect as during initial use; often is associated with
physical dependence.
Toxic: Causing temporary or permanent effects that are detrimental (harmful)
to the functioning of a body organ or group of organs.
Vertigo: The sensation of dizziness.
Withdrawal: A variety of symptoms that occur after use of an addictive drug
is reduced or stopped. The effects of withdrawal tend to be the opposite
to the original effects of the drugs of dependence. Symptoms include
stomach cramps, sweating, runny nose, loss of appetite, diarrhea, and
irritability.
This glossary provides a quick reference for teachers and students. Some of
the terms are abridged from websites/textbooks.
139
References for Teachers
Supplementary Resources
References for Teachers:
General
“Hong Kong Narcotics Report” (Publishes annually by the Narcotics Division,
Security Bureau of the HKSAR Government and the Action Committee
Against Narcotics)
http://substanceabuse.about.com/gi/dynamic/offsite.htm?site=http://www.nid
a.nih.gov/
http://parentingteens.about.com/library/fs/blsldicindex.htm?terms (Street
names)
http://parentingteens.about.com/library/weekly/aa052302a.htm?terms (Party
drugs)
http://www.drugarm.org.au/
h t t p :/ / www. d ru gf ree a me rica . o rg/
h t t p :/ / www. e ro wid . o rg/ ch e m ica ls/
http://www.drugarm.org.au/main_index/teachers_menu.htm (Site with
pictures and brief introduction for each drug)
h t t p :/ / www. u sd o j. go v/ d e a /
http://www.nlm.nih.gov/medlineplus/cocaineabuse.html
http://www.nida.nih.gov/ResearchReports/Prescription/Prescription.html
Chinese websites
http://health.yahoo.com/health/drugs_tree/medication_or_drug/
http://www.bses.hcc.edu.tw/effect/duping/2a.htm
http://info.gov.hk/nd/chinese/drug/index.htm
http://www.catholic.org.hk/spiritual/drug.htm (介紹有關的徵兆、成因、經常被
濫用藥物種類及潛在危險)
http://www.nwcmoed.com.hk.ro/ (含多種類型的毒品介紹)
http://www.info.gov.hk/nd/text/chinese/info/index.htm (介紹麻醉鎮痛劑、迷幻
劑、鎮抑劑、興奮劑、鎮靜劑的醫藥用途及濫用後果)
http://www.hkcs.org/overview/csnews/c209/c209_31.htm (探討被訪者對此等
藥物的了解、服藥後的徵狀及處理方法)
http://www.raveparty.com.hk/drugs.htm (介紹忘我(Fing 頭丸)、海洛英、氯胺
酮(K 仔)、冰及大麻等藥物)
http://www.info.gov.hk/healthzone/exhibits/saab001/ (含藥物濫用與酗酒的定
義、影響及戒除方法)
140
References for
Teachers
Amphetamines
http://www.erowid.org/chemicals/mdma/mdma.shtml
#http://substanceabuse.about.com/library/weekly/aa040700.htm (kills brain
cells)
http://www.erowid.org/chemicals/mdma/references/journal/1999_mcelhatton
_lancet_1/1999_mcelhatton_lancet_1_media1.shtml
http://faculty.washington.edu/chudler/mdma.html
http://weber.lm.fju.edu.tw/~swduh/sociology_of_drug/amphetamine_1.htm
(Chinese)
http://www.greencross.org.tw/drugabuse/amph_withdraw.htm (Chinese)
http://substanceabuse.about.com/library/weekly/aa040700.htm
http://www.nida.nih.gov/Infofax/ecstasy.html
http://www.drugabuse.gov/ResearchReports/methamph/methamph.html
http://www.med.harvard.edu/AANLIB/home.html (Brain Atlas)
CNS depressants (Benzodiazepines)
http://faculty.washington.edu/chudler/barb.html
http://faculty.washington.edu/chudler/roof.html
http://www.hon.ch/Dossier/MotherChild/preg_drugs/benzodiazepines.html
http://womenshealth.about.com/library/bldaterapedrugfaq.htm?terms=Treat
ment+Rohypnol
Cocaine
