Experimenting with narcotics leaves lasting health impact | Sunday Observer

Experimenting with narcotics leaves lasting health impact

7 March, 2021

Reports of large hauls of illegal drugs entering the country have revealed that new and more dangerous drugs have managed to bypass the sentries at entry points. Drugs such as ICE, Ecstacy, smokeless cigarettes and toffees containing drugs, smuggled by drug mafia target mostly young persons wanting to experiment with anything new. Not only do these tainted products have drastic consequences on health, they create a growing community of drug dependent persons who become a burden to their parents, society and the State. Ending this dangerous trend is thus the need of the hour and the present government is currently throwing its fullest weight to eradicate the rising drug menace in Sri Lanka, vowing to end it within the next few years.   

The Sunday Observer spoke to Senior Prof of Forensic Medicine, General Sir John Kotelawala Defence University, Ratmalana, and Emeritus Prof of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo who was also the Chairman of the National Dangerous Drugs Control Board, Prof Ravindra Fernando on the health impacts of drug usage, how they could be reversed with early detection and treatment and what he thought about the focus on rehabilitating offenders.   


Q. Recent raids by the police and Anti-Narcotics personnel have discovered large quantities of illegal drugs entering the country, such as, heroin, cannabis, smokeless cigarettes, ICE, Ecstacy, and tobacco containing drugs.  What are the most commonly used drugs in Sri Lanka at present?

A. They are cannabis (ganja) and heroin.

Q. Have you seen an increase in the use of harmful drugs in the past ten years? If so what age groups are most likely using them? Why?

A.  Yes, there is an increase in the use of harmful drugs. In drug dependence, it is always young people who are mainly involved, and experiment with drugs.

Q. What are the harmful effects of drug abuse on the human body in general?

A. All drugs are chemicals that affect the body and the brain. The effects depend on the type of drug. Some effects of drugs include long-lasting and permanent health consequences. The tragedy is that all kinds of drug abuse affect the brain. They cause large amounts of dopamine, a neurotransmitter that helps regulate our emotions, motivation and feelings of pleasure, to flood the brain and produce a ‘high.’ Eventually, drugs can change how the brain works and interfere with a person’s ability to make choices, leading to intense cravings and compulsive drug use. Over time, this behaviour can turn into a substance dependency, or drug addiction.

Q. Any other adverse effects?

A. More deaths, illnesses and disabilities are associated with drug abuse than any other preventable health condition. People suffering from drug and alcohol addiction have a higher risk of unintentional injuries, accidents and domestic violence incidents.

Q. I understand that each of the drugs mentioned has a specific impact on the health of the user. Can you elaborate by discussing these specific impacts separately?

A. I will discuss the two common addictive drugs, heroin and cannabis.

Heroin is a drug that comes from the opium poppy and is in the class of drugs called depressants, because it slows down the brain and the central nervous system. It is one of a group of very strong pain-killing drug called narcotic analgesics or opioids. As soon as heroin enters the brain, the person experiences a surge of the pleasurable sensation known as a ‘rush.’ When heroin enters the brain and crosses the blood-brain barrier, it is converted to morphine and quickly binds to opioid receptors, producing that euphoric feeling.

Users usually experience dry mouth, a warm flushing of the skin, and their extremities begin to feel heavy. Sometimes, users can experience nausea and vomiting.

After the initial, short-term effects of the drug, users can feel drowsy for several hours, due to heroin’s effect on the central nervous system.

In heroin overdose, breathing can slow to the point of being life-threatening.

Cannabis is a herbal drug made from the Cannabis sativa plant. It contains chemicals called cannabinoids, which affect the central nervous system - the brain and nerves. Cannabinoids are found in the highest levels in the leaves and flowers of cannabis.

Cannabis containing large amounts of Tetrahydrocannabinol can cause anxiety, psychosis, heart attack, and irregular heart rhythm. Using cannabis for at least 1-2 weeks can also lead to dependence. People with cannabis dependence might experience withdrawal after stopping cannabis use. Symptoms of withdrawal include nervousness, shaking, difficulty in sleeping, decreased appetite, sweating, headache, and depressed mood.

Q. ICE, Ecstasy and smokeless cigarettes are relatively new drugs. Tell us how they impact on the health of the users.

ICE is crystal methamphetamine, a stimulant drug, which means it speeds up the messages travelling between the brain and the body.

ICE usually comes as small clear crystals that look like ice. It can also come as white or brownish crystal-like powder with a strong smell and bitter taste.

ICE is generally smoked or injected, and sometimes swallowed or snorted.

Methylenedioxy-methamphetamine (MDMA) or ecstasy is a synthetic drug that alters mood and perceptions. MDMA was initially popular in nightclubs and at all-night dance parties (‘raves’), but the drug now affects a broader range of people.

MDMA increases the activity of three brain chemicals:

Dopamine — produces increased energy/activity and acts in the reward system to reinforce behaviours

Norepinephrine — increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems

Serotonin — affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust.

Other health effects include nausea, muscle cramping, involuntary teeth clenching, blurred vision, chills and sweating

Alternative tobacco and nicotine delivery products : Examples of alternative tobacco and nicotine delivery products include E-cigarettes or ‘vaping’, Smokeless tobacco and Waterpipes, in various forms, size, and flavour. Alternative tobacco products contain harmful chemicals and toxins that have health risks. The chemicals and toxins may cause serious health problems, including cancer.

