Dextromethorphan and paranoia.

By David Joel Miller.

Sometimes over-the-counter medications cause paranoia.

Fearfulness

Paranoia.
Photo courtesy of Pixabay.com

Dextromethorphan is a common antitussive (cough suppressant) medication found in over-the-counter medications. It is a common ingredient in over 140 over-the-counter medications. Unfortunately, Dextromethorphan has become an increasingly abused substance among those in the 18 to 25-year-old range. Abuse by younger teens is reported to be on the rise.

Because dextromethorphan can be purchased over-the-counter or stolen from grocery stores and pharmacies, many users have underestimated the serious, long-term effects of dextromethorphan abuse.

When taken according to directions most over-the-counter medications are relatively safe. Any medication, including over-the-counter medications, may result in side effects or allergic reactions. Abuse of Dextromethorphan can have some serious health consequences.

When Dextromethorphan is taken in larger than recommended amounts it can produce psychoactive effects. “Use in amounts exceeding those recommended, a practice which is known as “Robotripping,” may result in a toxidrome of psychomotor agitation, hallucinations and paranoia best characterized as Intoxication Delirium (Stanciu, C. et al., 2016.)

Dextromethorphan shares pharmacologic and neurobehavioral properties similar to opiates and phencyclidine (PCP.) Because of its cough suppression action is like the opiate codeine, as the dose increases it can produce dreamlike states and hallucinations somewhat like the “pipedreams” of opium smokers. As the dose increases significant unpleasant and health impairing results occur. At very high doses Delirium and misperceptions occur, resulting in paranoia and violent behavior similar to PCP intoxication.

“Intoxicated excited delirium describes the most serious and potentially deadly DXM-induced medical condition involving psychotic behavior, elevated temperature, and an extreme psychomotor agitation fight-or-flight response by the nervous system. Due to extreme violence frequently encountered such presentations, typically encountered in the emergency room setting with law enforcement involvement, have resulted in sudden death secondary to cardiac or respiratory arrest, an outcome associated with the use of physical restraints” (Stanciu, C. et al., 2016.)

One online user bulletin board, I will leave the website name out, included a number of user warnings. Users report tolerance to dextromethorphan happens rapidly, often after a single dose. Reports of paranoia were common, both paranoia caused by taking dextromethorphan and users reports of high anxiety which they called “paranoid” about the many other negative results from use.

Users have reported impaired daily functioning for as long as six years afterward.

On the way to psychosis and paranoia, users may experience a variety of alterations in perception. Commonly reported are auditory, visual, and tactile hallucinations. That may pass through a period of excitability and pressured speech which can easily be mistaken for bipolar mania. Nervousness, confusion, and disorientation can occur. A variety of physical symptoms are also likely, including tremors, slurred speech, and occasionally seizures. Some less pleasant symptoms include nausea, vomiting, respiratory depression, coma, and even death.

The particular gene responsible for metabolizing dextromethorphan is polymorphic meaning there are a number of different mutations of this gene in humans. Because of this a new user never knows just how dextromethorphan may affect them. Some people need to take a large amount to feel the effects while other people can have a serious adverse effect even at doses only a little above the label recommendations (Stanciu, C. et al., 2016.)

There are antidotal reports of serious interactions between dextromethorphan and commonly used substances such as alcohol and marijuana. In medical settings, life-threatening interactions between prescribed psychiatric medications and intentional overdoses of dextromethorphan-containing products.

Dextromethorphan is not the only drug of abuse which has been connected to an increased risk of developing paranoia. Reports of paranoia among drug users are common. Paranoia can be difficult to identify and diagnose. It is often only considered in the context of diagnosing the paranoid type Schizophrenia or Paranoid Personality Disorder. Recent studies have suggested that paranoia falls on a continuum and paranoia has rarely been studied outside the seriously mentally ill. Many things about the drug using lifestyle increase the risk of paranoia. Another reason for the shortage of information about rates of paranoia and its treatment among drug users has been the systematic exclusion of those with a substance use disorder from psychological research. Given the large overlap between those with a substance use disorder and a diagnosed mental illness, there’s a lot we haven’t learned about trust issues, suspicion, and various levels of paranoia among those with a co-occurring disorder.

I’ll continue to watch for and read research about the trust to suspicion continuum so watch for future posts on this topic.

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Pseudohallucinations – OK to see things?

