Dear Buzzed,
I have been playing with various substances since I smoked my first joint in Aspen, Colo., in 1981. I have smoked (more or less) every day since and have suffered none of the clichéd pitfalls (yet). I’ve received a B.A., have fathered two children and have an income of $54,000 and a mortgage.
I also have been a heavy drinker since my Memphis State days and continue to indulge — whenever the demands of work and parenting will allow, usually later at night. Add in the fact that I have recently discovered a means of obtaining painkillers (Vicodin) via the Internet and I’m feeling a little like a junkie, which — let’s not be coy — I am.
I’ve also been taking Prozac (20 mg) for the past six months to try to combat my obsessive-compulsive behavior. (I told my doctor that I wanted to try Prozac to help me stop smoking — which is partially true, just not tobacco.) Anyway, that seems to have no effect lately, but I’m constantly surprised by how my physical stamina has held up against my barrage of abuse.
I’ve had annual physicals with complete blood work, and my reports all come back fine. My liver numbers are fine, my blood pressure is fine, and although my cholesterol is rather high, my doctor seems almost annoyed at my insistence on having these checks. My question is, are there some people whose systems can take it better or for longer than others? It seems to me that I should have been dead years ago. So many others have died from their overindulgences (Keith Whitley, Alexander Gudonov, various rock stars, etc.).
So why am I still around? I can’t keep this up forever. I know this question seems stupid, but I am totally serious: When am I going to give out?
Concerned Junkie
Dear Junkie,
You wonder why you are doing fine despite regular heavy drinking, daily smoking (we assume you mean pot) and occasional Vicodin (generic name: hydrocodone). So do we! You’ve given us a lot to talk about — regular and heavy alcohol use, drug combinations, use of addictive narcotics and resistance to antidepressants. Where to begin?
First, you are doing a couple of things right. Limiting your drug use in response to the demands of parenting and work means that you have the ability to keep it under control. You are also having regular physicals and working with a doctor — at least to some degree, if not fully honestly — on your substance abuse problem. This is all good. Now, on to your various indulgences.
You didn’t tell us how much you are drinking. If you are drinking no more than a couple of drinks every day, you probably won’t experience significant negative health consequences, and you may even derive some cardiovascular benefit. On the other hand, if you are drinking more than that, you might be surprised to know that heavy alcohol use can be the most dangerous part of your daily routine. As you guessed, your liver and cardiovascular system suffer the most from alcohol use. And alcohol could be playing a part in your elevated cholesterol levels.
One joint a day of marijuana is unlikely to cause serious physical problems in the short term, and the long-term risk of lung and cardiovascular disease is less than from smoking one pack of cigarettes. However, the marijuana will impair your memory and could well impair your job performance. Its sedative properties and anxiety-reducing effects may leave you unmotivated to do much of anything.
Even the Vicodin, if you keep it under control and don’t become addicted, won’t have terrible physical consequences, although it could put a crimp in your sex life and make you constipated. It is a fairly mild narcotic, and many people take it as a prescribed medication for years without suffering any ill effects.
Our greatest worry is about your combined use of all these psychoactive drugs. You certainly can’t be as sharp mentally as you would be without the drugs. If you smoke pot every day, it is basically always in your system, since it takes your body up to a week to clear 90 percent of even one dose of the active ingredient, tetrahydrocannabinol (THC). Adding this to the alcohol and Vicodin means that you are overloading yourself with too many depressant drugs. Furthermore, the more drugs you take, the greater the chances of experiencing a dangerous interaction with prescribed drugs should you get sick or have an accident.
Also, things must not be going so well for you emotionally if you are taking antidepressants. Frequently, heavy alcohol drinkers also suffer from depression, and it is not clear if that results from their drinking or if they are drinking to cope with an underlying depression. The only way to really figure it out is to stop drinking.
You are obviously worried enough to go to a doctor for Prozac. You might have picked a good strategy for dealing with your substance abuse. Prozac might have some ability to decrease the addictiveness of several drugs, including alcohol and narcotics. And you correctly observe that the effectiveness of antidepressants can wane. This antidepressant resistance is just your brain adapting to the chronic presence of the drug. Talk to your doctor, who might suggest increasing the dose or switching to another antidepressant.
