Harms & Mixing

Developmental: it can start out simply as a prescription from the doctor, but lead into use that impairs parenting skills, adds to family conflicts, sets examples of use to minors leading to further child abuse and neglect.

Physical health: injecting can lead to increased rates of HIV/HCV infection. Smoking can lead to respiratory diseases.  Drug use in general can lead to overdose; cancers, strokes, seizures, liver and heart disease.

Psychological health: increase risk of dependence, psychosis, drug-induced schizophrenia, reckless behaviour, mood disorders and bad withdrawal symptoms.

Personal safety: can range from an innocent cigarette burn to any number of intentional and unintentional injuries to self and others.  Weakened immune systems and taking more risks to get drugs are common.

Social well-being: social ramifications due to having a criminal record, increased legal issues, unwanted pregnancy, financial, work, personal relationship problems and the stigma of injecting.

Abuse Potential: propensity for the drug to be abused due to:

  • euphoria at low doses
  • drug acts quickly
  • tolerant effects
  • cross-tolerant to barbituates and alcohol
  • used without the need for medical supervision in dose and dosage
  • readily available to the public.

Drug Toxicity: the physical/emotional/mental harms that come from a particular drug and its use.

  • Acute: a drug has a lethal toxicity when toxic in small    doses, or immediately or soon after taken.
  • Chronic: a drug has a lethal toxicity when toxic over a long period of time.
  • PolyDrug Use: is drug taking behaviour involving two or more drugs taken simultaneously.
  • Addiction: is a disease of the brain similar to other brain disorders and diseases such as Schizophrenia, Parkinsons and Alzheimers.

Tolerance: the body is able to cope with increasing amounts of a psychoactive drug over a period of repeated usage.  Over time, the desired effect of the drug requires higher dosage to achieve the same effect, or there is a diminished effect if the dosage does not change.

  • Behavioural: tolerance is maximized when circumstances, surroundings & settings do not change.
  • Cellular: the cells build a tolerance.
  • Metabolic: metabolism builds a tolerance through increased rate.

4 Phases of Addiction:

  1. Primary – has to be treated first before other things
  2. Progressive
  3. Chronic
  4. Fatal

The 3 C’s:

  1. Compulsion
  2. Loss of Control
  3. Continued use despite negative consequences

DAWN Reports:

  • Drug Awareness Warning Network: (USA) that monitors and records drug-related emergency department visits.
  • Lethal dose: minimum amount of drug taken to produce death in a given percentage of the population.
  • Effective dose: the minimal amount of a particular drug necessary to produced desired effects in a given percentage of the population.
  • Therapeutic index: LD50/ED50.
  • Margin of safety: LD1/ED99
  • Ed episode: an illicit or non-medical drug-related emergency department (ED) visit.
  • ED Mention: reported substance recorded during an ED episode.
  • ME mention: substance recorded in the medical examiner’s report following a drug-related death.

Some Factors Influencing Drug Use:


  • Sex: in general, men use more than women, while women have more body fat.
  • Age: plays a large role in how, why, where and even what you use
  • Ethnicity: are you more inclined to do a certain drug because of your race?
  • Genetics: Asian populations do not metabolize alcohol well.
  • Pregnancy: smoking, alcohol and drug use cause adverse effects for the fetus.
  • Liver or kidney dysfunction: can affect how drugs are metabolized
  • Hormone Levels: can affect the high
  • Body Size: affects how drug is absorbed and metabolized
  • Nutrition: affects your sensitivity to a drug.  e.g. poor nutrition can lead to a bad trip, dehydration, etc.
  • Alcohol or other drug use: can influence one another, often adversely
  • Tolerance: can vary according to the drug effect.
  • Psychological factors: such as set, setting, emotional preparedness and psychiatric illness can alter the high tremendously.

