Using Drugs Recreationally: What Are the Risks?

Many adults in the U.S. use drugs recreationally. In fact, according to the 2018 National Survey on Drug Use and Health, close to 1 in 5 people aged 12 and older have used drugs in the past year. And this number has only been going up in the past 20 years. 

At the same time, scientists and doctors are also interested in whether certain recreational drugs might actually have medical benefits. They’re studying drugs like MDMA and hallucinogens to see if they could actually be used to treat health conditions like PTSD (post-traumatic stress disorder), eating disorders, and depression.

But even if some drugs turn out to be helpful for medical care, that doesn’t mean that they’re completely safe for everyone — especially when used recreationally. Using drugs can be dangerous and can cause health problems, accidents, and addiction, among other issues. And there’s evidence that some types of drugs can damage the brain — especially if they’re used a lot, or when a person is young. 

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Sometimes, the damage can be permanent.

What are recreational drugs?

Recreational drugs are substances that people take for “fun” instead of for a medical reason. 

Commonly used recreational drugs include: 

• Cannabis (marijuana)

• Cocaine

• Crack

• Heroin

• Hallucinogens

• Inhalants

• Methamphetamine

Prescription drugs can be misused recreationally, too. According to the National Institutes of Health (NIH), the most three most misused types of prescription medication are:

• Opioids

• Sedatives

• Stimulants

Alcohol and tobacco are technically “recreational drugs.” But they won’t be covered in this article, since they’re available to all adults without a prescription. Keep in mind, though, that both alcohol and tobacco do have risks of their own.

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How do drugs affect the brain?

Different drugs interact with the brain in different ways. Drugs interact with the brain’s neurons and change the way the different parts of your brain communicate. Other drugs cause the brain to release large amounts of certain neurotransmitters (the ones that cause someone to feel relaxation or pleasure). 

These brain effects are why many people choose to use recreational drugs. The way drugs interact with the brain causes people to feel “high,” which most people describe as a sense of euphoria, elation, and relaxation. But this process of changing the way neurons communicate can, in some cases, lead to lasting damage. Recreational drug use can also put people at risk for addiction, accidents, and health problems.

Does recreational drug use damage the brain?

It’s not clear. There’s evidence that many illicit drugs, like cocaine and cannabis, can have long-term effects on the brain. We also know that recreational drug use (including cannabis) is linked to many neurological risks, including:

• Loss of gray matter in the brain

• Damaged or dead neurons

• Memory loss

• Mental illness

• Poor impulse control

• Lower IQ

• Thinking problems

• Seizures

• Stroke

• Inability to feel pleasure without drugs

• Oxygen deprivation in the brain

• Coma or death 

But it’s hard to say for sure whether or not recreational drug use always causes brain damage. It seems to be different for different people, and for different drugs. The risk for brain damage may depend on:

• Which type(s) of illicit drugs a person uses

• How often a person uses drugs

• How long a person has been using drugs

• How old a person was when they first started using drugs

• Whether or not a person has overdosed on drugs 

For example, someone who uses a lot of cannabis as a teenager may be more likely to have major brain changes than someone who only uses it once or twice as an adult. 

What parts of the brain do drugs affect?

Different drugs can affect different areas of the brain. Some of the main areas include:

• Basal ganglia: This is a group of structures in your brain that helps to control thinking, behavior, and emotions. It also plays a role in your body’s physical movements and in how you experience pleasure and reward. 

• Amygdala: This is a part of the brain that helps you process emotions, like fear or happiness. It also plays a role in remembering things that are important to you, like a scary experience or a happy event. 

• Prefrontal cortex: This part of the brain is responsible for self-control and decision making. It also helps you to plan, organize, and solve problems. Keep in mind: In teenagers and young adults, this part of the brain is still growing — it’s not fully mature until you’re about 25 years old. 

Is it safe for adults to use recreational drugs?

Using recreational drugs comes with inherent risks.

Even though some drugs like cannabis are legal in certain states, that doesn’t mean they’re safe. Taking drugs, even in small amounts, can lead to dangerous consequences, including death.

