Addiction Medicine

Addiction medicine is a medical specialty focused on the prevention, evaluation, diagnosis, treatment, and recovery of individuals with substance use disorders (SUDs). It encompasses a wide range of substances, including alcohol, opioids, stimulants, and newer synthetic drugs. Addiction medicine integrates biological, psychological, and social approaches to address the complexities of addiction.

Common Addictions

Alcohol Addiction

  • Prevalence: Most commonly abused substance worldwide.
  • Street Names: Booze, liquor, drink.
  • Health Risks: Liver disease, cardiovascular issues, neurological damage.

Symptoms of Intoxication (Timeline):

  1. Immediate: Slurred speech, impaired coordination, euphoria.
  2. Moderate: Vomiting, slowed reaction times, ataxia.
  3. Severe: Respiratory depression, unconsciousness, coma.

Symptoms of Withdrawal (Timeline):

  1. 6-12 hours: Tremors, anxiety, nausea, tachycardia.
  2. 12-24 hours: Insomnia, diaphoresis, mild hallucinations.
  3. 48-72 hours: Seizures, delirium tremens (DTs).

Medical Treatment:

  • Outpatient:
    • Benzodiazepines: Diazepam (10-20 mg every 6-8 hours, taper gradually).
    • Thiamine: 100 mg daily to prevent Wernicke’s encephalopathy.
    • Acamprosate: 666 mg three times daily for relapse prevention.
  • Hospital:
    • Intravenous benzodiazepines (e.g., Lorazepam 1-2 mg every 4-6 hours).
    • Intravenous fluids and electrolyte correction.
    • Close monitoring for DTs.
  • Rehabilitation Center:
    • Long-term counseling and support groups (e.g., AA).
    • Adjunct medications for cravings: Naltrexone (50 mg daily).

Cocaine Addiction

  • Street Names: Coke, blow, snow, crack.
  • Health Risks: Cardiovascular issues, paranoia, cognitive decline, nasal damage.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, increased energy, hypervigilance.
  2. Moderate: Tachycardia, dilated pupils, agitation.
  3. Severe: Seizures, hyperthermia, cardiovascular collapse.

Symptoms of Withdrawal (Timeline):

  1. 6-12 hours: Fatigue, depression, hypersomnia.
  2. 1-3 days: Anhedonia, irritability, intense cravings.
  3. Up to 1 week: Vivid dreams, persistent low mood.

Medical Treatment:

  • Outpatient:
    • Modafinil: 200 mg daily to address fatigue.
    • Psychotherapy: CBT for craving management.
  • Hospital:
    • Symptomatic management: Lorazepam (1-2 mg for agitation).
    • Cardiovascular support: Beta-blockers for tachycardia.
  • Rehabilitation Center:
    • Contingency management therapy.
    • Support groups like Cocaine Anonymous.

Methamphetamine Addiction

  • Street Names: Meth, ice, crystal, speed.
  • Health Risks: Severe dental decay (“meth mouth”), psychosis, cardiovascular issues.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, hyperactivity, talkativeness.
  2. Moderate: Paranoia, aggression, tachycardia.
  3. Severe: Hyperthermia, seizures, cardiovascular collapse.

Symptoms of Withdrawal (Timeline):

  1. 6-12 hours: Fatigue, excessive sleep, irritability.
  2. 24-48 hours: Depression, intense cravings.
  3. Up to 1 week: Persistent low mood, anxiety.

Medical Treatment:

  • Outpatient:
    • Bupropion: 150 mg daily to mitigate cravings.
  • Hospital:
    • Sedation: Benzodiazepines for agitation.
    • Cooling measures for hyperthermia.
  • Rehabilitation Center:
    • Behavioral therapy.
    • Structured support groups.

MDMA (Ecstasy) Addiction

  • Street Names: Molly, E, X.
  • Health Risks: Dehydration, hyperthermia, serotonin syndrome.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, heightened sensory perception, increased sociability.
  2. Moderate: Jaw clenching, sweating, tachycardia.
  3. Severe: Hyperthermia, agitation, seizures.

Symptoms of Withdrawal (Timeline):

  1. 24-48 hours: Fatigue, irritability, anhedonia.
  2. 2-4 days: Depressive symptoms, cravings.

Medical Treatment:

  • Outpatient:
    • Hydration and rest: To manage mild symptoms.
  • Hospital:
    • Cooling measures and IV fluids for hyperthermia.
    • Benzodiazepines for agitation or seizures.
  • Rehabilitation Center:
    • Psychotherapy focused on serotonin stabilization.

Marijuana (Cannabis) Addiction

  • Street Names: Weed, pot, marijuana, ganja.
  • Health Risks: Impaired memory, dependency, respiratory issues.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, relaxation, increased appetite.
  2. Moderate: Altered perception of time, paranoia, dry mouth.
  3. Severe: Anxiety, hallucinations, psychosis.

