Episode 48: Dr. Greg McDonald, Pathology of Drug Abuse

Gregory McDonald, DO, graduated from the Philadelphia College of Osteopathic Medicine in 1989. He went on to complete a residency in anatomic pathology at the Lankenau Hospital followed by a forensic pathology fellowship at the University of Pennsylvania and the Medical Examiner's office in Philadelphia, Pennsylvania. After completion of this fellowship, he served for 14 years as an assistant medical examiner in Philadelphia, Pennsylvania.

Dr. McDonald currently serves as Dean of the School of Health Sciences and is a professor and chairman of the Department of Forensic Medicine and Pathology at the Philadelphia College of Osteopathic Medicine. His work at PCOM also includes serving as the program director of the Master of Science (MS) in Forensic Medicine program. Dr. McDonald lectures extensively to DO, physician assistant and forensic medicine students as well as providing residents and attending physicians with continuing education programs. He has been the recipient of multiple awards for outstanding teaching.

In addition to his teaching duties at PCOM he has lectured regionally and nationally in subjects including post mortem changes, determination of cause and manner of death, blunt and sharp force injury, asphyxiation and child abuse. Dr. McDonald is also the chief deputy coroner of Montgomery County Pennsylvania.

He has served as the Vice Chairman and Chairman of the American Osteopathic Board of Pathology where he also is the Chairman of the subcommittee on Forensic Pathology. Certified in both anatomic pathology and forensic pathology, he has completed more than 8,000 autopsies and has testified in more than 800 court cases.

Intro Voices

Where do I go? It only happened once. I think I was singled out. The phone calls began about one month ago. What is hazing? Something happened to me when I was younger. I'm worried about my safety. He said he was sorry. Can someone help me? Where can I get help? Can someone help me?

 

Intro Voices 

This is “You Matter”, a podcast for the NYU community developed by the Department of Public Safety.

 

Karen Ortman  00:07

Hi everyone and welcome back to You Matter, a podcast created to teach, inspire and motivate members of the NYU community who have been victimized in some form or fashion, and to identify resources both on and off campus that can help. I am your host Karen Ortman, Associate Vice President of Campus Safety Operations at the Department of Public Safety and a retired law enforcement professional. Today I welcome back Dr. Greg McDonald, Chief Deputy Coroner from Montgomery County, Pennsylvania, the Dean of the School of Health Sciences, and the chair of the Department of Forensic Medicine and Pathology at the Philadelphia College of Osteopathic Medicine. Today Dr. McDonald and I are going to have a frank informative discussion about the pathology of drug abuse. Dr. McDonald, it's great to see you. And welcome back to you, Mater.

 

Dr. Greg McDonald  00:28

Thank you. Thanks for having me. I really enjoyed my last visit and hopefully people will enjoy this one as well.

 

Karen Ortman  00:31

I think they will. So Dr. McDonald, in your experience, why do people start consuming drugs in the first place?

 

Dr. Greg McDonald  01:36

Well, it's multifactorial, many people do it as a form of self-medication. There's a lot of underlying mental health issues out there and they're, quite frankly, not being addressed as well as we would like them to be so people treat themselves for anxiety, depression, and a variety of other mental health issues with substances that make them feel better in the short term. But, in the long term, it certainly can have many more mental health issues and can also produce a great variety of physical health problems and oftentimes even death.

 

Karen Ortman  02:11

So it's a band aid, essentially.

 

Dr. Greg McDonald  02:13

Essentially.

 

Karen Ortman  02:15

What are the statistics associated with addiction today?

 

Dr. Greg McDonald  02:42

Well, it depends on portions of the country that you go to, that you’re in. Obviously, the opiate epidemic is gripping most of the country right now. When I say opiates, you know, we'll get into specifics, but that can range from abuse of prescription opiates, like oxycodone, to more illicit forms like fentanyl and heroin. I don't have specific numbers for you, but those tend to be some of the biggest drugs that are producing some pathology like that I see in my practice.

 

Karen Ortman  03:25

So you mentioned that the opioid addiction is gripping the country right now. Can you attribute that to a cause?

 

Dr. Greg McDonald  03:35

Well again, this too, is multifactorial. Some people believe that people have gotten addicted to prescribed drugs, like oxycodone and then they start to abuse it. You know, I'm not here to besmirch the appropriate use of prescription painkillers, I think they have a place but they do have an addictive potential. Some people who start taking them for legitimate reasons, maybe a back injury or some other type of injury, and then they get addicted. And then they start buying the oxycodone on the street illicitly or they move to a more potent form of opiate like heroin or fentanyl. It's really a downward slope from there.

 

Karen Ortman  04:31

I've heard people speak in the past of a physical dependence and an addiction, what are the differences between the two?

