What is alcohol use disorder?

Alcohol use disorder (AUD) is a chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD ranges from mild to severe.

What are synthetic cathinones ("bath salts")?

“Bath salts” is the name given to synthetic cathinones, a class of drugs that have one or more laboratory-made chemicals similar to cathinone. Cathinone is a stimulant found naturally in the khat plant, grown in East Africa and southern Arabia.

Chemically, cathinones are similar to amphetamines such as methamphetamine and to MDMA (Ecstasy or Molly). Common lab-made cathinones found in “bath salts” include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone (Drone, Meph, or Meow Meow), and methylone, but there are many others. These lab-made cathinones can be much stronger than the plant product and can cause harmful effects.

“Bath salts” are usually white or brown crystal-like powder and are sold in small plastic or foil packages labeled “Not for Human Consumption.” They are sometimes labeled as “plant food,” “jewelry cleaner,” or “phone screen cleaner.” They are sold online and in drug product stores. These names or descriptions have nothing to do with the product. It’s a way for the drug makers to avoid detection by the Drug Enforcement Administration or local police.

The lab-made cathinone products sold as “bath salts” should not be confused with products such as Epsom salts (the original bath salts) that people add to bathwater to help ease stress and relax muscles. Epsom salts are made of a mineral mixture of magnesium and sulfate.

“Bath salts” are sometimes marketed as cheap substitutes for other drugs such as MDMA (Molly or Ecstasy) or cocaine. Methylone, a common chemical in “bath salts”, has been substituted for MDMA in capsules sold as Molly in some places. There is no way to know what is in a dose of “bath salts” other than testing it in a lab.

How "Bath Salts" Are Used

“Bath salts” are usually swallowed, snorted through the nose, inhaled, or injected with a needle. Snorting or injecting is the most harmful. 

Banning “Bath Salts”

At the end of the last decade, bath salts began to gain in popularity in the United States and Europe as “legal highs.” In October 2011, the Drug Enforcement Administration put an emergency ban on three common lab-made cathinones until officials knew more about them. In July 2012, President Barack Obama signed legislation permanently banning two of them—mephedrone and MDPV, along with several other lab-made drugs often sold as marijuana substitutes (like K2/Spice).

Although the law also bans chemically similar versions of some of these drugs, manufacturers have responded by making new drugs different enough from the banned substances to get around the law. To protect the public, the government is constantly monitoring newer formulas.

What is cocaine?

Cocaine is an addictive stimulant drug made from the leaves of the coca plant native to South America. Cocaine comes in two forms:

• Powder cocaine is a white powder (which scientists call a hydrochloride salt). Street dealers often mix cocaine with other substances like cornstarch, talcum powder, or sugar. They also mix cocaine with stimulant drugs like amphetamines, or synthetic opioids, including fentanyl, which has caused deaths.
• Crack is a form of cocaine that has been processed to make a rock crystal that people smoke. The term “crack” refers to the cracking sound the rocks make when they are heated.

How Cocaine Is Used

There are a few different ways that cocaine can enter the body: through the nose by snorting, and directly into the blood stream by injecting or rubbing it into gums above the teeth. The crystal of crack cocaine is heated in a glass pipe to produce vapors that are absorbed into the blood through the lungs.

What are cough and cold medicines?

Millions of Americans take cough and cold medicines each year to help with symptoms of colds. When taken as instructed, these medicines can be safe and effective. They become harmful when taken in a way or dose other than directed on the package.

Several cough and cold medicines contain ingredients that are psychoactive (mind-altering) when taken in higher-than-recommended dosages, and some people misuse them. These products also contain other ingredients that can add to the risks. Many of these medicines are bought “over the counter” (OTC), meaning you do not need a prescription to have them. 

