All Drugs and Their Effects

[MAVI]

Alcohol

Alcohol is a liquid produced by fermentation, which is the action of yeast on liquids containing sugars and starches. Pure alcohol has no colour or smell, but has a very strong taste experienced as a burning sensation. Alcoholic drinks vary in colour and taste because of other ingredients that are added to them.

Alcohol is a depressant drug—not a stimulant as many people think. Alcohol slows down activity in the central nervous system, which means it slows down the messages going between the brain and the body. Depressant drugs affect concentration and coordination, and slow the person's response time to unexpected situations.

In small quantities, depressants such as alcohol cause people to become relaxed and lower their inhibitions. They feel more confident and often act in a more extroverted manner. In larger quantities, depressants can cause unconsciousness and even death.


Effects of alcohol

How alcohol is absorbed into the body

Alcohol is absorbed directly into the bloodstream through the stomach and the small intestine. Food in the stomach slows down the rate at which alcohol is absorbed, but does not prevent intoxication or drunkenness. All alcohol consumed will reach the bloodstream, regardless of how much food is in the stomach. Alcohol is distributed throughout the water in the body, but not into fatty tissue.
How alcohol leaves the body

The liver breaks down about 91 per cent of alcohol, and a small amount leaves the body in urine, sweat and the breath. The liver can only work at a fixed rate, getting rid of about three-quarters of a standard drink an hour. Sobering up takes time, and cold showers, exercise, black coffee, fresh air or vomiting will not speed up the process. Someone who drinks a lot at night may still have a high concentration of alcohol in their bloodstream the following day.
Possible health benefits of alcohol

Research shows that moderate amounts of alcohol can reduce the risk of developing some types of cardiovascular disease in people aged 40–45 years and over. However, it is important to remember that the risk of cirrhosis, some cancers and other diseases becomes greater with increased alcohol consumption.
Immediate effects

After a few drinks the person may feel more relaxed, have reduced concentration and slower reflexes.

After a few more drinks, they may have fewer inhibitions, more confidence, reduced coordination, slurred speech and intense moods (for example, sad, happy, angry).

If the person continues to drink they may experience confusion, blurred vision and poor muscle control.

Continuing to drink may result in nausea, vomiting and sleep.

Consuming more alcohol could possibly result in coma or death.
"Binge" drinking

Binge drinking can be described as drinking heavily over a short period of time or drinking continuously over a number of days or weeks.

Binge drinking is harmful because it results in immediate and severe intoxication. As well as health risks, this can lead people to take risks and put themselves in dangerous situations.

Common effects of binge-drinking episodes are hangovers, headaches, nausea, shakiness and vomiting.



Long-term effects

Heavy consumption of alcohol over a long period of time can cause damage to many parts of the body. Impairment of brain and liver functions can be permanent. If the person’s diet is also poor, this can further affect their health. Emotional difficulties, such as depression and relationship problems, are also likely.

Other possible long-term effects include:

* cancer of the mouth, throat, oesophagus, lips, liver
* brain injury, loss of memory, confusion, hallucinations
* high blood pressure, irregular pulse, enlarged heart and changes in red blood cells
* weakness and loss of muscle tissue
* sweating, flushing and bruising of the skin
* inflamed stomach lining, bleeding and stomach ulcers
* increased risk of lung infections
* severe swelling of the liver, hepatitis and cirrhosis
* inflamed pancreas
* tingling and loss of sensation in hands and feet
* for men, impotence, shrinking of testicles and damaged and reduced sperm
* for women, greater risk of gynaecological problems.

Social problems

Excessive alcohol use can effect all areas of a person's life, including family, work and personal relationships.

* Family problems: Arguments over someone's drinking can cause family and relationship problems that may lead to break up.
* Work problems: Drinking alcohol at work and hangovers can lead to poor performance and accidents at work, while illness can result in absenteeism.
* Legal problems: Drink-driving may lead to fines, loss of license and even imprisonment.

More on support for families
Tolerance and dependence

People who drink heavily usually develop a tolerance to alcohol. This means that they need to drink more to experience the same effect. As a result, some people can drink large amounts of alcohol without appearing to be intoxicated. However, the amount of alcohol consumed can still damage their health.

People who regularly drink heavily may become dependent on alcohol. Dependence can be psychological or physical, or both. People who are psychologically dependent on alcohol find that drinking becomes far more important than other activities in their life. People who are physically dependent upon alcohol find that their body is used to functioning with alcohol present.
Withdrawal

If a person who is physically dependent on alcohol suddenly stops drinking they will experience withdrawal symptoms because their body has to readjust to functioning without alcohol.

Alcohol withdrawal symptoms include:

* loss of appetite
* nausea
* anxiety
* insomnia
* irritability
* confusion
* tremors
* sweating.

In severe cases, alcohol withdrawal may cause convulsions, cramps, vomiting, delusions, hallucinations and even death. A person considering withdrawing from alcohol should first consult a doctor or other health professional.
Treatment

While abstinence may be a suitable treatment aim for some people, many programs recognise that for others this may not be possible or realistic. Most programs adopt strategies that have an overall aim of reducing the harms and risks related to the person’s alcohol use.

Some treatment options include counselling, withdrawal (detoxification) and medication (pharmacotherapy). Residential and "out-patient" programs are available.

Treatment is more effective if tailored to suit a person's circumstances, and usually involves a combination of methods.



Research has shown that alcohol affects women differently than men.

* Higher blood alcohol concentration (BAC): If a man and a woman drink exactly the same amount of alcohol, the woman will almost always have a higher BAC. One reason is that a woman’s body contains more fatty tissue and less water than a man’s body and women are often smaller than men.
* Health problems: Women may develop liver damage and other health problems at lower levels of alcohol consumption than men. Women who drink alcohol are at an increased risk of developing breast cancer and gynaecological problems than women who don’t drink.
* Hormonal differences: Some research suggests that a woman’s reaction to alcohol may vary at different stages of her menstrual cycle, due to differences in hormone levels. Women who take the contraceptive pill may take longer to get rid of alcohol in their bodies than women not on the pill.

For all these reasons, health authorities recommend that women should drink less alcohol than men.
Pregnancy and breastfeeding

Alcohol consumed during pregnancy crosses the placenta to the baby. It can cause problems in pregnancy, such as bleeding, miscarriage, stillbirth and premature birth.

There are no known safe levels of alcohol consumption during pregnancy. Babies born of women who are heavily dependent on alcohol can suffer alcohol withdrawal symptoms after birth, have poor coordination and movement, and foetal alcohol syndrome (FAS). Babies with FAS may be born with facial defects and physical and intellectual disablility.

There is evidence that that alcohol is excreted into breast milk and can reduce the milk supply. For women who are breastfeeding it is better to avoid consumption of alcohol as much as possible.


* maternal alcohol consumption can harm the developing fetus or breastfeeding baby.
* For women who are pregnant or planning a pregnancy, not drinking is the safest option.
* For women who are breastfeeding, not drinking is the safest option.

See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including alcohol, and prescribed and over-the-counter medications.


Standard drinks

The use of standard drinks can help people to monitor their alcohol consumption and exercise control over the amount they drink.

A standard drink is defined as one that contains 10 grams of pure alcohol. Different types of alcoholic drinks contain different amounts of pure alcohol. For example, each of the drinks below are equal to approximately one standard drink:

* Two 285ml pots/middies/schooners/handles of light beer (2.7% Alc./Vol)
* One 375ml stubbie of mid strength beer (3.5% Alc./Vol)
* Three-quarters of a 375ml stubbie of full strength beer (4.8% Alc./Vol)
* One 285ml pot/middy/schooner/handle of full strength beer (4.8% Alc./Vol)
* 100ml of wine (13.5% Alc./Vol)
* Two-thirds of a 330ml bottle of alcoholic soda (5% Alc./Vol)
* 30ml of spirit or liqueur (40% Alc./Vol).

Keep in mind:

* The "standard" size of drinks served in some hotels may be bigger than the standard drinks you are used to. Large wine glasses can hold two standard drinks or even more.
* Drinks served at home often contain more alcohol than a standard drink.
* Cocktails can contain as many as five or six standard drinks, depending on the recipe.

More information on standard drinks
Blood alcohol concentration

Blood alcohol concentration (BAC) is the amount of alcohol in the bloodstream. A BAC of 0.05 means the person has 0.05 grams of alcohol in every 100ml of their blood.

Since the liver ****bolises alcohol at a rate of about three-quarters of a standard drink an hour, the BAC level drops over time, unless more alcohol is consumed.

BAC is measured with a breathalyser, or by analysing a sample of blood.
Factors affecting your BAC

The more a person drinks, the higher their BAC. However, two people who drink the same amount might register quite different BACs. This is due to a range of factors, including:

* Body size: A smaller person will have a higher BAC than a larger person, because the alcohol is concentrated in a smaller body mass.
* Empty stomach: Someone with an empty stomach will reach a higher BAC sooner than someone who has just eaten a meal. Food in the stomach slows down the rate at which alcohol passes into the bloodstream.
* Body fat: People with a lot of body fat tend to have higher BAC. Alcohol is not absorbed into fatty tissue, so the alcohol is concentrated in a smaller body mass.
* Sex: After consuming the same amount of alcohol, a female will almost always have a higher BAC than a male.

