Reproductions supplied by EDRS are the best that can be madeThis DEA magazine delivers clear, scientific information about drugs in a factual, straightforward way, combined with scores

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Joseph, Donald E., Ed.

Drugs of Abuse.

Drug Enforcement Administration (Dept. of Justice),Washington, DC.

2003-02-0069p.

For full text: http://www.usdoj.gov/dea/pubs/abuse/index.html.

Guides Non-Classroom (055)EDRS Price MF01/PC03 Plus Postage.*Drug Education; *Drug Legislation; *Illegal Drug Use;Inhalants; Marijuana; NarcoticsHallucinogens; Steroids

This Drug Enforcement Administration publication deliversclear, scientific information about drugs in a factual, straightforward way,combined with precise photographs shot to scale. The publication is intendedto serve as an A to Z guide for drug history, effects, and identificationinformation. Chapters are included on the Controlled Substances Act and thedifferent drug classes, including narcotics, depressants, stimulants,cannabis, hallucinogens, steroids, and inhalants. A directory of domestic DEAoffices is provided, as well as National Guard Counterdrug Coordinators. andNational Guard Drug Demand Reduction Administrators. (GCP)

Reproductions supplied by EDRS are the best that can be madefrom the original document.

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This document has been reproduced asreceived from the person or organizationoriginating itMinor changes have been made toimprove reproduction quality

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February 2003

°

DRUGS OF ABUSE

www.d ea. g ov

PRODUCED &PUBLISHED BYDrug Enforcement AdministrationU.S. Department of JusticeArlington, Virginia 22202

Donald E. JosephEditor

Charles J. LylesArt Director

Suzanne T. VigilDesign and Layout

Gretchen FeussnerPharmacologist

Drug and Chemical Evaluation StaffText and Research

National Guard Counterdrug Program

3

DRUGS OF BUS:

FROM THE ADMINISTRATOR

I am pleased to introduce this latest edition ofDrugs of Abuse. This DEA magazine delivers clear,scientific information about drugs in a factual,straightforward way, combined with scores ofprecise photographs shot to scale.

I believe that Drugs of Abuse fulfills an importanteducational need in our society because of agrowing trend to view the abuse of drugs asa harmless personal decision. Unfortunately,that kind of misinformation can have lethalconsequences. For example, there was BrittneyChambers in Colorado who died after taking asingle Ecstasy pill on her 16th birthday. A friendwho was with Brittney when she took the Ecstasylater said, "I'd heard nothing bad would happenwhen you took Ecstasy."

There is also a widespread belief that marijuana is abenign drug that should be excluded from the anti-drug effort. However, we know that marijuanaimpairs judgement, makes workers groggy, andrenders motor vehicle drivers unsafe on America'shighways. In addition, anti-social behavior amongyouth is clearly linked to frequency of marijuanause. The difficult truth is that there is no safe wayto take marijuana, Ecstasy, or any other illegaldrug.

Around the world and across the nation, the DEAis working hard to identify and arrest the traffickersof these dangerous drugs. We're succeeding inthat. But just as important, we're working hard toeducate America's youth, their parents, and theirteachers about the very real dangers of club drugsand all other illegal drugs. Drugs of Abuse is animportant step in that direction. For additionalinformation about drugs, I invite you to explore ourweb site at: www.dea.gov.

I would like to express my appreciation to theNational Guard for joining us as partners in thepublication of this magazine. And I am deeplygrateful to the dedicated men and women of theDEA who work hard every day to keep our schoolsand neighborhoods safe and secure.

I am optimistic about winning our national struggleagainst drugs, overcoming the crime and terrorismthey spawn, and restoring the broken families theyleave in their wake. Together, we can make a dif-ference. Thank you.

John B. Brown, IIIActing Administrator

CONTENTSDRUGS OF ABUSETHE CONTROLLEDSUBSTANCES ACT 1

Federal Traficking Penalties (Chart)Federal Traficking Penalties-

Marijuana (Chart)Regulatory Requirements (Chart)

CHEMICAL CONTROL 10

INTRODUCTION TODRUG CLASSES 12

NARCOTICS ...... .14Narcotics of Natural Origin

OpiumMorphineCodeineThebaine

Semi-Synthetic NarcoticsHeroinHydromorphoneOxycodoneHydrododone

Synthetic NarcoticsMeperidine

Narcotics Treatment DrugsMethadoneDextroproxypheneFentanylPentazocineButorphanol

DEPRESSANTS 26Barbiturates

Controlled Substances Uses andEffects (Chart)

BensodiazepinesGamma Hydroxybutric AcidParaldehydeChloral HydrateGlutethimide 7 MethaqualoneMeprobamate

Newly Marketed Drugs

STIMULANTS 35CocaineAmphetamines

MethcathinoneMethylphenidate

Anorectic DrugsKhat

CANNABIS 42MarijuanaHashishHashish Oil

HALLUCINOGENS .. . .46LSDPsilocybin & Psiocyn and OtherTryptaminesPeyote & MescalineMDMA (Ecstasy) &

Other PhenethylaminesPhencyclidine (PCP) & Related DrugsKetamine

STEROIDS 53

INHALANTS.. ....... 56

DOMESTIC DEAOFFICES 58

NATIONAL GUARD 59Counterdrug CoordinatorsDrug Demand ReductionAdministrators

CONTROLLEDSUBSTANCESACT

DRUGS OF ABUSE

The Controlled Substances Act /CSAI, Title 11 ofthe Comprehensive Drug Abuse Preventionand Control Act of 1970, is the legal foun-dation of the government fight against abuseof drugs and other substances. This law is aconsolidation of numerous laws regulatingthe manufacture and distribution of narcotics,stimulants, depressants, hallucinogen anabolicsteroids and chemicals used in the illicit pro-duction of controlled substances.

Controlling Drugs orOther SubstancesFORMAL SCHEDULINGThe CSA places all substances which were in somemanner regulated under existing Federal law intoone of five schedules. This placement is based uponthe substance's medical use, potential for abuse, andsafety or dependence liability. The Act also provides amechanism for substances to be controlled, or addedto a schedule; decontrolled, or removed from control;and rescheduled or transferred from one schedule toanother. The procedure for these actions is found inSection 201 of the Act (21 U.S.C. 81 1).

Proceedings to add, delete, or change the scheduleof a drug or other substance may be initiated bythe Drug Enforcement Administration (DEA), theDepartment of Health and Human Services (HHS),or by petition from any interested person: the manu-facturer of a drug, a medical society or association,a pharmacy association, a public interest group con-cerned with drug abuse, a state or local governmentagency, or an individual citizen. When a petition isreceived by DEA, the agency begins its own inves-tigation of the drug.

The agency also may begin an investigation of adrug at any time based upon information receivedfrom law enforcement laboratories, state and locallaw enforcement and regulatory agencies, or othersources of information.

Once DEA has collected the necessary data, the Ad-ministrator of DEA, by authority of the Attorney Gen-eral, requests from HHS a scientific and medical evalu-ation and recommendation as to whether the drug orother substance should be controlled or removed fromcontrol. This request is sent to the Assistant Secretaryof Health of HHS. HHS solicits information from theCommissioner of the Food and Drug Administration(FDA), evaluations and recommendations from theNational Institute on Drug Abuse, and on occasionfrom the scientific and medical community at large.The Assistant Secretary, by authority of the Secretary,compiles the information and transmits back to DEA amedical and scientific evaluation regarding the drugor other substance, a recommendation as to whetherthe drug should be controlled, and in what scheduleit should be placed.

The medical and scientific evaluations are bindingon DEA with respect to scientific and medical mat-ters. The recommendation on scheduling is bindingonly to the extent that if HHS recommends that thesubstance not be controlled, DEA may not controlthe substance.

Once DEA has received the scientific and medicalevaluation from HHS, the Administrator will evaluateall available data and make a final decision whetherto propose that a drug or other substance shouldbe controlled and into which schedule it should beplaced.

The threshold issue is whether the drug or other sub-stance has potential for abuse. If a drug does not have

6

a potential for abuse, it cannot be con-trolled. Although the term "potentialfor abuse" is not defined in the CSA,there is much discussion of the termin the legislative history of the Act.The following items are indicatorsthat a drug or other substance has apotential for abuse:( I ) There is evidence that individuals

are taking the drug or other sub-stance in amounts sufficient tocreate a hazard to their health orto the safety of other individualsor to the community; or

(2) There is significant diversion ofthe drug or other substancefrom legitimate drug channels;orIndividuals are taking the drugor other substance on theirown initiative rather than on thebasis of medical advice from apractitioner licensed by law toadminister such drugs; or

(4) The drug is a new drug so re-lated in its action to a drug orother substance already listedas having a potential for abuseto make it likely that the drugwill have the same potential forabuse as such drugs, thus mak-ing it reasonable to assume thatthere may be significant diver-sions from legitimate channels,significant use contrary to orwithout medical advice, or thatit has a substantial capability ofcreating hazards to the health ofthe user or to the safety of thecommunity. Of course, evidenceof actual abuse of a substanceis indicative that a drug has apotential for abuse.

(3)

In determining into which schedulea drug or other substance shouldbe placed, or whether a substanceshould be decontrolled orrescheduled, certain factors arerequired to be considered. Specific

Over 60 percent of the heroin that issold in the United States originates inthe poppy fields of South America.

I

The milky fluid that oozes from theseedpod of the poppy is opium.

41V Md.%

t

Heroin is manufactured in remote"laboratories" using rudimentaryequipment.

2

findings are not required for eachfactor. These factors are listed in Sec-tion 201 (c), (21 U.S.C. 811 (c)), ofthe CSA and are as follows:

The drugs actual or relativepotential for abuse.

(2) Scientific evidence of the drug.-pharmacological effects. Thestate of knowledge with respectto the effects of a specific drugis, of course, a major consid-eration. For example, it is vitalto know whether or not a drughas a hallucinogenic effect if itis to be controlled because ofthat. The best available knowl-edge of the pharmacologicalproperties of a drug should beconsidered.The state of current scientificknowledge regarding the sub-stance. Criteria (2) and (3) areclosely related. However, (2)is primarily concerned withpharmacological effects and(3) deals with all scientificknowledge with respect to thesubstance.

(4) Its history and current pat-tern of abuse. To determinewhether or not a drug shouldbe controlled, it is important toknow the pattern of abuse ofthat substance, including thesocio-economic characteristicsof the segments of the popula-tion involved in such abuse.The scope, duration, and signifi-cance of abuse. In evaluatingexisting abuse, the Administra-tor must know not only thepattern of abuse but whetherthe abuse is widespread. Inreaching his decision, theAdministrator should considerthe economics of regulationand enforcement attendant tosuch a decision. In addition,he should be aware of thesocial significance and impact

II)

(3)

(5)

of such a decision upon thosepeople, especially the young,that would be affected by it.

(6) What, if any, risk there is to thepublic health. If a drug createsdangers to the public health,in addition to or because ofits abuse potential, then thesedangers must also be consid-ered by the Administrator.The drug's psychic or physi-ological dependence liability.There must be an assessmentof the extent to which a drug isphysically addictive or psycho-logically habit-forming, if suchinformation is known.Whether the substance isan immediate precursor of asubstance already controlled.The CSA allows inclusion ofimmediate precursors on thisbasis alone into the appropri-ate schedule and thus safe-guards against possibilities ofclandestine manufacture.

After considering the above listedfactors, the Administrator mustmake specific findings concerningthe drug or other substance. Thiswill determine into which schedulethe drug or other substance willbe placed. These schedules areestablished by the CSA. They areas follows:

171

18)

Schedule IThe drug or other substance hasa high potential for abuse.The drug or other substance hasno currently accepted medicaluse in treatment in the UnitedStates.There is a lack of acceptedsafety for use of the drug orother substance under medicalsupervision.Some Schedule I substances areheroin, LSD, marijuana, andmethaqualone.

Heroin can then be pressed intobricks for bulk shipment to destinationcountries.

In another method of smuggling heroin,couriers swallow heroin-filled latexballoons before boarding commercial Schedule IVairlines.

Schedule IIThe drug or other substance has ahigh potential for abuse.The drug or other substance has acurrently accepted medical use intreatment in the United States ora currently accepted medical usewith severe restrictions.Abuse of the drug or other sub-stance may lead to severe psycho-logical or physical dependence.Schedule II substances includemorphine, PCP, cocaine, metha-done, and methamphetamine.

Schedule IllThe drug or other substance hasa potential for abuse less thanthe drugs or other substances inSchedules I and II.The drug or other substance has acurrently accepted medical use intreatment in the United States.Abuse of the drug or other sub-stance may lead to moderate orlow physical dependence or highpsychological dependence.Anabolic steroids, codeine andhydrocodone with aspirin or Ty-lenol®, and some barbiturates areSchedule III substances.

Mexican brown heroin and SoutheastAsian heroin.

3

The drug or other substance hasa low potential for abuse relativeto the drugs or other substances inSchedule III.The drug or other substance has acurrently accepted medical use intreatment in the United States.Abuse of the drug or othersubstance may lead to limitedphysical dependence or psycho-logical dependence relative tothe drugs or other substances inSchedule III.Included in Schedule IV are.Darvon ®,Talwin ®, Equanil® ,Va-lium® and Xanax ®.

Schedule VThe drug or other substance hasa low potential for abuse relativeto the drugs or other substancesin Schedule IV.The drug or other substance has acurrently accepted medical use intreatment in the United States.Abuse of the drug or other sub-stances may lead to limited phys-ical dependence or psychologicaldependence relative to the drugsor other substances in ScheduleIV.

Over-the-counter cough medi-cines with codeine are classifiedin Schedule V.

When the Administrator of DEA hasdetermined that a drug or othersubstance should be controlled,decontrolled, or rescheduled, a pro-posal to take action is published inthe Federal Register The proposalinvites all interested persons to filecomments with DEA. Affected partiesmay also request a hearing with DEA.If no hearing is requested, DEA willevaluate all comments received andpublish a final order in the FederalRegister, controlling the drug as pro-posed or with modifications basedupon the written comments filed.This order will set the effective datesfor imposing the various require-ments imposed under the CSA.

If a hearing is requested, DEA willenter into discussions with the partyor parties requesting a hearing in anattempt to narrow the issue for litiga-tion. If necessary, a hearing will thenbe held before an Administrative LawJudge. The judge will take evidenceon factual issues and hear argumentson legal questions regarding the con-trol of the drug. Depending on thescope and complexity of the issues,the hearing may be brief or quiteextensive. The Administrative Law

The Upper Huallaga Valley of Peru isthe primary source of the coca leaf.

rt

After they are picked, coca leaves aredried in the open air.

3

Coca leaves are "stomped" in crude pitscalled pozos as part of the process toextract alkaloids.

4

Judge, at the close of the hearing,prepares findings of fact and con-clusions of law and a recommendeddecision which is submitted to theAdministrator of DEA. The Adminis-trator will review these documents,as well as the underlying material,and prepare his/her own findings offact and conclusions of law (whichmay or may not be the same asthose drafted by the AdministrativeLaw Judge). The Administrator thenpublishes a final order in the FederalRegister either scheduling the drugor other substance or declining todo so.

Once the final order is published inthe Federal Register, interested par-ties have 30 days to appeal to a U.S.Court of Appeals to challenge theorder. Findings of fact by the Ad-ministrator are deemed conclusive ifsupported by "substantial evidence".The order imposing controls is notstayed during the appeal, however,unless so ordered by the Court.

Emergency or TemporarySchedulingThe CSA was amended by theComprehensive Crime Control Actof 1984. This Act included a provi-sion which allows the Administratorof DEA to place a substance, on atemporary basis, into Schedule Iwhen necessary to avoid an immi-nent hazard to the public safety.

This emergency scheduling au-thority permits the scheduling ofa substance which is not currentlycontrolled, is being abused, andis a risk to the public health whilethe formal rule making proceduresdescribed in the CSA are being con-ducted. This emergency schedulingapplies only to substances with noaccepted medical use. A temporaryscheduling order may be issued for

one year with a possible extension ofup to six months if formal schedulingprocedures have been initiated. Theproposal and order are published inthe Federal Register as are the pro-posals and orders for formal schedul-ing. [21 U.S.C. 811 (h)j

Controlled Substance AnaloguesA new class of substances was createdby the Anti-Drug Abuse Act of 1986.Controlled substance analogue aresubstances which are not controlledsubstances, but may be found in theillicit traffic. They are structurally orpharmacologically similar to ScheduleI or II controlled substances and haveno legitimate medical use. A sub-stance which meets the definition ofa controlled substance analogue andis intended for human consumptionis treated under the CSA as if it were acontrolled substance in Schedule I.[21U.S.C.802(32)(A).21U.S.C.813)

International Treaty ObligationsUnited States treaty obligations mayrequire that a drug or other sub-stance be controlled under the CSA,or rescheduled if existing controls areless stringent than those required bya treaty. The procedures for thesescheduling actions are found in Sec-tion 201 (d) of the Act. [21 U.S.C.811 (d)]

The United States is a party to theSingle Convention on Narcotic Drugsof 1961, designed to establish effec-tive control over international anddomestic traffic in narcotics, cocaleaf, cocaine, and cannabis. Asecond treaty, the Convention onPsychotropic Substances of 1971,which entered into force in 1976,is designed to establish comparablecontrol over stimulants, depressants,and hallucinogens. Congress ratifiedthis treaty in 1980.

The process results in coca paste.

Powdered cocaine.

The bright green plants in the center ofthe photo are cannabis, hidden amongother foliage to avoid detection.

5

REGULATIONThe CSA creates a closed system ofdistribution for those authorized tohandle controlled substances. Thecornerstone of this system is the reg-istration of all those authorized byDEA to handle controlled substances.All individuals and firms that areregistered are required to maintaincomplete and accurate inventoriesand records of all transactions involv-ing controlled substances, as well assecurity for the storage of controlledsubstances.

RegistrationAny person who handles or intendsto handle controlled substancesmust obtain a registration issued byDEA. A unique number is assignedto each legitimate handler of con-trolled drugs: importer, exporter,manufacturer, distributor, hospital,pharmacy, practitioner, and research-er. This number must be made avail-able to the supplier by the customerprior to the purchase of a controlledsubstance. Thus, the opportunity forunauthorized transactions is greatlydiminished.

Record keepingThe CSA requires that complete andaccurate records be kept of all quanti-ties of controlled substances manu-factured, purchased, and sold. Eachsubstance must be inventoried everytwo years. Some limited exceptionsto the recordkeeping requirementsmay apply to certain categories ofregistrants.From these records it is possible totrace the flow of any drug from thetime it is first imported or manufac-tured through the distribution level,to the pharmacy or hospital thatdispensed it, and then to the actualpatient who received the drug. Themere existence of this requirement is

sufficient to discourage many formsof diversion. It actually serves largedrug corporations as an internalcheck to uncover diversion, such aspilferage by employees.

