Drug Awareness

Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. 

What is alcohol?

Alcohol is produced by the fermentation of yeast, sugars, and starches. It is a central nervous system depressant, absorbed from the stomach and small intestine into the bloodstream. 

Mathematics of Alcohol

A standard drink equals 0.6 ounces of pure ethanol, or 12 ounces of beer. A standard drink also equals 8 ounces of malt liquor, 5 ounces of wine. or 1.5 ounces (a "shot") of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

Alcohol remains the most troublesome drug of abuse in Iowa. Alcohol consumption, treatment admissions, and involvement with the criminal justice system are all increasing.

• Above the Influence
• National Institute on Alcohol Abuse and Alcoholism
• Partnership for Drug-Free Kids
   

Cocaine is an addictive stimulant drug made from the leaves of the coca plant native to South America. It produces short-term euphoria, energy, and talkativeness. It also has dangerous physical effects like raising heart rate and blood pressure.

• National Institute on Drug Abuse - Cocaine 

Cocaine is a Schedule II controlled substance.

Cocaine is a powerfully addictive drug of abuse. Individuals who have tried cocaine have described the experience as a powerful high that gave them a feeling of supremacy. However, once someone starts using cocaine, one cannot predict or control the extent to which he or she will continue to use the drug. The primary ways of administering cocaine are sniffing or snorting, injecting, and smoking (including free-base and crack cocaine).

Health risks exist regardless of whether cocaine is inhaled (snorted), injected, or smoked. However, it appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted. Smoking allows extremely high doses of cocaine to reach the brain very quickly and results in an intense and immediate high. The injecting drug user is also at risk for acquiring or transmitting HIV infection/AIDS if needles or other injection equipment are shared.

Health Hazards

Physical Effects - Physical effects of cocaine use include constricted peripheral blood vessels, dilated pupils, and increased body temperature, heart rate, and blood pressure. Some cocaine users report feelings of restlessness, irritability, and anxiety, both while using and between periods of use. An appreciable tolerance to the high may be developed, and many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure.

Paranoia and Aggression - High doses of cocaine and/or prolonged use can trigger paranoia. Smoking crack cocaine can produce particularly aggressive paranoid behavior in users. When addicted individuals stop using cocaine, they may become depressed. This depression causes users to continue to use the drug to alleviate their depression.

Long-Term Effects - Prolonged cocaine snorting can result in ulceration of the mucous membrane of the nose and can damage the nasal septum enough to cause it to collapse. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Added Danger - When people mix cocaine and alcohol, they are compounding the danger each drug poses and unknowingly causing a complex chemical interaction within their bodies. Researchers have found that the human liver combines cocaine and alcohol to manufacture a third substance, cocaethylene, which intensifies cocaine's euphoric effects and possibly increases the risk of sudden death.

Promethazine-codeine cough syrup is a medication that contains codeine. Codeine is an opioid that acts as a cough suppressant. It can also produce relaxation and euphoria when consumed at a higher-than-prescribed dose. It also contains promethazine HCl, an antihistamine that additionally acts as a sedative. Although only available by prescription, promethazine-codeine cough syrup is sometimes diverted for abuse.

Dextromethorphan (DXM) is a cough suppressant found in many over-the-counter cold medicines. It may produce dissociative effects or hallucinations when taken in a high dose. 

• Additional NIDA Information

Counterfeit pills are fake medications that have different ingredients than the actual medication. They may contain no active ingredient, the wrong active ingredient, or have the right ingredient in the wrong quantity. Counterfeit pills may contain lethal amounts of fentanyl or methamphetamine. They are extremely dangerous because they often appear identical to legitimate prescription pills. Often, the user is unaware of how lethal they can be.

• Fake Pills Cause Real Harm
• DEA Fact Sheet - Counterfeit Pills
• DEA - One Pill Can Kill
• YourLifeIowa - Fake Pills
• NIDA - Fentanyl DrugFacts

Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine. Pharmaceutical fentanyl was developed for pain management treatment of cancer patients. It is applied in a patch on the skin. Because of its powerful opioid properties, Fentanyl is also diverted for abuse. Fentanyl is added to heroin to increase its potency, or be disguised as highly potent heroin. Many users believe that they are purchasing heroin and actually don’t know that they are purchasing fentanyl. This often results in overdose deaths. Clandestinely-produced fentanyl is primarily manufactured in Mexico.

