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Cocaine DrugFacts | National Institute on Drug Abuse

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Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Although health care providers can use it for valid medical purposes, such as local anesthesia for some surgeries, recreational cocaine use is illegal. As a street drug, cocaine looks lik…

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What is heroin?

Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.

How do people use heroin?

People inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, a practice called speedballing.

What are the effects of heroin?

Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.

Prescription Opioids and Heroin

Prescription opioid pain medicines such as OxyContin ® and Vicodin ® have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use. Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin and about 80 percent of people who used heroin first misused prescription opioids. More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.

This suggests that prescription opioid misuse is just one factor leading to heroin use. Read more about this intertwined problem in our Prescription Opioids and Heroin Research Report.

Short-Term Effects

People who use heroin report feeling a "rush" (a surge of pleasure, or euphoria). However, there are other common effects, including:

dry mouth

warm flushing of the skin

heavy feeling in the arms and legs

nausea and vomiting

severe itching

clouded mental functioning

going "on the nod," a back-and-forth state of being conscious and semiconscious

Long-Term Effects

Injection Drug Use, HIV, and Hepatitis

People who inject drugs such as heroin are at high risk of contracting the HIV and hepatitis C (HCV) virus. These diseases are transmitted through contact with blood or other bodily fluids, which can occur when sharing needles or other injection drug use equipment. HCV is the most common bloodborne infection in the Unites States. HIV (and less often HCV) can also be contracted during unprotected sex, which drug use makes more likely.

Read more about the connection between heroin and these diseases in our Heroin Research Report.

People who use heroin over the long term may develop:

insomnia

collapsed veins for people who inject the drug

damaged tissue inside the nose for people who sniff or snort it

infection of the heart lining and valves

abscesses (swollen tissue filled with pus)

constipation and stomach cramping

liver and kidney disease

lung complications, including pneumonia

mental disorders such as depression and antisocial personality disorder

sexual dysfunction for men

irregular menstrual cycles for women

Other Potential Effects

Heroin often contains additives, such as sugar, starch, or powdered milk, that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage. Also, sharing drug injection equipment and having impaired judgment from drug use can increase the risk of contracting infectious diseases such as HIV and hepatitis (see "Injection Drug Use, HIV, and Hepatitis").

Can a person overdose on heroin?

Yes, a person can overdose on heroin. A heroin overdose occurs when a person uses enough of the drug to produce a life-threatening reaction or death. Heroin overdoses have increased in recent years.

When people overdose on heroin, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage.

How can a heroin overdose be treated?

Naloxone is a medicine that can treat an opioid overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of heroin and other opioid drugs. Sometimes more than one dose may be needed to help a person start breathing again, which is why it's important to get the person to an emergency department or a doctor to receive additional support if needed. Read more in the Substance Abuse and Mental Health Services Administration's Opioid Overdose Prevention Toolkit.

Naloxone is available as an injectable (needle) solution and nasal sprays (NARCAN ® Nasal Spray and KLOXXADO ®). Friends, family, and others in the community can use the nasal spray versions of naloxone to save someone who is overdosing.

The rising number of opioid overdose deaths has led to an increase in public health efforts to make naloxone available to at-risk persons and their families, as well as first responders and others in the community. Some states have passed laws that allow pharmacists to dispense naloxone without a prescription from a person's personal doctor.

Read more about naloxone in Naloxone DrugFacts.

Is heroin addictive?

Heroin is highly addictive. People who regularly use heroin often develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. A substance use disorder (SUD) is when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home. An SUD can range from mild to severe, the most severe form being addiction.

Those who are addicted to heroin and stop using the drug abruptly may have severe withdrawal. Withdrawal symptoms-which can begin as early as a few hours after the drug was last taken-include:

restlessness

severe muscle and bone pain

sleep problems

diarrhea and vomiting

cold flashes with goose bumps ("cold turkey")

uncontrollable leg movements ("kicking the habit")

severe heroin cravings

Researchers are studying the long-term effects of opioid addiction on the brain. Studies have shown some loss of the brain's white matter associated with heroin use, which may affect decision-making, behavior control, and responses to stressful situations.

How is heroin addiction treated?

A range of treatments including medicines and behavioral therapies are effective in helping people stop heroin use. It's important to match the best treatment approach to meet the particular needs of each individual patient.

There are medicines being developed to help with the withdrawal process. The FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.

Medicines to help people stop using heroin include buprenorphine and methadone. They work by binding to the same opioid receptors in the brain as heroin, but more weakly, reducing cravings and withdrawal symptoms. Another treatment is naltrexone, which blocks opioid receptors and prevents opioid drugs from having an effect. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.

Behavioral therapies for heroin addiction include methods called cognitive-behavioral therapy and contingency management. Cognitive-behavioral therapy helps modify the patient's drug-use expectations and behaviors, and helps effectively manage triggers and stress. Contingency management provides motivational incentives, such as vouchers or small cash rewards for positive behaviors such as staying drug-free. These behavioral treatment approaches are especially effective when used along with medicines. Read more about drug addiction treatment in our Treatment Approaches for Drug Addiction DrugFacts.

Points to Remember

Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of various opium poppy plants.

Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.

People inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, called speedballing.

Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.

People who use heroin report feeling a "rush" (or euphoria). Other common effects include dry mouth, heavy feelings in the arms and legs, and clouded mental functioning.

Long-term effects may include collapsed veins, infection of the heart lining and valves, abscesses, and lung complications.

Research suggests that misuse of prescription opioid pain medicine is a risk factor for starting heroin use.

A person can overdose on heroin. Naloxone is a medicine that can treat a heroin overdose when given right away, though more than one dose may be needed.

Heroin can lead to addiction, a form of substance use disorder. Withdrawal symptoms include severe muscle and bone pain, sleep problems, diarrhea and vomiting, and severe heroin cravings.

A range of treatments including medicines and behavioral therapies are effective in helping people stop heroin use. However, treatment plans should be individualized to meet the needs of the patient.

Learn More

For more information about heroin, visit our:

References

1. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. 2014;71(7):821-826. doi:10.1001/jamapsychiatry.2014.366.

2. Carlson RG, Nahhas RW, Martins SS, Daniulaityte R. Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160:127-134. doi:10.1016/j.drugalcdep.2015.12.026.

3. Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017 Nov;74:63-66. doi: 10.1016/j.addbeh.2017.05.030. Epub 2017 May 23. PubMed PMID: 28582659. https://www.ncbi.nlm.nih.gov/pubmed/28582659

4. Centers for Disease Control and Prevention (CDC). Multiple Cause of Death, 1999-2015. CDC WONDER Online Database. https://wonder.cdc.gov/mcd-icd10.html. Accessed April 4, 2017.

5. Li W, Li Q, Zhu J, et al. White matter impairment in chronic heroin dependence: a quantitative DTI study. Brain Res. 2013;1531:58-64. doi:10.1016/j.brainres.2013.07.036.

6. Liu J, Qin W, Yuan K, et al. Interaction between dysfunctional connectivity at rest and heroin cues-induced brain responses in male abstinent heroin-dependent individuals. PloS One. 2011;6(10):e23098. doi:10.1371/journal.pone.0023098.

7. Qiu Y, Jiang G, Su H, et al. Progressive white matter microstructure damage in male chronic heroin dependent individuals: a DTI and TBSS study. PloS One. 2013;8(5):e63212. doi:10.1371/journal.pone.0063212.

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Heroin DrugFacts | National Institute on Drug Abuse

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Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.

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What are inhalants?