There is one distinction betweenscheduled items for recordkeepingrequirements. Records for ScheduleI and II drugs must be kept separatefrom all other records of the handler;records for Schedule III, IV, and Vsubstances must be kept in a "readilyretrievable" form. The former methodallows for more expeditious investiga-tions involving the highly abusablesubstances in Schedules I and II.

DistributionThe keeping of records is required fordistribution of a controlled substancefrom one manufacturer to another,from manufacturer to distributor, andfrom distributor to dispenser. In thecase of Schedule I and II drugs, thesupplier must have a special orderform from the customer. This orderform (DEA Form 222) is issued byDEA only to persons who are prop-erly registered to handle Schedules Iand II. The form is preprinted withthe name and address of the custom-er. The drugs must be shipped to thisname and address. The use of thisdevice is a special reinforcement ofthe registration requirement; it makesdoubly certain that only authorizedindividuals may obtain Schedule Iand II drugs. Another benefit of theform is the special monitoring it per-mits. The form is issued in triplicate:the customer keeps one copy; twocopies go to the supplier who, afterfilling the order, keeps a copy andforwards the third copy to the nearestDEA office. For drugs in Schedules III,IV and V no order form is necessary.The supplier in each case, however,is under an obligation to verify theauthenticity of the customer. The

lor

Because of successful marijuanaeradication efforts by law enforcement,many illicit growers cultivate the plantindoors.

supplier is held fully accountablefor any drugs which are shipped toa purchaser who does not have avalid registration.

Manufacturers must submit periodicreports of the Schedule I and II con-trolled substances they produce inbulk and dosage forms. They alsoreport the manufactured quantity andform of each narcotic substance listedin Schedules III, IV and V as well asthe quantity of synthesized psychotro-pic substances listed in Schedules I, II,

III, and IV. Distributors of controlledsubstances must report the quantityand form of all their transactions ofcontrolled drugs listed in Schedules Iand II and narcotics listed in ScheduleIII. Both manufacturers and distribu-tors are required to provide reports oftheir annual inventories of these con-trolled substances. This data is enteredinto a system called the AutomatedReports and Consolidated OrdersSystem (ARCOS). It enables DEA tomonitor the distribution of controlledsubstances throughout the country,and to identify retail level registrantsthat receive unusual quantities ofcontrolled substances.

In the past, it was the marijuana leavesthat were dried, crushed and smoked. Dispensing to Patients

The dispensing of a controlled sub-stance is the delivery of the controlledsubstance to the ultimate user, whomay be a patient or research subject.Special control mechanisms operatehere as well. Schedule I drugs arethose which have no currently ac-cepted medical use in the UnitedStates; they may, therefore, be usedin the United States only in researchsituations. They generally are sup-plied by only a limited number of firmsto properly registered and qualifiedresearchers. Controlled substancesmay be dispensed by a practitioner bydirect administration, by prescription,or by dispensing from office supplies.

Today, marijuana abusers prefer thecolas, or buds of the plant, because ofits higher THC content. Leaves are nowdiscarded or used as filler.

6

Records must be maintained by thepractitioner of all dispensing of con-trolled substances from office suppliesand of certain administrations. TheCSA does not require the practitionerto maintain copies of prescriptions,but certain states require the use ofmultiple copy prescriptions for Sched-ule II and other specified controlledsubstances.

The determination to place drugs onprescription is within the jurisdictionof the FDA. Unlike other prescrip-tion drugs, however, controlledsubstances are subject to additionalrestrictions. Schedule II prescriptionorders must be written and signedby the practitioner; they may not betelephoned into the pharmacy exceptin an emergency. In addition, a pre-scription for a Schedule II drug maynot be refilled; the patient must seethe practitioner again in order to ob-tain more drugs. For Schedule III andIV drugs, the prescription order maybe either written or oral (that is, bytelephone to the pharmacy). In addi-tion, the patient may (if authorized bythe practitioner) have the prescriptionrefilled up to five times and at anytimewithin six months from the date of theinitial dispensing.

Schedule V includes some prescrip-tion drugs and many over-the-coun-ter narcotic preparations, includingantitussives and antidiarrheals. Evenhere, however, the law imposes re-strictions beyond those normally re-quired for the over-the-counter sales;for example, the patient must be atleast 18 years of age, must offer someform of identification, and have his orher name entered into a special logmaintained by the pharmacist as partof a special record.

Marijuana buds are hung out to dry.

Marijuana is rolled into cigarettes andsmoked.

Hollowed out cigars packed withmarijuana are called blunts, and aregaining in popularity.

7

QuotasDEA limits the quantity of ScheduleI and II controlled substances whichmay be produced in the UnitedStates in any given calendar year.By utilizing available data on salesand inventories of these controlledsubstances, and taking into accountestimates of drug usage providedby the FDA, DEA establishes annualaggregate production quotas forSchedule I and II controlled sub-stances. The aggregate productionquota is allocated among the variousmanufacturers who are registeredto manufacture the specific drug.DEA also allocates the amount of

< bulk drug which may be procuredby those companies which preparethe drug into dosage units.

SecurityDEA registrants are required byregulation to maintain certainsecurity for the storage and dis-tribution of controlled substances.Manufacturers and distributors ofSchedule I and II substances muststore controlled substances in spe-cially constructed vaults or highlyrated safes, and maintain electronicsecurity for all storage areas. Lesserphysical security requirements ap-ply to retail level registrants suchas hospitals and pharmacies. Allregistrants are required to make ev-ery effort to ensure that controlledsubstances in their possession arenot diverted into the illicit market.This requires operational as well asphysical security. For example, reg-istrants are responsible for ensuringthat controlled substances are distrib-uted only to other registrants thatare authorized to receive them, or tolegitimate patients and consumers.

PENALTIESThe CSA provides penalties for unlawful manufac-turing, distribution, and dispensing of controlledsubstances. The penalties are basically determinedby the schedule of the drug or other substance, andsometimes are specified by drug name, as in the caseof mar juana. As the statute has been amended sinceits initial passage in 1970, the penalties have beenaltered by Congress. The following charts are anoverview of the penalties for trafficking or unlawfuldistribution of controlled substances. This is not inclu-sive of the penalties provided under the CSA.

User Accountability /Personal Use PenaltiesOn November 19, 1988, Congress passed the Anti-Drug Abuse Act of 1 988, P L. 100-690. Two sectionsof this Act represent the Federal Government's attemptto reduce drug abuse by dealing not just with theperson who sells the illegal drug, but also with theperson who buys it. The first new section is titled"UserAccountability" and is codified at 21 U.S.C. § 862and various sections of Title 42, U.S.C. The secondinvolves "personal use amounts" of illegal drugs, andis codified at 21 U.S.C. § 844a.

User AccountabilityThe purpose of User Accountability is to not only makethe public aware of the Federal Governments positionon drug abuse, but to describe new programs intend-ed to decrease drug abuse by holding drug abuserspersonally responsible for their illegal activities, and im-posing civil penalties on those who violate drug laws.

It is important to remember that these penalties arein addition to the criminal penalties drug abusersare already given, and do not replace those criminalpenalties.

The new User Accountability programs call for moreinstruction in schools, kindergarten through seniorhigh, to educate children on the dangers of drugabuse. These programs will include participation bystudents, parents, teachers, local businesses and thelocal, state and Federal Government.

User Accountability also targets businesses inter-ested in doing business with the Federal Govern-ment. This program requires those businessesto maintain a drug-free workplace, principallythrough educating employees on the dangers ofdrug abuse, and by informing employees of thepenalties they face if they engage in illegal drugactivity on company property.

8

There is also a provision in the law that makes publichousing projects drug-free by evicting those residentswho allow their units to be used for illegal drug ac-tivity, and denies Federal benefits, such as housingassistance and student loans, to individuals convictedof illegal drug activity. Depending on the offense, anindividual may be prohibited from ever receiving anybenefit provided by the Federal Government.

Personal Use AmountsThis section of the 1 988 Act allows the governmentto punish minor drug offenders without giving theoffender a criminal record if the offender is in pos-session of only a small amount of drugs. This law isdesigned to impact the "user" of illicit drugs, whilesimultaneously saving the government the costs ofa full-blown criminal investigation.

Under this section, the government has the optionof imposing only a civil fine on individuals possessingonly a small quantity of an illegal drug. Possessionof this small quantity, identified as a "personal useamount" carries a civil fine of up to S 10,000.

In determining the amount of the fine in a particularcase, the drug offender's income and assets will beconsidered. This is accomplished through an admin-istrative proceeding rather than a criminal trial, thusreducing the exposure of the offender to the entirecriminal justice system, and reducing the costs to theoffender and the government.

The value of this section is that it allows the gov-ernment to punish a minor drug offender withoutsaddling the offender with a criminal record. Thissection also gives the drug offender the opportunityto fully redeem himself or herself, and have all publicrecord of the proceeding destroyed. If this was thedrug offender's first offense, and the offender haspaid all fines, can pass a drug test, and has not beenconvicted of a crime after three years, the offendercan request that all proceedings be dismissed.

If the proceeding is dismissed, the drug offender canlawfully say he or she had never been prosecuted,either criminally or civilly, for a drug offense.

Congress has imposed two limitations on this section'suse. It may not be used if (1) the drug offender hasbeen previously convicted of a Federal or state drugoffense; or (2) the offender has already been finedtwice under this section.

U.S. Department of JusticeDrug Enforcement Administration

Dr gSchedule

MethamphetamineSchedule II

HeroinSchedule I

Cocaine

Schedule II

Cocaine BaseSchedule II

PCP

Schedule II

LSD

Schedule I

FentanylSchedule II

Fentanyl AnalogueSchedule I

Others(Schedules I & II)

(Includes I gm or more flunitrazepam)

OthersSchedule III

(Includes 30 mgs - 999 mgs flunitrazepam)

Others*Schedule IV

(Includes less than 30 mgs flunitrazepam)

All

Schedule V

Qua tity

5 - 49 gmspure or 50-499 gmsmixture

100-999gms mixture

500-4,999gms mixture

5- 49 gmsmixture

10- 99 gmspure or 100-999 gmsmixture

1 9 gmsmixture

40-399 gmsmixture

10 - 99 gmsmixture

Any

Any

Any

Any

Federal Trafficking Penalties

Not less than 5yrs and not morethan 40 yrs. Ifdeath or seriousinjury, not lessthan 20 or morethan life. Fine ofnot more than $2million if anindividual, $5million if otherthan anindividual.

Not less than 10yrs and not morethan life. If deathor serious injury,not less than life.Fine of not morethan $4 million ifan individual,$10 million ifother than anindividual.

Not more than 20yrs. If death orserious injury,not less than 20yrs, not morethan life. Fine $1

million individual,$5 million notindividual.

Not more than 30yrs. If death orserious injury,life. Fine $2million individual,$10 million notindividual.

Off

Not more than 5 yrs. Fine not morethan $250,000 individual, $1 millionnot individual.

Not more than 3 yrs. Fine not morethan $250,000 individual, $1 millionnot individual.

Not more than 1 yr. Fine not more than$100,000 individual, $250,000 notindividual.

Quan rty

50 gms ormore pureor 500 gmsor moremixture

1 kg ormoremixture

5 kgs ormoremixture

50 gms ormoremixture

100 gms ormore pureor 1 kg ormoremixture



Not less than 10yrs and not morethan life. If deathor serious injury,not less than 20or more than life.Fine of not morethan $4 million ifan individual,$10 million ifother than anindividual.

Not less than 20yrs and not morethan life. If deathor serious injury,not less than life.Fine of not morethan $8 million ifan individual,$20 million ifother than anindividual.


Life imprisonment

Not more than 10 yrs. Fine not more than$500,000 individual, $2 million not individual.

Not more than 6 yrs. Fine not more than $500,000individual, $2 million not individual.

Not more than 2 yrs. Fine not more than $200,000individual, $500,000 not individual.

* Although flunitrazepam is a Schedule IV controlled subs ance, quantities of 30 or more milligrams of flunitrazepam are subject to greater statutory maximum penaltiesthan theabove-referenced penalties for Schedule IV controlled substances. See 21 U.S.C. §841(b)(1)(C) and (D).

U

4111.1,

1

M rjuanaQuantity

1,000 kgs or

more mixture,

or 1,000

or more plants

1st Offense

Not less than 10 years,

not more than life

If death or serious injury, not lessthan 20 years, not more than life

Fine not more than $4 million individual,$10 million other than individual

I

2nd Offense

Not less than 20 years,

not more than life

If death or serious injury,then life


100 kgs to

999 kgs

mixture, or

100-999

plants

Not less than 5 years,not more than 40 years


Fine not more than $2 million individual,

$5 million other than individual

Not less than 10 years,not more than life



Bf

50 to 99 kgs

mixture

50 to 99

plants

More than10 kgs

Not more than 20 years


Fine $1 million individual,$5 million other than individual

Not more than 30 years


Fine $2 million individual,$10 million other than individual

More than 1 kg

Less than

50 kgs mixture

1 to 49

plants Not more than 5 years Not more than 10 years

10 kgs or lessFine not more than $250,000,

$1 million other than individual

Fine $500,000 individual,$2 million other than individual

1 kg or less

*Includes Hashish and Hashish Oil

15

(Marijuana is a Schedule I Controlled Substance)

a a

D - -4111P

R gistration

Recordke

DistributionRest icti ns

aspen i g Limits

ManufacturingSecurit

Manu cturingot

Import/Exportar -o is

mport/ExpsNo areotic

ep,ort o Dby Manufacturer istributor

epo s toby Manufacturer/Distributo

No - a otic

Schedule

Required

Separate

Order forms

Research useonly

Vault/safe

Yes

Permit

Permit

Yes

Yes

42.

Schedule

Required

Separate

Order forms

Rx: written,no refills

Vault/safe

Yes

Permit

Permit

Yes

Yes

0 '

ScheduleIII

Required

Readilyretrievable

Recordsrequired

Rx. written ororal; refillsNote 1

Secure storagearea

NO but somedrugs limitedby Schedule II

Permit

Note 2

Yes

Note 3

ScheduleIV

Required

Readilyretrievable

Recordsrequired

Rx. written ororal; refillsNote 1

Secure storagearea


Permit

Declaration

Manufactureronly

Note 3

a

ScheduleV

Required

Readilyretrievable

Recordsrequired

OTC (Rx drugslimited toM D 's order)

Secure storagearea


Permit toimport, declara-tion to export

Declaration

Manufactureronly

No

Note 1- With medical aurthorization, refills up to 5 in 6 months Note 3 - Manufacturer reports required for specific drugsNote 2 Permit for some drugs, declaration for others

16

U.S.Chemical Control

DRUGS OF ABUSEThe Controlled Substances Act (CSA) is the principalfederal law directed at combating the illicit manu-facture and distribution of controlled drugs in theUnited States. Since its passage in 1970, the CSAhas been amended on a number of occasions.The most recent change in the scope of the CSAis the implementation of amendments and regu-lations regarding chemicals and equipment usedin the illicit production of controlled substances.The clandestine production of drugs is depen-dent on the availability of chemicals necessary toaccomplish the illicit activity. Most of the drugs inthe illicit traffic, with the exception of marijuana,require chemicals to be produced. For example,although cocaine is produced naturally in the cocaplant, large amounts of chemicals are needed tosuccessfully extract the drug and purify it for theillicit market.

The controls placed on chemicals are substan-tially less than those imposed on controlled drugsbecause most of the chemicals have legitimateindustrial applications. For this reason, the term"regulated" more appropriately describes chemicalscovered under the CSA as compared to the term"controlled" that is used for drugs. Several itemsthat are regulated as chemicals under the CSA arealso non-controlled ingredients in drug productslawfully marketed under the Federal Food, Drugand Cosmetic Act and are, therefore, widely avail-able to the general public. Examples of these prod-ucts include over-the-counter (OTC) medicationscontaining ephedrine, pseudoephedrine, and/orphenylpropanolamine.

DEA chemical control was initiated in the UnitedStates with the passage of the Chemical Diversionand Trafficking Act of 1988 (CDTA) that becameeffective on August 1, 1989. The initial legislationwas drafted in 1985. The CDTA regulated 12 pre-cursor chemicals, eight essential chemicals, tablet-ing machines, and encapsulating machines byimposing record keeping and import/export report-ing requirements on transactions involving thesematerials. U.S. companies were the main sourceof tons of chemicals used in the production ofcocaine in the Andean countries of South America.The principal chemicals used in the production ofcocaine at that time included acetone, methyl ethylketone, methyl isobutyl ketone, ethyl ether, potas-sium permanganate, hydrochloric acid, and sulfu-ric acid. Soon after the CDTA became effective, thequantity of many of these chemicals exported fromthe United States declined significantly.

10

17

Cocaine traffickers reacted to the reduction in theavailability of U.S. chemicals for illicit production bydeveloping new sources of supply in other parts ofthe world. The U.S. Government, with the leadershipand assistance of the DEA, responded by eliciting thesupport of the international community for world-wide chemical control. The international communityresponded by incorporating Article 12 into the U.N.Convention Against Illicit Drug Traffic of 1988. Article12 established chemical controls on a list of 22 chemi-cals used in the production of heroin, cocaine, LSD,PCP, amphetamine, methamphetamine, MDMA andrelated drugs, and numerous other clandestinely pro-duced drugs. The DEA has sponsored a number ofinternational meetings and training seminars to edu-cate other nations in the benefits of chemical controlas a tool to fight drug trafficking. DEA efforts haveresulted in chemical control legislation and active pro-grams to prevent the diversion of chemicals used inthe clandestine production of drugs in many nations.

The Chemical Diversion and Trafficking Act (CDTA)also had an initial impact on the number of clan-destine methamphetamine laboratories in the UnitedStates. In the first three years after the law waspassed, the number of clandestine laboratories seizedby the DEA declined by 61 percent. In addition, inju-ries attributed to illicitly manufactured controlled sub-stances that were reported to the Drug Abuse Warn-ing Network (DAWN) declined by almost 60 percentduring the same time period.

The provisions of the CDTA regarding bulk ephedrineand pseudoephedrine caused methamphetamine traf-fickers to look for other sources of the precursors. Thetraffickers noted that the CDTA contained an exemp-tion for over-the-counter (OTC) products that con-tained regulated chemicals. They took advantage ofthis loophole by turning to single entity OTC ephed-rine tablets and capsules whose single active ingredi-ent was ephedrine as a source of precursor materialfor the illicit production of methamphetamine.

