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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Drugs are highly addictive and lead to physiological and psychological changes in the body. Addicts feel the need to get high during periods of low emotions.

A Little High, A Little Low - A Cautionary Tale

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AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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Debunking Myths About COVID-19 & Anti-Malarial Drugs

Introduction

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

Conclusion

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Nimrah H. Sattar

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Cannabis Abuse – Flying The Wrong Airplane In Adolescence

In recent years, the legalization of marijuana has become more common. This is partially due to research showing that the substance does not cause cancer like many had previously thought. However, it has also led some people to believe that cannabis usage is harmless. Thus, encouraging them to use it more often in adolescence. This might be true for adults as well, but studies have shown that young people who consume it might suffer from long-term problems related to memory loss, anxiety disorders, and other <a href="https://merisehat.pk/article/Mental%20Health">mental health issues</a>, which can be problematic later in life.

&nbsp;

Understanding Dangers Of Cannabis Abuse In Adolescence

In Pakistan, the use of the actual leaves itself is not very common due to the high prices. It is a drug that is solely enjoyed by the younger generation of the elite or upper middle class.&nbsp;

&nbsp;

The most common way of consumption in Pakistan is through ingestion, by making edible items out of the plant like brownies or gummies. However, a much cheaper alternative, that contains many of the same components as marijuana, is hash.&nbsp;

&nbsp;

Hash consumption in Pakistan is rampant in people of all classes due to its low-cost nature and easy availability. Hash is consumed by mixing it with cigarette components; smoking the mixture gives the user a feeling of lightheadedness.

&nbsp;

Recent studies in adolescent cannabis abusers show that their IQ drops with their utilization of marijuana.&nbsp;&nbsp;

&nbsp;

The usage of THC or tetrahydrocannabinol (the main component in cannabis) causes the reduction of gray matter in the brain as well as certain changes to white matter. This results in an imbalance in neurotransmitters, which leads to memory impairment and poor concentration.&nbsp;

&nbsp;

These effects worsen when exposure to THC is prior to 16 years of age. The data, thereby, suggests that the younger the users are, the longer the detrimental effects would last<a href="#accordion">[2]</a>.

&nbsp;

This is especially important because the brain continues to develop until age 25, and chronic use of cannabis in young adults might affect its development. Additionally, research shows that adolescents who have a family history of schizophrenia are at an even higher risk when using marijuana before age 16.&nbsp;

&nbsp;

While gray matter is directly related with intelligence, there are no reported direct ties of marijuana with low IQ<a href="#accordion">[5]</a>.

&nbsp;

Given how marijuana affects intelligence and mental health, it&#39;s important for parents to be aware of this information so they make informed decisions about their children&#39;s usage patterns.&nbsp;

&nbsp;

Consumption of cannabis at a young age could cause social anxiety and depression disorders due to neurobiological reasons<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

Utilization of THC affects regulation of serotonin (which is responsible for mood regulation), dopamine (which is responsible for controlling reward and pleasure centers), and norepinephrine (which is responsible for vigilance and concentration)<a href="#accordion">[7]</a>.

<h5>&nbsp;</h5>

Lack Of Motivation To Perform Daily Activities

Sometimes, heavy use of THC reduces motivation, due to activation of specific proteins in the brain. This change in motivation makes it more difficult for individuals who abuse it heavily to perform daily tasks, and even leads them to drop out of school<a href="#accordion">[3]</a>.

&nbsp;

One reason why this happens is because THC affects the brain&#39;s reward system, which is responsible for motivation, memory, and learning. THC has been shown to increase dopamine levels (a neurotransmitter involved in reward) by up to 60% after just 1 dose.&nbsp;

&nbsp;

However, research also shows that chronic use could decrease dopamine levels by as much as 50%. At first glance, these numbers seem contradictory &mdash; how could someone experience both increases and decreases? It turns out there are ways that cannabis use affects the brain&#39;s reward system differently depending on the person&rsquo;s age as well as the amount of dosage taken<a href="#accordion">[4]</a>.

&nbsp;

Decreased Cognitive Learning Ability&nbsp;

The ability to plan, organize, solve problems, make decisions, remember and control emotions and behavior is called executive function. This is a set of skills that allows us to accomplish tasks and achieve goals.

&nbsp;

Cannabis use has been proven to impair cognitive functions on a number of levels. The usage of cannabis on a developing brain worsens the impact greatly as compared to its impact on adults. While there is enough evidence that supports the claim of cannabis having detrimental effects on adolescent brains, the longevity of these effects remains to be elucidated.