Although other substances that are misused can be inhaled, the term inhalants refers to the various substances that people typically take only by inhaling. These substances include:

solvents (liquids that become gas at room temperature)

aerosol sprays

gases

nitrites (prescription medicines for chest pain)

Inhalants are various products easily bought and found in the home or workplace-such as spray paints, markers, glues, and cleaning fluids. They contain dangerous substances that have psychoactive (mind-altering) properties when inhaled. People don't typically think of these products as drugs because they're not intended for getting high, but some people use them for that purpose. When these substances are used for getting high, they are called inhalants. Inhalants are mostly used by young kids and teens and are the only class of substance used more by younger than by older teens.

How do people use inhalants?

People who use inhalants breathe in the fumes through their nose or mouth, usually by sniffing, snorting, bagging, or huffing. It's called different names depending on the substance and equipment they use. For more information, read NIDA's Research Report on Inhalants.

Although the high that inhalants produce usually lasts just a few minutes, people often try to make it last by continuing to inhale again and again over several hours.

Products Used as Inhalants

Solvents

industrial or household products, including:

paint thinners or removers

dry-cleaning fluids

gasoline

lighter fluid

art or office supply solvents, including:

correction fluids

felt-tip marker fluid

electronic contact cleaners

glue

Aerosols

household aerosol items, including:

spray paints

hair or deodorant sprays

aerosol computer cleaning products

vegetable oil sprays

Gases

found in household or commercial products, including:

butane lighters

propane tanks

whipped cream aerosols or dispensers (whippets)

used as anesthesia (to make patients lose sensation during surgery/procedures), including:

Nitrites
How do inhalants affect the brain?

Most inhalants affect the central nervous system and slow down brain activity. Short-term effects are similar to alcohol and include:

slurred or distorted speech

lack of coordination (control of body movement)

euphoria (feeling high)

dizziness

People may also feel light-headed or have hallucinations (images/sensations that seem real but aren't) or delusions (false beliefs). With repeated inhalations, many people feel less self-conscious and less in control. Some may start vomiting, feel drowsy for several hours, or have a headache that lasts a while.

Unlike other types of inhalants, nitrites, which are often prescribed to treat chest pain, are misused in order to improve sexual pleasure by expanding and relaxing blood vessels.

What are the other health effects of inhalants?

Long-term effects of inhalant use may include:

liver and kidney damage

hearing loss

bone marrow damage

loss of coordination and limb spasms (from nerve damage)

delayed behavioral development (from brain problems)

brain damage (from cut-off oxygen flow to the brain)

In addition, because nitrites are misused for sexual pleasure and performance, they can lead to unsafe sexual practices or other risky behavior. This increases the chance of getting or spreading infectious diseases such as HIV/AIDS or hepatitis.

Read more about drug use and HIV/AIDS in Drug Use and Viral Infections (HIV, Hepatitus) DrugFacts. Read more about drug use and hepatitis at our webpage about viral hepatitis.

Can a person overdose on inhalants?

Yes, a person can overdose on inhalants. An overdose occurs when a person uses too much of a drug and has a toxic reaction that results in serious, harmful symptoms or death.

These symptoms can cause seizures and coma. They can even be deadly. Many solvents and aerosol sprays are highly concentrated, meaning they contain a large amount of chemicals with a lot of active ingredients. Sniffing these products can cause the heart to stop within minutes. This condition, known as sudden sniffing death, can happen to otherwise healthy young people the first time they use an inhalant. Using inhalants with a paper or plastic bag or in a closed area may cause death from suffocation (being unable to breathe).

How can an inhalant overdose be treated?

Because inhalant overdose can lead to seizures or cause the heart to stop, first responders and emergency room doctors try to treat the overdose by treating these conditions. They will try to stop the seizure or restart the heart.

Can inhalants cause addiction, a form of substance use disorder?

Although it's not very common, repeated use of inhalants can lead to addiction, a form of substance use disorder (SUD). An SUD develops when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home. An SUD can range from mild to severe, the most severe form being addiction.

Those who try to quit inhalants may have withdrawal symptoms that include:

How can people get treatment for addiction to inhalants?

Some people seeking treatment for use of inhalants have found behavioral therapy to be helpful:

Cognitive-behavioral therapy helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs.

Motivational incentives uses vouchers or small cash rewards for positive behaviors such as staying drug-free.

More research is needed to identify the most effective treatment options for addiction to inhalants.

Points to Remember

Although other substances that are misused can be inhaled, the term inhalants refers to the various substances that people typically take only by inhaling.

Inhalants are various products easily bought and found in the home or workplace-such as spray paints, markers, glues, and cleaning fluids. They contain dangerous substances that have psychoactive (mind-altering) properties when inhaled.

People who use inhalants breathe them in through the mouth (huffing) or nose.

Most inhalants affect the central nervous system and slow down brain activity.

Short-term health effects include slurred or distorted speech, lack of coordination, euphoria (feeling high), dizziness, and hallucinations.

Long-term health effects may include liver and kidney damage, loss of coordination and limb spasms, delayed behavioral development, and brain damage.

A person can overdose on inhalants. Because inhalant overdose can lead to seizures or cause the heart to stop, first responders and emergency room doctors try to stop the seizure or restart the heart.

Although it's not very common, repeated use of inhalants can lead to addiction, a form of substance use disorder. Withdrawal symptoms include nausea, sweating, problems sleeping, and mood changes.

Some people seeking treatment for use of inhalants have found behavioral therapy to be helpful.

Learn More

For more information about inhalants, visit our:

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Inhalants DrugFacts | National Institute on Drug Abuse

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Although other substances that are misused can be inhaled, the term inhalants refers to the various substances that people typically take only by inhaling. These substances include: solvents (liquids that become gas at room temperature) aerosol sprays gases nitrites (prescription medicines for chest pain) Inhalants are various products easily bought and found in the home or workplace-such as spray paints, markers, glues, and cleaning fluids.

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What is MDMA?

3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.

MDMA was initially popular in the nightclub scene and at all-night dance parties ("raves"), but the drug now affects a broader range of people who more commonly call the drug Ecstasy or Molly.

How do people use MDMA?

People who use MDMA usually take it as a capsule or tablet, though some swallow it in liquid form or snort the powder. The popular nickname Molly (slang for "molecular") often refers to the supposedly "pure" crystalline powder form of MDMA, usually sold in capsules. However, people who purchase powder or capsules sold as Molly often actually get other drugs such as synthetic cathinones ("bath salts") instead (see " Added Risk of MDMA").

Some people take MDMA in combination with other drugs such as alcohol or marijuana.

How does MDMA affect the brain?

MDMA increases the activity of three brain chemicals:

Dopamine-produces increased energy/activity and acts in the reward system to reinforce behaviors

Norepinephrine-increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems

Serotonin-affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.

Other health effects include:

nausea

muscle cramping

involuntary teeth clenching

blurred vision

chills

sweating

MDMA's effects last about 3 to 6 hours, although many users take a second dose as the effects of the first dose begin to fade. Over the course of the week following moderate use of the drug, a person may experience:

irritability

impulsiveness and aggression

depression

sleep problems

anxiety

memory and attention problems

decreased appetite

decreased interest in and pleasure from sex

It's possible that some of these effects may be due to the combined use of MDMA with other drugs, especially marijuana.

What are other health effects of MDMA?

High doses of MDMA can affect the body's ability to regulate temperature. This can lead to a spike in body temperature that can occasionally result in liver, kidney, or heart failure or even death.

In addition, because MDMA can promote trust and closeness, its use-especially combined with sildenafil (Viagra ®)-may encourage unsafe sexual behavior. This increases people's risk of contracting or transmitting HIV/AIDS or hepatitis.

