Substance Use

Commonly Used Substances


Caffeine is an alkaloid found naturally in coffee, tea, kola nuts, mate, and guarana. It is a stimulant to the central nervous system, cardiac muscles, and respiratory system. Caffeine is a diuretic and delays fatigue. People can vary in their sensitivity to caffeine, and listed below are common side effects of caffeine use.

Side Effects:

  • Elevated mood and energy
  • Shakiness
  • Insomnia
  • Headaches
  • Dizziness
  • Increased heart rate
  • Dehydration
  • Dependency

Dependency can occur after regular use of caffeine, and the body experiences withdrawal symptoms when caffeine intake is decreased or eliminated. Even you may have experienced one of the side effects of skipping the usual morning cup – a caffeine withdrawal headache.

The American Medical Association Council on Scientific Affairs suggests that 2-3 cups of coffee a day or up to 5 servings of any caffeinated beverage is considered average moderate use for most people. Drinking up to 10 cups of coffee is considered excessive, and too much caffeine can cause trouble breathing, confusion, diarrhea, fever, or vomiting.  Large amounts of caffeine over time have been linked to health problems like osteoporosis or fibrocystic disease, and you may want to limit your intake if you are prone to sleep problems or have acid reflux, stomach problems, high blood pressure, or chronic headaches.

Caffeine + Alcohol:

Mixing caffeine with alcohol can be dangerous. The stimulation caused from caffeine has the ability to mask the depressant effects of alcohol. Masking the body’s natural response to alcohol can also inhibit a person’s ability to respond to the body’s natural warning signs during alcohol use. People mixing the two substances are more likely to binge drink and experience the harmful effects and increased risks normally associated with alcohol.

Centers for Disease Control, Fact Sheets – Caffeine and Alcohol:

Cannabis; “Marijuana”

Cannabis is a substance that acts as a depressant, which means that it slows nervous activity in the brain. Cannabis comes in the forms of marijuana, hashish, or hash oil; and they can be smoked or added to foods.  The active ingredient in cannabis is known as “THC.” THC is short for delta-9 tetrahydrocannabinol, which binds to the CB1 (cannibinoid) receptor in the central nervous system. THC is the chemical responsible for the commonly described effects of cannabis.

Effects depend on:

  • How much you use
  • How often and how long you’ve used
  • Smoked or ingested
  • Your mood, expectations, environment
  • Your age
  • Pre-existing medical or psychiatric conditions
  • Any alcohol or other drugs taken (illicit or prescription)

Side Effects:

Marijuana taken in low doses:

  • Feeling relaxed or sleepy
  • Spontaneous laughter or excitement
  • Increased appetite
  • Dry mouth
  • Introverted disposition

Marijuana taken in large doses:

  • Difficulty concentrating
  • Blurred vision
  • Clumsiness
  • Slowed reflexes
  • Bloodshot eyes
  • Visual or auditory hallucinations
  • Increased heart rate
  • Lowered blood pressure
  • Mild anxiety
  • Paranoia

Long-term effects:

  • Memory loss
  • Difficulty learning
  • Mood swings
  • Regular colds or flu
  • Decreased sex drive
  • Fertility difficulties
  • Dependency
  • Financial, work, and social problems

Smoking cannabis has increased risks associated with the risks of smoking, which can cause sore throat, asthma, and bronchitis.

A family history of mental illness can also be a predisposition to increased intensity of psychological effects from cannabis, such as anxiety, depression, and psychotic symptoms (e.g., hallucinations, delusions).

Withdrawal Symptoms:

  • Anxiety
  • Irritability
  • Aggressive/angry behavior
  • Loss of appetite
  • Upset stomach
  • Sweating
  • Chills
  • Tremors
  • Restless sleep and/or nightmares

Withdrawal symptoms can last for only a week, with the exception of sleep which can be affected for a longer period of time.

Cannabis + Alcohol:

Cannabis and alcohol are both depressants to the central nervous system, which means mixing can lead to increased side effects and risks from both substances. Effects can include increased dizziness, anxiety, panic, disorientation, nausea, vomiting, and loss of consciousness.