Two commonly misused cough and cold medicines are:

• Dextromethorphan (DXM) cough syrup, tablets, and gel capsules. These OTC cough medicines are safe for stopping coughs during a cold if you take them as directed. Taking more than the recommended amount can produce a "high" and sometimes dissociative effects (like you are detached from your body).
• Promethazine-codeine cough syrup. These prescription medications contain an opioid drug called codeine, which stops coughs, but when taken in higher doses produces a "buzz" or "high."

Read more about prescription drugs and what happens to the brain and body when someone misuses them.

How Cough and Cold Medicines Are Misused

Cough and cold medicines are usually sold in liquid syrup, capsule, or pill form. They may also come in a powder. Drinking promethazine-codeine cough syrup mixed with soda (a combination called "lean" or "sizzurp") was referenced frequently in some popular music beginning in the late 1990s and has become increasingly popular among youth in several areas of the country.

Young people are often more likely to misuse cough and cold medicines containing DXM than some other drugs because these medicines can be purchased without a prescription.

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What is heroin?

Heroin is a very addictive drug made from morphine, a psychoactive (mind-altering) substance taken from the resin of the seed pod of the opium poppy plant. Heroin’s color and look depend on how it is made and what else it may be mixed with. It can be white or brown powder, or a black, sticky substance called “black tar heroin.”

Heroin is part of a class of drugs called opioids. Other opioids include some prescription pain relievers, such as codeine, oxycodone (OxyContin), and hydrocodone (e.g. Vicodin).

Heroin use and overdose deaths have dramatically increased over the last decade. This increase is related to the growing number of people misusing prescription opioid pain relievers like OxyContin and Vicodin. Some people who become addicted to those drugs switch to heroin because it produces similar effects but is cheaper and easier to get. 

In fact, most people who use heroin report they first misused prescription opioids, but it is a small percentage of people who switch to heroin. The numbers of people misusing prescription drugs is so high, that even a small percentage translates to hundreds of thousands of heroin users.¹ Even so, some research suggests about one-third of heroin users in treatment simply started with heroin. Maybe they were mistakenly told that only one use cannot lead to addiction. Both heroin and opioid pill use can lead to addiction and overdose. 

How Heroin is Used

Heroin is mixed with water and injected with a needle. It can also be sniffed, smoked, or snorted. People who use heroin sometimes combine it with other drugs, such as alcohol or cocaine (a “speedball”), which can be particularly dangerous and raise the risk of overdose.

To learn more about the different types of opioids, visit our Prescription Opioids Drug Facts page.

What are inhalants?

Inhalants are chemicals found in ordinary household or workplace products that people inhale on purpose to get “high.” People often don’t realize that inhaling the fumes of these products, even just once, can be very harmful to the brain and body and can lead to death. In fact, the chemicals found in these products can change the way the brain works and cause other problems in the body.

Although different inhalants cause different effects, they generally fall into one of four categories.

Volatile solvents are liquids that become a gas at room temperature. They are found in:

• paint thinner, nail polish remover, degreaser, dry-cleaning fluid, gasoline, and contact cement
• some art or office supplies, such as correction fluid, felt-tip marker fluid, glue, and electronic contact cleaner

Aerosols are substances under pressure that are released as a fine spray. They include:

• spray paint, hair spray, deodorant spray, vegetable oil sprays, and fabric protector spray

Gases may be in household or commercial products, or used in the medical field to provide pain relief. They are found in:

• butane lighters, propane tanks, whipped cream dispensers, and refrigerant gases
• anesthesia, including ether, chloroform, halothane, and nitrous oxide (commonly called “laughing gas”).

Nitrites are often sold in small brown bottles labeled as:

• organic nitrites, such as amyl, butyl, and cyclohexyl nitrites and other related compounds
• amyl nitrite, used in the past by doctors to help with chest pain and sometimes used today to diagnose heart problems
• nitrites, now banned (prohibited by the Consumer Product Safety Commission) but can still be found, sold in small bottles labeled as “video head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.”

