Substance Abuse And The Kidneys

The development stages of mankind include the Bronze Age followed by the Stone Age and then the Iron Age. We are now in the Stoned Agel The first recorded instance of recreational drugs use was in the 3rd century B.C — Arabic traders smoked opium and Aztecs chewed hallucinogenic mushrooms. In the past 30 years, the number of people using recreational drugs has skyrocketed. The advent of the club scene and easier access to drugs is responsible for an acceleration in substance abuse in India.

Newton’s third law of motion states that, for every action there ¡s an equal and opposite reaction.’ This is true for drug abuse as well – for every drug action there is an equal drug reaction. The momentary pleasure of the high is soon offset by long-lasting and life-threatening adverse events. The kidney is especially vulnerable to the complications of drug abuse as all substances need to go through the kidneys to be cleared out of the body.

Substances with the potential to be abused include legal drugs like tobacco and alcohol and illegal drugs like heroin (opium), cocaine, cannabis, amphetamines (ecstasy), sedatives (diazepam or temazepam), solvents (glue) and mushrooms. These drugs can affect the kidney directly by damaging kidney tissue or indirectly, by causing high blood pressure, seizures, infections or blocks in blood supply. Legal drugs and their effects have already been discussed earlier. Among the illegal drugs, heroin and cocaine are most often abused.

Heroin

This is broken down to morphine in the body. It can be eaten or smoked (‘chasing the dragon’), sniffed (‘snorting’), injected intravenously (‘mainlining’) or injected subcutaneously (skin popping’). It is often injected in combination with cocaine (speed balling’). A coma from overdose leads to muscle destruction and kidney failure. Low blood pressure, oxygen deprivation, dehydration and increased blood acid levels caused by heroin aggravates this.

Skin popping causes pus collections which can subsequently infect kidneys, heart, brain and other vital organs. Mainlining is associated with hepatitis B, C and HIV infections among other viral, bacterial and fungal infections. These infections also cause kidney disease independently. Heroin has been proven to cause a condition called FSGS in the kidney which leads to massive protein losses in the urine and subsequent kidney failure and dialysis dependence. This condition has no treatment and can be reversed only by discontinuing heroin use.

Cocaine

It is an extract from the coca shrub and can be snorted, smoked or injected. It can cause kidney failure by muscle destruction, seizures, high blood pressure and blockage of kidney arteries leading to choking of kidneys. Like heroin, cocaine too causes FSGS. In addition, cocaine worsens pre existing kidney disease. Cocaine is also known to cause sudden death by blocking coronary (cardiac) arteries leading to heart attacks.

Cannabis

Known by a multitude of names — Grass. weed, Mary Jane, marijuana, pot, bhang, ganja, hash, hemp, etc. cannabis is the most abused ‘soft’ drug. Since cannabis is usually smoked in combination with tobacco, most of the kidney effects are similar to those due to smoking. In addition, cannabis can cause blockage of kidney arteries and kidney destruction.

Amphetamines

Colloquially called ‘speed,’ amphetamines were originally used as an appetite suppressant in 1914. Their ability to temporarily increase stamina and cause euphoria led to their abuse in clubs. Ecstasy, the most popular amphetamine, is used during extended group dancing when attending ‘rave’ parties. The overheated environments, increased physical activity and dehydration cause very high body temperatures, seizures, liver dysfunction, muscle destruction, acute kidney failure, high blood pressure, cardiac arrests and bladder outlet failure leading to inability to pass urine.

With greater press coverage, the users of ecstasy are becoming aware of the risk of dehydration and often drink large quantities of water after taking the drug to prevent this. This practice gives rise to a fresh set of problems as life-threatening chemical disturbances like low sodium can occur due to over- dilution’ In many clubs, nowadays, chill out rooms are provided to prevent high body temperatures — leading to the origin of the teenage slang — ‘chilling out.’

Sedatives

Diazepam or temazepam are often used to induce sleep. They may be abused alone or in a ‘cocktail’ of drugs. They cause acute kidney failure, limb gangrene and muscle destruction often requiring dialysis.

Solvents

Glue sniffing,’ first emerged as a form of substance abuse in the early 1960s. The various substances that are inhaled to produce a ‘high’ include paints, fuels, cements, lacquer thinners and correction fluids. These contain solvents like benzene, toluene, ketones and other hydrocarbons which cause a ‘high’ similar to alcohol intoxication. The primary toxin – toluene causes kidney damage by inducing kidney stones, bloody urine, acidification detects, hepatorenal syndrome and kidney inflammation/infection.

Peer pressure might instigate youngsters to experiment with drugs to appear ‘cool,’ however, the momentary ‘high’ is soon followed by a dangerous ‘low’ of disease and even death.

What is frightening is that disease and death can follow even a single episode of drug abuse. This is way too uncool and youngsters need to be appropriately educated about the perils of substance abuse.