32
Table 1. Toxic effects and addiction risk of major illicit and
licit psychoactive substances
a
/
Drug category
Acute toxicity Chronic toxicity
Relative
risk of
addiction
Alcohol and related
drugs (benzodi-
azepines, barbitu-
rates)
Psychomotor impairment, impaired
thinking and judgement, reckless or
violent behaviour; lowering of body
temperature, respiratory depression
Hypertension, stroke, hepatitis,
cirrhosis, gastritis, pancreatitis,
c/
organic brain damage, cognitive
deficits, foetal alcohol syndrome,
c/
withdrawal effects: shakes, seiz-
ures, delirium tremens
3
Cocaine,
amphetamines
Sympathetic overactivity: hypertension,
cardiac arrhythmias, hyperthermia; acute
toxic psychosis: delusions, hallucina-
tions, paranoia, violence, anorexia
Paresthesias, stereotypy, seizures,
withdrawal depression, chronic
rhinitis, perforation of nasal
septum
1
Caffeine Cardiac arrhythmias, insomnia, restless-
ness, excitement, muscle tension,
jitteriness, gastric discomfort
Hypertension, anxiety, depression,
withdrawal headaches
5
Cannabis (mari-
juana, hashish)
Psychomotor impairment; synergism with
alcohol and sedatives
Apathy and mental slowing,
impaired memory and learning
(brain damage?), impaired
immune response
b/
4
Nicotine Nausea, tremor, tachycardia; high doses:
hypertension, bradycardia, diarrhoea,
muscle twitching, respiratory paralysis
Coronary, cerebral and peripheral
vascular disease, gangrene, gastric
acidity, peptic ulcer, withdrawal
irritability, impaired attention and
concentration, retarded foetal
growth, spontaneous abortion
b/
2
Opiates Sedation, analgesia, emotional blunting,
dream state; nausea, vomiting, spasm of
ureter and bile duct; respiratory dep-
ression, coma, synergism with alcohol
and sedatives; impaired thermoregula-
tion; suppression of sex hormones
Disorders of hypothalamic and
pituitary hormone secretion,
constipation, withdrawal cramps,
diarrhoea, vomiting, gooseflesh,
lacrimation and rhinorrhea
2
Hallucinogens
(LSD, PCP)
Sympathetic overactivity; visual and
auditory illusions, hallucinations,
depersonalization; PCP only: muscle
rigidity, hyperpyrexia, ataxia, agitation,
violence, stereotypy, convulsions
Flashbacks, depression, prolonged
psychotic episodes
5
Source: Avram Goldstein and Harold Kalant, "Drug policy: striking the right balance", Science, 28 September 1990,
p. 1514.
a/
Listed here are effects due to the drugs themselves. As the effects are dose-related and subject to individual variation
in sensitivity, not all are expected to be seen in every user. Approximate rankings for relative risk of addiction are on a five-
point scale, where 1 is most severe.
b/
Bronchitis, emphysema, precancerous changes, lung cancer, pulmonary hypertension, and cardiovascular damage by
carbon monoxide are consequences of smoking tobacco or marijuana, not due to the respective psychoactive drugs. Inhalation
of smoke by non-smokers is also a significant hazard. With equivalent smoking, these chronic toxic effects occur sooner with
marijuana than with tobacco.
c/
These effects result only from alcohol, not benzodiazepines or barbiturates.