How Inhalants Are Used

People who use inhalants breathe in the fumes through their nose or mouth, usually by "sniffing," "snorting," "bagging," or "huffing." It's called different names depending on the substance and equipment used. 

What is marijuana?

Marijuana is the dried leaves and flowers of the Cannabis sativa or Cannabis indica plant. Stronger forms of the drug include high potency strains - known as sinsemilla (sin-seh-me-yah), hashish (hash for short), and extracts including hash oil, shatter, wax, and budder.

Of the more than 500 chemicals in marijuana, delta-9-tetrahydrocannabinol, known as THC, is responsible for many of the drug’s psychotropic (mind-altering) effects. It’s this chemical that distorts how the mind perceives the world. In other words, it's what makes a person high.

Read 10 things you can learn about marijuana.

Strength and Potency

The amount of THC in marijuana has increased over the past few decades. In the early 1990s, the average THC content in marijuana was less than 4 percent. It is now about 15 percent and much higher in some products such as oils and other extracts (see below). Scientists do not yet know what this increase in potency means for a person’s health. Some people adjust how they consume marijuana (by smoking or eating less) to compensate for the greater potency. There have been reports of people seeking help in emergency rooms with symptoms, including nervousness, shaking and psychosis (having false thoughts or seeing or hearing things that aren't there), after consuming high concentrations of THC. 

Marijuana Extracts

Smoking extracts and resins from the marijuana plant with high levels of THC is on the rise. There are several forms of these extracts, such as hash oil, budder, wax, and shatter. These resins have 3 to 5 times more THC than the plant itself. Smoking or vaping it (also called dabbing) can deliver dangerous amounts of THC and has led some people to seek treatment in the emergency room. There have also been reports of people injured in fires and explosions caused by attempts to extract hash oil from marijuana leaves using butane (lighter fluid).

What is MDMA (Ecstasy or Molly)?

MDMA, short for 3,4-methylenedioxymethamphetamine, is most commonly known as Ecstasy or Molly. It is a laboratory-made drug that produces a “high” similar to the stimulants called amphetamines. It also produces psychedelic effects, similar to the hallucinogens mescaline and LSD. MDMA first became popular in the nightclub scene, at “raves” (all-night dance parties), and music festivals or concerts. It is now used by a broader range of people. The drug’s effects generally last from 3 to 6 hours.

MDMA is a Schedule I substance, which means that the U.S. Government has determined that it has no medical benefit and a high potential for abuse. Researchers, however, continue to investigate the possible medical benefits, for example, with patients that have post-traumatic stress disorder (PTSD) and terminal cancer patients with anxiety. However, patients in those studies are under strict medical supervision. 

How MDMA (Ecstasy/Molly) is Used

Most people who use MDMA take it in a pill, tablet, or capsule. The pills can be different colors and sometimes have cartoon-like images on them. Some people take more than one pill at a time, called “bumping.” The popular term “Molly” (slang for molecular) refers to the pure crystalline powder form of MDMA, usually sold in capsules. But this is mostly a marketing gimmick—testing on "Molly" seized by police shows a variety of other ingredients.

In fact, researchers and law enforcement have found that much of the Ecstasy sold today contains other harmful and possibly deadly drugs. In some recent cases, drugs sold as MDMA actually contain no MDMA at all. Frequently, MDMA is mixed with or replaced by synthetic cathinones, the chemicals in “bath salts". Some MDMA pills, tablets, and capsules have also been found to contain caffeine, dextromethorphan (found in some cough syrups), amphetamines, PCP, or cocaine.

What is methamphetamine (meth)?

Image

Photo by DEA Crystal Methamphetamine

Methamphetamine—known as “meth”— is a laboratory-made, white, bitter-tasting powder. Sometimes it's made into a white pill or a shiny, white or clear rock called crystal. Meth is made in the United States and often in Mexico—in "superlabs"—big, illegal laboratories that make the drug in large quantities. But it is also made in small labs using cheap, over-the-counter ingredients such as pseudoephedrine, which is a common ingredient in cold medicines. Drug stores often put these products behind the counter so people cannot use them to create meth in home labs. Other chemicals, some of them toxic, are also involved in making methamphetamine. Meth is sometimes pressed into little pills that look like Ecstasy to make it more appealing to young people.

