60.7% of TTU students have never used tobacco/nicotine delivery products, e.g., cigarettes, e-cigarettes, vape products, water pipe or hookah, chewing tobacco, cigars, etc.² There are long-term effects on the brain even with short term nicotine usage. Although nicotine itself does not cause cancer, cigarette smoke contains over 7,000 chemicals, at least 69 of which are known to cause cancer.³ Smoking is also directly responsible for about 90% of lung cancer deaths.³

Here's a non-comprehensive list of some of the chemicals in tobacco smoke and where else they can be found:³

• Acetone, found in nail polish remover
• Acetic acid, an ingredient in hair dye
• Ammonia, a common household cleaner
• Arsenic, used in rat poison
• Benzene, found in rubber cement and gasoline
• Butane, used in lighter fluid
• Cadmium, an active component in battery acid
• Carbon monoxide, released in car exhaust fumes
• Formaldehyde, embalming fluid
• Hexamine, found in barbecue lighter fluid
• Lead, used in batteries
• Naphthalene, an ingredient in mothballs
• Methanol, a main component in rocket fuel
• Nicotine, used as an insecticide
• Tar, a material for paving roads
• Toluene, used to manufacture paint

Nicotine can especially harm the brain as it continues developing until about age 25, and people who vape/smoke are more susceptible to severe complications from illnesses. Smoking cigarettes affects every organ in the body, particularly the lungs and heart. In liquid and vaporized forms (smoke and vapes), nicotine is easily absorbed from the lungs into the blood stream. Nicotine then stimulates the adrenal glands to release adrenaline; this stimulates the central nervous system and increases blood pressure, breathing, and heart rate. 

Lung diseases:

• Chronic bronchitis
• Emphysema
• Chronic obstructive pulmonary disease (COPD)
• Exacerbate asthma symptoms

Heart diseases:

• Stroke
• Heart attack
• Vascular disease
• Aneurysm

Vaping can be less harmful than smoking, but it's still not safe. 63% of youth are unaware that vapes contain nicotine.⁴ However, vapes and e-cigarettes contain nicotine and are extremely addictive.

Nicotine content in cigarettes and vapes vary. Cigarettes can carry 6 - 28 mg of nicotine, while vapes can range from 0 (nicotine-free) - 50 mg. It is difficult to compare smoking via cigarette vs. vape as there are discrepancies by brand, nicotine content, puff amount and duration, etc.; however, 1 mL of vape juice typically yields about 100 puffs, meaning that roughly 1 mL of vape juice is equivalent to about 4-5 packs of cigarettes.⁵

What's in the pod:

• Nicotine is a highly addictive substance that negatively affects adolescent brain development
• Propylene glycol is a common additive in food; also used to make things like antifreeze, paint solvent, and artificial smoke in fog machines
• Carcinogens are chemicals known to cause cancer, including acetaldehyde and formaldehyde
• Acrolein is an herbicide primarily used to kill weeds, can cause irreversible lung damage
• Diacetyl is a chemical linked to a lung disease called bronchiolitis obliterans aka "popcorn lung"
• Diethylene glycol is a toxic chemical used in antifreeze and linked to lung disease
• Heavy metals such as nickel, tin, lead
• Cadmium is a toxic metal found in traditional cigarettes that causes breathing problems and disease
• Benzene is a volatile organic compound (VOC) found in car exhaust
• Ultra-fine particles that can be inhaled deep into the lungs

As with most addictive substances, nicotine activates the brain's reward circuits and increases levels of a chemical messenger in the brain called dopamine, which reinforces rewarding behaviors. The reward from nicotine is what causes its highly addictive properties.

Repeated exposure alters circuit sensitivity to dopamine and leads to changes in other brain circuits responsible for learning, stress, and self-control. For many tobacco users, the long-term brain changes induced by continued nicotine exposure result in addiction. Most smokers would like to stop smoking, and each year about one half of smokers try to permanently quit. Yet, only about 6% of smokers can quit each year ⁴ because it is such an addictive substance. Being without nicotine can cause a regular user to experience irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite. These withdrawal symptoms may begin within a few hours after the last cigarette, quickly driving people back to substance use.