Medical Use:

In recent years, there has been an increase in medical research, medical use, and decriminalization of cannabis products. The cannabis plant contains over 100 other cannabinoids, which are a large family of chemicals related to THC. The two cannabinoids of medical interest are THC and cannabidiol (CBD). THC is used as an appetite stimulant and an antiemetic, which suppresses nausea and vomiting. The antiemetic in THC is used to control vomiting and nausea, cancer chemotherapy, and used to subside weight loss in AID’s patients. This antiemetic is also used to decrease pain, inflammation, and spasticity. CBD is a non-psychoactive cannabinoid, which means it has no mind-altering effects, and it has been used to reduce pain and inflammation, control epileptic seizures, and treat psychosis and addictions. The National Institute of Health continues to investigate possible therapeutic uses of other cannabinioids. Despite its medical uses, cannabis is still a controlled substance that should be taken with responsibility, moderation, and caution.

Australian Drug Foundation:
National Institute on Drug Abuse:

Cocaine; “Blow;” “Crack”

Cocaine originates from the leaves of the coca plant native to South America. Cocaine can be in powdered form, which is snorted or dissolved and injected, or in the form of a crystal rock, known as crack, that can be smoked. Cocaine is a central nervous system stimulate that increases levels of the neurotransmitter dopamine. Normally nuerons release dopamine in response to a potential reward, like the smell of food, and then recycle the dopamine back to shut off the signal. Cocaine prevents the recycling of dopamine, which leads to the build up and amplification of the dopamine signal. Though it can be described as feeling high or euphoric, this process also causes disruption in normal, healthy brain communication and can lead to addiction.

Side Effects:

These intensity and duration of cocaine’s effects are dependent on whether it was smoked, snorted, or injected. The effects of snorting cocaine may last 15-30 minutes, whereas the effects from smoking may last only 5-10 minutes. Effects include:

  • Increased energy and alertness
  • Elevated mood
  • Feelings of superiority
  • Irritability
  • Paranoia
  • Restlessness
  • Anxiety
  • Constricts blood vessels
  • Dilates pupils
  • Increases body temperature, heart rate, and blood pressure
  • Headaches
  • Tremors
  • Vertigo
  • Muscle twitches

Long-term use:

  • Loss of appetite, weight loss, malnourishment
  • Cardiovascular: disturbances with heart rhythm, increased risk for heart attack
  • Neurological: strokes, seizures, headaches, coma
  • Gastrointestinal: abdominal pain, nausea, bowel gangrene
  • Respiratory: nosebleeds, problems swallowing, hoarseness, chronic runny nose
  • Injection damages: severe allergic reactions, track marks, death
  • Increased risk for contraction of blood-borne diseases, such as HIV or hepatitis C
  • Death

Withdrawal Symptoms:

  • Agitation
  • Restlessness
  • Fatigue
  • Generalized malaise (general feeling of discomfort, illness, or lack of well-being)
  • Increased appetite
  • Vivid nightmares
  • Slowed activity
  • Depression
  • Cravings

Signs of cocaine use include:

  • Dilated pupils
  • Excited, exuberant speech
  • High levels of energy and activity
  • Nosebleeds
  • Weight loss

Brief History: Cocaine is a derivative of the coca plant which is native to the Andes Mountains. The native people would chew on coca leaves to combat elevation sickness, elevate mood, aid in digestion and for religious ceremonies. It was not until 1859 that Albert Nieman was able to isolate cocaine from the coca leaves and transform it into the addictive product most people are familiar with today. Cocaine became popular in the medical community in the 1880’s and quickly became an additive to many familiar and popular products we still consume today like Coca-Cola. Not to worry once and increasingly large amount of people started to experience nasal damage from snorting and even were dying from overdoses of cocaine, it became banned from Coca-Cola in 1903 and quickly removed from other products too. In 1922 the drug was officially banned and fell out of style until it re-emerged as a popular drug for business people and entertainers in the 1970’s.