By David Joel Miller.

Pseudohallucinations – sometimes we expect people to “see things.”

Sometimes it’s okay to see things that are not really there. When someone is under

Pseudohallucinations

Pseudohallucinations.
Photo courtesy of Pixabay.com

the influence of drugs, particularly hallucinogens or powerful stimulants, it is common for them to see things that others don’t.

When crack cocaine first became common, the emergency rooms in large cities experienced a rash of people who were “seeing things.” Many of these people received a diagnosis of schizophrenia or a related psychosis.

The same phenomenon occurred again when methamphetamine became cheap and readily available. More recently we are seen people under the influence of “bath salts,” who are hallucinating.

None of these drug-induced hallucinations should be used as symptoms for making the diagnosis of schizophrenia or related psychosis.

True hallucinations can be a feature of several mental illnesses. In addition to schizophrenia, people with severe major depressive disorder, bipolar disorder, and other mental illnesses may experience hallucinations. Sometimes people with severe mental illness also use drugs which can create Pseudohallucinations. Sorting out the meaning of hallucinations is a job for a professional.

Some authorities differentiate between Hallucinations, Pseudohallucinations, and Parahallucinations.

If someone is experiencing hallucinations and they know it is the result of “good drugs,” this is a Pseudohallucination and likely will be diagnosed as a drug intoxication disorder, Hallucinogen Persisting Perception Disorder F16.983 or stimulant-induced psychotic disorder if the hallucinations continue after withdrawal from a stimulant.

Alcohol can also cause hallucinations.

When chronic alcoholics are withdrawing from alcohol that can experience a condition called delirium tremens or the DT’s for short. DT’s consists of shakes and hallucinations when the level of alcohol in the bloodstream declines. This is a very serious condition and can lead to death. If someone has ever had the shakes or hallucinated while withdrawing from alcohol they should be sent to a hospital to detox. Friends don’t let friends die from DT, s.

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Abusing prescription drugs.

By David Joel Miller.

Almost 24 million Americans abuse prescription medication each year.

The majority (87%) of the people who get Rx’s use the meds responsible. The abuse is

Drug Abuse

Abuse of Prescription Drugs.
Photo courtesy of Pixabay.com

the result of misuse by the other 13%. Many people underestimate the risks involved in using prescription drug incorrectly.

Abuse of a prescription drug can result in addiction, permanent health damage, or even death.

Just because you get your drugs with a prescription doesn’t make them safe, particularly when you don’t use them as prescribed.

What meds are abused?

The national survey on drug use and health tracks the abuse of four types of prescription medication. Besides prescription pain meds many other prescriptions meds get abused. The other big abuse culprits? Tranquilizers (5.7 million) and RX stimulants (4.8 million, and sedatives (1.4 million.) Many other medications can be misused. Prescriptions don’t work well when you take them some days and not others. I’ve learned in working with mental health clients not task them if they are taking their meds. They almost always say yes. If I asked them how many days, they took their meds last week, I get answers like two or three days. Most prescriptions will be effective if you take them sporadically. You can’t make up for missed doses by taking extra on other days.

Pain medication abuse.

One-third of the US adult population, almost 92 million people, use prescription pain meds. Of those 92 million about 11.5 million abused their prescription pain meds. The majority of people (63.4%) who abuse prescription pain medication do so because of physical pain. Given the current publicity the people abusing prescription opiates, this is significant. The main reason people with a chronic pain condition abuse meds is because they are still in pain.

Approximately 40% abuse prescription pain meds for mental or emotional reasons, to relax, to sleep, to get high or to simply see what it would be like to experiment with the drug. I think it’s important to note that much of the high-powered opiates being abuse are being manufactured or brought into the US illegally.

Even over-the-counter pain meds, while not included in many studies, are subject to abuse. People with emotional pain may experience this as pain in the body. Over-the-counter pain meds are not effective for treating depression or anxiety. Taking excessive amounts of over-the-counter pain medications can result in damage to your liver or kidney.

Abuse of prescription tranquilizers.

About one-third of the people prescribed tranquilizers abuse them. Of those abusing tranquilizers, two-thirds were using them for the reasons they have been prescribed but not in the way the doctor had prescribed them. The remaining one-third of abusers do so for emotional or recreational reasons.

A very dangerous way of abusing tranquilizers is to take them while consuming alcohol. This combination can result in death.