In addition to the drug's impact on neurotransmitters and their receptors, behavioral factors can affect withdrawal symptom severity. For many people who smoke, the feeling, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can worsen withdrawal or craving.

The least risky way to engage with any substance is abstinence. E-cigs containing very low percent per mL of nicotine are safer alternatives to smoking cessation (e.g., smoking cigarettes), with less long-term damage from smoke. However, they are not inherently “safe.” Decrease substance cravings by changing cues/routine (e.g., rearrange furniture, go for a walk, watch a new show).

Cocaine is a powerful stimulant drug made from the leaves of the coca plant. Cocaine may occasionally be used as local anesthesia for some surgeries, but the recreational use is illegal. Street dealers may mix cocaine with cornstarch, flour, or synthetic opioids to increase profits. Adding synthetic opioids, like fentanyl, to cocaine can increase the risk of accidental overdose. 

Cocaine increases the levels of dopamine in the brain by preventing dopamine from being recycled, causing large amounts to accumulate and halt normal communication. With repeated cocaine use, the brain becomes less sensitive to the drug. This can lead to users taking stronger and more frequent doses to try to obtain the same high. Cocaine's effects appear as soon as the drug is consumed and last up to an hour. When cocaine is mixed with alcohol, the two substances create cocaethylene, a dangerous substance that can catalyze the toxicity of alcohol and cocaine on the heart.⁷

Repeated use of cocaine can cause the brain's reward pathways to become desensitized to natural triggers. Meanwhile, stress circuits become more sensitive, leading to increased discontent and adverse moods when not taking the drug, meaning less cocaine may be needed to produce toxic effects in the body. These two effects often encourage addiction, and tolerance to cocaine through repeated use can increase risk of overdose.

Potential short-term physiological effects:

• Mental alertness
• Hypersensitivity to sight, sound, and touch
• Restlessness 
• Anxiety and panic
• Irritability
• Paranoia
• Tremors
• Vertigo
• Muscle twitches

Severe medical complications that can occur:⁷

• Cardiovascular effects, including disturbances in heart rhythm, heart attack, inflammation of the heart muscle, deterioration of the ability of the heart to contract, and aortic ruptures
• Neurological effects, including headaches, seizures, strokes, coma, bleeding within the brain, and psychosis
• Gastrointestinal effects, including abdominal pain, nausea, and tears and ulcerations within the gastrointestinal tract
• Sudden death, most commonly from cardiac arrest or seizures

Health effects may depend on the method used to consume cocaine:

• Snorting: Loss of smell, nosebleeds, frequent runny nose, and problems with swallowing
• Smoking: Cough, asthma, respiratory distress, and higher risk of infections like pneumonia
• Consuming by mouth: Severe bowel decay from reduced blood flow
• Needle injection: Higher risk for contracting HIV, hepatitis C, and other bloodborne diseases; skin or soft tissue infections; as well as scarring or collapsed veins

7.3% of TTU students reported that they had ever used cocaine.² In Texas, any amount of cocaine in someone's possession is an automatic felony. Penalties can range from fines, arrests, and time in prison depending on the amount of cocaine in someone's possession. 

MDMA is a synthetic drug that is both a stimulant and a hallucinogen that can come in pill or powder form. MDMA is commonly known as ecstasy or molly and produces feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception. 

The effects of MDMA usually set in within 45 minutes of taking a single dose. Users report feeling an enhanced sense of well-being, increased extroversion, emotional warmth, empathy, willingness to discuss emotionally charged memories, and enhanced sensory perception.⁸

Ecstasy pills may be laced with other substances, like caffeine or amphetamines, to make the drug cheaper. When MDMA is laced with amphetamines, like speed or meth, it may lead to heart issues or overdose. 

