RECREATIONAL USE OF MEDICATION
What do we consider recreational use of medication?
Recreational use of medication is considered to be any use that is not performed for medical purposes. Forms of recreational medication include taking medication that has been prescribed to another person, taking higher doses than you should, and taking medication in other ways than predetermined (e.g. crushing and sniffing or injecting).
In this article, we deal with the most commonly recreationally used substances with psychoactive effects, which are found in freely available medicines and prescription medicines. Before we take a closer look at the individual substances, it is necessary to mention a few general risks that apply to all medicines and ways to partially reduce these risks.
“Twelve rules for recreational use”:
- All the psychoactive substances in medicines can be addictive and cause health problems that you can avoid altogether only if you do not take the substance. Never use these substances during pregnancy and consult over-the-counter medicines with your doctor.
- Before taking the medicine, always find enough information about the effects, dosage, interval between doses (e.g. within one day, but also in the long term), contraindications and methods of use.
- Always try to have at least one experienced and sober person with you who can monitor your condition (and you should also watch yourself), secure enough food and fluids, and find a safe and familiar environment.
- In case of health problems, do not hesitate to call the ambulance (155) and provide it with all the information about the type and amount of the substance used (drug use is not a crime, so do not be afraid to provide accurate information!). Put the person in a stabilized position, leave him/her lying on the ground and in no case pour liquid into his/her throat. In case you start to have health problems and e.g. you start to fall into a coma, also try to lie down in a stabilized position.
- Active substances in medicines are generally safe when used as they should be, but if used more frequently / intensively their effects pose a health risk.
- This also applies to the way you take it, e.g. if you sniff medicines that are intended for oral use, you are exposed to a much stronger effect (e.g. hallucinations, but also an unintended effects) and you are also exposed to a much higher risk of overdose.
- The rate of release may also vary (labeled IR for immediate release, SL / SR for gradual release, and XL / XR / ER for prolonged release), especially in case of stimulants, but if you divide / crush the drugs, they will work immediately, which entails the above-mentioned risks of stronger effects and overdose.
- Set limits on the regularity of use and the amount of substance used according to recommendations and personal experience, larger doses do not always mean a better experience, because from a certain point unintended effects and health risks begin to prevail over enjoyment.
- Different drugs containing the same active substance may differ in the concentration of the substance or in its form, therefore never derive dosing e.g. codeine syrup from a similar syrup without comparing the medicines.
- The combined use of drugs is the biggest risk factor after dosing, so try to avoid any combinations, or at least those mentioned here.
- There is an ever-growing market for counterfeit medicines such as Xanax, which are then marketed as original medicines, however, the may contain various concentrations of active substance or other ingredients (they may be dangerous on their own or in combination with other substances, which you may not be aware of), or they do not contain the original substance at all.
- If you are taking prescription or over-the-counter medications, you run the risk of taking the medication despite your contraindications to your condition or to other medicines you are taking (e.g. taking amphetamines despite cardiovascular problems).
The most often used recreational substances in more detail (name of the medication in parentheses):
If you do not take these substances, you will avoid all risks.
Alprazolam (Xanax, Neurol, Frontin, Helex)
Effects: It belongs to the group of benzodiazepines, has sedative effects and is used to treat anxiety disorders. The most common effects include sedation and drowsiness, physical relaxation, impaired control of movement, dizziness, suppression of memories to memory loss, euphoric feelings, confusion and compulsive (compulsive) use of other doses. The effects start after 20-40 minutes, last 5-8 hours and post-effects (positive or negative fading effects) last 6-24 hours. You can experience increased aggression, irritability and anxiety when the medication finishes its effects, which motivates you to take the next dose, but with such use you only build up tolerance and dependence on alprazolam. Symptoms of overdose include confusion, impaired reflexes, and worsened coordination and coma.
