Buzzed

Cynthia Kuhn

GENRE: Health & Wellness

PAGES: 400

COMPLETED: March 27, 2024

RATING:

Short Summary

Cynthia Kuhn, Scott Swartzwelder, and Wilkie Wilson take readers on a sobering tour of the most commonly used psychoactive drugs in the world, explaining what they are, how they work, and why they can be so dangerous. Buzzed cuts right to the chase, bringing personality and education to the drugs everybody’s heard of but may not fully understand, including alcohol, cocaine, marijuana, opioids, and more.

Key Takeaways

How Drugs Work — All drugs, whether it’s hard drugs, cold medicine, alcohol, aspirin, or anything else, achieve their results by acting on receptors located on the surface of nerve cells in the brain. When binding to these receptors, some drugs produce an excitatory effect, while others produce an inhibitory action. An example is caffeine, which binds to adenosine receptors and prevents adenosine from reaching the receptors. Adenosine is responsible for making us increasingly drowsy throughout the day. When it’s blocked by caffeine, fatigue is delayed and we feel more alert and focused.

Drugs & Addiction — Most drugs are highly addictive. This is because drugs have a way of lighting up the reward centers of our brain through the activation of dopamine, a neurotransmitter that is released when we do things that produce feelings of pleasure. Dopamine seems to be involved with anything in life that’s addictive, whether it’s drugs, gambling, sex, people, video games, Netflix, or anything else. Done consistently enough, we usually start to build a tolerance for an addictive behavior. When our tolerance builds, we have to do more of the behavior to produce the same level of dopamine release in the brain. This process contributes to the vicious downward spiral often associated with heavy addiction.

Mixing Is Dangerous — Many drugs interact dangerously with each other and can cause major problems when mixed or taken around the same time. It’s best to avoid mixing drugs altogether. This rule includes fairly innocent-seeming situations like having a glass of wine after taking an antibiotic. Sedatives offer a good example; when alcohol, which is a sedative, is mixed with another sedative, like an antianxiety medication, the sedation effect of both drugs is magnified and can lead to dangerous outcomes.

Favorite Quote

“Not only may THC and its metabolites stay in the blood for days but they also stay in the fatty deposits of the body much longer because they are very lipid-soluble — they easily get absorbed into and stored in fat. THC stored in fatty deposits is released from these tissues slowly over a rather long period of time before finally being eliminated. What all this means is that about 30% of ingested THC (and its metabolites) may remain in the body a full week after smoking and may continue to affect mental and physical functions subtly. In fact, the remnants from a single large dose of THC may be detectable up to three weeks later.”

Book Notes

Introduction

About the Authors — Cynthia Kuhn, Scott Swartzwelder, and Wilkie Wilson are PhDs, professors, and scientists working at Duke University and the Duke University School of Medicine. All three have deep knowledge of the different classes of drugs scattered around the world and their effects on our brain and overall physiology.
About the Book — The authors wrote this book to provide high-quality education about the world’s various drugs, including a detailed overview of how they work and the impact they have on our health. The authors contend that drugs, both legal and illegal, are widely available and will only continue to become more prominent in the years ahead. They wrote the book to help educate people about these drugs.
Drugs: Knowledge Gap — There is a big knowledge gap when it comes to what scientists and medical professionals understand about drugs and what the public understands. The gap continues to grow every day as new discoveries are made in the field of neuroscience. Making things more complicated is the avalanche of information on the Internet posted by random people who do not understand what they’re talking about. Some of this misinformation can be dangerous. This book aims to close the knowledge gap a bit with high-quality, accurate information from three scientists who have studied these drugs throughout their career.
Fentanyl — Fentanyl is a drug in the opioid class. It offers a nice example of how a drug can go from helpful to harmful very quickly. Fentanyl is a fast-acting opioid often used in the operating room. The chemical is safe and effective if there is a medical professional monitoring bodily functions like heart rate, blood pressure, and the amount of oxygen reaching the brain. But even a small error in dosage or usage can turn it into a dangerous and deadly chemical. The problem is that fentanyl is sold to the public illegally by dealers, many times to college students who use it irresponsibly. The outcomes can be tragic.

Prologue: Just Say Know

Drugs Are Unpredictable — Not only does every single drug affect the brain differently; they also react differently based on the individual taking them. A certain dosage for one person may be too much, or too little, for another. The compound’s degree of purity also plays a major role; one bag of drugs might be more pure than a second bag of the same drug. When purity is not consistent, it can create huge risks of overdose. Additionally, drugs taken together can become lethal due to the different effects they have on the brain. The point? Drugs are very unpredictable. And dangerous, too.

Ch. 1: Alcohol

About Alcohol — Alcohol falls under the sedative drug class, but it also sort of acts like a stimulant in the first few minutes after consumption. When people use it, they get an immediate rush but then slip into a general feeling of relaxation. When it wears off, they turn drowsy and sleepy (this is the result of the alcohol inhibiting certain regions of the brain and causing sedation). This motivates many to keep throwing down drinks; they want the buzz to continue. The effects of alcohol largely depend on the concentration of ethanol (alcohol) in the drink (e.g. 3-7%, 20%, 40%, etc.) and whether or not you’ve had anything to eat. Drinking on an empty stomach is particularly risky.
Alcohol: Do Not Mix — Alcohol should never, ever be consumed alongside other drugs, especially ones that also make you sleepy like opioids, marijuana, sleep medications (e.g. Ambien), and even certain cold medicines that have antihistamines (for allergies). This is because all of these other drugs sedate the brain, just like alcohol does. You’re basically doubling the sedative effect of alcohol and risking overdose by taking these at the same time. Additionally, alcohol can have bad side effects when taken alongside certain over-the-counter pain relievers like Aspirin, Tylenol, and ibuprofen. For example, Aspirin, Tylenol, and ibuprofen can be highly irritating to the stomach and cause liver damage when taken with alcohol. It’s best to simply not mix alcohol with anything at all (even simple pain relievers like Tylenol, Advil, ibuprofen, etc.), but below are a few that should definitely be avoided:
- Sedatives
- Antianxiety Medication
- Sleep Medication
- Antibiotics
- Blood Thinners
- Antidepressants
- Antidiabetic Medication
- Antihistamines
- Antipsychotic Medication
- Antiseizure Medication
- Heart Medication
- Narcotic Pain Relievers (“Pain Killers”)
- Non-narcotic Pain Relievers (Tylenol)
Interesting Fact — In the old days, people used to think alcohol was some kind of magical elixir that had healing properties. Whiskey can even be translated to mean “water of life.”
Alcohol: Different Types & Ethanol — Ethanol is the alcohol used in beverages. But there are a lot of different kinds of alcohol. For example, the alcohol we rub on the skin before giving an injection or drawing blood (rubbing alcohol) is isopropyl alcohol. Methanol is another type of alcohol found in windshield wiper fluid, perfumes, paint, car parts, and more. A case of methanol poisoning is very serious. The overall chemical structure of most alcohols makes them very toxic to the human body, which is why ethanol is the only one that should ever be consumed.
Alcohol: Getting Into the Body — Ethanol is a small molecule and can therefore easily be absorbed into the body. Once a drink is consumed, it enters the stomach and small intestine, where small blood vessels give the alcohol access to the blood. About 20% of a given dose of alcohol is absorbed through the stomach, and most of the remaining 80% is absorbed through the small intestine. Once they enter the bloodstream, the alcohol molecules are carried throughout the body and into direct contact with the cells of virtually all the organs, including the brain. A few additional notes on this:
- Drinking On Empty Stomach — The reason alcohol can hit you so fast on an empty stomach is due to the fact that a substantial amount of blood goes to the brain, which then absorbs the blood containing alcohol. When there’s no food in the stomach to slow this process down, the alcohol can go “straight to your head.” Without food, alcohol is absorbed by the brain and body in about an hour; with food, the process is more like two hours. Because of how this process works, eating after consuming alcohol doesn’t have any effect on alcohol that you’ve already consumed. It does help with additional alcohol, however.
  - Quote (P. 37): “Indeed, the presence or absence of food in the stomach is perhaps the most powerful influence on the absorption of alcohol. When someone drinks on an empty stomach, the blood absorbs the alcohol very rapidly, reaching a peak concentration in about one hour. By contrast, the same amount of alcohol consumed with a meal would not be completely absorbed for nearly two hours. The food dilutes the alcohol and slows the emptying of the stomach into the small intestine, where alcohol is very rapidly absorbed. Peak blood alcohol concentration could be as much as three times greater in someone with an empty stomach than in someone who has just eaten a large meal.”
- Higher Concentration = Faster Absorption — The higher concentration of alcohol in the drink, the faster it is absorbed in the body. This means shots (with alcohol levels of 40% sometimes) will hit you faster than a simple beer, even if you drank the exact same amount of alcohol using both beverages. This is because higher concentration of alcohol enters the bloodstream faster. The blood then carries the alcohol to the brain and other organs in the body.
  - Quote (P. 38): “More rapid absorption usually means higher peak blood alcohol concentrations, so a person who drinks shots might have a higher blood alcohol level than a person who drinks the same amount of alcohol in the form of beer or wine.”
- Body Type Matters — A person’s body type also matters when it comes to alcohol absorption and distribution. A heavier person will have a higher tolerance because there’s more fat and/or muscle available to absorb the alcohol. A heavier person therefore will have a lower blood alcohol level than somebody who is leaner and drank the same amount.
- Alcohol Sedates the Brain — Again, alcohol is a sedative. When somebody drinks a ton of alcohol, they often pass out (“black out”). Why? This is because the alcohol has sedated certain regions of the brain, including those that control breathing. When breathing is sedated, people pass out.
Alcohol: Getting Out of the Body — About 95% of alcohol is absorbed and metabolized in the body; only around 5% of it is eliminated unchanged via the urine, sweat, or lungs (“alcohol breath”). This essentially means you can’t really just “piss it out” of your system; it has to be broken down and metabolized by the liver. The proportion exhaled stays constant enough to give an accurate estimate of how much alcohol is in the blood, which is why breathalyzers are used by cops to determine how intoxicated somebody is. A few additional notes on this topic:
- Getting Nauseous — One of the main side effects of alcohol is that it makes you nauseous and ill. Why? How does this process work? Most alcohol is metabolized by the liver, where an enzyme called alcohol dehydrogenase, or ADH, breaks ethanol down into acetaldehyde, which in turn is broken down by another enzyme called acetaldehyde dehydrogenase into acetate, which then becomes part of the energy cycle of the cell. The intermediate product, acetaldehyde, is a toxic chemical that can make a person feel sick. Although under normal conditions acetaldehyde is broken down quite rapidly, if it accumulates in the body via lots of drinking, intense feelings of nausea and illness result. One of the first drug therapies to treat alcoholism was actually a drug called disulfiram, which allowed acetaldehyde to build up quickly, making the person sick and (hopefully) putting an end to the drinking right away.
- Rate of Metabolism — The speed and rate at which alcohol is metabolized in the liver remains constant over time, and the average adult metabolizes the alcohol from one ounce of whiskey (which is generally 40% alcohol) in about an hour. This means that if a drinker consumes more than this amount, the liver becomes overloaded and the additional alcohol simply accumulates in the blood and body tissues and awaits its turn for metabolism. All of this leads to a situation where the person has a higher blood alcohol level and remains highly intoxicated while the liver works. The liver is trying to do its thing to restore you to feeling normal, but it has to work its way through all of the alcohol first, and the rate that it works through the alcohol remains the same no matter what. In short, X number of standard drinks per hour = Y amount of intoxication. The rate of metabolism by the liver is constant and predictable.
- More Enzymes — Continued drinking therefore results in the liver creating more and more enzymes in order to metabolize the alcohol. These enzymes also break down other drugs and medications in random ways, which is why you don’t want to combine alcohol with these other products.
Alcohol: Effects On Neurotransmitters — For many years, it was thought that alcohol treated all nerve cells equally, inhibiting their activity by disturbing the structure of each cell’s outer membrane. But we’ve learned that it has powerful effects on specific cell types in the brain. Two cell types that are particularly important for understanding how alcohol affects the brain are those that express either GABA receptors or glutamate receptors. Dopamine is another neurotransmitter that is impacted by alcohol.
- GABA & Glutamate — When working correctly, these two neurotransmitters work together to excite and inhibit certain brain cells to achieve balance in the brain. GABA receptors are considered the chief inhibitory receptors for the central nervous system, while glutamate receptors are the chief excitement receptors in the nervous system. When alcohol is introduced, it increases activity of GABA receptors (whose job is to inhibit brain cell activity) and decreases glutamate receptors (whose job is to excite other brain cells). This is the primary way alcohol suppresses brain activity — it essentially increases activity of GABA receptors and decreases activity of glutamate rectors to achieve suppression (sedation) of brain activity.
  - Quote (P. 43): “Alcohol increases the inhibitory activity of GABA receptors and decreases the excitatory activity of glutamate receptors. These are the two primary ways alcohol suppresses brain activity. While the enhancement of GABA activity is probably responsible for many of the general sedating effects of alcohol, the suppression of glutamate activity may have a more specific effect: impairment in the ability to form new memories or think in complex ways while intoxicated.”
- Dopamine — Dopamine is the main chemical messenger in the reward centers of the brain. These reward centers promote the experience of pleasure. Alcohol increases the release of dopamine in these reward centers. Studies have shown that this only happens as blood alcohol levels are rising, not while falling or stagnant. Essentially, people get a hit of dopamine when they start drinking, but it fades over time. This usually prompts people to keep drinking so they can get another hit of dopamine.
Alcohol: Memory Issues — Building on the bullet above, alcohol decreases glutamate receptor activity. A receptor called NMDA is one of the types of glutamate receptors most impacted by alcohol. The NMDA receptor is known to be crucial for the formation of new memories. Because alcohol decreases glutamate receptor activity (and therefore decreases NMDA receptor activity), it causes memory deficits. This is why many people “can’t remember” what they did the night before when they were drinking.
- Quote (P. 43): “We know that the activity of a particular subtype of glutamate receptor, called the NMDA receptor, is very powerfully inhibited by alcohol — even in very low doses. The NMDA receptor is also known to be critical for the formation of new memory. Alcohol’s powerful suppression of activity at the NMDA receptor may therefore account for the memory deficits that people experience after drinking.”
Hangovers: Don’t Take Tylenol — Hangovers are caused by alcohol’s impact on blood vessels and fluid balances in the body. Some people choose to take a pain reliever before bed after a night of drinking to help prevent a hangover. Whatever you do, don’t take Tylenol. It can interact in a dangerous way with alcohol and could cause liver damage. Aspirin and ibuprofen also could cause stomach issues when taken with alcohol.
Alcohol: Effects On the Brain — Research has shown that long-term, chronic drinking can damage the brain by shrinking it. The cortex (the part of our brain that gives us consciousness and controls most of our mental functions) is especially vulnerable to damage from alcohol. In particular, the frontal lobes of the cortex (which act as an “executive manager” for the rest of the brain) can experience a lot of damage. Other areas of the brain that experience damage from alcohol include the hippocampus and mammillary bodies, which are important for memory. Recent research indicates that people who drink occasionally (“social drinkers”) are also prone to this kind of damage, albeit at a far smaller scale than chronic drinkers.
- Quote (P. 47): “Although many of the studies of brain shrinkage have assessed people with long histories of heavy drinking, some of the more recent ones have included social drinkers and found similar, though less severe, effects. The shrinkage occurs while the person is still using alcohol. If the person stops drinking for a prolonged period, the brain will recover somewhat — not because new nerve cells grow, but because support cells, or parts of the remaining nerve cells, grow.”
Chronic Drinking: Long-term Mental Functioning Issues — Chronic drinkers put themselves at risk of severe brain damage over time. The five areas of mental ability consistently compromised by chronic alcohol abuse are below. About 70% of people who seek treatment for alcohol-related problems suffer significant impairment of these abilities. When somebody stops drinking, they do recover some of these abilities, but only slightly. They don’t fully recover.
- Memory Formation — Heavy drinkers have a hard time creating new memories. They can still remember things from their past, like childhood, but they may have a hard time telling you what they did last week. This selective memory deficit is likely due to damage to the hippocampus, mammillary bodies, and frontal lobes.
- Abstract Thinking — Heavy drinkers have a hard time with abstract thinking, including working on word puzzles, interpreting the meaning of stories, etc.
- Problem Solving — Heavy drinkers aren’t very good at solving problems. This difficulty likely has something to do with the damage alcohol does to the “executive functions” of the frontal lobes in the cortex of the brain.
- Attention & Concentration — Chronic drinkers struggle with attention and concentration
- Perception & Emotion — Chronic drinkers aren’t able to perceive emotion very well. Subtle things like interpreting tone and cadence in another person’s language is tough for them.
Social Drinking — Social drinkers are those who engage in drinking fairly frequently, but do not show signs of alcohol addiction. Usually college kids and people who are early in their professional careers fall into this category. Chronic social drinkers also experience brain damage from alcohol, but at a far smaller scale than alcoholics. It’s hard to pinpoint exactly, but three drinks per day is the threshold for experiencing pretty bad brain damage from alcohol. Within the realm of social drinkers, it’s the person who binge drinks every weekend who experiences more brain damage than someone who has one drink per day.
- Quote (P. 51): “Among social drinkers, the pattern of alcohol consumption plays a very important role in determining whether the person will develop deficits in mental functioning. The more alcohol drunk during each drinking session, the higher the likelihood that mental deficits will develop. Consider two people who each drink five drinks per week, on average. The first person has one drink on each of the five days of the week, and the second person has four drinks on each Saturday night and one in the middle of each week. The second person will be more likely to develop the kinds of deficits in the aforementioned abilities for chronic alcoholics.”
- Quote (P. 51): “However, when all the complexities of the research are taken into consideration, it is reasonable to estimate that people who drink three or more drinks per day on average are at substantial risk of developing permanent deficits in certain cognitive abilities.”
Alcohol: Tolerance — Some people who drink regularly talk about building tolerance to alcohol, meaning they can drink more without getting as messed up by it. This phenomenon applies only to the brain; having a tolerance to alcohol means it takes more drinks for the brain to experience the effects of alcohol. In fact, if you are experiencing tolerance to alcohol, it indicates that the exposure to it has changed your brain. It does not mean your liver has developed tolerance. Your liver is experiencing more and more permanent damage as you drink more and more alcohol.
Alcohol During Pregnancy — Women should not drink at all while pregnant. Not even a sip of alcohol. Although alcohol is metabolized in the liver, all tissues and organs absorb it, including the fetus in a woman’s stomach. When a woman drinks, her child drinks. The results of drinking during pregnancy are disastrous and life-shattering for the child. Drinking during pregnancy leads to lifelong neurological, cognitive, behavioral, and learning disabilities. The changes in genes that drinking during pregnancy creates not only impact the child; they are often passed down to the child’s child. This is because genes have been permanently changed by the alcohol.
Alcoholism: Genetic Factors — It’s clear that alcoholism has a firm foundation in genetics. In other words alcoholism, like diabetes, runs in the family. The risk for both men and women doubles when there is a history of alcohol problems on the family. The genes that a child inherits from alcoholic parents cause them to be predisposed to alcohol.
Alcohol: Impact on Brain Development — The human brain doesn’t finish fully developing until around age 25. One of the last regions of the brain to develop fully are the frontal lobes of the cortex, responsible for making executive decisions and critical thinking, and the hippocampus, which is associated with memory and learning. As a result, young people are especially vulnerable to the dangers of alcohol. Research has shown time and again that alcohol negatively affects learning and memory, especially in the adolescent years as the brain is developing.
- Quote (P. 64): “One study looked at brain structures associated with learning and executive function and found that normal developmental patterns were altered across an eight-year period between adolescence and the midtwenties among individuals who engaged in heavy drinking during adolescence.”
- Quote (P. 64): “The emerging bottom line seems to be that repeated alcohol exposure during adolescence has lots of negative effects on the developing brain, some of which appear to persist into adulthood.”
Chapter Takeaway — Chronic alcohol consumption poses a dangerous threat to brain development and functioning. It essentially works as a sedative, inhibiting certain regions of the brain, which allow you to feel relaxed, loose, and, eventually, drowsy/sleepy. The regions most inhibited by alcohol are the frontal lobes of the cortex (used for executive thinking/decision-making) and the hippocampus and mammillary bodies (used for memory and learning). This is why we make poor choices and have a hard time remembering things when we drink. Three drinks per day, on average, seems to be the threshold for creating permanent damage to your brain.