How safe drug use is highly depends on what drug we’re talking about. The United Nations has removed cannabis from its list of the world’s most dangerous drugs. And cannabis has generally not been found to increase mortality (although more research is needed to be able to say this for sure). Mild to moderate cannabis use may even be helpful for some medical conditions, as we’ll discuss later.

Even cannabis, though, can cause permanent damage to the brain — especially if a person uses it a lot, or uses it when they’re a teenager or young adult. And some other types of drugs, like stimulants or opioids, are even more likely to do so.

This isn’t to say that a person will definitely die or face permanent damage if they use drugs recreationally. But there are risks that come with recreational drugs, and it’s important to be aware of them.

Are there any benefits of recreational drug use?

There aren’t any medical benefits of recreational drug use. Only risks. 

But you might be wondering: If recreational drug use is so dangerous, then why are scientists now studying some drugs for medical uses?

The potential medical benefits of cannabis, in particular, have been well-studied, especially in recent years. Research suggests that medically supervised cannabis use can successfully be used to treat a variety of health conditions. Psychedelic drugs like LSD and MDMA are also being studied to determine whether they might be helpful for the treatment of some mental illnesses.

Why do people choose to use recreational drugs?

Despite the risks, many people choose to use recreational drugs. Why? It’s hard to say for sure. 

One research study found that people who take drugs usually do so for 10 perceived benefits. The three most commonly reported benefits were:

1. To improve their social life (feel more confident in social settings)

2. For enjoyment and a sense of euphoria

3. To alter their state of mind and escape from their own thoughts

Some argue there are many social and psychological benefits to drugs, and that recreational drug use is discouraged more due to social stigma than because of any real risks.

Researchers have found that how dangerous a drug is has nothing to do with how it’s classified by governments, including in the U.S. and the United Kingdom. 

For example, cannabis (which may potentially be safer than alcohol or nicotine) is classified by the government as a Schedule I drug, the same classification as heroin. Alcohol and nicotine, which are highly deadly substances, aren’t on the schedule at all.

Are the perceived benefits of recreational drug use worth their risks? Below, we’ll cover the risks of some commonly used recreational drugs, as well as how they’re currently being used in medical care.

Risks of cannabis

Cannabis use has been associated with permanent brain damage (IQ loss), an increased risk for mental illness, and more problems in life like relationship problems and job performance. People experience memory loss and delayed reflexes when using cannabis. Cannabis use also increases the risk of developing a psychotic disorder, possibly even after a person has stopped taking it. 

Smoking cannabis is also just as bad as smoking cigarettes, because burning cannabis creates toxic chemicals that damage the lungs.

Medical uses and benefits of cannabis

According to the NIH, cannabis is helpful for some health conditions. Medical cannabis can be used for:

• Managing pain

• Helping to control nausea and vomiting

• Helping to boost appetite

Medical cannabis may also be helpful for multiple sclerosis, inflammatory bowel disease, and epilepsy, though more research is needed in these areas. 

There are also several cannabis-related medications that have been approved by the FDA. These medications aren’t exactly the same as cannabis, but they do contain some of the same (or similar) substances. These include:

• Epidiolex: This is a medication that contains pure cannabidiol (CBD). CBD is a cannabinoid that comes from cannabis. Epidiolex is used to treat some types of seizure disorders. 

• Marinol and Syndros (dronabinol): Dronabinol is a lab-made version of THC. THC is a cannabinoid found in cannabis. It’s used to treat nausea and vomiting from chemotherapy. It can also be used for low appetite and weight loss in people with HIV/AIDS.

• Cesamet (nabilone): Nabilone is a lab-made substance that’s similar to THC. It’s also used for nausea and vomiting caused by chemotherapy. 

Risks of stimulant drugs (cocaine, methamphetamines, prescription stimulants)

Stimulant misuse can lead to chronic anhedonia, which is the psychological term used when someone is unable to feel pleasure or happiness. This has to do with the ways in which stimulant drugs affect the parts of the brain responsible for pleasure and reward. 