Adverse effects to MDMA include:

• Restlessness, insomnia, irritability, depersonalization, anxiety, and panic attacks
• Nausea 
• Jaw clenching, teeth grinding, and muscle or joint stiffness
• Increased heart rate and high blood pressure 
• Impulsiveness
• Dysregulation of body temperature, including hyperthermia, hot flashes, or chills
• Loss of consciousness and seizures

With regular use of MDMA, users have reported sleep disturbances, lack of appetite, concentration difficulties, depression, heart disease, and impulsivity.⁶ MDMA can be fatal in certain situations; the effects of the drug, combined with a hot environment, physical activity, and other drugs can lead to physical complications and possible fatal events.

Warning signs of a serious physical complication or fatal event after MDMA use include:

• Excessive thirst and profuse sweating
• Muscle cramping
• Shaking chills
• Blurred vision
• Fainting 
• Seizures

These signs can lead to liver, kidney, or heart failure. In extreme conditions, this could result in death. If you notice someone experiencing these symptoms, call emergency services immediately. 

Methamphetamine, or meth, is a synthetic and powerful stimulant affecting the central nervous system. Meth releases large amounts of dopamine into the brain, making it difficult for individuals to quit using the substance.

Meth affects both the brain and the body. It can speed up the body's systems to dangerous and sometimes lethal levels, including increasing blood pressure and heart rate. Meth is highly addictive and with long term use can cause severe changes to segments of the brain involved with emotion and memory.

Short-term risks include:

• Decreased appetite
• Weight loss
• Anxiety
• Hypothermia
• Higher heart rate and blood pressure

Long-term risks include:

• Damage to the kidney and liver
• Heart damage
• Hallucinations
• Anxiety and depression
• Paranoia          

In 2021, over 100,000 people lost their lives in the United States due to a drug overdose. Of this total, 66% of overdose deaths were attributable to opioids.⁹Opioids are pain-relieving drugs that can produce feelings of relaxation, euphoria, and pleasure. Opioids include drugs like codeine, heroin, opium, oxycodone, morphine, and fentanyl. Many opioid drug overdoses can be attributed to an increase of illegally used fentanyl.

Opioids attach to proteins called opioid receptors in the brain and body. When opioids attach to receptors, pain messages that are usually sent from the body to the brain are blocked.¹⁰

Side effects and risks include:

• Sleepiness and relaxation
• Euphoria
• Nausea and vomiting
• Constipation
• Slowed breathing
• Confusion, dizziness, and increased risk of bone fractures 
• Depression
• Liver damage
• Sensitivity to pain and an extreme response to pain
• Muscle spasms and itchy skin
• Immune system and hormonal dysfunction
• Irregular heartbeat
• Overdose 

Taking opioids for extended periods of time can lead to tolerance and dependence on the drug, prompting users to take more of the drug to elicit the same effect. Those who are dependent may experience withdrawal symptoms when usage is stopped.

Fentanyl is a synthetic opioid that is used for end-stage cancer treatment and is one hundred times more powerful than morphine.¹¹ However, it is often used illegally for the purpose of mixing with other drugs like cocaine and heroin during lacing. Dealers may mix fentanyl with other drugs to decrease their production cost. Due to the potency of fentanyl, the drug's effect on the body may be stronger. Some dealers may use fentanyl-laced substances to create a more addictive product and ensure customers frequently buy. This is extremely dangerous for users who are unaware the substance is laced as lacing does not allow individuals to accurately track their drug intake. 

​Xanax is a powerful benzodiazepine. Benzodiazepines are a class of medication that slow brain activity and nervous system functions to create a calming or sedative effect. Xanax is often prescribed to treat panic disorders, anxiety disorders, and anxiety caused by depression. ​However, the drug is extremely addictive when used for prolonged periods of time and tolerance to the drug can develop quickly.

​Side effects and risks of long-term Xanax use include:

• Slurred speech
• Confusion
• Drowsiness
• Dizziness
• Weakness
• Blurred vision
• Lack of motor coordination
• Difficulty breathing
• Coma

It's important to note that combining Xanax with alcohol, other benzodiazepines, or opioids can be incredibly dangerous. The result of mixing these drugs could result in very slowed breathing or respiratory failure. This combination can also result in overdose or death.