Symptoms of Withdrawal (Timeline):

  1. 24-48 hours: Irritability, insomnia, decreased appetite.
  2. 2-4 days: Restlessness, cravings.
  3. Up to 1 week: Anxiety, depression, fatigue.

Medical Treatment:

  • Outpatient:
    • Gabapentin: 300 mg three times daily for withdrawal symptoms.
    • Melatonin: 3-5 mg nightly for sleep disturbances.
  • Hospital:
    • Symptomatic management (e.g., benzodiazepines for severe agitation).
  • Rehabilitation Center:
    • Motivational interviewing and behavioral therapies.

LSD (Lysergic Acid Diethylamide) Addiction

  • Street Names: Acid, blotter, dots.
  • Health Risks: Persistent hallucinations, anxiety, psychosis.

Symptoms of Intoxication (Timeline):

  1. Immediate: Altered perception, hallucinations, synesthesia.
  2. Moderate: Tachycardia, anxiety, pupil dilation.
  3. Severe: Panic attacks, psychosis.

Symptoms of Withdrawal (Timeline):

  1. 1-3 days: Mild anxiety, difficulty concentrating.
  2. 1-2 weeks: Flashbacks, persistent low mood.

Medical Treatment:

  • Outpatient:
    • Supportive care and counseling.
  • Hospital:
    • Benzodiazepines for severe agitation.
  • Rehabilitation Center:
    • Long-term counseling to address psychological effects.

 

PCP (Phencyclidine) Addiction

  • Street Names: Angel dust, rocket fuel, hog.
  • Health Risks: Severe agitation, hallucinations, psychosis, cardiovascular issues.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, dissociation, numbness.
  2. Moderate: Hallucinations, tachycardia, hypertension, aggression.
  3. Severe: Seizures, coma, hyperthermia.

Symptoms of Withdrawal (Timeline):

  1. 24-48 hours: Cravings, irritability, depression.
  2. 2-5 days: Anxiety, fatigue, nightmares.

Medical Treatment:

  • Outpatient:
    • Antipsychotics: Haloperidol (2-5 mg orally or IM as needed for psychosis).
  • Hospital:
    • Sedation: Benzodiazepines (Lorazepam 1-2 mg for agitation).
    • Cooling measures and IV fluids for hyperthermia.
  • Rehabilitation Center:
    • Behavioral therapy and long-term support.

Fentanyl Addiction

  • Street Names: China white, TNT, apache.
  • Health Risks: Extreme respiratory depression, high overdose risk, death.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, pinpoint pupils, drowsiness.
  2. Moderate: Slurred speech, respiratory depression.
  3. Severe: Cyanosis, coma, death.

Symptoms of Withdrawal (Timeline):

  1. 6-12 hours: Anxiety, sweating, yawning.
  2. 12-48 hours: Muscle aches, vomiting, diarrhea.
  3. 48-72 hours: Severe cravings, agitation, insomnia.

Medical Treatment:

  • Outpatient:
    • Buprenorphine/Naloxone (Suboxone): Initial dose 2-4 mg, titrate up to 16 mg daily.
    • Clonidine: 0.1 mg twice daily for withdrawal symptoms.
  • Hospital:
    • Naloxone (Narcan) for overdose: 0.4-2 mg IV or IM, repeat as necessary.
    • Methadone: Initial dose 20-30 mg, adjusted based on symptoms.
  • Rehabilitation Center:
    • Maintenance therapy with Methadone or Buprenorphine.
    • Intensive counseling and peer support groups.

Cocaine Addiction

  • Street Names: Coke, blow, snow, crack.
  • Health Risks: Cardiovascular issues, paranoia, cognitive decline, nasal damage.

Symptoms of Intoxication (Timeline):

  1. Immediate: Euphoria, increased energy, hypervigilance.
  2. Moderate: Tachycardia, dilated pupils, agitation.
  3. Severe: Seizures, hyperthermia, cardiovascular collapse.

Symptoms of Withdrawal (Timeline):

  1. 6-12 hours: Fatigue, depression, hypersomnia.
  2. 1-3 days: Anhedonia, irritability, intense cravings.
  3. Up to 1 week: Vivid dreams, persistent low mood.

Medical Treatment:

  • Outpatient:
    • Modafinil: 200 mg daily to address fatigue.
    • Psychotherapy: CBT for craving management.
  • Hospital:
    • Symptomatic management: Lorazepam (1-2 mg for agitation).
    • Cardiovascular support: Beta-blockers for tachycardia.
  • Rehabilitation Center:
    • Contingency management therapy.
    • Support groups like Cocaine Anonymous.