Because of all these variable factors, counting the number of standard drinks you consume can only give a rough guide to your BAC.
Reducing the risks
Low-risk drinking guidelines

Reducing the risk of alcohol-related harm over a lifetime

* The lifetime risk of harm from drinking alcohol increases with the amount consumed.
* For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

Reducing the risk of injury on a single occasion of drinking

* On a single occasion of drinking, the risk of alcohol-related injury increases with the amount consumed.
* For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

Children and young people under 18 years of age

* For children and young people under 18 years of age, not drinking alcohol is the safest option.
* Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.
* For young people aged 15–17 years, the safest option is to delay the initiation of drinking for as long as possible.

Pregnancy and breastfeeding

* Maternal alcohol consumption can harm the developing fetus or breastfeeding baby.
* For women who are pregnant or planning a pregnancy, not drinking is the safest option.
* For women who are breastfeeding, not drinking is the safest option.



The guidelines are supported by a body of evidence detailing how and why these recommendations were developed.

Research is now available that indicates that alcohol, even at low levels, can have harmful effects to our health both in the short- and long-term.

Regular consumption of two drinks a day translates to a lifetime risk of death from alcohol-related disease of 0.4 in 100. With every drink above that, the risk increases substantially.

Risk of short-term harm through injury was also shown to increase dramatically where over four drinks were consumed on a single occasion.

The levels of drinking proposed in the guidelines aim to support an acceptable amount of risk.
How to drink less

* Start with a soft drink: You will drink much faster if you are thirsty, so have a non-alcoholic drink to quench your thirst before you start drinking alcohol.
* Use standard drinks: Monitor how much alcohol you drink. By converting what you drink into standard drinks, it is easier to keep track.
* Drink slowly: Take sips and not gulps. Put your glass down between sips.
* Eat before or while you are drinking: Eating slows your drinking pace and fills you up. If you have a full stomach, alcohol will be absorbed more slowly.
* Avoid salty snacks: Salty food like chips or nuts make you thirsty, so you drink more.
* Avoid "shouts": Don’t get involved in shouts, or rounds. Drink at your own pace—not someone else’s. If you do get stuck in a shout, buy a non-alcoholic drink for yourself when it’s your turn.
* One drink at a time: Don’t let people top up your drinks. It is hard to keep track of how much alcohol you have drunk.
* Pace yourself: Try having a "spacer", a non-alcoholic drink every second or third drink.
* Stay busy: If you have something to do, you tend to drink less. Play pool or dance—don’t just sit and drink.
* Try the low-alcohol alternative: A wide range of light beers are available. Low-alcohol or non-alcoholic wines are also becoming more available. Most places that serve cocktails also serve non-alcoholic versions.
* Have alcohol-free days: Have at least two days a week when you don’t drink at all.
* Keep a diary: Write down how much you drink each day. This can make you more aware of exactly how much you drink.
* Be assertive: Don’t be pressured into drinking more than you want or intend to. Tell your friends "thanks, but no thanks".

Alcohol can be an enjoyable part of life. However, alcohol can cause problems when consumption is not controlled.

[MAVI]

Amphetamines

Amphetamines belong to a group of drugs called "psychostimulants". Amphetamines stimulate the central nervous system and speed up the messages going to and from the brain to the body.

Most amphetamines are produced in backyard laboratories and sold illegally. People who buy amphetamines illegally are often buying these drugs mixed with other substances that can have unpleasant or harmful effects.
What do they look like?

Amphetamines are a whole family of related drugs—each with its own recipe—and are taken in different ways. They can be in the form of powder, tablets, capsules, crystals or red liquid.

Amphetamines can come as a white through to a brown powder, sometimes even orange and dark purple. They have a strong smell and bitter taste.

Amphetamine capsules vary considerably in colour and are sometimes sold in commercial brand shells. They are packaged in "foils" (aluminium foil), plastic bags or small balloons when sold on the street.

Amphetamine tablets vary in colour, and can be a cocktail of drugs, binding agents, caffeine and sugar.

Crystal methamphetamine, or "ice", generally comes in large "sheet-like" crystals, or as a crystalline powder.

The reddish-brown liquid is sold in capsules.

MDMA, or "ecstasy" as it is more commonly known, is another illicit drug related to amphetamines. It is usually available in small tablets.

Why are they used?

People use amphetamines for different reasons. Some use the drugs to get "high" and dance all night. Others use the drugs to help stay awake for long periods of time, to improve performance in sport or at work, or to boost their self-confidence. Amphetamines can reduce tiredness and increase endurance.

For medical purposes, amphetamines are prescribed to treat narcolepsy (where a person has an uncontrollable urge to sleep) and attention-deficit hyperactivity disorder (ADHD).
How are they taken?

Amphetamines are most commonly swallowed, injected or smoked. They are also "snorted", or sniffed, through the nose. Some people insert them anally ("shafting").
Street names

Common names for amphetamines are "speed", "up", "fast", "louee", "goey", "whiz", "pep pills", "uppers". Crystal methamphetamine is also known as "ice", "shabu", "crystal meth", or "glass".

Effects of amphetamines

The effects of any drug (including amphetamines) vary from person to person, depending on the individual’s size, weight and health, how much and how the drug is taken, whether the person is used to taking it and whether other drugs are taken. It also depends on the environment in which the drug is used; for example, whether the person is alone, with others or at a party.
Immediate effects

Soon after taking amphetamines, the following effects may be experienced:

* Speeding up of bodily functions
Amphetamines speed up the body’s activity. Heart rate, breathing and blood pressure increase. A dry mouth, increased sweating, enlargement of the eye’s pupils and headaches may occur.
* More energy and alertness
Users may feel energetic and full of confidence, with a heightened sense of well being. Other effects include feeling wide awake and alert, becoming talkative, restless and excited, and having difficulty sleeping. Panic attacks may also be experienced.
* Reduced appetite
* Irritability
Some users become anxious, irritable, hostile and aggressive. Sometimes people feel a sense of power and superiority over others.

Impure amphetamines

Most amphetamines sold illegally contain a mixture of pure amphetamines and other substances such as sugar, glucose, bicarbonate of soda and ephedrine. These additives can be highly poisonous. They can cause collapsed veins, tetanus, abscesses and damage to the heart, lungs, liver and brain. And because the person doesn’t know whether they are using 5 per cent or 50 per cent pure amphetamines, it is easy to overdose by accident.
In greater quantities

Very high quantities of amphetamines can cause paleness, headaches, dizziness, blurred vision, tremors, irregular heartbeat, stomach cramps, sweating, restlessness, irregular breathing and loss of coordination. Some users have collapsed after taking amphetamines. High quantities can also create an "amphetamine psychosis", characterised by paranoid delusions, hallucinations and aggressive or violent behaviour.
Effects of overdosing

Due to the unknown strength and mix of street amphetamines, some users have overdosed and experienced strokes, heart failure, seizures and high body temperature. Some have died as a result. Injecting runs a greater risk of overdosing due to large amounts of the drug entering the blood stream and quickly travelling to the brain.
Coming down

As the effects of amphetamines begin to wear off, a person may experience a range of symptoms including uncontrolled violence, tension, radical mood swings, depression and total exhaustion.
Long-term effects

Regular use of amphetamines may result in chronic sleeping problems, anxiety and tension, high blood pressure and a rapid and irregular heartbeat. In order to combat these drug-related effects, people who use amphetamines may also use alcohol, benzodiazepines, other sedatives/hypnotics, cannabis and opiates.

Other possible long-term effects include:

* Malnutrition
Amphetamines reduce appetite, resulting in people being less likely to eat properly.
* Psychosis
Frequent heavy use can cause "amphetamine psychosis". Symptoms may include paranoia as well as delusions, hallucinations and bizarre behaviour. These symptoms usually disappear a few days after the person stops using amphetamines.
* Reduced resistance to infections
Regular amphetamine users often don’t eat or sleep properly and are generally run down, so their resistance to infections is reduced.
* Violence
People who use amphetamines regularly or in high quantities may suddenly become violent for no apparent reason.
* Brain damage
There is some evidence that amphetamine use may damage brain cells. This damage can result in reduced memory function and possibly other impairments in thinking.

Tolerance and dependence

People who are physically dependent on amphetamines usually develop tolerance to the drug, making it necessary to take more and more to get the same effect. The quantity taken can reach a stage at which no further increase in the amount taken will produce the desired effect.

Dependence on amphetamines can be psychological or physical, or both. People who are psychologically dependent on amphetamines find that using them becomes far more important than other activities in their life. They crave the drug and will find it very difficult to stop using it. People who are physically dependent on amphetamines find that their body has become used to functioning with the amphetamines present.
Withdrawal

If a person who is dependent on amphetamines suddenly stops taking it, they will experience withdrawal symptoms, because their body has to readjust to functioning without the drug.

Amphetamine withdrawal symptoms may include hunger, extreme fatigue, anxiety, irritability and depression. People may also have a long but restless sleep, often interrupted by nightmares. Some experience severe distress or feelings of panic.
Treatment options
There are a number of drug treatment options available in Australia. While abstinence may be a suitable treatment aim for some people, many programs recognise that for others this may not be possible or realistic. Most programs adopt strategies that have an overall aim of reducing the harms and risks related to the person’s drug use.

Some treatment options include counselling, group therapy, withdrawal (detoxification) and medication (pharmacotherapy). Residential and "out-patient" programs are available.

Treatment is more effective if tailored to suit a person's circumstances, and usually involves a combination of methods.