Q.  Withdrawal symptoms: If drug users withdraw from his habit of drug dependence, what are the symptoms they are likely to experience during this period of withdrawal?  

A. Symptoms depend on the type of drug. For example, heroin withdrawal symptoms may last only a week or so, but symptoms can be serious. They include nausea, abdominal pain, sweating, shaking, agitation, depression, muscle spasms and cravings for the drug.

Q. Do these adverse effects occur in short term or long term users? 

A. It can occur if a person is a drug dependent, usually a long time user.

Q. Are they reversible?

A. The effects may disappear after a time.

Q.  Can drug abuse be cured?   Is it correct that cocaine abuse leading to perforated nasal septum, keratitis of the eyes, dental erosions, heart muscle disease, coronary artery disease and liver disease are not reversible?

A. Yes, cocaine abuse can be very harmful and can cause all the above effects.

Q. Does it affect one’s vision?

A. There are many articles on effects on eyes due to cocaine. In most cases the main mechanism are central retinal artery occlusion. The vision impairment may develop from three to 10 hours after the cocaine use, and the outcome, despite the intensive treatment is usually poor. All doctors should keep in mind the possibility of cocaine users developing sudden and painless vision loss.

Q. Some drugs I understand cause skin rashes. Is this correct? How do you identify them from normal skin rashes?

A. Skin rashes caused by drugs vary in appearance. For example, meth, crystal meth, or methamphetamine is perhaps the most well-known drug on the list for causing some serious issues on the skin. Commonly referred to as meth sores, the open sores caused from regular meth use are often the result of a number of different psychological and physical side effects that come from regularly using this highly dangerous drug.

Q. What drugs lead to unpredictable or violent behaviour?

A. Studies show an unequivocal, causal relationship between aggressive behaviour and cannabis, cocaine, heroin and methamphetamine use.

Q What about alcohol? Does it fall into the drug abuse category?

A. Yes, alcohol is a drug of abuse.

Q.  Is there a safe dosage of alcohol one can take? Some doctors recommend a pint of beer or ale or red wine as good for the heart. Is this a good thing?

A.  According to the WHO, approximately three million people die every year due to alcohol consumption. Some experts suggest various safe levels but people who drink do not stop at safe levels. 

Q. What about smoking? A cigarette contains many harmful ingredients that can impact the lung. What are they?

A. Some of the chemicals found in tobacco smoke include Nicotine (the addictive drug that produces the effects in the brain that people are looking for), hydrogen cyanide, formaldehyde (embalming fluid!), lead, arsenic and benzene.

Q. Has there been a rise in smoking in recent years?

A. There is no correct statistics to comment, 

Q. What about second-hand smoking? Can it affect a non-smoker? How?

A. Second-hand smoke is the combination of smoke from the burning end of a cigarette and the smoke breathed out by smokers. Second-hand smoke contains more than 7,000 chemicals. Hundreds are toxic and about 70 can cause cancer.

Q. Can smoking cause those with respiratory conditions like asthma to aggravate? 

A. Yes.

Q. Is there a link to illegal drugs and pre-existing diseases such as, diabetes, hypertension, and heart disease? 

A. Abusing substances can have negative effects on the heart. If someone has cardiovascular disease and begins or continues to abuse substances, their condition could worsen rapidly.

Smoking cannabis may also increase the risk of heart problems such as heart attack and abnormal heart rhythm.

Alcohol addicts have increased risks of irregular heart rate, heart attack and difficulty in pumping blood (congestive heart failure).

Alcohol abuse can raise blood pressure (hypertension), which is a major contributing factor to many heart conditions.

Q. Does taking illegal drugs interfere with one’s sexual life?

A. Researchers have found that drug abuse negatively affects sexual performance in men even after years of abstinence.

Q. We are now in the midst of a Covid-19 pandemic. How vulnerable are drug users to this highly infectious virus and its new variants that pose fresh threats?

A. Studies have shown people with substance use disorders are significantly over-represented among those with Covid-19. Risk of Covid-19 was highest among those who had received a diagnosis of substance use disorders within the past year. 

Q. Rehabilitation of drug abusers has been given high priority by the present government. What are the recent interventions made in this direction by the Drugs authorities?

A. Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependence on  substances such as, alcohol, prescription drugs, and drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, and cease substance abuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused. Treatment includes medication for depression or other disorders and counselling by experts.

Q. Any gaps in making Sri Lanka a safe country free from the menace of drugs? How would you like to see them rectified? 

A. There should be more concentrated effort by everyone involved in rehabilitation to make Sri Lanka a safe country.

Q. The present government has pledged to wipe out this drug menace in the next few years.  Your comments?  

A. It is a great commitment to eradicate the drug menace from Sri Lanka. However, so far the efforts taken are not adequate. There should be more concentrated effort by everyone involved in rehabilitation to make Sri Lanka a safe country. 

Q. Your message to all those especially vulnerable youth leading risky lives?

A. Stop experimenting with drugs of abuse. Avoid friends who are using drugs. Drugs are not essential for your health. In fact taking a non medical illegally smuggled drug for even a short time can leave lasting health impacts mentally and physically for life.