Cocaine + Alcohol:

Using cocaine with alcohol can cause a 30% increase of cocaine in the blood system. The combination of alcohol and cocaine produces what is called cocaethylene. Cocaethylene can increase the amount of dopamine that is released. It can also enhance the risk for cardiac death and enhances the length of the high. Cocaethylene also has a higher cardiovascular toxicity than cocaine by itself. Also the combined use of cocaine and chronic alcohol can lead to an increase of brain-to-plasma cocaine ratio. Tests on mice have shown that the combination of alcohol and cocaine are 50%-100% more lethal then that of cocaine alone. Cocaine and cocaethylene may disrupt the function of the limbic parts of the brain which control the heart. They also bind to muscinaric and sigma receptors which are also molecules of the brain, which may lead to abnormal heart function, mental disorders, and delirium.

National Institute on Drug Abuse:;
MedlinePlus, Cocaine withdrawal:

Drug Enforcement Administration Museum:


Heroin scientifically called diacetylmorphine, is an opioid synthesized from morphine, a naturally occurring substance extracted from the seeds of the opium poppy plant. This substance comes in a white or brown powder or black tar which can then be injected, inhaled, snorted, or smoked. Two styles of injection include direct vein administration and “skin popping,” injecting the drug anywhere on the body not directly in the veins. Injecting heroin is one of the more well-known, popular and stigmatized methods of administering heroin. As heroin use increases amongst the younger generations many are choosing to avoid injecting the drug in favor of other less stigmatized methods. Once heroin enters the body it is converted back into morphine which binds to opioid receptors that are involved with the perception of pain and reward.

Side Effects:

  • “Rush” (a surge of euphoria)
  • Depressed respiration
  • Dry mouth and warm flushed skin
  • Clouded mental functioning
  • Nausea and vomiting
  • Suppression of pain and heavy feeling in extremities
  • Spontaneous abortion

Long-Term Effects

  • Addiction (tolerance and dependence)
  • Collapsed veins
  • Bacterial infections
  • Abscesses
  • Infection of heart lining and valves
  • Arthritis and other rheumatologic problems
  • Liver and kidney disease

** For those who inject the drug there is an added risk of HIV and Hepatitis C from shared needles and fluids**

Signs of use:

  1. Environmental Signs: non-medical needles and syringes, burned silver spoons and foil, missing shoelaces and other materials used to tie off for injection.
  2. Behavioral Signs: increased time spent sleeping, slurred or incoherent speech, worsed performance in school or work, decreased attention to hygiene, loss of motivation, wearing clothes to hide marks.
  3. Physical Signs: Weight loss, needle track marks, infections or abscesses at injection site, loss on menstrual cycle in women.

Withdrawal Symptoms

Withdrawal symptoms with heroin can start as soon as a couple of hours of administration but are more likely to set in 24 to 48 hours following the last high. Symptoms include: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, goose bumps, cold flashes and kicking movements.

Brief History: Pharmaceutical companies began emerging throughout the 1800’s. One of the companies that emerged out of Germany at this time was the Bayer Company. Researchers at this company were able to formulate and compose plant derived drugs. Experimentation lead to the discover of morphine (derived from the poppy seeds of opium plants) which was a common pain killer used during the American Civil War and Franco-Prussian War but it was highly addictive. Later modifications of morphine lead to the creation of a new molecule and the substance that came to be known as heroin. in 1898, heroin was presented as a cough, chest and lung medicine, mainly for the patients of pneumonia and tuberculosis. Heroin became quickly adopted at the go to drug for pain relief over morphine because it was non-addictive. As experimental groups and patients were tested using heroin it became clear that this new drug was even more addictive and harmful than its parent morphine. In 1906 the Pure Food and Drug Act was passed which required all contents of medications to be listed and in 1914 the Harrison Narcotic Act which began the process of federal regulation of opium and cocaine.

Heroin and Alcohol:

Both substances are depressants and when used together can be fatal because of the combined influence on the central nervous system. Combined use can result in coma with permanent brain damage. Heroin is often administered where alcohol is readily available so the pairing of the two substances often occurs. Addicts might turn to alcohol if heroin is unavailable.

National Institute on Drug Abuse:

History Today:


Hydrocodone is available only in combination with other ingredients. Hydrocodone is analgesic and antitussive which means it is used as a cough suppressant and pain reliever. This substance is considered abuse any time it is used other than as recommended by a doctor. Additionally, increasing your dose, lengthening the use of your dose, or taking more in a day then recommended are all incidences of abusing this drug.