Dosing: Low dose: 0.25-0.5 mg, medium dose: 0.5-1.5 mg, high dose: 1.5-2 mg. Xanax tablets are distributed in 4 doses – 0.25 mg, 0.5 mg, 1 mg, and 2 mg. The first three mentioned tablets can be divided into halves by breaking, and the last, 2 milligrams, can be divided into quarters by breaking. If you do not have a weight to the nearest tenth of a milligram, use dosing with the tablets themselves. All tablets have their weight indicated on them. The maximum daily dose is 10 mg per day, but do not take it all at once. If you want to try the pills about which authenticity you are not sure about, take a test dose of 0.25 mg and wait at least an hour before taking it again.
How to reduce the risks associated with use? Use Alprazolam only orally, other methods are ineffective and you also risk damaging various organs. You can reduce your chances of becoming addicted by avoiding regular use and continuous use for more than 4 weeks. After using the substance, try to avoid excessive movement and in no case drive a motor vehicle.
What combinations should I avoid? Definitely do not use Alprazolam in combination with benzodiazepines, barbiturates, GHB / GBL, alcohol and opioids, as their similar effect multiplies muscle relaxation, memory loss, sedation, breathing problems and may cause suffocation with vomiting in sleep.
Effects: It belongs to the group of benzodiazepines, has calming effects and is used for the short-term treatment of insomnia, anxiety, panic attacks and to alleviate the withdrawal symptoms of alcohol and opiates. It relaxes muscles, has no antidepressant effects and has a higher potential for abuse compared to other benzodiazepines. Side effects include lethargy, excessive sedation, reduced mobility, memory impairment and nausea. Intensive use impairs the ability to learn. The effects start after 10-20 minutes, last 4-8 hours and end with post-effects (positive or negative reverberation of effects) with a duration of 1-16 hours.
Dosing: Low dose: 2.5-5 mg, medium dose: 5-10 mg, high dose: 10-15 mg. The maximum daily dose is 60 mg, but in divided doses, not at once!
How to reduce the risks associated with use? Take Bromazepam only orally, other methods are ineffective and you also risk damaging various organs. You can reduce your chances of becoming addicted by avoiding regular and continuous use for more than 8 weeks.
What combinations should I avoid? Cimetidine, fluvoxamine and propranolol slow down the metabolism of bromazepam, causing dangerous accumulation of bromazepam in the body. The combination with other benzodiazepines, alcohol, GHB / GBL and opioids is dangerous due to the amplification of the effects of the substances used, a high chance of dropping off and vomiting, difficulty breathing. Ketamine, PCP, MXE and DXM cause loss of mobility, loss of consciousness and vomiting, and in DXM also bad trip. While MAOI antidepressants strengthen the effects of bromazepam, SSRIs weaken them. The remaining common drugs such as marijuana, MDMA, cocaine, etc. have reduced effects in combination with Bromazepam and cause impaired coordination of movement.
Diazepam (Diazepam, Oparin)
Effects: Diazepam, also known as Valium, is a benzodiazepine with sedative and sleep-inducing effects. Effects include muscle relaxation, decreased anxiety, euphoria, changing appetite, irritation, anger, memory loss and lethargy. Diazepam can sometimes cause complete temporary memory loss, depression and, with long-term use, personality changes, derealization, and social and emotional separation. The effects start after 20-40 minutes, last 4-8 hours and post-effects (positive or negative fading effects) can last up to 36 hours.
Dosing: Low dose: 2.5-5 mg, medium dose: 5-15 mg, high dose: 15-30 mg. The maximum daily dose is 1 mg / kg body weight / day, so if you are 80 kg, you can take a maximum of 80 mg in a minimum of 3 doses.
How to reduce the risks associated with use? Use diazepam only orally, other methods are ineffective and you also risk damaging various organs.
What combinations should I avoid? The combination with other benzodiazepines, alcohol, GHB / GBL and opioids is dangerous due to the amplification of the effects of the substances used, a high chance of dropping off and vomiting, difficulty breathing. Ketamine, PCP, MXE and DXM cause loss of mobility, loss of consciousness and vomiting, and with DXM also bad trip. While MAOI antidepressants strengthen the effects of diazepam, SSRIs weaken them. The remaining common drugs such as marijuana, MDMA, cocaine, etc. have reduced effects in combination with diazepam and cause impaired coordination of movement.