 

Dr. Greg McDonald  04:43

Well, physical dependence, and opiates are a good example of that, is that your body changes. The receptors in your body change, and your body craves and depends on it. If you withdraw from opiates that you've been taking for a long period of time, you really have some significant physical withdrawal effects; you know, nausea, vomiting, a variety of gastrointestinal problems, and then individuals really feel ill. That's why it can be so difficult to withdraw from those substances, many times it requires medical supervision to do so. Now, there are other drugs that are addicting, but not as physical, they don't produce the same type of physical dependency. An example of that may be cocaine, where people get just, especially crack cocaine, they constantly get this high but rather short lived and they want to continue getting that high but they don't have the same significant withdrawal effects as you may have with opiates.

 

Karen Ortman  05:56

When you speak of the physical dependence, and all the symptoms associated with what you just mentioned, is there any danger associated with withdrawing, not under the care of a physician when you are physically dependent?

 

Dr. Greg McDonald  06:12

People can become nauseous, they can vomit and by doing so, they can aspirate their vomit. Sometimes they are driven to self-harm, either just harming themselves or actually suicide. People can and they have detoxed on their own successfully, but I think for someone who is a long term user to be successful, and dangerous, they really need significant medical help with it.

 

Karen Ortman  06:53

Okay, let's talk about the most commonly used drugs today in an effort to inform and educate. You and I had this conversation before we ever got to the studio today about really having a dialogue that will inform people. We're not here to lecture anybody really, it is to provide information. So, there are drugs that are commonly used and abused and there are those drugs that are more likely to lead to addiction.

 

Dr. Greg McDonald  07:32

Well, one of the major drugs that's abused is alcohol and that's a different conversation that we can maybe have another time. That certainly can have lethal consequences and produces long term complications, cirrhosis of the liver, and a variety of other things. Again, withdrawal from alcohol can be lethal if it's not done appropriately. Other drugs that are elicit, again, are cocaine, cocaine is a rather common one throughout the country, and it's interesting that certain portions of the country have different increase of certain illicit drugs.

 

Karen Ortman  08:21

Why is that?

 

Dr. Greg McDonald  08:23

Well, it depends on the availability of the drug, how it is becoming introduced into the country. Some drugs are easily more manufactured in the country like methamphetamine, for instance, to make methamphetamine you need a laboratory and to make a sizable amount of it, the laboratory has to be pretty big. It's difficult to have a large meth lab in a row home in Philadelphia, but in a farmhouse in the Midwest, you may be able to do that more efficiently and you sell your product.

 

Karen Ortman  09:02

So why can't you have a meth lab in a row home in Philadelphia, if you have an entire basement, like if you have the space in order to create that lab, what about that location is prohibitive?

 

Dr. Greg McDonald  09:27

Well, you can have it, one of my cases, there were people in a hotel room actually, that were had a meth lab, but you have to understand, it's a laboratory, so you're going to have to be taking in laboratory equipment and chemicals. That's oftentimes going to produce various types of odors. So, if you're in that closed space, you're more likely to get the attention of law enforcement, unwanted attention from neighbors, those types of things. So it doesn't lend itself to a widespread distribution network if you're in those small areas.

 

Karen Ortman  10:06

Gotcha. So back to cocaine. Is cocaine highly addictive?

 

Dr. Greg McDonald  10:11

Yes, it is. And there are different types of cocaine, different ways that that can be taken; it is oftentimes snorted or you can mix it and inject it. Then there's another very addictive for cocaine and that's called crack cocaine. That is mixed and put in what they call rocks, that's why its called crack. It makes a sound when it's being cooked and it's cracked, and when you inhale that, it is very highly addictive. The high there is very potent, very significant, but very short as well; so you take the cocaine, and then 10, 15, 20 minutes later, you're craving it again. That's where that addictive potential comes in.

 

Karen Ortman  11:12

So can you speak to what happens when you inhale crack cocaine? What is happening internally.

 

11:22

While you're inhaling it, and people hold their breath for as long as they can, so they the lungs are essentially absorbing the cocaine and passing it on into the bloodstream. The longer person can hold that the greater the likelihood of them getting more cocaine into their bloodstream. That can cause lung problems, you're inhaling this foreign body, these foreign substances into your lungs, as you're inhaling, and you're holding your breath that can really damage the elasticity of the lungs. You can have ruptures and something that we call a pneumothorax, where your lung ruptures and collapses on itself. Those are just some of the longer pulmonary complications that can ensue from it. Other things people develop are what we call crack hands because they have to light the pipe, it's oftentimes very hot and they get burns on their hands. The smoke from the crack produces an anesthetic effect on the eyes, they rub their eyes and they can produce damage to the cornea of their eyes. So there's a lot of other manifestations besides the lung problems.

 

Karen Ortman  12:38

Can somebody become an addicted person to cocaine in whatever form and sustain that over a significant period of time?

 

Dr. Greg McDonald  12:54

Oh yeah, there are people who can be cocaine addicts for decades and certainly over that time have develop some significant complications. Some people died the first time they used cocaine, others can use it in varying degrees for decades, and it certainly has long term damage to various organs.