Pregnancy and breastfeeding

Amphetamine use during pregnancy can affect foetal development. Amphetamine use has been linked with bleeding, early labour and miscarriage. Amphetamine use during pregnancy has also been linked to an increased risk of foetal abnormalities, including smaller head size, eye problems, cleft palate, delayed motor development, limb defects and changes to the brain. Amphetamines also cause the heart rate of mother and baby to increase.

If amphetamines are used close to birth the baby may be unsettled and may be over-active and agitated. Babies of mothers who regularly use amphetamines may also experience withdrawal symptoms in the first few weeks after birth.

Not much is known about the effects of amphetamines on the mother during breastfeeding. There is evidence that babies feed poorly and may be irritable.

See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.

Hepatitis and HIV

Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis B, hepatitis C and HIV (Human Immunodeficiency Virus—the virus that causes AIDS).

Reducing the risks

The aim is to reduce drug-related harm to both the community and the individuals who use drugs.

Harm-minimisation strategies range from encouraging "non-use" through to providing the means for people who use drugs to use them with reduced risks.


Remember: there is no safe level of drug use.

What to do in a crisis

* If someone overdoses or has an adverse reaction while using amphetamines it is very important that they receive professional help as soon as possible. A quick response can save their life.
* Call an ambulance, Don’t delay because you think you or your friend might get into trouble. Ambulance officers are not obliged to involve the police.
* Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
* Ensure that the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing.
* If the person is unconscious, don’t leave them on their back—they could choke. Turn them on their side and put them in the recovery position. Gently tilt their head back so their tongue does not block the airway.
* If breathing has stopped, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
* Provide the ambulance officers with as much information as you can—what drugs were taken, how much was taken, how long ago and any pre-existing medical conditions.
* Before using amphetamines, make sure you and your friends know what to do in a crisis.

[MAVI]

Analgesics

Analgesics, also known as "painkillers", are used medically to relieve pain.

Many analgesics are relatively safe to use when taken as prescribed or instructed by your doctor or pharmacist, in conjunction with the manufacturer's instructions on the packaging. Some extra precautions may apply to patients with pre-existing medical conditions such as kidney failure or gastric ulcers.
What do they look like?

Analgesics are available in many forms. These include tablets, capsules, suppositories, soluble powders and liquids.

Some people may misuse analgesics, in error or deliberately. This page outlines some commonly used over-the-counter analgesics, including what they are used for, possible side effects and risks associated with using them outside the recommended doses. The painkillers covered are:

* aspirin
* codeine (in combination products)
* ibuprofen
* paracetamol.

Each of these drugs are medicines that can be purchased "over the counter" from a supermarket or pharmacy. They are often combined with other medicines to make various other preparations such as cold and ’flu medicines and other medicinal products. For example, aspirin and codeine are ingredients in Codral Blue® and paracetamol, codeine and doxylamine are ingredients in Mersyndol®.
How are they used?
Medical uses

Analgesics are used to relieve pain. Some analgesics can also be used to reduce fever, to help relieve the symptoms of cold and ’flu, soothe swollen tissues, reduce inflammation, control diarrhoea, and as a cough suppressant.

Health professionals may also prescribe analgesics for a range of other medical conditions.

When taking any kind of medicine, including analgesics, it is important to follow carefully the directions of your health professional and those on the packaging of the analgesic. All medicines, even those that can be purchased without a prescription (over-the-counter medicines) have side effects that can damage your health.

Non-medical uses

Some people misuse analgesics. They may intentionally take more than the recommended dose, or they may take it for longer than the recommended period. Some people may also take analgesics when they do not need to, or they may use them in an attempt to become intoxicated. Misusing over-the-counter analgesics increases the risk of side effects and overdose, and can damage your health.


Chemical and brand names

Analgesics are known by their chemical (generic) names and their brand or trade names. Some examples include:


Generic name Brand/trade name/s
Aspirin Aspro Clear, Disprin
Aspirin and codeine Aspalgin, Codral Blue
Ibuprofen ACT-3, Brufen, Nurofen
Ibuprofen and codeine Nurofen Plus
Paracetamol Dymadon, Lemsip, Panadol, Panamax, Tylenol
Paracetamol and codeine Codral Pain Relief, Dymadon Co and Dymadon Forte, Panadeine Forte, Panamax Co
Paracetamol, codeine and doxylamine Mersyndol, Mersyndol Forte, Panalgesic


Analgesics and other drugs

Combining analgesics with other drugs, including prescribed medicines, alcohol and illicit drugs, can alter the effects, sometimes with unpredictable consequences.

Here are a few examples of the many interactions of analgesics and other drugs:

* Drinking alcohol while taking certain analgesics such as aspirin and ibuprofen can increase the risk of gut irritation and discomfort.
* Some analgesics, such as aspirin and ibuprofen, can alter the effects of some blood pressure medicines and may increase bleeding tendencies associated with medicines such as warfarin.
* Taking codeine with some medicines, such as sedatives, certain antidepressants and certain antihistamines, can increase the sedative effects and reduce the breathing rate.
* Naltrexone blocks the effects of codeine and other opioids.

Pregnancy and breastfeeding

There is generally no increased risk of birth defects associated with taking over-the-counter analgesics while pregnant. However, there are some risks in using analgesics during pregnancy or breastfeeding, including:

* Premature closing of the heart duct through which blood bypasses the lungs of the foetus. This can be caused by some analgesics such as aspirin and ibuprofen if taken late in pregnancy.
* Prolonged labour with related bleeding difficulties, due to using some analgesics such as aspirin and ibuprofen close to the birth.
* Withdrawal symptoms in the baby after birth if the mother has taken large doses of codeine late in the pregnancy.

Always check with your health professional if you are taking, or planning to take, any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.


Reducing the risks

Follow carefully the directions of your health professional, or on the packaging of the analgesic, and do not exceed the recommended dose. If you are concerned about the amount of analgesics you are taking, talk to a health professional.

All medicines, including those that can be purchased over the counter, can have side effects and can damage your health if they are misused.

[MAVI]

Benzodiazepines

Benzodiazepines (pronounced BEN-ZOH-DIE-AZ-A-PINS) are depressant drugs. Benzodiazepines, also known as "minor tranquillisers", are prescribed by doctors to relieve stress and anxiety and to help people sleep. Some people use benzodiazepines illegally, to become intoxicated.

Like other depressants, benzodiazepines work by slowing down the activity of the central nervous system. In the short term, they can help with relaxation, calmness and relief from tension and anxiety. But they do not solve the problem that caused the anxiety in the first place and they can have a range of unwanted side effects.
What do they look like?

Benzodiazepines usually come in the form of tablets and capsules, in a range of colours and designs. They are generally stamped with their name and milligram quantity.
How are they used?
Medical uses

Benzodiazepines are prescribed as sedatives/hypnotics (to induce sleep) or anxiolytics (to relieve anxiety). They vary in how quickly they work and how long they last. They are also used to treat epilepsy, to relax muscles, to help people withdraw from alcohol, or as an anaesthetic before surgery.
Non-medical uses

Some people use benzodiazepines illegally to become intoxicated. They may use them when they can't get heroin, when they are trying to get off heroin or to increase the effects of heroin. People who use stimulant drugs such as amphetamines (speed) or MDMA (ecstasy) may use benzodiazepines to help when they are "coming down" from a "high", and to help them sleep.
Chemical and brand names

Benzodiazepines are known by their chemical (generic) names and their brand/trade names. In each case, these are exactly the same drug, usually made by different companies. There are over 24 different prescribed benzodiazepines, including:



Chemical name


Brand names

Diazepam


Valium, Ducene

Oxazepam


Alepam, Murelax, Serepax

Nitrazepam


Alodorm, Mogadon

Temazepam


Normison, Euhypnos, Temaze



Effects of benzodiazepines

The unwanted negative effects of benzodiazepines vary according to dose.
Low to moderate doses

The immediate effects of low to moderate doses include mild impairment of thought processes, memory and coordination; drowsiness, tiredness and lethargy; dizziness; vertigo; and blurred or double vision. The person may experience a dry mouth, slurred speech and stuttering, tremors, nausea and vomiting, loss of appetite, constipation or diarrhoea. Feelings of euphoria or isolation and emotional depression may also occur.
Higher doses

Higher doses can result in drowsiness, over-sedation and sleep. They may produce an effect similar to alcohol intoxication. Other effects can include confusion, slurred speech, poor coordination, impaired judgement, difficulty thinking clearly, loss of memory, blurred or double vision and/or dizziness. Mood swings and aggressive outbursts may also occur. The symptoms intensify as the dose increases. Feelings of jitteriness and excitability often become evident as the effects of large doses wear off.
Overdose

Very high doses of benzodiazepines can cause respiratory depression, unconsciousness or coma. Death rarely occurs from overdose of benzodiazepines alone, but deaths can occur if large doses are combined with alcohol or other drugs. Deaths can also occur from inhalation of mucus or vomit when a person is unconscious.
Bingeing

A "binge" is when a large amount of benzodiazepines is taken in one session, rather than as prescibed by a doctor. There is a strong possibility of overdosing and that a high level of benzodiazepine will remain in the bloodstream the day after a binge. This makes it dangerous to drive or operate machinery. If the binges are fairly close together, there is a risk of developing dependency on the drug.
Long-term effects

The use of benzodiazepines over a long period of time (more than two to three weeks) should be carefully monitored by your doctor. Some of the health effects of using high doses of benzodiazepines in the long term include:

* muscle weakness
* skin rashes
* weight gain
* increased risk of accidents
* increased risk of falling
* sexual problems
* menstrual irregularities
* memory loss
* confusion and diffculty thinking clearly
* lethargy and lack of motivation
* fatigue
* drowsiness
* difficulty sleeping and disturbing dreams
* nausea
* personality change and changes in emotional responses
* anxiety
* irritability, paranoia and aggression
* depression.