Barbiturates are sedative medications that cause users to feel relaxed or drowsy. Many barbiturates are used to stop or prevent seizures. Barbiturates increase the amount a certain brain chemical to slow the activity of brain cells.

Common barbiturates include phenobarbital, thiopental, amobarbital, methohexital, and secobarbital. While these medications are useful for preventing seizures, preventing convulsions, and helping with insomnia, taking these drugs without or against the advice of medical professionals is extremely dangerous.

Barbiturate usage risks:

• Coordination problems and muscle weakness
• Clouded thinking
• Nausea
• Slurring of speech
• Slow heart rate
• Overdose

Barbiturates have a high potential for abuse, and long-term use can result in tolerance and physical dependence. Due to this tolerance, prolonged use can lead to overdose. 

Signs of a barbiturate overdose include shallow breathing, clammy skin, dilated pupils, weak and rapid pulse, respiratory failure, and coma. If you notice any of these symptoms, make sure to immediately call 911 or emergency services as medical professionals can improve the chances of surviving the overdose.

Psilocybin, often known as magic mushrooms, are hallucinogens that alter a person's senses and way of thinking. Psilocybin is a hallucinogenic chemical found in certain types of mushrooms. The effects of psilocybin can last four to six hours but can last several days for some individuals.¹²

Psilocybin works by activating serotonin receptors in the prefrontal cortex, which is responsible for mood, cognition, and perception. Because psilocybin activates this part of the brain, users may experience distortional thinking in environmental perception. 

Side effects may include:

• Euphoria
• Change in consciousness, mood, thought, and perception
• Dilation of pupils
• Visual and auditory hallucinations
• Stomach discomfort and nausea
• Fast or irregular heartbeat
• Facial flushes, sweating, and chills
• Fear, agitation, and confusion
• Derealization and delirium
• Psychosis and syndromes resembling schizophrenia

Some psilocybin users risk accidental poisoning by consuming poisonous mushrooms. Although the risk of this is small, it is important to know the symptoms of mushroom poisoning. These symptoms include muscle spasms, confusion, and delirium. If someone is experiencing these symptoms, it's important to go to the emergency room immediately.

LSD is one of the most powerful hallucinogens and is a manufactured chemical that comes as a white or clear powder. This powder or liquid is usually placed on small squares of blotter paper and put on one's tongue. It's important to note that using LSD has a possibility of triggering or worsening mental health problems such as anxiety, schizophrenia, or psychosis.¹³

Some users of psilocybin and LSD may experience the negative effects of the substance and have a “bad trip.”¹⁴ A bad trip may include unpleasant or intense hallucinations, anxiety, paranoia, and panic or fear.

There is also a risk of developing hallucinogen-persisting perception disorder. With this disorder, individuals may experience persistent and stressful distortions with how they perceive the world. These distressing situations are often flashbacks to an incredibly upsetting situation. This may last for weeks to years after using psilocybin or LSD.

Ketamine is categorized as a dissociative hallucinogen. Ketamine is used as a surgical anesthetic for humans and animals. Most illegal ketamine is taken from veterinarian offices.¹⁵ When ketamine is used illegally/recreationally, it causes a dissociative state and induces visual disturbances, disorientation, sedation, and euphoria. Like various other street drugs, ketamine may also be laced with other drugs, like fentanyl, to add weight to the substance and improve the dealer's profits. 

Side effects may include:

• Flashbacks
• Poor sense of smell
• Mood and personality changes, depression
• Poor memory, thinking, and concentration
• Abnormal liver or kidney function
• Abdominal pain
• Dependence
• Overdose

It's possible to develop a tolerance and/or become addicted to ketamine, allowing the possibility of overdose. By taking a large amount of ketamine or mixing it with other drugs, the possibility of fatal events increases. Signs of a ketamine overdose include inability to move, rigid muscles, high blood pressure, fast heartbeat, convulsions, and unconsciousness. If you notice any of these symptoms, contact 911 or emergency services immediately.