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Other Commonly Abused Substances

By Gerald F. O’Malley, DO, Professor of Emergency Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University and Hospital ; Rika O’Malley, MD, Attending Physician, Department of Emergency Medicine, Einstein Medical Center

(See also Drug Use and Abuse.)

Recreational drug use typically involves mind-altering drugs, but it may involve drugs taken for other purposes, usually losing weight or enhancing athletic performance. Taking these drugs without medical need and medical supervision can endanger the quality of life, health, or safety of the user. Using a drug this way is considered a substance use disorder. Anabolic steroids are probably the most commonly used drugs in this group. Others include

  • Diuretics

  • Erythropoietin and darbepoetin

  • Growth hormone

  • Ipecac syrup

  • Laxatives

Diuretics

Diuretics are drugs that speed the elimination of salt and water by the kidneys. Diuretics are used to treat a variety of disorders, including high blood pressure and heart failure. However, some people, including athletes and people with eating disorders such as anorexia nervosa, take diuretics to help them lose weight quickly. Inappropriate use of diuretics may cause dehydration and severe deficiencies of electrolytes such as potassium. Such deficiencies can lead to severe illness or death.

Erythropoietin and Darbepoetin

Erythropoietin is a hormone produced by the kidneys. It stimulates bone marrow to produce red blood cells. Erythropoietin is also manufactured as a drug. Darbepoetin is a drug similar to erythropoietin. Both drugs are used to increase production of red blood cells in people with certain kinds of anemia. These drugs may be taken by athletes because they believe that with more red blood cells, more oxygen can get to their muscles, enabling them to perform better.

Using erythropoietin or darbepoetin without medical need may change the body’s regulation of red blood cell production, so that the number of red blood cells suddenly decreases when these drugs are stopped.

Growth Hormone

Growth hormone is produced by the pituitary gland to help the body control how proteins, carbohydrates, and fats are used to stimulate growth. Growth hormone is also manufactured as a drug and is sometimes given to children of small stature when their body is unable to make enough growth hormone. Some athletes abuse growth hormone because they believe it can increase muscle growth and strength while decreasing body fat.

Use of growth hormone without medical need over a long period can cause an increase in fat levels in the blood, diabetes, and an increase in heart size, which may result in heart failure.

Laboratory tests to identify growth hormone not made by the person’s own body are not routinely available.

Ipecac Syrup

Ipecac syrup is a drug that triggers vomiting. It is sometimes used to treat children who have swallowed chemicals or poisons. However, people with eating disorders such as anorexia nervosa often take ipecac syrup to help them lose weight. Inappropriate use of ipecac may cause diarrhea, severe deficiencies of electrolytes, weakness, irregular heart rhythms, and heart failure.

Laxatives

Laxatives are drugs that speed the passage of substances through the digestive tract and that are used to treat constipation. However, people who falsely believe they must have frequent bowel movements as part of being healthy often abuse laxatives. In addition, people with eating disorders such as anorexia nervosa sometimes take laxatives because they believe doing so can help them lose weight.

Laxatives used often and without medical need may cause dehydration and severe deficiencies of electrolytes. Regular use of laxatives can also interfere with absorption of other drugs, causing them to stop working. Inappropriate use of laxatives over a long period can damage the muscle layers of the large intestine. Severe constipation and other intestinal disorders (such as diverticulosis) may result.

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