Injecting benzodiazepines

Injecting benzodiazepines can be very dangerous and can result in serious health problems. Most benzodiazepines are intended for oral use but some people inject them. Serious effects include:

* collapsed veins
* red, swollen, infected skin
* amputation of limbs due to poor circulation
* damage to organs
* stroke, and even death.

Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis B, hepatitis C and HIV (human immunodeficiency virus—the virus that causes AIDS).

Call the alcohol and drug information service in your state or territory to find out where to obtain clean needles and syringes.

Tolerance and dependence

People who are physically dependent on benzodiazepines can develop tolerance to the drug. This can happen very quickly and means that more of the drug is required to get the same effect.

Dependence on benzodiazepines can be psychological or physical, or both. Dependence can occur after using them for a few months and is not related to the size or physical effect of the daily dose taken. Dependency can still develop for people on long-term, low doses.

People who are psychologically dependent feel as though they can’t cope without benzodiazepines. They crave the drug and find it very difficult to stop using it.

People who are physically dependent on benzodiazepines have become used to functioning with the drug present.
Withdrawal

If a dependent person suddenly stops taking benzodiazepines, or severely cuts down their dose, they may experience physical withdrawal symptoms as their body readjusts to functioning without the drug.

Withdrawal symptoms from benzodiazepines vary from person to person, but can be quite severe. Some people have no symptoms at all, while others may have symptoms lasting from a few weeks or months to a year. Symptoms tend to come and go, but all withdrawal symptoms eventually disappear as the body adjusts to functioning without the drug.

Withdrawal symptoms can include:

* headaches
* aching or twitching muscles
* tremor
* faintness or dizziness
* sweating
* nausea, vomiting and stomach pains
* bizarre dreams
* inability to sleep properly
* fatigue
* difficulty concentrating
* anxiety and irritablity
* altered perception
* heightening of the senses of sight, touch, hearing, smell and taste.

Other less common withdrawal symptoms may include delirium, delusions, hallucinations, seizures and paranoia.

People who have been using benzodiazepines for more than a month should not suddenly stop taking them without seeing a doctor or health worker. A slow reduction in dose over time is recommended to reduce the severity of the withdrawal symptoms. If you suffer from anxiety and/or insomia keep in mind they may simply be withdrawal symptoms. If so, these symptoms will eventually cease.
Treatment options

For people who use benzodiazepines for non-medical purposes, there are a number of drug treatment options. Some aim solely for the user to achieve a drug-free lifestyle. Others recognise abstinence as one option, with the overall aim of reducing harm/risks related to a person's drug use.

Treatment is more effective if tailored to suit a person's circumstances and usually involves a combination of methods. The different options include counselling, group therapy and supervised/home withdrawal.


Pregnancy and breastfeeding

If you have been prescribed benzodiazepines, talk to your doctor if you are pregnant or breastfeeding.

Benzodiazepines taken during pregnancy cross the placental barrier and can affect the growth and development of the foetus, especially if the mother is taking more than the prescribed dose or taking bezodiazepines that have not been prescribed for her. High doses of benzodiazepines during pregnancy may lead to the baby being born with a temporary loss of muscle tone, poor feeding, drowsiness and a low temperature.

Benzodiazepines can be passed from mother to baby through breast milk and may have a sedative effect. The baby’s body cannot process these drugs quickly, and they can accumulate in high doses.

See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.

Preventing and reducing harms

If you are concerned about your dosage, talk with your prescribing health professional. There is no standard dosage suitable for everyone.

In the short term, benzodiazepines may help in getting through a difficult period of your life. However, when benzodiazepines are stopped, the problems will still be there. It is important to try and deal with those problems.

Make regular appointments with your health professional to review your medication and discuss possible alternatives.

There are many ways to deal with stress and anxiety without using benzodiazepines. Relaxation, stress management, counselling, a healthy diet and plenty of exercise all help. Talk to your doctor or contact your local community health service to find alternative ways of dealing with stress and anxiety.

If you are using benzodiazepines for non-medical purposes, and you are planning to stop using them, talk to a health professional and make sure you have medical support for a gradual withdrawal program.

What to do in a crisis

If someone overdoses or has an adverse reaction while using benzodiazepines, it is very important that they receive professional help as soon as possible. A quick response can save their life.

* Call an ambulance. Don’t delay because you think you or the person might get into trouble. Ambulance officers are not obliged to involve the police.
* Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
* Ensure the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing.
* If the person is unconscious, don’t leave them on their back—they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
* If the person has stopped breathing, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
* Provide the ambulance officers with as much information as you can—what benzodiazepines were taken, how long ago and any pre-existing medical conditions.
* Before using benzodiazepines, make sure you and your friends know what to do in a crisis.

[MAVI]

Cannabis

Cannabis is a drug that comes from Indian hemp plants such as Cannabis sativa and Cannabis indica. The active chemical in cannabis is THC (delta-9 tetrahydrocannabinol).

Cannabis is a depressant drug. Depressants do not necessarily make the person feel depressed. Rather, they affect the central nervous system by slowing down the messages going between the brain and the body.
What does it look like?

There are three main forms of cannabis:

* Marijuana is the most common and least powerful form of cannabis. It is the dried leaves and flowers of the plant. Marijuana looks like chopped grass, and ranges in colour from grey-green to greenish-brown. Marijuana is smoked in hand-rolled cigarettes (joints) or in a pipe (a bong).
* Hashish (hash) is dried cannabis resin which comes in small blocks. The blocks range in colour from light brown to nearly black. The concentration of THC in hashish is higher than in marijuana, producing stronger effects. Hash is added to tobacco and smoked, or baked and eaten in foods such as "hash cookies".
* Hash oil is a thick, oily liquid, golden-brown to black, that can be extracted from hashish. It is usually spread on the tip or paper of cigarettes and then smoked. Hash oil is more powerful than the other forms of cannabis. This form is rarely found in Australia.

A non-potent form of cannabis (Indian hemp) is used to produce fibres for use in paper, textiles and clothing.

More pictures of cannabis

THC

THC (delta-9 tetrahydrocannabinol) is the chemical in cannabis that makes you feel "high". This means you experience a change in mood and may see or feel things in a different way. Some parts of the plant contain a higher level of THC. For example, the flowers, or "heads", have more THC than the stems and leaves.

THC is absorbed into the bloodstream through the walls of the lungs (if cannabis is smoked), or through the walls of the stomach and intestines (if eaten). The bloodstream carries the THC to the brain, producing the "high" effects. Drugs that are inhaled get into the bloodstream quicker than those eaten.
Street names

"Grass", "pot", "hash", "weed", "reefer", "dope", "herb", "mull", "buddha", "ganja", "joint", "stick", "buckets", "cones", "skunk", "hydro", "yarndi", "smoke", "hooch"
Effects of cannabis

The effects of any drug (including cannabis) vary from person to person. It depends on many factors, including an individual’s size, weight and health, how the drug is taken, how much is taken, whether the person is used to taking it and whether other drugs are taken.
Immediate effects

Small doses of cannabis can have effects that last 2–4 hours after smoking. These effects include:

* relaxation and loss of inhibition
* increased appetite
* affected perception of colour, sound and other sensations
* impaired coordination
* affected thinking and memory.

Other common immediate effects include increased heart rate, low blood pressure and reddened eyes.
In greater quantities

Larger quantities of marijuana make the above effects stronger, and also tend to distort a person’s perceptions.

Very large quantities of marijuana can produce:

* confusion
* restlessness
* feelings of excitement
* hallucinations
* anxiety or panic, or detachment from reality
* decreased reaction time
* paranoia.

Long-term effects

Research shows evidence of some long-term effects in some regular cannabis users.

* Respiratory illness
The way that cannabis is smoked means that more tar is inhaled and retained in the lungs than tobacco, placing cannabis users at an increased risk of respiratory illness such as lung cancer and chronic bronchitis. Cigarette smokers who also smoke cannabis have an even greater risk of respiratory disease.
* Reduced motivation
Many regular users have reported that they have less energy and motivation, so that performance at work or school suffers.
* Brain function
Concentration, memory and the ability to learn can all be reduced by regular cannabis use. These effects can last for several months after ceasing cannabis use.
* Hormones
Cannabis can affect hormone production. Research shows that some cannabis users have a lower sex drive. Irregular menstrual cycles and lowered sperm counts have also been reported.
* Immune system
There is some concern that cannabis smoking may impair the functioning of the immune system.

Cannabis and psychosis

It is believed that cannabis use—especially if heavy and regular—may be linked to a condition known as a drug-induced psychosis, or "cannabis psychosis". This can last up to a few days. The episodes are often characterised by hallucinations, delusions, memory loss and confusion.

There is some evidence that regular cannabis use increases the likelihood of psychotic symptoms occurring in an individual who is vulnerable due to a personal or family history of mental illness. Cannabis also appears to make psychotic symptoms worse for those with schizophrenia and lowers the chances of recovery from a psychotic episode.


Medicinal use of cannabis

Cannabis has been used medicinally for many centuries. There is evidence to suggest it is useful in providing relief from nausea and vomiting caused by chemotherapy, wasting and severe weight loss, pain, glaucoma, epilepsy and asthma.
Tolerance and dependence

With regular use, people can develop a mild tolerance to cannabis. This means they need to take more and more to get the same effect.