Side Effects:

  • Reduction of pain
  • Dizziness
  • Constipation
  • Nausea and vomiting
  • When snorted, burning in nose and sinuses
  • Drowsiness
  • Lightheadedness/fuzzy thinking
  • Anxiety
  • Mood swings
  • Dry throat
  • Difficulty urinating
  • Narrowing of the pupils
  • Slowed or irregular breathing
  • Chest tightness
  • Bloody stools
  • Breathing problems
  • Rapid or irregular heartbeat
  • Severe allergic reaction (rash, hives, itching, or swelling)

Overdose Symptoms:

  • Narrowed or widened pupils
  • Slow, shallowed, or stopped breathing
  • Slowed or stopped heartbeat
  • Cold, clammy, or blue skin
  • Excessive sleepiness
  • Loss of consciousness
  • Seizures
  • Death

Long-Term Use:

The most dangerous effects of long-term use are the effects of addiction, which is common due to its similarity to codeine, heroin, and morphine. Repeated use leads to tolerance, which means a person has to use more each time to get the same effect. Side effects of long-term use include the following:

  • Hearing loss
  • Liver damage
  • Financial, social, and work problems
  • Mental health problems

Withdrawal Symptoms

Withdrawal symptoms varies by individual, depending on how long the substance was used; however, common symptoms includes the following:

  • Anxiety
  • Constant shivering
  • Diarrhea
  • Difficulty sleeping
  • Fever
  • Hallucinations
  • Intense sweating
  • Nausea
  • Rapid/irregular heartbeat
  • Severe pain
  • Vomiting

Hydrocodone taken and used with alcohol:

Using both substances simultaneously increases the central nervous system side effects, which include drowsiness, dizziness, feeling faint, difficulty concentrating, and impairment of thinking and judgment. Severe side effects could also occur, which include low blood pressure, respiratory distress, fainting, coma, or even death.  Some formulations of narcotic pain medications can also rapid release when used with alcohol, which can quickly lead to severe or lethal side effects.

Coalition against Drug Abuse: The Effects of Hydrocodone Use:
MedlinePlus: Hydrocodone: Hydrocodone and Alcohol/Food Interactions:


Everyday household items that contain psychoactive substances that are “huffed” from a container, dispenser, soaked rag, balloon or paper bag in order to feel high. The high from inhalants typically lasts only a few minutes which results in continued use during a specified time period. Inhalants are most abused by kids and adolescents. Adults will typically abuse nitrates “poppers” to enhance sexual pleasure and performance.

Short Term Effects:

  • Slurred speech
  • Lack of coordination
  • Euphoria
  • Dizziness
  • Headache
  • Hallucinations
  • Delusions
  • Nausea and Vomiting

Long Term Effects:

  • Loss of Coordination
  • Limb Spasms (due to damage of the protective sheath (myelin) around the nerve fibers)
  • Liver, Kidney, and Bone Marrow Damage
  • Hearing loss
  • Brain damage from lack of oxygen
  • Heart failure “sudden sniffing death” (mainly caused by aerosols)

LSD; “Acid”

LSD is short for Lysergic Acid Diethylamide, and acts as a potent mood-changing chemical and hallucinogen. It is a man-made substance from lysergic acid, which is naturally found in ergot (a fungus). LSD is normally taken orally in the form of tablets, capsules, and liquid. The side effects can vary widely, and can be felt as soon as 10 minutes and can last as long as 12 hours.

Effects depend on:

  • Dosage
  • Personality
  • Mood
  • Expectations
  • Surroundings

Side Effects:

  • Hallucinations (Auditory and visual)
  • Mood swings
  • Delusions
  • “Cross-over” senses (hearing colors or seeing sounds)
  • Fear (For loss of control, for insanity, or for death)
  • Impaired perceptions of depth, time, and space
  • Flashbacks
  • Hypertension
  • Dilated pupils
  • Sweating
  • Loss of appetite
  • Sleeplessness
  • Dry mouth
  • Tremors
  • Speech difficulties

Possible After-Effects

  • Tolerance (Need for higher dosage after previous use)
  • Flashbacks, unexpected and unpredictable
  • Psychosis

LSD + Alcohol

LSD blocks the subjective effects of alcohol, which means a person may not feel the effects of alcohol when using both substances. This increases the risks associated with alcohol poisoning.