&nbsp;

Individuals with cannabis-related impairment in executive functions have been found to have trouble learning and applying the skills required for successful recovery, which puts them at increased risk for relapse to cannabis use<a href="#accordion">[6]</a>.

&nbsp;

To conclude, marijuana abuse is dangerous for adolescents. It affects their cognitive and emotional development in a negative way, as well as impairs their ability to perform daily tasks. While cannabis is beneficial with respect to human health, these benefits are only for adult users consuming it in low doses. Young people should avoid using cannabis or other substances at all costs; it would help them steer clear of problems such as addiction or dependence later on in life.

Key Points

<ul><li>Usage of cannabis in adolescents is known to trigger anxiety and depression.&nbsp;</li><li>Marijuana abuse in adolescence runs the risk of the individual dropping out from school due to diminished ability to learn, and reduced cognitive learning capacity.</li><li>Neurotransmitters like epinephrine, dopamine, and serotonin are greatly imbalanced due to THC use and abuse which might lead the individual towards addiction.</li><li>It is common in individuals who abuse marijuana to easily lose interest in many of the tasks they used to perform. They might even lose the motivation to carry out basic daily life tasks, which is believed to give rise to more addiction.</li></ul>

[1] Daniel K. Hall-Flavin, M., n.d. Marijuana and depression: What's the link?. Mayo Clinic

[2] Emmet Power, S. S. C. H. A. O. N. D. C. a. M. C., 2021. Intelligence quotient decline following frequent or dependent cannabis use in youth: a systematic review and meta-analysis of longitudinal studies. Psychol Med, 51(2), pp. 194-200.

[3] Ileana Pacheco-Colón, M. J. M. L. a. R. G. P., 2019. Non-Acute Effects of Cannabis Use on Motivation and Reward Sensitivity in Humans: A Systematic Review. Psychol Addict Behav..

[4] Michael A P Bloomfield, A. H. A. N. D. V. a. O. D. H., 2017. The effects of Δ9-tetrahydrocannabinol on the dopamine system. Nature, p. 369–377.

[5] Nicholas J. Jackson, J. D. I. j. R. K. ,. D. I. C. T. W. G. I. M. M. A. R. a. L. A. B., 2016. Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies. PNAS, 113(5), pp. 500-508.

[6] Rebecca D. Crean, P. N. A. C. B. a. B. J. M. P., 2012. An Evidence Based Review of Acute and Long-Term Effects of Cannabis Use on Executive Cognitive Functions. J Addict Med, 5(1), pp. 1-8.

[7] Washington.edu, n.d. Marijuana.

Umna Salah

Iqra Mazhar

Just A Little Dose

Microdosing, as the name suggests, is the process of administration of small doses of new or pre-approved chemicals to improve physiological functions.

 
Microdosing sounds a lot like drug abuse, doesn&rsquo;t it? But that&rsquo;s far from the truth. The aim of microdosing is to enhance brain functioning and, in many cases, even treat mental illness through unconventional ways to minimize the side effects and possible dependency on drugs. 
&nbsp;

Understanding The Pros And Cons Of Microdosing

Microdosing, as the name suggests, is the process of administration of small doses of new or pre-approved chemicals to improve physiological functions. The microdose is also referred to as sub pharmacological dose.&nbsp;

&nbsp;

The pharmacokinetic predictors are the users, ensuring the dosage does not have an impact on the clearance, distribution or bioavailability of the compound<a href="#accordion">[1]</a>.

&nbsp;

Microdosing is often used in the process of drug development to determine the therapeutic index of the drug. This practice dates back all the way to the 16th century.

<div>&nbsp;</div>

In order for a dose to be considered sub pharmacological or a microdose, it has to be 1/10th or 1/20th of the normal dose. The target is to avoid the high and/or the intoxication associated with the drug, along with ensuring that possible addiction to the drug does not occur. Since the phenomenon is not widely supported by scientists or healthcare practitioners, there is no set schedule and people who are practicing this have been doing it all on their own based on their own observations and hypotheses<a href="#accordion">[2]</a>. A lot of the positive results are disregarded by many professionals in the name of a placebo effect, but is it what microdosing really is?&nbsp;

&nbsp;

So far, these are the benefits that have been promised by people practicing microdosing from all over the world:

<ul>
	<li>Microdosing on psychedelics has been associated with improved mood.</li>
	<li>Some psychedelics are used to treat anxiety and depression. They exert effects similar to serotonin reuptake inhibitors.</li>
	<li>Improved sleep and an increased sense of well-being.</li>
	<li>Microdosing may help manage symptoms of ADHD.</li>
	<li>It improves cognition.</li>
	<li>It boosts energy.</li>
	<li>It enhances psychomotor performance especially in people over 55 years of age.</li>
</ul>