Heavy and frequent use of cannabis can cause physical dependence. Physical dependence occurs when a person’s body has adapted to a drug and is used to functioning with the drug present.

It is possible to become psychologically dependent on cannabis. This means that using cannabis becomes far more important than other activities in their life. Some people crave the drug and find it very difficult to stop using it.
Withdrawal

Abrupt termination of cannabis use can produce withdrawal symptoms. Withdrawal symptoms include sleep disturbance, irritability, loss of appetite, nervousness, anxiety, sweating and upset stomach. Sometimes chills, increased body temperature and tremors occur. The withdrawal symptoms usually last for less than a week, although the sleep disturbances may persist for longer.
Treatment options

There are a number of drug treatment options available in Australia. Some treatment options include counselling, withdrawal (detoxification) and medication. Most programs adopt strategies that have an overall aim of reducing the harms and risks related to the person's drug use.

Information on cutting down or quitting


Pregnancy and breastfeeding

If cannabis is used during pregnancy the baby may be born smaller and lighter than other babies. Low birth weight can be associated with infections and breathing problems. There is also some evidence that cannabis use during pregnancy may affect the baby's behaviour.

Little is known about the effects of cannabis use on breastfeeding. It is believed that some of the drug will pass through the breast milk to the baby, and the baby may become unsettled and demand frequent feeding.

See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.

More on alcohol, other drugs and pregnancy

[MAVI]

Cocaine

Cocaine belongs to a group of drugs known as "stimulants". Stimulants speed up the messages going between the body and the brain.

Cocaine is extracted from the leaves of the coca bush (Erythroxylum coca), which is native to South America. The coca leaf extract is then processed to create cocaine hydrochloride, freebase and crack.

The leaves of the coca bush have long been chewed and brewed into tea by indigenous people in South America for its stimulant and appetite suppressant properties. Cocaine has been used in a range of energy providing medicines, foods and drinks. It has also been used as a local anaesthetic.
What does it look like?

The most common from of cocaine is cocaine hydrochloride. This is a white, crystalline powder with a bitter, numbing taste.

Cocaine hydrochloride can be further processed to produce cocaine base, known as "freebase" and "crack". Freebase is a white powder, while crack generally comes in the form of crystals that range in colour from white or creamy colour to transparent with a pink or yellow hue.

Cocaine hydrochloride is often mixed, or "cut", with other substances such as lactose and glucose, to dilute it before being sold.


How is it used?

Cocaine hydrochloride is most commonly "snorted" (sniffed through the nose). It can also be injected. Some people rub it into their gums, where it is absorbed into the bloodstream. Others add it to a drink or food. Freebase and crack are usually smoked.

Street names

C, coke, nose candy, snow, white lady, toot, Charlie, blow, white dust and stardust. Freebase is also known as base, and crack is sometimes referred to as rock or wash.
Effects of cocaine
Immediate effects

The effects of cocaine can last anywhere from a few minutes to a couple of hours, depending on how the cocaine is taken and the person taking it. When the immediate "rush" of the cocaine has worn off, the person may experience a "crash". Other immediate effects that may be experienced include:

* physiological arousal, including increased body temperature and heart rate
* enlarged pupils
* exhilaration
* anxiety
* dry mouth
* increased breathing rate
* increased talkativeness or quiet contemplation and rapture
* feelings of great physical strength and mental capacity
* increased libido and elevated sexual arousal
* feelings of wellbeing
* anxiety, agitation and panic
* paranoia
* upredictable violent/aggressive behaviour
* feeling more awake and alert, reduced need for sleep
* increased performance on simple tasks
* headache
* increased blood pressure and heart rate (after initial slowing)
* reduced appetite
* increased body temperature
* indifference to pain and localised pain relief.

In greater quantities

The immediate effects of cocaine intensify when the drug is taken in greater quantities. People may also experience tremors, muscle twitches, nausea and vomiting, rapid and weak pulse, arrhythmia, chest pain, heart attack, hyperthermia, seizures and stroke.

High quantities and frequent, heavy and long-term use of cocaine can lead to a "cocaine psychosis", which is characterised by paranoid delusions, hallucinations, bizarre, aggressive or violent behaviour. These symptoms usually stop a few days after the person takes cocaine, although some people may need treatment. Some people take cocaine in high-dose "binges", which means that they take cocaine repetitively over several hours or days. The binge is followed by the "crash", whereby a person experiences feelings of intense depression, lethargy and hunger.
Overdose

The risk of overdose is high, since the strength and mix of street cocaine is usually unknown. An overdose of cocaine can result in increased heart rate and body temperature, seizures, heart attack, brain haemorrhage, kidney failure, stroke and repeated convulsions. All of these can lead to coma and death.
Long-term effects

Long-term effects of cocaine use include:

* insomnia
* depression
* anxiety, paranoia and psychosis
* eating disorders and weight loss
* sexual dysfunction
* hypertension and irregular heart beat
* sensitivity to light and sound
* hallucinations—some people may even experience sensations of insects crawling under the skin
* cerebral atrophy (wasting of the brain) and impaired thinking.

Some of the other long-term effects of cocaine are related to the method of using cocaine:

* Repeated snorting damages the lining of the nose and nasal passages, and can also damage the structure separating the nostrils.
* Smoking crack cocaine can cause breathing difficulties, chronic cough, bronchitis and other respiratory problems.
* Cocaine is "cut" with substances that are poisonous when injected. They can cause collapsed veins, abscesses and damage to the heart, liver and brain.
* If injected into the skin cocaine can cause severe vasoconstriction, which may prevent blood flowing to the tissue, potentially resulting in severe tissue damage.

Tolerance and dependence

People who use cocaine can develop a tolerance to the euphoric effects of cocaine very quickly. This makes it necessary to take more and more cocaine to get the same effect.

In contrast, some people who use cocaine regularly may develop a "reverse tolerance", whereby they experience the adverse effects of cocaine more intensely.

Dependence on a drug can be psychological, physiological, or both.

A person who is psychologically dependent on cocaine finds that using cocaine becomes more important than other activities in their life. Because of its powerful euphoric effects, people who use cocaine may develop a strong psychological dependence upon it.

Physical dependence on a drug occurs when a person gets used to functioning with the drug present. It is less clear as to whether it is possible to develop a physiological dependence on cocaine.
Withdrawal

If a person who is dependent on cocaine suddenly stops taking it, or significantly cuts down the amount they are using, they can experience withdrawal symptoms.

Cocaine withdrawal generally occurs in three phases: the "crash", the "withdrawal" and the "extinction".

The crash, which usually occurs in the first few days, describes the withdrawal symptoms experienced immediately after the person stops using cocaine. Symptoms can include:

* agitation
* depression or anxiety
* feelings of intense hunger
* intense craving for cocaine
* insomnia or prolonged, but disturbed, sleep
* extreme fatigue and exhaustion.

The withdrawal phase may last up to ten weeks. During this phase, people experience severe cravings for cocaine. Other withdrawal symptoms during this phase include:

* lack of energy
* anhedonia (inability to feel pleasure)
* anxiety
* angry outbursts.

The extinction phase may last indefinitely. It involves intermittent cravings for cocaine. These generally occur in response to people, places or objects that are conditioned cues and provoke memories of taking the drug. These cravings may surface months or years after cocaine use has stopped.
Treatment options


Treatment options include counselling, group therapy, withdrawal (detoxification) and medication (pharmacotherapy). Residential and supervised/home withdrawal programs are available.

Treatment is more effective if tailored to suit a person's circumstances and usually involves a combination of methods.

For referral to a treatment service, contact the alcohol and drug information service in your state or territory.


Pregnancy and breastfeeding

Cocaine use during pregnancy can affect foetal development. Cocaine increases the heart rate in both the mother and the unborn baby, reducing the supply of blood and oxygen to the baby. This means the baby is more likely to be small and grow slowly after the birth. Cocaine use during pregnancy may cause bleeding, miscarriage, premature labour or stillbirth.

Some research has indicated that children of women who use cocaine may experience long-term mental or physical effects. A number of foetal abnormalities have been reported including malformations of the brain, skull, genito-urinary tract, heart, limbs and/or face.

If cocaine is used close to birth, the baby may be born unsettled and showing symptoms of hyperactivity and agitation. Babies of mothers who regularly use cocaine may also experience withdrawal symptoms after birth, including distressed breathing, sleepiness, poor feeding and lack of responsiveness.

It is likely that, if a mother continues to use cocaine while breastfeeding the drug will be present in her milk, which may have adverse effects on the baby. The baby may be irritable, unsettled and difficult to feed.

See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.


Cocaine, hepatitis and HIV

Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting of bloodborne viruses such as hepatitis B and hepatitis C and HIV (Human Immunodeficiency Virus—the virus that causes AIDS).


Harm-minimisation strategies range from encouraging "non-use" through to providing the means for people who use drugs to use them with reduced risks.

What to do in a crisis

If someone overdoses or has an adverse reaction while using cocaine it is very important that they receive professional help as soon as possible. A quick response can save their life.

* Call an ambulance. Don't delay because you think you or the person might get into trouble. Ambulance officers are not obliged to involve the police.
* Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
* Ensure that the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing.
* If the person is unconscious, don’t leave them on their back—they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
* If the person has stopped breathing, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
* Provide the ambulance officers with as much information as you can—how much cocaine was taken, how long ago, and any pre-existing medical conditions.
* Plan to know what to do in a crisis.