Ch. 2: Caffeine

About Caffeine — Caffeine falls in the stimulant drug class. It is a stimulant that temporarily enhances concentration and focus. It’s found in items like coffee, chocolate, tea, soda, energy drinks, pre-workout, and over-the-counter pain relievers. Fatal overdoses are extremely rare, but it does often raise blood pressure and heart rate. It is the world’s most popular and widely-used psychoactive drug; over 90% of the population consumes caffeine in some form or fashion and over 2 billion cups of coffee are consumed daily. In soda, caffeine is used purely as an additive and isn’t part of the soda-making process; it is added in for its addictive properties.
Caffeine: Slow Half-life — Caffeine is absorbed into the blood, evenly distributed throughout the body, metabolized in the liver, and excreted through the kidneys. But it takes a long time for the body to get rid of caffeine. The half-life for caffeine is anywhere from 3-7 hours. Therefore, the caffeine you consume in the morning is still around in the afternoon. A person who drinks several cups of coffee and sodas across a morning and afternoon is adding on to an existing load of caffeine. This partly contributes to sleep issues for a lot of people.
Caffeine: How It Works — Caffeine works by blocking neurotransmitters called adenosine from reaching their adenosine receptors in the brain. It is not some magical energy pill. Adenosine leaks out of brain cells (neurons). As your neurons become more and more active throughout your day, they leak more and more adenosine. The adenosine then goes out and attaches to adenosine receptors, causing us to get tired. This is why we get progressively tired throughout the day. When adenosine binds to their adenosine receptors in the brain, it causes sedation (causes us to get sleepy). Caffeine temporarily blocks adenosine from reaching their receptors, keeping us more alert and focused.
- Quote (P. 75): “Adenosine receptors, the main site of caffeine action, cause sedation when adenosine binds to them. Adenosine, a by-product of cellular metabolism, leaks out of cells. So, as neurons become more active, they produce more adenosine, and this provides a ‘brake’ on all the neural activity — an ingenious self-regulation by the brain. Caffeine thus produces activation of brain activity by reducing the ability of adenosine to do its job.”
Caffeine: Effects On the Brain — Caffeine arouses the brain at about 200 mg. At 500 mg, it increases heart rate and breathing. At these levels, caffeine actually narrows blood vessels in the brain, reducing blood flow to the brain (although in the body, it actually widens blood vessels). This is surprising considering caffeine also stimulates the brain and produces elevated levels of concentration and focus. Side effects of caffeine withdrawal include headaches and fatigue. Most people don’t experience caffeine withdrawal because they’re constantly caffeinated. It takes a very long time for the body to eliminate caffeine, and most people ingest it daily.
Caffeine: Effects On the Heart — Caffeine does impact the heart by acting on the heart directly and acting on the brain, which regulates the cardiovascular system. That said, unless you take a huge amount of caffeine (more than 500 mg), it doesn’t really have a noticeable impact on the functioning of the heart. You shouldn’t develop heart problems from caffeine, unless you have a history of heart issues. Caffeine is also known to elevate blood pressure, but, again, it doesn’t have a huge impact on it unless you take high doses. It would take a very high dose to cause significant elevations of blood pressure in somebody who has normal blood pressure.
- Quote (P. 77): “So it seems that moderate caffeine consumption (up to 500 milligrams per day) probably does not place the user at significant risk for heart problems. Above that level, however, the risk of heart attack may increase.”
Caffeine Is a Diuretic — Adenosine receptors aren’t exclusively located in the brain; these receptors exist throughout the body, including the kidneys. By blocking adenosine from reaching its receptors in the kidneys, caffeine increases urine production, much like a diuretic does. Caffeine also slows the release of an antidiuretic hormone that the brain normally uses to slow urine production in the body. In these ways, caffeine acts as a diuretic and increases urine production in people who consume it.
Caffeine: Effects On the Respiratory System — Caffeine has two notable influences on the respiratory system. First, it increases the rate of breathing. Second, it relaxes the smooth muscles in the lungs, making it easier to breathe. As a result of these influences, caffeine is sometimes used to help people breathe who are suffering from allergy scares.
Caffeine: Pregnancy Issues — It’s not completely clear, but it appears that caffeine can be harmful for women who are pregnant. Much like alcohol, caffeine is absorbed by the body. For women, that means their fetus is exposed to caffeine when it is consumed. Usually this manifests as low birth weight in the child, or the loss of pregnancy altogether. It may be best to avoid caffeine entirely when pregnant.
Caffeine & Stress — Caffeine amplifies stress. It doesn’t necessarily cause stress, but it will act as fuel on the fire if you are already stressed about something. This happens because caffeine increases the amount of adrenaline that already exists in the body when you are stressed out. When there’s adrenaline in the body, it raises blood pressure. Caffeine adds to it.
- Quote (P. 80): “Caffeine increases some of the normal stress responses because it increases the amount of adrenaline that is active in the body under stressful circumstances. Thus, it seems that caffeine users who find themselves under stress (or who use caffeine even more during stressful periods to work more effectively) may experience more of the effects that stress can produce. Adrenaline release increases blood pressure during stress, and the caffeine-induced rise adds to this. Thus, caffeine and stress together lead to greater bodily stress responses than either does alone.”
Caffeine: Impact on Physical Performance — Caffeine has been shown to enhance physical performance and endurance. In fact, many people take caffeine before workouts in the form of pre-workout powder. One of the ways caffeine improves performance is by releasing fats into the blood, which your muscles then use as energy instead of burning up glucose (sugar). The result is more endurance because your body has more fuel to burn in the form of fat and glucose. As mentioned in a previous bullet, caffeine also makes it easier to breathe, which can help runners. Caffeine also seems to improve muscle performance during exercise, likely because it stimulates your mind and increases focus. A downside of caffeine for exercise purposes is that it tends to dehydrate the body. It also can elevate heart rate, which could be a problem for people with heart conditions who use caffeine when working out.
Caffeine & Stroke — When brain cells are injured, such as what happens when oxygen to the brain is cut off during a stroke, it can actually be beneficial to have caffeine in your system. The reason for this involves caffeine’s ability to block adenosine. When brain cells are under duress, adenosine can pile up and cause a lot of further damage. Caffeine’s ability to block adenosine can beneficial in these scenarios. It’s not clear if this is actually true, but studies in animals seem to indicate that it is.
- Quote (P. 83): “When brain cells are injured or under stress, adenosine can reach dangerously high levels and actually damage the cells. Having the caffeine on board when the animals’ brains were stressed may have reduced the potential toxic effect of adenosine. Of course, this does not mean that everybody should walk around buzzed on caffeine all the time just in case they suffer a stroke or brain injury. But if it happens to be there, it might be protective.”
Caffeine & Coffee — The amount of caffeine in a cup of coffee depends on a lot of different factors, including type of bean used, method of roasting, and the method of brewing. A little more on these:
- Type of Coffee Bean — Robusta beans are grown in Africa and have as much as twice the amount of coffee as arabica beans, which are grown in South America and the Middle East. Robusta beans are cheaper and are generally what you find in canned coffees in grocery stores. Arabica coffee produces a better-tasting cup of coffee, but is usually only found at specialty coffee retailers. A typical cup of coffee brewed from arabica beans generally has 70-100 mg of caffeine, whereas the comparable amount of Robusta coffee may have closer to 150 mg.
- Method of Roasting — Dark-roasted coffee beans contain less caffeine and less acid than lighter-roasted ones. Many people think that dark-roasted coffees contain more caffeine because they often have a more powerful taste than the lighter roasts. In fact, the additional roasting associated with the darker product allows more time for caffeine to be broken down in the beans.
- Fineness of Grind & Method of Brewing — The finer the grind, the more surface area of ground coffee comes into contact with the brewing water. This creates more opportunity for caffeine to be extracted from the ground beans. As for brewing method, a cup of coffee made using a drip-type coffeemaker generally has about 20% more caffeine than a cup made in a percolator.
- Espresso — Espresso is really a completely different drink than brewed coffee. It has less liquid in the cup, but a greater concentration of caffeine. As a result, a small cup of espresso has about the same amount of caffeine as a normal-sized brewed coffee drink. Espresso is made by passing water rapidly through relatively tightly packed coffee grounds under high pressure. The result is that the oils and other products in the coffee are more fully extracted than under other coffee brewing conditions.
Drugs: Higher Concentration = Faster Absorption — In general, across all drug classes, the higher concentration of the drug in a particular solution (e.g. liquid), the faster it is absorbed by the body. This is why a cup of espresso feels like it has more caffeine than a regular cup of coffee, even though they actually contain about the same amount. This is also why a person who drinks one shot of alcohol feels it more than somebody who drinks the same exact amount of alcohol but in beer form; the shot has a higher concentration of the alcohol, meaning it will be absorbed faster by the body.
- Quote (P. 86): “When a drug is more concentrated in a certain solution, it tends to be absorbed more rapidly across the membranes of the stomach and small intestine. So, even though a single espresso (espresso solo) may have the same or less caffeine than a cup of coffee, its more rapid absorption can result in a more rapid onset of the caffeine effects and a greater feeling of ‘rush.’”
Chapter Takeaway — Caffeine is technically the most used drug in the world. It alters your mental state by making you a little more alert. Caffeine accomplishes this by blocking the neurotransmitter adenosine from reaching adenosine receptors in the brain and body.

Ch. 3: Ecstasy

About Ecstasy — Ecstasy falls under the entactogen drug class. There are many different kinds of drugs that are considered ecstasy, with drugs called MDMA and MDA being the most popular. All of the drugs that are considered ecstasy increase heart rate, blood pressure, and body temperature and produce a sense of energy and alertness. Rather than feeling an energizing euphoria, users of ecstasy report feeling a warm state of “empathy” and good feelings for people. This drug is considered a Schedule I drug by the Drug Enforcement Agency (DEA), meaning it has a high potential for abuse and no accepted medical uses. Death is caused by an overdose, which involves greatly increased body temperature, hypertension, and kidney failure.
Ecstasy: The Empathy Drug — Ecstasy is typically taken orally in the form of pills or capsules, which are synthesized by illegal labs. An average dose is 100 mg. MDMA is well absorbed by the gastrointestinal tract, and peak levels are reached in an hour. The effects last for 3-6 hours. Again, ecstasy is the empathy drug; it causes users to feel an overwhelming sense of empathy for people and decreases aggression. Interestingly, it doesn’t put you in a state where you lose touch with the world; users can still function fairly normally. It causes a combination of amphetamine and hallucinogen-like effects, meaning it prompts slight hallucinations (nothing major) and it makes people hyperactive (increased heart rate, blood pressure, etc.).
- Quote (P. 99): “MDMA users provide very consistent reports of the feelings that result from taking it. Almost all users say that it causes a feeling of empathy, openness, and caring. The enhancement of positive emotions has been described as a decrease in defensiveness, fear, the sense of separation from others, aggression, and obsessiveness.”
- Quote (P. 100): “In both animals and humans, MDMA causes a combination of amphetamine and hallucinogen-like effects. MDMA does not typically cause overt hallucinations, but many people have reported enhanced perception of sensory stimuli and distorted time perception while under the influence of the drug. It causes an amphetamine-like hyperactivity in people and animals, as well as the classic signs of stimulation of the fight-or-flight response. For instance, heart rate and blood pressure increase, and the smooth muscles of the breathing tubes (bronchioles) dilate. The pupils dilate, and blood flow to the muscles increases.”
Ecstasy: How It Works — Ecstasy achieves its results by increasing levels of dopamine, norepinephrine, and serotonin in the synapses of the brain. It essentially “dumps” a large amount of these neurotransmitters into the synapse. Although it increases all three, ecstasy especially does a good job of increasing levels of serotonin (mood booster) compared to other drugs. It is very effective at raising serotonin levels. Ecstasy’s increase of dopamine levels helps explain elevations in body temperature when using the drug, while its increase of norepinephrine explains the elevations in heart rate and blood pressure via our fight-or-flight mode. Typically, users feel “down” or depressed as the ecstasy begins to wear off.
- Quote (P. 101): “Much of what MDMA [ecstasy] does is explained by its ability to increase the levels of the monoamine neurotransmitters dopamine and norepinephrine and serotonin in the synapse. Like amphetamine, MDMA actively ‘dumps’ them into the synapse, and the amount of these neurotransmitters that is released is much larger than is usually seen with cocaine. Unlike amphetamine, MDMA does a very good job of increasing the levels of serotonin. While amphetamine is ten to one hundred times better at releasing dopamine and norepinephrine than serotonin, MDMA is the opposite: it releases serotonin more effectively than it does dopamine.”
- Quote (P. 102): “Dopamine and norepinephrine also play a role in the effects of MDMA. . . Dopamine also contributes to the dangerous body temperature increases that can occur when MDMA is used in warm environments. Norepinephrine, as the primary neurotransmitter of the sympathetic nervous system, is responsible for the fight-or-flight responses of heart rate and blood pressure.”
Chapter Takeaway — Ecstasy is the empathy drug. Taking it induces high levels of empathy and love for people, primarily by elevating serotonin in the brain. Ecstasy is considered a Schedule I drug by the Drug Enforcement Agency (DEA), meaning it has a high potential for abuse and no accepted medical uses.

