Steroids, Dissociatives, Club Drugs, Inhalants, and Hallucinogens
Anabolic-androgenic steroids, inhalants, hallucinogens, dissociative anesthetics and “club drugs” are a heterogeneous group of substances that have considerable potential for misuse and associated morbidity and/or mortality. Steroid use often goes undetected, even by addiction psychiatrists, though significant medical and psychiatric consequences often arise from chronic use. Inhalants, which are commonly found in household products and used by adolescents, quickly reach high concentrations in the brain through crossing the blood–brain barrier as well as alveolar membranes, leading to rapid “high.” Hallucinogens represent a diverse group of compounds that alter sensory perceptions often by modulating serotonin. Dissociatives cause a disconnection between thoughts, identity, consciousness and memory by their antagonism of NMDA receptors and include substances like PCP, dextromethorphan, and ketamine. MDMA, commonly known as “ecstasy,” is a common club drug that modulates monoamines in neuronal synapses. GHB is another “club drug” that has both medical and recreational use, though has a serious, alcohol-like withdrawal syndrome. In order to appreciate the unique characteristics of these substances and provide effective management for patients using them, an understanding of the history of these compounds, their epidemiology and prevalence, their associated comorbidities, the various forms of these substances, their general pharmacodynamics and pharmacokinetics, their patterns of use and misuse, their pathogenesis, their presenting signs and symptoms, and the adverse medical effects associated with them are presented.