• Fentanyl Awareness Day
• DEA Fact Sheet - Fentanyl
• NIDA - Fentanyl DrugFacts
• Naloxone Iowa

Fentanyl is a Schedule II controlled substance.

First synthesized in Belgium in the late 1950s, fentanyl, (Schedule II controlled substance) with an analgesic potency of about 80 times that of morphine, was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze®. Thereafter; two other fentanyl analogues were introduced; alfentanil (Alfenta®), an ultra-short (5-10 minutes) acting analgesic, and sufentanil (Sufenta®), an exceptionally potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery. Today, fentanyls are extensively used for anesthesia and analgesia. Duragesic®, for example, is a fentanyl transdermal patch used in chronic pain management, and Actiq® is a solid formulation of fentanyl citrate on a stick that dissolves slowly in the mouth for transmucosal absorption. Actiq® is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil®) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals.

Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical community and continues in the present. United States authorities classify fentanyl as a narcotic. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are similar to those of heroin, with the exception that there is less of a euphoric 'high' associated with the drug and a stronger analgesic effect. Additionally, fentanyl may be hundreds of times more potent — though in some places, it is sold as heroin, often leading to overdoses. Fentanyl also has a shorter half-life than that of heroin, and is most commonly used orally, but like heroin, can also be smoked, snorted or injected.

Actiq has appeared on the streets under the street name of "percopop". The pharmacy retail price ranges from $16 to $50 per unit (based on strength of lozenge), with the black market cost anywhere from $20 to $60 per unit, depending on the strength.

Some heroin dealers mix fentanyl powder with larger amounts of heroin in order to increase potency or compensate for low-quality heroin, and to increase the volume of their product. As of late May 2006, a mix of fentanyl and either cocaine or heroin has caused an outbreak in overdose deaths in the United States, heavily concentrated in the cities of Detroit, Philadelphia, Milwaukee, Camden, Chicago and Little Rock. The mixture of fentanyl and heroin is known as "magic", among other names, on the street.

Both Actiq and Duragesic are becoming as popular as OxyContin in pharmacy burglaries and robberies. In the U.S., law enforcement agencies are being instructed in how to tell the difference between Actiq and other medications so they are better able to notice abuse of the drug.

Several large quantities of illicitly-produced fentanyl have been seized by U.S. law enforcement agencies. In June 2006, 945 grams of 83%-pure fentanyl powder were seized by Border Patrol agents in California from a vehicle which had entered from Mexico. Mexico is the source of much of the illicit fentanyl for sale in the U.S. However, there has been one domestic fentanyl lab discovered by law enforcement, in April 2006 in Azusa, California. The lab was a source of counterfeit 80 mg OxyContin tablets containing fentanyl instead of oxycodone, as well as bulk fentanyl and other drugs.

The "china white" form of fentanyl refers to the clandestinely produced alpha-methyl strain (AMF) . This has been reported in the literature to be twice the strength of regular fentanyl. The main bonus of the alpha-methyl is it provides a site of resistance to metabolic degradation resulting in a drug with an increased duration. 

Fentanyl has been diverted by pharmacy theft, fraudulent prescriptions and illicit distribution by patients, physicians and pharmacists. Theft has also been identified at nursing homes and other long-term care facilities. Fentanyl oral transmucosal lozenges (Actiq®) are typically sold at $20-25 per unit or $450 per carton (contains 24 units) while transdermal patches (Duragesic®) are sold at prices ranging from $10 to $100 per patch depending upon the dose of the unit and geographical area. There is evidence of large illegal distribution rings selling fentanyl products along with other opioid pharmaceuticals.

Source: DEA Diversion Control Program

Health Hazards

Symptoms of an overdose from fentanyl are:

Low breathing
Seizures
Dizziness
Confusion
Dry mouth
Weakness
Loss of consciousness
Coma
Confusion
Tiredness
Cold and clammy skin
Small pupils

Typical side effects of duragesic therapy include abdominal pain, anxiety, confusion, constipation, depression, diarrhea, dizziness, dry mouth, euphoria, hallucinations, headache, impaired or interrupted breathing, indigestion, itching, anorexia, nausea, agitation, shortness of breath, sleepiness, sweating, urinary retention, vomiting, and weakness.