Ch. 4: Hallucinogens

About Hallucinogens — Hallucinogens are drugs that change a person’s thought processes, mood, and perceptions. At high doses, these drugs cause people to perceive an experience as actually happening when, in fact, it is not (this is called a hallucination). At lower dose levels, they cause milder disturbances of perception, thought, and emotion, but not the complete fabrication of unreal events as experienced in a hallucination. Interestingly, users report widely different experiences when taking hallucinogens; there doesn’t appear to be one standard experience. Much of the experience depends on past drug use and the environment in which the drug was taken. LSD is the most commonly used hallucinogen. Popular nicknames for hallucinogens include acid and mushrooms. Below are the three main groups of hallucinogens:
- LSD/Serotonin Group — Dealers package LSD as a liquid by placing drops onto a piece of absorbent paper (blotter paper), or sell it as a piece of candy, or as pills or capsules. Psilocybin mushrooms are also in this category. Psilocybin mushrooms contain the active compounds psilocin and psilocybin, which resemble LSD in the effects they produce. LSD typically causes hallucinations, some of which lead to accidental death (e.g. somebody thinking they can fly from the top of a building). Hallucinations usually feel to the user like he’s watching his actions from outside of his body. LSD and psilocybin act on serotonin receptors, essentially boosting levels of serotonin. Physically, these drugs are fairly safe compared to the next two categories below.
- Belladonna Alkaloids — These have been used medically for thousands of years. However, their recreational abuse is just now becoming popular. Belladonna alkaloids in the United States are most often obtained either through prescription medication that contains them or from tea prepared from the leaves of jimsonweed. These drugs can cause dangerous elevations in body temperature, blood pressure, and heart rate — to the point that death becomes a possibility.
- PCP, Ketamine, and Dextromethorphan — Ketamine is an anesthetic used primarily in children and in veterinary practices. PCP produces a bizarre, dissociative state that comes the closest to resembling psychosis of all the hallucinogens. Dextromethorphan, the main ingredient in many cough syrups and pills, causes a unique, dissociative state at doses higher than those used for cough suppression.
Hallucinogens: Moving Through the Body — Most hallucinogens are taken by mouth, usually in pill form. Once ingested, LSD is absorbed efficiently from the stomach and intestines and enters the brain quickly. Once in the brain, hallucinogens temporarily bind to certain receptors of brain cells, which causes their effects. LSD “trips” last the longest of the typical hallucinogens (4-6 hours per dose). The effect of a particular hallucinogen depends on two things related to its chemical structure: (i) the more fat soluble the drug, the more quickly it enters the brain; and (ii) the more slowly the drug gets degraded, the longer the “trip” (LSD lasts pretty long because it is not quickly metabolized by the liver).
Hallucinogens: LSD — Lysergic acid diethylamide (LSD) is the best known and most commonly used hallucinogen in the U.S. It is also the most potent. The effects of LSD depend on the dose. Typical doses today are between 50-150 micrograms. These levels are enough to produce full-blown hallucinations in nontolerant individuals. LSD was first synthesized in a laboratory in the 1940s. From a physical body perspective, LSD is a fairly safe drug — it doesn’t really raise heart rate, body temperature, and blood pressure like PCP and belladonna alkaloids (discussed later in the chapter) do. Its effects are mostly psychologically-centered; it takes users on a “trip.” The experience of taking LSD usually goes as follows:
- 0-30 mins — Dizziness, nausea, weakness, twitches, anxiety
- 30-60 mins — Blurred vision, increased contrasts, visual patterns, feelings of unreality, lack of coordination, tremulous speech
- 1-4 hours — Increased visual effects, wavelike motions, impaired distance perception, euphoria, slow passage of time
- 4-7 hours — Above effects continue
- 7-12 hours — Returning to normal
- Late effects — Headache, fatigue
Hallucinogens: Psilocybin Mushrooms — Hallucinogenic mushrooms are the second most used hallucinogen in the U.S. The most popular are psilocybin mushrooms, which are what most people mean when they say they’ve “taken shrooms.” The experience when taking psilocybin mushrooms is viewed as a milder and shorter LSD-like experience. Scientists are currently experimenting with psilocybin (derived from psilocybin mushrooms) to treat certain disorders like anxiety, depression, and PTSD. Psilocybin and LSD enter the brain via the same receptors as serotonin, the body’s “feel good” hormone. People with depression or anxiety often have low levels of serotonin, as do people with PTSD. LSD and psilocybin act on serotonin receptors in the brain, essentially boosting them.
- Quote (P. 122): “At low doses, psilocybin causes simple feelings of relaxation, physical heaviness or lightness, and some perceptual distortions (especially visual). At higher doses, more physical sensations occur, including light-headedness; numbness of the tongue, lips, or mouth; shivering or sweating; nausea; and anxiety. The psychological effects mirror those of LSD.”
About Belladonna Alkaloids — Belladonna alkaloids are a group of plant-based compounds that affect the central nervous system. They are produced by the plant Jimsonweed. Teas prepared from any part of the plant, or the chewed seeds alone, produce a bizarre dream state at extremely high doses. This dream-like state is far different than the experience prompted by the serotonin-related hallucinogens like LSD. Most users do not remember the experience because the drug causes amnesia. These drugs can be very dangerous physically and could result in death — ingesting doses large enough to produce this mental state causes dangerous effects on heart rate, breathing, and body temperature.
- Quote (P. 130): “The belladonna alkaloids mimic the complete shutdown of the parasympathetic nervous system — the mouth becomes dry, the pupils dilate, the heart speeds up, the bronchioles (breathing passages in the lungs) dilate, and digestion slows. These drugs also affect regions of the brain involved in the control of body temperature, which can rise to dangerous levels. Finally, they block one receptor for the neurotransmitter acetylcholine that is important for memory, so users often don’t remember the experience.”
- Quote (P. 130): “Belladonna alkaloids have very different actions from the serotonin-related hallucinogens (LSD and Psilocybin). They induce a bizarre delirium that users remember only as strange dreams. These dreams often include the sensation of flying.”
- Quote (P. 141): “The belladonna alkaloids represent a particular danger. These drugs prevent the action of one of the major neurotransmitters in the body (acetylcholine) at many of its synapses. At doses that cause hallucinations, they increase heart rate and body temperature to dangerous levels: death can result.”
About PCP & Ketamine — PCP and ketamine are among the most complicated drugs discussed in this book, because they have so many different effects on brain activity. PCP can produce a state similar to getting drunk, taking amphetamine, and taking a hallucinogen simultaneously. It is most frequently taken for the amphetamine-like euphoria and stimulation it produces. Many of PCP’s bad side effects also resemble those of amphetamine, such as dangerous increases in blood pressure and body temperature. However, at the same time, it causes a “drunken” state characterized by poor coordination, slurred speech, and drowsiness. People under the influence of PCP may be less sensitive to pain. Finally, at higher doses it causes a dissociative state in which people seem very out of touch with their environment. Observers frequently report that a PCP-intoxicated person has a blank stare and seems very detached from what is going on. The discovery that a single dose of ketamine can rapidly alleviate serious depressive symptoms has led to renewed clinical interest in the drug.
About Dextromethorphan — Dextromethorphan is the main constituent of many over-the-counter cough remedies. At appropriate doses (a teaspoon or two), this drug decreases coughing and doesn’t do much else. However, it is a cousin of the hallucinogenic anesthetics PCP and ketamine, and some drug users have discovered that if they take excessive doses (equivalent to drinking an entire bottle of cough syrup), they can experience a dissociative state that is dose-related. While the lower end of the abused range (ten pills) leads to a mild state, very high numbers of pills (sixty pills) can lead to an intense dissociated, hallucinatory state.
How They Work: LSD & Psilocin — The chemical structures of drugs like LSD and psilocin strongly resemble serotonin, which is an important neurotransmitter that helps regulate mood and sleep, modulate eating behavior, maintain a normal body temperature and hormonal state. Drugs that enhance all of the actions of serotonin are useful for treating depression and suppressing overeating. We now know that there are at least 13 types of serotonin receptors, each of which has a specific effect on behavior. Drugs like LSD and psilocin achieve hallucinations by stimulating two of the 13 serotonin receptors.
How They Work: Belladonna Alkaloids — Belladonna alkaloids work by a completely different mechanism, which explains the different state that they cause. They act by preventing the actions of the neurotransmitter acetylcholine at one of its receptors. Acetylcholine is the neurotransmitter that nerves use to stimulate muscle and allow movement. It has two types of receptors: one is stimulated by nicotine, and the other slows the heart and helps to form memories.
How They Work: PCP, Ketamine, and Dextromethorphan — All three drugs block the actions of the neurotransmitter glutamate at one of its receptors. This blockade can, on its own, produce most of the effects of these drugs, including feeling disconnected from your body or environment after either recreational use or medical use in anesthesia. PCP and to a lesser extent ketamine act like amphetamine to release the neurotransmitter dopamine.
LSD: Health Benefits? — Although LSD is an illegal drug, there continues to be interest among scientists and researchers about the potential health and medicinal benefits it could provide in “microdoses.” Steve Jobs experimented with LSD and praised it for some of the health, work productivity, and creativity benefits he experienced while taking it. Some believe that LSD, in microdoses, can provide these type of benefits consistently. Experimental researchers are continuing to investigate the possibilities.
Chapter Takeaway — LSD and psilocybin are the two most well-known hallucinogens. Both of these drugs act on serotonin receptors in the brain, elevating levels of serotonin. LSD normally leads to hallucinations and “trips”, while psilocybin mushrooms generally prompt a milder LSD-like experience. Belladonna alkaloids and PCP are two very dangerous hallucinogenic drugs that can lead to dangerous and potentially fatal elevations in heart rate, body temperature, and blood pressure.

Ch. 5: Herbal Drugs

About Herbal Drugs — Herbal drugs, like most drugs discussed in this book, are simply drugs from plant matter. There are many over-the-counter herbal drugs that are marketed and sold as natural products that claim to treat conditions like obesity, memory, and immune function. A 2012 study revealed that the herbal drug market in the U.S. that year totaled $12.8B. The biggest danger with herbal drugs, however, is that many are untested and unregulated.
Herbal Drugs & Supplements: Unregulated — Because most of herbal drugs are sold as nutritional supplements rather than as “drugs,” they are not subject to FDA requirements. Therefore, neither their safety nor their effectiveness has been established in controlled scientific studies. They simply are not regulated like normal prescription and nonprescription medications are controlled in the U.S. In 1994, Congress passed the Dietary Supplement Health and Education Act, or DSHEA. This law says that the FDA will not regulate any natural product (e.g. vitamins, minerals, herbs). This can lead to a situation where you may buy a herbal drug that is marketed as a nutritional supplement but turns out to be something you weren’t expecting or is simply not safe and/or is ineffective. This is not to say that some herbal drugs aren’t helpful and effective; the point is that herbal drugs and all supplements are not regulated and tested like normal medications are.
Melatonin — Melatonin is a molecule primarily released by the pineal gland (a tiny gland that sits on top of the brain), so it is a natural part of the human body. Melatonin is only released at night. When it gets dark outside, visual cues from the eyes are relayed to the brain (the part that controls circadian rhythm) and the pineal gland, which then releases melatonin into the bloodstream. Melatonin then acts on certain receptors located on brain cells in an attempt to trigger sleep.
Melatonin: A Herbal Drug Supplement — Melatonin is one of the more popular herbal drugs, and it’s taken by many people as a supplemental sleep aid. But there is usually a misunderstanding about how melatonin supplements work. Melatonin’s role is to regulate the timing of when sleep occurs by signaling darkness throughout the brain and body. Contrary to popular belief, it does not have influence when it comes to generating sleep. Essentially, melatonin provides the instruction to start sleep, but does not participate in sleep itself. Melatonin is therefore not a very effective sleep aid. As mentioned in a previous bullet, herbal drugs (like melatonin) are also not regulated by a governing body, like the FDA. Because of its effects on sleep timing, the one-time melatonin is useful is when you have traveled a long distance and are experiencing jet lag.
- Quote (P. 154): “Finally, we do not know conclusively the long-term effects of this drug (melatonin). It isn’t even known whether melatonin is effective if given for a long period of time. Most sleep medications lose their effectiveness with time, and it wouldn’t be surprising if melatonin did as well. If so, a dangerous situation could develop if a person started increasing their dose to compensate for the loss of effect.”
Chapter Takeaway — The biggest takeaway from this chapter is that herbal drugs and supplements — whether it be melatonin, creatine, whey protein, ashwagandha, turmeric, ginseng, or anything else — are not regulated or tested by a governing body like the FDA because most are considered supplements rather than drugs. Therefore, neither their safety nor their effectiveness has been established in controlled scientific studies. They simply are not regulated like normal prescription and nonprescription medications are controlled in the U.S. Tread carefully when considering herbal drugs and nutrition supplements.

Ch. 6: Inhalants

About Inhalants — Inhalants are in the mixed drug class. The three main inhalants in this drug category include nitrites, anesthetics, and solvents (paint, sprays, gas, glue, spray paint, etc.). These chemicals have very little in common in terms of chemical structure and toxic effects other than they are all taken by inhalation. A little more on all three primary inhalants.
- Nitrites — Nitrites basically relax and widen (dilate) blood vessels, the bladder, the anus, and other tissues. The relaxed blood vessels produce a drop in blood pressure, an increased heart rate, and a sense of warmth and mild euphoria. Visual distortions can also occur.
- Anesthetics — Nitrous oxide (“laughing gas”) is the mildest of the anesthetics. It produces mild euphoria and reduction of pain, followed by drowsiness. Other anesthetics produce the same effects but cause major sedation at modest levels.
- Solvents — Solvents produce effects similar to those of alcohol. Because of their easy access to glues, gasoline, solvents, paints, and sprays, many children begin to use drugs by inhaling these common solvent chemicals. They get a buzz, but along with that buzz comes toxic effects that would horrify any chemical safety expert. Gas and glue sniffing are a problem.
Nitrites: How They Work — These yellow, flammable liquids have a fruity odor and essentially relax muscles that control blood vessels throughout the body. When these muscles relax, blood vessels, veins, and arteries widen (dilate), which lowers blood pressure and allows oxygen-rich blood to reach the heart easier. The medical uses of nitrites have a long and successful history, dating back to the synthesis of nitroglycerin (a compound widely known for being an explosive) in 1846. Today, nitroglycerin and other nitrites are used to help relieve chest pain and discomfort in heart disease patients. This is because these nitrites widen blood vessels, veins, and arteries, allowing oxygen-rich blood to reach the heart easier when a patient experiences chest pain. Nitroglycerin can be crucial when somebody is experiencing a heart attack.
- Quote (P. 164): “Like all of these compounds, nitroglycerin relaxes blood vessels, and today it is very commonly used to relieve the pain that patients with heart disease feel when one of the vessels supplying blood to their heart has a spasm (angina pectoris). Remember the scene in movies when an old person grabs his heart, falls to the floor, and struggles to get his medicine out of his pocket? Then the bad guy takes the medicine away and the victim dies? Almost certainly, it was nitroglycerin that he needed.”
Cyanide: A Poison — Blood carries oxygen to the tissues by way of the red blood cells, which contain hemoglobin to bind oxygen and then release it to the cells of the body. If the hemoglobin cannot bind oxygen, then a person will die rapidly because the tissues will be suffocated. This is the way that cyanide (which was used in Nazi gas chambers) works. In 1982, Tylenol bottles in the Chicago area were laced with cyanide and killed seven people.
Anesthetics: How They Work — Anesthesia is used in operating rooms around the country every day to perform surgery. But prior to 1847, anesthetics were not used during surgery, creating a miserable and painful experience for patients. Today, anesthesia does three critical things that allow surgery to take place routinely: pain relief, muscular relaxation, and loss of consciousness. Many different chemicals and gases can be used for anesthesia purposes. All of them achieve their results by suppressing the firing of nerve cells in the brain. In particular, scientists believe the chemicals and gases increase the action of the neurotransmitter GABA, which inhibits excitable activity in the brain, essentially knocking you out. Anesthesia in the medical setting is achieved by breathing air containing a small percentage of these gases; the rest is oxygen. These gases in high doses create problems with respiration, blood pressure, and the heart. Drug users inhale the gases in uncontrolled ways, which can easily lead to overdose. The margin between anesthesia and death is actually pretty slim; medical practitioners have to be very careful about dosage, and they need to monitor the patient at all times.
- Quote (P. 167): “One of the most important drug experiences anyone can have is that of proper anesthesia in the operating room. Most surgery could not be carried out without proper anesthesia, because it serves three important functions: pain relief, muscular relaxation, and loss of consciousness. All of the gas anesthetics produce the loss of consciousness, and some of them produce the muscle relaxation and pain relief.”
- Quote (P. 168): “Lots of chemicals and gases can be anesthetic agents, ranging from inert gases like xenon to the most modern compounds. Scientists still do not know exactly how anesthetics work. We know that they suppress the firing of nerve cells, and some can relax various muscles. At this point the best evidence is that, in part, they suppress consciousness by increasing the action of the neurotransmitter GABA, which inhibits excitable activity in neural networks.”
- Quote (P. 169): “The window of concentration between anesthesia and death is very narrow for these drugs. In medical settings the gases are carefully mixed with oxygen and survival body functions are monitored continuously.”
Anesthetics: Nitrous Oxide — Nitrous oxide (“laughing gas”) is the mildest of the anesthetics. It produces mild euphoria and reduction of pain, followed by drowsiness. Other anesthetics produce the same effects but cause major sedation at modest levels. Nitrous oxide alone is not enough to knock you out. It’s role in the medical setting is mostly to add to, or compliment, other anesthetics and sedatives, or for minor procedures that do not require the loss of consciousness. It’s an effective pain reliever that won’t knock you out cold. When a good amount of nitrous oxide is inhaled, it can create a really euphoric, giddy feeling, which is where the term “laughing gas” comes from. The first medical usage of this gas came in the mid-1800s, when dentists found it to be an excellent way to suppress pain.
- Quote (P. 169): “One cannot easily achieve deep surgical anesthesia with nitrous oxide alone, unless it is applied in an environment where the atmospheric pressure is raised. Now it is used medically only to augment other anesthetics and sedatives, or for minor procedures that do not require the loss of consciousness. When nitrous oxide is inhaled in sufficient quantity, there is a euphoric feeling that comes along with the pain relief. The term laughing gas arises from the giddy state that it produces.”
Solvents: How They Work — Solvents include all sorts of industrial chemicals, such as glues, gasoline, paints, and sprays. They are extremely toxic and not recommended whatsoever. In terms of experience, these chemicals deliver many of the same effects that alcohol and anesthetics produce. People who abuse these chemicals generally do so by “huffing,” which involves soaking a rag with the chemicals and breathing through the rags, or putting the chemicals into a cup and breathing in the fumes. Again, inhaling these chemicals is extremely toxic, dangerous, and not recommended. This is why having the garage door down with the car running is deadly — fuel fills the space and the person inside the car inhales the extremely toxic chemicals from the gas.
- Quote (P. 171): “If there were ever a drug category to ‘just say no’ to, this [solvents] is it. This category of chemicals is literally a wastebasket of anything that anyone can get in vapor form and then inhale. It consists of all sorts of industrial chemicals, such as toluene, benzene, methanol, chloroform, Freon and other coolants, paints, glues, and gases. We take the position that these compounds are so toxic to both the first-time user and the long-term user that they should never be used under any circumstances.”
Chapter Takeaway — Nitrites, anesthetics, and solvents make up the three major categories of inhalants. These are three very different compounds with varying experiences and toxicity levels.