 

Karen Ortman  13:21

What would be a reason that ingesting cocaine would be a cause of death.

 

Dr. Greg McDonald  13:28

Cocaine has its most damaging effects on the heart and the blood vessels. So cocaine increases your adrenaline, right? We call it epinephrine, increase your heart rate, increase your pressure, your heart starts beating more rapidly. And other things happen, the blood vessels feeding your heart can close up, providing less blood flow to your heart. It also causes the heart to have what we call an arrhythmia and irregular beating of the heart. All these things together, you know, they can occur in combination and that's how most people die of cocaine, they die of heart related complications, or their heart may just have stopped beating and sudden cardiac death, or they may die of complications of the high blood pressure, they have strokes oftentimes. If I do an autopsy on a young person and I see that they've had a stroke, that's pretty uncommon in most young people, so that may indicate that they were using some kind of cocaine. It also can produce rupture of certain blood vessels, like the biggest blood vessel in your body, the aorta. It really has a devastating effect on the heart, even on someone who's really young and otherwise healthy.

 

Karen Ortman  14:52

Would cocaine be considered a stimulant? 

 

Dr. Greg McDonald  14:54

Yes, it is. It's definitely considered a stimulant.

 

Karen Ortman  14:59

How about opiates?

 

Dr. Greg McDonald  15:02

Good question. Opiates are a different classification of drugs. They are produced by a different substance. They are derived typically from the poppy plant, but there are some types of opiates that can be made chemically in a lab. Once again, there are opiates that have legitimate medicinal uses when they're prescribed appropriately and you know, those include oxycodone, and some morphine sulfate, and what have you. Sometimes even fentanyl can be used. Obviously, because they do their job so well, they can have effects on addiction, they can produce addiction, and dependency. One of the most common historically, of the opiates that are abused, would be heroin. Heroin is a synthetic, what we call a semi-synthetic derivative of morphine, most opiates are chemically related to morphine, but heroin itself does not have an approved medical use so that would be an illicit drug. It does have a very rapid mechanism of action; it can have some profound effects very quickly. That is different than cocaine in that it is a depressant, a type of depressant, and painkiller. So heroine would most likely kill people, not so much through effects on the heart, but it tends to affect the lungs producing decreased respiratory rate, decreased breathing, as well as producing a massive amount of fluid building up in the lung, something that we call pulmonary edema. And that oftentimes, results in their death.

Karen Ortman  17:11

I've often met people who are addicted to heroin and they inject the substance through their veins. They have often spoke of that sort of immediate sensation that is very pleasant for them, that they're continuously seeking from that point forward. Can you speak to what the reason that they are experiencing this sort of rush from this drug? Is there any sort of scientific explanation as to why the heroin impacts the user in that way?

 

Dr. Greg McDonald  18:04

It gets down to its effects on the ability to decrease pain, right, and that has very rapid onset for us to do that. So that rapid onset equates to a feeling of euphoria, right? Not only does it decrease pain, but it makes you feel really good. You have this feeling of euphoria in a relatively quick fashion. So you have someone who, maybe they're not physically in pain, but maybe they have depression or they have anxiety, they take the heroin and now that goes away at least temporarily but then they develop something. This is true for most illicit drugs; they develop something called tolerance so that your body gets used to the amount of drugs that you're taking. But now, because you've been using it for a long period of time, you need a larger and larger dose of the drug to have the same physiological effects and so over time you get that larger and larger tolerance. One phenomenon that I'd like to mention, it's very important that we see, unfortunately in forensic pathology, is someone who is a long term heroin user, for instance, maybe they go into rehab, or maybe they get arrested and they go into jail. At that time, they don't have access to the heroin, right? So they lose their tolerance, and they can lose it pretty quickly within just a few weeks. Then they're either discharged from the hospital or the rehab center or they are released from prison. They come out in the street and they start using the same amount of heroin they used before they went in and lost their tolerance. That is really what, oftentimes, we see; that someone dies because they they've lost their tolerance. You find that at the scene, you'll find paperwork from a rehab center they were released from or prison that they were released from. That oftentimes accounts for some of the lethal cases of heroin use.

 

Karen Ortman  20:21

Really good point. Thank you. You spoke of natural versus synthetic, natural being from poppy which is like morphine and codeine, and synthetic fentanyl, methadone, and then you spoke of semi-synthetic, which is heroin. Is there a difference in the effects that any of the substances in each of these categories will have on the user because of their status as natural, synthetic, or semi synthetic?