Hallucinogens are a diverse group of drugs that alter perception. They alter awareness of surrounding objects and conditions. They can also alter thoughts and feelings. They cause hallucinations, or sensations and images that seem real though they are not. Hallucinogens can be found in some plants and mushrooms (or their extracts) or can be human-made. People have used hallucinogens for centuries, mostly for religious rituals. Common hallucinogens include the following: ayahuasca, DMT, LSD, peyote, and psilocybin.

• National Institute on Drug Abuse - Hallucinogens

Many products found in the home or workplace contain volatile substances that have mind-altering properties when inhaled. These products include spray paints, markers, glues, and cleaning fluids. People do not typically think of these products as drugs because they were never intended for that purpose. However, these products are sometimes abused in that way. They are especially abused by young children and adolescents. They are the only class of substance abused more by younger than by older teens.

• National Institute on Drug Abuse - Inhalants

“Kratom” commonly refers to an herbal substance that can produce opioid- and stimulant-like effects. 

While there are no uses for kratom approved by the U.S. Food and Drug Administration, people report using kratom to manage drug withdrawal symptoms and cravings (especially related to opioid use), pain, fatigue and mental health problems.

Rare but serious effects have been reported in people who use kratom, including psychiatric, cardiovascular, gastrointestinal and respiratory problems.

Kratom is currently legal in Iowa.

• DEA Fact Sheet - Kratom
• NIDA - Kratom
• LAPPA - Regulation of Kratom in America

Tetrahydrocannabinol, or THC, is the psychotropic ingredient in marijuana.

Marijuana concentrates have very high levels of THC.

Solvent-based products tend to be especially potent, with THC levels documented at an average of about 54-69% and reported to exceed 80%, while non-solvent based extraction methods produce average THC levels between 39-60%. In comparison, the THC content in marijuana plant material, which is often used in marijuana cigarettes, is lower—with samples seized by the U.S. Drug Enforcement Agency averaging just over 15%.

Exposure to high levels of THC increases the risks of physical dependence and addiction. Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis.

• NIDA
• NIDA - Marijuana Concentrates
• NIDA - Cannabis
• Iowa Medical CBD Program
• Iowa Consumable Hemp

Marijuana is a Schedule I controlled substance.

It is commonly grown in any climate that can sustain plant life. Marijuana can be grown locally or smuggled into the United States from other source countries.

Usually smoked as a cigarette or joint, or in a pipe or bong, marijuana has appeared in "blunts" in recent years. These are cigars that have been emptied of tobacco and refilled with marijuana, sometimes in combination with another drug, such as crack. Some users also mix marijuana into foods or use it to brew tea.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). Short-term effects of marijuana use include problems with memory and learning; distorted perception; difficulty in thinking and problem-solving; loss of coordination; and increased heart rate, anxiety, and panic attacks.

Health Hazards

Effects of Marijuana on the Brain - Researchers have found that THC changes the way in which sensory information gets into and is acted on by the hippocampus. This is a component of the brain's limbic system that is crucial for learning, memory, and the integration of sensory experiences with emotions and motivations. Investigations have shown that THC suppresses neurons in the information-processing system of the hippocampus. In addition, researchers have discovered that learned behaviors, which depend on the hippocampus, also deteriorate.

Effects on the Lungs - Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers have. These individuals may have daily cough and phlegm, symptoms of chronic bronchitis, and more frequent chest colds. Continuing to smoke marijuana can lead to abnormal functioning of lung tissue injured or destroyed by marijuana smoke.

Regardless of the THC content, the amount of tar inhaled by marijuana smokers and the level of carbon monoxide absorbed are three to five times greater than among tobacco smokers. This may be due to marijuana users inhaling more deeply and holding the smoke in the lungs.

Effects of Marijuana Use during Pregnancy - Research has shown that babies born to women who used marijuana during their pregnancies display altered responses to visual stimuli, increased tremulousness, and a high-pitched cry, which may indicate problems with neurological development. During infancy and preschool years, marijuana-exposed children have been observed to have more behavioral problems and to perform tasks of visual perception, language comprehension, sustained attention, and memory more poorly than non-exposed children do. In school, these children are more likely to exhibit deficits in decision-making skills, memory, and the ability to remain attentive.