Ch. 7: Marijuana

About Marijuana — Marijuana doesn’t belong to a specific class of drugs, but it is considered illegal at the federal level. State laws vary, with 38 having legalized it for medical use and 24 for recreational use (as of March 2024). Overdosing on marijuana is impossible, but it does impair judgement and motor skills enough to make driving a car very dangerous, which is where many people get into trouble. Smoking or vaping marijuana produces a relaxed feeling at first, followed by drowsiness and sedation. Marijuana’s effects on functioning (e.g. memory and learning) can last long after the high is gone. Because THC present in marijuana takes a long time for the body to eliminate, its effects on cognitive functioning can last for a day or more after the high is gone.
- Quote (P. 175): “People’s experiences with marijuana vary widely and depend upon the potency of the drug taken. In general, smoking or vaping marijuana first relaxes a person and elevates his or her mood. These effects are usually felt within a few minutes and followed about a half hour later by drowsiness and sedation. Some people experience this as stimulation followed by a relaxed feeling of tranquility.”
- Quote (P. 176): “The effects of marijuana on mental functions, including learning and memory, can last far beyond the feeling of being high. Because it takes so long for the body to eliminate THC and its by-products (some of which also affect brain function), a person’s cognitive functions can be affected for a day or more after a single dose.”
Marijuana: Individual Drugs — There are a number of different marijuana products, all of which have different levels of potency depending on the amount of delta-9-tetrahydrocannabinol (THC) in each product. It’s sort of like alcohol in this way; the higher the percentage of alcohol in a beverage, the more potent that beverage will be. A few marijuana products include:
- Low-grade marijuana (average 1-3% THC)
- High-grade marijuana (average 10-20% THC)
- Hashish (7-20% THC)
- Hash oil (up to 70% THC)
- “Tinctures” or other liquids used in vaping systems (up to 90% THC)
Marijuana: The Cannabis Plant — All marijuana products people use for their psychoactive effects come from the cannabis plant. The cannabis plant is a highly versatile plant. Hemp, a strong fiber in the stem, has been used to make rope, cloth, and paper. When dried, the leaves and flowers of the plant are used as marijuana for their psychoactive and medicinal effects. The roots of the plant have also been used to make medicines. Finally, cannabis seeds are still used for oil and animal feed. Cannabis sativa and cannabis indica are the two most prevalent species of cannabis plant. Cannabis indica is the plant used to create marijuana (think of the Logic song called Indica Badu).
Marijuana: THC — The cannabis plant contains more than 400 chemicals, and several are psychoactive. By far the most psychoactive is THC, which is found in the plant’s resin, which is basically the sticky coating that protects the flowers from excessive heat from the sun. The amount of THC present in the flowers of a cannabis plant via the resin varies considerably and depends on several factors. As the plant matures, the balance of chemicals in the resin changes, as does the amount of it. Early in maturation, cannabidiolic acid (CBDA) predominates and is converted to cannabidiol (CBD), which is converted to THC as the plant reaches its floral peak. The extent to which CBD is converted to THC largely determines the “drug quality” of the individual plant.
- Quote (P. 178): “Today, much cultivation of ‘drug’ strain marijuana plants has occurred, but the amount of THC present in the flowers of individual plants varies considerably. In addition to the genetic makeup of the plant, the growing conditions, timing of harvest, drying environment, and storage environment can all significantly influence the potency of the final product. As the plant matures, the balance of various chemicals in the resin changes, as does the amount of resin secreted at the flowering tops of the plant.”
- Quote (P. 178): “Early in maturation, cannabidiolic acid (CBDA) predominates and is converted to cannabidiol (CBD), which is converted to THC as the plant reaches its floral peak. The extent to which CBD is converted to THC largely determines the ‘drug quality’ of the individual plant. When the plant matures into the late floral and senescent stages, THC is converted to cannabinol (CBN). A plant that is harvested at the peak floral stage has a high ratio of THC to CBD and CBN, and the psychoactive effect is often described as a ‘clear,’ or ‘clean,’ high, with relatively little sedative effect. However, some cultivators allow the plants to mature past this peak to produce marijuana with a heavier, more sedative effect.”
- Quote (P. 179): “Burning marijuana for smoking produces hundreds of additional compounds. So when someone smokes a single joint, hundreds upon hundreds of chemical compounds enter the body. We know that many of these compounds act on various organs and systems in the body, but we don’t know what effects most of them have, either acutely or after prolonged use. Many scientific studies have, therefore, restricted their attention to THC, allowing us to evaluate at least some of the effects of cannabinoids on the brain and behavior.”
Marijuana: “Headache Pot” & “Hospital Pot” — Again, the amount and quality of THC in a marijuana product will vary considerably, but the THC content of most marijuana products in the U.S. is around 15%. THC comes from resin secreted by the cannabis plant. Below is a little more about what differentiates each grade of marijuana and the THC present in each of the corresponding marijuana products. Although there are multiple ways to consume marijuana, it is smoked the majority of the time.
- Low-grade Marijuana — Low-grade marijuana is made from the leaves of both male and female cannabis plants. These leaves contain very little THC compared to female leaves in isolation. Because of the mixture, these products will contain very little THC (1-3%). Smokers sometimes call this “headache pot” because smoking it can produce more of a headache than a high.
- Medium-grade Marijuana — Medium-grade marijuana is made from the dried flowering tops of female cannabis plants raised with and fertilized by male plants. Fertilization limits the psychoactive potency of the resulting marijuana because the female flowers secrete THC-containing resin only until fertilization. After that, the flower no longer needs the protective resin, and it begins to produce a seed. Less resin means less THC, which results in less of a high.
- High-grade Marijuana — High-grade marijuana is made from the flowering tops of female plants raised in isolation from male plants. The resulting marijuana is called sinsemilla, which means “without seeds.” As the female flowers mature without fertilization, they continually secrete resin to coat the delicate flowers and small leaves surrounding them; the flowers grow in thick clusters, heavy with resin. When these “buds” are harvested and dried, they contain an average of around 12-16% THC. Some samples of sinsemilla test as high as 24%. Products with this much THC can sometimes startle the user, causing them to panic and rush to the hospital. That’s where the name “hospital pot” comes from.
Marijuana: Different Products — Because the cannabis plant is a very versatile plant, there are many different marijuana products available. Most people smoke it, but there are also many ways to consume marijuana products, whether it’s through a pipe, smoking a cigarette, inhaling via a bong, eating it, or vaping it using an e-cigarette. What follows is some information on common marijuana products people use:
- Hashish — Hashish is produced when the resin of a cannabis plant is separated from the plant material. The purest form of hashish is virtually 100% resin, although most hashish products on the market are not pure resin — they also contain other plant material to balance it out. The average THC content of hashish is around 8% but can vary quite a bit — up to 20%. Hashish is often smoked in a pipe or rolled into a cigarette along with tobacco or lower-grade marijuana.
- Hash Oil — Hash oil is the most potent product made from the cannabis plant. After the plant is boiled in alcohol, the solids are filtered out, and when the water evaporates, what’s left is hash oil. Hash oil is generally a thick, waxy substance that is very high in THC content — ranging from 20-70%. It can be scraped onto the inner rim of a pipe bowl for smoking or used to lace tobacco or marijuana cigarettes.
- Marijuana Liquids — With the introduction of electronic vaping systems like e-cigarettes and “MODs” for vaping nicotine, many different liquids have been formulated for delivering cannabinoid-containing vapor. How do these compare in potency to marijuana, hashish, or hash oil? You name it, and the potency options are there. There are “e-liquids” that contain relatively little THC, and there are others that are extremely potent. But THC potency is not the only variable when it comes to e-liquid; the balance of different cannabinoids can also vary widely. The number of possible potency/cannabinoid mixture combinations is endless, so it’s very important for users to know what they are vaping in order not to be taken by surprise.
Marijuana: Method of Consumption Matters — How a person consumes marijuana matters in terms of how much THC gets into the body. A cigarette allows for approximately 10-20% of the THC in the marijuana to be transferred. A pipe is somewhat more efficient, allowing about 40-50% to transfer, and a water pipe (or bong) is quite efficient. The vapor from e-cigarettes is not as bothersome to the lungs as actual smoke from a cigarette, so people who use an e-cigarette to inhale marijuana/THC can take long hits without having to cough. This can sometimes lead to people taking in far more THC than they intended.
Marijuana: Moving Through the Body — When somebody smokes/inhales marijuana, the lungs immediately absorb it. Because blood from the lungs goes directly from the heart to the brain, the high, as well as the effects on heart rate and blood vessels, occurs within minutes. Much of the THC is actually gone from the brain within a few hours after smoking. However, THC also accumulates in other organs, such as the liver, kidneys, spleen, and testes. This is why marijuana/THC remains in the body (and brain) and has subtle effects for days and weeks — it stays in the blood for awhile and it is very fat-soluble, so it piles into the body’s fat and various organs.
- Quote (P. 182): “Although much of the high wears off relatively soon after smoking or vaping, THC remains in the body much longer. About half of the THC is still in the blood twenty hours after smoking. And once the blood carrying the THC passes through the liver, some of the THC is converted into other compounds that may remain there for several days. Some of these metabolites have psychoactive effects as well, so that although the initial high may disappear within an hour or two, some of the effects of marijuana on mental and physical functions may last for days.”
- Quote (P. 183): “Not only may THC and its metabolites stay in the blood for days but they also stay in the fatty deposits of the body much longer because they are very lipid-soluble — they easily get absorbed into and stored in fat. THC stored in fatty deposits is released from these tissues slowly over a rather long period of time before finally being eliminated. What all this means is that about 30% of ingested THC (and its metabolites) may remain in the body a full week after smoking and may continue to affect mental and physical functions subtly. In fact, the remnants from a single large dose of THC may be detectable up to three weeks later.”
Marijuana: Smoking vs. Eating — The large majority of people smoke marijuana, but it’s also possible to eat it. The differences in how marijuana/THC interacts with the body are significant when eating vs. smoking. Rather than experiencing the immediate shift from normal to high that happens when you smoke it, eating marijuana means the THC it contains will take longer to reach the brain, and some of the THC will be broken down by the liver before it reaches the brain.
- Quote (P. 183): “When marijuana (or any drug) is taken into the stomach, the blood that absorbs it goes to the liver before flowing to the rest of the body (including the brain). This means two things: First, the liver breaks down some of the THC before it ever has a chance to affect the brain. Second, the remaining THC reaches the brain more slowly because of its indirect route through the bloodstream. However, because the body absorbs THC more slowly when marijuana or other cannabis products are eaten, the peak levels of the drug last longer (though they are lower than they would be if the same amount were smoked or vaped).”
Cannabinoid Receptors — In the early 1990s, researchers discovered that our brains contain cannabinoid receptors — basically brain receptors for THC. The chemical that our brain makes to interact with these receptors is called endocannabinoids. These receptors seem to play a role in things like learning, control of anxiety, and responsiveness to other drugs. In short, cannabinoids help regulate communication between cells in the brain, and when additional cannabinoids are added in via cannabis, it causes disruptions in learning and memory. A nice description of what these receptors do is below:
- Quote (P. 184): “They [cannabinoids] essentially act as moment-by-moment feedback systems between communicating neurons that shift the intensity of the signals traveling between those cells. This allows brain circuits to react to changes in the intensity of their communications — a kind of self-regulation of the communication between cells. This is important because it influences how messages are sent and received by a cell. Obviously, for a communication system like this to work, delicate balances of endocannabinoid concentrations are required within neural circuits. When additional, exogenous (‘from the outside’) cannabinoids are added to the mix by a person using cannabis products, those delicate concentrations can get ramped way up, disrupting the normal process of communication between neurons. While this disruption is part of what causes the feeling of being high, it also compromises the function of neural circuits in ways that disrupt learning and memory as well as other aspects of information processing.”
Cannabinoid Receptors & The Hippocampus — There is a high concentration of cannabinoid receptors in the hippocampus, an area of the brain that is very involved with memory. Not surprisingly, marijuana seems to have a significant negative impact on a person’s memory. What happens is this: when marijuana is consumed, the THC in it suppresses cannabinoid receptors in the hippocampus, hurting their ability to create new memories. This is widely viewed as the biggest downside of the drug. It’s important to note that, like alcohol, the negative effects on memory only take place while using the drug; people have no problem recalling memories that took place when they were not high. But ask a person who is high to remember a story and they will be very compromised.
- Quote (P. 185): “The hippocampus is critically involved in the formation of new memories and has a very high concentration of cannabinoid receptors. Not surprisingly, the inhibition of memory formation by marijuana is its most well-established negative effect on mental function.”
- Quote (P. 185): “These experiments make a compelling case that the memory deficits associated with acute marijuana use are due to the THC suppressing the activity of hippocampal cells and hindering the acquisition of new memory.”
- Quote (P. 185): “While people are high, they are significantly less able to store new information than when they aren’t. In fact, the single most common and reproducible cognitive effect of marijuana is this interference with memory processing. It is important to emphasize that, as with alcohol exposure, the deficit is not in the ability to recall old, well-learned memories, but rather in the ability to form new ones.”
Marijuana: Effects On the Body — In addition to the effects it has on the brain, marijuana also impacts the body in a number of ways. First, marijuana increases heart rate by about 20-30 beats per minute. Second, it impairs the functioning of the lungs. Third, it can sometimes lead to nausea and vomiting — a syndrome that is called cannabinoid hyperemesis syndrome (CHS). Also, smoked marijuana contains carcinogens, which can contribute to cancer. These are just a few of the many effects marijuana can have on the body.
Marijuana: Dependence & Withdrawal — All things considered, marijuana is a fairly safe drug to use compared to most of the others discussed in this book. While it appears that it does mildly activate dopamine in the reward centers of the brain, it is not a very addicting substance compared to other drugs. As a result, most people don’t become dependent on it like other highly-addictive drugs such as heroin or cocaine. Withdrawal symptoms are also very, very mild compared to other drugs.
Marijuana: Long-term Effects — Studies have shown that marijuana does permanently impair mental and cognitive functioning, as well as memory, to some degree if used consistently over a long period of time. The negative effects appear to be most pronounced in people who begin using marijuana in their teenage years. The younger you start using cannabis, the worse the long-term effects of the drug.
Marijuana: Medicinal Benefits — There’s no doubt that marijuana and its mellowing effects have positive medicinal benefits for some people who are in a lot of pain and/or going by through an uncomfortable illness. All things considered, it’s a pretty safe drug compared to the others discussed in this book, including alcohol, which is legal. One report indicates the cannabis plant is the largest cash crop in the U.S., topping corn and wheat combined. All of that said, it’s not a harmless drug; it stays in the body and brain for a good amount of time and does seem to have some negative effects on cognitive functioning and memory.
Chapter Takeaway — Marijuana is not as bad as people have made it seem. While it does seem to impair cognition and memory to some degree, it is a relatively safe drug that you can’t overdose on, is not addictive, and can provide some medicinal benefits for people dealing with chronic pain and illness. The potency of the marijuana depends on several factors, including concentration of THC in the product and method of consumption.

