Category Archives: Drugs

Codeine Syrup

Jamarcus Russell with the Oakland Raiders (2007-2010)

Jamarcus Russell, the former NFL quarterback and exorbitantly paid #1 overall draft pick in 2007, was arrested last week for unlawful possession of codeine syrup without a prescription during an undercover sting. He was suspected of illegally abusing the controlled prescription cough medication for recreational use as Purple Drank.

Purple Drank (aka Syrup, Sizzurp, Drank) is an increasingly popular party drink found in the South. It’s a liquid concoction typically consisting of codeine syrup, promethazine (antihistamine), clear soda, and Jolly Ranchers. It conjures up similarities to the super-sweet mystery “jungle juice” often found at college frat parties (which on the otherhand is legal unless underage drinking is involved).  The codeine-based mixture was born out of the underground rap scene in Houston in the 60’s.  It gained popularity in the early 90’s when hip hop music artist DJ Screw credited the drink as the source of his inspiration for creating the “chopped and screwed” remixing style. The music is characterized by the slowing down of the tempo of rap music, just as how codeine slows down brain activity. The drink’s popularity further spread from Texas to other parts of the South and later entered into the mainstream’s awareness when Three 6 Mafia released its hit single “Sippin’ On Some Syrup” in 2000. Now, Russell is almost rendering Purple Drank as much of a household term as The Office’s “That’s what she said!”

Codeine is an opioid, like morphine and heroin. The drug is abused for the euphoric high and rush that it gives people. Clinically, codeine is used as a painkiller, as in Tyelnol #3, and a cough suppressant, as opioids suppress the cough reflex. Although codeine is 1/10 as potent as morphine and way less toxic than heroin, it nevertheless carries all the potential negative effects of opioid misuse – intoxication with speech slurring and cognitive impairment, addiction, and death by coma and respiratory depression.  The effects of opioids are further intensified by alcohol, an often deadly combo of CNS depressants. You can probably guess what caused DJ Screw’s premature death.

Stopping or reducing heavy and prolonged opioid use will lead to withdrawals.  Although opioid withdrawal is rarely ever life-threatening, it causes very distressing symptoms like irritability and dysphoria, piloerection (fancy way of saying goosebumps), nausea, diarrhea, muscle cramps, aches, and flu-like symptoms.  It’s definitely not what you want to be going through on a first date. Interestingly, the common expressions used to describe the abrupt cessation of habitual behavior – go cold turkey and kick the habit – come from the opioid withdrawal symptoms of goosebumps (resembling a plucked turkey) and muscle spasms in the leg (causing kicking movements), respectively.

Prior to his recent legal troubles, Russell’s life on the field was no better. Two months earlier, the Raiders severed ties with him and released him to unrestricted free agency.  Currently, no NFL team would even consider touching him with a 10-foot pole. He’s arguably the biggest draft bust in NFL history. Notorious for his poor work ethic and bad decision making, he also had significant weight gain issues that seems to strengthen the case that he’s been sipping the syrup for some time (the sugar in soda and hard candy coupled with antihistamines will certainly make you a great candidate to compete on the Biggest Loser).  If codeine is truly behind his on-field failure, it would be wise for the once highly-touted natural athlete to seek professional help for his substance use. Maybe then, he could resurrect his career and possibly lead his team to winning a championship title (and then thank his psychiatrist on national TV as Ron Artest did).

If you’re interested in psych issues and sports, you should check out the Sports Psychiatrist, a dear friend and colleague of mine.

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Marijuana

Cannabis

It’s April 20th.

For the marijuana smoking counter culture, today is known as 420, pronounced four-twenty – National Weed Day. Many marijuana (MJ) users celebrate by convening  across the nation to light up a joint, smoke a bowl, or eat some pot brownies. Unlike Halloween, in which you probably wouldn’t find anyone in costume on the other 364 days, MJ use is ubiquitous and ever-present in the mainstream.  Whether you’re watching TV or listening to music on the radio, attending a sporting event or concert, you’re as likely to be exposed to something MJ-related (like Weeds, Bob Marley, or the downwind smell of pot) as you are to something Kate Gosselin-related at a supermarket checkout line.

MJ is the most prevalently used illicit substance in the world. It is often referred to as the “gateway” drug as once naive recreational drug users may later progress to experimenting with harder drugs such as dropping ecstasy, snorting a line of cocaine, or smoking crystal meth. MJ has more aliases than the National Hockey League has fans. In the medical profession, MJ is frequently referred to as Cannabis, the Greek name of the plant, and THC, its main active ingredient.