<div>&nbsp;</div>

Lysergic acid diethylamide is known for its hallucinogenic effects in people and it is very commonly used by artists of all kinds to change their perspectives and broaden their horizons. It is now widely used for microdosing as well. 5-10% of the usual dose if taken, can induce mood enhancing effects, is beneficial for cognitive health, and even helps deal with pain.&nbsp;

&nbsp;

LSD microdosing was an open secret. The game changed when Apple founder Steve Jobs talked about how LSD played a vital role in his life.&nbsp;

&nbsp;

LSD microdosing should never be done continually. It is always better to start off with microdosing 2 days and then skip 2 days (avoid microdosing). So, you can be microdosing from Monday to Friday and leaving the weekends sober. Alternatively, it can also be done by taking small doses of LSD every other day.

&nbsp;

The following effects of LSD microdosing have been reported by many users<a href="#accordion">[8]</a>:&nbsp;&nbsp;

<ul>
	<li>Reduced anxiety</li>
	<li>Reduced depression</li>
	<li>Enhanced energy levels</li>
	<li>Reduced pain</li>
	<li>Headache&nbsp;</li>
	<li>Better sleep quality</li>
</ul>

<div>&nbsp;</div>

Though it is important to bear in mind that many, if not all of the previously mentioned&nbsp; effects, might be placebo effects as suggested by&nbsp; several researchers including the research conducted by the University of Chicago. The main issue is that these beneficial effects are reported in uncontrolled environments by regular users who have literally no idea of psychiatry and how the brain works.&nbsp;

&nbsp;

According to the research done by University of Chicago, they administered small doses of the psychedelic to people but ensured that the people were unaware of it in order to truly monitor their impact &ndash; without involving the bias from the subject&rsquo;s thoughts or attitudes towards the drug that would automatically alter the results. It was found that while the people experienced a little high, there was no actual mood enhancement or improved cognitive action in the brain<a href="#accordion">[9]</a>.

<div>&nbsp;</div>

Psilocybin is one of the most common substances that is used for microdosing. Researchers are heavily invested in trying to determine the true extent of its therapeutic uses and its impact on depression and anxiety: the two mental illnesses it is mostly used for treating. Microdosing Psilocybin has garnered mixed perspectives over the years, with experts on one hand calling it a mere placebo effect, and on the other there are studies that discuss its impact on the brain<a href="#accordion">[6]</a>.

&nbsp;

According to many researches based on experiments and data extracted from people who practice microdosing psilocybin, there has been a significant impact on their cognitive function and mental concentration<a href="#accordion">[3]</a>. However, research also indicates that&nbsp; full doses of the substance may lead to permanent behavioral changes, making it a very slippery slope with different possible outcomes, some of which may not even be desirable.&nbsp;

&nbsp;

Psilocybin administration is sometimes mixed with other substances like lion&rsquo;s mane mushrooms or niacin. This combination may not have a huge impact on younger users, but it is known to increase psychomotor functions in people over 55 years i.e., psychomotor performance was limited to older adults<a href="#accordion">[4]</a>.

&nbsp;

Interestingly, in many case studies, psilocybin users have been compared to placebo groups and both groups have reported similar effects<a href="#accordion">[7]</a>. Its impact on mood and mental health is still considered to be minimal and gradual.&nbsp;

&nbsp;

The issue is that since these <a href="https://merisehat.pk/article/the-rise-of-new-weight-loss-drugs-a-comprehensive-overview-and-accessibility-concerns">drugs</a>, especially psilocybin are illegal, there is little to no long-term extensive research on its use and its long-term effects. However, data accumulated from long-term abusers of such drugs suggests that prolonged use of psilocybin may lead to valve damage or cardiac valvulopathy<a href="#accordion">[5]</a>.

<div>&nbsp;</div>

The biggest risk with microdosing is the entire unsupervised practice itself. In many cases, people are just subjecting themselves to long-term health issues with no actual outcome because many studies have proven that in most cases, the benefits are caused due to placebo effects and the drugs may not have any significant impact on the individual at all.

&nbsp;

Despite this, the ever-growing community of microdosers is attracting a lot of people who are not well-versed with science. This not only gives rise to misuse and possible overdosing incidents; it also promotes the practice of illegal substance use that can potentially cause irreversible damage to the user.

