What are other mechanisms of illicit drug use besides spiraling?

Mechanisms of Illicit Drug Use Beyond Spiraling

The primary mechanisms of illicit drug use include injection, inhalation, sniffing, smoking, and ingestion, each with distinct health risks and patterns of use. 1

Routes of Administration

Injection

• Direct introduction of drugs into the bloodstream via needles and syringes
• Highest risk for bloodborne infections (HIV, hepatitis C)
• Approximately 9-12% of new HIV cases and 50% of new hepatitis C cases in the US are associated with injection drug use 2
• Requires paraphernalia including needles, syringes, and drug preparation equipment (water, cotton, cooker)

Inhalation

• Breathing in vapors or smoke through the nose or mouth
• Common with solvents, aerosols, and gasoline
• Household products such as glues are frequently abused this way 2
• Rapid absorption through lung tissue

Sniffing/Snorting

• Absorption through nasal mucosa
• Common with powdered substances like cocaine
• Can cause damage to nasal passages over time

Smoking

• Inhalation of substances that have been heated or burned
• Used with cannabis, crack cocaine, methamphetamine
• Rapid delivery to the brain through pulmonary circulation

Ingestion

• Oral consumption of substances
• Includes swallowing pills, liquids, or other forms
• Common with prescription drug misuse and over-the-counter medications 2

Behavioral Mechanisms

Multiple Drug Use

• More than 50% of people who inject drugs illicitly use multiple substances through various routes 2
• Simultaneous use of illicit drugs and legal substances increases risk of drug interactions and overdose 2

Drug-Seeking Behavior

• "Doctor shopping" (visiting multiple prescribers to obtain additional prescriptions)
• Emergency calls or visits near the end of office hours
• Repeated "loss" of prescriptions
• Tampering with prescriptions
• Reluctance to provide prior medical records 3

Environmental Factors

• Unstable living conditions
• Limited availability of sterile injection equipment
• Social marginalization and stigma
• Lack of access to substance abuse treatment programs 2

Neurobiological Mechanisms

Neurotransmitter Systems

• Different classes of drugs affect specific neurotransmitter systems:
  • Stimulants: increase dopamine and norepinephrine
  • Opioids: bind to opioid receptors
  • Cannabis: affects endocannabinoid system
  • MDMA/ecstasy: increases serotonin levels 1

Tolerance and Dependence

• Tolerance: reduced response after repeated administration (higher doses needed for same effect)
• Physical dependence: physiological adaptation resulting in withdrawal symptoms upon discontinuation
• Withdrawal may be precipitated by antagonist drugs or abrupt discontinuation 3

Risk Factors and Associations

Genetic Factors

• Genetic liability underlying cannabis use significantly explains variability in other illicit drug use
• Potential common underlying genetic predisposition for multiple substance use 4

Behavioral Health Factors

• Avoidant coping strategies associated with continued drug use
• Depression often co-occurs with substance use
• Reduced cognitive avoidance and depression associated with better treatment outcomes 5

Health Consequences

Infectious Disease Transmission

• HIV, hepatitis C, STDs, and tuberculosis are prevalent among people who use drugs illicitly
• HSV-2 prevalence is 38-61% among people who use drugs illicitly compared to 17% in the general population 1

Mortality Risk

• Drug overdose is the leading cause of mortality among people who inject drugs
• Opioid pain medications account for the highest number of unintentional overdose deaths, followed by cocaine and heroin 2
• Drug overdose death rates increased nearly fivefold during 1990-2007 2

Neurological Damage

• Ischemic and hemorrhagic stroke
• Subarachnoid hemorrhage
• Leukoencephalopathies
• Toxicity may be caused by the drug itself or by contaminants 6

Prevention Considerations

• Overdose prevention training programs can reduce mortality 2
• Coping skills training interventions may help reduce avoidant coping strategies and improve abstinence 5
• Careful assessment, prescribing practices, and periodic reevaluation help limit abuse of opioid drugs 3

Understanding these various mechanisms of illicit drug use is essential for developing comprehensive prevention and treatment approaches that address the complex physical, psychological, and social factors involved in substance use disorders.