As for why you are physically OK so far — well, you haven’t set the bar very high when you compare yourself to the entertainers you listed. On the rock star scale of overindulgence, you are an amateur. Nevertheless, you are engaged in a pattern of drug use that could lead to serious problems, and we are glad you are concerned.
Dear Buzzed,
I am a 49-year-old male in reasonable health. My doctor prescribed Adderal after a diagnosis of adult ADD. I have been taking it for almost two years and it has helped. My concerns are about the long-term effects of amphetamines like this. I take between 5 and 10 milligrams daily. I have taken “holidays” from the drug but find I function much better when I resume taking it.
Attentive
Dear Attentive,
You are asking about a subject that evokes almost as much controversy as any health issue we’ve seen lately. ADD, also known as ADHD (attention-deficit hyperactivity disorder), is a hot topic these days because many kids, and a notable number of adults, are using stimulants like Adderal (an amphetamine) and Ritalin (methylphenidate) to help them focus on a task, whether it be schoolwork or sophisticated engineering analyses. To illustrate just how widespread the use of stimulants can be, we heard about a school system near us in which 12 percent of the children were being given stimulants for attention problems.
Stimulants work, and they can make a huge difference in some people’s performance. What we don’t know is exactly how they work and who really needs them. So with that caveat in mind we’ll engage in a little informed speculating for you.
Numerous research studies have shown that stimulants increase the levels of at least two adrenaline-like chemicals in the brain — norepinephrine and dopamine. Adderal and Ritalin seem to work predominantly on dopamine, which we believe is perhaps the most crucial neurochemical involved in attention disorders. Dopamine is an important chemical in the brain’s reward system. Our brains release dopamine when we discover good food, a willing sex partner and other novel and “stimulating” situations.
Dopamine also allows the brain to focus on the task at hand, whether hunting, having sex or fighting. One recent theory suggests that these two effects of dopamine may be related: The dopamine system may make us pay attention to stimuli that are important for our survival.
There is now speculation, and some data, that people with attention disorders either lack enough dopamine or the proper chemical sensors for it in their brain cells. Either way, they may try various strategies on their own to jump-start a dysfunctional system. People with ADD might take recreational drugs such as cocaine, become risk takers in sports, sex or other stimulating situations or just fidget in the classroom and pester other students. However the problem manifests itself, a person’s behavior can get so out of hand that he or she may need to seek treatment from a psychiatrist or other specialist in attention disorders.
There are a number of drugs that treat ADD, including the Adderal you take, Ritalin and even the antidepressant Wellbutrin (buproprion). Often one of these drugs is used with an antidepressant like Prozac to treat depression that has arisen from the life disruption caused by the ADD. Sometimes a specialist has to try a number of drugs or combination of drugs to find a treatment that boosts attention levels without creating other problems like anxiety, high blood pressure or sleep disorders.
The level of Adderal you are taking is thought to be very safe. Sometimes people on Adderal lose their appetites, and the drug can cause a slight increase in heart rate and blood pressure. These effects are usually minimal when the patient follows the doctor’s instructions. As you may have heard, it’s possible to become addicted to stimulants, and long-term use at levels much higher than yours can cause injury to the brain’s dopamine system. But if you pay attention to your doctor’s orders, you should be just fine.
Buzzed appears every week in Salon Health. If you have a question, send it to us at buzzed@salon.com.
Dear Buzzed,
After an accident, I spent several months in physical therapy and on painkillers. I have fully recovered, but I’m having a very, very hard time ending my use of painkillers. I have resorted to ordering them over the Internet, and even purchasing them from another accident victim. Each time I try to quit cold turkey I get as sick as a dog and relapse, while tapering off leads to even more use. What can I do?
Addicted to Painkillers
Dear Addicted,
You have experienced both the good and the bad sides of narcotic analgesics, since that is almost certainly what your doctor gave you after your accident. We are really glad that you wrote, because you represent a large group of people who feel embarrassed about their use of narcotics. You shouldn’t be. These are good drugs when taken properly.