<div>&nbsp;</div>

<ul>
	<li>Microdosing has been used in professional practices for a very long time for the determination of therapeutic index of the drugs.</li>
	<li>Currently, the process is used for inducing psychiatric effects on people with mental illnesses or just to enhance your brain function.</li>
	<li>While microdosing can be done on any drugs, the most commonly used type of drugs are psychedelics, including psilocybin and LSD</li>
	<li>Many researchers have reported that there is no robust evidence backing the self-proclaimed therapeutic effects of microdosing and these benefits are solely due to placebo effects.&nbsp;</li>
</ul>

<div>&nbsp;</div>

[1] Anderson T, Petranker R, Christopher A, et al. Psychedelic microdosing benefits and challenges: An empirical codebook. Harm Reduction Journal. 2019;16(1). doi:10.1186/s12954-019-0308-4

[2] Smith DG. More people are microdosing for mental health. but does it work? The New York Times.

[3] Nichols DE. Psychedelics. Pharmacological Reviews. 2016;68(2):264-355. doi:10.1124/pr.115.011478

[4] Rootman JM, Kiraga M, Kryskow P, et al. Psilocybin microdosers demonstrate greater observed improvements in mood and mental health at one month relative to non-microdosing controls. Nature News.

[5] Radcliffe S. Microdosing psilocybin mushrooms may improve mental health and mood. Healthline.

[6] Siebert A. Microdosing psychedelics is trendy, but does it work? here's what science says. Forbes.

[7] Kuypers KPC. The therapeutic potential of microdosing psychedelics in depression. Therapeutic Advances in Psychopharmacology. 2020;10:204512532095056. doi:10.1177/2045125320950567

[8] Microdosing LSD: Benefits, risks, and more. Medical News Today.

[9] Loomis I. Study of LSD microdosing doesn't show a therapeutic effect. UChicago Medicine.

Every Ice Is Not Cool

&ldquo;I destroy homes

I tear families apart

I&rsquo;ll take your children and that is just the start

I&rsquo;m more precious than diamonds, more valuable than gold

The sorrows I bring are a sight to behold&rdquo;

Even though the poem is someone else&rsquo;s discernment, I couldn&#39;t agree more. Crystal meth, ice, and methamphetamine are all names of the same drug that has been responsible for causing life-changing addiction and the reason behind the destruction of families. It changes how a person thinks about their life matters and even how they react to different situations.

Drugs are never good, but drugs like ice should be especially avoided because of their strong impact on the individual&rsquo;s cognitive abilities. 
&nbsp;

Understanding the Adverse Effects of Crystal Meth Addiction

Generally, people often confuse addiction with dependence. These are two separate states.

Addiction is when a person can&rsquo;t stop using a drug. They&rsquo;re basically abusing it, irrespective of any negative effect that they might be experiencing at the time. It can occur both with and without physical dependence on the drug; however, physical dependence is a common symptom of addiction.

On the other hand, dependence means that the body is dependent on the drug to function. So, the individual feels a need to use more of that substance to feel the same effect. If they stop taking it, they immediately experience withdrawal symptoms, including physical, behavioral, and psychological symptoms. 
&nbsp;

The following symptoms are considered red flags<a href="#accordion">[6]</a>:

<ul>
	<li>The uncontrollable and irresistible urge to (ab)use the substance, such that the person can&rsquo;t think of anything else</li>
	<li>The person wants to or already uses that substance regularly</li>
	<li>The person always has a supply at hand</li>
	<li>The person engages in risky behavior, including violence and unprotected sex</li>
	<li>The person is willing to spend money obtaining the substance even when they have financial issues</li>
	<li>The person uses more of the substance to get the same effect (tolerance level)</li>
	<li>The person uses the substance despite the problems it creates</li>
	<li>The person experiences withdrawal symptoms once they stop using it 
	&nbsp;</li>
</ul>

Ice is considered greatly addictive that can alter how the body responds to different situations, and its effects are often long-lasting. This synthetic product was initially introduced as a therapeutic intervention. However, due to more targeted drugs available, the use of methamphetamine as a therapeutic agent is now greatly reduced. Even in the rare cases that it is used, it is only prescribed for uncontrollable <a href="https://merisehat.pk/disease/attention-deficit-hyperactivity-disorder-adhd">ADHD</a> and severe obesity<a href="#accordion">[3]</a>.

The illegally-used drug called crystal meth is essentially methamphetamine that&rsquo;s available in the form of an ice-like crystal; semi-transparent and white or blue in color. Despite being illegal, this substance is frequently abused. 
&nbsp;

A study in 2020 shows that nearly 2,600,000 people who were 12 years or older, which is about 0.9% of the US population, were found to be using Methamphetamine, including its crystal form<a href="#accordion">[3]</a>.

