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Drugs

November 13, 2009

Matthew Vasey, MD



I believe as young adults it is important to be prepared to face the consequences of your actions. My concern is there seems to be a dangerous disconnect between drug use and effect simply based on perhaps not fully understanding the consequences. People don't jump out of airplanes without parachutes I presume, because they know what will happen. Hopefully I can provide some useful information from and emergency room perspective and shed light on why there aren't many 50, 60, 70, 80, 90 year-olds using the drugs that will be mentioned, under the assumption those who have used since their teen years will have likely died in their 20's, 30's and 40's.

I consider there to be 3 key points when considering the effect of an illicit drug: (1) stimulant vs. depressant (2) infection and (3) the "High Effect". Stimulants tend to dangerously affect your heart and blood vessels. Depressants tend to dangerously affect your brain and lungs. Infections can more or less be anywhere there are bacteria. "High Effect" is basically what I will term dangers associated with impairment or being passed out.

Stimulants are drugs such as cocaine, crack, crystal meth and ecstasy (although this drug has additional properties beyond acting as a stimulant). They cause the heart to pump blood out in large amounts and at high pressures requiring a lot of heart muscle activity. There is a supply and demand mismatch of oxygen and blood vessels can rupture in dangerous areas. Death and disability can result from heart attack, arrhythmia, cardiomyopathy or poor heart function, stroke and seizure.

Depressants are drugs such as heroin, morphine, oxycodone and the semi-, synthetic derivatives ie. oxycontin, percocet, T3, vicodin, roxicodone. Along with xanax, klonopin, ambien and GHB. Depressants lead to a decreased brain stimulus to breathe both when you are awake, and more dangerously when passed out. Breathing less times per minute produces a poor exchange of inhaled oxygen and exhaled carbon dioxide. Your blood pH or chemistry slowly changes becoming more acidic. The intricate balance of cellular physiology or function is disrupted and cells begin to die everywhere in the body along with the body itself.

Death from infection is a very common and well understood means through which humans die. The term sepsis or "septic shock" results from bacteria toxin or juice in the blood stream causing blood vessel dilation which translates to a low blood pressure. Low pressure leads to inadequate perfusion of blood with oxygen to tissue therefore multi-organ dysfunction syndrome and cell death ensue. Skin infections at the administration site like injecting or snorting can lead to sepsis. Bacteria on needles introduced to the blood stream seed bacteria on the valves of the heart and grow like cauliflower and are termed vegetations. Many weeks of intravenous antibiotics are required along with an open heart procedure to cut out and replace the affected heart valve. These vegetations often flick off in the highly turbulent environment of the beating heart and they land in your brain causing a stroke and leaving half of the body limp with a lot of symptoms contingent on the lottery draw of where in the brain the vegetation settled, not to mention there is now bacteria in the brain which can lead to a space occupying and brain liquifying lesion. Pneumonia or lung infections from a variety of bacteria aquired through drug inhalation or breathing in vomit when passed out can lead to sepsis, even bacteria normally found only in the colon with feces has been a source of pneumonia from a, very, very dirty crack pipe used for smoking. Hepatitis from sharing needles treatable only by liver transplant leads to death from liver failure and build up of toxic metabolites. Contracting HIV and developing AIDS from needle sharing is fatal from what can be any number of complex, yet otherwise trivial infections in people with normal immune systems.

The "High Effect" is what I have creatively come up with to represent the effects related to impairment and/or being passed out. Just a few things that may have detrimental health ramifications secondary to impairment include: motor vehicle collisions, suicide, homicide, falling in to subways, fighting, emotional and mental turmoil, and prostitution are some that come to mind. Then of course when one is passed out and can no longer protect themselves, they might be murdered, kidnapped, have their organs removed for sale on the black market, beaten, sexually molested, photographed naked, raped, exposed to roaches and rats.

I spoke just the other day in the hospital with a patient who had a complicated drug history who has been clean for over a decade. He had tried all the treatments and programs unsuccessfully at first, then one morning he woke up and he was tired of being tired. He thought about life 1 year in the future rather than thinking only about his next high. Somehow, that day he worried he was going to die if he didn't stop, then all the same interventions that had failed previously, worked and have so for over 10 years.

If you are looking for help: "Drug addiction help"

REFERENCES

Judith E. Tintinalli, MD, MS, Gabor D. Kelen, MD, J. Stephan Stapczynski, MD,O. John Ma, MD and David M. Cline, MD Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6e The American College of Emergency Physicians
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