 

Dr. Greg McDonald  20:55

Yes, in a way and it really has come down to their chemical structure. They have similar chemical structures, but they are manipulated chemically in a lab oftentimes to have maybe a higher potency like fentanyl does, right? And now, one of the major problems is fentanyl does have you have some significant uses in medicine, but now we're starting to see clandestine laboratories, many of them are coming from other countries, that are making analogs of fentanyl. So it may be north fentanyl or acetyl fentanyl, and there are some of them, quite frankly, that I've never heard of before. We don't even have names for them yet because they're changing them. So the each of these, depending on the chemical structure of them, they have different abilities to decrease pain; some are very, very potent. Let's take fentanyl, for instance depending on who you ask and what source you cite, fentanyl typically is 30 to maybe 100 times more potent than heroin. So imagine that you're your own heroin user, you buy on the street what you think is, and I'm just using this number a gram of heroin, but it's not just heroin, it may be mixed with a half a gram of fentanyl. So now you're taking something that is much, much more powerful than what you're used to, right? And, that's what we see. Oftentimes, you will see clusters of drug related deaths in certain portions of a city or county or state. It comes from distribution of usually one of these types of drugs that are chemically altered to be really, really potent. The user doesn't always know that and they purchase it, and they do the normal amount that they're used to. Unfortunately, the outcome is often lethal.

 

Karen Ortman  23:13

Now why are we hearing so much about fentanyl? Over the course of the last two years, you see billboards about it, you read about it, people are dying from it, high profile people in the entertainment industry. Why all of a sudden?

 

Dr. Greg McDonald  23:42

It was always there. Fentanyl was always potentially there but you would have had access through medicine, right? People would have to steal it from a pharmacy, a laboratory, or something along those lines. But now, as I mentioned previously, a lot of these fentanyl analogs are coming in from overseas. And it’s cheaper than buying oxycodone, many times its cheaper than heroin and obviously that's going to drive up the usage of it. It's cheaper, you can sell more of it, if you're a drug dealer, you're going to make a bigger profit on it. So again, every day they're coming out with different forms of fentanyl. So this is getting a little bit out of mine my expertise, and you may know more about it than I do, but for the DEA to label a drug as an illicit drug, they're labeling a certain type of compound, a formula. So you change that chemical formula a little bit, that drug may not be considered, quote, illegal until the DEA catches up with it, recognizes it, and makes it illegal. It's kind of a cat and mouse game between law enforcement and the illicit drug manufacturers.  It's multifactorial, again, there's so many different spokes to this wheel to try and stop it, you can stop it from being produced in the first place, stop it from getting into the country, stop them from being distributed in the country, but it is really a very difficult thing to do.

 

Karen Ortman  25:42

Is fentanyl powder or liquid?

 

Dr. Greg McDonald  25:45

It can be delivered in a couple different ways. It can be delivered in powder. Fentanyl even has, for people who are chronic pain like maybe cancer patients, it can be delivered by what we call trans-dermally. You have fentanyl patches, you put that on your skin and that is a relatively safe way of delivering the fentanyl in a kind of gradual way. Interesting, I've heard of people illicitly getting these fentanyl patches, and they smoke them, they'll put them under their tongue, or use them in ways that are not meant to be used and obviously they're likely to get more fentanyl in a relatively short period of time, than what was planned through the transdermal patch.

 

Karen Ortman  26:38

What are the signs of abuse of substances like heroin and fentanyl?

 

Dr. Greg McDonald  26:45

It depends on how they are using it. Most of the time it's going to be injected. So what you would see would be new or old puncture sites on the arms, oftentimes, that's where most of the veins are accessible. And you may see fresh new or puncture sites over time, if a person is a chronic user, what we call track marks. Track marks are usually these linear kind of rope like scars that can occur in any part of the body, but mostly in the arms. That's due to repeated injection, that initially creates an inflammatory response that produces scar tissue, you may see these long rope like scars in what we call like the little crease of your arm here, the antecubital fossa. So that may be something that you would see. People, if they have a job and they're wearing short sleeve shirts, they may start injecting in other parts of the body and their legs, their neck, maybe a variety of different areas. Now, if their veins start to become scarred, what we call fibrotic, not be able to get access to a usable vein, they do something we call skin popping, where they injected just underneath the skin, called subcutaneous injections now produce kind of like a little blister, and then they can absorb the heroin or fentanyl that way. Now, it's not as quick a high as you would get if you injected directly into your veins, obviously. You see skin popping, oftentimes, in people who have really damaged their veins and can't use them very much. The problem with skin popping is when you do that, it can produce infections, soft tissue infections into your legs can become significantly infected and result in hospitalization. So you may see really big, oval to round scars, either on their hands or their lower extremities. That usually indicates a long term use of the substances. Heroin can be snorted as well like cocaine, not so much anymore, but some people are doing it so that they don't get exposed to IV drug injecting HIV or something or hepatitis. You still can't get HIV and hepatitis even through snorting but you're less likely to do so. So if they're snorting it then they tend to have nasal problems, bleeding of their nose, they may have some destruction of the cartilage in the nose. Those tend to be less significant trauma. But many times if a person is very careful, and they cover a parts of their body, they can be a long term user and unless you're a physician and examining their whole body you may not see anything. 

