False: Amphetamines are Schedule 2 drugs.

The Misuse of Drugs Regulations (1985) divides drugs into five schedules with specific rules for storing, prescribing and record keeping for each schedule.

True: The features include dysphoric mood, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation, anhedonia and impaired attention. It is not always recognized by the abuser (Gelder et al 2006, p. 464; Sadock & Sadock 2005, p. 1192; Wright et al 2005, p. 443).

True: In a large female twin study, Kendler & Prescott (1998) calculated the heritability for cannabis use at about 35%. However, heavy cannabis use, abuse and dependence had heritability ranging from 62–79%. The COGA (Collaborative Study on the Genetics of Alcoholism) concluded that cocaine, alcohol and cannabis abuse are all familial, with evidence of specific and common addictive factors. The relative risk for a sibling of a cannabis dependent proband to develop dependence was 1.78 (Bierut et al 1998; Kendler & Prescott 1998).

True: The mixture of cocaine and heroin taken intravenously – ‘speedball’ – is particularly euphorigenic (Sadock & Sadock 2005, p. 1226).

True: Ecstasy has two optical isomers. The R (−) isomer has LSD-like effects and releases serotonin. The S (+) isomer has amphetamine-like effects and releases dopamine (Sadock & Sadock 2005, p. 1199; Wright et al 2005, p. 445).

True: The reported MDMA withdrawal symptoms include tiredness, feeling sleepy and weak, changes in appetite, low mood and trouble concentrating. Weekend users describe a midweek ‘crash’ in mood which may represent withdrawal symptoms. However, many do not consider them as true withdrawal symptoms (www.drugabuse.gov; Wright et al 2005, p. 446).

False: MDMA (ecstasy) is a substituted amphetamine. MDMA is metabolized to MDA. In animals, MDA causes selective, long-lasting damage to serotonergic nerve terminals. It is unclear if the usual dose of MDMA produces enough MDA to cause neurotoxicity in humans (Sadock & Sadock 2005, p. 1199; Wright et al 2005, p. 445).

False: Hallucinogenic drugs primarily affect perception, mood and cognition. At the usual doses they have relatively minimal effects on memory and orientation. Hallucinogens include ergot alkaloid derivatives, e.g. LSD; indolealkylamines, e.g. psilocybin and dimethyltryptamine (DMT); and phenethylamines, e.g. mescaline and ecstasy (MDMA) (Sadock & Sadock 2005, p. 1238; Wright et al 2005, p. 447).

False: LSD is the most potent mood- and perception-altering drug known. The effects can be felt at doses as low as 25 micrograms. An oral dose of 30 micrograms can produce effects lasting 6 to 12 hours. The usual dose is 75–100 μg. (Sadock & Sadock 2005, p. 1242; Wright et al 2005, p. 447).

True: The neurological symptoms of LSD intoxication are usually mild. Dilated pupils, increased deep tendon reflexes, muscle tension, mild incoordination and ataxia frequently occur (Sadock & Sadock 2005, p. 1242; Wright et al 2005, p. 447).

False: LSD is a postsynaptic 5-HT_2A receptor partial agonist. 5-HT_2A receptors are concerned with perception and also hallucinations (Anderson & Reid 2002, p. 18; Wright et al 2005, p. 447).

True: Even brief simple advice provided by doctors about quitting smoking increases the likelihood that a smoker will successfully quit and remain a non-smoker 12 months later. Although the success rate of brief advice is modest, achieving cessation in about 1 in 40 smokers, brief advice is one of the most cost effective interventions in medicine (Coleman 2004).

A Cochrane review suggested that the increment in those giving up with brief advice is 2%. As this is an increment, the total numbers giving up would be higher still and, hence, the NNT of 40 must be viewed with caution (Lancaster & Stead 2004).

False: Only doctors who hold a special licence, issued by the Home Secretary, are permitted to prescribe heroin, dipipanone or cocaine for addiction. However, any doctor may prescribe them to any patient (including addicts) for the treatment of organic disease (Ghodse 2002, p. 396).