Abuse of prescription stimulants.

The primary legal use of these medications is to treat ADHD. About 30% of those taking prescription stimulant medications abuse them. Weight loss, to help study, or to get high are some of the reasons people reported abusing prescription stimulants.

What are some of the ways prescription meds are abused?

  1. Taking meds prescribed to someone else.
  2. Taking more pills or taking them more often than the doctor prescribed.
  3. Using prescription meds in a way other than the way the doctor recommended.

Over the counter medications were not included in the government’s survey of drug misuse despite the serious health consequences of abusing over-the-counter medications. I’ve tried to highlight some of the issues involved in abusing over-the-counter meds in the paragraphs above.

For more on this issue see SAMHSA report at https://www.samhsa.gov/data/sites/default/files/report_3210/ShortReport-3210.html

T

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Commonly abused stimulant drugs.

By David Joel Miller.

A few stimulant drugs account for a major portion of drug abuse.

How drugs are used

Drugs.
Photo courtesy of Pixabay.com

Abuse of stimulant drugs has become a major problem in America. Some of these stimulant drugs have some limited medical uses. Recreational drug use seems to run in cycles. A new drug or a new form of a drug becomes popular for a while only to be replaced by the next “in” drug. Here is a brief description of the primary types of stimulant drugs being abused today.

Cocaine.

Cocaine comes from the coca plant which was originally found growing wild in the Andes Mountains of South America. Coca leaves were used there, probably for thousands of years, by the native population who would chew the leaves or mix them with roasted sea shells and hold the mixture next to their gum similar to the way chewing tobacco is used. Chewing a few leaves produces a mild stimulant effect which allowed the natives to work more effectively at high altitudes.

In the late 1800’s European chemists isolated the active ingredient, cocaine. Cocaine was promoted by Doctors, particularly Freud, for treatment for a variety of illnesses. The first great cocaine epidemic occurred in the 1880’s.

Cocaine can be used in a variety of ways; powdered cocaine can be snorted, and crack cocaine can be smoked. The 1980’s saw a second cocaine epidemic with the introduction much cheaper crack cocaine. Cocaine was used for a while to treat depression but this is no longer an acceptable use because when a stimulant drug wears off the depression is worse than before.

The only currently accepted medical uses for cocaine are eye and nose surgeries.

Amphetamines.

Amphetamines became popular during World War II when both sides used them. Initially, they were thought of as wonder drugs and were used for the treatment of respiratory problems, obesity, and to increase attention and prevent sleep. Amphetamines were widely prescribed for both weight loss and to increase productivity.

In the 1960’s the dangerous properties of amphetamines were recognized. Today use of the older amphetamines is largely restricted to the treatment of ADHD.

Methamphetamine.

There had been some use of injectable methamphetamine in the 1970’s. In the 1990’s methamphetamine began to replace other stimulant drugs, first in Hawaii and later, on the West Coast of the United States, ultimately spreading throughout America. Methamphetamine manufactured synthetically in large quantities became considerably cheaper and lasts longer than other stimulant drugs. Methamphetamine is used as an injectable drug and is available in a smokable crystal form.

From a mental health standpoint, methamphetamine is diagnosed as an amphetamine use disorder. Substance abuse treatment often provides separate categories for amphetamine and methamphetamine disorders. While amphetamines are usually prescription grade medical pharmaceuticals which are diverted for illegal use, methamphetamine is produced by illegal labs in huge quantities for recreational use and abuse. See drug diagnoses.

The sight of the meth addict, sucked up from loss of weight, often covered with scabs, frequently paranoid and hallucinating, has become a common sight in hospital emergency rooms and on the streets of America’s cities.

Khat.

Khat is a stimulant plant which grows wild in East Africa, where it was chewed by natives the same way coca leaves were chewed in South America. The leaves are most stimulating when chewed fresh. Khat contains two stimulant chemicals, Cathine, and cathinone. Both of these chemicals and many other related compounds are now produced synthetically.

Bath Salts.

Bath salts have nothing to do with bathing. These synthetic stimulant drugs, largely related to cathinone, are imported into the United States labeled “not for human consumption.” These are often mixed and sold under various labels such as “bath salts, herbal incense, water pipe cleaner,” and many other names. This family of chemicals can produce strong stimulant effects as well as hallucinations. Because these are mixtures of chemicals and are sold labeled “not for human consumption” they have been very difficult to regulate. As quickly as federal regulators ban one chemical, the manufacturers and marketers of bath salts change their formulations. There are frequent reports of permanent neurological damage because of using these drugs.