Read more about drug use and HIV/AIDS in DrugFacts: HIV/AIDS and Drug Abuse

Read more about drug use and hepatitis.

Added Risk of MDMA

Adding to MDMA's risks is that pills, capsules, or powders sold as Ecstasy and supposedly "pure" Molly may contain other drugs instead of or in addition to MDMA. Much of the Molly seized by the police contains additives such as cocaine, ketamine, methamphetamine, over-the-counter cough medicine, or synthetic cathinones ("bath salts"). These substances may be extremely dangerous if the person does not know what he or she is taking. They may also be dangerous when combined with MDMA. People who purposely or unknowingly combine such a mixture with other substances, such as marijuana and alcohol, may be putting themselves at even higher risk for harmful health effects.

Is MDMA addictive?

Research results vary on whether MDMA is addictive. Experiments have shown that animals will self-administer MDMA-an important indicator of a drug's abuse potential-although to a lesser degree than some other drugs such as cocaine.

Some people report signs of addiction, including the following withdrawal symptoms:

fatigue

loss of appetite

depression

trouble concentrating

Does MDMA Have Value in Therapy?

MDMA was first used in the 1970s as an aid in psychotherapy (mental disorder treatment using "talk therapy"). The drug did not have the support of clinical trials (studies using humans) or approval from the U.S. Food and Drug Administration (FDA). In 1985, The U.S. Drug Enforcement Administration (DEA) labeled MDMA as an illegal drug with no recognized medicinal use. However, some researchers remain interested in its value in psychotherapy when given to patients under carefully controlled conditions. MDMA is currently in clinical trials as a possible treatment aid for post-traumatic stress disorder (PTSD); for anxiety in terminally ill patients; and for social anxiety in autistic adults. Recently, the FDA gave MDMA-assisted psychotherapy for PTSD a Breakthrough Therapy designation. More information on MDMA research can be found by contacting sponsors of various MDMA studies listed on clinicaltrials.gov.

How can people get treatment for addiction to MDMA?

There are no specific medical treatments for MDMA addiction. Some people seeking treatment for MDMA addiction have found behavioral therapy to be helpful. Scientists need more research to determine how effective this treatment option is for addiction to MDMA.

Points to Remember

3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception. It is chemically similar to stimulants and hallucinogens.

MDMA is commonly called Ecstasy or Molly.

People who use MDMA typically take it as a capsule or tablet. Many people take it in combination with other drugs.

MDMA acts by increasing the activity of three brain chemicals: dopamine, norepinephrine, and serotonin.

Effects include increased energy, distorted perception, involuntary teeth clenching, dangerously high body temperature, and depression.

Many people are unaware that Ecstasy and supposedly "pure" Molly also often contain not only pure MDMA but other drugs that may be particularly dangerous when mixed with MDMA.

Research results vary on whether MDMA is addictive. Some people report signs of addiction.

Some people seeking treatment for MDMA addiction have found behavioral therapy to be helpful. There are no specific medical treatments for MDMA addiction.

Learn More

For more information about MDMA, visit:

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MDMA (Ecstasy/Molly) DrugFacts | National Institute on Drug Abuse

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3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.

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What is methamphetamine?

Crystal methamphetamine

Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug that looks like glass fragments or shiny, bluish-white rocks. It is chemically similar to amphetamine, a drug used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, a sleep disorder.

Other common names for methamphetamine include blue, crystal, ice, meth, and speed.

How do people use methamphetamine?

People can take methamphetamine by:

smoking

swallowing (pill)

snorting

injecting the powder that has been dissolved in water/alcohol

Because the "high" from the drug both starts and fades quickly, people often take repeated doses in a "binge and crash" pattern. In some cases, people take methamphetamine in a form of binging known as a "run," giving up food and sleep while continuing to take the drug every few hours for up to several days.

How does methamphetamine affect the brain?

Methamphetamine increases the amount of the natural chemical dopamine in the brain. Dopamine is involved in body movement, motivation, and reinforcement of rewarding behaviors. The drug's ability to rapidly release high levels of dopamine in reward areas of the brain strongly reinforces drug-taking behavior, making the user want to repeat the experience.

Short-Term Effects

Taking even small amounts of methamphetamine can result in many of the same health effects as those of other stimulants, such as cocaine or amphetamines. These include:

increased wakefulness and physical activity

decreased appetite

faster breathing

rapid and/or irregular heartbeat

increased blood pressure and body temperature

How Do Manufacturers Make Methamphetamine?

Currently, most methamphetamine in the United States is produced by transactional criminal organizations (TCOs) in Mexico. This methamphetamine is highly pure, potent, and low in price. The drug can be easily made in small clandestine laboratories, with relatively inexpensive over-the-counter ingredients such as pseudoephedrine, a common ingredient in cold medications. To curb this kind of production, the law requires pharmacies and other retail stores to keep a purchase record of products containing pseudoephedrine, and take steps to limit sales.

Methamphetamine production also involves a number of other very dangerous chemicals. Toxic effects from these chemicals can remain in the environment long after the lab has been shut down, causing a wide range of health problems for people living in the area. These chemicals can also result in deadly lab explosions and house fires.

What are other health effects of methamphetamine?

Long-Term Effects

People who inject methamphetamine are at increased risk of contracting infectious diseases such as HIV and hepatitis B and C. These diseases are transmitted through contact with blood or other bodily fluids that can remain on drug equipment. Methamphetamine use can also alter judgment and decision-making leading to risky behaviors, such as unprotected sex, which also increases risk for infection.

Methamphetamine use may worsen the progression of HIV/AIDS and its consequences. Studies indicate that HIV causes more injury to nerve cells and more cognitive problems in people who use methamphetamine than it does in people who have HIV and don't use the drug. Cognitive problems are those involved with thinking, understanding, learning, and remembering.

Long-term methamphetamine use has many other negative consequences, including:

extreme weight loss

addiction

severe dental problems ("meth mouth")

intense itching, leading to skin sores from scratching

anxiety

changes in brain structure and function

confusion

memory loss

sleeping problems

violent behavior

paranoia-extreme and unreasonable distrust of others

hallucinations-sensations and images that seem real though they aren't

In addition, continued methamphetamine use causes changes in the brain's dopamine system that are associated with reduced coordination and impaired verbal learning. In studies of people who used methamphetamine over the long term, severe changes also affected areas of the brain involved with emotion and memory. This may explain many of the emotional and cognitive problems seen in those who use methamphetamine.

Although some of these brain changes may reverse after being off the drug for a year or more, other changes may not recover even after a long period of time. A recent study even suggests that people who once used methamphetamine have an increased the risk of developing Parkinson's disease, a disorder of the nerves that affects movement.

Are there health effects from exposure to secondhand methamphetamine smoke?

Researchers don't yet know whether people breathing in secondhand methamphetamine smoke can get high or have other health effects. What they do know is that people can test positive for methamphetamine after exposure to secondhand smoke. More research is needed in this area.

Can a person overdose on methamphetamine?

Yes, a person can overdose on methamphetamine. An overdose occurs when the person uses too much of a drug and has a toxic reaction that results in serious, harmful symptoms or death.

In 2017, about 15 percent of all drug overdose deaths involved the methamphetamine category, and 50 percent of those deaths also involved an opioid, with half of those cases related to the synthetic opioid fentanyl. (CDC Wonder Multiple Causes of Death-see #42 on Meth RR.) It is important to note that cheap, dangerous synthetic opioids are sometimes added to street methamphetamine without the user knowing

How can a methamphetamine overdose be treated?