Methamphetamine is a stimulant drug. Stimulants are a class of drugs that can boost mood, increase feelings of well-being, increase energy, and make you more alert. But they also have dangerous effects like raising heart rate and blood pressure, and use can lead to addiction. Methamphetamine’s pleasurable effects can disappear even before the drug levels fall in the blood, leading people to use more and more, sometimes not sleeping and using the drug for several days.

Methamphetamine is classified as a Schedule II drug, meaning it has high potential for abuse and is legally available only through a prescription that cannot be refilled. It is prescribed by doctors in limited doses in rare cases for certain medical conditions.

How Methamphetamine Is Used

Methamphetamine is:

• swallowed
• snorted
• injected with a needle
• smoked

“Crystal meth” is a large, usually clear crystal that is smoked in a glass pipe. Smoking or injecting the drug delivers it very quickly to the brain, where it produces an immediate and intense high. Because the feeling doesn’t last long, users often take the drug repeatedly, in a “binge and crash” pattern.

What are prescription depressants?

Depressants, sometimes referred to as central nervous system (CNS) depressants or tranquilizers, slow down (or “depress”) the normal activity that goes on in the brain and spinal cord. Doctors often prescribe them for people who are anxious or can't sleep.

When prescription depressants are taken as prescribed by a doctor, they can be relatively safe and helpful. However, it is considered misuse when they are taken not as prescribed, to get "high," or when you take some prescribed for someone else. This can lead to dependence and addiction are still potential risks. Addiction means you continue to seek out and take the drug despite negative consequences. 

Depressants can be divided into three primary groups: barbiturates, benzodiazepines, and sleep medications.

Depressants

Type	Conditions They Treat
Barbiturates mephobarbital (Mebaral®) phenobarbital (Luminal®) sodium pentobarbital (Nembutal®)	Seizure disorders Anxiety and tension
Benzodiazepines alprazolam (Xanax®) clonazepam (Klonopin®) diazepam (Valium®) estazolam (ProSom®) lorazepam (Ativan®)	Acute stress reactions Panic attacks Convulsions Sleep disorders
Sleep Medications eszopiclone (Lunesta®) zolpidem (Ambien®) zaleplon (Sonata®)	Sleep disorders

How Prescription Depressants Are Misused

Depressants usually come in pill or capsule form. People misuse depressants by taking them in a way that is not intended, such as:

• Taking someone else’s prescription depressant medication, even if it is for a medical reason like sleep problems.
• Taking a depressant medication in a way other than prescribed—for instance, taking more than the prescribed dose or taking it more often, or crushing pills into powder or opening capsules to snort or inject the drug.
• Taking a depressant to get "high."
• Taking a depressant with other drugs or to counteract the effects of other drugs, such as stimulants.
• Mixing them with other substances, like alcohol or prescription opioids.

Read more about prescription drugs and what happens to the brain and body when someone misuses them.

What are prescription drugs?

Prescription drugs are often strong medications, which is why they require a prescription from a doctor or dentist. There are three kinds of prescription drugs that are commonly misused:

• Opioids—used to relieve pain, such as Vicodin®, OxyContin®, or codeine
• Depressants—used to relieve anxiety or help a person sleep, such as Valium® or Xanax®
• Stimulants— used for treating attention deficit hyperactivity disorder (ADHD), such as Adderall® and Ritalin®

Prescription drug misuse has become a large public health problem, because misuse can lead to addiction, and even overdose deaths.

What Makes Prescription Drug Misuse Unsafe

Every medication has some risk for harmful effects, sometimes serious ones. Doctors and dentists consider the potential benefits and risks to each patient before prescribing medications and take into account a lot of different factors, described below. When prescription drugs are misused, they can be just as dangerous as drugs that are made illegally.