National Institute on Drug Abuse, DrugFacts: Hallucinogens – LSD, Peyote, Psilocybin, and PCP:
National Highway Traffic Safety Administration, Lysergic Acid Diethylamide (LSD): 

MDMA; “Ecstasy;” “Molly”

MDMA is short for methylenedioxymethamphetamine and is most commonly known as “Ecstasy” or “Molly.” It is a man-made stimulant that is similar to amphetamines. It is commonly taken orally as a pill, tablet, or capusule, as well as a pure crystalline powder form known as “Molly.” Since the substance is man-made, it is common for makers to include other substances like caffeine, amphetamines, PCP, and cocaine, or substitute other chemicals for MDMA, such as the chemicals found in “bath salts.”

Effects depend on:

  • Size and weight
  • Previous health
  • Previous use
  • Mixing with other substances
  • Amount taken
  • Recipe of drug

Side Effects

Effects typically last 3-6 hours; however, users may take more than one pill at a time (called “bumping”), take a second dose when the first begins to fade, or use with other substances. Once a pill is ingested, it can take only 15 minutes for effects like the following to begin:

  • Increased activity of serotonin, dopamine, and norepinephrine
  • Elevated mood
  • Hyperactive and alert
  • Decreased or increased sensations (e.g., lost sense of time or increased sense of touch)
  • Sense of arousal, love, and/or trust
  • Anxiety
  • Agitated/Irritable
  • Excessive sweating
  • Chills
  • Dizziness
  • Blurred Vision
  • Faintness
  • Nausea
  • Teeth clenching
  • Dehydration
  • Muscle tension
  • Increased heart rate and blood pressure
  • Increased body temperature (*Leads to serious heart, liver, or kidney problems)
  • Increased risk for unsafe sex


It is common for users to experience after effects as a result of MDMA, and long-term use can prolong them. Overdose or death is possible from using MDMA, which can occur from the increase in body temperature, known as hyperthermia. Hyperthermia can lead to liver, kidney, heart failure, or death.

  • Restlessness
  • Confusion
  • Depression
  • Problems with sleep
  • Anxiety
  • Dependence or cravings

Signs of MDMA use include:

  • Dilated pupils
  • Increased sweating
  • Energetic or hyperactive

MDMA + Alcohol

Mixing MDMA with alcohol or other depressants, like cannabis or benzodiazepines, can cause an enormous amount of strain on the body, increase the risks of both substances, and increase the likelihood to overdose. It is also important to note that both substances rapidly increase dehydration.

National Institute on Drug Abuse for Teens – Drug Facts:
Australian Drug Foundation – Drug Info:

Methamphetamine; “Meth;” “Crystal”

Methamphetamine is a highly addictive central nervous system stimulant. Methamphetamines are typically found in the form of white, odorless, bitter-tasting crystalline powder that can be swallowed, mixed with water or alcohol, smoked, snorted, or injected. Methamphetamine creates a rush of dopamine levels in the brain, which falsely signals reward, motivation, and pleasure.

Side Effects:

  • Increased energy and alertness
  • Decreased need for sleep
  • Decreased appetite
  • Euphoria and rush
  • Increased respiration
  • Increased physical activity
  • Rapid heart rate
  • Sweating
  • Tightened jaw muscles, grinding teeth
  • Irregular heart-beat
  • Increased blood pressure
  • Increased body temperature
  • Itching, welts on skin
  • Nausea, vomiting, diarrhea
  • Hyperactivity
  • Irritability and moodiness
  • Anxiousness and nervousness
  • Aggressiveness and violent behavior
  • Paranoia
  • Involuntary body movements
  • Severe depression and suicidal tendencies

Long-Term Use:

Using methamphetamines habitually can cause serious health conditions such as fatal kidney, liver damage, lung disorders and stoke. Habitual use can also cause possible brain damage and permanent psychological problems. Long-term use include the following common symptoms:

  • Addiction
  • Anxiety
  • Confusion/disorientation
  • Insomnia
  • Mood disturbances
  • Violent behavior
  • Psychosis
    • Paranoia
    • Hallucinations (Visual and auditory)
    • Delusions
    • Repetitive motor functions
  • Extreme weight loss
  • Severe dental problems
  • Skin sores
  • Changes in brain structure
  • Deficits in thinking and motor skills
  • Increased distractibility
  • Memory loss
  • Increased risk for infectious diseases (HIV, Hepatitis B and C), unsafe sex, and general risky behavior as a result of altered judgment and inhibitions.