Morphine and codeine are the “natural” members of this group because they come from the opium poppy. Meperidine, methadone and oxycodone are the synthetic members, and heroin is the most infamous, known more for its addictiveness than its ability to kill pain. Because these medications are the most effective analgesic (painkilling) drugs that exist, doctors frequently prescribe them after surgery or serious injury.
All of these drugs work in the same way. As you probably know, your brain produces its own endorphins — morphinelike compounds that regulate the functions of cells all over the body. Endorphins can calm you, decrease the sensation of pain and help control your breathing and digestion. Narcotics substitute for your own endorphins by binding to the cells that are normally stimulated by these compounds. So when you take your painkiller, you are stimulating a system that already exists in your body to minimize pain. Narcotics also stimulate the center in your brain that generates the feeling of pleasure, which is why they are addictive.
So why do you feel so rotten when you try to stop? Narcotics work because they affect the cells more than your own endorphins do; in response, your body adapts and tries to return things to normal by reducing the cells’ sensitivity to both the painkilling drugs and the natural endorphins. That’s how what is called tolerance to a particular drug develops.
The feeling you get when you stop is called withdrawal, and it may be responsible for most of your woes. Your digestive tract offers a good example of this process. Opiates slow the movement of material through the intestine, so it’s likely you suffered from constipation at first. Since you have been taking a painkiller for quite a while, your body has probably adapted to this retarding effect by speeding things up, leading to relatively normal bowel function even while you’re taking the drug.
When you stop ingesting the drug, this speeding-up effect remains, but is no longer balanced by the slowing influence of the drug. The result: stomach cramps and diarrhea. The other sensations you experience when you stop — chills, achiness, flulike symptoms and increased sensitivity to pain — arise because many parts of your body have reduced their sensitivity to your own endorphins. When you feel compelled to keep taking the drug to avoid the unpleasant effects of withdrawal, you are experiencing a physical dependence — which can happen even when you take the drugs as prescribed by a doctor.
Does this mean you are addicted? Not necessarily. Physical dependence is one of the key criteria used to determine addiction, but another very important one is your drug-use pattern. Are you losing control over how you take the drug? You don’t say how much or how frequently you are ingesting painkillers, but clearly it is more than your doctor prescribed because you are buying somebody else’s drugs — which, by the way, is illegal. The fact that you are willing to go to such lengths to get the drugs suggests that you may be headed down the road to addiction.
The best way to get out of this mess is to do it step by step. Don’t try going cold turkey. If you taper the dose down bit by bit, the withdrawal symptoms should be manageable. You need to go to your doctor and discuss pain management strategies, and have him or her help you gradually reduce your dosage of narcotics. If your original physician is not available or doesn’t want to help, you should seek out a pain management specialist, who will be very familiar with this type of problem. If your recovery from the accident is proceeding normally, the doctor should be able to switch you to a drug like ibuprofen so you can get the pain relief you may still need.
Buzzed appears every week in Salon Health. If you have a question, send it to us at buzzed@salon.com.
Dear Buzzed,
I went out the other night to a party, and had about four beers and half a glass of wine within about three and a half hours. I noticed I was getting a little more drunk than usual, but didn’t think much more about it. Afterward, I took a few hits of a joint. Ten to 20 minutes later, sounds began to echo and I couldn’t really see straight or clearly. Soon after, I was vomiting and on the verge of passing out. When I managed to get home, I did pass out, and could barely move the few times I was awoken by my boyfriend. The next day, I felt somewhat shaky but not really hung over.
I have never been affected in this way by the combination of alcohol and pot. From the severity of my reaction, does it sound like I may have been slipped something, or does it sound like I’d taken leave of my intelligence for the evening?
Wondering
Dear Wondering,
It sounds to us like you got much more than you bargained for. As you probably know, lots of people combine the use of marijuana and alcohol, and we certainly don’t hear reports of such powerful effects. (However, if we’ve missed something, we hope our readers will tell us!) We think you were right to suspect that you were given an additional drug — more about that shortly.