Ch. 8: Nicotine

About Nicotine — Nicotine is a legal drug that doesn’t necessarily belong to any particular drug class. It does act like a stimulant though, increasing attention, concentration, and (possibly) memory. It also acts like a stimulant in that it raises heart rate and blood pressure quite a bit. It’s possible to overdose on nicotine, but it’s extremely rare. As seen with smokers, nicotine is a highly addictive drug, although it lacks the obvious mind-altering effects of alcohol, stimulants, or opioids. People don’t use nicotine because it provides a rush or a high. Rather, most users report that it calms them and reduces anxiety. Popular nicotine products include:
- Tobacco
- Chewing Tobacco (“Chew”, “Dip”)
- Cigars
- Cigarettes
- E-Cigarettes (“Vaping”)
- MODs (“Vaping”)
- Pipe Tobacco
- Nicotine Gum
Nicotine: Brief History — Like many drugs, nicotine started out being used as a medicine. In 1828, French chemists isolated the active ingredient in tobacco and called it nicotine after Jean Nicot, the French diplomat who brought tobacco from Portugal to France. By 1890, people began to realize nicotine was actually bad for you and stopped prescribing it as medicine. In the 1800s, most people consumed tobacco (and the nicotine contained in it) by chewing it, but smoking it via cigars became the norm in the early 1900s. Cigars allowed the nicotine to be absorbed via the mouth (chewing the cigar) and the lungs (smoking the cigar). Cigarettes later caught on, and 40% of U.S. adults were smokers by the 1960s. Today, it’s about 16%, mostly because we’ve found that smoking (tobacco) is a major cause of cancer.
Nicotine: Getting Into the Body — Like marijuana, the speed and efficiency with which nicotine enters the blood and is transferred to the brain depends largely on how it is administered. When a person smokes tobacco, or inhales nicotine using an e-cigarette or MOD, the nicotine is absorbed very rapidly into the blood through the lungs and passes into the brain in seconds. Chewing tobacco via “chew” or “dip” leads to a much slower absorption of nicotine in the body and brain. Chewing tobacco actually delivers more nicotine than smoking a cigarette does (because, when smoking, a lot of it gets exhaled and misses the lungs), but both result in essentially the same peak concentration of nicotine in the blood; one just gets there faster via the lungs (smoking, e-cigarettes, etc.) than the other does via absorption in the mouth (chew). Cigars are unique because the user can chew on the tobacco/nicotine and smoke it.
Nicotine: Moving Around the Body — How is nicotine distributed in the body once it’s in? Once again, it depends on the way it was administered. Smoking a cigarette results in a peak concentration in the lungs, blood, and brain within about 10 minutes. But these concentrations decline rapidly as nicotine is redistributed to other body tissues — 20 minutes after smoking, the nicotine concentration in the blood and brain is down to half of what it had been just 10 minutes earlier. With chewing tobacco, the distribution throughout the body is slower, but peak nicotine concentrations are basically the same to those obtained after smoking a cigarette.
Nicotine: Leaving the Body — Nicotine leaves the brain and body very fast. Its effects are very brief. In essence, nicotine’s quick route to the brain leads to a fast, potent hit. It also means that people can’t get enough; the effects hit almost immediately (if smoked), then they quickly subside, leaving the user wanting more. This partly explains why nicotine is so addictive. Once nicotine is absorbed into the body the liver breaks it down, and the kidneys get rid of it via the urine.
- Quote (P. 221): “These characteristics also set up the smoker for addiction in two ways. First, nicotine’s rapid route to the brain provides a quick and potent hit. Second, the rapid redistribution out of the brain means that the brain areas that control the behaviors associated with smoking are ready for more nicotine soon after the smoker finishes the last cigarette.”
- Quote (P. 221): “After nicotine is absorbed and distributed throughout the body, the liver breaks most of it down into two inactive metabolites: cotinine and nicotine-N-oxide. The kidneys eliminate these metabolites through the urine. Cotinine is the marker used in urine screens for nicotine because it stays in the body for several days.”
Nicotine: Is It Addictive? — Yes. Very much so. Nicotine promotes three behaviors that are typical of an addictive substance. Think about smokers and how hard they find it to kick the habit. The three ways nicotine is addictive include:
- Reinforcement — Reinforcement is something that motivates an individual to work toward getting more. Nicotine promotes the release of the neurotransmitter dopamine in brain regions that mediate reinforcement. In short, users experience nicotine and get a good release of dopamine from the act. The dopamine feels good, prompting the user to want more and more. The fact that it leaves the brain so quickly also contributes to this.
- Tolerance — People who smoke cigarettes or otherwise consume nicotine begin to develop a tolerance to the chemical. This means, over time, it takes more and more nicotine to get the same dopamine hit. This prompts users to keep consuming nicotine, whether via chew, smoking, e-cigarettes, etc.
- Withdrawal — Once you’re in, it’s hard to get out. The side effects that come with trying to stop smoking or consuming nicotine in other ways are not pleasant. Because it’s so hard to stop, people keep returning to nicotine.
Nicotine: e-Cigarettes & MODs — In recent years, e-Cigarettes and MODs (“vaping”) have become a popular way to consume nicotine and other chemicals. What has made these devices so popular is that they involve many of the same behaviors of smoking — such as “taking a puff.” When it comes to nicotine, these devices deliver the substance without the tobacco and 7,000 chemicals released when smoking a cigarette. When vaped, nicotine is absorbed straight into the lungs, just like a cigarette or cigar.
- Quote (P. 223): “The use of e-cigarettes or MODs — which deliver nicotine but contain no tobacco — involves many of the same habits associated with smoking and delivers nicotine to the lungs like cigarettes do. So the experience is very much like actual smoking — without the smoke, or most of the 7,000 or so chemicals that are released when tobacco is burned.”
Nicotine: Does It Cause Cancer? — No. The reason smoking is so effective at causing cancer is due to the tobacco and all of the chemicals that are inhaled when smoking. Nicotine is actually used in gum, skin patches, and delivered directly via e-cigarettes to help people stop smoking; with these products, the user still gets the nicotine they crave but without the tobacco and toxic chemicals that come with smoking.
- Quote (P. 233): “They [ENDS] deliver nicotine, which is addictive, of course, but it does not cause cancer. A striking number of people in the United States believe that nicotine causes cancer, which it absolutely does not. Cigarette smoke contains about 7,000 different chemicals, and 70 of them cause cancer. Nicotine is not one of those 70 cancer-causing chemicals.”
Nicotine: Effects On the Heart — Nicotine and smoking are just as destructive to the heart as they are to the lungs. Nicotine prompts the release of adrenaline, which increase heart rate and blood pressure. When somebody is smoking, the carbon monoxide in smoke also decreases the ability of blood to carry oxygen, making things even more stressful for the heart. Cigarette smoke is also toxic to the blood vessels. It is estimated that 30% of deaths involving the heart and vascular system are related to smoking.
- Quote (P. 226): “Nicotine affects the heart in several ways. The heart is a big muscle, and like all muscles it needs a rich supply of oxygen to do its work pumping blood throughout the rest of the body. When nicotine is in the system, it results in the release of adrenaline, which increases heart rate and blood pressure. The heart then needs more oxygen to increase its workload, but its oxygen supply doesn’t increase, so it must do extra work with no extra help.”
Secondhand Smoke = Deadly — Prolonged and regular exposure to secondhand smoke (defined as smoke exhaled by a smoker) is a significant contributor to cancer and heart disease. We’ve known for more than 20 years now that secondhand smoke can double a person’s risk of heart disease. Secondhand smoke is also a carcinogen and alone is responsible for a huge number of lung cancer deaths every year.
- Quote (P. 227): “The Environmental Protection Agency, after considerable study of this issue, determined that secondhand smoke is indeed a carcinogen and in and of itself is responsible for a significant number of lung cancer deaths each year in the United States.”
- Quote (P. 227): “The effects of secondhand smoke on the development of heart disease are even more alarming. We’ve known for over twenty years that regular exposure to secondhand smoke can double a person’s risk of heart disease.”
Chew: Also Cancerous — Chewing tobacco is not much better than smoking. Just as with smoking, nicotine prompts the release of adrenaline, spiking blood pressure and heart rate. Chewing tobacco can also lead to mouth and esophagus cancer, as well as gum disease.
ENDS: An Alternative to Smoking? — ENDS, Electronic Nicotine Delivery System, are devices that deliver nicotine into the lungs. These are e-cigarettes, vapes, and MODs. These devices were created to help smokers stop smoking. They involve many of the same mannerisms that come with smoking cigarettes (taking a puff) and deliver nicotine, but they don’t have the toxic smoke and chemicals that come with smoking. For a chronic smoker, these can really help avoid cancer, although the nicotine will still raise blood pressure and heart rate via the release of adrenaline. Nicotine is absolutely not cancerous.
- Quote (P. 232): “Powered by a rechargeable battery, an atomizer converts liquid nicotine (mixed with other chemicals and flavorings) into a warm mist, allowing it to be drawn into the lungs.”
- Quote (P. 235): “The more popular models that have been developed since then feature a refillable tank for holding the e-liquid, which is heated by a small battery to produce vapor. The e-liquids can contain varying concentrations of nicotine as well the chemicals that enable the nicotine to be aerosolized (turned into vapor), and various flavorings.”
Chapter Takeaway — Nicotine prompts the release of adrenaline, which increases blood pressure and heart rate. These effects can help narrow focus and concentration. But nicotine is not cancerous. When somebody smokes, the smoke released during the act contains 7,000 chemicals, about 70 of which are cancerous. Nicotine isn’t one of them. Like smoking, chewing tobacco also causes cancer; smoking mostly causes lung cancer, while chew mostly causes cancer of the mouth and esophagus. It’s the tobacco that’s causes cancer, not nicotine.

Ch. 9: Opioids

About Opioids — Opioids are drugs that produce effects like those of the opium poppy and its active agent morphine. They can be natural products from the poppy, or synthetic molecules created in laboratories. People who inject opioids experience a rush of pleasure and then sink into a dreamy, pleasant state in which they have little sensitivity to pain. Breathing slows considerably, and the skin flushes. Pinpoint pupils are another hallmark of opioids. When opioids are taken by ways other than injection, the same type of effect takes place, except that a pleasant drowsiness takes place instead of a rush. Opioid overdose is lethal and is not infrequent. Breathing slows to a point that it stops and the user dies.
- Quote (P. 240): “Opioid drugs are any drugs, natural or synthetic, that produce the characteristic opioid effects: the combination of a dreamy, euphoric state; lessened sensation of pain; slowed breathing; constipation; and pinpoint pupils.”
Interesting Fact — Morphine derives its name from Morpheus, the Greek god of dreams, who was often depicted with a handful of opium poppies. Opioids are well-known for their ability to create a euphoric dream state.
Opioids: A Brief History & Rise of Heroin — The use of opioids has been going on for a very, very long time. But in 1805, morphine, the active ingredient in the opium poppy, was purified, and in 1853 Alexander Wood invented the hypodermic syringe. In 1898, the Bayer Company began adding an extra chemical group onto morphine, which made it more soluble in fat so it could enter the brain faster. This produced heroin and marked the beginning of the opioid crisis, where people are hooked on opioids. Today, opioid drugs are mostly used in the medical setting for their extremely strong ability to reduce pain. The problem is that all of them are extremely addictive. Another problem is that, because they are illegal, drug lords try to make their own opioids, which can vary widely in potency. This has led to a lot of overdoses — people don’t know what they’re consuming. In fact, it’s possible that Prince died of a fentanyl overdose because he thought he was taking the less potent Vicodin (hydrocodone).
- Quote (P. 240): “Today, opioid drugs are a mainstay of the medical treatment of pain. There just aren’t substitutes for their effectiveness at reducing pain. However, all opioid drugs are addictive. Some doctors so fear addiction in their patients that they withhold needed treatments.”
Opium: Where It Comes From — Opium refers to a preparation of the opium poppy. Opium farmers around the world cut the developing seedpod of the opium poppy and collect the gummy fluid that oozes out of the cut over the next few days. The sap is then refined in several ways. It may be dried into a ball and used directly (gum opium) or dried and pounded into a powder (opium powder). Raw opium appears as a brown tarry substance.
Types of Opioids — There are many different types of opioids. Many, like morphine, are direct natural products of the seedpod of the opium poppy. Others are modified, man-made opioids that have been chemically altered by scientists. In the medical setting, opioids are primarily used to help patients deal with pain (e.g. following surgery). Opioids found on the street can vary considerably in potency and overall content, which is why these can be very dangerous — you simply don’t know what’s in them. A few of the common types of opioids are below:
- Morphine — Morphine is one of the primary opioids doctors prescribe for pain, and it is one of the major components of the gummy fluid that oozes out of the opium poppy when farmers cut into the seedpod.
- Codeine — Codeine is a much less potent opioid than morphine that is usually delivered in pill form and is used for milder pain.
- Heroine — Heroine is simply a slightly modified version of morphine. It was chemically modified by scientists to be more fat-soluble so it can enter the brain and deliver a high faster. It is broken up into small amounts and appears on the streets in bags of loose powder. Color ranges from white to black to brown depending on the source and overall quality. White is more pure, but purity varies widely. The concentration on the street usually ranges between 5-66%. South America and Mexico are the two major suppliers of heroine to the U.S.
- Hydromorphone — This is a chemically altered version of morphine modified by scientists. Hydromorphone is a very, very strong opioid and is widely abused.
- Oxycodone (OxyContin) — This is also a chemically altered opium modified by scientists, although the central ingredient from the opium poppy being changed isn’t morphine, it’s thebaine. Oxycodone ranks between morphine and codeine in its effectiveness against pain. This one is also widely abused — most people find it and abuse it in OxyContin, which is a delayed-release form of oxycodone that is designed to release the drug gradually, providing pain relief for hours.
- Hydrocodone (Vicodin) — Hydrocodone is found in a product called Vicodin. This one is also a chemically altered opioid. It is a moderately strong opioid that is also widely abused.
- Meperidine (Demerol) — Meperidine is used like morphine for intense postsurgical pain, but it works well even with oral use. Meperidine has a definite downside: it can cause seizures at high doses — a feature that has led to decreased use by physicians in recent years.
- Fentanyl (Sublimaze) — Fentanyl and its relatives are very fat-soluble, very fast-acting opioids that anesthesiologists use when they put patients to sleep. In fact, it is the most fat-soluble opioid and will deliver a high in seconds when injected, and it only lasts about an hour. Fentanyl is also used in patches that release the drug slowly through the skin to provide more long-lasting pain relief. Its most unusual formulation is a lollipop designed to deliver the drug to young children before surgery. Many addicts use fentanyl in its injectable form, which often causes overdose. Fentanyl’s high comes on fast and is intense, brief, and can be very close to fatal suppression of breathing.
- Methadone — This one is primarily used as an opioid drug to treat opioid addiction. Methadone is a very long-lasting opioid that is taken as a pill. Its unique time course makes it particularly useful for replacement therapy for treating opioid addiction as well as chronic pain. The gradual and mild onset of action staves off withdrawal signs but doesn’t provide a “high.” This makes it useful when trying to help somebody through opioid withdrawals.
- Buprenorphine — Like methadone, this is another opioid used to treat opioid addiction.
- Tramadol & Tapentadol — Tramadol and tapentadol are drugs with multiple actions. Both cause pain relief through opioid effects and blockade of norepinephrine uptake. Tramadol also blocks the reuptake of serotonin, and its opioid actions are weak enough that it has little abuse liability. Tapentadol is a more effective opioid and therefore has some risk of abuse. For both drugs, the combined actions seem to provide better pain relief with fewer side effects and less abuse.
Strength of Opioids — All opioid drugs bind to the same molecule in the brain, but they do so with varying degrees of success. What follows is a list of opioids that bind very well, bind intermediately well, and bind poorly. The clinical use of these drugs is determined in large part by this quality. As the table shows, a drug like codeine won’t do much good with the pain caused by major abdominal surgery, and hydromorphone would be overdoing it for a simple headache. Generally the stronger the opioid, the more risk for addiction.

Opioids: How People Take Them — Most opioid drugs enter the bloodstream easily from all kinds of routes because they are very good at dissolving in fatty substances. Heroin and fentanyl represent one extreme — they are so fat-soluble that they can be absorbed in the nose after somebody snorts it. Most other opioids are not quite as fat-soluble and cannot be absorbed well after snorting. Intravenous injection is the route that delivers opioids into the bloodstream the fastest. It’s also the most dangerous way to take opioids. As mentioned, snorting is an option as well, as is smoking them. And, of course, opioids come in pill form (e.g. when prescribed by a doctor) to be taken orally.
Opioids: Delivering a High — How quickly opioids deliver their effects depends on the method of consumption. Injecting them into the veins gets them into the bloodstream the fastest; smoking them is second-fastest. With these two methods, the high is delivered in minutes. It also depends on what kind of opioid is being taken — the most fat-soluble opioids will take effect immediately. Fentanyl is the fastest, achieving a high in seconds. Heroin is slightly slower, taking a few minutes. Morphine is third at about five minutes. Taking a opioid pill is a bit slower (30 mins) because it has to go through the small intestine, into the bloodstream, and past the liver. This also means a portion of the opioid is metabolized before it reaches the brain, which is why the high isn’t as intense as injecting or smoking the opioid.
- Quote (P. 246): “The rate at which opioids enter the brain depends mainly on how the user takes them. The fastest way to get high is to inject the drug directly into the bloodstream. The second fastest is to smoke it. When users smoke or inject opioids, peak levels in the brain occur within minutes. Fentanyl is the most fat-soluble and achieves maximum brain concentrations in seconds. Heroin is a little slower; it takes a couple of minutes. Morphine is slower still, but not by much (five minutes). The faster the buzz, the greater the danger of death by overdose, because drug levels in the brain can rise so quickly.”
Opioids: The Experience & Breathing — All opioids cause a pleasant, dreamy, drowsy state in which all cares are forgotten (nodding off), and there is decreased sensation of pain. While the user is on a dreamy, pleasant state, breathing slows, and the pupils constrict. The slowing of breathing is one of the more concerning parts about using opioids. People who die from taking opioids usually take too much, to the point where their breathing stops. The reason breathing slows is that the drugs act on the opioid receptors in the brain that specifically deal with breathing and the control of breathing.
- Quote (P. 255): “The most dangerous thing about the opioid drugs by far — and the usual cause of death — is the suppression of breathing, which can be fatal within minutes after an injection. It’s not the result of cumulative toxicity but can happen with a single dose. Usually at this point the patient has become sedated and sleepy and has pinpoint pupils. The most common reason for overdose with opioids is that the user has received a dose that is much higher than expected.”
Reversing Opioid Overdose — There’s a drug that, if provided to the user fast enough, can almost instantly reverse the downward spiral of an opioid overdose. The drug is an opioid receptor-blocking drug called naloxone. When injected into the bloodstream, this medication can stop an opioid overdose in its tracks.
Opioids: How They Work In the Brain — Opioids achieve their effects by acting on specific receptors of the endorphin/enkephalin class of neurotransmitters in the brain. These neurotransmitters control things like movement, mood, and physiology. They control bodily activities like digestion, body temperature, and breathing. They are also involved in pain management and reward circuits, which is why stimulating them makes you high and more resistant to pain. All of these things happen when a neurotransmitter in the brain releases endorphins and enkephalins. Normally, neurons only release these when called upon. But when an opioid (e.g. heroine) is delivered, they start firing these off like crazy, and basically all opioid receptors in the body are stimulated simultaneously. That’s why you get the major shift.
- Quote (P. 249): “Opioids act on specific receptor molecules for the endorphin/enkephalin class of neurotransmitters in the brain. These endogenous opioids are chemical neurotransmitters that control movement, moods, and physiology. They help to control many bodily activities, including digestion, regulation of body temperature, and breathing. They also help to process pain sensations, and they activate reward circuits, which is why stimulating them makes you high. All of these behaviors arise when neurons in different parts of the brain release endorphins or enkephalins. Normally, each neuron is doing its job, firing away only if it is called upon; activation of all the endogenous opioid neurons virtually never happens. Taking heroin is like every endogenous opioid neuron in the brain firing all at once.”
Endorphins: Our Own Opioids — The brain actually produces its own, natural opioids. These are endorphins and enkephalins (mentioned in the bullet above). Endorphins are usually released in the brain when we’re doing something pleasurable (e.g. finishing a run, listing to music we like, sex, etc.). That’s why it’s called the “runner’s high.” They work by binding to opiate receptors on nerve cells in the brain, just like opioid drugs do. Overall, these natural opioids play an important role in suppressing pain and promoting reward.
Opioids: Addiction, Tolerance, and Withdrawal — The same mechanisms that allow opioids to reduce pain also stimulate reward centers in the brain that can lead to addiction and dependence. They go hand in hand; can’t have one without the other. As a result, opioids are highly addictive. On top of that, it’s fairly easy to build up tolerance to the different effects of opioids, meaning you have to take larger and larger doses to get the same results. Opioid withdrawal is very unpleasant and difficult, but it isn’t life-threatening (unlike alcohol withdrawal).
Opioids: Long-term Effects — Surprisingly, opioids don’t have a lot of serious long-term effects. They don’t seem to do a tremendous amount of damage to the organs of the body, unlike alcohol, which is very destructive over the long haul. They can cause constipation and issues with fertility in men and women, but they are otherwise not that bad from a long-term, chronic use perspective. The short-term effects (e.g. suppression of breathing, risk of overdose, etc.) are obviously very dangerous.
Chapter Takeaway — Opioids are made from the opium and chemicals of the opium poppy. In the medical setting, they are primarily used as pain killers for people who have just undergone a major procedure. They do a great job of suppressing pain, but they are also very addictive. One of the major dangers of opioids is their tendency to suppress breathing; breathing slows considerably when using them. People who overdose on opioids often suppress breathing to the point where they stop breathing altogether. The potency of the various types of opioids depends largely on how fat-soluble they are — fentanyl is the most fat-soluble and creates a high in seconds when injected into the bloodstream.