Remember there is no safe level of drug use.

[MAVI]

Buprenorphine

Buprenorphine (‘bup’, ‘B’) is available by prescription, under the name of Subutex, as a treatment for heroin dependence. It has been found to be effective in reducing the need to continue using heroin (buprenorphine maintenance) and also in helping people to withdraw from heroin and methadone. Buprenorphine is also prescribed to treat severe pain.

The information provided here discusses buprenorphine maintenance treatment.

Buprenorphine (pronounced bew-pre-nor-feen) has been found to be effective in treating heroin dependence by:

* preventing withdrawal symptoms, such as cravings for heroin
* blocking the effects of heroin. Using heroin will not provide the ‘high’ that would normally be expected, therefore it takes away one of the main reasons to use heroin.

How effective is buprenorphine?

The effectiveness of any treatment, including for heroin or other opioid dependency (addiction), is more likely to be successful if it is part of a comprehensive treatment program.

Often, a range of factors contribute to an individual’s use of drugs. Thus, it is strongly recommended that those wanting to remain free of heroin engage in a treatment program that addresses the physical (the body), psychological (the mind) and environmental issues relating to the person’s drug use. This may involve combining several treatment approaches, such as buprenorphine maintenance, counselling, alternative or holistic therapies such as massage and naturopathic treatment; and developing a positive support network including peers, family and friends and support groups.

As with any type of treatment or approach to heroin dependency, buprenorphine maintenance may be effective for some people but will not suit everyone. A doctor or drug counsellor who spends time assessing the person’s specific situation and explaining different options will recommend an approach that is appropriate for that individual.

Buprenorphine is one in a number of maintenance treatments for heroin dependence. Others include:

* Methadone (if using buprenorphine, the transfer to methadone can occur rapidly)
* Naltrexone (if using buprenorphine, the transfer to naltrexone can take place within 3–5 days)

More on treatment
Advantages of buprenorphine maintenance treatment

There are many benefits of being on buprenorphine maintenance, when compared with continuing the use of heroin:

* Maintenance treatment holds the person stable while they readjust their lives. The person may decide later to work towards reducing their dose of buprenorphine until they no longer require medical treatment.
* Using buprenorphine on its own is unlikely to result in an overdose.
* Health problems are reduced or avoided, especially those related to injecting, such as HIV, hepatitis B and hepatitis C viruses, skin infections and vein problems.
* Doses are required only once a day, sometimes even less often, because buprenorphine’s effects are long lasting.
* Buprenorphine is much cheaper than heroin.
* Staying off heroin can provide the opportunity to experience more ‘life opportunities’, such as. greater personal happiness, more close and stable relationships with others, employment and more money to buy goods for personal enjoyment.

What are the side effects?

Buprenorphine is generally well tolerated; however, some side effects have been reported. Most of these symptoms occur very early in treatment—in the first week or so. Side effects may be due to the combined experience of withdrawal from opioids and taking buprenorphine. It is important to report any side effects to a health professional.

The most common side effects are similar to those listed under the section ‘Buprenorphine withdrawal’.
Related issues

Before a person commences any drug treatment program, it is important that all the relevant information has been explained to them by a qualified health professional and, where appropriate, to carers such as family, friends etc. This includes the length of the program, how much it costs, what other supports are included or recommended, all the risks and side effects, and any other health issues to consider. When deciding on the suitability of buprenorphine maintenance, the following issues should also be discussed with a health professional:

* existing liver conditions, such as acute hepatitis
* respiratory illnesses
* if a woman is pregnant, wanting to become pregnant or breastfeeding (it has not been established that using buprenorphine during pregnancy is safe)
* buprenorphine may impair the ability to drive and operate machinery safely, so it may not be appropriate for people in certain occupations.

For referral to a buprenorphine prescribing doctor or dispensing pharmacy, contact the alcohol and drug service in your State or Territory.
Starting on buprenorphine maintenance

People who use heroin and those on a methadone program can use buprenorphine. After beginning on daily doses of buprenorphine, the dose is adjusted until the person is stabilised (free from withdrawal symptoms such as cravings). The dose may then be reduced to every second day or three times a week.

For people who use heroin, the first dose of buprenorphine is taken at least 6 hours after last using heroin; ideally, just as withdrawal symptoms begin.

People on a methadone program with a daily dose of 30 milligrams or less can transfer straight onto buprenorphine, and are unlikely to experience withdrawal symptoms. Those on methadone doses above 30 milligrams may need to have their methadone dose reduced before transferring to buprenorphine. If transferring to buprenorphine from methadone doses above 30 milligrams, withdrawal symptoms may be experienced similar to those listed under ‘Buprenorphine withdrawal’. It is not recommended that anyone on a daily methadone dose of more than 60 milligrams transfer to buprenorphine.

In general, people on methadone programs have a slightly higher risk of experiencing withdrawal symptoms than those taking heroin when transferring to buprenorphine. This means that some people may feel slightly uncomfortable for a short period of time before the buprenorphine stabilises them.

How is buprenorphine taken?

A Subutex tablet must be placed under the tongue and allowed to dissolve. Chewing or swallowing the tablet will make it ineffective. Injecting Subutex is dangerous, and can lead to severe vein damage, blood clots and other health complications.

Subutex dissolves within 2–8 minutes after placing it under the tongue. The effects begin within 30–60 minutes of taking the dose and peak within 2–4 hours, lasting between 4 hours to three days, depending on the dosage.
What is the right dosage?

The dosage of buprenorphine often varies for each person. As a guide, doses range from 4 milligrams to 32 milligrams per day for people with heroin dependence. A health practitioner should be informed of any side effects that are experienced, so that the dosage can be adjusted where appropriate. When first starting on buprenorphine maintenance, it may take a number of days (typically from three to seven days) for the effects of buprenorphine to become stable in the body. Continuing heroin use can make it difficult for the person to stabilise.
Missed doses

If a person misses their buprenorphine doses for more than five days in a row, they will need to undergo a review by the prescribing health professional. If this occurs, it is recommended that the person start again on a lower dose of buprenorphine.
Using buprenorphine with other drugs

Combining the use of any drugs can increase or alter the effects that are usually experienced from using the individual drug. It is often difficult to predict the consequences of combining the use of different drugs.

It is particularly important to avoid using other depressant drugs, such as benzodiazepines (‘benzos’), e.g. Valium, with buprenorphine. Using benzodiazepines with buprenorphine may lead to breathing difficulties, coma or death.

Using buprenorphine with heroin or other opiates, such as methadone, increases the chances of experiencing ongoing withdrawal symptoms.

Always check with your doctor or pharmacist before using buprenorphine with alcohol, medicines or other drugs.
Buprenorphine withdrawal

Withdrawal from long-term use of buprenorphine may produce symptoms similar to those experienced from heroin withdrawal. However, withdrawal symptoms tend to be milder with buprenorphine than those from methadone and other opioids.

Withdrawal symptoms vary from person to person, but may include:

* cold- or flu-like symptoms
* headaches
* sweating
* aches and pains
* sleeping difficulties
* nausea
* mood swings
* loss of appetite.

These effects usually peak in the first two to five days. Some mild effects may last a number of weeks.

[MAVI]

Ecstasy

Ecstasy is a street term for a range of drugs that are similar in structure to MDMA (methylenedioxymethamphetamine). Ecstasy is similar in structure and affect to amphetamines and (in high doses) hallucinogens.

Amphetamines, such as "speed", are stimulants that speed up activity in the nervous system. Hallucinogens, such as LSD, typically affect perception and can cause things to appear distorted or things that don't exist to be seen or heard.

Ecstasy is illegal and its ingredients are often hard to obtain. Therefore, manufacturers may substitute a wide range of substances when making the drug. It is possible that when you buy ecstasy it will contain little MDMA.

Like other illegally manufactured drugs, such as speed, there are no controls on factors such as the strength and hygiene of the drug. This increases the chances of a person overdosing, being poisoned or experiencing other adverse reactions after taking the drug.
Street names

Ecstasy is also known as "E", "XTC", "eccy", "the love drug".
How is it used?

Ecstasy usually comes in tablet form, in various colours, sizes, shapes and designs.

Swallowing is the most common way that ecstasy is used. Ecstasy tablets are also crushed and snorted. They are sometimes inserted into the anus (known as "shafting" or "shelving"). Injecting ecstasy has increased in Australia over recent years.

More pictures of ecstasy
Effects of ecstasy

The effects of any drug (including ecstasy) can vary from person to person. Because ecstasy is commonly taken prior to, or during, dance or "rave" parties, the stimulant effects are likely to increase. Hence, the person taking the drug may be more prone to prolonged and vigorous dancing, further exacerbating some of the dangers listed below.

People having any of the following conditions put themselves at greater risk of physical and psychological harm by taking ecstasy: hypertension, heart disease, diabetes, liver problems, epilepsy, a history of mental illness or panic attacks.

The effects of ecstasy usually begin within 20 minutes of taking the drug, and may last up to 6 hours. Some people have reported symptoms persisting for 32 hours after using ecstasy.

There are usually three phases:

* coming up: where the effects can be smooth and bumpy, and users may feel a rush
* plateau: where the user may feel good, happy, relaxed
* coming down: where the user may feel physically exhausted, depressed, irritable.

Immediate effects

Many people have experienced the following effects soon after taking ecstasy:

* increase in confidence
* feelings of well being
* feelings of closeness to others, hence the term "love drug"
* anxiety
* dilated pupils
* jaw clenching, teeth grinding
* increase in heart rate, body temperature and blood pressure
* nausea
* loss of appetite
* sweating.