Research shows that combining alcohol and THC, the active ingredient in pot, impairs a person more than either substance does alone. One’s physical performance, like driving a car, is particularly affected, and the effects appear to be additive. For example, if you drink an amount of alcohol that impairs your reaction time by 10 percent, and if you then smoke enough pot to impair your reaction time by 10 percent, your total impairment will be 20 percent. This information is important for people who smoke pot while having a couple of drinks and think that they are below the legal limit for driving while intoxicated. Although their blood alcohol levels won’t be higher from smoking, they will be much more impaired than if they had just been drinking.
So, what could you have ingested that would produce such a striking reaction? Our best bet is that there was something in the alcoholic drinks besides alcohol. Based on your symptoms, it could well have been GHB (gamma hydroxybutyrate), which is clear and colorless and is easily added to drinks without the consumer being able to detect it. We talked about its effects in a recent column, so here we’ll only say that it is profoundly sedative and makes you throw up. Because it also can produce amnesia, it has been used as a date-rape drug.
Another possibility is that there was something added to the marijuana. For years there have been reports that marijuana is sometimes laced with embalming fluid (mostly formaldehyde) and PCP (aka phencyclidine or angel dust). The embalming fluid smells quite distinctive, and unless you noticed something odd about the joint, it is unlikely that was the problem. On the other hand, PCP could have been there and you never would have known it.
PCP is a very complex drug that is a close relative of the anesthetic ketamine. Originally designed to be an anesthetic that would suppress consciousness without affecting respiration and cardiovascular functions, PCP proved to be unsuitable clinically. It can produce schizophrenia-like symptoms, hallucinations and dissociative feelings. Some people react to it by becoming virtually paralyzed (catatonia). Your symptoms don’t sound exactly like this, but you can never predict how a particular individual will respond to a drug, especially when other drugs are present. It’s impossible to point to hard data on the subject because there are no controlled studies of mixing PCP or GHB with alcohol and marijuana.
You also might want to reconsider whether your experience had anything to do with a drug. It’s natural and appropriate to believe that this change in your brain function was caused by using these drugs, but sometimes coincidences do occur, and some underlying condition like epileptic seizures can be precipitated by the modest use of a drug.
So our advice is twofold: First, if you experience anything like this again, or any other unexpected changes in the way you feel, see your doctor right away; and second, always be aware that the recreational drug you take may not be quite what you expected.
Buzzed appears every week in Salon Health. If you have a question, send it to us at buzzed@salon.com.
Dear Buzzed,
I have pimples all over my face. Can I take Accutane to clear up acne caused by lithium?
Broken Out
Dear Broken Out,
First of all, we are happy that you are being conscientious about taking your lithium. Lithium can dampen the mood swings people with manic-depressive illness experience — the feeling of one moment being euphoric, the next in deep depression. However, you have to take lithium every day to experience this mood-stabilizing effect. Unfortunately, lithium has many side effects, including nausea, sleepiness, excessive urination, weight gain, changes in the thyroid gland, and — you guessed it — bad acne. Some people stop taking the drug for these reasons alone. But quitting lithium can be life threatening. A manic or depressive incident can often follow, so it’s important to speak with a physician before altering your regimen.
Lithium works because it affects crucial chemicals in your brain. It has so many side effects because it also affects similar enzymes in the rest of your body. This medication can make it harder for your kidney to concentrate your urine, so many end up having to run to the bathroom all the time. Similarly, lithium probably affects skin chemicals in the same way, and this makes your face break out.
Unfortunately, Accutane (isotretinoin) may be not be the right treatment for your acne. While it is the most effective medicine available to clear up cystic acne, it has been associated with the development of depression in about 1 percent of patients who take it. There is one case report in the medical literature of a bipolar patient who was doing well, but started experiencing mood problems when she took Accutane to treat acne, although we can’t be sure that Accutane actually caused the mood problems. Some psychologists argue that mood changes result when people’s acne clears up, but their life problems don’t!