Ch. 10: Sedatives

About Sedatives — Sedatives are drugs that promote a sense of relaxation, reduction of anxiety, and a general “mellow” feeling. At higher doses, sedatives produce drowsiness, slurred speech, muscle incoordination, and more. People generally become impaired and lose their motor skills. Sedatives become really dangerous when mixed with alcohol, which is a type of sedative in its own right. When mixed with other drugs, like alcohol, fatal suppression of breathing can happen. This result can also happen if somebody takes too much of a certain sedative. Sadly, “roofies” are a type of sedative that predators have been known to slip into a woman’s drink to knock her out. Many drugs classify as sedatives, but they all fall under one of four buckets:
- General Sedatives
- Benzodiazepines
- Drugs for Sleep
- GHB
Sedative No. 1: General Sedatives — The first bucket of sedatives is general sedatives. Barbiturates are one of the drugs that fall under the general sedatives category and offer a good look at how all general sedatives work. Barbiturates essentially work by enhancing the inhibiting ability of the neurotransmitter GABA. Remember, GABA promotes inhibition of brain cells, which leads to sedation. Sedatives, like alcohol and barbiturates, basically boost GABA’s abilities. In short, if there is enough GABA and enough barbiturates in the brain, they combine to overwhelm nerve cells so they cannot fire, and all networks shut down, causing sedation. And that’s the goal of a sedative. Problems occur when the sedative shuts down areas of the brain responsible for life, like breathing. This only really occurs if a user takes way too much of the sedative. When taking a sedative, it’s important to make sure you know exactly what you’re taking and what the appropriate dosage is.
- Quote (P. 263): “Our best understanding of the general sedatives comes from studies of the barbiturates. The barbiturates and other drugs act by increasing the inhibitory function of the neurotransmitter GABA at its binding site on the nerve cells.”
- Quote (P. 264): “With a sedative, shutting down is exactly what we want to have happen, but only in certain areas. What we don’t want is for those areas responsible for life to shut down, and there is the secret to good pharmacology — finding a drug that will do exactly what you want and not what it must not do. The barbiturates and other general sedatives are terrific if you know just how to use them, and they can be deadly if you don’t.”
- Quote (P. 264): “The message from this is that all of these sedatives are alike in their mechanism of action, but they can be very different in their potency, and maybe even in their specific potency on critical life-support networks. Anytime you take a sedative, know exactly what you are taking and the appropriate dose for that drug.”
- Quote (P. 265): “We have already talked about what can happen at high doses — death by respiratory depression. At normal doses, the major concern is that they can have sedative effects that outlast their sleep-inducing properties so that, for example, driving, flying an airplane, or performing other activities requiring muscle coordination can be impaired for up to a day after a single dose.”
Sedative No. 2: Benzodiazepines — Benzodiazepines are among the most prescribed drugs in the world. Why? They are very effective at treating anxiety, an issue that continues to plague millions of people. They act very similarly to general sedatives — enhancing the abilities of GABA neurotransmitters to inhibit nerve cells in the brain. The difference is that they have a way of inhibiting receptors that specifically participate in thinking and worrying rather than cells that participate in things like breathing, which is what general sedatives tend to target most. Benzodiazepines are not a perfect drug, however. They cause drowsiness and muscle incoordination; they are easy to build a tolerance to, meaning you have to always up the dosage; stopping abruptly can lead to seizures because GABA is no longer being enhanced, meaning the brain is firing on all cylinders again; and memory and learning are degraded while using these drugs. Valium is a commonly prescribed benzodiazepine.
- Quote (P. 266): “The benzodiazepines are remarkable because they are one of the closest drugs we have to a ‘magic bullet’ for anxiety. Used in the proper way, benzodiazepines can provide significant relief from anxiety without disrupting normal functions.”
- Quote (P. 266): “The mechanism of action of these drugs is just about the same as that of the general sedatives — the enhancement of GABA inhibitory systems. So, the question arises of why they don’t suppress respiration and cause death. It’s because they work through a special benzodiazepine-binding site on the GABA receptor molecule (the place where GABA interacts with the nerve cell), and the nerve cells that control respiration and other important functions do not have many benzodiazepine sites on their GABA receptors. They might appear to be almost the perfect drug, because the receptors are on cells that participate in thinking and worrying but not on those that keep us alive. It is no wonder that these are among the most prescribed drugs on earth.”
- Quote (P. 267): “The general sedatives do this, too, but few people take them chronically, while a lot of people take benzodiazepines for prolonged periods. Because general learning is a problem, it is unrealistic for people who need to learn new information to expect to do so to their full potential if using these drugs. Once people stop taking benzodiazepines, however, this effect on learning disappears and they return to normal function.”
Benzodiazepines & “Roofies” — Benzodiazepines can cause amnesia (forgetting things easily), which is why some (bad) people slip these sedatives into a woman’s drink to knock her out and then commit sexual abuse. The woman later wakes up and has no idea what happened because of the amnesia properties of the drug, especially when it’s mixed with alcohol in the drink. The technical name for roofies is Flunitrazepam, and it is widely distributed in the underground market. The U.S. has banned the importation of it.
- Quote (P. 267): “There are reports of benzodiazepines being put into the drinks of women who are then raped but have amnesia for the whole event. This may have become more prominent because of the availability of flunitrazepam (the brand name is Rohypnol, commonly called ‘roofies’), which is an especially potent benzodiazepine. A very small amount (two milligrams) will easily disappear in a drink but be quite effective.”
Sedative No. 3: Drugs for Sleep — Problems with sleep are a huge issue in our society, and many people seek medical help. As a result, many sedative drugs specifically designed to help promote sleep have been created over the years. A few of the commonly prescribed sleep medications include:
- Ambien (Zolpidem) — Ambien is chemically unrelated to benzodiazepines, but it achieves its results by acting on a specific benzodiazepine receptor that induces sleep. Unlike benzodiazepines, Ambien does not reduce anxiety, so it is thought to be less rewarding and less prone to cause dependence than normal benzodiazepines like Valium. Ambien received FDA approval in 1993. In general, it appears to be a safe drug if it is taken when prescribed by a doctor and the user goes to bed after taking it. The drug will cause drowsiness and it will impair motor skills, which is why it should only be taken for sleep. It should never be mixed with other drugs, especially other sedatives like alcohol. Ambien has been known to cause amnesia while taking it — there are many reports of people doing things (e.g. sleep walking, sleep shopping, and even sleep murder) in their sleep while on this drug.
- Belsomra (Suvorexant) — This is completely different than all other sleep drugs. Introduced in 2014, Belsomra acts on a different receptor. It essentially works by blocking specific wake-promoting neurotransmitters called orexins, which are secreted by a small number of neurons in the hypothalamus. When orexins are blocked, the user is unable to stay awake. This drug is still so new that it’s hard to tell if it’s a solid option.
- Lunesta (Eszopiclone) — Lunesta came to market in 2005 and basically does the exact same thing as Ambien. The two are very similar products.
- Rozerem (Ramelteon) — Rozerem is a completely different sleep-inducing agent that works through melatonin receptors.
Sedative No. 4: GHB — GHB, gamma-hydroxybutyrate, is a very potent sedative that is available usually in an odorless and colorless liquid. Originally sold over-the-counter, it was banned by the FDA in 1990. Today, it is sometimes prescribed for patients dealing with narcolepsy, a condition where a person falls asleep several times throughout the day. GHB is very potent and very toxic. Overdoses can occur easily. Similar to “roofies” (described earlier), GHB has been known to be slipped into a woman’s drink at a nightclub by predators. GHB produces a high like alcohol, as well as sedation at higher doses. Interestingly, it appears GHB may also be a neurotransmitter synthesized in the brain.
What Causes Addiction? — Whether we’re talking about food, drugs, sex, video games, or anything else, our current understanding of addiction is that drugs and behaviors that promote the actions of the neurotransmitter dopamine have the capacity to produce not only dependence, but addiction. Dopamine in the neurotransmitter that is released when we’re doing things that are pleasurable and feel good. As we build tolerance to things, it requires more and more of the thing to release the same amount of dopamine and get that pleasant, rewarding feeling. This is how the spiral of addiction happens.
- Quote (P. 305): “All drugs that inhibit dopamine uptake or release dopamine will be potentially addictive.”
Chapter Takeaway — There are tons of sedative drugs, but they all fall under one of four general buckets. Most sedatives (including alcohol) achieve their results by basically boosting the neurotransmitter GABA, enhancing GABA’s ability to inhibit certain areas of the brain, which then causes sedation. Sedatives should never be mixed with alcohol or any other sedative.

Ch. 11: Steroids

About Steroids — There are many different types of steroids, but anabolic steroids are ones that promote muscle growth. Steroid refers to their chemical structure, and anabolic refers to their ability to promote muscle growth. Testosterone, and any drug that acts like testosterone, is an example of an anabolic steroid. Yes, testosterone is a (legal) steroid. Steroids don’t cause overdose in the same way opioids and other drugs can, but they do cause many changes in body function that can lead to serious injury and death.
Testosterone: The Body’s Natural Steroid — Men and women produce testosterone; it’s the body’s natural steroid hormone, although men produce much more than women. Estrogen is the primarily natural steroid hormone in women. Testosterone in men is released by the testes and is responsible for the development of genitalia in the fetus, changes to the body during puberty, brain function and sexual drive, sperm development, muscle growth, and more. It typically peaks in the body during adolescence and the early 20s. It tapers off in the 30s and slowly begins to decline from there. Problems can arise when a man doesn’t produce enough testosterone. Physicians will often help this problem by prescribing anabolic steroids.
- Quote (P. 279): “In a normal man, testosterone is present from the time of fetal life. During fetal development, it is responsible for the development of the male genitalia, and it contributes to the differentiation of brain functions that are different in men and women, like reproduction and sexual behavior. During puberty, testosterone production increases dramatically in men, causing the rapid growth in height, the thickening and coarsening of body hair, the lowering of the voice, genital development, acne, and the muscle growth that happens at that stage of life. . . Once puberty is over, testosterone levels tend to be fairly constant until the third decade, and decline slowly after that.”
Steroids: Anabolic Steroids — Again, anabolic steroids are supplemental drugs like testosterone that promote muscle growth. They are often prescribed by physicians to help men who have inadequate testosterone production in their body. Men and women have used anabolic steroids to boost athletic performance (e.g. Barry Bonds). Anabolic steroids are also used to help with tissue regrowth after an injury (e.g. my ear/sudden hearing loss). It’s important to note that steroids that reduce inflammation aren’t anabolic steroids; those are variations of cortisol. People with asthma often take these kinds of steroids. These steroids are not dangerous and are primarily designed to reduce inflammation in the body (e.g. my tonsil inflammation).
- Quote (P. 277): “Testosterone and drugs that act like testosterone in the body are anabolic steroids.”
- Quote (P. 277): “Normally, the main anabolic steroid in the body is testosterone.”
Steroids: Testosterone Supplements — People use testosterone supplements as anabolic steroids. The problem with these supplements is that they are cleared from the body quickly. As a result, people have developed synthetic derivatives that have the same effect as testosterone but last longer. There are also testosterone “look-alikes” that claim to be testosterone but are really just gimmicks. These contain vitamins, amino acids, and herbs that are touted as “testosterone raisers” but have no real effect on muscle metabolism and growth.
- Quote (P. 278): “Testosterone is a natural hormone, and so it has the advantage of not having unexpected toxicities. For users, its disadvantage is that the body eliminates it quickly. There are numerous synthetic derivatives; the most common ones in the clandestine market include boldenenone, methandrostenolone, stanozol, nandrolone, and trenbolone. Each of these has the same effects as testosterone but remains active longer.”
Steroids: SARMS — Biomedical scientists have developed several “SARMs,” or specific androgen receptor modulators, that specifically target anabolic actions of testosterone in the muscle and bone, without effects on reproductive organs. These include ostarine, andarine, ligandrol, and cardarine. None of these has been approved yet by the FDA, and they exist only as research chemicals.
THG & The BALCO Controversy — Athletes have always tried to get a leg up on the competition. One of the ways they have done this is by using anabolic steroids that have slight modifications in order to pass drug tests. BALCO was a lab in the Bay Area that created a designer steroid called tetrahydrogestrinone (THG), which was a slight derivative of testosterone that had never been seen before and therefore was not banned. MLB players Barry Bonds, Jason Giambi, and many more were eventually caught using this steroid, among others. BALCO claimed to be a nutritional supplement company.
Steroids: How Users Take Them — In men, testosterone is released in the testes, and when doctors treat male patients who have inadequate testosterone levels, they try to provide steady, low doses. That’s not how steroid users use testosterone. Users, like athletes, instead employ steroids by “stacking” them via a cycle that lasts 4-18 weeks, starting with low doses of several steroids and gradually increasing the dosage. The amounts they take are huge in comparison to the normal regimens doctors use to treat men with inadequate testosterone levels. In normal men, with normal levels of testosterone, taking steroids doesn’t have a huge impact, because the body produces about the right about of testosterone. But when bodybuilders and athletes take it in high enough doses, the edge they get is enough to give them a competitive edge. This is because steroids help them build a little more muscle than they already have (which is usually a lot) and it limits the damage cortisol does on muscle breakdown, helping them retain more muscle.
- Quote (P. 82): “For many years, the scientific establishment denied that anabolic steroids could cause any real improvement in athletic performance. This conviction was based on results of controlled scientific studies done on men who were not particularly fit and who already had optimal levels of testosterone. They put them all on an exercise regimen and gave some men testosterone and others a placebo. All of the men usually improved in performance because of the exercise regimen. Because the male body makes about the optimal amount of testosterone, adding a little usually has little impact. The situation for bodybuilders and others who use anabolic steroids is quite different — they are maximally fit to start, just looking for that slight edge, and taking huge amounts does improve performance enough for that winning edge. Although testosterone normally works only on its own receptor to build muscle, when such huge amounts are taken, scientists have speculated that it ‘spills over’ onto the catabolic steroid receptor and prevents the effects of cortisol. So instead of just muscle building, huge amounts of anabolic steroids might prevent muscle breakdown, too.”
Steroids: Harmful Effects — Steroids definitely have some bad health consequences. In women, the effects seem to be most problematic. This is because women do make a small amount of testosterone naturally, so the very high levels that result from taking anabolic steroids leads to some masculine characteristics, such as extra muscle, a deeper voice, thicker hair, and an enlarged clitoris. The anatomical changes are irreversible. In men, anabolic steroids usually suppress libido and halt sperm production. Steroids also seem to have a negative effect on heart health, and users seem to have a higher chance of any-cause mortality (death).
- Quote (P. 283): “The combination of hypertrophy (increased growth) of the heart, increased tendency of the platelets to clot, and increased levels of lipids in the blood likely contributes to the increased risk of heart attack in men who use anabolic steroids to improve athletic performance.”
- Quote (P. 283): “Most important, death (from any cause) is more common in men who use anabolic agents than in men of comparable age and health who do not.”
Chapter Takeaway — There are many types of steroids, but anabolic steroids are drugs that help promote muscle growth. Testosterone is an example of a commonly used steroid. When taken in high enough doses, anabolic steroids can give people a competitive edge with their bodies, although there are long-term health consequences of using.

