The Neurochemical Basis of a Drug-Induced "High"
The euphoric sensation, or "high," associated with drug misuse occurs due to a surge of dopamine in the brain's reward center. Dopamine is a neurotransmitter responsible for feelings of pleasure and motivation. Both prescribed and illegal drugs can cause a supraphysiological concentration of dopamine, leading to intense pleasure. With repeated use, the brain's reward system can be altered, leading to dependence and addiction where the user seeks the drug compulsively despite harmful consequences.
Prescription Medications Commonly Misused
Opioids (Painkillers)
Opioids are a class of drugs prescribed to manage moderate to severe pain. They interact with opioid receptors in the brain to reduce pain signals and produce a sense of euphoria. When misused, opioids can cause a relaxed, happy feeling, but also carry a high risk of addiction, overdose, and death. Examples of commonly misused opioids include:
- Oxycodone: (e.g., OxyContin, Percocet)
- Hydrocodone: (e.g., Vicodin, Norco)
- Fentanyl: A powerful synthetic opioid, sometimes prescribed in patch form (e.g., Duragesic)
- Hydromorphone: (e.g., Dilaudid)
Central Nervous System (CNS) Depressants
CNS depressants are used to treat anxiety, sleep disorders, and seizures by slowing down brain function. Misusing these drugs can result in feelings of well-being, reduced anxiety, and lowered inhibitions, but also causes confusion, impaired coordination, and memory issues. Mixing CNS depressants with alcohol significantly increases the risk of respiratory distress, coma, or death. Key types include:
- Benzodiazepines: (e.g., Xanax, Valium, Ativan)
- Barbiturates: (e.g., Nembutal)
- Sleep Medications: (e.g., Ambien, Lunesta)
Stimulants
Prescription stimulants are used to treat conditions like Attention-Deficit/Hyperactivity Disorder (ADHD) and narcolepsy. They increase alertness, attention, and energy. When abused, they can create a feeling of exhilaration and high energy, but also cause an increased heart rate, blood pressure, and body temperature. Common stimulants include:
- Amphetamines: (e.g., Adderall)
- Methylphenidate: (e.g., Ritalin, Concerta)
- Dexmethylphenidate: (e.g., Focalin)
Over-the-Counter (OTC) Medications with Abuse Potential
Some easily accessible OTC medications can also be abused for their psychoactive effects, with dextromethorphan (DXM) being a prime example.
- Dextromethorphan (DXM): A cough suppressant found in many cold and cough syrups (e.g., Robitussin, NyQuil). At high doses, DXM can produce hallucinations and dissociative effects similar to PCP or ketamine, along with stimulation. Misuse can also cause impaired judgment, blurred vision, and seizures.
Dangers of Medication Misuse
Regardless of the medication, using a substance other than as prescribed carries significant dangers, including but not limited to:
- Overdose: The risk of a life-threatening overdose is extremely high, especially with opioids and CNS depressants, which can suppress breathing.
- Addiction and Dependence: The brain's reward system can be hijacked, leading to compulsive drug-seeking behavior and painful withdrawal symptoms upon cessation.
- Cardiovascular Issues: Stimulant misuse can cause irregular heartbeat, high blood pressure, heart attack, or stroke.
- Cognitive Impairment: Long-term use of depressants and other drugs can lead to lasting memory problems, confusion, and difficulty concentrating.
- Psychological Effects: Misuse can exacerbate mental health conditions like anxiety and depression and cause psychosis, paranoia, or hostility.
A Comparative Look at Misused Medication Classes
| Feature | Opioids | CNS Depressants | Stimulants | OTC (e.g., DXM) |
|---|---|---|---|---|
| Mechanism | Binds to opioid receptors, releasing dopamine and relieving pain. | Slows CNS function, increases GABA activity, reduces anxiety. | Increases norepinephrine and dopamine levels in the brain. | Affects serotonin receptors; high doses interact with NMDA receptors. |
| Desired Effects (Misuse) | Euphoria, pain relief, relaxation. | Feelings of well-being, sedation, anxiety reduction. | Exhilaration, increased energy and alertness. | Euphoria, hallucinations, dissociation. |
| Short-Term Risks | Nausea, constipation, slowed breathing, drowsiness, overdose. | Drowsiness, confusion, impaired memory, respiratory depression, overdose risk when mixed with alcohol. | Increased heart rate and blood pressure, anxiety, insomnia, paranoia. | Nausea, dizziness, impaired judgment, hallucinations, seizures. |
| Long-Term Risks | Addiction, depression, tolerance, overdose, physical dependence. | Dependence, severe withdrawal (potentially fatal), cognitive impairment, worsening of mental health issues. | Addiction, paranoia, malnutrition, heart damage, mood disorders. | Addiction, potential brain damage, kidney or liver damage. |
Conclusion
Misusing medications to get high is a serious and dangerous endeavor. Whether a substance is prescribed or available over-the-counter, taking it in a manner other than its intended therapeutic use can lead to severe health consequences, dependency, and potentially fatal overdose. The feeling of euphoria is a short-lived and risky effect that comes with an immense cost to physical and mental health. The appropriate and safe way to use any medication is under the direct supervision and guidance of a qualified healthcare professional. For anyone struggling with drug misuse, effective treatments and support are available and can lead to successful recovery.
Where to Find Help
If you or someone you know is struggling with substance misuse, confidential and free assistance is available. You can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) for treatment referrals and information. You can also find a treatment facility near you by visiting FindTreatment.gov.