Another study in 2020 reported that around 153,000 people aged 12 years and older used methamphetamine for the first time that year<a href="#accordion">[3]</a>.

Drug users heat the substance and then smoke it in a glass pipe. Sometimes, though, they&rsquo;d crush it and snort or inject it into their system. However, smoking is preferred because it&rsquo;s quickly absorbed into the bloodstream, which in turn causes ice addiction.

According to the United Nations Office on Drugs and Crime, around 500 metric tons of amphetamine stimulants were produced in the year 2015 alone! Statistics also show that there were around 24.7 million amphetamine drug abusers around the world and in the year 2018, this number dramatically progressed. Moreover, the abuse of street methamphetamine was mostly in parts of Asia, Europe, Australia, and the United States<a href="#accordion">[1]</a>. 
&nbsp;

It should be kept in mind that using crystal meth once only does not get a person addicted. However, it gives them a taste of all the ups and rarely of the down. They feel awake and full of energy, their appetite drops, and their heartbeat and breathing increases<a href="#accordion">[3]</a>.This rewarding feeling is what makes them crave more of that substance.

Studies in Pakistan show that ice is gaining popularity with the younger generation. A lot of healthcare practitioners and researchers have attested to the fact that a great number of users are made up of students, educated families, and well-off families. Also, parents do not let their kids get the necessary attention they need because of their apparent social status. This needs to be corrected because the usage of crystal methamphetamine among the Pakistani population is increasing by the day. Based on data shared by Pakistan&rsquo;s anti-narcotic forces, around 27 million people abuse drugs in Pakistan and the fact that families would rather keep it a secret means there&rsquo;s even less room for researchers to gather data to find the required treatment<a href="#accordion">[2]</a>. 
&nbsp;

If you thought ice was the coolest name (no pun intended), you are in for a treat because crystal meth is also known by these names:

<ul>
	<li>Glass</li>
	<li>Blade</li>
	<li>Crystal</li>
	<li>Quartz 
	&nbsp;</li>
</ul>

Biochemically, crystal methamphetamine is an excellent central nervous excitant. Those who abuse ice are easy to identify: their pupils are dilated, they breathe faster than usual, and experience excessive sweating. People high on meth also eat very less and complain about dizziness, headache, and nausea. They are unable to sleep for as long as they have meth available and the only time they actually sleep is when they faint! This can take days or even as long as a week, depending on how soon their stock lasts.

Their problems don&rsquo;t end even when they collapse because once they&rsquo;re conscious, they feel drained of energy and depressed. Consequently, they are more drawn to drugs or other addictive substances at that moment as it seems the only way to get rid of their fatigue and depression. Family members or loved ones may find small plastic bags with remnants of ice and narrow glass tubes with black substance in their stuff. 
&nbsp;

People who abuse ice often exhibit feelings of nervousness; they&rsquo;re talkative and overly energetic. If the drug usage is heavy or the symptoms are more severe, then they may even have visual hallucinations, like feeling as if insects are crawling under their skin, and trying to get them out usually results in injuries to the face or other parts of their bodies.

As mentioned earlier, pharmaceutical methamphetamine is manufactured as a medication to manage Attention-Deficit/Hyperactivity Disorder (ADHD) and even severe obesity<a href="#accordion">[4]</a>. When the drug is made for therapeutic purposes, it is classified as a Schedule II drug by the United States Controlled Substances Act, which means<a href="#accordion">[1]</a>:

<ul>
	<li>It has a high potential for abuse</li>
	<li>It has otherwise, accepted medical use</li>
	<li>It has the potential to lead to severe psychological or physical dependence 
	&nbsp;</li>
</ul>

Crystal meth use can have serious risks and may cause dangerous drug toxicity and an easy overdose amidst the rush. Side effects of doing ice include<a href="#accordion">[3]</a>:

<ul>
	<li>Rapid heart rate</li>
	<li>High blood pressure</li>
	<li>Increase respiratory rate</li>
	<li>Increased body temperature</li>
	<li>Dental problems</li>
	<li>Insomnia</li>
	<li>Anxiety</li>
	<li>Paranoia</li>
	<li>Aggression and violence</li>
	<li>Cardiovascular issues, such as stroke and heart attack</li>
	<li>Tremor</li>
	<li>Death 
	&nbsp;</li>
</ul>

When a person loses their &ldquo;high,&rdquo; they enter a zone called a &ldquo;tweaking&rdquo; stage<a href="#accordion">[5]</a>. During this stage, they start feeling hopeless and crave the ice drug again.