Caffeine and related compounds.

Caffeine is one of the milder stimulant drugs and is the most widely used drug on planet earth. It is estimated that 90% of the world’s population consumes caffeine or a related compound on a regular basis. Occasionally someone receives a caffeine overdose and presents in an emergency room. Caffeine overdoses usually result from consuming energy drinks which are high in caffeine combined with alcohol or by consuming large quantities of caffeine pills to stay awake longer than the human body should.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why Pharmacokinetics matters.

By David Joel Miller.

What is pharmacokinetics and why does it matter?

Drugs affect the body.

Why Pharmacokinetics matters.
Drugs affect the body.
Photo courtesy of Pixabay.com

Drugs are everywhere in our society. Not just Street drugs, or the legal drugs such as tobacco and alcohol. Most of us are exposed to drugs all day, every day. Even the people who say they “don’t do drugs” should be concerned about drugs and pharmacokinetics. When we hear about drugs, most of us think illegal drugs. It’s easy to overlook the long-term effects of use and abuse of prescription medication, over-the-counter medication, and the vitamins and herbal remedies all around us every day.

Pharmacokinetics deals with how drugs enter the body, how they get absorbed, how they get transported and delivered throughout the body, and ultimately how are drugs eliminated from the body. In a past post, we talked about routes of administration; the way drugs get into the body.

How much of that drug did you take?

For most drugs the more you take, the stronger the effect. Let’s take a simple, common drug, alcohol to illustrate this principle. If someone drinks a twelve-ounce beer, they consume about half an ounce of pure alcohol. Drinking twelve ounces of whiskey will result in the consumption of about six ounces of alcohol. With whiskey, you drink the same amount of liquid, but because the whiskey is more concentrated, you received a much higher dose of Alcohol than the beer drinker does. Measurement of alcohol consumption requires the use of an idea called the standard drink.

Drug dose is computed based on body weight.

A three-hundred-pound man will need to take a higher dose of medicine than a twenty-pound child. Heavier people contain more volume of liquids, so any chemical they take into their system becomes more dilute. For most medications, your Doctor will want to know your body weight, so they know how much medication to give you.

When it comes to Street drugs or even alcohol, most people don’t consider the effect that body weight has on the drug using experience. Thin people will get higher blood concentrations of the drug even when they take the same amount. Recently we have seen many people who had weight loss surgery, lost a large amount of weight, and developed a significant problem when they consume alcohol or other drugs.

Drug absorption matters.

Some drugs are readily absorbed into the bloodstream. When you consume liquid drugs or very soluble ones, they readily pass through the stomach, into the intestine, and are absorbed into the bloodstream. Solid drugs vary a great deal in their bioavailability, which is the part of the drug that becomes absorbed into the bloodstream and reaches the site of action.

An example of the problem of bioavailability involves pregnant women. Calcium is often added to the diet of a pregnant woman to help the fetus develop strong bones. Limestone is high in calcium, but no matter how much you grind it up, most of the limestone will pass through the body undigested. How much of the calcium in your vitamin supplement will be absorbed into your bloodstream, it’s bioavailability, matters.

Drug distribution varies from drug to drug.

Drugs that are highly water-soluble travel readily throughout the body. Blood nourishes all the cells in the body, and the parts of the body that received the most blood also received the largest doses of drugs. Drugs tend to accumulate in the heart, brain, kidney, and liver. Parts of the body that get little blood flow, the muscles and fat, received little of the active drug. Can you see why taking an oral supplement to “melt away fat” is unlikely to work?

A few drugs, such as THC in marijuana, are fat soluble. These drugs will tend to accumulate in the parts of the body which have the largest fat content.

Drug elimination – how the drug leaves the body.

Eventually, any drugs that go into your body will get broken down and eliminated. Many drugs are metabolized by enzymes produced in the liver. These drugs are especially hard on the liver when taken in excessive quantities. This process is the reason heavy alcohol consumption increases the risk for four separate types of liver disease.