Higher doses

Higher quantities don't appear to enhance the desirable effects and may cause:

* convulsions (fits)
* vomiting
* floating sensations
* irrational or bizarre behaviour
* hallucinations.

Overdose

Overdose from ecstasy can occur. It is usually characterised by very high body temperature and blood pressure, hallucinations and an elevated heartbeat. This is especially dangerous for those who have an existing heart condition or breathing problems, and for people with depression or other psychological disorder.
Death

Although it is difficult to determine the exact number of ecstasy related deaths that have occurred, the toxic effects of ecstasy that can lead to death include:

* heart attack
* brain haemorrhage
* blood clotting
* kidney failure
* overheating: the combination of taking ecstasy with prolonged and vigorous dancing raises the body temperature to dangerous levels. Because it is often taken in hot, humid venues the risk of death by overheating (hyperthermia) is further increased
* drinking too much: several deaths have occurred from dilutional hyponatremia—a condition whereby a person’s brain swells from excess fluid intake, inducing a coma

Long-term effects

Research indicates that few people tend to use ecstasy for a long time. This is possibly due to the severity of undesirable effects, which tend to increase the longer ecstasy use continues, while the pleasurable effects diminish. A person taking ecstasy regularly may find that they are not eating or sleeping enough and are neglecting their health. They may become "run down", have reduced energy levels and be more susceptible to colds, 'flu and infections.

Currently, much research is being undertaken to investigate the effects of ecstasy on the brain. There is limited evidence suggesting that ecstasy causes damage to some parts of the brain.
Tolerance and dependence

Tolerance to a drug occurs when a person needs larger amounts of a drug over time to achieve the same effects. Research suggests that, while some people may develop tolerance to the effects of ecstasy, using larger amounts will increase the severity of undesirable effects, rather than increase the pleasurable effects.

There is evidence that people can become psychologically dependent on ecstasy and it can be very difficult for them to stop or decrease their use. Physical dependence occurs when a person’s body gets used to functioning with the drug present. At present, there is no conclusive evidence that people can become physically dependent on ecstasy.
Treatment options

A number of drug treatment options are available . While abstinence may be a suitable treatment aim for some people, many programs recognise that for others this may not be possible or realistic. Most programs adopt strategies that have the overall aim of reducing the harms and risks related to the person’s drug use.

Some treatment options include counselling, withdrawal (detoxification) and pharmacotherapy. Residential and "out-patient" programs are available.


Pregnancy and breastfeeding

Most drugs cross the placenta, and therefore have some effect on the foetus. It is possible that miscarriage can result from using ecstasy. The use of amphetamine-like substances such as ecstasy during pregnancy has also been associated with delayed development and subtle abnormalities in the newborn.

It is possible that if a mother uses ecstasy while breastfeeding the drug will be present in her milk and may have adverse effects on the baby.

Check with your doctor or other health professional if you are taking or planning to take any substances during pregnancy or while breastfeeding, including prescribed and over-the-counter medications.

More on alcohol, other drugs and pregnancy
Ecstasy, hepatitis and HIV

Research has shown that, due to some effects of ecstasy, certain people are more prone to practising unsafe sex. This increases the chances of contracting HIV, hepatitis or other sexually transmissable infections. Sharing needles, syringes and other injecting equipment can also increase the risk of contracting blood-borne viruses.

You can search for needle and syringe programs in your area or call the alcohol and drug information service in your state/territory.

Guidelines for safer dancing

It is recommended that those using ecstasy in dance or rave environments sip water regularly rather than drink a lot all at once. If dancing, sip a total of around 500ml an hour; if inactive sip up to 250ml an hour. Wearing light, loose clothing and taking regular rests from dancing (15 minutes after every hour of dancing) will help reduce the risk of overheating. Check that your body has cooled down, your breathing and heart rate are back to normal, and that you are feeling well.
Warning signs of overheating and dehydrating

The following are important signs to watch out for:

* feeling very hot, unwell and confused
* not being able to talk properly
* headache
* vomiting
* not being able to urinate, or noticing that urine is thick and dark
* not perspiring, even when dancing
* heart rate or pulse not slowing down even when resting
* fainting, collapsing or convulsing (having fits).

If these symptoms start, then:

* stop dancing
* tell a friend and ask them to stay with you until you feel better
* ask your friend to get some cold water, and sip it slowly
* splash cold water onto your skin
* rest in a quiet, cool area
* fan your body.

If symptoms persist and your body doesn’t cool down, go to the first aid area of the venue or get to a hospital immediately.
What to do in a crisis

If someone overdoses or has an adverse reaction while using ecstasy, it is very important that they receive professional help as soon as possible. A quick responses can save their life.

* Call an ambulance ! Don't delay because you think you or your friend might get into trouble. Ambulance officers are not obliged to involve the police.
* Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
* Ensure the person has adequate air, by keeping crowds back and opening windows. Loosen tight clothing.
* If the person is unconscious, don’t leave them on their back — they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
* If breathing has stopped, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
* Provide the ambulance officers with as much information as you can—what drugs were taken, how long ago, and any pre-existing medical conditions.
* Before using ecstasy, make sure you and your friends know what to do in a crisis.

[MAVI]

GHB - Fantasy

Gamma hydroxybutyrate (GHB) is a depressant drug. Depressants slow down the activity of the brain and other parts of the central nervous system. Alcohol, heroin and benzodiazepines are drugs that also have depressant effects.

GHB occurs naturally in the brain. It was first manufactured and studied in the 1960s, and has been used in several countries as a general anaesthetic. GHB was withdrawn from use in most countries.

Street names

Fantasy, grievous bodily harm (GBH), liquid ecstasy, liquid E, liquid X, salty water, Georgia Home Boy, soap, scoop, organic Quaalude, cherry meth, blue nitro.
What does it look like?

GHB commonly comes as a bitter or salty-tasting liquid, usually sold in small bottles or vials, such as soy sauce containers. At one time it was most commonly available as a bright blue liquid (sometimes called "blue nitro"), but it now comes in a variety of colours, as manufacturers and dealers often add food colourings to distinguish it from other liquids. It is occasionally sold as a crystal powder.

How is it used?

GHB is generally swallowed, although a small number of people have been reported as injecting or "shelving" it (inserting into anus). GHB has been trialled as a treatment for alcohol and opiate (for example, heroin) withdrawal, and sleep disorders such as narcolepsy.

GHB has been marketed as a dietary supplement for body builders. It is claimed that GHB can increase the release of human growth hormone by prolonging slow-wave sleep, the stage of sleep when the highest amount of growth hormone is released. There is no evidence to support this theory. GHB has been known to be used to facilitate sexual assault. Due to its appearance, GHB is easy to slip into a drink and it can cause drowsiness, sleep and short-term memory loss. This means that victims may not be able to resist or recall a sexual assault.

Some people take GHB for its ability to increase relaxation, sociability and disinhibition. Others may take it to help with the symptoms of the "comedown" after using stimulants, such as amphetamines and ecstasy.
Effects of GHB

The effects of GHB appear to vary greatly according to the amount used—a small increase in amount can result in a dramatic increase in effect. One of the most dangerous aspects of using GHB is the small difference between an amount that produces the desired effect and the amount that results in overdose. A further risk is that there is often no way to be sure that the drug is manufactured correctly. Improperly made GHB may result in an extremely toxic mixture of GHB and the chemical sodium hydroxide.
Immediate effects

Generally, the effects of GHB are experienced within 15 minutes of use, and last for approximately 3 hours. Effects of a low to moderate dose may include:

* feelings of euphoria
* increased libido
* lowered inhibitions
* memory lapses
* drowsiness
* sleep
* dizziness and headache
* tremor
* decreased body temperature, blood pressure and heart rate
* nausea
* diarrhoea
* urinary incontinence.

Overdose

Using GHB carries a high risk of overdose, due to the small difference between the amount required to produce a "high" and that which causes overdose. Not knowing the strength of GHB increases the risk of overdose.

High doses of GHB can result in:

* dizziness
* vomiting
* tremors
* tunnel vision
* loss of coordination (ataxia)
* confusion, irritation and agitation
* hallucinations
* blackouts and memory lapses
* seizures
* coma
* respiratory arrest (stop breathing) and death.

Signs of overdose

* Person appears to be asleep but cannot be woken.
* Person is incoherent, sweating profusely, vomiting and has irregular or shallow breathing.
* Person is not able to stand and/or has involuntary muscle contractions.

Long-term effects

The long-term effects of GHB are difficult to identify due to a lack of research in this area but it is possible to become physically and psychologically dependent on it.

Tolerance and dependence

There is evidence that GHB is highly addictive. People who use GHB regularly can develop a tolerance and dependence very quickly. Dependence on GHB can be psychological, physical or both.

People who are psychologically dependent on GHB find that using the drug becomes far more important than other activities in their life. They crave the drug and will find it very difficult to stop using it. Physical dependence occurs when a person's body adapts to GHB and gets used to functioning with the GHB present. People who are physically dependent on GHB usually develop tolerance to the drug, making it necessary to take more and more GHB to get the same effect.
Withdrawal

If a physically dependent person stops taking GHB, they may experience withdrawal symptoms because their body has to readjust to functioning without GHB.

Withdrawal symptoms usually start about 12 hours after the last dose and can continue for about 15 days.

