Q: My friends say that smoking out of a hookah (or shisha) is safe and not bad for you like cigarettes are. What are the health facts on smoking out of a hookah?

A: Tobacco smoked out of hookahs (also known as shishas or Arabic water pipes) involves the same risks as smoking tobacco in any other form, including increased risk of developing lung cancer and other respiratory-related health problems. Be cautious when tobaccos sold for hookahs claim to contain no tar, as the tar is only produced when the material is smoked. Sometimes, people smoke herbal fruits or flavors out of hookahs, but there exists no research on possible effects from smoking non-tobacco material. 

Q: Is it okay to vomit after ingesting mushrooms containing psilocybin?

A: Yes, many people vomit after ingesting “magic” mushrooms. This does not mean one is necessarily having an adverse reaction. 

Q: What are the risks associated with using cough syrup to get high? It has seen a lot of attention in the media and I trust that Safety First can provide realistic information.

A: There is little evidence that cough syrup is currently widely abused. When it is used by teenagers to “get high”, the doses consumed are too small to cause serious poisoning.

Most cough syrups contain a mixture of medicinal compounds. A few preparations are high in ethanol, which at significant doses cause intoxication akin to drunkenness. However, since swallowing large amounts of cough syrup is difficult and noxious, therefore little alcohol intoxication exists.

The medicinal compound of real importance in most OTC cough remedies is dextromethorphan. This is the active ingredient in all ‘DM” products and in some not labeled DM. This compound, which has slight abilities to suppress cough, is derived from synthetic opioids. It has very little, if any, opiate effect. In very high doses some consumers have described a “dissociative” effect—separating the user from sensory input without causing coma or unconsciousness. Some substances with this effect have been misused, such as phencyclidine and ketamine, both of which have been studied as anesthetics. I doubt that DXM has major dissociative effects but there are websites describing this effect and how to achieve it.

Assessment of fake ecstasy (MDMA) has revealed some DXM substitution. DXM is only legally available in the USA in liquid cough preparations, though there are some capsular DXM products available outside the USA.

Some cough products contain anticholinergic products (chlorpheneramine, atropine, ipratropium etc.). These agents in high doses cause excitation, elevated temperature, urinary obstruction and other severe effects. These are usually not encountered in cough syrup consumption because the dose is not high enough. DXM poisoning is usually not serious because the dose is not high enough. Remember the magic phrase of toxicology (paraphrasing Paracelcus); “it’s the dose that makes the poison.”

Q: What is Formaldehyde and what would Formaldehyde be classified as? Thank you for help.

A: Formaldehyde is a tissue preservative and ingredient used in embalming fluid. There is a pervasive belief in the USA that marijuana is treated with formaldehyde and sold as “dank” or “wet” and is extremely powerful and dangerous. Law enforcement agents often claim that this mixture causes strange and crazy behavior in users. I have never seen an analysis of marijuana confirming the presence of formaldehyde. In a group of users presenting to an emergency room claiming the prior use of “dank,” upon analysis the material contained phencyclidine (“angel dust” or PCP). PCP was once called “embalming fluid” on the street and has been added to marijuana or other smoking materials and perhaps resulted in the claim that it is embalming fluid.

Q: I recently found around 300 25 mg tablets in my son’s room. They are something called Nortriptyline. I looked them up on the Internet and don’t understand why or what he may be doing with them. Could you tell me what kids may be doing with these or did they just get them from a parent’s medicine cabinet?

A: This antidepressant, like its relative amitriptyline (Elavil), has some sedative properties and I have known individuals taking it to promote sleep. However, it is has little abuse potential and is not a controlled substance. As you suspect, it was likely procured from a parent’s medicine cabinet.

Q: What does it mean to lose a vein?

A: It is my understanding, having spoken with hundreds of intravenous drug users, that losing a vein means that that particular vein has been used so much to inject, that it closes off and can no longer be used for that purpose.

Q: What are the short long-term effects for roofies (rohypnol)? How is it used? Who most often use it? Is there a treatment? What are the effects of it?

A: To learn about Rohypnol (and other drugs), we encourage you to get the book, “From Chocolate to Morphine: Everything You Need to Know about Mind-Altering Drugs,” which provides a very balanced point of view on a wide array of drugs. You can read a review of the book and buy a copy in our Resources section.

On page 88, the authors state:
“A newer drug of this class [antianxiety drugs] deserves special comment. Flunitrazepam (Rohypnol) is not approved in the United States but is marketed in the rest of the world as a remedy for insomnia and as a pre-anesthetic medication for patients undergoing surgery. It is much more potent than Valium, last longer (eight hours or more), and has become widely available on the black market under the name “roofies.” Most users take it with other drugs. For example, they use it to enhance the high of low-quality heroin or to come down off crack cocaine. Most often, people mix it with alcohol, a potentially dangerous combination that can cause disorientation, amnesia, respiratory depression, and death.

Using tranquilizers to deal with everyday difficulties cause the same problem associated with all depressant drugs: long-timer dependence of a particularly stubborn kind. It is very difficult to wean people off benzodiazepines, since the withdrawal is unpleasant and dangerous. (Abrupt cessation can cause seizures and respiratory arrest.) Even though the health consequences of dependence on antianxiety drugs may be less severe than those of dependence on alcohol, the result is the same. There is no treatment of the underlying causes of anxiety, merely the creation of a legal drug habit.”