Emerging Street Drugs: A Comprehensive Guide

 

The illicit drug landscape is constantly evolving, with new substances emerging on the streets. These drugs often pose significant public health risks due to their high potency, unknown chemical composition, and lack of regulation. This guide provides an overview of some of the newest drugs, their effects, dangers, and medical considerations for healthcare providers and first responders.

  1. Nitazenes (Synthetic Opioids)
  • Description: Nitazenes are synthetic opioids, significantly more potent than fentanyl.
  • Street Names: Iso, Protonitazene, Metonitazene.
  • Forms: Pills, powders, liquid formulations.
  • Effects: Euphoria, respiratory depression, sedation.
  • Dangers: Extreme overdose risk due to high potency.
  • Medical Considerations:
    • Overdose Treatment: Naloxone (Narcan) may require higher doses.
    • Withdrawal Management: Methadone or Buprenorphine.
  1. Xylazine (“Tranq”)
  • Description: Xylazine is a veterinary tranquilizer increasingly found mixed with opioids.
  • Street Names: Tranq, Zombie Drug.
  • Forms: Injectables, powders mixed with fentanyl or heroin.
  • Effects: Sedation, muscle relaxation, profound CNS depression.
  • Dangers:
    • Severe necrotic skin ulcers at injection sites.
    • Respiratory depression resistant to Naloxone.
  • Medical Considerations:
    • Wound Care: Debridement and antibiotic therapy for skin infections.
    • Supportive Care: Oxygen therapy, intubation if necessary.
  1. Flualprazolam (Designer Benzodiazepines)
  • Description: A highly potent synthetic benzodiazepine with longer-lasting effects.
  • Street Names: Flu, Fake Xanax.
  • Forms: Tablets, powders.
  • Effects: Sedation, amnesia, respiratory depression.
  • Dangers:
    • Increased overdose risk when combined with opioids or alcohol.
  • Medical Considerations:
    • Overdose Treatment: Flumazenil in severe cases (use with caution).
    • Withdrawal Management: Gradual tapering with long-acting benzodiazepines (e.g., Diazepam).
  1. Protonitazene (Synthetic Opioid)
  • Description: An emerging synthetic opioid from the Nitazene class.
  • Street Names: ISO, Nitro.
  • Forms: Powder, tablets, nasal sprays.
  • Effects: Intense euphoria, analgesia, respiratory depression.
  • Dangers: High overdose potential, especially when mixed with other depressants.
  • Medical Considerations:
    • Overdose Treatment: High-dose Naloxone.
    • Addiction Treatment: Methadone or Buprenorphine.
  1. Synthetic Cathinones (New “Bath Salts”)
  • Description: A newer wave of synthetic cathinones with stimulant and hallucinogenic properties.
  • Street Names: Flakka 2.0, Cloud Nine.
  • Forms: Crystals, powders.
  • Effects: Increased energy, hallucinations, paranoia, aggression.
  • Dangers:
    • Severe psychosis, hyperthermia, cardiovascular collapse.
  • Medical Considerations:
    • Acute Management: Sedation with Benzodiazepines (e.g., Lorazepam 2-4 mg IV).
    • Cooling Measures: For hyperthermia.
  1. Synthetic Cannabinoids (New “Spice” Blends)
  • Description: Modified synthetic cannabinoids designed to evade legal restrictions.
  • Street Names: Kronic, Black Mamba.
  • Forms: Herbal mixtures, vape liquids.
  • Effects: Euphoria, hallucinations, confusion.
  • Dangers:
    • Cardiovascular issues, seizures, psychosis.
  • Medical Considerations:
    • Symptomatic Treatment: Benzodiazepines for agitation.
    • Psychiatric Care: For prolonged psychosis.
  1. Etizolam (Benzodiazepine Analog)
  • Description: A benzodiazepine-like drug with sedative and hypnotic properties.
  • Street Names: Etilaam, Etiz.
  • Forms: Tablets, powders.
  • Effects: Relaxation, drowsiness, amnesia.
  • Dangers:
    • High addiction potential, risk of fatal overdose when mixed with depressants.
  • Medical Considerations:
    • Withdrawal Management: Gradual tapering with long-acting benzodiazepines.

Public Health Implications

  1. Surveillance: Monitoring drug trends through toxicology reports and emergency department data.
  2. Education: Informing the public and healthcare professionals about the risks of these substances.
  3. Policy: Strengthening laws to control emerging drugs while ensuring harm-reduction strategies.

Conclusion

The rapid emergence of new street drugs underscores the need for vigilance in healthcare and law enforcement. Medical professionals must stay informed about these substances to provide effective treatment and reduce associated harms. This guide aims to support education and preparedness in addressing the challenges posed by these evolving threats.

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