 

Karen Ortman  30:00

It's interesting. So can long term use of cocaine, and we talked about earlier, Heroin, can that be fatal.

 

Dr. Greg McDonald  30:10

Yes, definitely. In the short term, it can be but over time, cocaine produces heart problems that become chronic, hardening of the arteries that can lead to heart attacks. Heroin, obviously, you have the infectious complications where you can get hepatitis C. Many people get hepatitis C from injecting, you can also get HIV, and then all the complications from that.

 

Karen Ortman  30:40

So you never know, you could be a short term user long term user. 

 

Dr. Greg McDonald  30:45

Exactly.

 

Karen Ortman  30:46

You could try it for the first time. And that could be it. 

 

Dr. Greg McDonald  30:52

Yep. Absolutely.

 

Karen Ortman  30:55

You spoke earlier about meth labs and how they're typically created in an environment in which there's a lot of space in rural environments, but we didn't speak about and methamphetamine and what it does to the body, to the person. Is it an addictive substance? And how do people ingest it?

 

Dr. Greg McDonald  31:28

Actually, it is addictive. It is a stimulant much like cocaine it does so has many the same effects as cocaine does.  It can be swallowed, it could be injected, it could be smoked, it could be snorted, there's a variety of different ways of taking methamphetamine and they can have a variety of psychiatric issues associated with that, they can become very violent, they display psychosis.

 

Karen Ortman  32:04

And this is different from the other drugs that we spoke about.

 

Dr. Greg McDonald  32:07

Well, you can get that similar effects in cocaine, you can get the psychosis, you can get the violent behavior. Oftentimes, we'll have what we call hyperthermia, where your body temperature increases to a potentially lethal level. With cocaine and methamphetamine this behavior, oftentimes, as you can imagine, would get the attention of law enforcement versus running around the neighborhood and or taking their clothes off because they're hot, and they're being violent or aggressive, obviously, that most of the time, we'll get the attention of law enforcement who has to come in and subdue them, which is difficult. Sometimes, the person doing the drugs dies when they're being pursued or die while they're in police custody and that's a whole other set of circumstances and a whole other discussion. They run through glass or they jump off buildings and so that also can obviously have injurious behavior and lethal effects as well.

 

Karen Ortman  33:18

Yeah. What are the signs of abuse of methamphetamine?

 

Dr. Greg McDonald  33:22

They get high blood pressure, they may be agitated quite frequently, they can have heart disease. It's not too dissimilar from other forms of injected drugs, so they may have track marks as well. They may have snorted, so they can have nasal problems. One thing in methamphetamine, and it can happen in other drugs, is they really lack personal hygiene; maybe they don't brush their teeth, they don't floss their teeth and they get really severe gum infections like gingivitis and tooth decay. Sometimes that is one of the most obvious signs that they may have been abusing drugs. You have someone who's relatively young and certainly would have access to dental care, but they have really poor dental hygiene.

 

Karen Ortman  34:28

So are you speaking specifically of methamphetamine? Or is this any drug?

 

Dr. Greg McDonald  34:32

Well, generally we associate it with methamphetamine, but just about any of the drugs that I mentioned, if you're addicted to a substance, that becomes your number one priority over eating, over sleeping, over your family, over yourself hygiene and what have you. It can happen in almost any of them, but we tend to think of it as occurring in methamphetamine and some dentists even refer to it as, quote, meth-mouth when they have really severe necrotizing gingivitis,

 

Karen Ortman  34:52

Over anything. Sure. What about prescription stimulants? For example, ADHD medications?

 

Dr. Greg McDonald  35:16

Yes. Again, these can be really good medications when they're delivered appropriately.  I mean, there are some people who have really significant learning disabilities or learning difficulties, maybe disabilities is not the correct term, and the certain ADHD type medications can really help them, but they are stimulants so they have to be used appropriately. They have to be monitored appropriately. If not, you do have the risk of abusing them. They are stimulants so they can have some of the effects that we talked about with cocaine, heroin, and methamphetamine, it's usually not quite as severe as that, but it can be a gateway; what we call a gateway drug. So someone starts using, you know, a prescription of an ADHD type of medication that they got, maybe, from their college roommate or what have you and they start using that, they get some success with that and they think well, maybe we go another step above and maybe they start using cocaine or methamphetamine.

 

Karen Ortman  36:28

Can you give an example of what these prescription stimulants are? What are some common ones?

 

Dr. Greg McDonald  36:38

There's a variety of them out there and quite frankly, right now the trade name slips my mind. 

 

Karen Ortman  36:48

Is Adderall one of them?

 

Dr. Greg McDonald  36:50

Adderall is one of the older ones, and one of the more common ones. But every day, they're coming out with different ones that have, they're trying to have less addictive capabilities to them, but Adderall certainly is one. Again, there's a whole list of drugs that are out there now and next week there'll probably be a variety of other drugs. And again, they're put together by a pharmacologist, and they do have legitimate uses but, you know, just like anything else, they do have that potential. They are considered to control substances and they can be abused appropriately.