Effects of Heavy Marijuana Use on Learning and Social Behavior - A study of college students has shown that critical skills related to attention, memory, and learning are impaired among people who use marijuana heavily, even after discontinuing its use for at least 24 hours. Researchers compared 65 "heavy users," who had smoked marijuana a median of 29 of the past 30 days, and 64 "light users," who had smoked a median of 1 of the past 30 days. After a closely monitored 19- to 24-hour period of abstinence from marijuana and other illicit drugs and alcohol, the undergraduates were given several standard tests measuring aspects of attention, memory, and learning. Compared to the light users, heavy marijuana users made more errors and had more difficulty sustaining attention, shifting attention to meet the demands of changes in the environment, and in registering, processing, and using information. The findings suggest that the greater impairment among heavy users is likely due to an alteration of brain activity produced by marijuana.

Longitudinal research on marijuana use among young people below college age indicates those who used have lower achievement than the nonusers, more acceptance of deviant behavior, more delinquent behavior and aggression, greater rebelliousness, poorer relationships with parents, and more associations with delinquent and drug-using friends.

Methamphetamine is a central nervous system stimulant drug. Due to its high potential for abuse, methamphetamine is classified as a Schedule II drug. Most of the methamphetamine used in this country comes from drug trafficking organizations from Mexico other countries. It can also be made in small, illegal laboratories. Its production endangers the people in the labs, neighbors, and the environment.

• Increase in Methamphetamine Use by Iowans
• Iowa Department of Public Health - Methamphetamine in Iowa
• National Institute on Drug Abuse - Methamphetamine

Methamphetamine, also called "meth," is a Schedule II controlled substance.

It is highly abused and has become an epidemic throughout the United States. Methamphetamine is a very strong central nervous system stimulant.

Methamphetamine is an addictive stimulant drug that strongly activates certain systems in the brain. Methamphetamine is closely related chemically to amphetamine, but the central nervous system effects of methamphetamine are greater. Both drugs have some medical uses, primarily in the treatment of obesity, but their therapeutic use is limited.

Street methamphetamine is referred to by many names, such as "speed," "meth," and "chalk." Methamphetamine hydrochloride, clear chunky crystals resembling ice, which can be inhaled by smoking, is referred to as "ice," "crystal," and "glass."

Health Hazards

Neurological hazards - Methamphetamine releases high levels of the neurotransmitter dopamine, which stimulates brain cells, enhancing mood and body movement. It also appears to have a neurotoxic effect, damaging brain cells that contain dopamine and serotonin, another neurotransmitter. Over time, methamphetamine appears to cause reduced levels of dopamine, which can result in symptoms like those of Parkinson's disease, a severe movement disorder.

Addiction - Methamphetamine is taken orally or intranasally (snorting the powder), by intravenous injection, and by smoking. Immediately after smoking or intravenous injection, the methamphetamine user experiences an intense sensation, called a "rush" or "flash," that lasts only a few minutes and is described as extremely pleasurable. Oral or intranasal use produces euphoria - a high, but not a rush. Users may become addicted quickly, and use it with increasing frequency and in increasing doses.

Short-term effects - The central nervous system (CNS) actions that result from taking even small amounts of methamphetamine include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hyperthermia, and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hyperthermia and convulsions can result in death.

Long-term effects - Methamphetamine causes increased heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, producing strokes. Other effects of methamphetamine include respiratory problems, irregular heartbeat, and extreme anorexia. Its use can result in cardiovascular collapse and death.

Nitazenes are a novel group of powerful illicit synthetic opioids. They have been linked to overdose deaths in several states. Nitazenes were created as a pain reliever nearly 60 years ago. They have never been approved for use in the United States. Laboratory tests show that the potency of certain nitazenes exceeds that of fentanyl.

• CDC
• DEA Drug Analysis - Nitazines
• DEA - Isotonitazine
• WHO - Isotonitazine

Opioids are a class of drugs that include the illegal drug heroin as well as powerful pain relievers available by prescription. These include:

• oxycodone (OxyContin®)
• hydrocodone (Vicodin®)
• codeine
• morphine
• fentanyl, and many others. 

These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain. 

Common Uses

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor. They are frequently misused (taken in a different way or in a greater quantity than prescribed, or taken without a doctor’s prescription). They can produce euphoria as well as pain relief. 

Effects of Misuse

Regular use—even as prescribed by a doctor—can produce dependence. When misused or abused, opioid pain relievers can lead to fatal overdose. The current epidemic of prescription opioid abuse has led to an increased use of heroin.