Federal legislation was passed in 1993 in responseto the methamphetamine traffickers' switch to OTCephedrine products. The legislation was the DomesticChemical Diversion and Control Act of 1993 (DCDCA)that became effective on April 16, 1994. The DCDCAeliminated the CDTA terminology of "precursors" and"essential" for chemicals regulated under that act andreplaced them with the terms "List I" and "List II" chem-icals. The DCDCA also removed the exemption forOTC single entity ephedrine tablets, thus closing theloophole left by the CDTA. In addition, it gave the DEA

the authority to remove the exemption for any otherdrugs containing listed chemicals if it was shown thatthey were being diverted for the illicit production ofcontrolled substances. The DCDCA required that allmanufacturers, distributors, importers, and exportersof List I chemicals be registered with the DEA andthat bulk manufacturers of List I and List II chemicalsreport on the total quantity of listed chemicals pro-duced during the year. Record keeping and reportingrequirements for transactions in single-entity ephed-rine products were also imposed by the DCDCA.

Methamphetamine traffickers quickly reacted to theprovisions of the DCDCA by switching to single-entitypseudoephedrine products and combination prod-ucts of ephedrine. The Comprehensive Methamphet-amine Control Act of 1996 (MCA) was passed to coun-ter the traffickers' response to the DCDCA. The MCAexpanded regulatory controls on all lawfully marketeddrug products containing ephedrine, pseudoephed-rine, and phenylpropanolamine, and it increased pen-alties for the trafficking and manufacturing of meth-amphetamine and listed chemicals. The MCA alsomade it unlawful for any person to distribute a "labo-ratory supply" to a person who uses, or attempts touse, that "laboratory supply" to manufacture a con-trolled drug or listed chemicals with reckless disregardfor the illegal uses to which such "laboratory supply"will be put. The Special Surveillance List was pub-lished by the Attorney General and consisted of alllisted chemicals, all mixtures, and all OTC productsand dietary supplements that contain listed chemicals,28 other chemicals frequently used in the clandes-tine production of controlled drugs, or listed chemi-cals and 4 pieces of laboratory equipment commonlyfound at clandestine drug laboratories. Individualswho violate the "laboratory supply" provision of theMCA are subject to a maximum civil fine of $25,000.Businesses that violate the provision are subject to amaximum civil fine of $250,000.

Ready access to chemical supplies is critical to drugtraffickers. Traffickers continuously look for loopholesin legislation and new methods of clandestine pro-duction routes in an effort to continue their illegalactivity. The DEA has embraced chemical control asan important tool in reducing the availability of clan-destinely produced drugs and is committed to depriv-ing drug traffickers of the chemicals needed to manu-facture illicit drugs. Currently, List I and List II of theCSA contain 35 chemicals.

18

v

INTRODUCTION TODRUG CLASSES

DRUGS OF ABUSEThe Controlled Substances Act (CSA) regulates five

classes of drugs: narcotics, depressants, stimulants,hallucinogens, and anabolic steroids. Each classhas distinguishing properties, and drugs withineach class often produce similar effects. However,all controlled substances, regardless of class, sharea number of common features. It is the purpose ofthis introduction to familiarize the reader with someof these shared features and to give definition toterms (printed in bold) frequently associated withthese drugs.

With the exception of anabolic steroids, drugs in theother classes are utilized to alter mood, thought,and feeling through their actions on the centralnervous system (brain and spinal cord). Forexample, some of these drugs alleviate pain, anxi-ety, or depression. Some induce sleep and othersenergize. Though therapeutically useful, the "feelgood" effects of these drugs contribute to theirabuse. The extent to which a substance is reliablycapable of producing intensely pleasurable feelings(euphoria) increases the likelihood of that substancebeing abused.

When drugs are used in a manner or amountinconsistent with the medical or social patterns ofa culture, it is called drug abuse. In legal terms,the non-sanctioned use of substances controlledin Schedules I through V of the CSA is considereddrug abuse. While legal pharmaceuticals placed

12

under control in the CSA are prescribed and usedby patients for medical treatment, the use of thesesame pharmaceuticals outside the scope of soundmedical practice is drug abuse.

In addition to having abuse potential, most con-trolled substances are capable of producing depen-dence, either physical or psychological. Physicaldependence refers to the changes that haveoccurred in the body after repeated use of a drugthat necessitates the continued administration ofthe drug to prevent a withdrawal syndrome.This withdrawal syndrome can range from mildlyunpleasant to life-threatening and is dependenton a number of factors. The type of withdrawalexperienced is related to the drug being used; thedose and route of administration; concurrent use ofother drugs; frequency and duration of drug use;and the age, sex, health, and genetic makeup ofthe user. Psychological dependence refers to theperceived "need" or "craving" for a drug. Individualswho are psychologically dependent on a particularsubstance often feel that they cannot function with-out continued use of that substance. While physicaldependence disappears within days or weeks afterdrug use stops, psychological dependence can lastmuch longer and is one of the primary reasons forrelapse (initiation of drug use after a period of absti-nence).

Contrary to common belief, physical dependence

19

is not addiction. While addicts are usually physicallydependent on the drug they are abusing, physicaldependence can exist without addiction. For exam-ple, patients who take narcotics for chronic painmanagement or benzodiazepines to treat anxietyare likely to be physically dependent on that medi-cation. Addiction is defined as compulsive drug-seeking behavior where acquiring and using a drugbecomes the most important activity in the user'slife. This definition implies a loss of control regardingdrug use, and the addict will continue to use a drugdespite serious medical and/or social consequences.The National Institute on Drug Abuse (NIDA) esti-mates that about five million Americans suffer fromdrug addiction.

Individuals that abuse drugs often have a preferreddrug that they use, but may substitute other drugsthat produce similar effects (often found in the samedrug class) when they have difficulty obtaining theirdrug of choice. Drugs within a class are often com-pared with each other with terms like potency andefficacy. Potency refers to the amount of a drugthat must be taken to produce a certain effect, whileefficacy refers to whether or not a drug is capableof producing a given effect regardless of dose. Boththe strength and the ability of a substance to pro-duce certain effects play a role in whether that drugis selected by the drug abuser.

It is important to keep in mind that the effectsproduced by any drug can vary significantly andis largely dependent on the dose and route ofadministration. Concurrent use of other drugs canenhance or block an effect and substance abusersoften take more than one drug to boost the desiredeffects or counter unwanted side effects. Risks asso-ciated with drug abuse cannot be accurately pre-dicted because each user has his/her own uniquesensitivity to a drug. There are a number of theoriesthat attempt to explain these differences, and it isclear that a genetic component may predisposean individual to certain toxicities or even addictivebehavior.

Youths are especially vulnerable to drug abuse.According to NIDA, young Americans engagedin extraordinary levels of illicit drug use in the lastthird of the twentieth century. Today, the majorityof young people (about 55 percent) have used an

13

illicit drug by the time they leave high school andabout 25 percent of all seniors are current (withinthe past month) users. The behaviors associatedwith teen and preteen drug use often result in tragicconsequences with untold harm to the community,themselves, and their families. For example, ananalysis of data from the National Household Surveyon Drug Abuse indicates that youngsters betweenthe ages of 12 and I7 who have smoked marijuanawithin the past year are more than twice as likely tocut class, steal, and destroy property than are thosewho did not smoke marijuana. The more frequentlya youth smokes marijuana, the more likely he or sheis to engage in these antisocial behaviors.

In the sections that follow, each of the five classesof drugs is reviewed and various drugs within eachclass are profiled. Although marijuana is classifiedin the CSA as a hallucinogen, a separate section isdedicated to that topic. There are also a numberof substances that are abused but not regulatedunder the CSA. Alcohol and tobacco, for example,are specifically exempt from control by the CSA. Inaddition, a whole group of substances called inhal-ants are commonly available and widely abused bychildren. Control of these substances under the CSAwould not only impede legitimate commerce, butwould likely have little effect on the abuse of thesesubstances by youngsters. An energetic campaignaimed at educating both adults and youth aboutinhalants is more likely to prevent their abuse. Tothat end, a section is dedicated to providing infor-mation on inhalants.

20

NarcoticsCrude opium

DRUGS OF ABUSE4T11 en Chinese it

't ii the1$'6ek oil gold

en ty,difyiadc,

jth"

,

14

Doctor's hypodermic syringe kit, circa 1900

The term "narcotic,"derived from the Greek

word for stupor, originallyreferred to a variety ofsubstances that dulled the

senses and relieved pain.Today, the term is used in a number of ways. Someindividuals define narcotics as those substancesthat bind at opiate receptors (cellular membraneproteins activated by substances like heroin or mor-phine) while others refer to any illicit substance as anarcotic. In a legal context, narcotic refers to opium,opium derivitives, and their semi-synthetic substi-tutes. Cocaine and coca leaves, which are also clas-sified as "narcotics" in the Controlled Substances Act(CSA), neither bind to opiate receptors nor producemorphine-like effects, and are discussed in the sec-tion on stimulants. For the purposes of this discus-sion, the term narcotic refers to drugs that producemorphine-like effects and have abuse potential.

Narcotics are used therapeutically to treat pain, sup-press cough, alleviate diarrhea, and induce anesthe-sia. Narcotics are administered in a variety of ways.Some are taken orally, transdermally (skin patches),or injected. They are also available in suppositories.As drugs of abuse, they are often smoked, sniffed, orinjected. Drug effects depend heavily on the dose,route of administration, and previous exposure tothe drug. Aside from their medical use, narcoticsproduce a general sense of well-being by reducingtension, anxiety and aggression. These effects arehelpful in a therapeutic setting but contribute totheir abuse.

Narcotic use is associated with a variety of unwantedeffects including drowsiness, inability to concentrate,apathy, lessened physical activity, constriction of thepupils, and dilation of the subcutaneous blood ves-sels, causing flushing of the face and neck, constipa-tion, nausea and vomiting, and most significantly,respiratory depression. As the dose is increased, thesubjective, analgesic (pain relief), and toxic effectsbecome more pronounced. Except in cases of acuteintoxication, there is no loss of motor coordinationor slurred speech as occurs with many depressants.

Among the hazards of illicit drug use is the ever-increasing risk of infection, disease, and overdose.While pharmaceutical products have a known con-

15

centration and purity, clandestinely produced streetdrugs have unknown compositions. Medical com-plications common among narcotic abusers ariseprimarily from adulterants found in street drugs andin the non-sterile practices of injecting. Skin, lung,and brain abscesses, endocarditis (inflammationof the lining of the heart), hepatitis, and AIDS arecommonly found among narcotic abusers. Sincethere is no simple way to determine the purity of adrug that is sold on the street, the effects of

illicit narcoticuse are unpredictable

and can be fatal Physicalsigns of narcotic overdose include

constricted (pinpoint) pupils, cold clammyskin, confusion, convulsions, severe drowsiness,and respiratory depression (slow or troubled breath-ing). With repeated use of narcotics, tolerance anddependence develop. The development of toler-ance is characterized by a shortened duration anda decreased intensity of analgesia, euphoria, andsedation, which creates the need to consume pro-gressively larger doses to attain the desired effect.

In this 191,1illustration forMeaure's story,the )vomandisplays her needlemarks, confessingshe became"habituated" whena doctor provided astock of morphineto ease painfrom "muscularrheumatism."Genteel ladies with easy access to doctors and drugsmade up the majority of the late 19th century addicts.

22

Tolerance does not develop uniformly for all actionsof these drugs, giving rise to a number of toxiceffects. Tolerant users can consume doses far inexcess of the dose they initially started with. Physicaldependence refers to an alteration of normal bodyfunctions that necessitates the continued presenceof a drug in order to prevent a withdrawal or absti-nence syndrome. The intensity and character of thephysical symptoms experienced during withdrawalare directly related to the particular drug of abuse,the total daily dose, the interval between doses, theduration of use, and the health and personality ofthe user. In general, shorter acting narcotics tendto produce shorter, more intense withdrawal symp-toms, while longer acting narcotics produce a with-drawal syndrome that is protracted but tends to beless severe. Although unpleasant, withdrawal fromnarcotics is rarely life threatening.

The withdrawal symptoms associated with heroin/morphine addiction are usually experienced shortlybefore the time of the next scheduled dose. Earlysymptoms include watery eyes, runny nose, yawn-ing, and sweating. Restlessness, irritability, loss ofappetite, nausea, tremors, and drug craving appearas the syndrome progresses. Severe depression andvomiting are common. The heart rate and bloodpressure are elevated. Chills alternating with flush-ing and excessive sweating are also characteristicsymptoms. Pains in the bones and muscles of theback and extremities occur, as do muscle spasms.At any point during this process, a suitable narcoticcan be administered that will dramatically reversethe withdrawal symptoms. Without intervention,the syndrome will run its course, and most of theovert physical symptoms will disappear within 7 to10 days.

The psychological dependence associated withnarcotic addiction is complex and protracted. Longafter the physical need for the drug has passed,the addict may continue to think and talk aboutthe use of drugs and feel strange or overwhelmed,coping with daily activities without being under theinfluence of drugs. There is a high probability thatrelapse will occur after narcotic withdrawal whenneither the physical environment nor the behavioralmotivators that contributed to the abuse have beenaltered.

16

There are two major patterns of narcotic abuse ordependence seen in the United States. One involvesindividuals whose drug use was initiated within thecontext of medical treatment who escalate theirdose by obtaining the drug through fraudulent pre-scriptions and "doctor shopping" or branching outto illicit drugs. The other, more common, patternof abuse is initiated outside the therapeutic settingwith experimental or recreational use of narcotics.The majority of individuals in this category mayabuse narcotics sporadically for months or evenyears. Although they may not become addicts,the social, medical, and legal consequences of theirbehavior is very serious. Some experimental userswill escalate their narcotic use and will eventuallybecome dependent, both physically and psycholog-ically. The younger an individual is when drug useis initiated, the more likely the drug use will progressto dependence and addiction.

NARCOTICS OFNATURAL ORIGIN

After the opium poppy pod has been scored, the liquidopium oozes out and dries on the pod. It is collectedand scraped into a ball shape.

The poppy plant is the source for non-synthetic nar-cotics. It was grown in the Mediterranean region asearly as 5000 B.C., and has since been cultivated ina number of countries throughout the world. Themilky fluid that seeps from incisions in the unripeseedpod of this poppy has, since ancient times,been scraped by hand and air-dried to producewhat is known as opium. A more modern method

23

of harvesting is by the industrial poppy straw pro-cess of extracting alkaloids from the mature driedplant. The extract may be in liquid, solid, or powderform, although most poppy straw concentrate avail-able commercially is a fine brownish powder. Morethan 500 tons of opium or its equivalent in poppystraw concentrate are legally imported into theUnited States annually for legitimatemedical use

4

Although opium is used in the form of paregoric totreat diarrhea, most opium imported into the UnitedStates is broken down into its alkaloid constituents.These alkaloids are divided into two distinct chemi-cal classes, phenanthrenes and isoquinolines. The

principal phenanthrenes are morphine,codeine, and thebaine, while the isoquino-lines have no significant central nervoussystem effects and are not regulatedunder the CSA.

MORPHINE

OPIUM

These opiate -basedsyrups were popular

for treating children withteething and dysentary.

There were no legal restrictions on the importationor use of opium until the early 1900s. In the UnitedStates, the unrestricted availability of opium, theinflux of opium-smoking immigrants from East Asia,and the invention of the hypodermic needle contrib-uted to the more severe variety of compulsive drugabuse seen at the turn of the 20th century. In thosedays, medicines often contained opium without anywarning label. Today, there are state, federal, andinternational laws governing the production anddistribution of narcotic substances.

17

Morphine is the principal con-stituent of opium and can rangein concentration from 4 to 21percent. Commercial opium isstandardized to contain 10-per-cent morphine. In the UnitedStates, a small percentage ofthe morphine obtained fromopium is used directly (about

15 tons): the remaining isconverted to codeine andother derivatives (about120 tons). Morphine is

one of the most effectivedrugs known for the relief of severe

pain and remains the standard againstwhich new analgesics are measured. Like most

narcotics, the use of morphine has increased signifi-cantly in recent years Since 1990, there has beenabout a 3-fold increase in morphine products in theUnited States

Morphine is marketed under generic and brandname products including MS-ContinO, OramorphSRO, MSIRO, RoxanolO, KadianO, and RMSO.Morphine is used parenterally (by injection) forpreoperative sedation, as a supplement to anes-thesia, and for analgesia. It is the drug of choicefor relieving pain of myocardial infarction and for itscardiovascular effects in the treatment of acute pul-monary edema. Traditionally; morphine was almostexclusively used by injection. Today, morphine ismarketed in a variety of forms, including oral solu-tions, immediate and sustained-release tablets andcapsules, suppositories, and injectable preparations.

In addition, the availability of high-concentrationmorphine preparations (i.e., 20-mg/m1 oral solu-tions, 25-mg/m1 injectable solutions, and 200-mgsustained-release tablets) partially reflects the useof this substance for chronic pain management inopiate-tolerant patients.

CODEINECodeine is the most widely used, naturally occur-ring narcotic in medical treatment in the world. Thisalkaloid is found in opium in concentrations rangingfrom 0.7 to 2.5 percent. However, most codeineused in the United States is produced from mor-phine. Codeine is also the starting material for theproduction of two other narcotics, dihydrocodeineand hydrocodone. Codeine is medically prescribedfor the relief of moderate pain and cough suppres-sion. Compared to morphine, codeine produces lessanalgesia, sedation, and respiratory depression, andis usually taken orally. It is made into tablets eitheralone (Schedule II) or in combination with aspirin oracetaminophen (i.e., Tylenol with Codeine, Sched-ule 111). As a cough suppressant, codeine is foundin a number of liquid preparations (these productsare in Schedule V). Codeine is also used to a lesserextent as an injectable solution for the treatment ofpain. Codeine products are diverted from legitimatesources and are encountered on the illicit market.

THEBAINEThebaine, a minor constituent of opium, is con-trolled in Schedule 11 of the CSA as well as underinternational law. Although chemically similar toboth morphine and codeine, thebaine producesstimulatory rather than depressant effects. Thebaineis not used therapeutically, but is converted into avariety of substances including oxycodone, oxy-morphone, nalbuphine, naloxone, naltrexone, andbuprenorphine. The United States ranks first in theworld in thebaine utilization. The following narcot-ics are among the more significant substances thathave been derived by modification of the phenan-threne alkaloids contained in opium.

18

25

SEMI-SYNTHETICNARCOTICSHEROINFirst synthesized from morphine in 1874, heroinwas not extensively used in medicine until the early1900s. Commercial production of the new painremedy was first started in 1898. While it receivedwidespread acceptance from the medical profes-sion, physicians remained unaware of its potentialfor addiction for years. The first comprehensive con-trol of heroin occurred with the Harrison NarcoticAct of 1914. Today, heroin is an illicit substancehaving no medical utility in the United States. It is inSchedule I of the CSA.