Drug Specific:

  • Dosage: how much, how often and how long you use plays a huge role in developing dependence.
  • Can it be used repeatedly or compulsively?
  • Can it be taken IV?
  • Can it produce a physical dependence?
  • Can it impair judgment?
  • Can it produce irreversible tissue damage and disease?
  • If you mix drugs they can produce a synergistic effect where the total effect is greater than the sum of single effects.
  • Drug interactions can be fatal, so be careful when on HIV/HCV medications and/or other drugs.


  • Economics plays a large role in the type of drugs you use.  Can your job support your style of use?  Do you use a type of drug to show your wealth?
  • Are you doing drugs to make a political statement?
  • Educate yourself about what you put into your body.  Do you know the effects of long term use?
  • Do drugs make you feel more connected to Mother Earth?  Give your spirituality/religion some thought.
  • Have your values about yourself and others changed?

Post-Acute Withdrawal Symptoms (PAWS)

How long they last depends on how much stress a person experiences in early recovery and how much damage was done to the CNS.  Usually they last from six months to two years.  If not properly managed they can lead to relapse.


  • Thinking clearly
  • Managing feelings and emotions
  • Memory problems
  • Recognizing and managing stress
  • Sleeping restfully
  • Physical coordination

Managing Symptoms:

  • Stabilization: talk openly and honestly to those who will not accuse, criticize or minimize how you are feeling.
  • Education: learn as much as you can about recovery
  • Self-protective behaviour: own your recovery.
  • Nutrition: three well-balanced meals a day, etc.
  • Exercise: daily to reduce tension.
  • Relaxation: includes having fun.
  • Spirituality: different things to different people.
  • Balance: moderation is the key.


While there are many reasons as to why people mix drugs the most common are:

  • to increase the effect or high
  • to decrease or take the edge off the high
  • explore a new high
  • unaware of drug mixing and the risks involved.


  • Don’t mix any amphetamines (meth, ecstasy) with anti-depressants
  • Don’t mix poppers and Viagra
  • Don’t mix alcohol with downers like GHB or Ketamine
  • Barbiturates (sedatives) should never be mixed with alcohol, it’s a deadly combo
  • Avoid ‘e’, ‘k’, or speed (meth) if you are taking Ritonavir or other anti-HIV medications

Hyperadditive Effects:

  • Most HIV medications create a build up of street drugs (making the effects much more intense), therefore you should consult with your physician before taking any recreational drugs. You can also get information anonymously by calling CATIE at 1-800-263-1638.
  • Alcohol with the following meds for sleep (barbituate-related), cardiovascular, insulin, anti-inflammatory, antihistamines, painkillers and anti-anxiety.
  • Plendil (blood pressure), Procardia (angina treatment), Zocor, Liptorand Mevacor cholesterol lowering) with grapefruit juice.
  • Lanoxin (heart problems) with licorice, bran, oatmeal and other high fibre foods).

Antagonistic: substances that do not work well together to create ‘negative’ or conflicting drug effects with corresponding psychological and physical symptoms.

  • Morphine/heroin with naloxone, naltrexone
  • Noraprim or related antidepressants with bran, oatmeal and other high fibre foods.
  • Soy products, some Vitamin K rich veggies (broccoli, cabbage, asparagus) with Coumadin.

Agonistic: substances that enhance one another creating a ‘hyper’ effect.

Toxic:  substances that by themselves are medically sound, but together produce a toxic concoction.

Drug Possible effects
Analgesics (pain killers) Increased depression of CNS
ASA (aspirin) Increased irritation of stomach lining
Antidepressants Enhanced depression of CNS, impairment of motor skills
Antihistamines Increased depression of CNS
Antihypertensive meds (blood pressure pills) Increased sedation, varies on drug
Oral contraceptives Slow rate of elimination of alcohol
Barbituates Increased depression of CNS, potentially lethal in higher doses
Tranquilizers Considerable increase in depression of CNS, potentially lethal
Anti-coagulants Increased anti-clotting effect, easy bruising
Insulin Increased chance of hypoglycemia
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