Amphetamines

AKA

Crank

Speed

Fast onset, usually within an hour.

Physical: mydriasis, anorexia, insomnia, hyperactivity—possible rhabdomyolysis, tremor, dry mouth, convulsions, chest pain, arrhythmia, heart block, coma.

Psychiatric: elation, irritability, hyperactivity, depression, panic, rapid speech, psychosis.

Mydriasis

Hyperactivity

Psychotic symptoms

Duration of detection in urine, 48 h

Dysphoric mood, suicidality in some cases

Fatigue/hypersomnia

Psychomotor retardation

Nightmares

Chronic use:

Clinical presentation similar to cocaine intoxication, but may last longer.

Cannabis

AKA

Marijuana

Blunt

Hashish

Weed

Pot

Ganja

Grass

Joints

Mary Jane

Physical: conjunctival injection, increased appetite, dry mouth, tachycardia, impaired motor performance, visual distortions.

Psychiatric: euphoria and/or dysphoria, anxiety, paranoia, impaired judgment.

Conjunctival injection

Increased appetite

Dry mouth

Tachycardia

Duration of detection in urine, 3 d to 4 weeks

False positives:

Dronabinol

Naproxen

Acute withdrawal symptoms rare, but slowed cognitive processing and irritability may persist.

Chronic use:

Chronic use is associated with chronic obstructive pulmonary disease, lung cancer, psychiatric illness (e.g., amotivational syndrome/chronic cannabis syndrome), and cognitive dysfunction.

In individuals predisposed to mental illness, chronic use can lead to anxiety, panic attacks, depression, paranoia, and psychosis.

Decreased fertility

Cocaine

AKA Crack

Coke

Rock

Speedballing (mixed with heroin)

Physical: mydriasis, tachycardia, elevated blood pressure, chest pain, cardiac arrhythmias, sweating or chills, gastrointestinal symptoms, anorexia, respiratory depression, dyskinesias, seizures, coma.

Psychiatric: euphoria, agitation, paranoia, hallucinations, impaired judgment.

Intoxication resembles mania — symptoms persisting >24-48 hrs may indicate an underlying bipolar disorder.

“Mania-like presentation”

Hallucinations

Duration of detection in urine. 6-8 h

Metabolites 2-4 d

False positives:

Fluconazole

Local anesthetics

Early symptoms include intense drug craving, restlessness, anxiety, depression followed by fatigue, decreased energy, insomnia/hypersomnia, increased appetite.

Chronic use:

Chronic use may lead to apathy, persistent psychosis, cognitive impairment.

Gamma-hydroxybutyric acid (GHB)

AKA Liquid ecstasy

Grievous bodily harm “Date rape drug”

Physical: vomiting, dizziness, respiratory depression.

Psychiatric: euphoria, relaxed state, disinhibition.

Commonly used as a recreational drug by party/nightclub attendees and as a growth hormone-releaser for bodybuilders.

Disinhibition

Altered level of consciousness

Missed by routine diagnostic urine screens.

Similar to those of alcohol/benzodiazepines

Anxiety and insomnia

Gastrointestinal upset

Tremor

Feelings of doom

Autonomic instability

Delirium tremens-like symptoms if severe

Hallucinogens

LSD (AKA Acid, Boomers, yellow sunshines)

Morning glory seeds

Mescaline (AKA cactus, mesc, peyote)

MDA, MDEA

Psilocybin (AKA magic mushroom, shrooms)

Physical: mydriasis, tachycardia, hypertension, hyperthermia.

Psychiatric: mood lability, anxiety/panic, grandiosity, intensified sensations, depersonalization, derealization, hallucinations, synesthesias, hyperacusis, impaired attention/concentration, amotivation.

Visual hallucinations

Synesthesias (blending of senses, e.g., sounds being seen)

Intense perceptions

Hyperacusis

Presence of clear sensorium

No acute withdrawal syndrome.