Some drugs are metabolized in the kidneys or the G.I. tract. Regardless of where the metabolism takes place, the majority of all drugs are removed from the body by the kidney. Some drugs, especially in large quantities, can be very hard on the kidneys. Drug abuse can result in impaired kidney function resulting in the need for kidney dialysis.

Drug metabolism is a sequential process.

Many drugs are broken down in stages. The first breakdown product is then metabolized into a second breakdown product and so on. These breakdown products or metabolic byproducts may also be psychoactive. When both cocaine and alcohol are present in the system, they and their metabolic byproducts can combine to produce Cocaethylene which is even longer lasting than the original cocaine and alcohol.

For more on this topic see – Drug Use, Abuse, and Addiction and Recovery

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

How drugs change your feelings.

By David Joel Miller.

Drugs of abuse alter the chemical balance in your brain.

PNG of brain.

Brain
Photo courtesy of Pixabay.com

The human brain is a very complex organ. Everything you think, feel, experience, or do is the result of brain activity. Drugs, especially drugs of abuse, can alter the chemical balance in your brain either temporary or sometimes permanently.

The brain is made up of millions of tiny nerve cells called neurons. These nerve cells connect to each other through billions of tiny nerve endings. In the early days of physiological psychology, this all seemed so simple.

Electricity moves information within a nerve cell.

Early on, we discovered that a nerve cell can develop an electrical charge and when this charge moved down the nerve cell, it transmitted information. Electrically stimulating a rat’s brain might cause him to move the leg.

Electrical stimulation doesn’t explain everything. Between one nerve cell and the next, there are infinitesimal, small gaps. Scientists refer to those gaps as synaptic gaps, or sometimes they speak of the connections between cells as synapses. It turns out that electricity doesn’t flow very well from one brain cell to another through the brain fluid.

Information moves from one nerve cell to another chemically.

The human nervous system manufacturers a large number of chemicals, some of which are called neurotransmitters. When I first studied the subject in the 1960s, we study two neurotransmitters. Today hundreds of neurotransmitters have been identified and studied. The more research I read, the more newly identified neurotransmitters I encounter.

Drugs of abuse alter the way information moves between cells chemically.

For a drug of abuse to affect the way you think, feel, or behave, it needs to do two things. First, it needs to get into your brain. The brain contains a large amount of fluid. Protecting that fluid from contamination is the blood-brain barrier. This membrane is designed to keep undesirable material out of your brain. All drugs of abuse must have molecules that can get through this blood-brain barrier.

Each neurotransmitter has a shape which fits a receptor in the next cell.

You hear a gun go off and your nervous system produces a stimulant chemical that gets your heart pounding and prepares you for action. That stimulant chemical is sometimes called adrenaline. A similar chemical is found in the nervous system. We, here in the US, call that chemical norepinephrine, in some other countries it is called noradrenaline. This chemical fits into receptors on other cells and causes them to act.

One of the explanations for how drugs of abuse affect your nervous system is called the “lock and key theory.” Each naturally occurring neurotransmitter has a shape, and other cells have a receptor designed to accept that shape. So, when your nervous system sends out norepinephrine, it fits into receptors throughout your nervous system to prepare you to take immediate action.

Drugs of abuse mimic the shapes of naturally occurring neurotransmitter.

Stimulant drugs, such as cocaine or methamphetamine, are shaped in a way that is similar to norepinephrine. Because they mimic a natural neurotransmitter’s shape, they can make all the circuits in your nervous system fire.

Drugs of abuse not only activate a few cells, but they can activate many cells in far more emphatic ways than your naturally occurring neurotransmitters do. Because of this, drugs of abuse can feel very pleasurable, but only for brief periods of time. Each time you use a drug, it changes the chemical balance in your brain. Over time it changes the balance so much, you are unable to feel the things you used to feel unless the drug is present in your system.

Of course, the process in the brain is far more complicated than this simple description. Many other things are taking place every time you think a thought or the chemistry in your brain changes. Understanding how drugs of abuse mess with the way your nervous system works helps to explain a large part of how those drugs can lead to abuse, dependence, addiction, and a whole range of disorders we call substance use disorders.

For more on this topic see – Drug Use, Abuse, and Addiction and Recovery

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Schedules of Controlled Substances.

By David Joel Miller.

How drugs are classified for legal purposes.

