With the number of drugs on and off the market, it can be overwhelming to know what’s what, especially if there are signs of abuse. In our winter 2025 issue of Island Scene magazine, Jeremy Roberts, M.D., of Advanced Psychiatric Therapeutics in Honolulu, helped explain prescription and recreational drugs used in Hawaii and signs of abuse to watch out for.
In addition to his listings of popular drugs (both legal and illegal) in Hawaii, we compiled information that Dr. Roberts provided regarding fentanyl, Ozempic, and popular recreational drugs such as marijuana, tobacco and alcohol, which, in some cases, can be more problematic than illegal substances.
Dr. Jeremy Roberts
What are the signs of misuse in recreational drugs? Why do you find the more socially acceptable drugs are highly problematic?
The socially acceptable drugs are the largest problems. Sure, I see a patient here and there who struggles with cocaine or methamphetamines. These can be profoundly damaging for the patient.
But in the outpatient setting, for every methamphetamine use disorder patient I see, I see five to 10 nicotine, alcohol, or marijuana use disorder patients. Their use is given a pass, both by society and themselves, as they can rationalize that this is “normal.” And for many, the use of alcohol or marijuana may be perfectly measured and reasonable (less so than nicotine). But be careful if you’re trying unsuccessfully to cut down; are having difficulties at work, home, or school; are engaging in dangerous situations as a result of use; or are developing tolerance. These are usually the first signs before more prominent addiction symptoms become clearer.
How do you feel about Ozempic, the medication originally used for people with type 2 diabetes, which has become highly popular due to its success in treating weight-loss?
Taking Ozempic for diabetes is perfectly acceptable and was the initial aim of the drug. If it also helps them lose weight in the process, awesome. I have several medications I use, that might have side effects that assist other conditions. Bupropion, for example, is very helpful in people with attentional challenges. So if I treat someone who suffers with depression and happens to also have attentional limitations that are treated, that’s great, a two for one! If it only helps the depression, that’s great, too. To limit a medication to only a single-minded purpose, and not recognizing the broader context of the patient, is to overlook half of the medicine.
There are many cases of people who needed to be pharmacologically managed until they engaged in better habits, and no longer required assistance once those habits developed. But unfortunately, I more often see the reverse. I talk with patients who tell me they want to manage their diabetes, hypertension, or cholesterol levels without medication, but fail to do so effectively, risking long-term injury to themselves until they recognize (months or years down the line, if at all) that their ability to implement self-control of their body is more limited than they would like to believe. I recognize how negative this sounds. And I, too, like to imagine I could make necessary changes in my life for the better. But evidence suggests that we’re all not very good at this.
Understanding the benefits and especially the precautions of the drugs we intake is vital.
What are some things about fentanyl that you wish people knew that they don’t know already?
In addition to relying on fentanyl to reverse the effects of an opioid overdose, there are pharmacologic treatments for opiate addiction that are profoundly and rapidly effective at restoring a normal life in a matter of a few weeks. Yes, this involves some longer acting opiates (such as suboxone or methadone) that “maintain” the patient, but in every way, the patient can function nearly identically to how they had before the addiction, without the drug destroying everything around them. I have treated so many patients who had their lives devastated and are now back to their highly functional baselines they had before the addiction.
Every person and case is different so it’s important to reach out to your primary care provider if you have any questions or concerns.
Read more about drugs on the market