True: The annual mortality rate is 1–2%. Approximately 5% die in the first 2 years (Ghodse 2002, p. 354; Wright et al 2005, p. 442).

False: However, some opioids, such as meperidine, have toxic metabolites that can cause delirium and occasionally seizures. Pethidine in high doses can cause seizures (Lishman 1997, p. 612; Sadock & Sadock 2005, p. 1274).

True: Muscle twitching, aching muscles and joints and abdominal cramps are features of opiate withdrawal (Gelder et al 2000, p. 524; Ghodse 2002, p. 97; Wright et al 2005, p. 438).

True: Heroin (diacetylmorphine) is a μ receptor agonist. It is more potent than morphine as it is more lipid-soluble and crosses the blood–brain barrier more quickly.

Methadone is as potent, weight for weight, as morphine. The withdrawal symptoms are similar in nature and severity to heroin and morphine. However, the slower onset of action causes less euphoriant effect and the long half-life leads to withdrawal symptoms only after 36 hours. Hence, patients consider methadone less potent (Sadock & Sadock 2005, pp. 1268, 1283).

False: Accurate assessment of the patient requesting treatment is very important. This should include a full drug history, a life history, physical examination and drug screening by testing either urine sample or oral swab to confirm dependent pattern of use. Prescribing methadone without a comprehensive assessment could convert the occasional user to an opiate dependent patient or worse still kill him (Ghodse 2002, p. 164).

False: Physical examination of the patient and in particular the skin is essential for diagnosis of injecting drug use. The skin bears stigmata of subcutaneous use, ‘skin popping’, with shallow sterile abscesses leaving shallow punched out marks. For intravenous use, the forearms are the most accessible and are often used first. Other sites would include the hands, legs, feet, neck and the groin. Evidence can range from needle puncture marks to infected and thrombosed veins, often with associated pigmentation ‘tracking’ (Ghodse 2002, p. 174).

False: Lofexidine is not an opioid. It is an α₂ adrenergic agonist, similar to clonidine, but causes less hypotension. It acts on the locus coeruleus and blocks the release of noradrenaline which is responsible for the autonomic symptoms of opiate withdrawal. Lofexidine is used in the symptomatic treatment of opiate withdrawal in patients who use small amounts of heroin and do not require methadone treatment; at the patient’s request, i.e. not wanting opiate substitution; or where substitutions are not available, e.g. in prisons (Gelder et al 2006, p. 459; Sadock & Sadock 2005, p. 1280; Wright et al 2005, p. 441).

False: Buprenorphine is a partial μ receptor agonist with tight receptor binding resulting in a long duration of action. The partial opiate agonist action means less positive reinforcement and effective antagonism at low doses. It is administered sublingually, or, very rarely, by injection because oral administration results in rapid metabolism by the liver (Ghodse 2002, p. 105).

True: The effects of LSD are short lasting, typically 6–12 hours. Primary intoxication with PCP lasts 4–6 hours. However, the following dose dependent effects may last for several weeks: initially, overactivity, irritability and elevated mood or sedation and impaired attention. With levels above 30 ng/mL, mood lability, psychosis and ataxia may occur. Paranoia and aggressive behaviour are most likely to occur between 30 and 100 ng/mL. PCP is highly lipophilic. Storage in fatty tissue may be a reason for its longer lasting effect.

False: Solvent abuse begins around 9–12 years, peaks between ages 13 and 15 years and is less common after 35 years. It is the commonest cause of death in 15-year-olds in the UK (DSM-IV 1994, p. 241; Johnstone et al 2004, p. 607; Wright et al 2005, p. 452).

False: There is no evidence for physical dependence. However, psychological dependence can occur. Tolerance can occur with sustained use over 6–12 months. Withdrawal symptoms including sleep disturbance, irritability, nausea, tachycardia, and, rarely, hallucinations and delusions have been reported (Gelder et al 2006, p. 468; Sadock & Sadock 2005, p. 1252).

True: Anabolic steroids affect the cholesterol profile negatively by increasing the level of low-density lipoproteins and decreasing the levels of high-density lipoproteins (Sadock & Sadock 2005, p. 1321).