From a public health perspective, substance abuse has long been a source of major concern, both for the individual’s health and for wider society as a whole. The UK has the highest rates of recorded illegal drug misuse in the western world. In particular, it has comparatively high rates of heroin and crack cocaine use. Substances that are considered harmful are strictly regulated according to a classification system that takes into account the harms and risks of taking each drug (see the tables) (Nutt et al. (2007)). The adverse effects of drug abuse can be thought of in three parts that together determine the overall harm in taking it: (1) the direct physical harm of the substance to the individual user, (2) the tendency of the drug to induce dependence, and (3) the effect of abuse of the drug on families, communities, and society (Gable (2004, 1993)). In this report, we discuss published evidence relating to the harm of substance misuse and consider the neuropsychopharmacological mechanisms behind addiction in an attempt to gain an improved picture of the potential devastation that abuse of these substances may evoke. 1. The Direct Physical Harm of the Substance to the Individual User The physical harm caused by a drug needs to be considered in terms of its acute toxicity, as well as its likelihood to produce long-term health problems. 1.1. Acute Toxicity Acute toxicity is the adverse effect produced by a drug following either a single exposure or multiple exposures under 24 hours apart. It is assessed by measuring the ratio of lethal dose to therapeutic dose. Research conducted on 20 human and nonhuman lethal doses of abused substances, which are distributed widely in Europe and North America, identified intravenous heroin to have the greatest direct physiological toxicity. Hallucinogens in general appeared to have the least [1]. The clinical sequelae of exposure to toxic levels of a drug can be present in a specific set of symptoms referred to as toxidrome. Cocaine, for example, at low doses produces euphoria, reduced fatigue, and a perception of increased mental acuity. Higher doses may result in several undesirable side effects including irritability, paranoia, panic, repetitive stereotyped behaviour, diaphoresis, mydriasis, tachyarrhythmias, stroke, and seizure [2, 3]. A thorough exploration of common and important toxidromes is beyond the scope of this paper but detailed information for UK healthcare professionals can be found on the clinical toxicology database [4]. 1.2. Long-Term Health Problems As well as acute physical harm, many drugs when
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