Heroin is an opioid drug that is synthesized from morphine. It is a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”

• Iowa Opioid Impacts and Solutions

Psilocybin is a chemical obtained from certain types of fresh or dried mushrooms.

Psilocybin mushrooms are ingested orally. They may also be brewed as a tea or added to other foods to mask their bitter flavor.

The psychological consequences of psilocybin use include hallucinations and an inability to discern fantasy from reality. Panic reactions and a psychotic-like episode also may occur, particularly if a user ingests a high dose.

Psilocybin is currently illegal in Iowa. 

• DEA
• DEA Fact Sheet - Psilocybin
• NIDA - Hallucinogens DrugFacts
• JAMA - Psilocybin Clinical Trials
• Science Daily Research

Synthetic drugs, also referred to as designer or club drugs, are chemically-created in a lab to mimic another drug such as marijuana, cocaine or morphine.

• Just Think Twice - Synthetic Drugs

Cannabinoids

Synthetic cannabinoids refer to man-made, mind-altering chemicals. They are sprayed on dried plant material so they can be smoked. Or, sold as liquids to inhaled in e-cigarettes and other devices.

National Institute on Drug Abuse - Synthetic Cannabinoids

• Called K2, Spice, and many other names, and are labeled as "not for human consumption" 
• A mixture of herbs, spices, or shredded plant material that is typically sprayed with a synthetic compound
• Can be smoked in pipes or joints, or made into tea
• Short term effects include: increased agitation, pale skin, seizures, vomiting, profuse sweating, uncontrolled body movements, elevated blood pressure, dysphasia, severe paranoia, delusions, and hallucinations
• Sold at tobacco shops, convenience stores, gas stations, head shops, truck stops, and via the Internet

Cathinones

Synthetic cathinones, also known as "bath salts," are synthetic drugs chemically related to a stimulant found in the khat plant. 

​National Institute on Drug Abuse - Synthetic Cathinones

• NOT real bath salts! They are referred to as novelty items, and are labeled “not for human consumption”
• Also marketed as bath crystals, plant food, and herbal incense
• Described as a white, tan or brown odorless, powdery substance
• Contain derivatives of the chemical cathinone. Cathinone is a Schedule 1 Controlled Substance. “Bath salts” may also contain large amounts of caffeine.
• Both MDPV and mephedrone are central nervous stimulants
• Effects are similar to cocaine, methamphetamine, or MDMA. Sometimes called “fake” cocaine or “fake” meth
• Can be snorted, injected, or eaten
• Physical Effects: racing heart beat, extreme elevations of blood pressure, sleeplessness, loss of appetite, strange eye movements
• Psychological Effects: extreme agitation or anxiety, hallucinations, paranoia, change in personality, depression, aggression or disturbed behavior, delusions, hostility, violence, suicidal thoughts
• Sold at tobacco shops, convenience stores, gas stations, head shops, truck stops, and via the Internet

Club Drugs

Club drugs tend to used by teenagers and young adults at bars, nightclubs, concerts, and parties. Club drugs include GHB, Rohypnol, ketamine, MDMA (Ecstasy), Methamphetamine, and LSD (Acid). 

• National Institute on Drug Abuse - MDMA (Molly/Ecstasy)

Vaping is the act of inhaling and exhaling an aerosol or vapor made from a liquid or dry material. The material is heated in an electronic powered device. These devices are called electronic cigarettes, or e-cigarettes.

The liquid can contain flavoring, nicotine, or marijuana concentrates.

Vaping is not considered safe, especially for teens and young adults. The adolescent brain is still developing. Inhaling any substance through these devices may be harmful.

Vaping is currently legal for Iowans 21+, when using legal substances.

• DEA
• NIDA - Vaping
• DEA Fact Sheet - Vaping and Marijuana Concentrates

Xylazine is a non-opioid veterinary tranquilizer. 

It is not approved for human use. 

Xylazine has been linked to an increasing number of overdose deaths nationwide. 

People exposed to xylazine often used it in combination with other drugs, with or without their knowledge. It is most often used with illicit fentanyl.

• NIDA
• Iowa HHS Public Safety Alert - Xylazine (May 2023)
• Iowa Poison Control Center Alert - Xylazine (May 2023)