Methamphetamines taken and used with alcohol:

Taking methamphetamines with alcohol can mask the effects of alcohol. Taking both alcohol and methamphetamines increases cardiovascular side effects and nervous system side effects. These side effects include increased heart rate, chest pain, blood pressure changes, dizziness, drowsiness, depression, and difficulty concentrating.

National Institute on Drug Abuse: Methamphetamine:
NIDA DrugFacts: Methamphetamine: Methamphethamine and Alcohol/Food Interactions:


Nicotine is found in the leaves of tobacco plants and constitutes up to 3% of the plant weight. Tobacco is typically smoked in the form of cigarettes and cigars or chewed in the form of dip.  Widespread use of nicotine is possible because it is legally available, socially acceptable and large marketing campaigns encourage people to start or continue use. Nicotine acts as both a stimulant and sedative. When first taken the adrenal glands are stimulated resulting in the release of epinephrine (adrenaline) and the brain releases dopamine which results in feelings of pleasure and euphoria. Smoking will often times become a habit and part of a persons daily routine ex. having a smoke with breakfast or while drinking.

Brief History: This history of nicotine as it relates to substance use lies in the history of tobacco. Tobacco plants are native to the America’s and had been used by native for close to 2,000 years for its medicinal and stimulant properties. When European explorers came to the Americas and used tobacco they enjoyed it so much that they brought it back to Europe. In the 1600’s the demand for tobacco was so high it became a cash crop for the United States. Due to the intensive labor required by the plant and an elitist mentality the Americans began importing African slaves in the 1700’s to work on plantations. Eventually, the popularity of tobacco lead to the discover of its negative health effects. As early as the 1890’s 26 states had banned the sales of tobacco to minors because of the negative health effects. Restrictions and regulations only continued to increase and in 1994 the FDA officially recognized that nicotine was dependency causing.

Note: The effects of nicotine are  different than the effects of cigarette or cigar smoking etc.

Side Effects:

  • Causes sudden releases of glucose which result in feelings of depression and fatigue
  • Withdrawl symptoms: headaches, anxiety, restlessness, difficultly concentrating, upset stomach, drowsiness

Side Effects of Tobacco:

  • Cancer: bladder, blood, cervix, colon, rectum, esophagus, kidney, uterus, larynx, liver, oropharynx, pancreas, stomach, trachea and Especially Lung Cancer (90% of all cases is caused by cigarettes)
  • Bronchitis
  • Emphysema
  • Increased risk for heart disease, stroke, heart attack, vascular disease
  • Pneumonia
  • Harms nearly every organ in the body
  • Causes increased complications with pregnancy

Tobacco smoke contains many different poisons including: carbon monoxide, tar, formaldehyde, cyanide and ammonia.

What about e-Cigarretes? 

E-cigarettes are electronic devises that mimic the look of real cigarettes but are not the same. They have a battery, heating element, and cartridge to hold a nicotine based liquid with flavoring. E-cigs take the tobacco out of cigarette smoking along with many of the harmful side effects but the addictive element of nicotine is still present. These devices are relatively new and not enough research has been conducted in order to understand the side effects people may have. There are arguments the both support and disapprove of the use of e-cigs. The main argument for support is that the e-cig is the perfect replacement for people who are trying to quit smoking cigarettes. The main argument made by those who disapprove of e-cigarette use is that it’s a gateway object and encourages people to start smoking actual cigarettes.

Center for Disease Control:

National Institute on Drug Abuse:


Salvia divinorum is a member of the mint family. Fresh salvia is ingested by chewing and extracting the juices from the leaves while dried saliva is typically smoked in order to induce hallucinogenic experiences that mimic psychosis. Highs have been described as intense but short lived appearing in less than 1 minute and lasting less than 30 minutes.