 

Karen Ortman  37:33

Can you speak to any dangers associated with combining prescription stimulants such as Adderall or an ADHD medication with alcohol, particularly the person who is not prescribed the medicine in the first place?

 

Dr. Greg McDonald  37:49

Well, when you're combining those two substances, especially alcohol, alcohol, decrease your inhibition, it decreases your ability to realize your behavior. And so you start to take more and more alcohol, then you may forget how much of the stimulant, the Adderall or what have you you've taken and then over time, and before you know it, you're having a lot of Adderall or you know, a stimulant in your body and that can lead to cardiac effects and you're not aware of that because you're also combining it with alcohol, or, you know, you start drinking more and more alcohol, the stimulant makes you feel a little bit better, but it'll be you know, that you're having a lot of alcohol, which is a depressant, which can have effect on your lungs, and your ability to breathe. Putting them together really is a bad combination for a variety of different reasons. 

 

Karen Ortman  38:47

Let's switch to substances such as ecstasy or Molly. What category would you put them in? 

 

Dr. Greg McDonald  38:59

Typically, they are put in what we call designer drugs. Ecstasy is a amphetamine, it's chemical structure is different than methamphetamine, but it is still a an amphetamine, is a little bit different. It can cause some of the same effects as methamphetamine as far as damaging the heart or the central nervous system, but and people who take ecstasy, usually will quit consider a party drug, they’re usually doing it around other people. Oftentimes that you know big parties, they call them raves, and they, methamphetamine, where make you violent and aggressive on ecstasy, which is a different type, tends to be oftentimes called the love drug. People who take it have feelings of empathy and comfort, they want to hug other people, they want to touch the people and want to be touched themselves so it's a little bit different there. But the health issues come in, where people are taking ecstasy at a party, right, and they may be dancing and partying for days at a time nonstop, and it increases your heart rate, increases your blood pressure, and increases your body temperature. Those combinations, especially your body temperature increasing, that can be lethal. It tends to drop your blood sugar level, which also can be lethal. That's the kind of issues that you can have with things like ecstasy. Other things that it does, you know, producers grinding the teeth that we call bruxism so they may chip their teeth, they may break their teeth, oftentimes, people who do ecstasy will have, what we call a chew toy or something, maybe a piece of leather in your mouth, they use a pacifier, lollipops, things like that to protect their teeth. So you may see someone who's sucking on a lollipop or has a pacifier, maybe a little odd in an 18 or 19-year-old person, but it may have a darker meaning for them.

 

Karen Ortman  41:34

I think you said a few minutes ago that it it can be fatal. 

 

Dr. Greg McDonald  41:42

Yes.

 

Karen Ortman  41:43

Taking ecstasy. Is that in terms of quantity? Or just you could do it one time? In what form does it come, let's establish that.

 

Dr. Greg McDonald  41:54

Usually it comes in a pill form and people can make it and so at these parties, they may sell it; so in a capsule, usually a tablet or a pill form that can be made. They take it even just one time and it can increase the heart rate, produce strokes, or heart attacks. You can imagine that a party where you're partying a lot and you forget how many you take and you may take a large amount of these in a relatively short period of time, and not know about them. That can really have some deleterious effects.

 

Karen Ortman  42:36

Let's say somebody is in the midst of an ecstasy high, and this really could go for any sort of high, but there are peers with this person, and they become concerned.

 

Dr. Greg McDonald  42:59

Right.

 

Karen Ortman  43:00

I mean, short of calling 911 or not calling 911 is there something that somebody can do to sort of render any sort of care in the moment?

 

Dr. Greg McDonald  43:15

If the person is still conscious, obviously, if they're unconscious in their heart stops beating, CPR and calling 911 is the key, but if they're really hot you want to get them into an air conditioned environment, that's really key. You want to make sure to cooled off and you can put some cold towels on them. Make sure they’re hydrated because dehydration is a major problem there. Those are things you can do. Maybe give them some type of sugar so that their blood glucose or blood sugar levels don't drop dangerously. Keep an eye on them so they don't inhale something, that's another reason why a lot of people use lollipops, to keep up their blood sugar. Those are some of the things that you can do. That would certainly remove a lot of the immediate life threatening issues that they may have.

 

Karen Ortman  44:14

But it's probably always best to call 911, I would think, anyway. 

 

Dr. Greg McDonald  44:19

Yes.

 

Karen Ortman  44:20

If there's some level of concern.

 

Dr. Greg McDonald  44:22

And again, playing off of that, these types of drugs also can lend themselves to drug facilitated sexual assault. You know, and that's a whole other issue that has to be addressed, but that's obviously a major problem.

Karen Ortman  44:44

Agreed. How about Molly, what is that substance?