You should consider talking with your doctor about other alternatives for treating your acne or taking other drugs for treating your mood problems. There are several other drugs, like carbamazepine (Tegretol) and valproate (Depakane or Depakote) that are effective in treating bipolar illness and do not have the severe potential side effects that lithium has. Women should know that if they get pregnant while taking Accutane, there is a very high chance that their baby will be born with serious birth defects. The manufacturer takes this so seriously that it requires women who want to start on the medicine to take a pregnancy test first.
By the way, it might surprise you to know that interactions between the skin and the mind are not at all unusual. First and foremost, people can get depressed because their acne is so bad. But psychiatrists have also speculated that getting stressed can make skin diseases — including eczema, alopecia (total loss of body hair), psoriasis and dermatitis — worse. Sometimes when people are very stressed, they pick at their skin and cause the skin damage themselves.
It’s best to discuss your particular case with a psychiatrist or dermatologist. It is critical that he or she know of all the medicines that you are taking so there are no interactions. You should be able to find a combination that better suits both your mood and your face. Good luck!
Buzzed appears every Wednesday in Salon Health. Do you have a question? We would love to hear from you. Contact us at buzzed.
Dear Buzzed,
I do not know of this personally — since I consider my mind too fragile to try hallucinogens, even at Caltech in the late ’70s — but I have heard anecdotes of people experiencing terrible, sometimes multiday, bad trips with jimson weed or the West European “witch” alkaloids (i.e., belladonna, hellebore, henbane).
In all of these cases, the person seems to never be able to have a hallucination again. The prospect of taking acid becomes unthinkably frightening, and even using marijuana can become so anxiety ridden as to be impractical. Is this true?
Curious
Dear Curious,
You’ve asked about a group of plants — jimson weed (thorn apple), mandrake, henbane and deadly nightshade — that have fascinated humans for at least 3,500 years. The ancient Egyptians and Greeks wrote about their various uses as poisons, medicines and hallucinogens. They were also popular with magicians and healers through the Middle Ages and with Native American tribes of North America. The active chemicals have been refined into modern medicines that are used to treat asthma and motion sickness, though some people still smoke or drink plant extracts for their intense hallucinatory properties.
In all of these plants, atropine and scopolamine are the active ingredients. These chemicals block the action of the neurochemical acetylcholine. A person who consumes one of these plants usually experiences a high heart rate, dry mouth, an elevated body temperature and dilated pupils and has difficulty urinating — all of the things that acetylcholine controls. It’s the dilated pupils that gave rise to the name “belladonna alkaloids” because women in the Middle Ages used them to enhance their appearance (hence belladonnna, or beautiful woman). These effects are profound and can be deadly, which is why they were popular poisons in the Middle Ages.
These chemicals can easily enter the body through the skin, so simply rubbing parts of the plants on a person can induce profound physical changes as well as an alteration of consciousness. No matter how the plant is taken, an additional mystical property is amnesia. Scopolamine easily enters the brain and blocks brain acetylcholine sensors, which prevents the nerve cells from recording new information. Thus a user might recall some very unpleasant physical effects that preceded and followed the hallucinations, but not so much about the actual experience itself. At the highest doses, these drugs can induce a state in which a person feels separated from himself or herself, resulting in a floating and flying sensation (one of the reasons they are called “witch” alkaloids).
There is no safe way to use these chemicals as mind-altering drugs. By the time a person is hallucinating, the drug is already affecting many of the body’s functions. The trancelike state that leads to hallucinations happens only after body temperature and heart rate are already at dangerous levels. When the brain senses the strong cardiovascular stimulation, it interprets these conditions as a very fearful experience and it remembers it very well. Thus any subsequent use of a mind-altering chemical may cue the brain to expect another of these hellish trips and trigger fear.
In an overdose situation, a user can have seizures or lapse into a coma. There are specific and effective treatments for atropine and scopolamine poisoning, but treating physicians first must know what is wrong. These events are so rare that they might be misdiagnosed, and a delay in treatment can result in brain damage or death. Our advice is to leave the use of these plants to the past.
Buzzed appears every Wednesday in Salon Health. Do you have a question on any type of drug — pharmaceutical or illegal? Send it to us at buzzed@salon.com.
