Drug Harms

Drug harms are what repeated use leaves in the body, the mind and life long after the high has ended. We are talking here about the young man who began complaining of constant palpitations after two years of captagon, the father whose eyes turned yellow after years of drinking, and the family drained by debts and promises. This page explains the harm organ by organ, its long-term effect on the brain and mental health, the differences between substance families, the danger of mixing and of the route of use, the link between drugs and cancer and crime, and what can recover after stopping. What the substance does during the hours of its effect, and how long it shows in a test, belongs in the section The effect of drugs during use.

How does harm build up silently over time?

Most long-term drug harms don't come from a single night, but from repetition that wears out the organ before giving it time to recover. Every time blood pressure rises because of a stimulant, it leaves a small mark in the artery wall; every drink adds a burden on the liver cells; and every late night draws on the store of sleep with which the brain repairs itself. Because these effects are silent at first, the user is reassured that they are "fine" until the problem appears all at once.

The World Health Organization estimates in its 2024 report that alcohol alone was linked to about 2.6 million deaths worldwide in 2019, and that the use of other drugs was linked to about 0.6 million deaths, many of them caused by liver disease, heart disease, cancer and infections that accumulated over the years.

Drug harms on the body, organ by organ

The heart and blood vessels

Stimulants such as cocaine, shabu and captagon raise blood pressure and pulse repeatedly, and over the years the heart muscle may enlarge and weaken, the arteries harden, and the likelihood of heart attack and stroke increases even in young people in their thirties. Alcohol in large amounts causes heart-muscle disease and rhythm disturbance. Injecting may carry bacteria to the heart valves, which become inflamed.

The lungs and respiratory system

Smoking hash and bango causes a chronic cough, phlegm and repeated inflammation of the airways, and it gets worse when mixed with tobacco, as is common in Egypt. Smoking crack and heroin on foil burns the airways, and makes simple colds turn into pneumonia.

The liver, kidneys and bladder

The liver is the first victim of alcohol: fat, then inflammation, then cirrhosis that may end in failure. Injecting adds the risk of viral hepatitis C and B. The kidneys are harmed by repeated dehydration and the muscle breakdown that may accompany stimulants and synthetic cannabis. Ketamine, however, leaves a special mark on the bladder, making its wall inflamed and shrunken, so the person suffers pain, frequent urination and blood in the urine; the details are in the article What ketamine does to the bladder and kidneys.

The mouth, teeth and digestive system

Shabu users lose their teeth quickly because of dry mouth, grinding and neglected hygiene. Opioids cause chronic constipation that may reach obstruction. Khat wears out the gums and stomach. With alcohol, the pancreas and stomach become inflamed. And there is a repeated-vomiting syndrome that emergency doctors know in people who have smoked hash heavily for years.

Hormones, fertility and pregnancy

Long-term opioid use lowers the male hormone, so desire and erection weaken and fertility falls, and in women the cycle is disturbed or stops, as the article The effect of drugs on the menstrual cycle explains. During pregnancy, most substances reach the fetus, which is why we devoted the article Drugs during pregnancy to ways of getting safe help without blame.

What do drugs do to the brain and mental health in the long term?

The most dangerous drug harms are not seen on scans. The brain adapts to the substance day after day, and this adaptation is the root of much of the harm. Its ability to enjoy ordinary things weakens, so the person seems flat and enthusiastic about nothing. Short-term memory, concentration and the ability to plan decline, so the student stumbles in his studies and the employee in his work. Over time, impulse control decreases, so the decision of "one last time" becomes harder each time.

On the psychological side, long-term use is linked to anxiety and depression, and suicidal thoughts may appear in periods of crash. Stimulants, high-potency cannabis and synthetic cannabis may uncover or trigger psychotic episodes with suspicion and hallucinations, which go away in some people with stopping and persist in others who are predisposed. Chronic alcohol use may cause a deficiency of the vitamin thiamine, leading to a memory disorder that is hard to treat if discovered late.

A table of drug harms by substance family

Drug harms differ from one family to another, although they all share dependence and mood disturbance. The table summarizes the most prominent things we see in the clinic with long-term use:

Mixing substances: when harm multiplies

We rarely receive a patient who uses a single substance. More common is a young man combining hash and tramadol, drinking alcohol with cocaine, or taking pregabalin to ease the captagon crash. In this mixing, drug harms multiply instead of adding up: the liver processes more than one substance at the same time, the heart receives contradictory signals, and alcohol with cocaine forms a compound in the body more toxic to the heart than either of them. The details are in the article Why mixing drugs becomes deadly.

