What is methamphetamine?

Methamphetamine is a powerful and highly addictive central nervous system stimulant closely related to amphetamine but significantly more potent and longer lasting. Medically, a pharmaceutical form known as Desoxyn® is occasionally prescribed in tightly controlled cases for ADHD or severe obesity, but this use is rare. Most methamphetamine encountered in testing programs is illicitly produced and used recreationally.

Illicit methamphetamine appears in several forms: crystal meth (clear or bluish shards resembling glass), powder (white or off-white), or paste depending on manufacturing methods. It may be smoked, injected, snorted, or taken orally. Recreational use produces intense euphoria, increased energy, and prolonged wakefulness but is associated with extreme risk—addiction, cardiovascular strain, neurological damage, and severe behavioral changes.

Effects:

• Intense euphoria and increased confidence

• Surge in energy and alertness

• Rapid heart rate and elevated blood pressure

• Hyperthermia (dangerously high body temperature)

• Decreased appetite

• Dilated pupils and rapid breathing

• Agitation, anxiety, and restlessness

• Insomnia or long periods of wakefulness

• Paranoia, aggression, or hallucinations

• High risk of dependence and severe withdrawal symptoms

What is Benzodiazepine? 

Benzodiazepines are a class of central nervous system depressants that act by enhancing the neurotransmitter GABA, producing calming effects such as reduced anxiety, muscle relaxation, and sedation. Medically, they are widely prescribed for anxiety disorders, insomnia, muscle spasms, seizure control, and alcohol-withdrawal management. Common prescription examples include Xanax® (alprazolam), Valium® (diazepam), Klonopin® (clonazepam), Ativan® (lorazepam), and Restoril® (temazepam).

Pharmaceutical benzodiazepines typically come as tablets, capsules, liquid solutions, or occasionally injectable formulations used in clinical settings. Illicitly misused benzodiazepines may appear as diverted prescription pills or counterfeit tablets produced to resemble pharmaceutical products. Recreational use often involves taking higher-than-prescribed doses to achieve sedation, euphoria, or potentiation of other substances, particularly opioids and alcohol, which drastically increases overdose risk. Benzodiazepines are associated with dependence, withdrawal, and impaired cognitive and motor function, especially with long-term misuse.

Effects:

• Sedation and drowsiness

• Reduced anxiety and muscle tension

• Impaired coordination and slowed reaction time

• Memory impairment or “blackouts”

• Slurred speech

• Confusion or cognitive slowing

• Dizziness or loss of balance

• Respiratory depression (especially with opioids or alcohol)

• Risk of dependence and withdrawal symptoms

• Emotional blunting or flattened affect

What is Cocaine?

Cocaine is a powerful central nervous system stimulant derived from the leaves of the coca plant. It rapidly increases dopamine levels in the brain, producing intense euphoria, heightened alertness, and a short-lived but highly reinforcing sense of energy. Pharmaceutical-grade cocaine exists in limited medical contexts (such as topical anesthesia for certain ENT procedures), but nearly all cocaine encountered in the United States is illicit and unregulated.

In its powdered form (cocaine hydrochloride), it typically appears as a fine white crystalline powder that is snorted, rubbed onto gums, or dissolved and injected. Another form, crack cocaine, is produced by processing the powder with baking soda or other agents to create small “rocks” that can be smoked, delivering a faster and more intense high. Because illicit cocaine is frequently adulterated with substances like levamisole, fentanyl, or local anesthetics, users face increased health risks beyond the effects of the drug itself.

Recreational cocaine use is associated with patterns of bingeing, addiction, cardiovascular complications, and significant behavioral changes. Its highly addictive nature, rapid onset, and short duration make it a major substance of concern across emergency departments, workplace testing programs, criminal justice systems, and treatment centers.

Effects:

• Intense euphoria and elevated mood

• Increased energy, alertness, and confidence

• Decreased appetite

• Dilated pupils

• Elevated heart rate, blood pressure, and body temperature

• Restlessness, agitation, or anxiety

• Insomnia and repetitive behaviors

• Increased risk of heart attack, stroke, or cardiac arrhythmias

• Strong cravings and high addiction potential

• Paranoia, aggression, or hallucinations at higher doses or during binges

What is Nicotine & Cotinine?

Nicotine is a highly addictive stimulant naturally found in tobacco plants and commonly consumed through cigarettes, cigars, vaping devices, and smokeless tobacco. Once absorbed, the body rapidly metabolizes nicotine into cotinine, a stable and longer-lasting biomarker used in toxicology testing. Cotinine is preferred for screening because it remains in the system longer and provides a more accurate indication of recent nicotine exposure.

• Nicotine appears in tobacco products (leafy material), vape liquids (clear to colored fluids), patches, gums, and lozenges formulated for cessation.

• Cotinine is not a drug or consumable substance—it’s a metabolite detected in biological samples (urine, saliva, blood) for screening purposes.

Nicotine is typically inhaled through smoking or vaping, or absorbed through oral or dermal products like chew, gum, or patches.

• Medical/therapeutic uses: Nicotine replacement therapies (NRT) such as gum, lozenges, and patches are FDA-approved to help smokers quit by delivering controlled, lower doses of nicotine.

• Recreational use: Smoking, vaping, or using smokeless tobacco products for stimulation, stress relief, or habit, often leading to dependence. Vaping has significantly increased nicotine exposure among young adults and teens.

Effects:

• Increased alertness and mild stimulation

• Elevated heart rate and blood pressure

• Relaxation or stress relief due to dopamine release

• Reduced appetite

• Dizziness or nausea (especially in new users)

• Headaches

• Withdrawal symptoms such as irritability and cravings

• Increased risk of cardiovascular disease with chronic use

• Reduced lung function and respiratory symptoms from smoking/vaping

• High addiction potential and difficulty quitting

What are Opiates?

Opiates are a class of drugs derived directly from the opium poppy plant and include substances such as morphine, codeine, and heroin. They are central nervous system depressants that act on opioid receptors to relieve pain, produce sedation, and create feelings of euphoria. Pharmaceutical opiates (like morphine and codeine) are used medically for pain management, anesthesia support, and cough suppression. These medications typically appear as tablets, capsules, oral syrups, or injectable liquids in regulated clinical settings.

Illicit opiates—particularly heroin—are commonly found as powder (white, tan, or brown), sticky tar-like substances (“black tar heroin”), or compressed forms depending on how they are manufactured. These forms are often snorted, smoked, or injected recreationally to achieve intense euphoria, but they carry significant risks due to unknown purity, adulterants, and high addiction potential. Misuse of pharmaceutical opiates, whether crushed and snorted or injected, also represents a major pathway to opiate dependence.

Effects:

• Pain relief and deep physical relaxation

• Sense of euphoria or “rush” (especially with heroin)

• Slowed breathing and heart rate

• Drowsiness and sedation

• Constricted (“pinpoint”) pupils

• Nausea and vomiting

• Itching or flushed skin

• Impaired coordination and slowed reaction time

• High risk of tolerance, dependence, and addiction

• Potential for respiratory depression leading to overdose