Four foreign source areas produce the heroin avail-able in the United States: South America (Colombia),Mexico, Southeast Asia (principally Burma), andSouthwest Asia (principally Afghanistan). How-ever, South America and Mexico supply most of theillicit heroin marketed in the United States. SouthAmerican heroin is a high-purity powder primarilydistributed to metropolitan areas on the East Coast.Heroin powder may vary in color from white to darkbrown because of impurities left from the manufac-turing process or the presence of additives. Mexicanheroin, known as "black tar," is primarily available inthe western United States. The color and consis-tency of black tar heroin result from the crude pro-cessing methods used to illicitly manufacture heroinin Mexico. Black tar heroin may be sticky like roofingtar or hard like coal, and its color may vary from darkbrown to black.

Pure heroin is rarely sold on the street, and the aver-age purity of heroin for major metropolitan areasnationally averaged about 37.2 percent in 2000. A"bag"- slang for a small unit of heroin sold on thestreet currently contains about 30 to 50 milligramsof powder; only a portion of which is heroin; theremainder could be sugar, starch, acetaminophen,procaine, benzocaine, or quinine, to name a fewof the cutting agents for heroin. Traditionally, thepurity of heroin in a bag ranged from 1 to 10 per-cent. More recently, heroin purity has ranged from

about 10 to 70 percent. Black tar heroin is oftensold in chunks weighing about an ounce. Its purityis generally far less than South American heroin andit is most frequently dissolved, diluted, and injected.

In the past, heroin in the United States was almostalways injected, because it was the most practicaland efficient way to administer low-purity heroin.However, the recent availability of higher purityheroin at relatively low cost has meant that a largerpercentage of today's users are either snorting orsmoking heroin, instead of injecting it. This trendwas first captured in the 1999 National HouseholdSurvey on Drug Abuse, which revealed that 60 to 70percent of people who used heroin for the first timefrom 1996 to 1998 never injected it.

According to that survey, an estimated 73 percentof the 471,000 first-time heroin users (from 1996 to1999) were under 25 years old. Snorting or smok-ing heroin is more appealing to these new usersbecause it eliminates both the fear of acquiringsyringe-borne diseases, such as HIV and hepatitis,as well as the social stigma attached to intravenousheroin use. Many new users of heroin mistakenlybelieve that smoking or snorting heroin is a safetechnique for avoiding addiction. However, boththe smoking and the snorting of heroin are directlylinked to high incidences of dependence and addic-tion.

According to the 2001 National HouseholdSurvey, during the 1990's, heroin incidence ratesrose to a level not reached since the 1970's. Theannual number of new users ranged from 55,000to 69,000 between 1989 and 1992. However,there were 110,000 new heroin users in 1994 and146,000 in 2000. Between 1975 and 1977, therewere approximately 120,000 to 140,000 new usersof heroin per year.

HYDROMORPHONEHydromorphone (Dilaudid®) is marketed in tablets(2, 4, and 8 mg), rectal suppositories, oral solu-tions, and injectable formulations. All products arein Schedule II of the CSA. Its analgesic potency isfrom two to eight times that of morphine, but it isshorter acting and produces more sedation thanmorphine. Much sought after by narcotic addicts,

19

hydromorphone is usually obtained by the abuserthrough fraudulent prescriptions or theft. The tab-lets are often dissolved and injected as a substitutefor heroin.

OXYCODONEOxycodone is synthesized from thebaine. Like mor-phine and hydromorphone, oxycodone is used asan analgesic. It is effective orally and is marketedalone in 10, 20, 40, and 80mg controlled-releasetablets (OxyContin ®), or 5 mg immediate-releasecapsules (Oxy1R0), or in combination products withaspirin (Percodan®) or acetaminophen (Percocet®)for the relief of pain. All oxycodone products arein Schedule II. Oxycodone is abused orally or thetablets are crushed and sniffed or dissolved in waterand injected. The use of oxycodone has increasedsignificantly. In 1990, nearly three tons of oxyco-done were manufactured in the United States. In

2000, about 47 tons were manufactured. Histori-cally, oxycodone products have been popular drugsof abuse among the narcotic abusing population.In recent months, concern has grown among fed-eral, state, and local officials about the dramaticincrease in the illicit availability and abuse of Oxy-Contin® products. These products contain largeamounts of oxycodone (10 to 80 mg) in a formula-tion intended for slow release over about a 12-hourperiod. Abusers have learned that this slow-releasemechanism can be easily circumvented by crushingthe tablet and swallowing, snorting, or injecting thedrug product for a more rapid and intense high.The criminal activity associated with illicitly obtainingand distributing this drug, as well as serious conse-quences of illicit use, including addiction and fataloverdose deaths, are of epidemic proportions insome areas of the United States.

HYDROCODONEHydrocodone is an orally active analgesic and anti-tussive Schedule II narcotic that is marketed in multi-ingredient Schedule III products. Hydrocodone hasan analgesic potency similar to or greater than thatof oral morphine. Sales and production of this drughave increased significantly in recent years (a four-fold increase between 1990 and 2000), as havediversion and illicit use. Trade names include Anex-

2 6

sia0, Hycodan®, Hycomine0, Lorcet®, Lortab®,Tussionex®, Ty lox®, Vicodin®, and Vicoprofen®.These are available as tablets, capsules, and/orsyrups. Generally, this drug is abused orally ratherthan by intravenous administration. Currently,about 20 tons of hydrocodone products are usedannually in the United States.

SYNTHETIC

NARCOTICSIn contrast to the pharmaceutical products derivedfrom opium, synthetic narcotics are producedentirely within the laboratory. The continuing searchfor products that retain the analgesic properties ofmorphine without the consequent dangers of toler-ance and dependence has yet to yield a productthat is not susceptible to abuse. A number of clan-destinely produced drugs, as well as drugs that haveaccepted medical uses, fall within this category.

MEPERIDINEIntroduced as an analgesic in the 1930s, meperi-dine produces effects that are similar, but notidentical, to morphine (shorter duration of actionand reduced antitussive and antidiarrheal actions).Currently it is used for pre-anesthesia and the reliefof moderate to severe pain, particularly in obstetricsand post-operative situations. Meperidine is avail-able in tablets, syrups, and injectable forms undergeneric and brand name (Demerol®, Mepergan®,etc.) Schedule II preparations. Several analoguesof meperidine have been clandestinely produced.During the clandestine synthesis of the analogueMKT a neurotoxic by-product (MPTP) was pro-duced. A number of individuals who consumed theMPPP-MPTP preparation developed an irreversibleParkinsonian-like syndrome. It was later found thatMPTP destroys the same neurons as those damagedin Parkinsons Disease.

20

NARCOTICSTREATMENTDRUGSMETHADONEGerman scientists synthesized methadone duringWorld War II because of a shortage of morphine.Although chemically unlike morphine or heroin,methadone produces many of the same effects.Introduced into the United States in 1947 as ananalgesic (Dolophine®), it is primarily used today forthe treatment of narcotic addiction. It is availablein oral solutions, tablets, and injectable Schedule IIformulations, and is almost as effective when admin-istered orally as it is by injection. Methadone's effectscan last up to 24 hours, thereby permitting once-a-day oral administration in heroin detoxification andmaintenance programs. High-dose methadone canblock the effects of heroin, thereby discouraging thecontinued use of heroin by addicts under treatmentwith methadone. Chronic administration of metha-done results in the development of tolerance anddependence. The withdrawal syndrome developsmore slowly and is less severe but more prolongedthan that associated with heroin withdrawal. Ironi-cally, methadone used to control narcotic addictionis frequently encountered on the illicit market andhas been associated with a number of overdosedeaths.

LAAMClosely related to methadone, the syntheticcompound levo alphacetylmethadol, or LAAM(ORLAM®), has an even longer duration of action(from 48 to 72 hours) than methadone, permittinga reduction in frequency of use. In 1994, it wasapproved as a Schedule II treatment drug for nar-cotic addiction. Both methadone and LAAM havehigh abuse potential. Their acceptability as narcotictreatment drugs is predicated upon their ability tosubstitute for heroin, the long duration of action,and their mode of oral administration.

27

BUPRENORPHINEThis drug is a semi-synthetic narcotic derived fromthebaine. High-dose sublingual tablets (Subox-one®, Subutex®) have recently been approved forthe treatment of narcotic addiction. Like metha-done and LRAM, buprenorphine is potent (30 to50 times the analgesic potency of morphine), hasa long duration of action, and does not need tobe injected. Unlike the other treatment drugs,buprenorphine produces far less respiratorydepression and is thought to be safer in overdose.Buprenorphine is also available in the United Statesas an injectable narcotic analgesic (Buprenex®) forhuman and veterinary use.

DEXTROPROPDXYPHENE

A close relative of methadone, dextropropoxyphenewas first marketed in 1957 under the trade nameof Darvon®. Oral analgesic potency is one-half toone-third that of codeine, with 65 mg approximatelyequivalent to about 600 mg of aspirin. Dextroproxy-phene is prescribed for relief of mild to moderatepain. Bulk dextropropoxyphene is in Schedule II,while preparations containing it are in Schedule IV.More than 100 tons of dextropropoxyphene are pro-duced in the United States annually, and more than30 million prescriptions are written for the products.This narcotic is associated with a number of toxicside effects and is among the top 10 drugs reportedby medical examiners in drug abuse deaths.

FENTANYLFirst synthesized in Belgium in the late 1950s, fen-tanyl, with an analgesic potency of about 80 timesthat of morphine, was introduced into medical prac-tice in the 1960s as an intravenous anesthetic underthe trade name of Sublimaze®. Thereafter; twoother fentanyl analogues were introduced; alfent-anil (Alfenta®), an ultra-short (5-10 minutes) actinganalgesic, and sufentanil (Sufenta®), an exception-ally potent analgesic (5 to 10 times more potentthan fentanyl) for use in heart surgery. Today,fentanyls are extensively used for anesthesia andanalgesia. Duragesic®, for example, is a fentanyl

21

transdermal patch used in chronic pain management, and Actiq® is a solid formulation of fentanylcitrate on a stick that dissolves slowly in the mouthfor transmucosal absorption. Actiq® is intended foropiate-tolerant individuals and is effective in treatingbreakthrough pain in cancer patients. Carfentanil(Wildnil®) is an analogue of fentanyl with an anal-gesic potency 10,000 times that of morphine andis used in veterinary practice to immobilize certainlarge animals. Illicit use of pharmaceutical fentanylsfirst appeared in the mid-1970s in the medical com-munity and continues to be a problem in the UnitedStates. To date, over 12 different analogues of fen-tanyl have been produced clandestinely and identi-fied in the U.S. drug traffic. The biological effectsof the fentanyls are indistinguishable from those ofheroin, with the exception that the fentanyls may behundreds of times more potent. Fentanyls are mostcommonly used by intravenous administration, butlike heroin, they may also be smoked or snorted.

PENTAZOCINEThe effort to find an effective analgesic with lessdependence-producing consequences led to thedevelopment of pentazocine ( Talwin®). Introducedas an analgesic in 1967, it was frequently encoun-tered in the illicit trade, usually in combination withtripelennamine and placed into Schedule IV of theCSA in 1979. An attempt at reducing the abuse ofthis drug was made with the introduction of TalwinNx®. This product contains a quantity of antagonist(naloxone) sufficient to counteract the morphine-likeeffects of pentazocine if the tablets are dissolved andinjected.

BUTORPHANOLWhile butorphanol can be made from thebaine,it is usually manufactured synthetically. It was ini-tially available in injectable formulations for human(Stadol®) and veterinary (Torbugesic0 and Torbutrol®) use. More recently, a nasal spray (StadolNSO) became available, and significant diversionand abuse of this product led to the 1997 controlof butorphanol in Schedule IV of the CSA. Butor-phanol is a clear example of a drug gaining favor asa drug of abuse only after it became available in aform that facilitated its mode of administration (nasalspray v. injection).

28

I DE 0 I

Trade Name: DemerolControlled Ingredient: meperidinehydrochloride, 100 mg

Trade Name: DemerolControlled Ingredient: meperidinehydrochloride, 50 mg

Trade Name: DilaudidControlled Ingredient:hydromorphone hydrochloride, 2 mg

Trade Name: DilaudidControlled Ingredient:hydromorphone hydrochloride, 4 mg

Trade Name: DolophineControlled Ingredient: methadonehydrochloride, 10 mg

Trade Name: HydromorphoneHydrochlorideControlled Ingredient:hydromorphone hydrochloride, 2mg

22

Trade Name: HydromorphoneHydrochlorideControlled Ingredient:hydromorphone hydrochloride, 2 mg

Trade Name: MS ContinControlled Ingredient: morphine sulfate, 100 mg



Trade Name: Oramorph SRControlled Ingredient: morphine sulfate, 30 mg


t


29BEST COPY AVAILA8LL

Trade Name: OxyContinControlled Ingredient:oxycodone hydrochloride, 10 mg

Trade Name: OxyContinControlled Ingredient: oxycodone hydrochloride,160 mg



Trade Name: Oxycodone &APAPControlled Ingredient: oxycodone hydrochloride,5 mgOther Ingredients: Acetominophen, 325 mg

Trade Name: PercocetControlled Ingredient: oxycodone hydrochloride,5 mgOther Ingredients: Acetominophen, 325 mg

Trade Name: Percodan-DemiControlled Ingredient: oxycodone hydrochlo-ride 2.25 mg andoxycodone terephthalate 0.19 mgOther Ingredients: aspirin, 325 mg

Trade Name: PercodanControlled Ingredient: oxycodone hydrochlo-ride 4.5 mg andoxycodone terephthalate 0.38 mgOther Ingredients: aspirin, 325 mg

Trade Name: TyloxControlled Ingredient: oxycodone hydrochlo-ride 4.5 mg andoxycodone terephthalate .38 mgOther Ingredients: Acetominophen, 500 mg

Schedule III

Trade Name: Aspirin withCodeine No. 4Controlled Ingredient: codeinephosphate, 60 mgOther Ingredients: aspirin, 325 mg

Trade Name: Fiorinal withCodeineControlled Ingredient: codeinephosphate 30 mg and butalbitol , 50mgOther Ingredients: aspirin,325 mg; caffeine, 40mg

23 BEST COPY AVAILABLE

Trade Name: LorcetControlled Ingredient:hydrocodonebitartrate, 10 mgOther Ingredients: acetaminophen, 650 mg

Trade Name: LorcetControlled Ingredient: hydrocodonebitartrate, 7.5 mgOther Ingredients: acetaminophen, 650 mg

Trade Name: LortabControlled Ingredient: hydrocodonebitartrate, 2.5 mgOther Ingredients: acetaminophen, 500 mg

Trade Name: LortabControlled Ingredient: hydrocodonebitartrate, 7.5 mgOther Ingredients: acetominophen, 500 mg

Trade Name: Phenaphen withCodeine No. 3Controlled Ingredient: codeinephosphate, 30 mgOther Ingredients: acetominophen, 325 mg

24

Trade Name: Phenaphen withCodeine No. 4Controlled Ingredient: codeinephosphate, 60 mgOther Ingredients: acetaminophen, 325 mg

Trade Name: Phenaphen withCodeine No. 2Controlled Ingredient: codeinephosphate, 15 mgOther Ingredients: acetaminophen, 325 mg

Trade Name: Phenaphen-650 withCodeineControlled Ingredient: codeinephosphate, 30 mgOther Ingredients: acetaminophen, 650 mg

Trade Name: SynalgosControlled Ingredient:dihydrocodeine, 16 mgOther Ingredients: aspirin, 356.4 mg;caffeine, 30 mg

Trade Name: TussionexControlled Ingredient: hydrocodone,5 mgOther Ingredients: phenyltoloxamine, 10 mg

31

BEST COPY AVAILAbu

IL

Trade Name: Tylenol withCodeine No. 2Controlled Ingredient: codeinephosphate, 15 mgOther Ingredients: acetominophen, 300 mg



Trade Name: VicodinControlled Ingredient: hydrocodone bitartrate,5 mgOther Ingredients: acetominophen, 500 mg

Trade Name: Vicodin ESControlled Ingredient: hydrocodone bitartrate,7.5 mgOther Ingredients: acetaminophen, 750 mg

Schedule IV

Trade Name: Darvocet-N 100Controlled Ingredient: propoxyphenenapsylate, 100 mgOther Ingredients: acetominophen, 650 mg

25

Trade Name: DarvonControlled Ingredient: propoxyphenehydrochloride, 65 mg

Trade Name: Darvon Compound-65Controlled Ingredient: propoxyphene hydro-chloride, 65 mgOther Ingredients: aspirin, 389 mg;caffeine, 32.4 mg

Trade Name: Darvon-NControlled Ingredient: propoxyphenenapsylate, 100 mg

Trade Name: TalacenControlled Ingredient: pentazocinehydrochloride, 50 mgOther Ingredients: acetaminophen, 650 mg

Trade Name: Talwin NxControlled Ingredient: pentazocinehydrochloride, 50 mgOther Ingredients: naloxonehydrochloride, 0.5 mg

Trade Name: WygesicControlled Ingredient: propoxyphene hydro-chloride, 65 mgOther Ingredients: acetaminophen, 650 mg

32

BEST COPY AVAILABLE

DRUGS OF ABUSE

DepressantsHistorically, people of almost every culture have usedchemical agents to induce sleep, relieve stress, andallay anxiety. While alcohol is one of the oldest andmost universal agents used for thesepurposes, hundreds of sub-stances have been devel-oped that producecentral nervoussystem

depression.These drugs have

been referred to as down-ers, sedatives, hypnotics, minor

tranquilizers, anxiolytics, and anti-anxiety medications Unlike most other

26

classes of drugs of abuse, depressants are rarelyproduced in clandestine laboratories. Generally,legitimate pharmaceutical products are diverted tothe illicit market. A notable exception to this is a rela-tively recent drug of abuse, gamma hydroxybutyricacid (GHB).

Chioral hydrate and paraldehyde are two of theoldest pharmaceutical depressants still in use today.Other depressants, including gluthethimide, meth-aqualone, and meprobamate have been importantplayers in the milieu of depressant use and abuse.However, two major groups of depressants havedominated the licit and illicit market for nearly a cen-tury, first barbiturates and now benzodiazepines.