• Personal information. Before prescribing a drug, health providers consider a person's weight, how long they've been prescribed the medication, other medical conditions, and what other medications they are taking. Someone misusing prescription drugs may overload their system or put themselves at risk for dangerous drug interactions that can cause seizures, coma, or even death.
• Form and dose. Doctors know how long it takes for a pill or capsule to dissolve in the stomach, release drugs to the blood, and reach the brain. When misused, prescription drugs are sometimes taken in larger amounts or in ways that change the way the drug works in the body and brain, putting the person at greater risk for an overdose. For example, when people who misuse OxyContin® crush and inhale the pills, a dose that normally works over the course of 12 hours hits the central nervous system all at once. This effect increases the risk for addiction and overdose.
• Side effects. Prescription drugs are designed to treat a specific illness or condition, but they often affect the body in other ways, some of which can be uncomfortable, and in some cases, dangerous. These are called side effects.  Side effects can be worse when prescription drugs are not taken as prescribed or are used in combination with other substances. See more on side effects below.

How Prescription Drugs are Misused

• Taking someone else’s prescription medication, even if it is for a medical reason (such as to relieve pain, to stay awake, or to fall asleep).
• Taking a prescription medication in a way other than prescribed—for instance, taking more than the prescribed dose or taking it more often, or crushing pills into powder to snort or inject the drug. 
• Taking your own prescription in a way that it is not meant to be taken is also misuse. This includes taking more of the medication than prescribed or changing its form—for example, breaking or crushing a pill or capsule and then snorting the powder.
• Taking the prescription medication to get “high.” 
• Mixing it with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with specific prescription drugs. 

What are prescription opioids?

Prescription opioids are medications that are chemically similar to endorphins – opioids that our body makes naturally to relieve pain. They are also similar to the illegal drug heroin. In nature, opioids are found in the seed pod of the opium poppy plant. Prescription opioids usually come in pill or liquid form, and are given to treat severe pain—for example, pain from dental surgery (read more about drug use and your mouth), serious sports injuries, or cancer. If you are in the hospital, they can be given through an IV (needle and tube) in your arm. Opioids are sometimes prescribed to treat pain that lasts a long time (chronic pain), but it is unclear if they are effective for long term pain.

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When opioids are taken as prescribed by a medical professional for a short time, they can be relatively safe and can reduce pain effectively. However, taking prescription opioids, puts you at risk for dependence and addiction. Dependence means you feel withdrawal symptoms when you stop taking the drug. Continued use can lead to addiction, where you continue to seek out the drug and use it despite negative consequences. These risks increase when the medications are misused. Prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol, and marijuana.

Opioid medications can be natural, created in labs from natural opioids, or synthetic (human-made). Common opioids and their medical uses are listed below.

Opioids

Opioid Types	Conditions They Treat
oxycodone (OxyContin®, Percodan®, Percocet®) hydrocodone (Vicodin®) diphenoxylate (Lomotil®) morphine (Kadian®, Avinza®) codeine fentanyl (Duragesic®) propoxyphene (Darvon®) hydromorphone (Dilaudid®) meperidine (Demerol®) methadone	severe pain, often after surgery some forms of long-lasting pain (severe) cough and diarrhea

Fentanyl is a powerful synthetic (human-made) opioid that is 50 to 100 times stronger than morphine, and is prescribed for extreme pain. It is extremely dangerous if misused, and is sometimes added to illicit drugs sold by drug dealers. Find out more about Fentanyl.

How Prescription Opioids Are Misused

People misuse prescription opioid medications by taking them in a way that is not intended, such as:

• Taking someone else’s prescription, even if it is for a medical reason like relieving pain.
• Taking an opioid medication in a way other than prescribed—for instance, taking more than the prescribed dose or taking it more often, or crushing pills into powder to snort or inject the drug.
• Taking the opioid prescription to get "high."
• Mixing it with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with prescription pain relievers.