Many consider MJ use to be harmless, positive, and even beneficial. Recreationally, MJ is associated with facilitating philosophical thinking, enhancing creativity, and heightening subjective experiences. How many moviegoers do you think were high when they munched on popcorn as they trancedly watched Avatar in 3-D? Medically, MJ has been legalized in 14 US states for treatment of chronic conditions such as glaucoma, pain disorders, chemotherapy-induced nausea and vomiting, HIV unintentional weight loss, and some neurological disorders.

Legalized for medicinal use only in a minority of states, MJ is criminal and illegal on the federal level. As such, the federal governing agency of prescription meds, the FDA, strictly regulates MJ among the highest of controlled substances. MJ is classified as a substance with high abuse potential, no current accepted medical use, and a lack of accepted safety for use under medical supervision. You may get a marijuana card, but you’re absolutely not gonna get a prescription for MJ says Uncle Sam.

The medical marijuana debate remains controversial in the medical profession. Although MJ has been shown to improve the aforementioned medical conditions, it nevertheless has adverse effects on the lungs, heart, and immune and reproductive systems. Moreover, it has the potential to cause cancer.  

In psychiatry, the position on MJ use errs on the side of restriction. Aside from addiction, MJ has been associated with increasing the risk of common psychiatric disorders like anxiety, bipolar, and psychosis. Chronic heavy users of “the chronic” may also experience a generalized lack of interest, decreased motivation, and impaired cognitive functioning. You may want to stay off the grass if you’re gunning to be the school valedictorian. Many MJ users may go through their entire lives without any significant functional impairment, experiencing at worst a “bad trip” from time to time. But what if that bad trip was lasting and permanent like schizophrenia? Is that a journey worth embarking on?

The origin of 420  in reference to weed has as many postulations as that of Tupac’s death. Some think 420 refers to the number of chemicals found in MJ, the police code for MJ use, or Adolf Hitler’s birthday. The leading belief seems to credit a group of pot-smoking teenagers who met up daily to get high after school at 4:20pm back in the early 70s. Whatever the reason, as far as I’m concerned, 420 can mean the number of arguments you can make for or against the use of MJ.

Since I’m a psychiatrist, you can probably surmise where I stand on the issue of marijuana use.

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Ambien

Hamlet by William Shakespeare

“To sleep, perchance to dream…,” Hamlet wondered  in his famous To Be or Not to Be soliloquy.

If he lived in modern times, Hamlet would probably pop an ambien and call it a night if he desired to sleep. This popular sleeping aid is gaining quite a bit of attention in the mainstream celebrity world- it’s use amongst celebs is almost as ubiquitous as their active Twitter accounts.

Jay-Z along with Alicia Keys raps about it in Empire State of Mind in reference to partying in NYC- “the city never sleeps, better slip you an ambien”; John Mayer tweets about his personal use and sings about it in Heartbreak Warfare; Jimmy Fallon jokes about it on his late-night talk show; and Tiger Woods probably takes it on nights before playing in the majors. Why not? He takes it for crazy ambien sex with one of his many former mistresses. You probably remember that infamous night he crashed his SUV which led to the unraveling of his secret lifestyle- yep, he was driving under the influence of ambien.

Ambien is a sedative or hypnotic prescription medication that knocks you out like a left hook from Manny Pacquiao.  It was first approved by the FDA in 1992 for the short-term treatment of insomnia. But it didn’t gain widespread use until the generics (zolpidem) came out in 2007. Although not approved for treatment of chronic insomnia, it is not uncommon for doctors to prescribe it for long-term use.

Common side-effects of ambien are drowsiness, impaired motor function, and a drugged feeling.  But more interestingly, side-effects may also include hallucinations, amnesia, euphoria, increased appetite and libido, and extroversion in social settings. And these effects may perhaps be the reason behind  the trend in ambien misuse for recreational purposes.  There are also many documented reports of ambien-related bizarre behavior, ie.  people cleaning out their fridge from sleep-eating politicians involuntarily joining the DUI club from sleep-driving, and wives engaging in unusual sexual behavior of which they have no recollection.

Before the days, or nights, of ambien, the common sleeping pills were the benzos (xanax, valium, ativan) and the barbiturates. These medications are far more dangerous than ambien. They are addictive and lethal in overdoses.  Guess which prescription meds were found in Marilyn Monroe, Jimi Hendrix, and Heath Ledger when they prematurely died?

Ambien is potentially lethal in an overdose since it’s a sedative, especially if combined with alcohol. The cause of death is cessation of breathing. Fortunately, there aren’t too many documented cases, if any,  of death primarily by ambien overdose. In my own clinical experience, I haven’t seen any yet.

Hamlet was contemplating suicide in his soliloquy- “for in that sleep of death what dreams may come.”  If he were to take a large dose of ambien, he would be at some risk of a fatal overdose. But he’s more likely to hallucinate and engage in an ongoing conversation with the skull until he falls soundly asleep, and not remember a thing the following morning.

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