Side Effects:

(Range from subtle to very strong depending on the dosage)

  • psychedelic changes in visual perception
  • mood and body changes
  • emotional swings
  • feelings of detachment
  • highly modified perception of external reality and self

Long Term Effects:

  • Not enough research has been done to know the long term effects

Many sources advise having a sitter present if using this drug due to the varying effects. Often times Salvia is marketed as a legal marijuana substitute although the effects are NOT the same.


Spice; “K2” “Skunk”

Spice is an herbal mixture that when smoked produces a similar experience to that of pot. Many spice products are marketed as being natural but this is a misrepresentation; synthetic chemical additives are not natural and many used in spice have come to be defined as schedule 1 drugs. One particular additive JWH-018 acts on the same THC receptors as marijuana only it can be 5-100 times  more potent. This chemical was so dangerous it was eventually banned only to be replaced by other synthetic materials. Although this is technically a “legal” drug to buy and consume the affects can be some what detrimental.

Side Effects:

  • Elevated mood
  • Relaxation
  • Altered perception
  • Anxiety
  • Paranoia
  • Hallucinations
  • Rapid heart rate
  • Vomiting
  • Agitation
  • Confusion
  • Increased blood pressure
  • Reduced Blood supply to the heart

Spice and Alcohol

It is common to think that synthetic marijuana and alcohol when combined will have the same effects as regular marijuana and alcohol do. This connection does not take into account the various and many times differing synthetic chemicals that are in spice and how they each interact with alcohol. At this time there is not enough research on these interactions of spice and alcohol to come to any conclusive results.


Anabolic steroids are synthetic variations of testosterone that can be legally prescribed to treat hormone deficiencies but can also be abused by those looking to enhance their bodies performance. Steroids can be taken orally, injected, or applied in a gel or cream. Generally, steroids are taken intermittently (“cycling”) in order to avert unwanted side effects. Continuous use of steroids can result in tolerance and the eventual halt in testosterone production.

Effects on Men

  • Develop breasts
  • Get painful erections
  • Testicles shrink
  • Lowered sperm count
  • Become infertile or impotent

Effects on Women:

  • Grow excessive face and body hair
  • Deepened voices
  • Menstrual irregularities
  • Enlarged Clitoris
  • Reduced breast size

Effects on both men and women:

  • Acne
  • Oily scalp and skin
  • Jaundice
  • Baldness
  • Ruptured tendons
  • Heart attack
  • Mood swings
  • Fits of Rages
  • Delusions

National Institute on Drug Abuse:

 Common “Date Rape” Substances

GHB; “Liquid X”

GHB (gamma-hydroxybutyrate) is a depressant to the central nervous system and is produced naturally at low levels in the brain. GHB can be found in liquid or powder form which are typically odorless, colorless, and tasteless for the purpose of discreetly combining it with alcohol or other beverages. Due to its stimulation of protein synthesis, it has also been used to aid in fat reduction and muscle building in body builders.

Effects depend on:

  • Body weight
  • Other chemical interactions
  • Individual reaction

Side Effects 

Once ingested, it can take as little as 10 minutes to begin feeling the side effects, which can last 2-5 hours.  Many of the side effects are similar to what a person may experience from alcohol.

  • Feelings of relaxation
  • Decreased motor function
  • Dizziness
  • Reduced inhibitions
  • Euphoria
  • Confusion
  • Dizziness
  • Drowsiness
  • Sedation
  • Inebriation
  • Agitation
  • Combativeness
  • Hallucinations
  • Nausea
  • Vomiting
  • Increased sweating
  • Visual changes/disturbances
  • Short-term amnesia
  • Uncontrollable shaking or seizures
  • Decreased body temperature
  • Suppressed gag reflex
  • Slowed breathing
  • Unconsciousness

Poisoning and overdose:

If a person overdoses, complete recovery can take up to 6 hours. Signs of an overdose can include the following:

  • Extreme nausea/ dizziness/ vomiting
  • Loss of consciousness
  • Shallow and/or slowed breathing
  • Vomiting
  • Non-responsive to deep pain
  • Fixed pupils
  • Coma
  • Death


  • Drowsy/ sleepy/ groggy
  • Hangover
  • Fuzzy head

Repeated use of GHB can lead to addictive behaviors and experiences, including withdrawal symptoms that can include insomnia, anxiety, tremors, and sweating.