Chronic use:

Psychosis

Depression

Flashbacks up to 30%

Parkinsonian symptoms

In individuals predisposed with schizophrenia, hallucinogen abuse may lead to early onset of psychosis and relapse of psychotic disorder.

Inhalants

Gasoline

Glue

Paint thinners

Spray paints

AKA laughing gas, poppers, snappers, whippets

Physical: dizziness, blurred vision/diplopia, nystagmus, slurred speech, ataxia, psychomotor retardation.

Psychiatric: belligerence, agitation, apatspaired judgment, social and occupational dysfunction.

“Bad trip”— syndrome of anxiety, panic, dysphoria, and paranoia. Can lead to suicidality and suicide attempts.

No acute withdrawal syndrome

Chronic use: psychosis, mania, organ damage (e.g., bone marrow, kidney, liver, brain).

MDMA

“Ecstasy”

Adam

XTC

X

Clarity

Eve

Lover’s speed peace

Physical: sympathetic overload (e.g., dilated pupils, elevated heart rate and blood pressure, arrhythmias), increased tactile sensitivity, tremor, and parkinsonism. When severe, serotonin syndrome and low serum sodium.

Psychological: restlessness, increased feeling of connectedness, amotivation, altered perception of time, altered mental status, paranoia, increased libido.

Profound feeling of attachment and connectedness.

Altered perception of time.

Withdrawal syndrome includes severe anhedonia, anorexia, amotivation, depressed mood.

Physiological dependence uncommon.

Chronic use: cognitive deficits.

Opioids

Heroin (AKA brown sugar, dope, smack, H)

Codeine (AKA Captain

Cody, Cody)

Fentanyl

Morphine (AKA M, Miss Emma)

Opium

Physical: miosis, slurred speech, drowsiness, staggering gait.

Psychological: initial euphoria followed by depression, psychomotor retardation/agitation, impaired functioning, impaired attention and memory.

Constricted pupils

Depressed mood

Sedation

Presence of track marks

Duration of detection in urine:

Heroin 36-72 h

Morphine 48-72 h

Methadone 72 h

False positives:

Chlorpromazine

Poppy seed

Dextromethorphan

Ofloxacin

Rifampin

Signs and symptoms of opioid withdrawal:

Physical-flu-like symptoms, nausea, abdominal cramps, vomiting, diarrhea, mydriasis, muscle and bone pain.

Psychiatric-affective disorders (especially depression), anxiety, irritability.

Symptomatic treatment may include NSAIDs, dicyclomine 10 mg q6h for abdominal cramps, bismuth subsalicylate 30 cc after each loose stool, and clonidine 0.1-0.2 mg p.o. q4-6h (hold for hypotension).

Phencyclidine PCP

AKA

Angel dust

Peace pill

Love boat

Physical: mydriasis, nystagmus (vertical > horizontal), hyperacusis, tachycardia, hypertension, numbness, rigidity, ataxia.

Psychiatric: mood instability, aggression, altered perception, disorganization, bizarre behaviors.

Mydriasis Nystagmus (vertical > horizontal) Ataxia Diminished pain sensation Aggression

Duration of detection in urine, 8 d

Symptoms appear after several days of use and include:

Depressed mood

Intense drug cravings

Increased appetite

Bruxism

Hypersomnia

Rohypnol (flunitrazepam)

Commonly used as a “date rape” drug.

Physical: hypotension, dizziness, visual changes, decreased muscular tension, urinary retention.

Psychiatric: decreased anxiety, loss of inhibition, altered mental status, confusion, aggression, anterograde amnesia.

Anterograde amnesia

Altered mental status

Decreased muscular tension

Withdrawal syndrome:

Physical: headache:

Tension Muscle pain

Paresthesias Increased risk of seizures Photosensitivity

Psychiatric: anxiety

^a May vary widely depending upon amount ingested, compound, physical state of patient, and other factors.