Stimulant misuse can also cause many different mental and physical health problems. You can also overdose and die from methamphetamines, prescription stimulants, and cocaine.

Medical uses and benefits of stimulants

When used as directed by a doctor, prescription stimulants like Adderall or Ritalin can be used to treat symptoms of ADHD (attention-deficit hyperactivity disorder) and narcolepsy. 

Cocaine is sometimes used as an anesthetic (painkiller) and to control bleeding in certain types of surgeries. 

Risks of opioids (heroin, fentanyl, some prescription painkillers)

Misusing opioids — including prescription opioids, heroin, and synthetic opioids — can be extremely dangerous. Half a million people have died in the U.S. of an opioid overdose since 1999. Opioids cause a person’s breathing to slow, which deprives the brain of oxygen. This can cause permanent brain damage, coma, or death. 

Medical uses and benefits of opioids

Prescription opioids are mostly used to treat moderate to severe pain. Common prescription opioids include:

• Hydrocodone (Vicodin)

• Oxycodone (OxyContin)

• Codeine

• Fentanyl

These aren’t usually good first-choice medications because of the risk for addiction, accidents, and overdose. They should only be used under very close supervision by a healthcare professional. 

Risks of MDMA (ecstasy, molly)

According to the NIH, using MDMA can lead to short-term symptoms like: 

• Anxiety

• Depression

• Sleep problems

• Irritability

• Problems with concentration and thinking

• Decreased interest in sex

• Decreased appetite

In high doses, MDMA can also make it hard for a person’s body to control its internal temperature. This can lead to organ failure and death.

Medical uses and benefits of MDMA

So far, there’s no accepted medical use for MDMA. But some scientists now think that MDMA combined with talk therapy might actually be beneficial in treating certain mental illnesses, like anxiety, depression, and PTSD. There’s also some evidence that it could be helpful for end-of-life anxiety in people who are nearing death. 

Risks of hallucinogenic drugs (LSD, acid, peyote, ‘magic’ mushrooms)

All hallucinogens can change a person’s perception of reality, which can lead to unsafe situations. In some cases, they can also lead to a rare condition called hallucinogen persisting perception disorder (HPPD). HPPD is a condition where someone has ongoing perception changes even after the drugs have worn off. 

Hallucinogens also affect the amount of serotonin in the body and brain. This can lead to a health problem called serotonin syndrome. This is especially true if a person also takes other medications that affect serotonin, like SSRIs. 

Medical uses and benefits of hallucinogens

Just like MDMA, there aren’t any approved medical uses for hallucinogens — yet. But there’s a lot of research right now looking at whether or not hallucinogens are helpful for certain health conditions. Scientists are especially interested in psilocybin (the active ingredient in “magic” mushrooms) as a potential treatment for depression, PTSD, and substance use disorders, among other conditions. 

Harm reduction: How to use drugs as safely as possible

It’s never 100% safe to use recreational drugs, but there are precautions a person can take to lower the risks. 

Here are some guidelines for safer drug use: 

• Know what’s in the drug. Many recreational drugs, especially opioids like heroin, are secretly laced with stronger, lab-created drugs like fentanyl. There is no way to tell just by looking at the drug that it hasn’t been laced. Fentanyl test strips can help prevent accidental fentanyl use and overdose. 

• Practice syringe safety. Syringe use has been linked to a much higher risk of contracting diseases like HIV and hepatitis C. Most cities have some sort of safe syringe exchange program, where people can get access to sterilized syringes. Taking advantage of these programs can prevent people from sharing needles.

• Carry naloxone (Narcan). Naloxone is a nasal spray that can reverse an opioid overdose. It’s available for free in many communities. 

• Use at a safe injection site. Many communities have “safe” or “clean” injection sites. These are places where drug users can take drugs under professional supervision. This can prevent overdoses, and it can help users access help if needed. 

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Written by:

N. Saya Des Marais, MSW

Saya is a masters-level social worker, mental health clinician, trainer, and mental health content writer. She's worked as a therapist and trainer at public schools, community mental health clinics, and digital health start-ups.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-HELP (4357) to learn about resources in your area.