Ch. 12: Stimulants

About Stimulants — Stimulants cause a sense of energy, alertness, talkativeness, and well-being that users find pleasurable. At the same time, users experience increased heart rate and blood pressure and dilation of the bronchioles (breathing tubes) in the lungs. When injected, snorted, or smoked, these drugs cause an intense feeling of euphoria. Caffeine is technically a stimulant, but it’s not included here because it’s very, very minor compared to the major stimulants. Stimulants are used by many students to stay awake and study for big exams. Although they don’t necessarily improve learning and memory, they allow you to hold attention better, and for longer. Popular drugs in the stimulant class include:
- Cocaine
- Amphetamine (Adderall)
- Methamphetamine
Stimulants: Bad Effects — There are three main dangers with stimulants. First, high doses can lead to death. High doses of cocaine often lead to seizures, sudden cardiac death, stroke, and more. High doses of amphetamine can cause seizures and lethal cardiac events. The second danger is psychiatric — with repeated, high-dose usage, stimulants can cause paranoia and a state of mind that resembles paranoid schizophrenia. Finally, addiction is very possible with any stimulant.
The Story of Cocaine & Origins of Coca-Cola — Cocaine appears on the leaves of several species of plants. The natives of South America used to chew coca leaves for their alerting effects and ability to increase endurance. The importation of coca to Europe and the purification of cocaine from the leaves by the German scientist Albert Niemann in 1860 led to a new era. Chemists and scientists began using cocaine to make stimulating drinks. Later, Georgia pharmacist John Pemberton created a cocaine drink called Coca-Cola. Another pharmacist, Asa Candler, realized how successful this drink could be and bought the rights to the formula. Candler used the recipe to create the Coca-Cola Company, and the rest is history as it is now one of the most iconic brands worldwide. Coca-Cola no longer includes cocaine after the drug became illegal in 1914. Coca-Cola now uses caffeine instead.
- Quote (P. 289): “Soon thereafter, the American pharmaceutical industry took note, and Parke-Davis started manufacturing a cocaine-containing tonic. The success of this tonic spawned a host of imitators, including Georgia pharmacist John Pemberton’s Coca-Cola, a tonic containing a (still) secret formula that included cocaine. Another pharmacist, Asa Candler, realized the financial potential of this concoction and purchased the rights to the formula. The rest is history, as his Coca-Cola Company became a fixture in the American landscape and now the world.”
- Quote (P. 290): “Why isn’t there still cocaine in Coca-Cola? The tale is familiar in today’s environment of public activism about product safety. During the early 1900s, unregulated sales of ‘tonics’ containing potent ingredients such as opium and cocaine boomed. Some of these formulations contained so much cocaine (hundreds of milligrams per milliliter instead of the 0.5 milligrams per milliliter in the original Parke-Davis formula) that toxicities became widespread. The medical establishment finally took note. [and cocaine was later banned]”
More About Cocaine — Cocaine abuse was wild in the 1970s. A new form of cocaine, called “crack,” was developed at this time and allowed users to inhale the drug. Cocaine is used in some cases medically as a local anesthetic, but on the street, the two most common forms are the white powder that is either snorted or dissolved for injection, and crack, a solid chunk of cocaine that is heated directly in a pipe to form a vapor that is inhaled into the lungs. Both the powdered cocaine and crack are prepared from leaves of the coca plant, which are mixed with solvents and processed through several steps to remove the cocaine from the leaves and purify it as crystals. The powdered form of cocaine isn’t 100% cocaine — it is mixed with other white powders to fill the bag. The reason for this is economical: the other powders allow dealers to save some cocaine. The purity of cocaine found on the street is about 50%, per a 2016 DEA report. Today, new cocaine users outnumber new meth users almost five to one, and Columbia is the source of most cocaine that arrives in the U.S.
The Story of Amphetamine — In the 1920s, scientists in China identified ephedrine as an important medicine for asthma because it helped open up the breathing tubes in the lungs. A few years later, a chemist named Gordon Alles found a way to synthesize amphetamine in an attempt to develop a synthetic form of ephedrine. He succeeded a little too well. Amphetamine opened up the lungs to help asthma patients, but it also came with a pleasurable stimulation and euphoria that ephedrine did not come with. Use of amphetamines skyrocketed in the 1930s, and Japanese scientists later synthesized methamphetamine (“meth”). Soldiers of many countries in World War II used amphetamine to stay alert during long tours of duty.
More About Amphetamine — After World War II, the use of amphetamine and methamphetamine became more widely used in society, and Japan in the 1960s experienced the first wave of addiction. Methamphetamine later earned the street name “Ice” and spread rapidly in the 1990s, sparking a new wave of addiction. In 2006, law enforcement in the U.S. listed methamphetamine as the number one problem they face, and today it is rated second behind heroine. Mexican “superlabs” are the primary source of methamphetamine today with law enforcement cracking down on U.S. labs.
Interesting Fact — In the 1960s and 70s, as cocaine, amphetamine, and methamphetamine abuse ran rampant, the slogan “Speed Kills” became popular to try to bring awareness to the lethal effects these stimulating drugs can have on people. Today, sports commentators use this phrase a lot to describe somebody who is fast.
Cocaine: Moving Through the Body — As with many drugs in this book, the method of consumption plays a big role in how quickly cocaine works. Snorting cocaine is a relatively slow way to deliver cocaine into the bloodstream due to absorption issues. Blood cocaine levels don’t peak for 30 mins when snorting. In “crack” form, cocaine forms a vapor that users inhale. This is as effective as injecting the drug into the veins. Maximum blood cocaine levels occur in 1-2 minutes with these methods. The liver degrades about half of a cocaine dose in an hour, so users are ready for another dose in about 45 minutes. This rapid rise and fall in blood cocaine levels often leaves the user wanting more. As a result, users will often keep taking hit after hit after hit until the entire amount is gone or they become so toxic that they have a seizure. Ingesting cocaine (e.g. taking a pill or eating/drinking) is a very slow and less effective route of delivery.
Amphetamine: Moving Through the Body — Similar to cocaine, smoking or injecting amphetamine and methamphetamine provides users with a very quick and effective hit that gets into the bloodstream very quickly. Amphetamine and methamphetamine are degraded more slowly than cocaine, meaning their effects last at least 2-4 hours. This leads to less of a rush-and-crash pattern when using these drugs.
Stimulants: Effects On the Brain — Amphetamines and cocaine are known for their ability to increase attention, alertness, and reduce fatigue. From a medical perspective, amphetamines are sometimes prescribed by doctors to treat attention deficit disorders like ADHD and narcolepsy, which is a condition where a person falls asleep several times throughout the day. However, these drugs also come with euphoria and a sense of well-being (a high) that can cause them to be addictive. Stimulants cause an increase in movement, hence the name. They are always on motion — moving, talking, exploring, and generally fidgeting nonstop. At very high doses, stimulants can cause a psychotic-like state that resembles paranoid schizophrenia.
The “Speedball” — People sometimes use cocaine or meth in combination with heroin or other opioids, which, as we now know, cause a relaxed and dream-like state. This combination is called a “speedball.” The two drugs, when mixed like this, sort of counter each other, which makes understanding the body’s signals difficult, leading to overdose. This is the combination of drugs that killed actors Chris Farley and John Belushi.
- Quote (P. 298): “The dreaminess of opioids is added to and cuts the edginess and arousal caused by cocaine. This combination [that forms the speedball] can be particularly dangerous: often people who are injecting cocaine slow down their intake of the drug when the jitteriness gets too great, but in the presence of heroin, these feelings are not so obvious, increasing the risk of an overdose [of either cocaine or heroin].”
Stimulants: Effects On the Body — When it comes to the body, cocaine and amphetamines initiate the features of the fight-or-flight mode: increasing heart rate, blood pressure, and body temperature. Blood vessels constrict, the bronchioles (breathing tubes) dilate and open up, and blood sugar increases. These effects can be helpful for improving a condition like asthma, but the effects of abusive use on the heart can be so bad that they may result in irregular heartbeat or heart failure. Most overdoses from stimulants like cocaine and amphetamines are due to their intense cardiovascular effects. Because they raise body temperature, stimulants should definitely not be taken when exercising vigorously; exercise already raises body temperature, so the combination can cause problems.
- Quote (P. 299): “Cocaine and amphetamines mimic the effects of the sympathetic nervous system: they initiate all the bodily responses of the fight-or-flight syndrome. They increase blood pressure and heart rate, constrict (narrow) blood vessels, dilate the bronchioles (breathing tubes), increase blood sugar, and generally prepare the body for emergency.”
Stimulants: The Monoamines — The monoamine neurotransmitters in the brain are important to understand when thinking about how stimulants achieve their results. The next bullet has information on how stimulants raise levels of the monoamine neurotransmitters and how those increases affect the brain and body. But this bullet is about the functions each monoamine carries out. The three monoamines are:
- Norepinephrine/Epinephrine — Norepinephrine is the chemical transmitter of the sympathetic nervous system. Epinephrine (adrenaline) is a transmitter that is important in our fight-or-flight response within the sympathetic nervous system. Norepinephrine organizes the behavior part of our fight-or-flight response. Norepinephrine prepares the body and brain for emergency. This includes paying attention to the environment (not doing simple body maintenance things, like eating) and deciding whether the risk is so great that you should run away. This prepares the body for physical activity: making the heart beat faster, bringing glucose and oxygen to muscles, and widening the breathing tubes to facilitate breathing.
- Dopamine — Dopamine does several important jobs. These neurons and neurotransmitters are responsible for reinforcement, or reward — the sense of pleasure we feel when doing things. All drugs (or any behavior) that increase dopamine are potentially addictive. Dopamine also helps regulate purposeful movement. To this point, the loss of dopamine neurons in Parkinson’s disease causes the gradual loss of voluntary movement that is so devastating. Finally, dopamine contributes to the increase in attention, focus, and executive functions that users experience when taking stimulants.
- Serotonin — Serotonin is involved in the regulation of sleep and mood and also in controlling appetite, body temperature, and more. When somebody takes a high dose of stimulants, their appetite is suppressed, their mood improves, and their body temperature increases. The increase in serotonin that stimulants cause plays a role in all of that.

Stimulants: How They Work — Stimulants achieve their brain and body effects basically by increasing levels of the three monoamine neurotransmitters in the brain. The monoamines are dopamine, norepinephrine/epinephrine (adrenaline), and serotonin. Stimulants increase all three of these, which then leads to an overload of these neurotransmitters in the synapses in the brain. Under normal conditions, the brain regulates these monoamines perfectly to achieve the right behaviors and bodily functions. But when stimulants are introduced, all three monoamines are increased and sort of overload the system, which is how they achieve their effects (e.g. euphoria and increased focus, attention, heart rate, blood pressure, body temperature, etc.). Some stimulants (e.g. cocaine) raise all of the monoamines, while others (e.g. bath salts) raise only certain ones.
- Quote (P. 302): “What do euphoria, blood pressure, appetite, and attention have in common that causes them all to be affected by stimulants? These behaviors/bodily functions are all regulated by a related group of neurotransmitters — the biogenic amines, or monoamine, neurotransmitters. Norepinephrine, epinephrine, dopamine, and serotonin are the monoamine neurotransmitters. They are related in structure, but each is a neurotransmitter in its own right that regulates a particular set of behaviors. Psychomotor stimulants increase the amount of monoamine neurotransmitters in the synapses.”
- Quote (P. 302): “They [stimulants] vary widely from each other in terms of which monoamines they raise and how much they raise them. Some, like cocaine, raise all three. These stimulants mimic what would happen if every one of the neurons that released a monoamine fired at once. It’s no wonder that the effects of stimulants are so complicated. Others, like MDPV, raise only dopamine and norepinephrine, so the effects are more restricted.”
- Quote (P. 303): “Imagine what happens when a person takes amphetamine: the body prepares for fight-or-flight both physically, by increasing heart rate and blood pressure, and mentally, by becoming hyperalert (via norepinephrine); the person explores the environment, moves around (perhaps purposefully, perhaps not), feels euphoric (courtesy of dopamine), and stops eating; body temperature rises [via serotonin], and the release of many hormones increases.”
- Quote (P. 303): “Stimulants work by interfering with the mechanism that monoamine neurons have for stopping neurotransmission and ‘recycling’ their products. Normally, monoamine neurons fire impulses and release their neurotransmitters, which go across the synapse and act on their receptors. Then the monoamine neurons recapture them by ‘pumping’ them back into the neuron. This process eliminates the monoamines from the synapse and is the main way that these neurons ‘turn off’ neurotransmission once it is started. Stimulants like cocaine, amphetamines, and bath salts block this pump. The result is that the norepinephrine, dopamine, and serotonin all stay in the synapse much longer once they are released. There is a subtle but important difference between cocaine and the amphetamines: the amphetamines use this pump themselves to enter the nerve terminal and, once inside, cause a massive ‘dump’ of neurotransmitter into the synapse. Therefore, they increase levels of neurotransmitters much more than cocaine does.”

Stimulants: The Most Addictive Drugs? — There is no doubt that stimulants are very, very addictive. Their ability to increase dopamine in the brain is the primary reason for their addictiveness. The very fast “rush” that people feel when using stimulants like cocaine and amphetamines is likely a big contributor to the dopamine increases. As mentioned in a previous bullet, users are ready for another hit of cocaine less than an hour after taking their previous dose. This leads to them taking hit after hit after hit, usually until the supply is gone. This extremely fast cycle in blood cocaine levels leads to users wanting more and more. It also contributes to the tendency for people to overdose or have seizures when taking these drugs — the repeated use is dangerous. In South America, people chew coco leaves all the time without any issues. It’s the way people take cocaine and amphetamines that contributes to their addictive properties. As a result, these drugs are possibly the most addictive drugs in the world.
- Quote (306): “Part of the addictiveness of cocaine may have much to do with how it is delivered to the body. The extremely fast rise in blood levels may be the important factor. Just as cigarettes deliver nicotine to the bloodstream rapidly, smoked cocaine (crack) delivers cocaine rapidly to the brain.”
- Quote (P. 307): “There is no question that psychomotor stimulants are addictive. As described in the Addiction chapter, the dopamine neurons on which they act play a primary role in addiction, and taking amphetamine or cocaine can be viewed simply as substituting drugs for natural reinforcers, such as food and sex. No other drugs in this book act so directly on reward systems or are so commonly addicting. Can some individuals use stimulants recreationally without addiction? Probably so, and yet we know that the drive to use cocaine or amphetamine is considerably stronger than that for any of the other addictive drugs.”
Stimulants: Diet Pills — Amphetamine was actually the original diet pill way back in the day. As mentioned in a previous bullet, the ability of stimulants like amphetamine to raise serotonin levels in the brain is a reason for its use as a diet pill at one point in time. Serotonin helps regulate appetite, so when more of it is released, it can suppress a person’s desire to eat. This is why many stimulant abusers are undernourished. Unfortunately, amphetamines, like all stimulants, are very addictive due to their ability to also increase dopamine, which is why amphetamine is no longer used as a diet pill.
- Quote (P. 308): “Amphetamine was the original diet pill. This use was based on the ability of amphetamine and drugs like it to suppress appetite. Unfortunately, it was impossible to separate the appetite-suppressing qualities from the addictive potential. . . The appetite inhibiting effects of amphetamine probably result from the release of norepinephrine and serotonin, and its addictive qualities from the release of dopamine.”
Chapter Takeaway — Stimulants like cocaine, amphetamine, methamphetamine, and bath salts are highly addictive drugs that create euphoria while increasing focus, attention, blood pressure, heart rate, and body temperature. They accomplish these results by elevating levels of the three monoamines in the brain: norepinephrine/epinephrine, dopamine, and serotonin. Cocaine used to be a key ingredient in Coca-Cola.

Ch. 13: Brain Basics

Brain Basics: The Principles — Nothing changes the way we feel or the way we perceive the world unless it interacts with our central nervous system (CNS). Whether we take a sip of wine, snort a line of cocaine, or see an attractive person, our CNS is the place where the action occurs. To understand how any drug works, there are a few principles to understand about brain function:
- Sensing the World — The brain is not only the organ that tells us who we are, what we are doing, and what we have done, but it is with our brains that we sense the world, control our actions, and maintain basic body functions such as heart rate, blood pressure, and breathing. Drugs can strongly affect all of these functions.
- The Brain Is Complex — The brain is an extraordinarily complex structure, with thousands of different sites for drug action on thousands of different kinds of nerve cells. This complexity can cause different people to have very different experiences with the same drug.
- Plasticity — The CNS, especially in children and young adults, has a remarkable capacity to change in response to experience; this is called plasticity. We see it happen every day as learning and remembering.
- Susceptible to Chemicals — The ability of the CNS to undergo plasticity can be modified by chemicals, whether taken for medical benefit or for recreational purposes. This is where drugs can have a major negative influence.
The Brain: Excitatory & Inhibitory Influences — The brain has an impressive system of excitatory and inhibitory influences that it balances beautifully to allow us to live a normal life. These influences play a large role in how we feel. It’s like a sports car moving along a winding country road with just the right amount of pressure on the accelerator (excitation) and the brakes (inhibition). More on these two influences:
- Inhibition — The brakes in the brain are the release of inhibitory chemicals. They suppress the firing of nerve cells by opening channels in the cells’ membranes, letting ions flow in a direction that causes the cells’ electrical potential to move away from the point at which it would fire a signal (an action potential). Without action potentials, there is no action. Therefore, the cell or network of cells is inhibited. An inhibited network can’t carry out its functions, so that function is lost. These could be functions like thinking, feeling anxiety, staying awake, having reflexes to pain, or breathing. Many drugs have an inhibitory influence on cells in our brain, which helps them achieve their effects.
- Excitation — An overly excited network of cells is like the sports car out of control at high speed. There is a chaos of discharges that randomly fire in many parts of the brain, leading to all sorts of feelings and movements.
GABA & Glutamate — The two most common neurotransmitters in the Central Nervous System are GABA and glutamate. These two neurotransmitters are responsible for much of the second-to-second processing in the CNS. GABA is a neurotransmitter that serves the inhibition role discussed in the bullet above. Glutamate is the neurotransmitter that serves the excitation role discussed in the bullet above. If either of these two is significantly blocked, the proper functioning of the CNS is disrupted.
Nerve Cells (Neurons) — Nerve cells are called neurons. Neurons are where information is stored, where feelings are senses, and where actions are initiated. Neurons are a bit different than the other cells of the body. They look like trees, with a trunk and the top with many branches. There is also a root system. Overall, there are several structures that make up the anatomy of a neuron. Below is a look at a few of the many elements of a neuron’s structure:
- Dendrites (Top of Tree) — Dendrites are located at the top of the neuron. This is where connections from other neurons in the brain are made. Dendrites are not where the nerve cell contacts other cells; that’s the job of the axon. Rather, dendrites are where the nerve cell receives signals from other nerve cells. These points of contact are called synapses, which serve as the foundation for the transfer of electrical impulses and signals between the cells. Neurotransmitters are then released to relay the signals across the synapses. For example, if a nerve cell synapses onto a muscle cell, it may tell the muscle to contract. If the nerve cell synapses onto another nerve cell, it can tell the receiving cell to either fire or stop firing, depending on the signals given off by the neurotransmitters.
- Body (Trunk) — The body of the nerve cell is where the genetic information for the cell is stored (in the nucleus)
- Axon (Root of Tree) — The axon is the root of the nerve cell and is responsible for branching off to make contact with other nerve cells or muscle cells and transmit signals to them. These are not the receiving end of nerve cells — that is what the dendrites are for. Rather, the axon is what initiates contact with another nerve cell and begins the transfer of electrical impulses and signals via a synapse that is formed after contact is made.
Synapses & Drugs — The synapse is the primary site of action where the majority of drugs affect human brain functions. One of the reasons drugs are so dangerous is that they can interfere with the signals given off by neurons at a synapse. They can also excite or inhibit certain receptors on nerve cells. In fact, some drugs, if taken at a high enough dosage, can completely stop a neuron from firing. For example, the toxic chemical found in the ovaries of a puffer fish (tetrodotoxin) can paralyze the cells of the muscles responsible for breathing and lead to death. Japanese restaurants have chefs who are trained to remove the ovaries before the fish is served. Another example: opioids. Opioids act on the opioid receptors in the brain that specifically deal with breathing and the control of breathing. In overdose situations, they can sometimes cause the neurons responsible for breathing to stop firing.
Receptors & Neurotransmitters — There may be as many as 100 neurotransmitters in the brain, each with their own unique functions. Each neuron also has a ton of different receptors on them that can be modified and messed with. These are two of the many reasons the brain is so complex. This diversity is also what has allowed humans to develop drugs that have quite specific effects; using drugs to excite or inhibit certain receptors leads to various outcomes.
The Central Nervous System (CNS) — The Central Nervous System is the brain, and it’s where everything takes place. It’s where “you” are. Your senses, behaviors, mood swings, likes, dislikes, and many of your bodily functions (e.g. circulatory system, breathing, and reflexes) are controlled in the CNS. It defines how we see and perceive our world. It is everything. When drugs are taken and interfere with the normal operations of the CNS, it leads to changes in your experience. This explains why drugs that are ingested don’t produce as much of a high as drugs that are injected into the veins or smoked — they have to be broken down by the stomach and intestines before they reach the brain. Drugs that are smoked or injected into the veins, on the other hand, go straight to the brain without being broken down in any way.
- Quote (P. 323): “But it is crucial to understand that the central nervous system controls almost everything about us: how we perceive the world through our senses (vision, hearing, smell, taste, touch); how we organize movement from the moment we are motivated to do something to the completion of the act; our motivation and emotional states (are we sad, excited, depressed, anxious, elated, bewildered, and so on); and how we organize these functions.”
- Quote (P. 323): “The brain also controls some very important body functions that sustain life. These are boring functions until they fail, and then they get attention right away. The three most vital functions that the CNS controls are the circulatory system (heart and blood vessels), the respiratory system (breathing), and the reflex system (which instantly, and without thinking, causes you to respond to a threat).”
Brain Plasticity — The CNS is remarkably flexible throughout the lifespan but especially in the early years of a person’s life. The brain is able to adjust much of its neurochemistry and connections to remember experiences, learn things, and much more. One important site of learning occurs at the synapse. A series of complicated events take place, but the synapses and neurons in the brain have remarkable plasticity and can adjust based on inputs and conditions. In short, the brain will literally change based on stimulus. For example, prolonged stress seems to shrink the dendrites on neurons, which may explain the cognitive difficulties we experience when we’re stressed out.
Brain Development: The Early Years — While the brains of adults change all the time, what goes on in adults is trivial compared to the phenomenal changes that occur while the brain is developing. The brain assembles itself carefully through the process of neurons growing out, and through chemical signals around them, gradually finding their way to the correct destination, where they make the connections that they then maintain. During this time of life, the physical changes in the brain are dramatic. New synaptic connections are being made at a high rate every day. Many of the neurons growing out never reach their destination and die in the process. Others reshape their connections until they are correct. As the brain matures, the connections between cells become permanent, and then they are insulated with myelin. What’s interesting is that the brain is not fully developed until around age 25.
- Quote (P. 328): “The big news is that the human brain is not fully developed until early in adulthood. And among the last parts to develop are the frontal lobe areas that give us the capability of inhibiting inappropriate behavior, handling complex tasks, and planning ahead.”
Interesting Fact — When it comes to adrenaline, there are multiple subtypes of receptors. One is called the beta-adrenaline receptor, and this receptor is responsible for the increase in heart rate and blood pressure that occurs under stress. Scientists have developed a “beta blocker called propranolol that can basically block the receptor. Propranolol is often prescribed by doctors to help patients keep their heart rate and blood pressure under control, even when stress is present.
Brain Plasticity: PTSD & Epilepsy — Two examples, albeit negative ones, of the brain’s remarkable ability to learn and adapt involve PTSD and epilepsy. Soldiers who have seen crazy things in battle often develop PTSD, which is basically caused by the fear systems in their brain becoming hyperactive due to the extreme conditions they’ve been in. The brain “learns” to be like this, which causes these patients to react to stimuli that doesn’t bother a regular person. Another example is epilepsy; this condition usually starts with one seizure where the brain’s neurons fire in a hyperexcited pattern. But epilepsy can sometimes develop if the brain “learns” to fire like this on a regular basis. This learning and plasticity ability of the brain is why taking drugs is so dangerous; if used on a regular basis, these chemicals have the power to permanently change our brain.
- Quote (P. 332): “Another example of neuroplasticity and ‘learning’ by the brain is epilepsy. In many cases, epileptic seizures begin with a lesion at one site in which the neurons fire in a hyperexcited, coordinated pattern. This neuronal excitability is transmitted to other, normal areas of the brain that, in turn, ‘learn’ to fire in the same way. Eventually enough of the brain ‘learns’ to fire in this way, and generalized seizures develop. Drugs called anticonvulsants can suppress the hyperexcitability, but we have no drugs that can erase the ‘learned’ tendency to generate the seizure activity.”
- Quote (P. 333): “While the details of all of the possibilities are beyond the scope of this book, it is important to understand that if a drug is altering your perception of the world or your reactions to your environment, there is a good chance that drug has the capacity to enable the brain to change in a permanent way that is likely not to be good in the long run.”
Chapter Takeaway — The brain is incredibly complex and is made up of a system of excitatory and inhibitory influences that it balances beautifully to keep us feeling good. When drugs are introduced into the system, they can begin to affect these influences. An example of this is how alcohol achieves sedation by increasing the activity of GABA (an inhibitory influence in the brain) while suppressing glutamate (an excitatory influence). The brain is also incredibly flexible and literally changes throughout the lifespan, especially in the early years of life.