Because methamphetamine overdose often leads to a stroke, heart attack, or organ problems, first responders and emergency room doctors try to treat the overdose by treating these conditions, with the intent of:

restoring blood flow to the affected part of the brain (stroke)

restoring blood flow to the heart (heart attack)

treating the organ problems

Is methamphetamine addictive?

Yes, methamphetamine is highly addictive. When people stop taking it, withdrawal symptoms can include:

How is methamphetamine addiction treated?

While research is underway, there are currently no government-approved medications to treat methamphetamine addiction. The good news is that methamphetamine misuse can be prevented and addiction to the drug can be treated with behavioral therapies. The most effective treatments for methamphetamine addiction so far are behavioral therapies, such as:

cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations likely to trigger drug use.

motivational incentives, which uses vouchers or small cash rewards to encourage patients to remain drug-free

Research also continues toward development of medicines and other new treatments for methamphetamine use, including vaccines, and noninvasive stimulation of the brain using magnetic fields. People can and do recover from methamphetamine addiction if they have ready access to effective treatments that address the multitude of medical and personal problems resulting from long-term use.

Points to Remember

Methamphetamine is usually a white, bitter-tasting powder or a pill. Crystal methamphetamine looks like glass fragments or shiny, bluish-white rocks.

Methamphetamine is a stimulant drug that is chemically similar to amphetamine (a drug used to treat ADHD and narcolepsy).

People can take methamphetamine by smoking, swallowing, snorting, or injecting the drug.

Methamphetamine increases the amount of dopamine in the brain, which is involved in movement, motivation, and reinforcement of rewarding behaviors.

Short-term health effects include increased wakefulness and physical activity, decreased appetite, and increased blood pressure and body temperature.

Long-term health effects include risk of addiction; risk of contracting HIV and hepatitis; severe dental problems ("meth mouth"); intense itching, leading to skin sores from scratching; violent behavior; and paranoia.

Methamphetamine can be highly addictive. When people stop taking it, withdrawal symptoms can include anxiety, fatigue, severe depression, psychosis, and intense drug cravings.

Researchers don't yet know if people breathing in secondhand methamphetamine smoke can get high or suffer other health effects.

A person can overdose on methamphetamine. Because methamphetamine overdose often leads to a stroke, heart attack, or organ problems, first responders and emergency room doctors try to treat the overdose by treating these conditions.

The most effective treatments for methamphetamine addiction so far are behavioral therapies. There are currently no government-approved medications to treat methamphetamine addiction.

Learn More

For more information about methamphetamine, visit our:

References

1. Chang L, Ernst T, Speck O, Grob CS. Additive effects of HIV and chronic methamphetamine use on brain metabolite abnormalities. Am J Psychiatry. 2005;162(2):361-369. doi:10.1176/appi.ajp.162.2.361.

2. Volkow ND, Chang L, Wang GJ, et al. Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. Am J Psychiatry. 2001;158(3):377-382. doi:10.1176/appi.ajp.158.3.377.

3. Wang G-J, Volkow ND, Chang L, et al. Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence. Am J Psychiatry. 2004;161(2):242-248. doi:10.1176/appi.ajp.161.2.242.

4. Curtin K, Fleckenstein AE, Robison RJ, Crookston MJ, Smith KR, Hanson GR. Methamphetamine/amphetamine abuse and risk of Parkinson's disease in Utah: a population-based assessment. Drug Alcohol Depend. 2015;146:30-38. doi:10.1016/j.drugalcdep.2014.10.027.

5. Bassindale T. Quantitative analysis of methamphetamine in hair of children removed from clandestine laboratories--evidence of passive exposure? Forensic Sci Int. 2012;219(1-3):179-182. doi:10.1016/j.forsciint.2012.01.003.

6. Farst K, Reading Meyer JA, Mac Bird T, James L, Robbins JM. Hair drug testing of children suspected of exposure to the manufacture of methamphetamine. J Forensic Leg Med. 2011;18(3):110-114. doi:10.1016/j.jflm.2011.01.013.

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Methamphetamine DrugFacts | National Institute on Drug Abuse

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Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug that looks like glass fragments or shiny, bluish-white rocks. It is chemically similar to amphetamine, a drug used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, a sleep disorder.

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Use the link to answer the questions on your chart

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Highlights

Anabolic-androgenic steroids are the best-studied class of appearance and performance enhancing drugs (APEDs). APEDs are used to improve appearance by building muscle mass or to enhance athletic performance.

Although anabolic steroids and other APEDs may directly and indirectly have effects on a person's mood, they do not typically produce a euphoric high. However, people who use these substances may develop a substance use disorder, defined as continued use despite adverse consequences.

Anabolic steroids can cause severe, long-lasting, and in some cases, irreversible damage. They can lead to early heart attacks, strokes, liver tumors, kidney failure, and psychiatric problems. In addition, stopping steroid use can cause depression, often leading to resumption of use.

What are anabolic steroids and other appearance and performance enhancing drugs (APEDs)?

Anabolic-androgenic steroids, often shortened to "anabolic steroids," "steroids," or "androgens," are the most widely misused APED. These are synthetic substances similar to the male sex hormone testosterone. They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects) in both males and females.

Note that in the context of this report, anabolic steroids refer only to the non-prescribed use (misuse) of testosterone and testosterone-like substances by athletes and non-athlete bodybuilders. This research report will not cover image enhancers, such as dermal fillers, Botox, or the skin tanner, melanotan.

Non-steroidal anabolics, include insulin, insulin-like growth hormone (IGF), and human growth hormone (HGH)-substances that are produced by the human body and are prescribed for legitimate medical uses but also sometimes misused for performance enhancement.

Ergo/thermogenics are compounds used to decrease body fat or to promote leanness versus muscle mass in endurance athletes. The three main categories of ergo/thermogenics are:

Xanthines: compounds that increase attention and wakefulness and suppress appetite. Examples are caffeine, the asthma drug theophylline, and theobromine-a substance found in chocolate, coffee, and tea.

Sympathomimetics: drugs that are similar in structure and action to epinephrine and norepinephrine-natural chemicals in the body that increase heart rate, constrict blood vessels, and raise blood pressure. An example is ephedrine, which is derived from the ephedra plant. Ephedrine/ephedra used to be included in dietary supplements that promoted weight loss, increased energy, and enhanced athletic performance. In 2004, the FDA banned the U.S. sale of dietary supplements containing ephedrine/ephedra due to various possible health risks including cardiovascular and nervous system effects.

Thyroid hormones: substances that regulate metabolism by altering the function of the thyroid. Cytomel is an example.

Nutritional/dietary supplements are substances purchased legally from nutritional stores or via the internet that are often taken in combination with other APEDs. Creatine, which boosts exercise capacity, is one common example.

What is the scope of anabolic steroid use in the United States?

All data refer to the United States population.
It is difficult to estimate the prevalence of steroid misuse in the United States because many national surveys that ask about drug use do not include questions about steroids. However, data on steroid misuse among young students are available from the NIDA-supported Monitoring the Future Survey.

How many young students use steroids?

In 2022, an estimated 0.8% of 8th graders, 0.5% of 10th graders, and 1.3% of 12th graders reported misusing steroids in the past 12 months. Source: 2022 Monitoring the Future Survey.

Why are anabolic steroids misused?

Anabolic steroids increase lean muscle mass when used in conjunction with weight training. The aim, for non-athlete weightlifters, is typically improvement of appearance. Steroid use is often associated with a form of male body dysmorphic disorder called muscle dysmorphia, a preoccupation with the perceived inadequate size of their muscles.