 

Dr. Greg McDonald  44:49

Well, depends on who you ask, sometimes these nicknames they have different meanings for different parts of the country. I know a lot of people use the term Molly as a type of ecstasy. So they may have slightly different chemical features to them, chemical structures to them but generally the effects are fairly the same. They can have a bit of a hallucinogenic effect, so when they go to these raves and things, they may have, you know, light shows and glow sticks and that type of thing, because that adds this visual component to the party. It does have a hallucinogenic effect, that obviously, for the individuals, is somewhat pleasurable.

 

Karen Ortman  45:49

Would LSD fall in the same category of ecstasy or Molly?

 

Dr. Greg McDonald  45:56

It's different, it's a hallucinogenic drug, but it has a different chemical structure, and I'll be honest with you, I can't remember the last time I've seen a death with LSD. I'm sure they're out there. It was much more prominent in the 60s and the 70s. One of the major issues with LSD is that people become hallucinogenic, they lose connection with reality. Maybe they think that they can fly, maybe they think that they can swim across the ocean, or they have self-destructive behaviors. I've heard of cases, people pulling out their own eyes. Obviously, that is one of the major dangers of LSD, you really don't know what you're doing and you're hallucinating, you're seeing things that may not be there. Of course, that may get the attention of law enforcement as well. There's a lot of bad things that can happen with LSD and it can have some long term effects, where people have what they call bad trip, and then they have some lingering effects of the LSD even years later, I've heard.

 

Karen Ortman  47:15

Can it be fatal?

 

Dr. Greg McDonald  47:17

It can, like any drug that could be fatal, but oftentimes, the fatalities are associated with their inability to connect with reality. They may jump through a window or something like that and oftentimes fatalities are associated with that. 

 

Karen Ortman  47:35

If we could move on to bath salts. Can you explain what bath salts is, its effects and what is the desired high one is looking for?

 

Dr. Greg McDonald  47:57

Yeah, they kind of get the name bath salt because they are a powder, it's a crystalline powder typically. This is a chemically derived substance but it is based in a drug, a plant that is grown in Africa that we call cat, K.A.H.T. So the bath salts are a more a synthetic version of that, a more pure version of the KAHT. KAHT was used, and I'm sure still is, in parts of Africa. People chew it. It's a leaf and they chew it, it's a very, very potent stimulant. They may be awake for days at a time. Some people were in the military, the gorillas or soldiers may be using this and they're wide awake for days at a time. That plant, the useful portions, the chemically active portions of that plant have been synthesized. It's a very long name, I won't go into it, it's meth. Methadrone is one of the more common names but there's other names, chemical names, that can be associated with it. This is a very potent stimulant, not unlike cocaine, or crystal meth. So they can have very similar effects. People can be sweating, they're hyperthermic, they have what we call excited delirium, or they're running around acting really aggressively acting inappropriately. They may die from that behavior, or being a such a very potent stimulant, oftentimes it's their heart or their cardiac activity that becomes shut down. They may have a heart attack, they may have a stroke, those types of things are what would kill them. 

 

Karen Ortman  50:11

Have you seen a lot of deaths as a result of bath salts?

 

Dr. Greg McDonald  50:14

I have not, not in this part of the country. Talking to my colleagues in the northeast part of the country, we haven't seen much at all. I think it was more popular down in the south like near Florida and those areas. Exactly why that is, I don't know, again, maybe that's just where they were able to distribute it.  I personally have never had a lethality associated with bath salts. 

 

Karen Ortman  50:48

One area that I would like to cover before we close is inhalants, typically called huffing. What is the craze? Educate me and our listeners regarding inhalants? When did you first see this...I don't even know what to call it, I mean, you're using regularly used household items for the purposes of getting high. When did you first start seeing huffing as a means by which someone gets high?

 

Dr. Greg McDonald  51:48

Well, the huffing goes back before you know I started training. When I was a kid in the 60s, 70s, 80s, it was being used. I don't see too much today. You know, we every once in a while we'll see a case of it that's lethal. You know, again, I won't have time to go into all the different substances that can be used but usually it's a volatile, substance, you know, spray paint, glue, those types of things; they put in a plastic bag and then a person who hails it. That can have really disastrous effects on the brain, it can produce some really permanent cognitive problems. When they're putting that in a plastic the plastic bag over their mouth, not only they're inhaling this toxic substance, but there's also a component of what we call us asphyxia, they're not breathing in oxygen, so you have that also complicating this, and sometimes that's more dangerous than the actual inhaling itself. They get high from it, most of them tend to have somewhat of a stimulatory capability, others may be more of a depressive capability depending on what they're using. Good news, now, is that they're limiting selling of things like spray paint. You can't just go in as a 12-year-old kid and get spray paint, they usually have to show identification and things like that. I think some of that has decreased the exposure to it. When I was a kid they call it sniffing glue, like the airplane glue, they would put it in a plastic bag and sniff that. That's too has been more regulated, it wasn't back then and people aren't building models as much as they used to be. We see it every once in a while but it's not quite what it was back in, I think, you know, the 60s and 70s.