http://www.drugabuse.gov/ResearchReports/Cocaine/cocaine2.html
http://ceiba.cc.ntu.edu.tw/health/note/drugabuse.htm (Chinese)
http://www.info.gov.hk/nd/text/info/4.htm (Hong Kong)
http://www.welcome.to/cocaine
http://ceiba.cc.ntu.edu.tw/health/note/drugabuse.htm (Chinese)
GHB
http://www.adf.org.au/drughit/facts/ghb.html
http://www.ceida.net.au/tools_for_workers/drugs/ghb.htm
http://www.emedicine.com/emerg/topic848.htm
Heroin
http://www.tcada.state.tx.us/research/facts/heroin.pdf
http://www.drugabuse.gov
http://www.health.org
141
References for Teachers
http://www.drugabuse.gov/ResearchReports/Heroin/herml
http://alcoholism.about.com/library/blnida04.htm?terms=The+Drug+Morphin
e
http://alcoholism.about.com/library/blnida04.htm?terms=The+Drug+Morphin
e
Inhalants
http://www.inhalants.com/
http://corp.aadac.com/drugs/beyond/Solvents.asp
Ketamine
http://www.nbcd.gov.tw/prop/prop_1-11.asp (Chinese)
http://www.greencross.org.tw/drugabuse/ketamine.htm (Chinese)
http://www.erowid.org/chemicals/ketamine/ketamine.shtml
http://www.drugabuse.gov/NIDA_Notes/NNVol15N2/Ketamine.html
LSD
http://www.drugabuse.gov/ResearchReports/Hallucinogens/hallucinogens.ht
ml
http://www.erowid.org/plants/peyote/peyote.shtml (Mescaline/peyote)
http://www.erowid.org/plants/mushrooms/mushrooms.shtml (Psilocybin and
magic or hallucinogenic mushrooms)
http://www.erowid.org/chemicals/ibogaine/ibogaine.shtml (Ibogaine)
Marijuana
http://www.nida.nih.gov/Infofax/marijuana.html
http://www.nida.nih.gov/MarijBroch/MarijparentsN.html
http://www.health.org/reality/articles/2001/birthdefects.asp
http://www.druganswer.com/chinese/index.html
Treatment
http://www.nida.nih.gov/ResearchReports/Prescription/prescription7.html#Tr
eating
142
References for Teachers
Organizations related to drug abuse in Hong Kong
The following is a list of some organizations that provide services to drugs
abusers in Hong Kong. Teachers may invite experienced personnel from
these organizations to give lectures to their students to enhance their
understanding of this complicated topic, or ex-drug abusers to share their
experience e.g. how they get hooked, the effects of drug on their bodies and
families, and how they overcame their addiction.
香港戒毒服務機構
Organizations Providing Services to Drug Abusers in Hong Kong
計劃
Programme
美沙酮門診治療計劃
Methadone Out-patient Treatment
Programme
自願住院戒毒治療和康復服務計劃
Voluntary Residential Treatment and
Rehabilitation Programme
機構名稱
Agency
衛生署美沙酮診所
Department of Health, Methadone
Clinics
香港戒毒會
The Society for the Aid and
Rehabilitation of Drug Abusers
(SARDA)
巴拿巴愛心服務團
Barnabas Charitable Service
Association
明愛黃耀南中心
Caritas Wong Yiu Nam Center
基督教得生團契
Christian New Being Fellowship
基督教正生會
Christian Zheng Sheng Association
得基輔康會
Drug Addict Counselling and
Rehabilitation Services (DACARS)
信義會芬蘭差會靈愛青年中心
Finnish Evangelical Lutheran Mission
Ling Oi Youth Center
香港晨曦會
Operation Dawn
143
References for Teachers
計劃
Programme
機構名稱
Agency
戒毒康復協會人道援助基金
SER Foundation for Humanitarian Aid
聖士提反會
St. Stephen’s Society
濫用精神藥物者輔導計劃
Counselling Programme for
Psychotropic Substance Abuse
基督教互愛中心
Wu Oi Christian Center
香港基督教服務處
Hong Kong Christian Service PS33
社會福利署「健康新一代」計劃
Social Welfare Department