As a result, some users report taking anabolic steroids to increase confidence and because they feel that they are at a point where they can no longer get bigger through weight training alone. Most users report that anabolic steroids help them achieve their ideal body.

Increasing muscle mass may also promote strength, which can improve performance in certain types of sports. More benefit is seen for strength-dependent sports (weightlifting, shot-put throwing, football) than for sports that require speed, agility, flexibility, and/or endurance.

Anabolic steroid users report using an average of about 11 APEDs per year. They are also more likely than non-steroid users to take supplements such as protein powders and creatine; estrogen blockers; ergo/thermogenics, such as caffeine or ephedrine; medications for erectile dysfunction; and other hormones such as insulin, thyroid hormones, and human growth hormone.

How are anabolic steroids used?

Commonly Misused Steroids

Oral Steroids
Injectable Steroids

Deca-Durabolin (nandrolone decanoate)

Durabolin (nandrolone phenpropionate)

Depo-Testosterone (testosterone cypionate)

Agovirin (testosterone propionate)

Retandrol (testosterone phenylpropionate)

Equipoise (boldenone undecylenate)

Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are applied to the skin. Many users start with the oral form and then progress to injectable forms, since the latter causes less liver damage. However, oral steroids clear more rapidly from the body, often making this the preferred route for users concerned with drug testing. Doses taken by people misusing these substances can be 10 to 100 times higher than the doses used to treat medical conditions.

Cycling, stacking, pyramiding, and plateauing

Another common mode of steroid misuse is referred to as "pyramiding," which typically involves taking them in a cycle of six to 12 weeks, tapering gradually rather than starting and finishing a cycle abruptly. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Steroid users believe that pyramiding allows the body time to adjust to the high doses, and the drug-free cycle allows the body's hormonal system time to recuperate.

A technique called "plateauing" may also be used, whereby steroids are staggered, overlapped, or substituted with another type of steroid to avoid developing tolerance. As with stacking, the effects of pyramiding, cycling, and plateauing have not been substantiated scientifically.

What are the side effects of anabolic steroid misuse?

A variety of side effects can occur when anabolic steroids are misused, ranging from mild effects to ones that are harmful or even life-threatening. Most are reversible if the user stops taking the drugs. However, others may be permanent or semi-permanent.

Cardiovascular system

high blood pressure

blood clots

heart attacks

stroke

artery damage

Hormonal system - Men

decreased sperm production

enlarged breasts

shrinking of the testicles

male-pattern baldness

testicular cancer

Hormonal system - Women

voice deepening

decreased breast size

coarse skin

excessive body hair growth

male-pattern baldness

Infection

Liver

Musculoskeletal system

short stature (if taken by adolescents)

tendon injury

Psychiatric effects

Skin

severe acne and cysts

oily scalp and skin

abscess at injection site

jaundice

Cardiovascular System

Steroid use has been associated with high blood pressure; decreased function of the heart's ventricles; and cardiovascular diseases such as heart attacks, artery damage, and strokes, even in athletes younger than 30. Steroids contribute to the development of cardiovascular disease partly by increasing the level of low-density lipoprotein (LDL) and decreasing the level of high-density lipoprotein (HDL). High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. If blood is prevented from reaching the heart or brain, the result can be a heart attack or stroke, respectively. Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle, so that it does not pump blood effectively.

Hormonal System

Steroid use disrupts the normal production of hormones in the body. Changes that can be reversed include decreased sperm production, decreased function of the testes (hypogonadism) that leads to low testosterone levels, and shrinking of the testicles (testicular atrophy). Irreversible changes include male-pattern baldness and breast development (gynecomastia) in men. Anabolic steroids may also act upon the hormone system to increase the risk of testicular cancer, especially when steroids are used in combination with insulin-like growth factor.

In females, anabolic steroids cause masculinization. Specifically, breast size and body fat decrease, the skin becomes coarse, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects become irreversible. It is commonly believed that anabolic steroids will produce irreversible enlargement of the clitoris in females, although there are no studies on this.

Infections

Liver

Musculoskeletal System

Evidence suggests that weightlifters who misuse anabolic steroids have stiffer tendons, which could lead to an increased risk for tendon injury.

Skin

Anabolic steroids can also produce jaundice, or yellowing of the skin or eyes, as a result of damage to the liver.

How does anabolic steroid misuse affect behavior?

Aggression

Case reports and small studies indicate that anabolic steroids increase irritability and aggression, although findings may be confounded by personality traits that are overrepresented in steroid users (i.e., antisocial, borderline, and histrionic personality disorder) and use of other drugs. People who misuse anabolic steroids report more anger than nonusers, as well as more fights, verbal aggression, and violence toward their significant others, sometimes called "roid rage." One study suggests that the mood and behavioral effects seen during anabolic-androgenic steroid misuse may result from secondary hormonal changes.

Psychiatric Disorders

Other Drug Use

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for addiction to heroin or other opioids found that 9.3 percent had previously misused anabolic steroids. Of these, most reported using opioids to counteract insomnia, irritability, depression, and withdrawal from anabolic steroids.

What are the risks of anabolic steroid use in teens?

How do anabolic steroids work in the brain?

Research with human cells demonstrates that anabolic steroids also interact with certain types of GABA A receptors, which could mediate the increased anxiety reported by steroid users. In addition, animal studies show that anabolic steroids increase serotonin levels in brain regions involved in mood and dopamine levels in reward-related brain regions. Chronic use of anabolic steroids has also been shown to cause dysfunction of these reward pathways in animals. Specifically, rats given twice daily nandrolone injections for four weeks showed loss of sweet preference (a sign of reward dysfunction) that was accompanied by reductions of dopamine, serotonin, and noradrenaline in the nucleus accumbens, a reward-related brain region.

Are anabolic steroids addictive?

An undetermined percentage of steroid users may develop a steroid use disorder. Substance use disorders are defined by continued use despite adverse consequences; for steroid users, these may include physical or psychological problems such as breast growth (in men), sexual dysfunction, high blood pressure, excessive fats in the blood, heart disease, mood swings, severe irritability, or aggressiveness. Anabolic steroid users also may give up other important activities for fear that they will miss workouts, violate their dietary restrictions, or be prevented from using steroids. Steroid users also typically spend large amounts of time and money obtaining the drugs, and they may try to reduce or stop anabolic steroid use without success-possibly due to depression, anxiety about losing muscle mass, or and other unpleasant effects of withdrawal.

How are anabolic steroids tested in athletes?

Although non-athlete weightlifters account for the bulk of anabolic steroid misuse, occasional steroid use by professional and Olympic athletes to improve performance or cheat in competition ("doping") has done the most to raise awareness of steroid misuse. The World Anti-Doping Agency (WADA) was founded in 1999 to consistently apply anti-doping policies across sports organizations and governments around the world. Non-compliant organizations can face sanctions such as event cancellation, loss of WADA funding, or ineligibility to host events.

Sports with the greatest numbers of anti-doping rules violations in 2015.

Refinements in drug testing have improved the ability to detect anti-doping violations, resulting in increased numbers of reported violations over recent years. For example, the discovery of long-term steroid metabolites has lengthened the drug detection window, making it more difficult for athletes to pass drug tests by simply discontinuing steroid use just prior to an event. In addition, more sensitive technologies have allowed detection of lower metabolite thresholds.