Codeine (Paramax-COD, Alnagon, Codeine, Moventig, Korylan, Relistor)
Effects: An opiate that causes feelings of relaxation, warmth, euphoria, increased self-confidence, pain relief, lethargy, confusion, nausea, stomach pain, sweating, breathing problems and vomiting. The effects start after 30-45 minutes and last 3-6 hours, post-effects (positive or negative fading effects) last 1-12 hours. Symptoms of an overdose include shallow breathing, very small pupils, pale skin or lips, fainting and respiratory arrest.
Dosing: Low dose: 50-100 mg, medium dose: 100-150 mg, high dose: 150-200 mg. The maximum daily dose is 240 mg.
How to reduce the risks associated with use? Start with lower doses to try and do not mix codeine syrups with other substances. Syrups tend to contain excipients that also have their risks and side effects, especially at higher doses. Take special care with paracetamol, which is fatal when exceeding a dose higher than 4000 mg. Higher doses of paracetamol can also cause permanent liver damage.
What combinations should I avoid? Alcohol, benzodiazepines, DXM, GHB / GBL, ketamine, and MXE, in combination with codeine, can cause inability to move, fall into a coma, and subsequently vomit (risk of suffocation). Combination with cocaine, amphetamines and tramadol impairs breathing ability and may cause seizures.
Tramadol (Tramal, Tramadol, Tramabene, Tralhit, Mabron, Adamon)
Effects: Tramadol is an analgesic (reduces pain). The most common effects include pain relief, lethargy, drowsiness, feelings of euphoria, hallucinations, feelings of floating and dreaming, dry mouth, vomiting. At higher doses, it can cause an increase in heart rate, irritability, seizures, difficulty breathing and falling into a coma. The effects start within 1 hour and last for 6 hours. It is difficult to recognize the symptoms of overdose, but common are irregular heartbeat, coma, vomiting, hypothermia, muscle pain and stiffness, weakness and seizures.
Dosing: It is between 50-100 mg, the daily dose should not exceed 400 mg. At higher doses, more side effects occur. It is used exclusively orally.
How to reduce the risks associated with use? Do not exceed the prescribed doses and do not take tramadol in any other way than orally.
What combinations should I avoid? The combination with tricyclic, MAOI, SSRI, and NDRI antidepressants causes serotonin syndrome (can cause irritation, sweating, diarrhea, seizures, coma, and death), these symptoms apply also to cocaine, MDMA, LSD, and morphine. The combination with other analgesics or sedatives impairs bodily functions and increases the chances of falling into a coma, vomiting and respiratory arrest.
DXM / Dextromethorphan (Robitussin, Stopex, Mugotussol, Dinarex)
Effects: DXM is an opiate with dissociative (dissociation from your self) effects. It is used to treat coughs and flu. It has various effects, such as loss of notion of time, bodily hallucinations, immersion into activities, loss of control, euphoria and loss of ego (depersonalization), memory loss, suppression, but also anxiety, impulsive behavior and hallucinations. Lower doses tend to be described as alcohol-like, higher doses as PCP-like, i.e. hallucinogenic and stimulating. DXM is known to often cause nausea, vomiting and a feeling of strain on the body. The effects start after 30-120 minutes, the onset lasts 60-120 minutes, the peak 3-6 hours, the finish of effects 2-4 hours and the post-effects (positive or negative fading effects) 4-24 hours. Tolerance drops to zero after 2 weeks. After using DXM you will have tolerance to all dissociatives. Some users claim to have built up a permanent tolerance after long-term use (not necessarily frequent). Withdrawal symptoms include fatigue, apathy, insomnia, nightmares, memory problems and constipation.
Dosing: Low dose: 100-200 mg, medium dose: 200-400 mg, high dose: 400-700 mg. The maximum daily dose is not specified, but may be around 3600 mg in 4 uses. On this page you will find an interactive calculator designed to calculate the volume of syrup in relation to the strength of the dose (scale 1-4): dxm.tripsit. However, watch out for other active ingredients in DXM-containing medicines and find the maximum daily dose for each one on the internet. When taking a dose repeatedly one after another, be careful about how DXM works – the effects come gradually and in waves, so wait at least 2 hours before the next usage. With repeated dosing, you may start with a large dose and then reduce the strength of subsequent doses (not recommended for beginners due to the strength of the first dose). If you want to achieve more mental than physical hallucinations, drink about 500 ml of grapefruit juice 1-2 hours before using DXM. Grapefruit juice changes the way DXM is metabolized by retaining enzymes that convert DXM to DXO.