Q: We have a son who is taking "Zanies" along with beer. We need information that helps us understand what he is doing (swallowing a pill, crushing and inhaling, or what?), the immediate effects, and long-term effects.

A: When you say, "Zanies," we assume you mean Xanax (alprazolam). If that's the case, we encourage you to get the book, From Chocolate to Morphine: Everything You Need to Know About Mind-Altering Drugs.

In terms of the method of administration (ingesting or inhaling), the faster the effects of the drug are felt, the more likely the potential for abuse, with smoking and injection as the most immediate, followed by snorting, and finally ingestion. Pills, such as Xanax, can be crushed and snorted, or ingested.

From the book (pgs. 86-89):
Xanax is a minor tranquilizer - simply another variation on the theme of alcohol and other sedative-hypnotics, with the same tendency to produce adverse effects and dependence. While they are safer in overdose and somewhat less dangerous in combination with alcohol than barbiturates, they can still make driving dangerous, and interfere with other motor skills, as well as memory and clear thinking. Be aware that these drugs are depressants and can cause unpleasant reactions and dependence.

Q: I have a mentally ill brother who used illegal drugs. Doesn't use of drugs, such as PCP, cause permanent mental illness?

A: We know of no evidence that mental illness is caused by PCP, or other licit or illicit drugs in common use. Of course, drugs make some people act strangely when they are under the influence or have overdosed. PCP has a particularly bad reputation in this regard. Fortunately, use of PCP has dropped to near zero levels in the USA.

Young people and adults who are mentally troubled, or on their way to serious mental illness, often attempt to manage their feelings and perceptions through use of alcohol or illicit drugs, to feel okay in other words. Heavy cigarette smoking among many schizophrenics seems to be an example of a legal (nicotine) that may have some kind of ameliorative effect. It appears that illicit drugs in common use neither heal nor cause mental illness. There is growing evidence that serious mental illnesses such as major depression and schizophrenia have preexisting, biogenetic causes and are to a degree treatable with anti-depressant and anti-psychotic pharmaceutical drugs.

Q: How do people act when they are on drugs? Like do they get moody or angered easily?

A: Each drug (including alcohol) produces a unique effect, and every individual responds differently, even to the same substance. Some drugs produce moodiness or anger in some individuals. Dr. Norman Zinberg’s classic book, “Drug, Set, and Setting,” explains this more fully. I recommend that you read it, and check out our Fact Sheets.

Q: Hello! What do you suggest I do? A year ago, I decided to help one a friend who had dropped out of two schools due to amphetamine and marijuana use. We dated and I thought I could influence by serving as a role model as I don't use drugs. I tried to show her life that without drugs can be wonderful. I even started to teach her ride how to snowboard, but nothing helps as she has become very apathetic. She tells me that she's not taking drugs anymore, but I am not convinced as she continues to go play slots at the local bar where all of her so-called 'friends' are - drug users - and I sometimes see her looking strange, with bloodshot eyes. My question is whether or not there is a standard or well-known method used to stop drug use.

A: You deserve credit for trying to help your friend and you should not feel badly about being unable to help her. A basic principle of intervention is that people do not quit drinking or using to please others. They may moderate or stop for a while, but pleasing someone else does not work in the long run.

Drug and alcohol abusers do not seek help until they realize they are living miserable lives because of alcohol and/or drugs. The 12-Step principle, "sick and tired of being sick and tired," sums it up. Unfortunately, many never get to this point on their own or even with help from others. Friends can assist, especially by helping the user connect their problems in living to alcohol or drugs. Never criticize or condemn the user, but rather focus on the results of use in their lives and its negative effect on others. Saying that they drink or use too much is pointless. It will only evoke denial. If you want to know more about this approach get a copy of the classic book Motivational Interviewing: Preparing People to Change Addictive Behavior by William R. Miller and Stephen Rollnick (The Guildford Press). In the meantime, take care of yourself. Tell your friend that when she is ready you will be there to help. But let go for now.

Q: On New Year’s Eve, my daughter came home from a friend’s house -- there was a party going on -- she feels that someone put something in her drink and she was very scared. She was numb for a while and then felt like she was floating. What could this be and should we take her to the hospital? What should we do? We have never had this happen and we don't know what to do. Thanks.

A: It sounds like your daughter's drink was spiked, with Ketamine, GHB, or Rohypnol. This very thing happened to my daughter when she was in college, and after the event she was fine. If your daughter is OK now, there is no reason for alarm, but it is important to follow up. The best time to talk about it would have been when she told you about her experience because by now she may not want to talk it.

It is clear that she was frightened and that is a good thing. If she still wants to discuss the experience, ask her how she might avoid having it happen again? Let her come up with the answers, but think of some yourself in case she asks you. For example, she should make sure she sees what goes into her drink. Perhaps she should not drink at all.

In the long run her experience may be a beneficial learning experience. It can be a dangerous world and being more aware of the dangers is good for all of us.