Drug Testing and Nutritional Supplements

Athletes taking over-the-counter nutritional supplements may believe that such products are safe. However, nutritional supplements are not subjected to the same pre-approval requirements and quality tests as FDA-approved medications. For example, some supplements advertised to promote weight loss have been found to contain banned stimulants such as ephedrine or clenbuterol. Other research shows that supplements sometimes contain prohormones or anabolic steroids. In a study looking at 634 nutritional supplements from 13 different countries, 15 percent included some type of prohormone not listed on the label. Another study showed that some non-labeled prohibited substances could be detected by drug tests up to 144 hours later.

Nutritional supplements sometimes contain banned substances that are not indicated in their labels. The FDA notes that consumers should be wary if a product meets any of these criteria:

products claiming to be alternatives to FDA-approved drugs or to have effects similar to prescription drugs

products claiming to be a legal alternative to anabolic steroids

products that are marketed primarily in a foreign language or those that are marketed through mass e-mails

sexual enhancement products promising rapid effects such as working in minutes to hours, or long-lasting effects such as 24 hours to 72 hours

products that provide warnings about testing positive in performance enhancement drug tests

According to WADA's codes, athletes are responsible for any prohibited substance found in their samples, regardless of whether ingestion was intentional or unintentional. However, sanctions may be reduced or avoided if the athlete can demonstrate that the substance was ingested through no significant fault or negligence on his/her part, or in some circumstances where the athlete did not intend to enhance performance.

What can be done to prevent steroid misuse?

Research suggests that high school athletes are less likely to use steroids if their peers and parents disapprove, indicating that peers and parents can be strong partners in prevention efforts.

However, research shows that simply teaching students about steroids' adverse effects does not convince adolescents that they will be adversely affected, nor does such instruction discourage young people from taking steroids in the future. Presenting both the risks and benefits of anabolic steroid use is more effective in convincing adolescents about steroids' negative effects, apparently because the students find a balanced approach more credible.

Research also indicates that some adolescents misuse steroids as part of a pattern of high-risk behaviors such as drinking and driving, carrying a gun, driving a motorcycle without a helmet, and using other illicit drugs. This suggests that a prevention program should focus on comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

NIDA-Funded Prevention Research Helps Reduce Steroid Misuse

A more sophisticated approach has shown promise for preventing steroid misuse among players on high school sports teams. The Adolescents Training and Learning to Avoid Steroids (ATLAS) program is showing high school football players that they do not need steroids to build powerful muscles and improve athletic performance. By educating student athletes about the harmful effects of anabolic steroids and providing nutrition and weight-training alternatives to steroid use, the ATLAS program has increased football players' healthy behaviors and reduced their intentions to misuse steroids. In the program, coaches and team leaders teach the harmful effects of anabolic steroids and other illicit drugs on immediate sports performance and discuss how to refuse offers of drugs.

Studies show that one year after completion of the program, compared with a control group, ATLAS-trained football student athletes in 15 high schools had:

less use of anabolic steroids and less intention to misuse them in the future

less misuse of alcohol, amphetamines, and narcotics

less misuse of "athletic enhancing" supplements

less likelihood of engaging in hazardous behaviors such as drinking and driving

better knowledge about anabolic steroid, alcohol, and marijuana effects; better knowledge of alternatives to steroid misuse; greater confidence in athletic abilities; and improved nutritional behaviors

What treatments are effective for anabolic steroid misuse?

Current views recommend that treatment for steroid use address the underlying causes of the steroid use. This can include:

psychological therapies (and possibly medications) for muscle dysmorphia

endocrine therapies to restore function in those suffering from hypogonadism and to alleviate symptoms of depression

antidepressants for those whose depression does not respond to endocrine therapies

pharmacological and psychosocial treatments for patients who are also dependent on opioids, which appear to also be effective in alleviating signs of anabolic steroid dependence

Find More Resources on Anabolic Steroids and Other Appearance and Performance Enhancing Drugs

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What are anabolic steroids and other appearance and performance enhancing drugs (APEDs)?

Anabolic-androgenic steroids, often shortened to "anabolic steroids," "steroids," or "androgens," are the most widely misused APED. These are synthetic substances similar to the male sex hormone testosterone. They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects) in both males and females.

Note that in the context of this report, anabolic steroids refer only to the non-prescribed use (misuse) of testosterone and testosterone-like substances by athletes and non-athlete bodybuilders. This research report will not cover image enhancers, such as dermal fillers, Botox, or the skin tanner, melanotan.

Non-steroidal anabolics, include insulin, insulin-like growth hormone (IGF), and human growth hormone (HGH)-substances that are produced by the human body and are prescribed for legitimate medical uses but also sometimes misused for performance enhancement.

Ergo/thermogenics are compounds used to decrease body fat or to promote leanness versus muscle mass in endurance athletes. The three main categories of ergo/thermogenics are:

Xanthines: compounds that increase attention and wakefulness and suppress appetite. Examples are caffeine, the asthma drug theophylline, and theobromine-a substance found in chocolate, coffee, and tea.

Sympathomimetics: drugs that are similar in structure and action to epinephrine and norepinephrine-natural chemicals in the body that increase heart rate, constrict blood vessels, and raise blood pressure. An example is ephedrine, which is derived from the ephedra plant. Ephedrine/ephedra used to be included in dietary supplements that promoted weight loss, increased energy, and enhanced athletic performance. In 2004, the FDA banned the U.S. sale of dietary supplements containing ephedrine/ephedra due to various possible health risks including cardiovascular and nervous system effects.

Thyroid hormones: substances that regulate metabolism by altering the function of the thyroid. Cytomel is an example.

Nutritional/dietary supplements are substances purchased legally from nutritional stores or via the internet that are often taken in combination with other APEDs. Creatine, which boosts exercise capacity, is one common example.

What is the scope of anabolic steroid use in the United States?

All data refer to the United States population.
It is difficult to estimate the prevalence of steroid misuse in the United States because many national surveys that ask about drug use do not include questions about steroids. However, data on steroid misuse among young students are available from the NIDA-supported Monitoring the Future Survey.

How many young students use steroids?

In 2022, an estimated 0.8% of 8th graders, 0.5% of 10th graders, and 1.3% of 12th graders reported misusing steroids in the past 12 months. Source: 2022 Monitoring the Future Survey.

Why are anabolic steroids misused?

Anabolic steroids increase lean muscle mass when used in conjunction with weight training. The aim, for non-athlete weightlifters, is typically improvement of appearance. Steroid use is often associated with a form of male body dysmorphic disorder called muscle dysmorphia, a preoccupation with the perceived inadequate size of their muscles.

As a result, some users report taking anabolic steroids to increase confidence and because they feel that they are at a point where they can no longer get bigger through weight training alone. Most users report that anabolic steroids help them achieve their ideal body.

Increasing muscle mass may also promote strength, which can improve performance in certain types of sports. More benefit is seen for strength-dependent sports (weightlifting, shot-put throwing, football) than for sports that require speed, agility, flexibility, and/or endurance.

Anabolic steroid users report using an average of about 11 APEDs per year. They are also more likely than non-steroid users to take supplements such as protein powders and creatine; estrogen blockers; ergo/thermogenics, such as caffeine or ephedrine; medications for erectile dysfunction; and other hormones such as insulin, thyroid hormones, and human growth hormone.

How are anabolic steroids used?