Barbiturates were very popular in the first half of the20th century. In moderate amounts, these drugsproduce a state of intoxication that is remarkablysimilar to alcohol intoxication. Symptoms includeslurred speech, loss of motor coordination, andimpaired judgment. Depending on the dose, fre-quency, and duration of use, one can rapidly developtolerance, physical dependence, and psychologicaldependence to barbiturates. With the developmentof tolerance, the margin of safety between the effec-

33

tive dose and the lethal dose becomes very narrow.That is, in order to obtain the same level of intoxica-tion, the tolerant abuser may raise his or her dose toa level that may result in coma or death. Althoughmany individuals have taken barbiturates therapeu-tically without harm, concern about the addictionpotential of barbiturates and the ever-increasingnumber of fatalities associated with them led to thedevelopment of alternative medications. Today, lessthan 10 percent of all depressant prescriptions in theUnited States are for barbiturates.

Benzodiazepines were first marketed in the 1960s.Touted as much safer depressants with far lessaddiction potential than barbiturates, today thesedrugs account for about one out of every five pre-scriptions for controlled substances. Although ben-zodiazepines produce significantly less respiratorydepression than barbiturates, it is now recognizedthat benzodiazepines share many of the undesirableside effects of the barbiturates. A number of toxiccentral nervous system effects are seen with chronichigh-dose benzodiazepine therapy, including head-aches, irritability, confusion, memory impairmentand depression. The risk of developing over-seda-tion, dizziness, and confusion increases substantiallywith higher doses of benzodiazepines. Prolongeduse can lead to physical dependence even at dosesrecommended for medical treatment. Unlike bar-biturates, large doses of benzodiazepines are rarelyfatal unless combined with other drugs or alcohol.Although primary abuse of benzodiazepines is welldocumented, abuse of these drugs usually occursas part of a pattern of multiple drug abuse. Forexample, heroin or cocaine abusers will use benzo-diazepines and other depressants to augment their"high" or alter the side effects associated with over-stimulation or narcotic withdrawal.

There are marked similarities among the withdrawalsymptoms seen with most drugs classified as depres-sants. In the mildest form, the withdrawal syndromemay produce insomnia and anxiety, usually thesame symptoms that initiated the drug use. Witha greater level of dependence, tremors and weak-ness are also present, and in its most severe form,the withdrawal syndrome can cause seizures anddelirium. Unlike the withdrawal syndrome seen withmost other drugs of abuse, withdrawal from depres-sants can be life threatening.

27

BARBITURATESBarbiturates were first introduced for medical usein the early 1900s. More than 2,500 barbiturateshave been synthesized, and at the height of theirpopularity, about 50 were marketed for humanuse. Today, about a dozen are in medical use.Barbiturates produce a wide spectrum of centralnervous system depression, from mild sedation tocoma, and have been used as sedatives, hypnotics,anesthetics, and anticonvulsants. The primary dif-ferences among many of these products are howfast they produce an effect and how long thoseeffects last. Barbiturates are classified as ultrashort,short, intermediate, and long-acting. The ultra-short-acting barbiturates produce anesthesia withinabout one minute after intravenous administration.Those in current medical use are the Schedule IVdrug methohexital (Brevital0) and the ScheduleIII drugs thiamyl (Surital0) and thiopental (Pento-thal0). Barbiturate abusers prefer the Schedule IIshort-acting and intermediate-acting barbituratesthat include amobarbital (Amyta0), pentobarbital(Nembutal0), secobarbital (Seconal0), and Tuinal0(an amobarbital/secobarbital combination product).Other short and intermediate-acting barbituratesare in Schedule III and include butalbital (Fiorinal0),butabarbital (Butisolq, talbutal (Lotusate0), andaprobarbital (Alurate0). After oral administration,the onset of action is from 15 to 40 minutes, andthe effects last up to six hours. These drugs areprimarily used for insomnia and preoperative seda-tion. Veterinarians use pentobarbital for anesthesiaand euthanasia. Long-acting barbiturates includephenobarbital (Lumina 10) and mephobarbital (Meb-aral0), both of which are in Schedule IV Effectsof these drugs are realized in about one hour andlast for about 12 hours, and are used primarily fordaytime sedation and the treatment of seizure dis-orders.

34

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BENZODIAZEPINESThe benzodiazepine family of depressants is usedtherapeutically to produce sedation, induce sleep,relieve anxiety and muscle spasms, and to preventseizures. In general, benzodiazepines act ashypnotics in high doses, anxiolytics in moderate

doses, and sedatives in low doses.Of the drugs marketed in the UnitedStates that affect central nervous

system function, benzodiazepinesare among the most widely prescribed

medications. Fifteen members of this groupare presently marketed in the United States,and about 20 additional benzodiazepines

i01140,

28

are marketed in other countries. Benzodiazepinesare controlled in Schedule IV of the CSA.

Short-acting benzodiazepines are generally used forpatients with sleep-onset insomnia (difficulty fallingasleep) without daytime anxiety. Shorter-actingbenzodiazepines used to manage insomnia includeestazolam (ProSom ®), flurazepam (Dalmane®),temazepam (Restoril®), and triazolam (Halcion®).Midazolam (Versed®), a short-acting benzodiaz-epine, is utilized for sedation, anxiety, and amnesiain critical care settings and prior to anesthesia. It

is available in the United States as an injectablepreparation and as a syrup (primarily for pediatricpatients).

Benzodiazepines with a longer duration of actionare utilized to treat insomnia in patients withdaytime anxiety. These benzodiazepinesinclude alprazolam (Xanax0), chlordiazepox-ide (librium0), clorazepate (Tranxene®),diazepam (Valium®, halazepam (Paxi-

pam®), lorzepam (Ativan0), oxazepam(Serax®), prazepam (Centrax®), and quaz-epam (Doral®). Clonazepam (Klonopin®),

diazepam, and clorazepate are alsoused as anticonvulsants.

a

36

Benzodiazepines are classifiedin the CSA as depressants.Repeated use of large doses

or, in some cases, daily use of therapeuticdoses of benzodiazepines is associated withamnesia, hostility, irritability, and vivid ordisturbing dreams, as well as tolerance andphysical dependence. The withdrawal syn-drome is similar to that of alcohol and mayrequire hospitalization. Abrupt cessation ofbenzodiazepines is not recommended andtapering-down the dose eliminates many ofthe unpleasant symptoms.

Given the millions of prescriptions writtenfor benzodiazepines (about 100 million in1999), relatively few individuals increasetheir dose on their own initiative or engagein drug-seeking behavior. Those individualswho do abuse benzodiazepines often main-tain their drug supply by getting prescrip-

tions from several doctors, forging prescriptions,or buying diverted pharmaceutical products on theillicit market. Abuse is frequently associated withadolescents and young adults who take benzodi-azepines to obtain a "high." This intoxicated stateresults in reduced inhibition and impaired judgment.Concurrent use of alcohol or other depressant withbenzodiazepines can be life threatening. Abuse ofbenzodiazepines is particularly high among heroinand cocaine abusers. A large percentage of peopleentering treatment for narcotic or cocaine addictionalso report abusing benzodiazepines. Alprazolamand diazepam are the two most frequently encoun-tered benzodiazepines on the illicit market.

FLUNITRAZEPAMFlunitrazepam (Rohypnol ®) is a benzodiazepinethat is not manufactured or legally marketed in theUnited States, but is smuggled in by traffickers. In

the mid-1990s, flunitrazepam was extensively traf-ficked in Florida and Texas. Known as "rophies,""roofies," and "roach," flunitrazepam gained popu-larity among younger individuals as a "party" drug.It has also been utilized as a "date rape" drug. In

this context, flunitrazepam is placed in the alcoholicdrink of an unsuspecting victim to incapacitate themand prevent resistance from sexual assault. Thevictim is frequently unaware of what has happenedto them and often does not report the incident toauthorities. A number of actions by the manufac-turer of this drug and by government agencies haveresulted in reducing the availability and abuse offlunitrazepam in the United States.

GAMMAHYDROXYBUTYRIC ACID(GHB)

In recent years, GHB has emerged as a significantdrug of abuse throughout the United States. Abus-ers of this drug fall into three major groups: (1) userswho take GHB for its MDMA-like hallucinogenic

29

effects or as an intoxicant or euphoriant; (2) body-builders who abuse GHB for its alleged utility as ananabolic agent or as a sleep aid; and (3) individualswho use GHB as a weapon for sexual assault. Thesecategories are not mutually exclusive and an abusermay use the drug illicitly to produce several effects.GHB is frequently taken with alcohol or other drugsthat heightens its effects and is often found atbars, nightclubs, rave parties, and gyms. Teenagersand young adults who frequent these establish-ments are the primary users. Like flunitrazepam,benzodiazepine is often referred to as a "date-rape"drug, and GHB involvement in rape cases is likelyto be unreported or unsubstantiated. GHB is quicklyeliminated from the body making detection in bodyfluids unlikely; and its fast onset of depressant effectsmay render the victim with little memory of thedetails of the attack. GHB produces a wide rangeof central nervous system effects, including dose-dependent drowsiness, dizziness, nausea, amnesia,visual hallucinations, hypotension, brady-cardia,severe respiratory depression, and coma. The use ofalcohol in combination with GHB greatly enhancesits depressant effects. Overdose frequently requiresemergency room care and many GHB-related fatali-ties have been reported. Gamma butyrolactone(GBL) and 1,4-butanediol are GHB analogues thatcan be used as substitutes for GHB. When ingested,these analogues are converted to GHB and produceidentical effects. GBL is also used in the clandestineproduction of GHB as an immediate precursor. BothGBL and 1,4-butanediol have been sold at healthfood stores and on various internet sites. The abuseof GHB began to seriously escalate in the mid-1990s.For example, in 1994, there were 56 emergencydepartment episodes involving GHB reported in theDrug Abuse Warning Network ((DAWN) a statisticalrecord of times a drug is involved in a drug abuseepisode in emergency rooms in the United States).In 2001, there were 3,340 GHB episodes. DAWNdata also indicated that most users were males,less than 25 years of age, taking the drug orallyfor recreational use. GHB was placed in ScheduleI of the CSA in March 2000. Gamma butyrolactone(GBL) was made a List I Chemical in February 2000.GHB has recently been approved as a medication(XYREM ®). GHB is being used in the treatment ofcataplexy associated with some types of narcolepsy.This approved medication is in schedual III of theCSA.

37

PARALDEHYDEParaldehyde (Paral ®) is a Schedule IV depressantused most frequently in hospital settings to treatdelirium tremens associated with alcohol with-drawal. Many individuals who become addictedto paraldehyde have been initially exposed duringtreatment for alcoholism and, despite the disagree-able odor and taste, come to prefer it to alcohol.This drug is not used by injection because of tissuedamage, and taken orally, it can be irritating to thethroat and stomach. One of the signs of paraldehydeuse is a strong, characteristic smell to the breath.

CHLORAL HYDRATEThe oldest of the hypnotic (sleep inducing) depres-sants, chloral hydrate was first synthesized in 1832.Marketed as syrups or soft gelatin capsules, chloralhydrate takes effect in a relatively short time (30minutes) and will induce sleep in about an hour. Asolution of chloral hydrate and alcohol constitutedthe infamous "knockout drops" or "Mickey Finn." Attherapeutic doses, chloral hydrate has little effect onrespiration and blood pressure. However, a toxicdose produces severe respiratory depression andvery low blood pressure. Chronic use is associatedwith liver damage and a severe withdrawal syn-drome. Although some physicians consider chloralhydrate to be the drug of choice for sedation ofchildren before diagnostic, dental, or medical pro-cedures, its general use as a hypnotic has declined.Chloral hydrate (Noctec® and other) and com-pounds, preparations, or mixtures containing choralhydrate are in Schedule IV of the CSA.

GLUTETHIMIDE ANDMETHAQUALONE

Glutethimide (Doriden®) was introduced in 1954and methaqualone (Quaalude® Sopor®) in 1965as safe barbiturate substitutes. Experience demon-strated, however that their addiction liability andthe severity of withdrawal symptoms were similar tothose of barbiturates. By 1972, "luding out," takingmethaqualone with wine, was a popular collegepastime. Excessive use leads to tolerance, depen-dence, and withdrawal symptoms similar to those of

30

barbiturates. In the United States, the marketing ofmethaqualone pharmaceutical products stopped in1984, and methaqualone was transferred to Sched-ule I of the CSA. In 1991, glutethimide was trans-ferred into Schedule II in response to an upsurge inthe prevalence of diversion, abuse, and overdosedeaths. Today, there is little medical use of glutethi-mide in the United States.

MEPROBAMATEMeprobamate was introduced as an anti-anxietyagent in 1955 and is prescribed primarily to treatanxiety, tension, and associated muscle spasms.More than 50 tons are distributed annually in theUnited States under its generic name and brandnames such as Miltown® and Equanil®. Its onsetand duration of action are similar to the intermedi-ate-acting barbiturates; however, therapeutic dosesof meprobamate produce less sedation and toxic-ity than barbiturates. Excessive use can result inpsychological and physical dependence. Cari-soprodol (Soma®), a skeletal muscle relaxant, ismetabolized to meprobamate. This conversionmay account for some of the properties associated

with carisoprodol and likely contributesto its abuse.

NEWLYMARKETEDDRUGSZolpidem (Ambien®) and zaleplon (Sonata®) aretwo relatively new, benzodiazepine-like CNS depres-sants that have been approved for the short-termtreatment of insomnia. Both of these drugs sharemany of the same properties as the benzodiazepinesand are in Schedule IV of the CSA.

38

EPRES SA --"c N CATION

Schedule II

Trade Name: Awns! SodiumControlled Ingredient amobarbital. 200 mg

I

Trade Name: DoridenControlled Ingredient glutethimide, 500 mg

Trade Name: Nembutal SodiumControlled Ingredient: pentobarbital 100 mg

Trade Name: Seconal SodiumControlled Ingredient: secobarbital sodium,100 mg

Trade Name: TaloaControlled Ingredient: amobarbital sodium,100 m& secobarbital sodium, 100 mg

Schedule IV

Trade Name: Ambien ZolpidemControlled Ingredient: Zolpidem Tartrate,10 mg

Trade Name: Amble. ZopidemControlled Ingredient: Zolpidem Tartrate,5 mg

Trade Name: AdvertControlled Ingredient: lorazepam. 1.0 mg

Trade Name: AlvanControlled Ingredient: lorazepam. 0.5 mg

Trade Name: AlvanControlled Ingredient: lorazepam. 2.0 mg

Trade Name: Contra:Controlled Ingredient: prazepam, 10 mg

Trade Name: Centre:Controlled Ingredient: prazepam, 10 mg

Trade Name: Centre:Controlled Ingredient: prazepam 5 mg


39

J1 11 -SA, I .1 CAT

Trade Name: Centrax PrazepamControlled Ingredient: prazepam5 mg

Trade Name: DalmaneControlled Ingredient: flurazepam hydrochloride,15 mg

Trade Name: DalmaneControlled Ingredient: flurazepam hydrochloride,30 mg

Trade Name: EquanilControlled Ingredient: meprobamate,200 mg

Trade Name: EquanilControlled Ingredient: meprobamate,400 mg

Trade Name: HalcionControlled Ingredient: triazolam,0.25 mg

Trade Name: HalcionControlled Ingredient: triazolam,0.50 mg

32

Trade Name: KlonopinControlled Ingredient: clonazepam,0.50 mg



Trade Name: LibriumControlled Ingredient: chlordiazepoxidehydrochloride, 10 mg



40

BEST COPY AVAILhuL.

Trade Name: Miltown 400Controlled Ingredient: meprobamate,400 mg

Trade Name: Miltown 600Controlled Ingredient: meprobamate,600 mg

Trade Name: PlacidylControlled Ingredient: ethchlorvynol,200 mg

Trade Name: PlacidylControlled Ingredient: ethchlorvynol, 500 mg

Trade Name: PlacidylControlled Ingredient: ethchlovynol,750 mg

Trade Name: RestorilControlled Ingredient: temazepam.15 mg

Trade Name: RestorilControlled Ingredient: temazepam.30 mg

33

Trade Name: SeraxControlled Ingredient: oxazepam,15 mg



Trade Name: TranxeneControlled Ingredient: chlorazepate dipotassium,15 mg

Trade Name: TranxeneControlled Ingredient: chlorazepate dipotassium,3.75 mg

Trade Name: TranxeneControlled Ingredient: chlorazepate dipotassium,7.5 mg

41BEST COPY AVAILABLL

Trade Name: ValiumControlled Ingredient: diazepam,10 mg



Trade Name: XanaxControlled Ingredient: alprazolam,0.25 mg



34

Trade Name: RohyphnolControlled Ingredient: flunitrazepam -notsold or marketed in the U.S. but illicitlysmuggled into the country

Trade Name: Rohyphnol

42BEST COPY AVAILABLE

Stimulants

DRUGS OF ABUSEStimulants are sometimes referred to as uppers andreverse the effects of fatigue on both mental andphysical tasks. Two commonly used stimulants arenicotine, found in tobacco products, and caffeine,an active ingredient in coffee, tea, some soft drinks,and many non-prescription medicines. Used inmoderation, these substances tend to relieve mal-aise and increase alertness. Although the use ofthese products has been an accepted part of U.S.culture, the recognition of their adverse effects hasresulted in a proliferation of caffeine-free productsand efforts to discourage cigarette smoking.

A number of stimulants, however, are under theregulatory control of the CSA. Some of these con-trolled substances are available by prescription forlegitimate medical use in the treatment of obesity,narcolepsy, and attention deficit disorders. As drugsof abuse, stimulants are frequently taken to pro-duce a sense of exhilaration, enhance self esteem,improve mental and physical performance, increaseactivity, reduce appetite, produce prolonged wake-fulness, and to "get high." They are recognizedas among the most potent agents of reward andreinforcement that underlie the problem of depen-dence.

Stimulants are diverted from legitimate channels orclandestinely manufactured exclusively for the illicitmarket. They are taken orally, sniffed, smoked, andinjected. Smoking, snorting, or injecting stimulantsproduces a sudden sensation known as a "rush" ora "flash." Abuse is often associated with a pattern of

binge use sporadically consuming large dosesof stimulants over a short period of time. Heavyusers may inject themselves every few hours, con-tinuing until they have depleted their drug supplyor reached a point of delirium, psychosis, and physi-cal exhaustion. During this period of heavy use, allother interests become secondary to recreating theinitial euphoric rush. Tolerance can develop rapidly,and both physical and psychological dependenceoccur. Abrupt cessation, even after a brief two orthree-day binge, is commonly followed by depres-sion, anxiety, drug craving, and extreme fatigueknown as a "crash."