Against Substance Abuse Scheme
明愛容圃中心
Caritas HUGS Center
物質誤用診所
Substance Abuse Clinic
香港路德會社會服務處-路德會青欣中心
Hong Kong Lutheran Social Service –
Cheer Lutheran Center
醫院管理局
Hospital Authority
九龍醫院
Kowloon Hospital
柬區尤德夫人那打素醫院
Pamela Youde Nethersole Eastern
Hospital
威爾斯親王醫院
Prince of Wales Hospital
瑪麗醫院
Queen Mary Hospital
葵涌醫院藥物誤用評估中心
Kwai Chung Hospital Substance Abuse
Assessment Unit
青山醫院屯門精神健康中心
Castle Peak Hospital Tuen Mun Mental
144
References for Teachers
計劃
Programme
輔導與多元化之綜合服務計劃
Counselling and Multiple Integrated
Service Programme
機構名稱
Agency
Health Center
明愛樂協會
Caritas Lok Heep Club
香港培康聯會
Pui Hong Self-help Association
勵扶青會
KELY Support Group
善導會
The Society for the Rehabilitation of
Offenders, Hong Kong
香港社會服務聯會
Hong Kong Council of Social Service
145
References for Students
References for students:
General websites
1. http://parentingteens.about.com/library/weekly/aa052302a.htm?terms
(Party drugs)
2. http://www.drugarm.org.au/
3 . h t t p :/ / www. d ru gf ree a me rica . o rg/
4 . h t t p :/ / www. e ro wid . o rg/ ch e m ica ls/
5. http://www.drugarm.org.au/main_index/teachers_menu.htm (Site with
pictures and brief introduction for each drug)
Chinese websites
1. http://health.yahoo.com/health/drugs_tree/medication_or_drug/
2. http://www.bses.hcc.edu.tw/effect/duping/2a.htm
3. http://info.gov.hk/nd/chinese/drug/index.htm
4. http://www.catholic.org.hk/spiritual/drug.htm (介紹有關的徵兆、成因、經
常被濫用藥物種類及潛在危險)
5. http://www.nwcmoed.com.hk.ro/ (含多種類型的毒品介紹)
6. http://www.info.gov.hk/nd/text/chinese/info/index.htm (介紹麻醉鎮痛
劑、迷幻劑、鎮抑劑、興奮劑、鎮靜劑的醫藥用途及濫用後果)
7. http://www.hkcs.org/overview/csnews/c209/c209_31.htm (探討被訪者對
8.
9.
此等藥物的了解、服藥後的徵狀及處理方法)
http://www.raveparty.com.hk/drugs.htm (介紹忘我(Fing 頭丸)、海洛英、
氯胺酮(K 仔)、冰及大麻等藥物)
http://www.info.gov.hk/healthzone/exhibits/saab001/ (含藥物濫用與酗酒
的定義、影響及戒除方法)
Amphetamines
1. http://www.erowid.org/chemicals/mdma/mdma.shtml
2. http://weber.lm.fju.edu.tw/~swduh/sociology_of_drug/amphetamine_1.ht
3.
4.
m (Chinese)
http://www.greencross.org.tw/drugabuse/amph_withdraw.htm (Chinese)
http://www.nida.nih.gov/Infofax/ecstasy.html
CNS depressants (Benzodiazepines)
1. http://faculty.washington.edu/chudler/barb.html
2. http://faculty.washington.edu/chudler/roof.html
146
References for Students
Cocaine
1. http://ceiba.cc.ntu.edu.tw/health/note/drugabuse.htm (Chinese)
2. http://www.info.gov.hk/nd/text/info/4.htm (Hong Kong)
3. http://ceiba.cc.ntu.edu.tw/health/note/drugabuse.htm (Chinese)
GHB
1. http://www.adf.org.au/drughit/facts/ghb.html
2. http://www.ceida.net.au/tools_for_workers/drugs/ghb.htm
Heroin
1. http://www.tcada.state.tx.us/research/facts/heroin.pdf
2.
3.
4.
http://www.health.org
http://alcoholism.about.com/library/blnida04.htm?terms=The+Drug+Mor
phine
http://alcoholism.about.com/library/blnida04.htm?terms=The+Drug+Mor
phine
Inhalants
1. http://www.inhalants.com/
2. http://corp.aadac.com/drugs/beyond/Solvents.asp
Ketamine
1. http://www.nbcd.gov.tw/prop/prop_1-11.asp (Chinese)
2. http://www.greencross.org.tw/drugabuse/ketamine.htm (Chinese)
3. http://www.erowid.org/chemicals/ketamine/ketamine.shtml
Marijuana
1. http://www.nida.nih.gov/Infofax/marijuana.html
2. http://www.druganswer.com/chinese/index.html
147