Commonly Misused Steroids

Oral Steroids

Anadrol (oxymetholone)

Anavar (oxandrolone)

Dianabol (methandienone )

Winstrol (stanozolol)

Restandol (testosterone undecanoate)

Injectable Steroids

Deca-Durabolin (nandrolone decanoate)

Durabolin (nandrolone phenpropionate)

Depo-Testosterone (testosterone cypionate)

Agovirin (testosterone propionate)

Retandrol (testosterone phenylpropionate)

Equipoise (boldenone undecylenate)

Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are applied to the skin. Many users start with the oral form and then progress to injectable forms, since the latter causes less liver damage. However, oral steroids clear more rapidly from the body, often making this the preferred route for users concerned with drug testing. Doses taken by people misusing these substances can be 10 to 100 times higher than the doses used to treat medical conditions.

Cycling, stacking, pyramiding, and plateauing

Another common mode of steroid misuse is referred to as "pyramiding," which typically involves taking them in a cycle of six to 12 weeks, tapering gradually rather than starting and finishing a cycle abruptly. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Steroid users believe that pyramiding allows the body time to adjust to the high doses, and the drug-free cycle allows the body's hormonal system time to recuperate.

A technique called "plateauing" may also be used, whereby steroids are staggered, overlapped, or substituted with another type of steroid to avoid developing tolerance. As with stacking, the effects of pyramiding, cycling, and plateauing have not been substantiated scientifically.

What are the side effects of anabolic steroid misuse?

A variety of side effects can occur when anabolic steroids are misused, ranging from mild effects to ones that are harmful or even life-threatening. Most are reversible if the user stops taking the drugs. However, others may be permanent or semi-permanent.

Cardiovascular System

Steroid use has been associated with high blood pressure; decreased function of the heart's ventricles; and cardiovascular diseases such as heart attacks, artery damage, and strokes, even in athletes younger than 30. Steroids contribute to the development of cardiovascular disease partly by increasing the level of low-density lipoprotein (LDL) and decreasing the level of high-density lipoprotein (HDL). High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. If blood is prevented from reaching the heart or brain, the result can be a heart attack or stroke, respectively. Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle, so that it does not pump blood effectively.

Hormonal System

Steroid use disrupts the normal production of hormones in the body. Changes that can be reversed include decreased sperm production, decreased function of the testes (hypogonadism) that leads to low testosterone levels, and shrinking of the testicles (testicular atrophy). Irreversible changes include male-pattern baldness and breast development (gynecomastia) in men. Anabolic steroids may also act upon the hormone system to increase the risk of testicular cancer, especially when steroids are used in combination with insulin-like growth factor.

In females, anabolic steroids cause masculinization. Specifically, breast size and body fat decrease, the skin becomes coarse, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects become irreversible. It is commonly believed that anabolic steroids will produce irreversible enlargement of the clitoris in females, although there are no studies on this.

Infections

Liver

Musculoskeletal System

Evidence suggests that weightlifters who misuse anabolic steroids have stiffer tendons, which could lead to an increased risk for tendon injury.

Skin

Anabolic steroids can also produce jaundice, or yellowing of the skin or eyes, as a result of damage to the liver.

How does anabolic steroid misuse affect behavior?

Aggression

Case reports and small studies indicate that anabolic steroids increase irritability and aggression, although findings may be confounded by personality traits that are overrepresented in steroid users (i.e., antisocial, borderline, and histrionic personality disorder) and use of other drugs. People who misuse anabolic steroids report more anger than nonusers, as well as more fights, verbal aggression, and violence toward their significant others, sometimes called "roid rage." One study suggests that the mood and behavioral effects seen during anabolic-androgenic steroid misuse may result from secondary hormonal changes.

Psychiatric Disorders

Other Drug Use

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for addiction to heroin or other opioids found that 9.3 percent had previously misused anabolic steroids. Of these, most reported using opioids to counteract insomnia, irritability, depression, and withdrawal from anabolic steroids.

What are the risks of anabolic steroid use in teens?

How do anabolic steroids work in the brain?

Research with human cells demonstrates that anabolic steroids also interact with certain types of GABA A receptors, which could mediate the increased anxiety reported by steroid users. In addition, animal studies show that anabolic steroids increase serotonin levels in brain regions involved in mood and dopamine levels in reward-related brain regions. Chronic use of anabolic steroids has also been shown to cause dysfunction of these reward pathways in animals. Specifically, rats given twice daily nandrolone injections for four weeks showed loss of sweet preference (a sign of reward dysfunction) that was accompanied by reductions of dopamine, serotonin, and noradrenaline in the nucleus accumbens, a reward-related brain region.

Are anabolic steroids addictive?

An undetermined percentage of steroid users may develop a steroid use disorder. Substance use disorders are defined by continued use despite adverse consequences; for steroid users, these may include physical or psychological problems such as breast growth (in men), sexual dysfunction, high blood pressure, excessive fats in the blood, heart disease, mood swings, severe irritability, or aggressiveness. Anabolic steroid users also may give up other important activities for fear that they will miss workouts, violate their dietary restrictions, or be prevented from using steroids. Steroid users also typically spend large amounts of time and money obtaining the drugs, and they may try to reduce or stop anabolic steroid use without success-possibly due to depression, anxiety about losing muscle mass, or and other unpleasant effects of withdrawal.

How are anabolic steroids tested in athletes?

Although non-athlete weightlifters account for the bulk of anabolic steroid misuse, occasional steroid use by professional and Olympic athletes to improve performance or cheat in competition ("doping") has done the most to raise awareness of steroid misuse. The World Anti-Doping Agency (WADA) was founded in 1999 to consistently apply anti-doping policies across sports organizations and governments around the world. Non-compliant organizations can face sanctions such as event cancellation, loss of WADA funding, or ineligibility to host events.

Sports with the greatest numbers of anti-doping rules violations in 2015.

Refinements in drug testing have improved the ability to detect anti-doping violations, resulting in increased numbers of reported violations over recent years. For example, the discovery of long-term steroid metabolites has lengthened the drug detection window, making it more difficult for athletes to pass drug tests by simply discontinuing steroid use just prior to an event. In addition, more sensitive technologies have allowed detection of lower metabolite thresholds.

Drug Testing and Nutritional Supplements

Athletes taking over-the-counter nutritional supplements may believe that such products are safe. However, nutritional supplements are not subjected to the same pre-approval requirements and quality tests as FDA-approved medications. For example, some supplements advertised to promote weight loss have been found to contain banned stimulants such as ephedrine or clenbuterol. Other research shows that supplements sometimes contain prohormones or anabolic steroids. In a study looking at 634 nutritional supplements from 13 different countries, 15 percent included some type of prohormone not listed on the label. Another study showed that some non-labeled prohibited substances could be detected by drug tests up to 144 hours later.

Nutritional supplements sometimes contain banned substances that are not indicated in their labels. The FDA notes that consumers should be wary if a product meets any of these criteria:

products claiming to be alternatives to FDA-approved drugs or to have effects similar to prescription drugs

products claiming to be a legal alternative to anabolic steroids

products that are marketed primarily in a foreign language or those that are marketed through mass e-mails

sexual enhancement products promising rapid effects such as working in minutes to hours, or long-lasting effects such as 24 hours to 72 hours

products that provide warnings about testing positive in performance enhancement drug tests

According to WADA's codes, athletes are responsible for any prohibited substance found in their samples, regardless of whether ingestion was intentional or unintentional. However, sanctions may be reduced or avoided if the athlete can demonstrate that the substance was ingested through no significant fault or negligence on his/her part, or in some circumstances where the athlete did not intend to enhance performance.

What can be done to prevent steroid misuse?

Research suggests that high school athletes are less likely to use steroids if their peers and parents disapprove, indicating that peers and parents can be strong partners in prevention efforts.