Therapeutic levels of stimulants can produce exhila-ration, extended wakefulness, and loss of appetite.These effects are greatly intensified when largedoses of stimulants are taken. Physical side effects,including dizziness, tremor, headache, flushed skin,chest pain with palpitations, excessive sweating,vomiting, and abdominal cramps, may occur as aresult of taking too large a dose at one time or takinglarge doses over an extended period of time. Psy-

chological effects include agitation, hostility, panic,aggression, and suicidal or homicidal tendencies.Paranoia, sometimes accompanied by both audi-tory and visual hallucinations, may also occur. Inoverdose, unless there is medical intervention, highfever, convulsions, and cardiovascular collapse mayprecede death. Because accidental death is partiallydue to the effects of stimulants on the body's cardio-vascular and temperature-regulating systems, physi-cal exertion increases the hazards of stimulant use.

35

43

COCAINE

Cocaine, the most potent stimulant of natural origin,is extracted from the leaves of the coca plant (Eryth-roxylon coca), which is indigenous to the Andean

highlands ofSouth America.Natives in thisregion chewor brew cocaleaves into a

tea for refresh-ment and torelieve fatigue,similar to thecustom of chew-ing tobacco anddrinking tea orcoffee.

Pure cocainewas first isolatedin the 1880sand used as

a local anes-thetic in eyesurgery. It was

particularly useful in surgery of the nose and throatbecause of its ability to provide anesthesia, as well asto constrict blood vessels and limit bleeding Manyof its therapeutic applications are now obsolete dueto the development of safer drugs.

Illicit cocaine is usually distributed as a white crys-talline powder or as an off-white chunky materialThe powder, usually cocaine hydrochloride, is oftendiluted with a variety of substances, the mostcommon being sugars such as lactose, ino-sitol, and mannitol, and local anesthet-ics such as lidocaine. The adulterationincreases the volume and for the drugtrafficker multiplies profits. Cocainehydrochloride is generally snorted ordissolved in water and injected. It is

rarely smoked because it is heat labile(destroyed by high temperatures).

36

"Crack," the chunk or "rock"form of cocaine, is a ready-to-use freebase. On the illicitmarket, it is sold in small, inex-pensive dosage units that aresmoked. Smoking delivers largequantities of cocaine to the lungs, pro-ducing effects comparable to intravenousinjection; these effects are felt almost immedi-ately, are very intense, and are quickly over. Onceintroduced in the mid-1980s, crack abuse spreadrapidly and made the cocaine experience avail-able to anyone with $10 and access to a dealer. In

addition to other toxicities associated with cocaineabuse, cocaine smokers suffer from acute respiratoryproblems including cough, shortness of breath, andsevere chest pains with lung trauma and bleeding.It is noteworthy that the emergence of crack wasaccompanied by a dramatic increase in drug abuseproblems and drug- related violence.

The intensity of the psychological effects of cocaine,as with most psychoactive drugs, depends on thedose and rate of entry to the brain. Cocaine reachesthe brain through the snorting method in three tofive minutes. Intravenous injection of cocaine pro-duces a rush in 15 to 30 seconds, and smoking pro-duces an almost immediate intense experience. Theeuphoric effects of cocaine are almost indistinguish-able from those of amphetamine, although they donot last as long. These intense effects canbe followed by a dysphoric crashTo avoid the fatigue and thedepression of comingdown, frequent,repeateddoses

are taken.Excessive doses

of cocaine may leadto seizures and deathfrom respiratory fail-ure, stroke, or heartfailure There is nospecific antidote forcocaine overdose

A small tool used to snort cocaine.

44

COCAINECultivation to product

7

1. Coca farmers, known as "campesinos," cultivate plants throughout the Andean region of South America.2. Depending on the method and variety of coca used, coca plants may take up to 2 years to mature fully.3. Once harvested, coca leaves are sometimes allowed to dry in the sun to keep the leaves from rotting.4. Cocaine base processors stomp the coca leaves to macerate the leaves and help extract desired alkaloids.5. The solution is transferred by bucket to a second plastic lined pit, where lime or cement is added.6. Gasoline is then added to the basic solution and mixed.7. Cocaine hydrochloride (NCI) is produced through further refining and processing the cocaine base.8. Cocaine HCI is the final product exported from South America.9. Crack is made in the U.S. from several basic household products and cocaine HO.

37

45

Cocaine is the second most commonly used illicitdrug (following mar juana) in the United States.Approximately 10 percent of the population overthe age of 12 has tried cocaine at least once in theirlifetime, about two percent has tried crack, andnearly one percent is currently using cocaine. Thereare no drugs approved for replacement-pharmaco-therapy (drugs taken on a chronic basis as a substi-tute for the abused drug, like methadone for heroinaddiction). Cocaine addiction treatment relies heav-ily on psychotherapy and drugs like antidepressantsto relieve some of the effects resulting from cocaineabuse.

AMPHETAMINESAmphetamine, dextroamphetamine, methamphet-amine, and their various salts, are collectively referredto as amphetamines. In fact, their chemical proper-ties and actions are so similar that even experiencedusers have difficulty knowing which drug they havetaken.

Amphetamine was first marketed in the 1930s asBenzedrine®, in an over-the-counter inhaler to treatnasal congestion. By 1937, amphetamine was avail-able by prescription in tablet form and was used inthe treatment of the sleeping disorder narcolepsyand the behavioral syndrome called minimal braindysfunction, which today is called attention deficithyperactivity disorder (ADHD). During World War II,amphetamine was widely used to keep the fightingmen going; both dextroamphetamine (Dexedrine())and methamphetamine (Methedrine®) becamereadily available.

As use of amphetamines spread, so did their abuse.In the 1960s, amphetamines became a cure-all forhelping truckers to complete their long routes with-out falling asleep, for weight control, for helpingathletes to perform better and train longer, andfor treating mild depression. Intravenous amphet-amines, primarily methamphetamine, were abusedby a subculture known as "speed freaks." With expe-rience, it became evident that the dangers of abuseof these drugs outweighed most of their therapeuticuses.

Increased control measures were initiated in 1965with amendments to the federal food and drug

38

laws to curb the black market in amphetamines.Many pharmaceutical amphetamine products wereremoved from the market including all injectableformulations, and doctors prescribed those thatremained less freely. Recent increases in medicaluse of these drugs can be attributed to their usein the treatment of ADHD. Amphetamine prod-ucts presently marketed include generic and brandname amphetamine (Adderall®, Dexedrine®,Dextrostat®) and brand name methamphetamine(Desoxyn®). Amphetamines are all controlled inSchedule II of the CSA.

To meet the ever-increasing black market demandfor amphetamines, clandestine laboratory produc-tion has mushroomed. Today, most amphetaminesdistributed to the black market are produced inclandestine laboratories. Methamphetamine labora-tories are, by far, the most frequently encounteredclandestine laboratories in the United States. Lawenforcement personnel routinely raid both large andsmall ("mom and pop") laboratories. The ease ofclandestine synthesis, combined with tremendousprofits, has resulted in significant availability of illicitmethamphetamine, especially on the West Coastwhere abuse of this drug has increased dramati-cally in recent years. Large amounts of metham-phetamine are also illicitly smuggled into the UnitedStates from Mexico.

Amphetamines are generally taken orally or injected.However, the addition of "ice," the slang name forcrystallized methamphetamine hydrochloride, haspromoted smoking as another mode of administra-tion. Just as "crack" is smokable cocaine, "ice" issmokable methamphetamine. Methamphetamine,in all its forms, is highly addictive and toxic. Theeffects of amphetamines, especially methamphet-amine, are similar to cocaine, but their onset isslower and their duration is longer. In contrast tococaine, which is quickly removed from the brainand is almost completely metabolized, metham-phetamine remains in the central nervous systemlonger, and a larger percentage of the drug remainsunchanged in the body, producing prolonged stim-ulant effects. Chronic abuse produces a psychosisthat resembles schizophrenia and is characterizedby paranoia, picking at the skin, preoccupation withone's own thoughts, and auditory and visual hallu-cinations. These psychotic symptoms can persist for

months and even years after use of these drugs hasceased and may be related to the neurotoxic effectsof these drugs. Violent and erratic behavior is fre-quently seen among chronic abusers of amphet-amines, especially methamphetamine.

METHCATHINONEMethcathinone, known on the streets as "Cat," is astructural analogue of methamphetamine and cathi-none. Clandestinely manufactured, methcathinoneis almost exclusively sold in the stable and highlywater soluble hydrochloride salt form. It is mostcommonly snorted, although it can be taken orallyby mixing it with a beverage or diluted in water andinjected intravenously. Methcathinone has an abusepotential equivalent to methamphetamine and pro-duces amphetamine-like activity. It was placed inSchedule I of the CSA in 1993.

ANORECTICDRUGS

A number of drugs have been developed andmarketed to replace amphetamines as appetitesuppressants. These anorectic drugs include benz-phetamine (Didrex ®), diethylproprion (Tenuate®,Tepanil ®), mazindol (Sanorex®, Mazanor ®), phen-dimetrazine (Bontril®, Pre 1u-270), and phentermine(lonamin ®, Fastin®, Adipex®). These substancesare in Schedule III or IV of the CSA and producesome amphetamine-like effects. Of these diet pills,phentermine is the most widely prescribed and mostfrequently encountered on the illicit market. TwoSchedule IV anorectics often used in combinationwith phentermine (phen-fen combo), fenfluramineand dexfenfluramine, were removed from the U.S.market due to heart valve problems.

METHYLPHENIDATE KHATMethylphenidate, a Schedule II substance, has ahigh potential for abuse and produces many ofthe same effects as cocaine or the amphetamines.The abuse of this substance has been documentedamong narcotic addicts who dissolve the tablets inwater and inject the mixture. Complications arisingfrom this practice are common due to the insolublefillers used in the tablets. When injected, thesematerials block small blood vessels, causing seriousdamage to the lungs and retina of the eye. Bingeuse, psychotic episodes, cardiovascular complica-tions, and severe psychological addiction have allbeen associated with methylphenidate abuse.Methylphenidate is used legitimately in the treat-ment of excessive daytime sleepiness associatedwith narcolepsy, as is the newly marketed ScheduleIV stimulant, modafinil (Provigil ®). However; theprimary legitimate medical use of methylphenidate(Rita lin®, Methylin®, Concerta®, Focalin ®) is totreat attention deficit hyperactivity disorder (ADHD)in children. The increased use of this substance forthe treatment of ADHD has paralleled an increasein its abuse among adolescents and young adultswho crush these tablets and snort the powder toget high. Youngsters have little difficulty obtainingmethylphenidate from classmates or friends whohave been prescribed it.

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For centuries, khat, the freshyoung leaves of the Cathaedulis shrub, have been con-sumed where the plant is culti-vated, primarily East Africa andthe Arabian Peninsula. There,chewing khat predates theuse of coffee and is used in asimilar social context. Chewedin moderation, khat alleviatesfatigue and reduces appetite.Compulsive use may result inmanic behavior with grandiosedelusions or in a paranoid typeof illness, sometimes accompa-nied by hallucinations. Khat hasbeen smuggled into the UnitedStates and other countries fromthe source countries for useby emigrants. It contains anumber of chemicals, amongwhich are two controlled sub-stances, cathinone (Schedule I)and cathine (Schedule IV). As

the leaves mature or dry, cathi-none is converted to cathine,which significantly reduces itsstimlatory properties.

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Schedule II

Trade Name: Biphetamine 12 1/2Controlled Ingredients: dl-amphet-amine, 6.25 mg ; dextroamphet-amine, 6.25 mg

Trade Name: Biphetamine 20Controlled Ingredients: dl-amphet-amine, 10 mg; dextroamphetamine,10 mg

Trade Name: DexedrineControlled Ingredients: dextroam-phetamine sulfate, 10 mg

Trade Name: DexedrineControlled Ingredients: dextroam-phetamine sulfate, 15 mg

Trade Name: Dexedrine SpansuleControlled Ingredients: dextroam-phetamine sulfate, 5 mg

Trade Name: DesoxynControlled Ingredients: metham-phetamine hydrochlorate, 5 mg

Trade Name: Desoxyn GradumetControlled Ingredients: metham-phetamine hydrochlorate, 5 mg 40

Trade Name: Desoxyn GradumetControlled Ingredients: methamphet-amine hydrochlorate, 10 mg

Trade Name: Desoxyn GradumetControlled Ingredients: methamphet-amine hydrochlorate, 15 mg

Trade Name: MethylphenidateHydrochlorideControlled Ingredients: methylpheni-date hydrochloride, 10 mg

Trade Name: MethylphenidateHydrochlorideControlled Ingredients: methylpheni-date hydrochloride, 20 mg

Trade Name: RitalinControlled Ingredients: methylpheni-date hydrochloride, 5 mg



BEST COPY AVAILABLE

S

Schedule III

Trade Name: DidrexControlled Ingredients: benzphet-amine hydrochloride, 50 mg

Trade Name: PlegineControlled Ingredients: phendimet-razine tartrate, 35 mg

Trade Name: Pre lu-2Controlled Ingredients: phendimet-razine tartrate, 105 mg

Schedule IV

Trade Name: AdipexControlled Ingredients: phenter-mine hydrochloride, 37.5 mg

r'

Trade Name: TenuateControlled Ingredients: diethylpro-prion hydrochloride, 25 mg

I

Trade Name: Tenuate DospanControlled Ingredients: diethylpro-prion hydrochloride, 75 mg

Trade Name: FastinControlled Ingredients: phenter-mine hydrochloride, 30 mg

Trade Name:, lonaminControlled Ingredients: phenter-mine hydrochloride, 15 mg

Trade Name: lonaminControlled Ingredients: phenter-mine hydrochloride, 30 mg

Trade Name: MazanorControlled Ingredients: mazindol,1.0 mg

Trade Name: SanorexControlled Ingredients: mazindol,1.0 mg

Trade Name: SanorexControlled Ingredients: mazindol,2.0 mg


ya

CAN NABI

DRUGS OF ABUSECannabis sativa L., the hemp plant, grows wildthroughout most of the tropic and temperate regionsof the world. Prior to the advent of synthetic fibers,the cannabis plant was cultivated for the tough fiberof its stem. In the United States, cannabis is legiti-mately grown only for scientific research.

Cannabis contains chemicals called cannabinoidsthat are unique to the cannabis plant. Amongthe cannabinoids synthesized by the plant arecannabinol, cannabidiol, cannabinolidic acids, can-nabigerol, cannabichromene, and several isomersof tetrahydrocannabinol. One of these, delta -9-tetrahydrocannabinol (THC), is believed to beresponsible for most of the characteristicpsychoactive effects of canna-bis Research has resultedin development andmarketing of thedronabinol

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(synthetic THC) product, Marinol®, for the controlof nausea and vomiting caused by chemotherapu-tic agents used in the treatment of cancer and tostimulate appetite in AIDS patients. Marinol® wasrescheduled in 1999 and placed in Schedule III ofthe CSA.

Cannabis products are usually smoked. Their effectsare felt within minutes, reach their peak in 10 to 30minutes, and may linger for two or three hours.The effects experienced often depend upon theexperience and expectations of the individual user,

as well as the activity of the drug itself.Low doses tend to induce a sense

of well-

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being and a dreamy state of relaxation, which maybe accompanied by a more vivid sense of sight,smell, taste, and hearing, as well as subtle altera-tions in thought formation and expression. This stateof intoxication may not be noticeable to an observer.However; driving, occupational, or household acci-dents may result from a distortion of time and spacerelationships and impaired coordination. Strongerdoses intensify reactions. The individual may expe-rience shifting sensory imagery, rapidly fluctuatingemotions, fragmentary thoughts with disturb-ing associations, an altered sense of self-identity,impaired memory and a dulling of attention despitean illusion of heightened insight. High doses mayresult in image distortion, a loss of personal identity,fantasies, and hallucinations.

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Three drugs that come from cannabismarijuana,hashish, and hashish oilare distributed on the U.S.illicit market. Having no currently accepted medicaluse in treatment in the United States, they remainunder Schedule I of the CSA. Today, cannabis is illic-itly cultivated, both indoors and out, to maximize itsTHC content, thereby producing the greatest pos-sible psychoactive effect.

MARIJUANAMarijuana is the most frequently encountered illicitdrug worldwide. The term "marijuana," as com-monly used, refers to the leaves and flowering topsof the cannabis plant that are dried to producea tobacco-like substance. Marijuana varies sig-nificantly in its potency, depending on the sourceand selection of plant materials used. The form ofmarijuana known as sinsemilla (Spanish, sin semilla:without seed), derived from the unpollinated femalecannabis plant, is preferred for its high THC content.Marijuana is usually smoked in the form of looselyrolled cigarettes called joints, or hollowed out com-mercial cigars called blunts. Joints and blunts maybe laced with a number of adulterants includingphencyclidine (PCP), substantially altering the effectsand toxicity of these products. Street names formarijuana include pot, grass, weed, Mary Jane, andreefer. Although marijuana grown in the UnitedStates was once considered inferior because of a lowconcentration of THC, advancements in plant selec-tion and cultivation have resulted in highly potentdomestic marijuana. In 1974, the average THC con-tent of illicit marijuana was less than one percent; in1999, potency averaged 7.03 percent. The THCcontent in today's sinsemilla averages 13.65 percentand ranges as high as 30 percent.

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Marijuana contains known toxins and cancer-caus-ing chemicals. Marijuana users experience the samehealth problems as tobacco smokers, such as bron-chitis, emphysema, and bronchial asthma. Some ofthe effects of marijuana use also include increasedheart rate, dryness of the mouth, reddening ofthe eyes, impaired motor skills and concentration,and frequently hunger and an increased desire forsweets. Extended use increases risk to the lungs andreproductive system, as well as suppression of theimmune system. Occasionally, hallucinations, fanta-sies, and paranoia are reported. Long-term chronicmarijuana use is associated with an AmotivationalSyndrome characterized by apathy, impairment ofjudgement memory and concentration, and loss ofinterest in personal appearance and the pursuit ofunconventional goals.

Rolling papers

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Below: Growing marijuanaindoors has become a popularmeans of cultivation. Itreduces the likelihood ofdetection more readilyand provides higher, moretechnologically advancedagricultural methods.

"- t.

HASHISH

Hashish consists of the THC-rich resinous material ofthe cannabis plant, which is collected, dried, andthen compressed into a variety of forms, such asballs, cakes, or cookie-like sheets. Pieces are thenbroken off, placed in pipes, and smoked. TheMiddle East, North Africa, and Pakistan/Afghanistanare the main sources of hashish. The THC contentof hashish that reached the United States, wheredemand is limited, averaged about 5 percent in the1990s.

HASHISH OILThe term hash oil is used by illicit drug users anddealers, but is a misnomer in suggesting any resem-blance to hashish. Hash oil is produced by extractingthe cannabinoids from plant material with a solvent.The color and odor of the resulting extract will vary,

depending on the type of solvent used.Current samples of hash oil, a

viscous liquid ranging fromamber to dark brown in color,average about 15 percentTHC. In terms of its psycho-active effect, a drop or twoof this liquid on a cigaretteis equal to a single "joint"of marijuana.