 

Karen Ortman  54:05

Right. Are there signs of abuse of one who huffs

 

Dr. Greg McDonald  54:12

There can be, sure, well one thing they may have spray paint on their hands. Okay, so if you have spray paint in your hands you're either painter, a graffiti artist, or maybe you're abusing it. That may be an obvious one. Other things, they may get a rash around their mouth by putting the plastic bag on their face. It's usually that substance, this compound is usually pretty irritating. So you see a skin rash around their mouth and nose.

 

Karen Ortman  54:42

Do they ever just ingest it directly into their mouth without using a bag?

 

Dr. Greg McDonald  54:47

I'm sure people have tried that but that usually results in sickness and doesn't get the high that they're looking for. Usually they'll be vomiting, I mean, they'll get pretty sick pretty quickly. It really has the most effects is when it becomes volatile, one becomes airborne and they can hail it. So again, I'm sure people have tried to snort it, drink it, and what have you, but the more deleterious effects will happen pretty quickly and I doubt they would continue to do that. 

 

Karen Ortman  55:25

What are the resources that are available for those who are addicted to anything that we have spoken of today? And, not only addicted but, have a desire to be sober and free of their addiction? Are there any resources that you can speak to?

 

Dr. Greg McDonald  55:51

Well, there's Narcotics Anonymous, like Alcoholics Anonymous. They tend to have a fairly good success rate. Certainly there is a cottage industry that's sprung up of rehabilitation centers. You have good ones, and you have some not so good ones.  They tend to have a 30-day program or 90 day program. The longer you can invest in those types of programs; I think the better the outcome is. It really requires a change in your lifestyle, and requires a change in how you look at things, and someone is going to deal with the underlying issue; mental health issue that may have prompted you to start using drugs

 

Karen Ortman  56:43

But it also means changing, you know, your circle of friends which is very important.

 

Dr. Greg McDonald  56:47

Yes, exactly, you're right. if the people you used to associate are the people that would buy drugs for you and vice versa, now, you have to disengage yourself from those social circles and have, and other people that they deal with. Depending on where you live, that can be very difficult to do. There's a lot of societal pressure, peer pressure, to engage in some of these activities, and to extricate yourself from that environment can be a real challenge.

 

Karen Ortman  57:25

Yeah, absolutely. Is there anything that you'd like to add that I haven't asked you? 

 

Dr. Greg McDonald  57:30

I think one very important thing is, we hear so much on the news about drug overdoses, right.  I understand why they're using that term, but to be more medically accurate, they're not overdoses in the vast majority of cases that I do autopsies on who died of drug abuse; it's not an overdose. I typically call it an adverse effect of drugs, and I'll stick to drugs, because they usually don't do a large amount of drugs, they may be doing a relatively small amount of drugs. And again, maybe because they've lost the tolerance that we talked about earlier, maybe it's their first time using a drug. There's no safe level of cocaine really, or heroin and there's no real lethal level, I mean, you could take a small amount of it, and it could kill you.

 

Karen Ortman  58:28

Right? So like you spoke of earlier, you can have a 20-year habit, a 40-year habit or a one-day habit. 

 

Dr. Greg McDonald  58:34

Exactly. 

 

Karen Ortman  58:35

And you don't know which category you would fit in.

 

Dr. Greg McDonald  58:41

And you could be have a 40 year habit and one day, for whatever reason, you're taking something that's really it's, you got to understand, especially with illicit drugs, they are not regulated very well, so you take something that is cut with some other substance and for 40 years you were a user and didn't die, and then that one day you use and you die.

 

Karen Ortman  59:03

Well, I'd venture to say they're not regulated at all.

 

Dr. Greg McDonald  59:06

Well, yes, I mean, illicit drugs, truly illicit drugs, that's for sure. And they're cut, mixed with various substances that are listed there allergic reaction and other types of problems.

 

Karen Ortman  59:21

Well, sir, I can see why you're the Dean of medical school, or of Philadelphia College of Osteopathic Medicine. You're a wealth of knowledge and I'm really happy that you agreed to be my guest today. So thank you.

 

Dr. Greg McDonald  59:39

Well, thank you so much, as always, it's a pleasure, and thanks for having me.

 

Karen Ortman  59:44

Absolutely. And we'll do it again next season, I'm sure.

 

Dr. Greg McDonald  59:47

Great. I look forward to it.

 

Karen Ortman  59:49

Thank you to my guest, Dr. McDonald, and to all of our listeners for joining us for today's episode of You Matter if any information presented today was triggering or disturbing, please feel free to contact the Wellness Exchange at 212-443-9999 or NYU’s Department of Public Safety and their Victim Services Unit at 212-998-2222. Please share like and subscribe to You Matter on Apple podcasts, Google Play, Tune in or Spotify.