How to reduce the risks associated with use? Do not dose the syrup with a spoon, it is not an exact method, use a kitchen measuring glass or syringe instead. Always shake the syrup before use to distribute the active ingredients evenly. Do not combine syrups and tablets, use the same product for one use. When using DXM, you can sometimes experience a “robo-walk”, i.e. the feeling that all your muscles are working at once, which is not painful, but it will reduce your ability to coordinate movement to a minimum. During the “robo-walk” it is best to avoid physical activity and focus on perceptions such as music or just on your thoughts.
What combinations should I avoid? Avoid combinations with SSRIs and MAOIs, antidepressants, MDMA, MDA, tramadol, MXE, 5-HTTP, and other substances with effects on serotonin, as you risk serotonin syndrome (may cause irritability, sweating, diarrhea, seizures, coma, and death). Stimulants such as cocaine or amphetamines increase heart rate and can cause panic attacks. Benzodiazepines, alcohol and GHB / GBL may impair mobility and lead to dropping off and vomiting (risk of suffocation). Combination with other opioids (e.g. tramadol) may lead to respiratory arrest and severe liver damage.
Effects: Methylphenidate is a stimulant used to treat ADHD and narcolepsy. Recreationally, it is most often used in the school environment by people without ADHD who want to improve their learning and concentration skills. Desired effects include arousal, cognitive euphoria (but this feeling is weaker than with other stimulants), improved ability to concentrate, suppress fatigue, improved memory, speeding up thoughts and improved motivation. On the other hand, it causes increased heart rate, dehydration, dry mouth, sweating, nausea, muscle stiffness and gnashing of teeth, anxiety and compulsive use. Post-effects are always negative: anxiety, fatigue and inability to fall asleep, depression, irritability, suppression of motivation and slowing of thoughts. When taken orally, the effects start within 20-60 minutes, the onset lasts 20-60 minutes, the peak 1.5-2.5 hours, the finish of effects 1-2 hours and the post-effects 2-6 hours. This applies to tablets with normal release, values for other types of release vary. Tolerance does not start until long-term repeated use and disappears after 2 weeks. It is less addictive than other stimulants.
Dosing: Low dose: 10-20 mg, medium dose: 20-40 mg, high dose 40-60 mg. The maximum daily dose is 60 mg.
How to reduce the risks associated with use? Take methylphenidate only orally, as sniffing and injecting will only increase the strength of the side effects and increase the risk of addiction, not to mention the destruction of the liver, veins or nasal mucosa. Excessive long-term use of methylphenidate can lead to psychosis, which is manifested by hallucinations, self-harm, delusions, confusion, paranoia, and anxiety or aggression.
What combinations should I avoid? Avoid combinations with other stimulants such as 25x-NBOMe, MDMA, PCP, 2C-Tx, DOx, 2C-x, cocaine, other amphetamines and MXE, as you increase the burden on the heart, but also risk psychosis, panic attacks, heart failure, seizures and in case of MDMA also increased neurotoxicity. Alcohol, in turn, masks the stimulatory effects of methylphenidate and therefore you can be more easily overdosed, but methylphenidate also masks the sedative effects of alcohol, which can lead to respiratory arrest after the effects of methylphenidate have subsided. When combined with DXM, you risk serotonin syndrome (may cause irritability, sweating, diarrhea, seizures, coma and death). If you take MAOI antidepressants, their interaction can fatally increase dopamine levels in the brain.
Quintero, G. (2009). Rx for a party: A qualitative analysis of recreational pharmaceutical use in a collegiate setting. Journal of American CollegeHealth, 58(1), 64–72. doi:10.3200/jach.58.1.64-72
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