!A,

Schedule III

Trade Name: Marino!Controlled Ingredients:dronabinol,2.5 mg

Trade Name: Marino!Controlled Ingredients:dronabinol,5 mg

Trade Name: Marino!Controlled Ingredients:dronabinol,10 mg

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14,

*) Ax

iyy

LSD blotter paper

Hallucinogens

DRUGS OF ABUSE44'

46

W.* * Ark

PHallucinogens are among the oldest 0known group of drugs used for their ability toknown

alter human perception and mood.A For centuries, many of the naturally

occurring hallucinogens found inplants and fungi have been used for a

variety of shamanistic practices. In morerecent years, a number of synthetic hal-

lucinogens have been produced, some ofwhich are much more potent than their naturallyoccurring counterparts.

The biochemical, pharmacological, and physi-ological basis for hallucinogenic activity is notwell understood. Even the name for this class:of drugs is not ideal, since hallucinogens do:not always produce hallucinations.

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However, taken in non-toxic dosages, these sub-stances produce changes in perception, thought,and mood. Physiological effects include elevatedheart rate, increased blood pressure, and dilatedpupils. Sensory effects include perceptual distor-tions that vary with dose, setting, and mood. Psy-chic effects include disorders of thought associatedwith time and space. Time may appear to standstill and forms and colors seem to change and takeon new significance. This experience may be eitherpleasurable or extremely frightening. It needs to bestressed that the effects of hallucinogens are unpre-dictable each time they are used.

Weeks or even months after some hallucinogenshave been taken, the user may experience flash-backsfragmentary recurrences of certain aspectsof the drug experience in the absence of actuallytaking the drug. The occurrence of a flashback isunpredictable, but is more likely to occur duringtimes of stress and seem to occur more frequentlyin younger individuals. With time, these episodesdiminish and become less intense.

The abuse of hallucinogens in the United Statesreceived much public attention in the 1960s and1970s. A subsequent decline in their use in the1980s may be attributed to real or perceived haz-ards associated with taking these drugs. However,a resurgence of the use of hallucinogens in the1990s is cause for concern. According to the 2001National Household Survey, the incidence of hallu-cinogen use has exhibited two notable periods ofincrease. Between 1965 and 1971, the number ofinitiates rose tenfold, from 90,000 to 900,000. Thesecond period of increase began in 1990 whenthere were approximately 600,000 new users. By2000, the number of initiates rose nearly threefold,to 1.5 million. Hallucinogenic mushrooms, LSD,and MDMA are popular among junior and seniorhigh school students who use hallucinogens.

There is a considerable body of literature that linksthe use of some of the hallucinogenic substancesto neuronal damage in animals, and recent datasupport that some hallucinogens are neurotoxic tohumans. However, the most common danger ofhallucinogen use is impaired judgment that oftenleads to rash decisions and accidents.

LSDLysergic acid diethylamide (LSD) is the most potenthallucinogen known to science, as well as the mosthighly studied. LSD was originally synthesized in1938 by Dr. Albert Hoffman. However, its halluci-nogenic effects were unknown until 1943 whenHoffman accidentally consumed some LSD. It waslater found that an oral dose of as little as 0.000025grams (or 25 micrograms, equal in weight to a fewgrains of salt) is capable of producing rich and vividhallucinations. LSD was popularized in the 1960sby individuals like Timothy Leary who encouragedAmerican students to "turn on, tune in, and dropout." LSD use has varied over the years but it stillremains a significant drug of abuse.

Because of its structural similarity to a chemical pres-ent in the brain and its similarity in effects tocertain aspects of psychosis, LSD wasused as a research tool to studymental illness. The average effec-tive oral dose is from 20 to 80micrograms with the effects ofhigher doses lasting for 10 to12 hours. LSD is usually soldin the form of impregnatedpaper (blotter acid), typi-cally imprinted with color-ful graphic designs. It hasalso been encounteredin tablets (microdots),thin squares of gelatin(window panes), insugar cubes and, rarely,in liquid form.

Physical reactions mayinclude dilated pupils, low-ered body temperature, nausea,"goose bumps," profuse perspiration,increased blood sugar, and rapid heart

LSD in hardpack containers

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LSD

rate. During the first hour after ingestion, theuser may experience visual changes with extremechanges in mood. In the hallucinatory state, theuser may suffer impaired depth and time percep-tion, accompanied by distorted perception of thesize and shape of objects, movements, color, sound,touch, and the users own body image. During thisperiod, the users' ability to perceive objects throughthe senses is distorted: they may describe "hearingcolors" and "seeing sounds." The ability to makesensible judgments and see common dangers isimpaired, making the user susceptible to personalinjury. After an LSD "trip," the user may suffer acuteanxiety or depression for a variable period of time.Flashbacks have been reported days or even monthsafter taking the last dose.

Psilocybin & Psilocynand OtherTryptaminesA number of Schedule I hallucinogenic substances

are classified chemically as tryptamines. Most ofthese are found in nature but many, if not all, canbe produced synthetically. Psilocybin (0- phospho-ryl-4- hydroxy -N, N-ethyltryptamine) and psilocyn(4-hydroxy-N, N-dimethyltryptamine) are obtainedfrom certain mushrooms indigenous to tropical andsubtropical regions of South America, Mexico, andthe United States. As pure chemicals at doses of

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10 to 20 mg, these hallucinogens produce musclerelaxation, dilation of pupils, vivid visual and auditorydistortions, and emotional disturbances. However,the effects produced by consuming preparations ofdried or brewed mushrooms are far less predictableand largely depend on the particular mushroomsused and the age and preservation of the extract.There are many species of "magic" mushrooms thatcontain varying amounts of these tryptamines, aswell as uncertain amounts of other chemicals. Asa consequence, the hallucinogenic activity, as wellas the extent of toxicity produced by various plantsamples, are often unknown.

Dimethyltryptamin (DMT) has a long history of useand is found in a variety of plants and seeds. It canalso be produced synthetically. It is ineffective whentaken orally, unless combined with another drugthat inhibits its metabolism. Generally it is sniffed,smoked, or injected. The effective hallucinogenicdose in humans is about 50 to 100 mg and lastsfor about 45 to 60 minutes. Because the effectslast only about an hour; the experience has beenreferred to as a "businessmans trip."

A number of other hallucinogens have very similarstructures and properties to those of DMT. Dieth-yltryptamine (DET), for example, is an analogueof DMT and produces the same pharmacologicaleffects but is somewhat less potent than DMT.Alpha-ethyltryptamine (AET) is another tryptaminehallucinogen added to the list of Schedule I hal-lucinogens in 1994. Bufotenine (5-hydroxy-N-N-dimethyltryptamine) is a Schedule I substance foundin certain mushrooms, seeds, and skin glands ofBufo toads. In general, most bufotenine prepa-rations from natural sources are extremely toxic.N,N-Diisopropy1-5-methoxytryptamine (referred toas Foxy-Methoxy and alpha methyl treptamine) areorally active tryptamines recently encountered in theUnited States.

Peyote & MescalinePeyote is a small, spineless cactus, Lophophora wil-liamsii, whose principal active ingredient is the hal-lucinogen mescaline (3, 4, 5-trimethoxyphenethyl-amine). From earliest recorded time, peyote has

been used by natives in northern Mexicoand the southwestern United States asa part of their religious rites.

The top of the cactus growingabove groundalso referred toas the crownconsists of disc-shaped buttons that are cutfrom the roots and dried.

These buttons are gener-ally chewed or soaked

in water to produce anintoxicating liquid. The hal-

lucinogenic dose of mescaline is

about 0.3 to 0.5 grams and lasts about 12hours. While peyote produced rich visual hal-lucinations that were important to the nativepeyote cults, the full spectrum of effectsserved as a chemically induced model ofmental illness. Mescaline can be extractedfrom peyote or produced synthetically. Bothpeyote and mescaline are listed in the CSAas Schedule I hallucinogens. Many chemicalvariations of mescaline and amphetamine havebeen synthesized for their "feel good" effects.4-Methyl-2,5-dimethoxyamphetamine (DOM) wasintroduced into the San Francisco drug scene inthe late 1 960s and was nicknamed STP; an acro-nym for "Serenity Tranquility, and Peace." Otherillicitly produced analogues include 4-bromo-2,5-dimethoxyamphetamine (DOB) and 4-bromo-2.5-dimethoxyPhenethylamine (2C-B or Nexus). In

2000, para methoxyamphetamine (PMA,) and paramethoxymethamphetamine (PMMA) were identifiedin tablets sold as Ecstasy. PMA, which first appearedon the illicit market briefly in the early 1970s, is asso-ciated with a number of deaths in both the UnitedStates and Europe. In 2001, significant seizures of2c-t-7 (dimethoxy-4-(n)-propylthiophenethylamide)and BZP (benzerpiperazine/and TFMPP Trifluoro-methylphenolpiperazine) were made. BZP andTFMPP were sold in combination and promoted asMDMA-like or even as MDMA. Tablets are often verysimilar to MDMA tablets.

MDMA (Ecstasy)& OtherPhenethylamines3.4-Methylenedioxymethamphetamine (MDMA,Ecstasy) was first synthesized in 1912 but remainedin relative obscurity for many years. In the 1980s,MDMA gained popularity as a drug of abuse result-ing in its final placement in Schedule 1 of the CSA.Today MDMA is extremely popular among "rave"participants, and in 2000, it was estimated that twomillion tablets were smuggled into the United States

every week.

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Assorted samples of MDMA

MDMA users at a'Rare" (usually heldin a warehouse) oftenbecome dehydrated andgrind their teeth.Sucking on a pacifiercan reduce sonicof thesesymptoms.

MDMA produces both amphetamine-like stimu-lation and mild mescaline-like hallucinations It is

touted as a "feel good" drug with an undeservedreputation of safety MDMA produces euphoria,increased energy, increased sensual arousal, andenhanced tactile sensations. However, it also pro-duces nerve cell damage that can result in psychi-atric disturbances and long-term cognitive impair-ments. The user will often experience increasedmuscle tension, tremors, blurred vision, and hyper-thermia. The increased body temperature can resultin organ failure and death.

MDMA is usually (distributed in tablet form andtaken orally at doses ranging from 2 to 1 0 mg perkilogram, depending on the users body weight.

Individual tabletsare often imprinted

with graphic designsor commercial logos,

and typically contain100 mg of MDMA After

oral administration, effects arefelt within 30 to 45 minutes, peak at 60 to 90

minutes, and last for 4 to 6 hours. Analysis of seizedMDMA tablets indicates that about 80 percent of allsamples actually contain MDMA. About 10 percentof the MDMA-positive samples also contain MDA(3.4-meth- ylenedioxyamphetamine), and MDEA(3.4-methyl-enedioxyethyl amphetamine), whileanother 10 percent contain amphetamine, meth-amphetamine, or both. Fraudulent MDMA tabletsfrequently contain combinations of ephedrine, dex-tromethorphan, and caffeine.

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Hundreds of compounds can be produced bymaking slight modifications to the phenethylaminemolecule. Some of these analogues are phar-maccologically active and differ from one anotherin potency, speed of onset, duration of action, andcapacity to modify mood with or without produc-ing overt hallucinations. The drugs are usuallytaken orally, sometimes snorted, and rarely injected.Because they are produced in clandestine labora-tories, they are seldom pure and the amount in acapsule or tablet is likely to vary considerably.

According to the 2001 National Household Survey,initiation of Ecstasy use has been rising steadily since1992. The increase from 1.3 million new users in1999 to 1.9 million in 2000 was statistically signifi-cant, as were the age- specific increases among 12to 17 year olds and 18 to 25 year olds.

Phencyclidine (PCP)& Related DrugsIn the 1950s, phencyclidine was investigated as ananesthetic but, due to the side effects of confusionand delirium, its development for human use wasdiscontinued. It became commercially available foruse as a veterinary anesthetic in the 1960s under thetrade name of Sernylan, and was placed in ScheduleIII of the CSA. In 1978, due to considerable abuse,phencyclidine was transferred to Schedule II ofthe CSA and manufacturing of Sernylan, was dis-continued. Today, virtually all of the phencyclidineencountered on the illicit market in the United Statesis produced in clandestine laboratories.

Phencyclidine, more commonly known as PCP isillicitly marketed under a number of other names,including Angel Dust, Supergrass, Killer Weed,Embalming Fluid, and Rocket Fuel, reflecting therange of its bizarre and volatile effects. In its pureform, it is a white crystalline powder that readilydissolves in water. However, most PCP on theillicit market contains a number of contaminantsas a result of makeshift manufacturing, causingthe color to range from tan to brown, and theconsistency from powder to a gummy mass.Although sold in tablets and capsules as wellas in powder and liquid form, it is commonly

applied to a leafy material, such as parsley, mint,oregano, or marijuana, and smoked.

The drug's effects are as varied as its appearance.A moderate amount of PCP often causes the userto feel detached, distant, and estranged from hissurroundings. Numbness, slurred speech, and lossof coordination may be accompanied by a sense ofstrength and invulnerability. A blank stare, rapid andinvoluntary eye movements, and an exaggeratedgait are among the more observable effects. Audi-tory hallucinations, image distortion, severe mooddisorders, and amnesia may also occur. In someusers, PCP may cause acute anxiety and a feeling ofimpending doom; in others, paranoia and violenthostility; and in some, it may produce a psychosisindistinguishable from schizophrenia. PCP use isassociated with a number of risks, and many believeit to be one of the most dangerous drugs of abuse.

Modification of the manufacturing process mayyield chemically related analogues capable ofproducing psychic effects similar to PCP Four ofthese substances (N-ethyl-l-phenylcyclohexylamineor PCE, l- (phenylcyclohexyl)- pyrrolidine or PCPy,II-I-( 2-thieny1)-cyclohexyll-piperdine or TCP and HI-(2-thienyl)cyclohexyll-pyrrolidine or TCPy have beenencountered on the illicit market and have beenplaced in Schedule I of the CSA. Telazol®, a Sched-ule III veterinary anesthetic containing tiletamine (aPCP analogue), in combination with zolazepam, (abenzodiazepine), is sporadically encountered as adrug of abuse.

101111

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KetamineKetamine is a rapidly actinggeneral anesthetic. Its pharma-cological profile is essentiallythe same as phencyclidine. LikePCP ketamine is referred to as adissociative anesthetic becausepatients feel detached or dis-connected from their pain andenvironment when anesthetizedwith this drug. Unlike most anes-thetics, ketamine produces onlymild respiratory depression andappears to stimulate, not depress,the cardiovascular system.

In addition, ketamine has both analgesic and amne-sic properties and is associated with less confusion,irrationality, and violent behavior than PCP. Useof ketamine as a general anesthetic for humanshas been limited due to adverse effects includingdelirium and hallucinations. Today, it is primarilyused in veterinary medicine, but has some utility foremergency surgery in humans.

Although ketamine has been marketed in the UnitedStates for many years, it was only recently associatedwith significant diversion and abuse and placed inSchedule III of the CSA in 1999. Known in the drugculture as "Special K" or "Super K," ketamine hasbecome a staple at dance parties or "raves." Ket-

amine is supplied to the illicit market by the diversionof legitimate pharmaceuticals (Ketaset®, Ketalar ®).It is usually distributed as a powder obtained byremoving the liquid from the pharmaceutical prod-ucts. As a drug of abuse, ketamine can be adminis-tered orally, snorted, or injected. It is also sprinkledon mar juana or tobacco and smoked. After oralor intranasal administration, effects are evident inabout 10 to 15 minutes and are over in about anhour. After intravenous use, effects begin almostimmediately and reach peak effects within minutes.Ketamine can act as a depressant or a psychedelic.Low doses produce vertigo, ataxia, slurred speech,slow reaction time, and euphoria. Intermediate

doses produce disorganized thinking, altered bodyimage, and a feeling of unreality with vivid visualhallucinations. High doses produce analgesia,amnesia, and coma.

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Steroids

DRUGS OF ABUSEAs athletes gathered at the 2002 Olympic

Games in Salt Lake City, Utah, the issue of per-formance enhancing drugs, especially anabolic

steroids, once again gained international atten-tion. These drugs are used by high school, college,professional, and elite amateur athletes in a varietyof sports (e.g., weight lifting, track and field, swim-ming, cycling, and others) to obtain a competitiveadvantage. Body builders andfitness buffs take anabolic ste-roids to improve their physicalappearance, and individu-als in occupations requiringenhanced physical strength(e.g., body guards, night clubbouncers, construction work-ers) are also known to use thesedrugs.

Concerns over a growing illicitmarket, abuse by teenagers,and the uncertainty of possibleharmful long-term effects of ste-roid use, led Congress in 1991to place anabolic steroids as aclass of drugs into Schedule IIIof the Controlled Substances Act(CSA). The CSA defines anabolicsteroids as any drug or hor-monal substance chemically andpharmacologically related to tes-tosterone (other than estrogens,progestins, and corticosteroids)that promotes muscle growth.

I is

Once viewed as a problem associated only withprofessional and elite amateur athletes, variousreports indicate that anabolic steroid abuse hasincreased significantly among adolescents. Forexample, the National Institute on Drug Abuse 2001Monitoring the Future survey reveals that steroidsare used predominately by males. For example,in 2001, the annual prevalance rates were two to

four times as high among males asamong females. The use of steroidsincreased significantly among 12thgraders in 2001, perhaps reflectinga cohort effect, since steroid use hadrisen sharpley among the youngerstudents in the prior two years.

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Most illicit anabolic steroids are soldat gyms, competitions, and throughmail operations. For the most part,these substances are smuggled intothe United States from many coun-tries. The illicit market includes vari-ous preparations intended for humanand veterinary use as well as bogusand counterfeit products. The mostcommonly encountered anabolic ste-roids on the illicit market include tes-tosterone, nandrolone, methenolone,stanozolol, and methandrostenolone.Other steroids seen in the illicit marketinclude boldenone, fluxoymesterone,methandriol, methyl testosterone,oxandrolone, oxymetholone, andtrenbolone.

A limited number of anabolic steroids have beenapproved for medical and veterinary use. The pri-mary legitimate use of these drugs in humans is forthe replacement of inadequate levels of testosteroneresulting from a reduction or absence of functioningtestes. Other indications include anemia and breastcancer. Experimentally, anabolic steroids have beenused to treat a number of disorders including AIDSwasting, erectile dysfunction, and osteoporosis. Inveterinary practice, anabolic steroids are used to pro-mote feed efficiency and to improve weight gain,vigor, and hair coat. They are also used in veterinarypractice to treat anemia and counteract tissue break-down during illness and trauma.