Drugs

Drugs.
Photo courtesy of Pixabay.com

The Controlled Substances Act of 1970 created another way to classify drugs. In another post, I talked about some of the ways drugs can be classified, by their origin, by their medical effect, or by the experience the user has. For legal purposes, some drugs are scheduled on one of five separate schedules of controlled substances.

The criteria for placing drugs on a particular schedule include whether they have an accepted medical use, their potential to be abused, and the likelihood they will produce dependence. Many people refer to drugs with a high abuse potential as narcotics. Narcotics technically are drugs that will put you to sleep, knock you out, and may potentially cause death. Many of the scheduled drugs are stimulants or Hallucinogens. When talking about legal regulation of drugs, it is important to know that the correct term is, controlled substances.

Here’s a brief description of the five drug schedules and some examples of drugs on each schedule.

Schedule I drugs.

These drugs have an extremely high abuse potential. They are likely to cause dependence, have withdrawal effects, and produce cravings. They are not currently accepted for medical use in the United States. These drugs are not believed to be safe even when used under medical supervision.

An example of the need for scheduling some drugs on schedule one is illustrated by the drug thalidomide. This drug was approved and widely used in Europe, where it was often prescribed to women for treatment of morning sickness. There was a good deal of pressure for it to be approved in the United States. One doctor at the FDA resisted the pressure to approve the drug for use in the US because of safety concerns.

After this drug was used in Europe for some time, it was discovered that the drug would produce serious birth defects when women who were pregnant were exposed to the drug. Even handling the medication could produce birth defects. Today this drug is used for treating cancers, but it continues to carry warnings that women who may become pregnant should not come in contact with this drug.

Some examples of drugs currently on schedule I include, heroin, peyote, psilocybin, ecstasy, LSD, methcathinone, marijuana, and most other products containing THC.

Schedules II drugs.

These drugs have a high abuse potential. They must have a recognized medical use, though it may require severe restrictions. Abuse of these drugs can result in either physical or psychological dependency. To prescribe these drugs, doctors must have a DEA number and use a triplicate prescription pad. One copy of each prescription stays with the doctor; one is given to the patient who must take it to the pharmacy, the third copy is sent to the DEA.

Examples of schedule two drugs include morphine, codeine, methadone, other opiates, Ritalin, methamphetamine, cocaine, PCP, and many other similar drugs.

Schedule III drugs.

Drugs on this schedule are more widely used for medical purposes. There are less likely to be abused than drugs on schedule II. These drugs can still be abused and may produce a mild to moderate substance use disorder.

Examples of schedule III drugs include Vicodin, Tylenol with codeine, Marinol a synthetic capsule containing THC, Ketamine, anabolic steroids, and similar drugs.

Schedule IV drugs.

These drugs have wide medical application in the US. They have a low potential for abuse when compared to drugs on schedules I, II, or III. People may build up some tolerance to these drugs and experience withdrawal, resulting in physical or psychological dependence, but these drugs are less likely to produce cravings than the drugs on the earlier schedules.

Examples of schedule IV drugs are Darvon, Valium, Librium, Ativan, Xanax, and similar drugs.

Schedule V drugs.

These drugs have many accepted medical uses in the US. They have the lowest abuse potential of all the scheduled drugs. Abuse of the drug may lead to some types of dependency. Some drugs on schedule V are available in both prescription strength and an over-the-counter version. For example, some pain relievers are available over-the-counter in two hundred milligrams strengths, the stronger six hundred and eight hundred milligrams versions require a prescription.

Just because drugs are on schedule V does not mean they are totally safe. Many people abuse over-the-counter pain relievers. Taking too many of these medications can result in permanent damage to either the liver or the kidney.

Some problems with drug schedules.

Despite the movement towards legalizing marijuana for medical and recreational use, the federal government continues to keep it on schedule I. This creates conflict between the federal government and state or local governments. Doctors who prescribe medical marijuana are likely to lose their DEA numbers. Doctors who work in hospitals or chronic pain clinics are unable to prescribe marijuana without losing their ability to prescribe stronger opiate pain medications.

Heroin continues to be a schedule I drug. This has prevented doctors from prescribing heroin to people who are addicted to opiates. In other countries, addicts, can receive their drugs by prescription and can administer them in safe injection sites where the used needles are properly disposed. Because heroin stays on schedule I, addicts are prescribed methadone a drug which is even harder to withdraw from than the heroin.

For more on this topic see – Drug Use, Abuse, and Addiction and Recovery

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.