Illicit Drug Use

Question 1

Opiods-Heroin

Answer 1

EffectsEuphoria, drowsiness, constipation, pupillary constriction, respiratory depression
Withdrawal featuresPiloerection, insomnia, restlessness, dilated pupils, yawning, sweating, abdominal cramps

Question 2

Amphetamine and cocaine

Answer 2

EffectsIncreased energy, insomnia, hyperactivity, euphoria, paranoia, reduced appetite
Withdrawal featuresHypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, increased appetite

Question 3

MDMA(ecstasy)

Answer 3

EffectsIncreased energy, increased sweating, jaw clenching, euphoria, enhanced sociability, increased response to touch
Withdrawal featuresDepression, insomnia, depersonalisation, derealisation

Question 4

Cannabis

Answer 4

EffectsRelaxation, intensified sensory experience, paranoia, anxiety, injected conjunctivae
Withdrawal featuresInsomnia, reduced appetite, irritability

Question 5

Hallucinogens eg lsd

Answer 5

EffectsPerceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, inco-ordination
Withdrawal featuresNo recognised withdrawal syndrome

Question 6

Ketamine

Answer 6

EffectsEuphoria, dissociation, ataxia, hallucinations, muscle rigidity
Withdrawal featuresNo recognised withdrawal syndrome

Question 7

Heroin withdrawal

Answer 7

Early features of heroin withdrawal include:-

Agitation
Yawning
Muscle aches
Sweating
Anxiety
Increased tearing
Runny nose

Late features include:-

Abdominal cramping
Vomiting
Dilated pupils
Diarrhea
Nausea
Piloerection

Question 8

PCP intoxication

Answer 8

People who have consumed PCP are typically ataxic and display dysarthria. Associated hallucinations tend to be complex rather than simple. Increased salivation rather than dry mouth would be expected. Phencyclidine (PCP, angel dust) is an infamous hallucinogenic sought for its ability to induce the illusion of euphoria, omnipotence, superhuman strength, and social and sexual prowess. The acronym PCP stems from its organic name 1-(1-phenylcyclohexyl) piperidine.

It is a NMDA receptor antagonist (similar to ketamine) that has dissociative properties.

Like ketamine, PCP was formerly used as a preinduction anesthetic and animal tranquilizer, hence it has street eponyms such as horse tranquilizer, hog, and elephant. It was used for its ability to provide anesthesia and analgesia without triggering cardiorespiratory depression, but was soon recalled when patients experienced psychosis, agitation, and dysphoria post-operatively.

It is available as a white crystalline powder (angel dust), tablet (PeaCe Pill), crystals, and liquid (whack). It can be snorted, smoked, ingested or injected intravenously or subcutaneously.

It has a large volume of distribution and so clinical effects do not reliably correlate with plasma concentration.

People who have taken PCP often present with the classic toxidrome of PCP intoxication:

violent behavior
nystagmus
tachycardia
hypertension
anesthesia
analgesia

Additional features include impaired motor function, and psychiatric symptoms including hallucinations, delusions, and paranoia (possibly due to its additional effect as a D2 agonist).

PCP intoxication is best managed with benzodiazepines along with supportive measures for breathing and circulation. Benzodiazepines are recommended in patients without psychosis, as antipsychotics can amplify PCP-induced hyperthermia, dystonic as well as anticholinergic reactions, and lower the seizure threshold. However, haloperidol has been described as a useful treatment for PCP-induced psychosis provided the patient is not hyperthermic.

Most deaths in PCP-intoxicated patients result from patients violent behavior, rather than direct effects of the drug.
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