What are prescription stimulants (amphetamines)?

Prescription stimulants increase—or "stimulate"—activities and processes in the body. When prescribed by a doctor for a specific health condition, like ADHD, they can be relatively safe and effective. However, it is considered misuse when they are taken not as prescribed, to get "high," or when you take some prescribed for someone else. This can lead to dependence and addiction.

Dependence means you will get uncomfortable withdrawal symptoms when you try to quit. Addiction means you continue to seek out and take these drugs despite negative consequences. 

There are three commonly misused types of stimulants: dextroamphetamines (e.g., Dexedrine®), dextromethylphenidate (e.g., Ritaln®), and stimulants that are a combination dextroamphetamines and amphetamines (e.g., Adderall®). Medical uses for these stimulant drugs are listed below:

Stimulants

Type	Conditions They Treat
dextroamphetamines (Dexedrine®) dextromethylphenidate/amphetamine combination (Adderall®) dextromethylphenidate (Ritalin® and Concerta®)	ADHD Narcolepsy (sleep disorder) Depression

Read more about prescription drugs and what happens to the brain and body when someone misuses them.

How Stimulants Are Misused

Prescription stimulants are normally taken in pill form, but some people who misuse them to get "high" crush the tablets and snort or inject them. This can be dangerous because ingredients in the tablets can block small blood vessels, damaging the heart and other organs.

Some teens are prescribed stimulants to manage their ADHD. But if they share their medication with friends, it is considered misuse. People misuse stimulants by taking them in a way that is not intended, such as:

• Taking someone else’s prescription stimulant medication, even if it is for a medical reason, like ADHD.
• Taking stimulant medication thinking it will improve your grades even though you do not have ADHD.
• Taking more than the prescribed dose.
• Taking a prescription stimulant medication in a way other than prescribed—for instance, crushing pills, adding them to water, and injecting the liquid.
• Taking the prescription stimulant to get "high."
• Mixing the prescription stimulant with alcohol and certain other drugs. A pharmacist can tell you which drugs are not safe to mix with stimulants. 

Stimulants have been misused as an "academic performance enhancer," (for example, to stay awake all night to cram for an exam). That's why people sometimes refer to them as "study drugs." However, there is no evidence that stimulants increase your grades if you do not have ADHD; although there might be several other reasons those students struggle in school. For example, a decline in grades can be related to students skipping classes. Skipping classes can be linked to the use of a variety of drugs or mental health issues.

What is salvia?

Salvia (Salvia divinorum) is an herb in the mint family found in southern Mexico. The main active ingredient in salvia, salvinorin A, changes the chemistry in the brain, causing hallucinations (seeing something that seems real but isn’t). The effects usually last less than 30 minutes but may be very intense and frightening.

Although salvia is not illegal (according to Federal law), several states and countries have passed laws to regulate its use. The Drug Enforcement Administration lists salvia as a drug of concern that poses risk to people who use it.

How Salvia is Used

Usually, people chew fresh S. divinorum ;leaves or drink their extracted juices. The dried leaves of S. divinorum are smoked in rolled cigarettes, inhaled through water pipes (hookahs), or vaporized and inhaled.

What is Spice?

Spice is a mix of herbs (shredded plant material) and laboratory-made chemicals with mind-altering effects. It is sometimes misleadingly called  “synthetic marijuana” or "fake weed" because some of the chemicals in it are similar to ones in marijuana. But, its effects are sometimes very different from marijuana, and often much stronger. Usually, the chemicals are sprayed onto plant materials to make them look like marijuana. 

Because the chemicals used in Spice have a high potential for abuse and no medical benefit, the Drug Enforcement Administration has made many of the active chemicals  found in Spice illegal. However, the people who make these products try to avoid these laws by using different chemicals in their mixtures.