However, research shows that simply teaching students about steroids' adverse effects does not convince adolescents that they will be adversely affected, nor does such instruction discourage young people from taking steroids in the future. Presenting both the risks and benefits of anabolic steroid use is more effective in convincing adolescents about steroids' negative effects, apparently because the students find a balanced approach more credible.

Research also indicates that some adolescents misuse steroids as part of a pattern of high-risk behaviors such as drinking and driving, carrying a gun, driving a motorcycle without a helmet, and using other illicit drugs. This suggests that a prevention program should focus on comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

NIDA-Funded Prevention Research Helps Reduce Steroid Misuse

A more sophisticated approach has shown promise for preventing steroid misuse among players on high school sports teams. The Adolescents Training and Learning to Avoid Steroids (ATLAS) program is showing high school football players that they do not need steroids to build powerful muscles and improve athletic performance. By educating student athletes about the harmful effects of anabolic steroids and providing nutrition and weight-training alternatives to steroid use, the ATLAS program has increased football players' healthy behaviors and reduced their intentions to misuse steroids. In the program, coaches and team leaders teach the harmful effects of anabolic steroids and other illicit drugs on immediate sports performance and discuss how to refuse offers of drugs.

Studies show that one year after completion of the program, compared with a control group, ATLAS-trained football student athletes in 15 high schools had:

less use of anabolic steroids and less intention to misuse them in the future

less misuse of alcohol, amphetamines, and narcotics

less misuse of "athletic enhancing" supplements

less likelihood of engaging in hazardous behaviors such as drinking and driving

better knowledge about anabolic steroid, alcohol, and marijuana effects; better knowledge of alternatives to steroid misuse; greater confidence in athletic abilities; and improved nutritional behaviors

What treatments are effective for anabolic steroid misuse?

Current views recommend that treatment for steroid use address the underlying causes of the steroid use. This can include:

psychological therapies (and possibly medications) for muscle dysmorphia

endocrine therapies to restore function in those suffering from hypogonadism and to alleviate symptoms of depression

antidepressants for those whose depression does not respond to endocrine therapies

pharmacological and psychosocial treatments for patients who are also dependent on opioids, which appear to also be effective in alleviating signs of anabolic steroid dependence

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Anabolic Steroids and Other Appearance and Performance Enhancing Drugs (APEDs) | National Institute on Drug Abuse

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Anabolic steroids are synthetic variations of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids.

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Use the links to answer the questions on your chart

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What are synthetic cannabinoids?

Synthetic cannabinoids are human-made mind-altering chemicals that are either sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense.

These chemicals are called cannabinoids because they are similar to chemicals found in the marijuana plant. Because of this similarity, synthetic cannabinoids are sometimes misleadingly called "synthetic marijuana" (or "fake weed"), and they are often marketed as safe, legal alternatives to that drug. In fact, they are not safe and may affect the brain much more powerfully than marijuana; their actual effects can be unpredictable and, in some cases, more dangerous or even life-threatening.

Synthetic cannabinoids are part of a group of drugs called new psychoactive substances (NPS). NPS are unregulated mind-altering substances that have become newly available on the market and are intended to produce the same effects as illegal drugs. Some of these substances may have been around for years but have reentered the market in altered chemical forms, or due to renewed popularity.

False Advertising

Synthetic cannabinoid products are often labeled "not for human consumption." Labels also often claim that they contain "natural" material taken from a variety of plants. However, the only parts of these products that are natural are the dried plant materials. Chemical tests show that the active, mind-altering ingredients are cannabinoid compounds made in laboratories.

Manufacturers sell these products in colorful foil packages and plastic bottles to attract consumers. They market these products under a wide variety of specific brand names. Hundreds of brands now exist, including K2, Spice, Joker, Black Mamba, Kush, and Kronic.

For several years, synthetic cannabinoid mixtures have been easy to buy in drug paraphernalia shops, novelty stores, gas stations, and over the internet. Because the chemicals used in them have no medical benefit and a high potential for abuse, authorities have made it illegal to sell, buy, or possess some of these chemicals. However, manufacturers try to sidestep these laws by changing the chemical formulas in their mixtures.

Easy access and the belief that synthetic cannabinoid products are "natural" and therefore harmless, have likely contributed to their use among young people. Another reason for their continued use is that standard drug tests cannot easily detect many of the chemicals used in these products.

How do people use synthetic cannabinoids?

The most common way to use synthetic cannabinoids is to smoke the dried plant material. Users also mix the sprayed plant material with marijuana or brew it as tea. Other users buy synthetic cannabinoid products as liquids to vaporize in e-cigarettes.

How do synthetic cannabinoids affect the brain?

Synthetic cannabinoids act on the same brain cell receptors as THC ( delta-9-tetrahydrocannabinol), the mind-altering ingredient in marijuana.

So far, there have been few scientific studies of the effects of synthetic cannabinoids on the human brain, but researchers do know that some of them bind more strongly than marijuana to the cell receptors affected by THC, and can produce much stronger effects. The resulting health effects can be unpredictable and dangerous.

Because the chemical composition of many synthetic cannabinoid products is unknown and may change from batch to batch, these products are likely to contain substances that cause dramatically different effects than the user might expect.

Synthetic cannabinoid users report some effects similar to those produced by marijuana:

elevated mood

relaxation

altered perception-awareness of surrounding objects and conditions

symptoms of psychosis-delusional or disordered thinking detached from reality

Psychotic effects include:

extreme anxiety

confusion

paranoia-extreme and unreasonable distrust of others

hallucinations-sensations and images that seem real though they are not

What are some other health effects of synthetic cannabinoids?

People who have used synthetic cannabinoids and have been taken to emergency rooms have shown severe effects including:

rapid heart rate

vomiting

violent behavior

suicidal thoughts

Synthetic cannabinoids can also raise blood pressure and cause reduced blood supply to the heart, as well as kidney damage and seizures. Use of these drugs is associated with a rising number of deaths.

Are synthetic cannabinoids addictive?

Yes, synthetic cannabinoids can be addictive. Regular users trying to quit may have the following withdrawal symptoms:

Behavioral therapies and medications have not specifically been tested for treatment of addiction to these products. Health care providers should screen patients for possible co-occurring mental health conditions.

Points to Remember

Synthetic cannabinoids refer to a growing number of human-made mind-altering chemicals sprayed on dried, shredded plant material or vaporized to produce a high.

Synthetic cannabinoids are sometimes misleadingly called "synthetic marijuana" (or "fake weed") because they act on the same brain cell receptors as THC, the mind-altering ingredient in marijuana.

The effects of synthetic cannabinoids can be unpredictable and severe or even life-threatening.

The only parts of synthetic cannabinoid products that are "natural" are the dried plant materials. Chemical tests show that their active ingredients are human-made cannabinoid compounds.

Synthetic cannabinoid users report some effects similar to those produced by marijuana:

elevated mood

relaxation

altered perception

symptoms of psychosis

Synthetic cannabinoids can also cause serious mental and physical health problems including:

rapid heart rate

vomiting

violent behavior

suicidal thoughts

Synthetic cannabinoids can be addictive.

Behavioral therapies and medications have not specifically been tested for treatment of addiction to these products.

This publication is available for your use and may be reproduced in its entirety without permission from the NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

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What are synthetic cannabinoids? Synthetic cannabinoids are human-made mind-altering chemicals that are either sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense.

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Use the link to answer the questions on your chart

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Synthetic Cathinones (“Bath Salts”) | National Institute on Drug Abuse

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Synthetic cathinones, more commonly known as “bath salts,” are human-made stimulants chemically related to cathinone, a substance found in the khat plant.