Your drug questions answered
From alcohol to cocaine, caffeine to cough syrup, Wits experts shed light on legal and not-so-legal drugs of choice.
Why is alcohol socially acceptable but not cannabis?
One is legal and the other isn’t! Any drug in excess, including alcohol, is dangerous. More people are addicted to tobacco, nicotine, and alcohol, than to other drugs. Alcohol users are much more likely to develop dependence and build tolerance, making alcohol a major drug of addiction.
- Lenore Manderson, Distinguished Professor of Medical Anthropology and Public Health, School of Public Health
What makes Coca-Cola addictive? What happens to your body when you drink Coca-Cola?
Coca-Cola's addictive qualities can be attributed to its high sugar content which triggers dopamine in the brain, creating a temporary sense of happiness and satisfaction. Caffeine provides the stimulating effect. This and other similar drinks’ excessive sugar content is a major cause of obesity, which is linked to heart disease, stroke, diabetes, and some cancers.
- Professor Susan Goldstein, Public Health Medicine Specialist, Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health
What are the long-term effects of caffeine?
This is dependent on several factors including body weight, genetics, chronic health conditions (including medication) and the amount regularly consumed. Possible effects include insomnia, dehydration, gastric irritation, heart palpitations, tremors, nervousness and anxiety (including panic attacks). Two to three cups of coffee a day (200-300mg of caffeine) is regarded as moderate use unlikely to cause harm. Positive effects have also been ascribed to coffee due to the antioxidant and anti-inflammatory properties of some of its other 1 000 constituents apart from caffeine. These include a reduced risk of type 2 diabetes, liver disease, Parkinson’s, Alzheimer’s, stroke, heart failure and colon cancer.
Studies show that dopamine release in the brain is the specific neuropharmacological mechanism underlying the addictive potential of both caffeine and sugar and is also caused by other drugs of dependence, including amphetamines and cocaine.
- Professor Karen Hofman, Director, Centre for Health Economics and Decision Science PRICELESS SA, School of Public Health
What makes cough syrup and Bioplus addictive?
Cough syrup and Bioplus are two different types of medications, and their potential for addiction and side effects can vary significantly.
Cough syrups can be classified into those containing codeine or other opioids, and those without opioids. Cough syrups that contain opioids like codeine have a higher potential for addiction. Opioids are pain relievers and can cause feelings of euphoria, leading to their abuse. Prolonged use of these syrups can result in physical dependence, tolerance (needing more of the drug to achieve the same effect), and addiction. Over-the-counter cough syrups that do not contain opioids are generally not considered addictive.
Bioplus is a brand of energy supplement that typically contains caffeine whose potential side effects are answered in question 3.
What are the side effects of the long-term use of painkillers?
The long-term use of painkillers, especially opioids, can lead to several adverse effects, including tolerance, physical dependence, and withdrawal symptoms when stopped. Chronic use can lead to constipation, nausea, drowsiness, and impaired cognitive function. Additionally, opioids can depress respiratory function, posing a risk of overdose. Nonsteroidal anti-inflammatory drugs may lead to gastrointestinal issues like ulcers and bleeding, as well as kidney problems. Paracetamol, in high doses, can cause liver damage. It's crucial to use painkillers under medical supervision and explore alternative pain management strategies for long-term relief.
- Maxine Turner (née Grose), PhD Candidate, Department of Pharmacy
How does addiction actually work? Is it a psychological or physiological response, or a combination of both?
More than 60% of individuals who experience early life trauma, including fear are considered to be at risk of developing an addiction to a substance. Fear impacts on the development of a normal stress response system and consequently dysregulates brain circuits.
The circuits involved in addiction are the:
- amygdala and hippocampus affected by fear,
- nucleus accumbens and the ventral pallidum which respond to rewards that increase dopamine,
- anterior cingulate gyrus and prefrontal cortex, responsible for cognitive control, downregulate control of the orbito-frontal cortex, and
- Orbito-frontal cortex evaluates the value of rewards and the decision to use a substance is given.
Where does cocaine come from? And how does it work?
Cocaine is found in the leaves of the Erythroxylum coca plant and is indigenous to South America, Mexico, Indonesia, and the West Indies. Its use has been documented as early as the 1400s and remnants of coca leaves have been found in the remains of Peruvian mummies.
In 1860, an active ingredient of the coca leaf he called cocaine was isolated by Albert Niemann whose colleague went on to develop its chemical formula. The two were credited with finding the effect of cocaine on mucous membranes although Peruvian surgeon Moréno y Maïz subsequently conducted the first animal studies. In 1884 Carl Koller demonstrated the benefits of cocaine as an anaesthetic, sparking worldwide interest in the drug. William Halsted and Richard Hall later developed the nerve and regional blocking techniques of cocaine.
Cocaine gained popularity among the medical fraternity for its clinical benefits, but this rapidly changed when it became a drug with potential for social abuse.
Cocaine’s dopaminergic action affects the brain’s reward systems. High levels of dopamine produce intense feelings of energy and alertness inducing further cravings as well as increased tolerance levels. This can become dangerous and can lead to addiction and overdose. Furthermore, cocaine’s rapid absorption, delivery to the brain, short half-life, intense central and peripheral neural stimulation all contribute to its abuse potential.
Medical cocaine administered in a controlled environment has reduced risks of adverse effects whereas unregulated recreational cocaine use is potentially highly dangerous. Cocaine is a scheduled drug and as per the Medicines and Related Substances Act 101 of 1965, drugs used for medicinal purposes should not be used for “satisfaction or relief of a habit or craving for the substance used or for any other such substance, except where the substance is administered or used in a hospital or similar institution maintained wholly or partly by the Government or a provincial government or approved for such purpose by the Minister”.
Is it better to vape rather than to smoke cigarettes?
Both cigarette smoke extract and e-cigarette extract inhibit neutrophil function. Neutrophils are a type of white blood cell that act as your immune system’s first line of defence. It’s important to note that this occurs whether or not the vaping liquid contains nicotine. Neutrophils also produce cell free DNA by exostosis in the form of NETS – Neutrophil extracellular traps. While this property is inhibited by cigarette smoke extract it is not by e-cigarette extract. These August 2023 study findings indicate that, while e-cigarettes may be less harmful than traditional cigarettes in some respects, they are still harmful and their use has the potential to result in pulmonary (lung) infection.
- Guy Richards, Emeritus Professor of Critical Care, School of Clinical Medicine