Harms linked to the route of use

Part of drug harm comes from the way the substance enters the body, independently of the substance itself:

• Injecting: sharing needles transmits hepatitis viruses and HIV, and abscesses, blocked veins and inflamed heart valves appear. The article The harms of injecting drug use explains this.
• Smoking: heat and smoke hurt the mouth, throat and lungs whatever the substance.
• Snorting: it dries the lining of the nose and may perforate the nasal septum with cocaine.
• Swallowing: it strains the stomach and liver, and makes it easy for the amount to build up unnoticed.

Do drugs cause cancer?

The link between drug harms and cancer differs by substance. Alcohol is classified by the International Agency for Research on Cancer, part of the World Health Organization, as a confirmed carcinogen, and is linked to cancers of the mouth, throat, esophagus, liver, colon and breast. Any smoke inhaled carries carcinogens, and the risk rises greatly when hash is rolled with tobacco. The link between hash alone and lung cancer, however, is not settled by the evidence so far. Another, indirect risk comes from injecting, as chronic viral hepatitis may develop into liver cancer years later.

Drug harms on the family, marriage and work

The family often reaches us before the patient, because the social harms of drugs fall on it first: the wife, the children and the parents before the person with the problem himself.

The article What addiction does to married life explains how the relationship can be repaired, while the article Driving under the influence of substances explains what the family can do to protect everyone on the road.

Why is the harm deeper in teenagers and young people?

The US National Institute on Drug Abuse (NIDA) explains that the brain continues to mature until the mid-twenties, and that the areas responsible for judgment and impulse control are the last to be completed. So drug harms at fifteen are not the same as at thirty: the risk is greater to memory and achievement, the chances of turning into addiction are higher, and psychosis is closer with high-potency cannabis. In our clinics we find young people who stumbled academically for two years before anyone noticed the cause. The article Teen addiction explains why they are more vulnerable, and the article Drug prevention offers practical steps for parents.

Drugs and crime: a link, not an inevitability

Not every user is a criminal, and this is a stigma that delays treatment a great deal. But the link exists through several doors: the need for money may push toward theft, some substances such as shabu and synthetic cannabis increase aggression and suspicion, alcohol weakens self-control, and possessing the substance itself breaks the law. Egyptian law opens a door to treatment instead of punishment for those who come forward seeking help, as the article Addiction and the law in Egypt explains.

Do drug harms go away after stopping?

This is the question we hear most from mothers, and the honest answer is: many drug harms improve, some remain, and the deciding factor is usually the timing of stopping, the type of substance and the length of use. A fatty liver recedes, sleep and appetite return, and concentration improves gradually. Brain-imaging studies have shown partial recovery of the dopamine system after long months of abstinence from stimulants. Advanced cirrhosis, severe bladder shrinkage and chronic infections, however, may need ongoing treatment.

1. 1The first weeksThe body catches its breath

   Sleep and appetite improve, liver function starts to improve, and palpitations decrease.

2. 2The first monthsThe mind regains its clarity

   Concentration and memory improve gradually, and mood stabilizes with psychotherapy and follow-up.

3. 3A year or moreDeeper repair

   The reward circuits partly recover, the ability to enjoy returns, and any remaining physical harm is assessed.

The details of this stage are in the article When does the body return to normal after quitting drugs?, and in the answer to the question Does an addict return to normal after treatment?

When does chronic harm turn into an emergency?

Drug harms may remain silent for years and then suddenly appear as a complication that needs hospital at once. Don't hesitate to act if you see one of these signs:

The signs of poisoning during the effect, such as slow breathing and loss of consciousness, are in the article Overdose and what to do until the ambulance arrives. You can also call the hotline of the General Secretariat of Mental Health and Addiction Treatment on 16328 for advice.

The drug harms article guide: each substance separately

Here are all the drug harms articles in the section, arranged by substance family, then a section for harms that go beyond a single substance, such as pregnancy, marriage and driving.

When should you seek help?

Don't wait for drug harms to show in a liver test or an ECG. If you notice a decline in health, study or work, or the signs of drug use have started repeating at home, intervening now preserves what can be preserved, and you can find the stages of addiction treatment explained step by step. At Riviera Life, licensed by the Egyptian Ministry of Health with fourteen years of experience, consultant psychiatrists and addiction specialists assess the case physically and psychologically in complete confidentiality, and the first step begins with a free consultation; call us on +201507999722.