Pubdate: Tue, 26 Jul 2005
Source: Chronicle Herald (CN NS)
Copyright: 2005 The Halifax Herald Limited
Contact:  http://www.herald.ns.ca/
Details: http://www.mapinc.org/media/180
Author: John Gillis

ANY DRUG CAN BE PRESCRIPTION FOR DISASTER

There are no such things as hard drugs or soft drugs, says pharmacologist 
Shaun Black.

"The brain doesn't care."

The manager of pharmacological and research services for Capital Health's 
addiction services branch said regular use of drugs ranging from alcohol 
and nicotine to OxyContin - outside prescription use - and crack cocaine 
change the way your brain works, maybe permanently.

"If you do this just once or twice, it's minimal," he said. "But if you're 
doing this over and over, and the dosages are increasing, the brain will 
adapt to having the drug there and it changes."

The common thread among psychoactive drugs, those that affect mental 
processes, seems to be their impact on dopamine, a neurotransmitter that 
helps the brain sense pleasure.

As the brain adapts to the presence of drugs, Mr. Black said, feeling that 
sensation becomes more difficult.

"It seems kind of cruel, doesn't it?" he said. "I can give you something 
that's going to make you feel like a million bucks, but after a while I'm 
going to take the pleasure away."

Mr. Black said the most widely used drug, and the one with the most 
significant health effects, is alcohol. Nicotine and cannabis are also 
commonly used and often people are consuming all three in combination.

Det. Const. Perry Astephen, a veteran member of the Halifax Regional Police 
drug squad, said the marijuana available in Canada today is much more 
potent than it was years ago. With sophisticated indoor growing operations, 
the level of THC (tetrahydrocannabinol), the psychoactive compound in 
marijuana, has increased.

Some drugs that are abused have legitimate medical uses. Often, people who 
get into trouble with those drugs began taking them under a doctor's 
orders, Mr. Black said.

He cited a category of drugs called benzodiazepines, or benzos - minor 
tranquillizers like Valium, Ativan and Xanax.

"They're primarily given for anxiety purposes or to help people sleep," he 
said. "They feel like alcohol when you take them. So almost by definition 
there is an abuse potential to the benzos."

The abuse of prescription narcotics like hydromorphone (sold as Dilaudid) 
and oxycodone (OxyContin) in Nova Scotia has been in the news over the past 
year, mainly because some users resort to crime to get their fix. But Mr. 
Black said far more people are using narcotics under normally, under 
doctor's orders, and usually for pain.

But there is a good trade in OxyContin and Dilaudid pills. Some people with 
legitimate access to pills will sell some for profit.

Cocaine became a problem in the Maritimes in the 1980s. It can be snorted, 
injected or smoked and it's not hard to find.

People from all walks of life and all socio-economic backgrounds get caught 
up in cocaine, Mr. Black said. "This is a drug that is out there. It's 
plentiful. And people, if they want it, they can get their hands on it."

Cocaine hydrochloride, the powdered form of the drug, can be inhaled or, 
for more immediate impact, injected into the bloodstream. The high from 
cocaine could last as much as an hour but is usually much shorter.

"You get this wonderful exhilaration and euphoria," Mr. Black said. "Your 
heart rate and your blood pressure pick up. You don't sleep and you don't eat.

"But when the drug starts to wear off, you feel terrible. You've lost all 
your energy."

Cocaine freebase or crack cocaine, the smokable form, reaches the brain 
almost instantly but the effects last only minutes. Once the crash begins, 
a crack user must either smoke more, if he has the cash to buy it, or deal 
with the sickness, Mr. Black said. The body's growing dependence on a drug 
to feel well is what leads to addiction.

Heroin is not a significant problem in a city the size of Halifax. That's a 
drug for much larger, more cosmopolitan markets, Mr. Black said.

Still, Dr. Connie LeBlanc, a Halifax emergency room physician, said she 
occasionally sees people with abscesses and blood infections from injecting 
heroin.

"Most people who take recreational drugs don't want to come to emergency," 
she said. "Unless things go really wrong or they get afraid, they don't 
tend to come in."

Ecstasy (methylenedioxymethamphetamine or MDMA) is one of those drugs that 
can scare or even kill users.

"It's an amphetamine that makes you hallucinate," Dr. LeBlanc said. "People 
will come in if the hallucinations are frightening them."

Because it's an amphetamine, ecstasy makes the pulse quicken and can cause 
jaw-clenching. Users get very dry and overheated. It can cause liver 
failure, renal failure and the destruction of muscles.

"That's how people die," she said.

Dr. LeBlanc said there's a false perception that drugs popularized in the 
rave scene like ecstasy and GHB (gamma hydroxybutyrate) are safe and anyone 
who overdoes it can sleep off the effects.

Dr. LeBlanc said the pills sold as ecstasy are only partly made up of MDMA 
and may also contain anything from caffeine to cocaine.

"It's kind of like eating a meal in the dark: you take your fork, put it 
down to your plate, what's on it goes into your mouth. Most of these people 
wouldn't let you feed them food if they didn't know what was in it."

Unlike ecstasy, a stimulant, GHB is a central nervous system depressant and 
too much of it can send a user into a deep coma, Dr. LeBlanc said. Some 
patients that land in the ER are vomiting and many need to be intubated.

"The problem is that if they didn't come in, they could stop breathing," 
she said. "Coma and vomiting is a bad combination. If you can't roll over 
to get it out, you breathe it in."

Using a depressant like alcohol with GHB just adds to the effect.

Mr. Black said the local medical community is readying itself to deal with 
the effects of methamphetamine,or crystal meth, an entirely synthetic drug 
that's become a problem in Western Canada and many American states.

Methamphetamine can be smoked or injected and is known to cause psychosis 
and mental health problems.

"It can be a drug-induced psychosis or something that you don't come back 
from," he said.

Another cause for worry is that methamphetamine doesn't need to be imported 
from larger centres.

"Bush-league chemists can actually make this one," Mr. Black said.

As far as he knows, no one is making crystal meth in the Halifax area. But 
it's coming.

"We're getting ourselves prepared," he said.
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MAP posted-by: Beth