It is important to know that this is the time when the user experiences psychotic symptoms. This essentially means that the user experiences delusions and the reality starts seeming bizarre. They may also feel uneasiness throughout the time and, therefore, should get professional help, such as a rehabilitation program. Rehab is a facility that offers specialized treatment and empowers patients to get rid of the craving, i.e., become sober<a href="#accordion">[4]</a>. 
&nbsp;

Methamphetamine withdrawal is not easy and can cause multiple acute (short-termed) and post-acute symptoms that vary from person to person. The intensity of ice drug withdrawal symptoms depends on multiple factors, including the route of administration, dosage, drug concentration, previous withdrawal symptoms, and how long they have been taking the drug<a href="#accordion">[3]</a>. 
&nbsp;

Acute ice withdrawal symptoms include<a href="#accordion">[3]</a>:

<ul>
	<li>Fatigue</li>
	<li>Anxiety</li>
	<li>Irritability</li>
	<li>Lack of energy</li>
	<li>Increased weight</li>
	<li>Dehydration</li>
	<li>Chills</li>
	<li>Insomnia followed by hypersomnia</li>
	<li>Dysphoria, which can lead to clinical depression and thoughts about committing suicide</li>
	<li>Inability to process thoughts clearly</li>
	<li>Anhedonia</li>
	<li>Social withdrawal</li>
	<li>Drug cravings 
	&nbsp;</li>
</ul>

Post-acute ice withdrawal symptoms include<a href="#accordion">[3]</a>:

<ul>
	<li>Depression</li>
	<li>Mood swings</li>
	<li>Cravings</li>
	<li>Anhedonia</li>
	<li>Psychosis</li>
	<li>Suicidal thoughts</li>
	<li>Fatigue and hypersomnia</li>
	<li>An increase in appetite</li>
	<li>Sexual dysfunction and loss of libido 
	&nbsp;</li>
</ul>

The craving for the drug is a crucial symptom and, unfortunately, the hardest one to get rid of. It can lead to repeated drug use, commonly known as a relapse<a href="#accordion">[3]</a>.

Ice withdrawal symptoms appear to be terrifying and can be hard to face, but with professional help, it&rsquo;s possible to detox successfully.

It is not easy to be addicted to something and similarly, it is not easy to lose a loved one to drug addiction, too. We all need to understand that it is nothing to be ashamed of because feelings like these create a hindrance in the treatment plan that can be offered. 
&nbsp;

Doing drugs is not cool. You know what cool is? Being a hero. Be a hero to your family and see that they will not be able to live if something happened to you because you refused to accept medical help and give up your drug addiction. Be a hero to the other addicted people out there and show them it can be restrained. But most importantly, be a hero to yourself; you deserve a happy life, not a delusional one.&nbsp; 
&nbsp;

Key Takeaways

<ul>
	<li>Methamphetamine or ice is considered a greatly addictive substance that can alter how the body responds to different situations, and this can be quite long-lasting.</li>
	<li>The illegally-used drug called crystal meth is essentially methamphetamine, which is available in the form of an ice-like crystal &ndash; semi-transparent and white or blue in color.</li>
	<li>Usually, crystal meth or ice is heated and then smoked in a glass pipe.</li>
	<li>A study in 2020 shows that people who were 12 years or older, which sums up about 0.9% of the US population, were using methamphetamine, including its crystal form.</li>
	<li>Another study in 2020 reported that around 153,000 people aged 12 years and older used methamphetamine for the first time that year.</li>
	<li>The &ldquo;high&rdquo; that comes from abusing the drug makes them feel alert and full of energy; their appetite drops and their heartbeat and breathing increase.</li>
	<li>Based on the data received from the United Nations Office on Drugs and Crime, around 500 metric tons of amphetamine stimulants were produced in the year 2015 alone!</li>
	<li>Statistics also show that there are around 24.7 million amphetamine-type drug abusers around the world.</li>
	<li>Pakistan&rsquo;s anti-narcotic forces shared that around 27 million people in Pakistan abuse drugs.</li>
	<li>Meth is also known as glass, blade, crystal, and quartz.</li>
	<li>Ice drug users develop dilated pupils, breathe faster than usual, and even feel sweaty.</li>
	<li>They are unable to sleep as long as they have meth available and the only time they actually sleep is when they faint!</li>
	<li>Ice drug users will be more drawn to drugs or other addictive substances when they lose their high, as it will seem like the only way to get rid of their fatigue and depression.</li>
	<li>Biochemically, crystal methamphetamine is a central nervous excitant.</li>
	<li>Crystal meth is classified as a Schedule II drug by the United States Controlled Substances Act.</li>
	<li>Pharmaceutical methamphetamine is manufactured as a medication to manage Attention-Deficit/Hyperactivity Disorder (ADHD) and even severe obesity.</li>
	<li>Side effects of doing ice include a rapid heart rate, insomnia, paranoia, and tremors.</li>
	<li>The time when a person loses their high, they apparently enter a zone called a &ldquo;tweaking&rdquo; stage.</li>
	<li>Methamphetamine withdrawal is not easy and leads to multiple acute and post-acute symptoms that vary from person to person.</li>
	<li>Acute ice drug withdrawal symptoms can include fatigue, anxiety, and irritability.</li>
	<li>Post-acute withdrawal symptoms from the ice drug include depression, mood swings, and craving for meth.</li>
	<li>Ice withdrawal symptoms make the user extremely uneasy and unpleasant; however, it is not fatal.</li>
</ul>

