Before and after: what each drug does to people

Street drugs take people apart. Prescribed ADHD treatment, for most patients, helps put their lives together. Here is what the government and medical research describe for each drug.

Crystal meth Street drug

Before

Ordinary health, teeth and skin
Stable weight, sleep and mood

After long-term use

“Meth mouth”: severe tooth decay and loss
Skin sores from intense itching and picking
Extreme weight loss, anxiety, paranoia, hallucinations
Changes in brain structure and function linked to memory and emotion (NIDA)

Close-up of a patient's teeth with severe decay and blackened stumps, a suspected case of meth mouth — Suspected “meth mouth” in a dental patient treated at the University of Tennessee College of Dentistry. Photo: Dozenist, Wikimedia Commons, CC BY-SA 3.0.

Before-and-after photos: the Multnomah County (Oregon) Sheriff’s Office “Faces of Meth” project shows booking photos of the same people over years of meth use. See also meth mouth.

Fentanyl Street drug

Before

Often a person who thought they were taking a pain pill, Xanax or “Adderall”

After

Slowed or stopped breathing, unconsciousness, death, sometimes from one pill
Fast-developing dependence and painful withdrawal
When cut with xylazine (“tranq”), severe wounds that can lead to amputation

A tiny pinch of fentanyl powder next to a penny — “2 milligrams of fentanyl, a lethal dose in most people,” shown next to a penny. Photo: U.S. Drug Enforcement Administration, public domain.

Photos: the DEA’s “Faces of Fentanyl” memorial shows thousands of Americans killed by fentanyl, many of them teenagers who took a single counterfeit pill.

Heroin Street drug

Before

Healthy veins, lungs and immune system

After long-term use

Collapsed veins, abscesses and heart-lining infections
HIV and hepatitis C from shared needles
Deterioration of the brain’s white matter (NIDA)
Fatal overdose, now usually with fentanyl mixed in

Three glass vials: a large amount of white heroin powder on the left, and tiny traces of carfentanil and fentanyl in the other two — What a lethal dose looks like, according to the DEA: heroin (left), carfentanil (center) and fentanyl (right). Photo: U.S. Drug Enforcement Administration, public domain.

More: NIDA: Heroin.

Crack and powder cocaine Street drug

Before

Normal heart rhythm and blood pressure
Healthy nasal passages and lungs

After long-term use

Heart attacks, strokes and dangerous heart rhythms, even in young people
Lung damage from smoking crack; nasal damage from snorting
Binge cycles, paranoia and severe addiction

A hand holding a spoon of white powder over a candle flame — Cooking cocaine on a spoon over a candle. Photo: Psychonaught, Wikimedia Commons, public domain.

More: NIDA: Cocaine.

Adderall, taken as prescribed FDA-approved medicine

Before treatment (untreated ADHD)

Trouble focusing, finishing work and staying organized
Higher rates of car crashes, injuries and accidents
Higher rates of substance abuse and criminal convictions

After treatment

Better focus at school and work
In large studies: fewer crashes, fewer injuries, less crime and less substance abuse during treatment
Lower death rates, especially from accidents and injuries (Swedish national study, JAMA, 2024)
Common side effects: lower appetite, trouble sleeping, faster heart rate

A pharmacy prescription bottle of Adderall XR 10 mg with blue capsules — Adderall XR 10 mg, dispensed by a pharmacy with a label reading “take one capsule every morning.” Photo: Ryanaxp, Wikimedia Commons, public domain.

Ryan Brandstrom describes his own before-and-after: without his medicine, “my mental and physical health deteriorated rapidly. I couldn’t be present for my wife. I couldn’t be present with my five children.” With it, “by that afternoon, the fog lifted. I was myself again.”

The studies behind these results are summarized on What the studies show.