Drugs of Abuse & Withdrawal
Stimulants, opioid dependence and its treatment, and other recreational drugs.
Stimulant Toxicity: Cocaine, Amphetamines and the Beta-Blocker Trap
Most poisons quieten the body — opioids slow the breath, sedatives dim the mind. Stimulants do the opposite: they turn the sympathetic nervous system up to a roar and leave it stuck there. The patient is hot, wired, pupils blown wide, heart racing against a soaring blood pressure. The danger is not just how ill they look but the quiet catastrophes underneath — a coronary in a twenty-year-old, a torn aorta, a bleed in the brain, muscle dissolving into the bloodstream. And there is a trap laid for the unwary doctor: the one obvious drug you reach for to slow that racing heart can kill the patient. Getting stimulant toxicity right is as much about what you must not give as what you do.
Opioid Dependence and Its Treatment: Agonists, Partial Agonists and Antagonists
The naloxone chapter is about the crash — the blue, apnoeic patient who needs their receptors emptied in seconds. This chapter is about everything that happens between the crashes: the slow rewiring of a brain around a drug, the misery of withdrawal, and the quietly brilliant pharmacology that treats it. The remarkable thing is that the three medicines that pull people out of opioid use disorder are the three textbook categories of receptor drug — a full agonist, a partial agonist, and an antagonist — each doing its job at the very same mu receptor. Get the pharmacology, and the whole treatment logic falls into place.
Other Recreational Drugs: Cannabinoids, Hallucinogens, GHB and Inhalants
Opioids and stimulants dominate the poisoning textbooks, but the party bag holds much more: the cannabinoids, the psychedelics and dissociatives, the club sedative GHB, and the solvents and nitrites that a teenager can buy at a corner shop. Most of these rarely kill, and most of the management is unglamorous — a quiet room, fluids, and a benzodiazepine. But each class hides one or two specific traps that turn a routine intoxication into a corpse: a synthetic cannabinoid that seizes, a solvent that stops the heart, a nitrite that turns the blood brown. Knowing which traps go with which drug is the whole game.
