False: The mortality rate for injecting drug users, including intravenous and subcutaneous, from all causes, is estimated to be 3–4% per year (Baciewicz 2005).

True: Many recreational amphetamine users do not progress to misuse and dependence but dependence can develop quickly in susceptible individuals. Tolerance is more likely in the more persistent users and in those taking high doses. A withdrawal syndrome called ‘crash’ may follow a binge of a few days or cessation following long-term use. The features vary from low mood, fatigue, increased sleep and increased appetite to severe depression with high risk of suicide (Ghodse 2002, p. 115; Gelder et al 2006, p. 464).

False: In order to calculate caffeine intake one should know the caffeine content of the various sources of caffeine, how the drink is prepared, e.g. brewed vs. instant and if the drink is strong or diluted. The caffeine content of 6 oz or 177 mL of selected drinks is: brewed coffee = 100 mg, instant coffee = 70 mg, decaffeinated coffee = 4 mg, leaf or bag tea = 40 mg and instant tea = 25 mg (Sadock & Sadock 2005, p. 1202).

True: Cannabis intoxication can cause visual hallucinations in the form of flashes of light, human faces, pictures of great complexity or flashbacks. This may be part of an acute toxic psychosis with confusion, persecutory delusions, auditory and visual hallucinations, anxiety, agitation and amnesia (Lishman 1997, p. 613; Solowij 1998, p. 30).

False: Amphetamine and cocaine can both cause drug-induced psychosis with persecutory delusions and hallucinations that may occur in clear consciousness. The condition will recover spontaneously over the course of a few days or 1 or 2 weeks at the most (Sadock & Sadock 2005, p. 1226; Wright et al 2005, p. 444).

False: Tolerance to successive doses of MDMA develops quickly. Weekend users describe a midweek ‘crash’ in mood that may represent withdrawal symptoms. In Australia, 2% of a sample of ecstasy users reported feeling dependent, i.e. ‘needing to use the drug every day to cope’. Dependence has also been reported in the UK. Overall, however, physical dependence has not convincingly been demonstrated (Gelder et al 2006, p. 465; Sadock & Sadock 2005, p. 1199; Wright et al 2005, p. 446).

True: Ecstasy was initially patented as an appetite suppressant. It has been used as an adjunct to psychotherapy termed psycholytic therapy (Sadock & Sadock 2005, p. 1198; Wright et al 2005, p. 445).

False: Cocaine is more likely than ecstasy to be associated with tolerance, withdrawal symptoms and dependence (Sadock & Sadock 2005, pp. 1198, 1226; Wright et al 2005, p. 446).

False: LSD, commonly referred to as ‘acid’, is sold on the street in tablets, capsules, and, occasionally, liquid form. It is odourless, colourless, and has a mild bitter taste. Often LSD is added to absorbent paper, such as blotting paper, and divided into small decorated squares, each square representing one dose, usually 75 micrograms. The exact dose contained in such a square or ‘tab’ can vary widely. It is usually taken by mouth (NIDA).

False: Formication is the tactile hallucination involving the sensation that tiny insects are crawling over the skin. It is seen in cocaine abuse and delirium tremens.

False: LSD is not considered an addictive drug because it does not produce compulsive drug-seeking behaviour, as do cocaine, amphetamine, heroin, alcohol, nicotine, etc. However, like other addictive drugs, LSD produces tolerance, and hence, those who take the drug repeatedly need progressively higher doses to achieve a state of intoxication. This is a dangerous practice, given the unpredictability of its effects. LSD does not cause physical dependence, but psychological dependence may occur (Gelder et al 2006, p. 466; www.drugabuse.gov).

True: According to the Office of National Statistics the prevalence of cigarette smoking in the UK during 2000–2001 was 27% in those aged 16 or over (www.statistics.gov.uk).

False: In the UK, any medical practitioner can prescribe methadone for the treatment of dependence. There are no legal constraints on the dose, the dosage form or the frequency with which methadone may be dispensed (Wright et al 2005, p. 441).

False: The reported mortality figures range from 12% in 22 years in London to 18% in 12 years in Sweden. The Home Office figures show an annual crude death rate 7.7/1000 person/year (Ghodse 2002, p. 356).

True: Dipipanone is an opioid analgesic. The only preparation available in the UK (Diconal) contains an antiemetic – cyclizine. Like any other opiate, dipipanone can cause tolerance, and psychological and physical dependence (ABPI 2005, p. 674; BNF 2005 4.7.2).

True: In the early stages of opioid use, the typical course is one of periods of abstinence lasting weeks or months, followed by relapse and reinstatement of dependence. Following abstinence oriented treatments, most relapses occur within the first 3 months and two-thirds relapse within 6 months. Depression and psychosocial stresses contribute to these relapses (Sadock & Sadock 2005, p. 1276).

False: Convulsions are more associated with alcohol and benzodiazepine withdrawal, and cocaine and amphetamine intoxication (Gelder et al 2000, p. 524; Ghodse 2002, p. 97; Wright et al 2005, p. 438).

False: If the mother is dependent on heroin, withdrawal symptoms in the newborn start within 24 hours. They include hyperactivity, irritability, restlessness, tremors, GI disturbances, vomiting, etc. Giving methadone before delivery delays the onset of withdrawal symptoms in the newborn until 48–72 hours after birth (Ghodse 2002, p. 318).

True: Naloxone is an opiate antagonist that displaces opiates by competitive antagonism. In accelerated detoxification, naloxone is used to precipitate immediate opiate withdrawal that can be treated with neuroleptics, propranolol and atropine. This procedure requires close supervision and monitoring, and is done very infrequently (Ghodse 2002, pp. 248, 266).

False: Lofexidine is not an opioid. It is a α₂ adrenergic agonist, similar to clonidine. They both act on the locus coeruleus and hence attenuate the release of noradrenaline. This reduces the autonomic symptoms of opiate withdrawal which are associated with noradrenergic overactivity (Sadock & Sadock 2005, p. 1280; Wright et al 2005, p. 441).

True: Naltrexone is a long-acting (up to 72 hours) opiate antagonist. It is used to prevent relapse. As it can also precipitate withdrawal, it is recommended that patients should remain opiate free for 7–10 days before commencing treatment with naltrexone. It can be given 2–3 times per week (Ghodse 2002, p. 266).

True: There are several types of glutamate receptors: NMDA, AMPA and kainate. The NMDA glutamate-calcium channel has multiple receptors surrounding the ion channel. One of the inhibitory modulatory sites is called the PCP site because phencyclidine binds to it. By allosteric modulation it blocks the NMDA glutamate receptor and decreases the influx of calcium (Stahl 2000, p. 387).

False: A 2004 survey carried out by Mori on behalf of the Youth Justice Board revealed that 15% of 11 to 16-year-olds had taken cannabis and 5% had used solvents (Gelder et al 2006, p. 468; www.drugscope.org.uk).

True: Inhalant intoxication can present with elated mood, illusions, visual, tactile and auditory hallucinations, delusions of omnipotence and body image disturbances (Lishman 1997, p. 629; Sadock & Sadock 2005, p. 1253; Wright et al 2005, p. 452).

True: Athletes using anabolic steroids have long recognized the symptoms of anger and irritability which they call ‘roid rage’. They may also experience hypomanic and even manic episodes (Sadock & Sadock 2005, p. 1325).