[1] Meth use statistics around the world (2019). Delphi Health Group.

[2] Ice drug in Pakistan. IPCRC.

[3] Crystal meth side effects: Short- and long-term effects of Crystal Meth

[4] Written by: Lauren Brande MALupdated on J9. Crystal Meth abuse signs, symptoms, and addiction treatment.

[5] Elizabeth Hartney BS. What does it feel like to get high on methamphetamine? Verywell Mind

[6] Vandergriendt C. Meth addiction: Symptoms, getting help, detox, treatment, and more. Healthline.

Arbaz Ansari

We live in a hyperactive society, where we can get things done at our fingertips. That feeling of accomplishment can give you a dopamine rush. But, what happens when that feeling is taken away from you? You start finding other ways to satisfy your brain&rsquo;s hunger for that happiness and satisfaction. In many cases, people adopt hobbies to keep themselves busy. But in some cases, things may take a darker turn, making people resort to drugs. 
&nbsp;

In a fast-paced society, everyone is trying to get things done at their earliest. Exhausted from screens, work and education, we often find ourselves looking for a break. For some people blowing off steam could be as simple as going on a trip, but for others, it may mean going on a mental trip.

&nbsp;

For most of us using drugs seems like a simple question i.e. you can choose to do it or not do it. However, the case is very different for people who find drugs as their way of escape. The frustration mentioned above is just the tip of the iceberg. Societies across the globe are facing a myriad of issues. Cancel culture is rampant, as is creating and promoting superficial lifestyles on social media; the quest to be the best is no longer an option but rather a necessity, leading to increased frustration, hopelessness and <a href="https://merisehat.pk/disease/depression">depression</a>. These frustrations are further augmented in socially-closeted countries where men are met with hate when they express any emotions, while women deal with multiple unexplainable stigmas. This causes people to shut themselves in their own minds.&nbsp; 
&nbsp;

Drug abuse is becoming a growing concern in Pakistan, and is affecting all social classes. Various existing stigmas hinder people from seeking professional help for their mental health which contributes to pent-up frustrations, traumas, or experiences.&nbsp; 
&nbsp;

Hence, drugs provide a way for people to escape their harsh reality, experience a rush of happy chemicals, or numb themselves. In many cases of drug abuse, people are often victims of abuse, rape or some sort of traumatic experience. While this does not justify drug abuse, it identifies a crucial problem &ndash; the need for increasing mental health awareness in Pakistan.

&nbsp;

Understanding The Dangers of Drug Abuse

Pakistan&rsquo;s greatest tragic loss has been its youth to drugs in the early 90s. In 1989, heroin use became very common in Pakistan and Afghanistan<a href="#accordion">[1]</a>. However, the strict regulations imposed since then have aided in gaining good control over the situation<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

<h4>"Your breathing can be influenced by many things. Try out our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> to find out your respiratory rate now!" </h4>

Some commonly abused drugs in Pakistan include:&nbsp; 
&nbsp;

Hashish: Hash, also known as chars, is by far the most commonly consumed drug by all classes of Pakistan.&nbsp;

Hash is a potent form of marijuana and is known to form several long-term and short-term side effects. These include: 
&nbsp;

<ul>
	<li>Lightheadedness&nbsp;</li>
	<li>Learning difficulties</li>
	<li>Difficulty in thinking, problem-solving and registering senses</li>
	<li>Paranoia</li>
	<li>Headaches</li>
	<li>Anxiety&nbsp;</li>
	<li>Panic attacks</li>
	<li>Respiratory issues involving bronchitis, pneumonia and lung cancer</li>
	<li>Cardiac arrhythmias&nbsp; 
	&nbsp;</li>
</ul>