Ch. 14: Drug Basics

The Principles of Drugs — There are a few principles of drugs and their effects on our bodies that should be understood. These principles include:
- Drugs Defined — A drug is any chemical put into the body that changes mental state or bodily function. This could mean vitamins, herbs, antibiotics, hard drugs, birth control pills, over-the-counter cold medicine, aspirin, vaccines, nicotine, marijuana, beer, caffeine, etc. Psychoactive drugs are ones that affect the brain in particular (e.g. caffeine, cocaine).
- Method of Consumption Matters — How a drug enters the body can make a huge difference in its effects.
  Ingesting a drug is usually the slowest route to the brain, and inhaling and intravenous injection are the fastest routes. If a drug is potentially lethal, then rapid administration of the drug by inhaling it or injecting it is the most dangerous way to take it and could result in death.
- Length of Effects Differ — The length of time a drug affects the central nervous system varies tremendously across drugs. Some drugs are removed in only a few minutes (e.g. cocaine), while others stay around for weeks (e.g. marijuana). With any compound, it is crucial to know how long its effects will last — even those effects you do not notice.
- Tolerance & Withdrawal — The effects of drugs can change with time as our bodies adapt to the drug. This is called tolerance. As a result, when drug use is stopped, these changes cause bodies to work abnormally once the drug is no longer present. This is called withdrawal.
How Drugs Work: Agonist vs. Antagonist — All drugs work by interacting with a particular molecule called a receptor. All of them — even an over-the-counter antacid (e.g. Tums) or nasal decongestant. Most receptors are located on the surface of cells, both in the brain and in the body. When a drug binds to its receptor and activates it, the drug is called an agonist. This means that the drug has an effect. Some drugs attach to a receptor and do not activate it but keep other molecules from getting to the receptor. These drugs are antagonists. They act by preventing normal processes from happening (e.g. caffeine attaching to receptors and blocking adenosine). Many of the psychoactive drugs we have discussed in this book work by preventing the action of normal neurotransmitters. In addition to the example of caffeine blocking adenosine to delay fatigue, another example of an antagonist is the poison in poison darts. The compound in the poison attaches to a certain receptor responsible for breathing and blocks the molecule that normally activates that receptor, which leads to death by asphyxiation.
- Quote (P. 339): “The toxins used in poison darts provide a vivid example. One active compound in these poisons, curare, prevents the neurotransmitter acetylcholine from working on its receptor. Acetylcholine is necessary to transmit from brain to muscle the information that permits muscle contraction. When curare blocks the action of acetylcholine, the muscles are paralyzed and the dart’s victim dies from paralysis of the muscles responsible for breathing.”
- Quote (P. 346): “The over-the-counter medications that people use to treat stuffy noses accomplish their effect by attaching to receptors on the blood vessels in the nose. These receptors are activated by the drug and cause the blood vessels to constrict. This decreases the volume of blood in the nose and helps to reduce the inflammation and swelling.”
How Well Drugs Work — How well a drug works depends a lot on how much is taken. The larger the dose, the greater the effect. Why? The more of the drug in your system, the more it binds to the various receptors that it was designed for. Efficacy of the drug matters as well. Some drugs bind so tightly to their receptors that it takes very little of the drug to activate all of the available receptors. These drugs are very potent. LSD is an example of this — it takes just a tiny amount of LSD to create hallucinations.
Drugs: Entering the Body — Another major factor in how well drugs work depends on how they are consumed. Drugs must get to their receptors in order to act. The faster a drug can get into the bloodstream, the quicker it delivers its effects. This is why injecting drugs into the veins is preferred by many drug users. The drugs are carried straight into the heart and distributed to the rest of the body via the circulatory system. Inhaling drugs (e.g. cigarettes, inhaling smoked cocaine/crack vapor, etc.) is also a very quick way to get drugs into the system. The mucous membranes in the nose allow for fairly easy absorption into the body and the bloodstream, which is why many users snort cocaine and amphetamine. Swallowing drugs is the slowest way to consume drugs; a large part of any drug dose that is swallowed never gets to the rest of the body because it is removed by the liver first. This is one of the liver’s many jobs: intercept toxins and eliminate them to protect the body.
- Quote (P. 342): “To recapitulate, the way people take a drug (the route of administration) and the amount they take determine the drug’s effects. Injecting drugs intravenously or smoking them results in nearly instantaneous effects because the levels of drug in the blood rise very rapidly. This speed accounts for the lure of injecting heroin intravenously or smoking crack. Injecting a drug intravenously or smoking it also offers the greatest risk of overdose. Drugs like heroin can be lethal because they take effect so quickly after intravenous injection that the drug user can reach fatal drug levels before it would be possible to get help. The same dose of drug taken orally will never exert as great an effect — some of it will be lost to metabolism because the process of absorption is gradual.”
Drugs: Moving In the Body — Once drugs are in the circulation, they have no problem getting into most tissues. The brain is an exception because it has a tight defense system called the blood-brain barrier that prevents many drugs from getting into it. All of the drugs discussed in this book do not follow that rule though — they easily pass through this barrier and affect the brain, which is why they create such wild psychoactive effects. There’s also the issue of “hiding” in the body. Some drugs, like the THC found in marijuana, are very fat-soluble, which allows them to build up in body fat. The drug will always eventually leave the fat and enter the bloodstream again and enter the brain, but the effects are usually very minor. What can be troublesome about this for marijuana users is that these tendencies of THC mean it will stay in the body for hours, days, and weeks after taking the drug. This means it could show up in a urine test weeks later.
Drug Tolerance: Antibiotics — As a general rule, you gradually build tolerance to a drug the more you take it. Tolerance is becoming a bit of a problem in the world of antibiotics. Because antibiotics are sometimes prescribed when they don’t need to be and are fed to animals that we eat (e.g. chicken, cows), bacteria that are found in the human body are beginning to become resistant to various antibiotics. This means the antibiotics we rely on to fight infections, for some people, may not be effective.
- Quote (P. 345): “Bacteria replicate between one and many times a day, so new generations are constantly appearing. When an individual bacterium appears that happens to be resistant to the drug [antibiotic], this individual and its offspring survive, and the infection becomes resistant. With the rising use of antibiotics (antibiotics in beef, antibiotics for many childhood diseases, etc.), more and more humans are carrying resistant populations of bacteria in their body that are difficult to treat with currently available antibiotics.”
Tolerance: How the Brain Reacts — As tolerance builds from repeated drug use (again, drugs could be many things), cells react by either adding or removing receptors on their surface in an effort to reestablish balance. As an example of this in action, consider a nasal decongestant. if somebody takes this over and over to try to clear their nose, receptors will eventually be removed from the surface of cells in the area to give the drug fewer receptors to bind to. The result is that the nasal decongestant stops working. This is partly why labels on some of these drugs and products tell users to avoid using the drug for more than a few days. The brain does this exact same thing in response to other drugs, like alcohol. With alcohol, it uses GABA to bind to the receptors of neurons in the brain that inhibit the neuron from firing. These neurons adapt by creating more receptors that stimulate firing while decreasing the number of receptors that inhibit firing. Now imagine the alcoholic stops using alcohol. You’re going to get a situation where the neurons are overly excited and will fire all over the place. This can lead to deadly seizures for somebody dealing with alcohol withdrawal.
- Quote (P. 348): The consequences of withdrawal from some drugs can be life-threatening. For example, alcohol is a sedative drug that slows the firing of neurons. Imagine a neuron prevented from firing every day by alcohol. A logical response would be for it to do whatever it could to fire more often. Now imagine many cells in the brain affected in this way. They adapt by increasing receptors that stimulate neural firing and decreasing receptors that inhibit firing. Now imagine an alcoholic who enters treatment and stops drinking abruptly. All these neurons are very excitable and the result is a tremendous overexcitation of the nervous system. This overexcitation can actually lead to seizures and death.”
Chapter Takeaway — Drugs include a lot of things outside of the hard drugs we all associate the word with. All drugs, all of them, work by either activating (agonist) or inhibiting (antagonist) certain receptors on the surface of cells. Their effects on the receptors lead to their effects on the brain and body. The dosage and method of consumption are the two most significant influences on how effective and fast a high is delivered.

Ch. 15: Addiction

The Principles of Addiction — Anything that stimulates the reward centers of the brain has the potential to be addictive. Drugs do that. Food can do that. Sex can do that. Video games can do that. Gambling can do that. Netflix can do that. Many different products and behaviors in life can cause the release of dopamine in the brain. Below are a few of the principles of addiction:
- Definition of Addiction — Addiction is the repetitive, compulsive use of a substance despite negative consequences to the user. Let’s say you’re addicted to muffins. Once you are a real muffin addict, you wait at the bakery door until opening time each day, neglecting your job or forgetting to take your children to school. You do this even if the muffin tastes lousy. It is this sort of compulsive, repetitive involvement in drug taking despite negative consequences that most experts view as addiction.
- Reward Circuits — Addictive drugs initially activate circuits in the brain that respond to normal pleasures, like food and sex. Every brain has these circuits, so every human could potentially become addicted to a drug.
- Drugs & Addiction — Drug taking accelerates and becomes compulsive for many reasons, including changes in the brain, the desire to experience pleasure from the drug, and the desire to avoid the discomfort of withdrawal
- Environment Matters — Many different factors in the life of an individual, such as family history, personality, mental health, social and physical environment, and life experience, play a role in the development of addiction
Addiction: Reward Circuits — Every person on earth has a built-in reward circuit in their brain. This reward circuit is responsible for making you feel pleasure when doing something that feels good. Its goal is to encourage you to keep doing the thing that feels good, with the idea that if it feels good, you will do it again and again. Sex is an example of an evolutionary pleasure. Sex may feel good to encourage reproduction. Drugs also stimulate the reward centers of the brain. Interestingly, studies in animals have shown that when the pleasure centers in the brain are damaged or destroyed, the animal will lose interest in an addictive behavior (e.g. food, sex, drugs). A rat who was repeatedly pressing a button to unlock cocaine will stop pressing the button when the reward center of its brain is compromised.
- Quote (P. 352): “The reason lies in a complicated neural circuit through which we engage in behaviors that feel good. The job of this neural circuit, presumably, is to cause us to enjoy activities or substances that are life-sustaining. If it is successful, then it is more likely that we will engage in the activity again. . . It is sometimes called the reward pathway. When this pathway is destroyed, an animal loses interest in food, in sex, and in exploring its environment.”
- Quote (P. 353): “Most experimental animals (pigeons, rats, monkeys) will press a lever to get an injection of cocaine, methamphetamine, heroin, nicotine, and alcohol. They will not press a lever for LSD, antihistamines, or many other drugs. . . if this pathway [reward center] is damaged in an animal, the animal will not work for drugs.”
Addiction: Role of Dopamine — The neurotransmitter dopamine plays a big role in addiction in two ways. First, one group of dopamine neurons runs through the reward center of the brain described in the previous bullet. When the dopamine neurons in this area are eliminated, animals stop working for food, sex, drive, and other addictive things. Second, addictive things — drugs, alcohol, gaming, food, gambling, etc. — cause the release of dopamine, leading to elevated dopamine levels when these items are consumed.
- Quote (P. 354): “One group of dopamine neurons runs directly through the reward circuit we just described. If the dopamine neurons in this circuit are destroyed, then animals will not work for food, sex, water, or addictive drugs. Furthermore, both natural reinforcers and most addictive drugs increase the release of dopamine from these neurons.”
- Quote (P. 354): “Cocaine, morphine, nicotine, cannabinoids, or alcohol will cause large increases in dopamine in the same area of the brain in which sex causes a rise.”
Dopamine: Anticipation of Reward — Studies in animals have shown that dopamine levels rise in anticipation of a reward or pleasurable experience. This may help explain why the pleasurable feelings of happiness that we feel in anticipation of a big trip to Hawaii, for example, match or even exceed the pleasurable feelings we experience while actually on the trip. The anticipation of something rewarding (e.g. drugs, gambling, video games, Netflix, food, etc.) is enough to release a lot of dopamine in the brain.
- Quote (P. 354): “We know from experiments in monkeys that dopamine starts going up in anticipation of a reward rather than when the reward arrives. Scientists now think that one important role dopamine plays is this anticipation for a known reward.”
Chapter Takeaway — Anybody who has a brain has the potential to become addicted to something, no matter who you are, what you believe in, or the culture you come from. This is because every brain has a reward center that can be stimulated by addictive properties like drugs, food, gambling, video games, and various other behaviors. The neurotransmitter dopamine plays a major role in the development of addiction.

Mack's Book Notes

Mack's Book Notes

Mack's Book Notes

Buzzed

Cynthia Kuhn

GENRE: Health & Wellness

PAGES: 400

COMPLETED: March 27, 2024

RATING:

Short Summary

Key Takeaways

Favorite Quote

Book Notes

Introduction

Prologue: Just Say Know

Ch. 1: Alcohol

Ch. 2: Caffeine

Ch. 3: Ecstasy

Ch. 4: Hallucinogens

Ch. 5: Herbal Drugs

Ch. 6: Inhalants

Ch. 7: Marijuana

Ch. 8: Nicotine

Ch. 9: Opioids

Ch. 10: Sedatives

Ch. 11: Steroids

Ch. 12: Stimulants

Ch. 13: Brain Basics

Ch. 14: Drug Basics

Ch. 15: Addiction

Mack's Book Notes

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