One thing I love about working in addictions and recovery is that I learn something new about substance abuse every day. Lately, it's been how people are abusing substances. Some of the most memorable ways, I can't post because I risk running afoul of HIPAA. Which is a shame because yesterday I learned a beauty that actually had me running for my reference books to see if it was REALLY possible to do the drug that way. I mean, the patient was doing it that way for more than a decade...but was it really affective for a high? Maybe it was effective enough for the patient to keep doing it like that.
Let's just say that many substances that are originally meant to be oral aren't always used orally. A lot go up the nose. Three years ago, I never would have dreamed that I'd be asking a patient on alprazolam (Xanax), "how much are you taking, and do you swallow or snort it?" Now I routinely ask even my non-CD patients that. Apparently you can get a good high using ground-up benzos and opiates intranasally.
Injection--usually IV but occasionally IM--is also popular for PO/sublingual meds. A few of them use PO/sublingual meds rectally or vaginally. You'd think that was just a hospice thing, but nope.
Transdermal patches; not just for the skin. In addition to placing fentanyl and other patches in covert places to avoid detection (don't ask me where I've found some of them), sucking on them is a popular way to get stoned. There's also apparently a way to extract the drug by needle for a IV/IM/PO dose, but I haven't figured out how that'd be possible.
Good old THC: smoked as well as noshed on. In fact, there are cookbooks devoted to the art of cooking with marijuana! Out of curiosity, I downloaded one: the Stoner's Handbook. Apparently the key to successful (read: effective) MJ consumption is fat: because THC is fat soluble, whatever you cook it in has to have fat for it to be absorbed in the GI tract. I did find a mac and cheese recipe (with bacon!) in there that I'd like to try, except that I'd have to cut out the ganja butter and substitute Land o' Lakes.
Alcohol is alcohol: it appears the best way that works is PO. Haven't come across a single patient that tried to IV/IM some whiskey or Coors' Light....not yet anyway.
I tell you, addictions/detox is never dull.