GHB + Alcohol:

Taking GHB with alcohol together increases the effects of both substances, which increases the likelihood of disorientation, inebriation, and loss of consciousness. Abuse of GHB is commonly with mixed with other substances, like alcohol. Due to its similar side effects to alcohol, GHB is also used as a date rape drug in order to quickly decrease a person’s inhibitions, incapacitate him/her, and increase the likelihood of short-term amnesia.

If you or someone you know has been the victim of sexual assault, consider reading our information and resources regarding sexual assault.

National Institute on Drug Abuse, “Drug Facts: Club Drugs”:
National Highway Traffic Safety Administration: Drugs and Human Performance Fact Sheets:

Ketamine; “Special K”

Ketamine is a hydrochloride that is known to be used as an animal tranquilizer by veterinarians. Ketamine is a synthetic chemical, dissociative anesthetic, and a hallucinogen. It is in the form of a white powder that can be snorted, injected (injected intramuscularly), mixed in drinks, or smoked. Ketamine distorts the perceptions of sight and sound. It also produces a feeling of not being attached to the self or to the environment. It acts on a type of glutamate receptor which produces a feeling of delirium and amnesia.

Effects depend on:

  • Age and weight
  • How much taken and how often taken
  • How long been taking it
  • Method used to take the drug
  • Environment
  • Other chemicals being taken with it

Side Effects:

Higher doses suppress the central nervous system, reduce level of oxygen to the brain, heart, muscles, and may also cause death.

  • Loss/distorted sensory perceptions
  • Blurred vision
  • Feelings of detachment from environment and self
  • Unusual excitement/nervousness/restlessness
  • Impaired attention, learning ability, and memory
  • Hallucinations
  • Delirium
  • Amnesia
  • Numbness
  • Confusion/Disorientation
  • Nausea and Vomiting
  • Impaired motor functioning
  • Fast/slow/irregular heart beat
  • Fast/slow/irregular/stopped breathing
  • Unusual tiredness/weakness
  • Loss of consciousness
  • Discomfort/pain/inflammation if snorted
  • Discomfort/pain/numbness at injection site

Ketamine + Alcohol:

Taking ketamine with alcohol increases central nervous system effects, such as dizziness, drowsiness, and difficulty with concentrating, thinking, and judgment. This mixture can also cause respiratory and cardiac problems, as well as increase the likelihood of losing consciousness or becoming comatose. In a catatonic state the body’s natural self-preserving reactions, like vomiting, won’t work. Additionally, this mixture is commonly used as a date rape drug to incapacitate a person.

If you or someone you know has been the victim of sexual assault, consider reading our information and resources regarding sexual assault.

National Institute on Drug Abuse, “Drug Facts: Club Drugs”:, Ketamine:

Rohypnol; “Roofies”

Rohypnol is flunitrazepam, which is a benzodiazepine not approved for medical use in the U.S. and banned from importation. Rohypnol is a fast-acting sedative that depresses the central nervous system. Rohypnol is typically odorless, colorless, and tasteless, and taken orally in pill form; however, it has also been known to be ground up and snorted. Effects can begin within 30 minutes, and can last for as long as 24 hours. Sedation can occur as soon as 20 minutes.

Side Effects:

  • Anterograde amnesia (no memory while under the influence of drug)
  • Confusion
  • Vision problems/blurred vision
  • Disorientation
  • Disinhibition/impaired judgment
  • Dizziness
  • Sleepiness
  • Muscle relaxation or loss of muscle control
  • Nausea and stomach problems
  • Difficulty with motor movements and speech
  • Loss of consciousness

Rohypnol + Alcohol:

The mixture of Rohypnol and alcohol, or other depressants, can be lethal. The sedative and toxic effects of Rohypnol are aggravated when ingested with alcohol. Due to its ability to cause sedation, disorientation, disinhibition, and amnesia, Rohypnol with or without alcohol has been commonly used as a date rape drug.

If you or someone you know has been the victim of sexual assault, consider reading our information and resources regarding sexual assault.

 National Institute on Drug Abuse, “Drug Facts: Club Drugs”:
Boston University Police, Rohypnol Fact Sheet:


Additional Resources:

Understanding Drug & Alcohol Addiction