Edibles: These are normal foods infused with drugs of any kind. In most cases, the drug is marijuana. Edibles are very common among the younger generation, often consumed as a recreational activity. However, edibles give a much stronger and heightened effect of the drug, and run a massive risk of overdosing<a href="#accordion">[3]</a>. The side effects of edible consumption include: 
&nbsp;

<ul>
	<li>Severe anxiety and panic attacks</li>
	<li>Excessive drowsiness</li>
	<li>Hallucinations</li>
	<li>Vomiting</li>
	<li>Paranoia</li>
	<li>Psychotic episodes</li>
	<li>Respiratory depression</li>
	<li>Agitation</li>
	<li>Impaired motor ability</li>
	<li>Psychosis 
	&nbsp;</li>
</ul>

Heroin: Most commonly used by the homeless, or people belonging to the lower class. Due to its extreme affordability, heroin is one of the most addictive drugs in the world. The opioid drug is made from morphine, and is often injected for maximum bioavailability. It is believed that even a single dose of heroin can get you addicted due to its high analgesic effects<a href="#accordion">[4]</a>.&nbsp;The side effects of heroin include: 
&nbsp;

<ul>
	<li>Insomnia</li>
	<li>Collapsed veins&nbsp;</li>
	<li>Damaged tissues</li>
	<li>Infection of heart valves and lining</li>
	<li>Abscesses</li>
	<li>Sexual dysfunction</li>
	<li>Depression and antisocial personality disorder</li>
	<li>Pneumonia</li>
	<li>Constipation and stomach cramps 
	&nbsp;</li>
</ul>

Psilocybin Mushrooms: Commonly known as magic mushrooms or shrooms, they are most commonly consumed in Karachi. The drug gives you a euphoric feeling, while making you hallucinate. So far, they are not considered addictive, but can cause permanent damage to the brain<a href="#accordion">[5]</a>. The long-term side effects may include: 
&nbsp;

<ul>
	<li>Change in personality</li>
	<li>Hallucinations</li>
	<li>Tolerance requiring the user to consume more every time</li>
	<li>Hallucinogen Persisting Perception Disorder (HPPD) also referred to as &lsquo;flashbacks&rsquo; 
	&nbsp;</li>
</ul>

Dipping tobacco: Also known as moist snuff, it is called &lsquo;naswar&rsquo; in Pakistan. Commonly used in KPK, this is grounded moist tobacco that is not for smoking purposes. It is administered by taking a small chunk out and stuffing it in a corner of your mouth<a href="#accordion">[5]</a>. Tobacco use, in general, has many side effects including: 
&nbsp;

<ul>
	<li>Oxidative stress</li>
	<li>Cardiovascular diseases</li>
	<li>Dyslipidemia</li>
	<li>High cholesterol 
	&nbsp;</li>
</ul>

Drug addiction is not a battle fought by individuals, but by societies as a whole. Drug addiction in general is deep-rooted by societal flaws.&nbsp;

Instead of shaming drug addicts or people who have been finding solace in substances, we need to create avenues for their rehabilitation.&nbsp;

Our primary responsibility in this war is to create dialogues, be more vocal about our thoughts and experiences, and help others cope with their issues in the healthiest way possible.

We as a society need to normalize discussing and seeking help for mental health and addictions issues.&nbsp; Alongside investing in avenues which allows for effective rehabilitation and re-integration of recovered addicts in society.&nbsp;

Our society needs to create more dialogue and awareness regarding drug use, along with providing better solutions for people to release their pent-up frustrations.

&nbsp;

<ul><li>Pakistan has been battling street drugs and substance abuse for ages.</li><li>The most common types of drugs consumed in Pakistan include hashish, edibles of marijuana, heroin, naswar, and psilocybin mushrooms.</li><li>The solution lies in normalizing discussing and seeking help for mental health and addictions issues, alongside creating more dialogue and awareness regarding drug use.&nbsp;</li></ul>

[1].Haq, I., 1996. Pak-Afghan Drug Trade in Historical Perspective. Asian Survey, 36(10), pp. 945-963

[2].Gossop, M., 1989. The detoxification of high-dose heroin addicts in Pakistan. Drug Alcohol Depend, 2(1), pp. 43-50.

[3].Rehab After Work, 2020. The Dangers of Marijuana Edibles.

[4].National Institute on Drug Abuse, n.d. Heroin Drug Facts.

[5].Drug Policy Alliance, n.d. What are the long-term health impacts of psilocybin mushrooms?

[6].Faiza Sajid, S. B., 2015. Effects of smokeless dipping tobacco (Naswar) consumption on antioxidant enzymes and lipid profile in its users. Pak J Pharm Sci, 5(18), pp. 29-33.