Spice is most often labeled "not for human consumption" and disguised as incense. Sellers of the drug try to lead people to believe it is “natural” and therefore harmless, but it is neither. In fact, the actual effects of spice can be unpredictable and, in some cases, severe or cause death.

How Spice is Used

Most people smoke Spice by rolling it in papers (like with marijuana or handmade tobacco cigarettes); sometimes, it is mixed with marijuana. Some people also make it as an herbal tea for drinking. Others buy Spice products as liquids to use in e-cigarettes. 

What are anabolic steroids?

Anabolic steroids are medications related to testosterone (male sex hormone) that are made in labs. Doctors use anabolic steroids to treat hormone problems in men, delayed puberty, and muscle loss from some diseases.

Bodybuilders and athletes might misuse anabolic steroids in attempts to build muscles and improve athletic performance, often taking doses much higher than would be prescribed for a medical condition. Using them this way, without a prescription from a doctor, is not legal—or safe—and can have long-term consequences.

Anabolic steroids are only one type of steroid. Other types of steroids include cortisol, estrogen, and progesterone. These are different chemicals and do not have the same effects.

How Anabolic Steroids Are Misused

When people take steroids without a doctor’s prescription or in ways other than as prescribed, it is called misuse.

Some people who misuse steroids take pills; others use needles to inject steroids into their muscles or apply them to the skin as a gel or cream.

What are tobacco, nicotine, and vaping (e-cigarette) products?

Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco leaves but nicotine is the one that can lead to addiction. Other chemicals produced by smoking tobacco, such as tar, carbon monoxide, acetaldehyde, and nitrosamines, also can cause serious harm to the body. For example, tar causes lung cancer and other serious diseases that affect breathing, and carbon monoxide can cause heart problems.

These toxic chemicals can be dangerous. In fact, tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarettes cause more than 480,000 premature deaths in the United States each year—from smoking or exposure to secondhand smoke. This represents about 1 in every 5 U.S. deaths, or 1,300 deaths every day. An additional 16 million people suffer with a serious illness caused by smoking. So, for every 1 person who dies from smoking, 30 more suffer from at least 1 serious tobacco-related illness.¹

How Tobacco and Nicotine Products Are Used

Tobacco and nicotine products come in many forms. People can smoke, chew, sniff them, or inhale their vapors.

• Smoked tobacco products.
  • Cigarettes: These are labeled as regular, light, or  menthol, but no evidence exists that “lite” or menthol cigarettes are safer than regular cigarettes.
  • Cigars and pipes: ?Some small cigars are hollowed out to make room for marijuana, known as "blunts," often done to hide the fact that they are smoking marijuana. Either way, they are inhaling toxic chemicals. 
  • Bidis and kreteks (clove cigarettes): Bidis are small, thin, hand-rolled cigarettes primarily imported to the United States from India and other Southeast Asian countries. Kreteks—sometimes referred to as clove cigarettes—contain about 60-80% tobacco and 20-40% ground cloves. Flavored bidis and kreteks are banned in the United States because of the ban on flavored cigarettes.
  • Hookahs or water pipes: Hookah tobacco comes in many flavors, and the pipe is typically passed around in groups. A recent study found that a typical hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide as smoking a cigarette.
• Smokeless tobacco products. The tobacco is not burned with these products:
  • Chewing tobacco. It is typically placed between the cheek and gums.
  • Snuff: Ground tobacco that can be sniffed if dried or placed between the cheek and gums.
  • Dip: Moist snuff that is used like chewing tobacco.
  • Snus: A small pouch of moist snuff.
  • Dissolvable products: These include lozenges, orbs, sticks, and strip.
• Vaping/electronic cigarettes (also called e-cigarettes, electronic nicotine delivery systems, vaping devices, e-cigs, or JUULing). Vaping products are battery-operated devices that deliver nicotine and flavorings without burning tobacco. In most products, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The resulting vapor is then inhaled (called “vaping”).