Some of the withdrawal symptoms that may be experienced include:

* confusion, agitation, anxiety, panic, feelings of doom
* paranoia
* insomnia
* tremor
* muscle cramps
* perspiration
* delirium
* hallucinations
* tachycardia (rapid heartbeat).

Sudden withdrawal from high doses may also result in bowel and bladder incontinence and blackouts, and may require medical assistance.


Pregnancy and breastfeeding

Little is known about the effects of GHB on the unborn child. As is the case with many other drugs and medication, it is not recommended that people use GHB while pregnant or breastfeeding.

Many drugs can cross the placenta and therefore have some effects on the unborn child. In general, drug use during pregnancy can increase the incidence of premature labour, resulting in low birth-weight babies.

If a mother continues to use GHB while breastfeeding, it is possible that the drug will be present in her milk and may have adverse effects on the baby.

Check with your doctor or other health professional if you are taking or planning to take any substances during pregnancy, including prescribed and over-the-counter medications.

If someone overdoses or has an adverse reaction while using GHB, it is very important that they receive professional help as soon as possible. A quick response can save their life.

[MAVI]

Heroin

Heroin is one of a group of drugs known as "opioids". Other opioids include opium, morphine, codeine, pethidine, oxycodone, buprenorphine and methadone.

Heroin and other opioids are depressants. Depressants do not necessarily make you feel depressed. Rather, they slow down the activity of the central nervous system and messages going to and from the brain and the body.
What does it look like?

Heroin can range from a fine white powder to off-white granules or pieces of brown "rock". It has a bitter taste but no smell and is generally packaged in "foils" (aluminium foil) or small, coloured balloons.


How is it made?

When the seedpod of the opium poppy is cut, a sticky resin (opium) oozes out. This resin is refined to produce opium. Opium takes its name from the opium poppy, Papaver somniferum, which grows in many parts of the world—commonly in Asia and the Middle East, but also in the United States and Australia.

For centuries, opium has been used by many cultures as a medicine and as a recreational drug. Morphine, codeine and pethidine are still widely used for medical purposes.

Heroin is made from morphine or codeine by a chemical process, but has a stronger painkilling effect than either of these drugs. The potency and purity of heroin used can vary substantially, depending on a number of factors, including:

* how it is manufactured
* the ingredients used (for example, morphine and codeine)
* what the final products is diluted ("cut") with.

How is it used?

Heroin is most commonly injected into a vein. It is also smoked ("chasing the dragon"), added to marijuana or tobacco cigarettes, or snorted.
Street names

smack, skag, dope, H, junk, hammer, slow, gear, harry, horse, black tar, china white, Chinese H, white dynamite, dragon, elephant, homebake, poison.

Effects of heroin

The effects of heroin may last 3 to 5 hours.
Immediate effects

* Intense pleasure and a strong feeling of wellbeing
* Confusion
* Pain relief
* Slowed breathing
* Decreased blood pressure and heart rate
* Constricted pupils
* Dry mouth
* Suppressed cough reflex
* Reduced sexual urges
* Drowsiness
* Slurred and slow speech
* Reduced coordination
* Nausea and vomiting

In greater quantities

The immediate effects intensify and last longer with higher quantities of heroin. The following effects are also likely to occur:

* The ability to concentrate is impaired.
* The user is likely to fall asleep ("on the nod").
* Breathing becomes shallower and slower.
* Nausea and vomiting are more likely to occur.
* Sweating, itching and increased urinary output are also likely.

Overdose

Using a large quantity of heroin can cause death. Breathing becomes very slow, the body temperature drops and the heartbeat becomes irregular.

Overdose may occur if:

* too much heroin is injected
* the strength or purity is high
* heroin is used with alcohol or sedatives (alcohol or benzodiazepines).

To reverse the effects of a heroin overdose, the attending ambulance officer will inject the drug naloxone (such as Narcan) to restart breathing. The Narcan may not last as long as the heroin, so the person will feel "stoned" again and may even become unconscious again. It is important that another quantity of heroin is not taken again on that day, as it may combine with the original quantity of heroin taken and could cause an overdose.

After an overdose, it is strongly advisable to seek advice at a hospital.
Short-term effects

Apart from overdosing, the major problem with short-term use of any opiate is the way it is used. For example, injecting heroin can result in skin, heart and lung infections, and diseases like hepatitis and HIV.
Long-term effects

In its pure form, heroin is relatively non-toxic to the body, causing little damage to body tissue and other organs. However, there are some long-term effects, including dependence, constipation, menstrual irregularity and infertility in women, loss of sex drive in men, intense sadness and cognitive impairment.

Many of the other long-term problems may be the result of other factors, such as the person's poor general care of the self, drug impurities and contaminants and blood-borne viruses.

Heroin is usually a mixture of pure heroin and other substances, such as caffeine and sugar. Additives can be highly poisonous. They can cause collapsed veins, tetanus, abscesses and damage to the heart, lungs, liver and brain.
Tolerance and dependence

People who are physically dependent on heroin usually develop tolerance to the drug, making it necessary to take more and more to get the desired effects. Eventually, a dose plateau is reached, at which no amount of the drug is sufficient. When this level is achieved, the person may continue to use heroin, but largely for the purpose of delaying withdrawal symptoms.

Dependence on heroin can be psychological, physical or both.

People who are psychologically dependent on heroin find that using it becomes far more important than other activities in their lives. They crave the drug and will find it very difficult to stop using it, or even to cut down on the amount they use.

People who are physically dependent on heroin find that their body has become used to functioning with the drug present.
Withdrawal

If a dependent person suddenly stops taking heroin, or severely cuts down the amount they use, they will experience withdrawal symptoms because their body has to readjust to functioning without the drug. This usually occurs within a few hours after last use.

Withdrawal symptoms can include:

* a craving for the drug
* restlessness
* yawning
* low blood pressure
* elevated heart rate
* stomach and leg cramps, muscle spasms
* loss of appetite, vomiting and diarrhoea
* goose bumps
* tears and a runny nose
* increased irritability
* insomnia
* depression.

These withdrawal symptoms get stronger and usually peak around 2 to 4 days after last use. They usually subside after 6 to 7 days, but some symptoms, such as chronic depression, anxiety, insomnia, loss of appetite, periods of agitation and a continued craving for the drug, may last for periods of months and even years. Sudden withdrawal from heroin rarely causes direct death, unless the user is also using other drugs and is in poor health. Withdrawal from heroin or opioids is much less dangerous than withdrawal from some other drugs like alcohol or benzodiazepines.

Treatment is more effective if tailored to suit a person’s specific situation, and usually involves a combination of methods. The different options include counselling, group therapy, medication (pharmacotherapy) and supervised home withdrawal.

Pharmacotherapy based treatments

Methadone

A synthetic opioid that can be used as a substitute for heroin. The intention is to reduce the impact that heroin has on the lives of people who are dependent on heroin by reducing the harms associated with injecting an expensive illicit drug of unknown strength and purity.


Buprenorphine

Can help treat heroin dependence by preventing withdrawal symptoms and by blocking the effects of heroin, so using heroin will not provide the "high" that would normally be expected.

Naltrexone

Naltrexone works by blocking the analgesic and euphoric effects of heroin and other opioids. It can assist in maintaining abstinence from heroin because the person is aware that they cannot achieve a "high" from using heroin.

Ultra Rapid Opiate Detox (UROD)

UROD is a quick method of withdrawing or detoxifying from opioids. It involves high doses of naltrexone given over a 48-hour period or less along with heavy sedation. By the end of the process, the patient should be physically withdrawn from opiates. UROD is currently under trial in Australia.


Pregnancy and breastfeeding

Using heroin while pregnant can affect foetal development. Heroin use has been associated with an increased risk of miscarriage and premature birth, and babies may be born smaller than average and may be prone to illness. The substances that are cut with heroin may also cause problems during the pregnancy and affect the developing foetus.

Injecting heroin can increase the risk of both the mother and baby becoming infected with blood-borne viruses, such as hepatitis and HIV. Heroin can pass through the placenta to the foetus, and after birth the baby can experience heroin withdrawal, known as Neonatal Abstinence Syndrome (NAS). Most babies can be comforted with supported care, but some babies with severe NAS may need to be treated with medication to help with the withdrawal.

Pregnant women who want to stop taking heroin need to be very careful. Sudden withdrawal from heroin may harm the baby and increase the risk of miscarriage, premature birth and stillbirth.

If a mother continues to use heroin while breastfeeding, it is possible that the drug will be present in her milk and may have adverse effects on the baby.

It is recommended that you check with your doctor or other health professional if you are taking or planning to take any substances during pregnancy, including prescribed and over-the-counter medications.

More on alcohol, other drugs and pregnancy
Heroin, hepatitis and HIV

Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis B, hepatitis C and HIV (human immunodeficiency virus—the virus that causes AIDS).

The alcohol and drug information service in your state or territory can provide information on where to obtain clean needles and syringes.


What to do in a drug crisis

If someone is suspected of having overdosed while using heroin, it is very important that they receive professional help as soon as possible. A quick response can save their life.

* Call an ambulance !..Don’t delay because you think you or your friend might get into trouble. Ambulance officers are not obliged to involve the police.
* Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
* Ensure adequate air by keeping crowds back and opening windows. Loosen tight clothing.
* If the person is unconscious, don’t leave them on their back — they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
* If breathing has stopped, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
* Provide the ambulance officers with as much information as you can—how much heroin was taken, how long ago, and any pre-existing medical conditions.
* Plan what to do in a crisis.