When used in combination with exercise train-ing and high protein diets, anabolic steroids canpromote increased size and strength of muscles,improve endurance, and decrease recovery timebetween workouts. They are taken orally or by intra-muscular injection. Users concerned about drugtolerance often take steroids on a schedule calleda cycle. A cycle is a period of between 6 and 14weeks of steroid use, followed by a period of absti-nence or reduction in use. Additionally, users tend to"stack" the drugs, using multiple drugs concurrently.Although the benefits of these practices are unsub-stantiated, most users feel that cycling and stackingenhance the efficiency of the drugs and limit theirside effects.

Another mode of steroid use is called "pyramiding."With this method users slowly escalate steroid use(increasing the number of drugs used at one timeand/or the dose and frequency of one or more ste-roids), reach a peak amount at mid-cycle and gradu-ally taper the dose toward the end of the cycle. Theescalation of steroid use can vary with different typesof training. Body builders and weight lifters tend toescalate their dose to a much higher level than dolong distance runners or swimmers.

The long-term adverse health effects of anabolicsteroid use are not definitely known. There is, how-ever, increasing concern of possible serious healthproblems associated with the abuse of these agents,including cardiovascular damage, cerebrovasculartoxicity, and liver damage.

Physical side effects include elevated blood pressureand cholesterol levels, severe acne, premature bald-ing, reduced sexual function, and testicular atrophy.In males, abnormal breast development (gyneco-mastia) can occur. In females, anabolic steroids havea masculinizing effect, resulting in more body hair, adeeper voice, smaller breasts, and fewer menstrualcycles. Several of these effects are irreversible. Inadolescents, abuse of these agents may prematurelystop the lengthening of bones, resulting in stuntedgrowth. With some individuals the use of anabolicsteroids may be associated with psychotic reac-tions, manic episodes, feelings of anger or hostility,aggression, and violent behavior.

A variety of non-steroid drugs are commonly foundwithin the illicit anabolic steroid market. These sub-stances are primarily used for one or more of thefollowing reasons: 1) to serve as an alternative toanabolic steroids; 2) to alleviate short-term adverseeffects associated with anabolic steroid use; or 3) tomask anabolic steroid use. Examples of drugs serv-ing as alternatives to anabolic steroids include clenb-uterol, human growth hormone, insulin, insulin-likegrowth factor, and GHB. Drugs used to prevent ortreat adverse effects of anabolic steroid use includetamoxifen, diuretics, and human chorionic gonado-tropin. Diuretics, probenocid, and epitestosteronemay be used to mask anabolic steroid use.

Over the last few years, a number of precursors toeither testosterone or nandrolone have been mar-keted as dietary supplements in the United States.Some of these substances include androstenedi-one, androstenediol, norandrostenedione, noran-drostenediol, and dehydroepiandrosterone (DHEA).

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STEROIDS IDENTIF CATION

Schedule III

Trade Name: AnadrolControlled Ingredients: oxymetholone,50 mg

Trade Name: Android-25Controlled Ingredients: methyltestoster-one, 25 mg

Trade Name: Depo- TestosteroneControlled Ingredients: testosteronecypionate, 200 mg/ml

Trade Name: TestosteroneControlled Ingredients: testosteronecypionate, 200 mg/ml

Trade Name: WinstrolControlled Ingredients: stanozolol,2mg/m1

Inhalants

DRUGS OF ABUSE

Inhalants are a diverse group of substances thatinclude volatile solvents, gases, and nitrites thatare sniffed, snorted, huffed, or bagged to produceintoxicating effects similar to alcohol. These sub-stances are found in common household productslike glues, lighter fluid, cleaning fluids, and paintproducts. Inhalant abuse is the deliberate inhalingor sniffing of these substances to get high,and it is estimated that about 1,000 sub-stances are misused in this manner. Theeasy accessibility, low cost, legal status,and ease of transport and concealmentmake inhalants one of the first substancesabused by children. About 15 to 20 percentof junior and senior high school students havetried inhalants with about 2 to 6 percent report-ing current use. According to the 2001 National

Household survey, between 1994 and 2000, thenumber of new inhalant users increased more than50 percent, from 618,000 new users in 1994 to979,000 in 2000. These estimates were higher thana previous peak in 1978 (662,000 new users).

The highest incidence of use is among 10to 12 year old children with rates of usedeclining with age. Parents worry about

alcohol, tobacco, and drug use butmay be unaware of the hazardsassociated with products foundthroughout their homes. Know-

ing what these products are, howthey might be harmful, and recog-

nizing the signs and symptoms oftheir use as inhalants, can help a parent

prevent inhalant abuse.

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For example, volatile solvents are found in a numberof everyday products. Some of these productsinclude nail polish remover, lighter fluid, gasoline,paint and paint thinner, rubber glue, waxes, andvarnishes. Chemicals found in these productsinclude toluene, benzene, methanol, methylenechloride, acetone, methyl ethyl ketone, methyl butylketone, trichhloroethylene, and trichlorethane. Thegas used as a propellant in canned whipped creamand in small lavender metallic containers called"whippets" (used to make whipped cream) is nitrousoxide or "laughing gas"the same gas used bydentists for anesthesia. Tiny cloth-covered ampulescalled poppers or snappers by abusers contain amylnitrite, a medication used to dilate blood vessels.

Butyl nitrite, sold as tape head cleanerand referred to as "rush," "locker

room," or "climax," is

often sniffed orhuffed to

get high.

Inhalantsmay be sniffeddirectly from an

open containeror huffed from

a rag soaked inthe substance

and held to theface. Alternatively,the open container

or soaked rag canbe placed in a bag

where the vaporscan concentratebefore being inhaled.

Some chemicals arepainted on the handsor fingernails or placed

on shirt sleeves or wristbands to enable an

abuser to continually inhalethe fumes without being detected by a teacher orother adult. Although inhalant abusers may preferone particular substance because of taste or odor, avariety of substances may be used because of simi-lar effects, availability, and cost. Once inhaled, theextensive capillary surface of the lungs allows rapidabsorption of the substance and blood levels peak

rapidly. Entry into the brain is fast and the intoxicat-ing effects are short lived but intense.

Inhalants depress the central nervous system, pro-ducing decreased respiration and blood pressure.Users report distortion in perceptions of time andspace. Many users experience headaches, nausea,slurred speech, and loss of motor coordination.Mental effects may include fear, anxiety, or depres-sion. A rash around the nose and mouth may beseen, and the abuser may start wheezing. An odorof paint or organic solvents on clothes, skin, andbreath is sometimes a sign of inhalant abuse. Otherindicators of inhalant abuse include slurred speechor staggering gait, red, glassy, watery eyes, andexcitability or unpredictable behavior.

The chronic use of inhalants has been associatedwith a number of serious health problems. Glueand paint thinner sniffing produce kidney abnormal-ities while the solvents toluene and trichloroethylenecause liver damage. Memory impairment, atten-tion deficits, and diminished non-verbal intelligencehave been related to the abuse of inhalants. Deathsresulting from heart failure, asphyxiation, or aspira-tion have occurred.

For more information regarding inhalants, contactthe National Inhalant Prevention Coalition bytelephone (1-800-269-4237) or by the Internet(www.inhalants org)

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DR GS ABU E

DOMESTIC DEA OFFICESAtlanta Division Dallas Division Los Angeles Division New York Division St. Louis Division(404) 331-4401 (214) 640-0801 (213) 894-2650 (212) 337-3900 (314) 538-4600Offices Offices Officea Offices OfficeaAugusta, GA McAlester, OK Riverside, CA Albany, NY Cedar Rapids, IAColumbus, GA Oklahoma City, OK Santa Ana, CA Buffalo, NY Des Moines, IAMacon, GA Tulsa, OK Ventura, CA Long Island, NY Sioux City, IARome, GA Amarillo, TX Guam Plattsburgh, NY Carbondale, ILSavannah, GA Ft. Worth, TX Hilo, HI Rochester, NY Fairview Fits., ILCharlotte, NC Lubbock, TX Honolulu, HI Syracuse, NY Quad Cities, ILGreensboro, NC Tyler, TX Maui, HI Westchester, NY Garden City, KSRaleigh, NC Lake Tahoe, NV Kansas City, KSWilmington, NC Denver Division Las Vegas, NV Philadelphia Division Topeka, KSBeaufort, SC (303) 705-7300 Reno, NV (215) 597-9530 Wichita, KSCharleston, SC Offices Offices Cape Giradeau, MOColumbia, SC Colorado Springs, CO Miami Division Dover, DE Springfield, MOFlorence, SC Glenwood Springs, CO (305) 590-4870 Wilmington, DE North Platte, NEGreenville, SC Grand Junction, CO Offices Allentown, PA Omaha, NEChattanooga, TN Steam Boat Springs, CO Freeport, Bahamas Harrisburg, PA Rapid City, SDJackson, TN Billings, MT Nassau, Bahamas Pittsburgh, PA Sioux Falls, SDJohnson City, TN Salt Lake City, UT Ft. Lauderdale, FL Scranton, PAKnoxville, TN St. George, UT Ft. Myers, FL Washington, DC DivisionMemphis, TN Casper, WY Ft. Pierce, FL Phoenix Division (202) 305-8500Nashville, TN Cheyenne, WY Gainesville, FL (602) 664-5600 Offices

Jacksonville, FL Offices Baltimore, MDBoston Division Detroit Division Key Largo, FL Lake Havasu City, AZ Hagerstown, MD(617) 557-2100 (313) 234-4000 Key West, FL Nogales, AZ Salisbury, MDOffices Offices Naples, FL Sierra Vista, AZ Bristol, VABridgeport, CT Lexington, KY Orlando, FL Tucson, AZ Hampton, VAHartford, CT London, KY Panama City, FL Yuma, AZ Norfolk, VANew Haven, CT Louisville, KY Pensacola, FL Richmond, VANew Bedford, MA Madisonville, KY Tallahassee, FL San Diego Division Roanoke, VASpringfield, MA Kalamazoo, MI Tampa, FL (619) 616-4100 Winchester, VABangor, ME Lansing, MI Titusville, FL Offices Charleston, WVPortland, ME Grand Rapids, MI W. Palm Beach, FL Carlsbad, CA Clarksburg, WVManchester, NH Saginaw, MI Imperial County, CA Wheeling, WVPortsmouth, NH Cincinnati, OH Newark Division San Ysidro, CAProvidence, RI Cleveland, OH (973) 273-5000Burlington, VT Columbus, OH Officea San Francisco Division

Dayton, OH Atlantic City, NJ (415) 436-7900Caribbean Division Toledo, OH Camden, NJ Offices(787)775 -I815 Youngstown, OH Paterson, NJ Bakersfield, CAOffices Fresno, CABridgetown, Barbados El Paso Division New Orleans Division Modesto, CASanto Domingo, D.R. (915) 832-6000 (504) 840-1100 Oakland, CAPort-au-Prince, Haiti Offices Offices Sacramento, CAKingston, Jamaica Albuquerque, NM Birmingham, AL San Jose, CACuracao, Nether. Antilles Las Cruces, NM Huntsville, AL Santa Rosa, CAPonce, Puerto Rico Alpine, TX Mobile, ALPort of Spain,Trinidad & Tobago

Midland, TX Montgomery, ALFayetteville, AR

Seattle Division(206) 553-5443

St. Thomas, VI Houston Division Ft. Smith, AR OfficesSt. Croix, VI (713) 693-3000 Little Rock, AR Anchorage, AK

Offices Baton Rouge, LA Fairbanks, AKAustin, TX Lafayette, LA Boise, ID

Chicago Division Beaumont, TX Monroe, LA Bend, OR(312) 353-7875 Brownsville, TX Shreveport, LA Eugene, OROffices Corpus Christi, TX Gulfport, MS Medford, ORRockford, IL Del Rio, TX Jackson, MS Portland, ORSpringfield, IL Eagle Pass, TX Oxford, MS Salem, OREvansville, IN Galveston, TX Blaine, WAFt. Wayne, IN Laredo, TX Spokane, WAIndianapolis, IN McAllen, TX Tacoma, WAMerrillville, IN San Antonio, TX Tri-Cities, WAMinneapolis/St. Paul, MN Waco, TX Yakima, WABismarck, NDFargo, NDGreen Bay, WIMadison, WIMilwaukee, WI

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D2UGS OF ABUSENational GuardCounterdrug CoordinatorsAlabamaCounterdrug Coordinator1750 Congressman Dickinson,PO Box 3711Montgomery, AL 36109(334) 213-7658AlaskaCounterdrug CoordinatorPO Box 5800, Bldg 60802, Camp CarrollFt. Richardson, AK 99505(907)428-3617ArizonaCounterdrug Coordinator5636 E. McDowell RoadPhoenix, AZ 85008(602) 267-2623ArkansasCounterdrug CoordinatorDOMS-CD,Bldg 16412, Camp JT RobinsonN. Little Rock, AR 72199(501) 791-5492CaliforniaCounterdrug Coordinator10293 Rockingham DriveSacramento, CA 95827(916) 854-3715ColoradoCounterdrug Coordinator55 S. Potomac StreetAurora, CO 80012(303) 677-8303ConnecticutCounterdrug Coordinator360 Broad StreetHartford, CT 06105(860) 493-2723DelawareCounterdrug CoordinatorFirst Regiment RoadWilmington, DE 19808(302) 326-7085District of ColumbiaCounterdrug Coordinator2001 E. Capital StreetWashington, DC 20003(202) 685-9726FloridaCounterdrug CoordinatorPOMSO-CD, 2305 State Rd #207St. Augustine, FL 32086(904) 823-0438GeorgiaCounterdrug CoordinatorJOPS-CD, 1651 Perry Street, Bldg 826Dobbins ARB, GA 30069(678) 655-3473GuamCounterdrug Coordinator622 E. Harmon Ind Park RoadFort Juan MunaTamuning, GU 96911(671) 472-7588HawaiiCounterdrug Coordinator3949 Diamond Head RoadHonolulu, HI 96816(808) 732-0209

IdahoCounterdrug Coordinator4736 Kennedy Street, Bldg T-927Boise, ID 83705(208)422-3530

IllinoisCounterdrug Coordinator1301 N. MacArthur Blvd,Camp LincolnSpringfield, IL 62702(217) 761-3728IndianaCounterdrug Coordinator3766 W. Morris StreetIndianapolis, IN 46241(317) 486-8291IowaCountcrdrug Coordinator7700 NW Beaver DriveJohnston, IA 50131(515) 252-4606KansasCounterdrug CoordinatorPO Box 19012, Bldg 684,Forbes FieldPauline, KS 66619(785) 862-0001KentuckyCounterdrug CoordinatorJoint Spt Opns, 5751 Briar Hill RdBldg28Lexington, KY 40512(859) 293-4142LouisianaCounterdrug CoordinatorLANG-POTO-CD, Bldg 35,Jackson BarracksNew Orleans, LA 70146(504) 278-8556MaineCounterdrug CoordinatorHQ, MEARNG, Camp KeyesAugusta, ME 04333(207) 626-4416MarylandCounterdrug Coordinator29th Div St, 5th Regt ArmoryBaltimore, MD 21201(410) 576-6135MassachusettsCounterdrug Coordinator50 Maple StreetMilford, MA 01757(508) 233-6804MichiganCounterdrug Coordinator2500 S. Washington AvenueLansing, MI 48913(517) 483-5896MinnesotaCounterdrug CoordinatorMNAG-MSO-CDC, 20 W. 12th StSt. Paul, MN 55155(651) 282-4147MississippiCounterdrug CoordinatorNGMS-OTO-DS, 550 Keyway Dr.Flowood, MS 39233(601) 313-1670MissouriCounterdrug CoordinatorMONG CD Program, 2302 Militia DriveJefferson City, MO 65101(573) 638-9599MontanaCounterdrug Coordinator1900 Williams St, PO Box 4789Helena, MT 59604(406) 324-3177

NebraskaCounterdmg CoordinatorDCSOPS-CD, 1300 Military RoadLincoln, NE(402) 309-1860NevadaCounterdrug Coordinator685 East Plum LaneReno, NV 89502(775) 348-9724New HampshireCounterdrug CoordinatorSt Mil Res, 4 Pembroke RdConcord, NH 03301(603) 227-1542New JerseyCounterdmg CoordinatorPOTO-CDTF, Bldg 3650,Saylors Pond RdFt. Dix, NJ 08640(609) 562-0812New MexicoCounterdrug CoordinatorPO Box 5610Albuquerque, NM 87185(505) 846-1031New YorkCounterdrug Coordinator109th AG, 1 Air National Guard RdScotia, NY 12302(518) 786-3477North CarolinaCounterdrug Coordinator4105 Reedy Creek RoadRaleigh, NC 27607(919) 664-6322North DakotaCounterdmg CoordinatorFrain Barracks, Bldg 040,PO Box 5511Bismarck, ND 58502(701)333-2050OhioCounterdrug CoordinatorAGOH-PA, 2825 W. Dublin Granville RdColumbus, OH 43235(614) 336-6426OklahomaCounterdrug CoordinatorOK-POT-MS-CD, 3501 Military Cir NEOklahoma City, OK 73111(405) 228-5043OregonCounterdrug CoordinatorPO Box 12889Salem, OR 97309(503)584-3938PennsylvaniaCounterdrug CoordinatorFt Indiantown Gap, Bldg 8-64Annville, PA 17003(717) 861-2482Puerto RicoCounterdrug CoordinatorPO Box 9023786, Stop 3 1/2Gen Esteves St #100San Juan, PR 00901(787) 977-4867Rhode IslandCounterdrug Coordinator570 Read School House RoadCoventry, RI 02816(401) 392-0827

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South CarolinaCounterdrug CoordinatorTAG-CS-CD, 1 Nat'l Guard Rd, Stop 24Columbia, SC 29201(803) 806-1559South DakotaCounterdrug CoordinatorSDMSCA-CD, 2823 W Main StreetRapid City, SD 57702(605) 737-6723TennesseeCounterdrug CoordinatorVoluntrrt Tng SiteBldg 603, Fitzhugh Blvd,Smyma, TN 37167(615) 355-3901TexasCounterdrug CoordinatorPO Box 5218, Bldg 10, Camp MabryAustin, TX 78763(512) 782-5154UtahCounterdrug Coordinator12953 S. Minuteman DriveDraper, UT 84020(801) 523-4150VermontCounterdrug CoordinatorVT NG, Green Mtn Armory,Camp JohnsonColchester, VT 05446(802) 338-3350VirginiaCounterdrug CoordinatorVAOT, Bldg 473, Ft PickettBlackstone, VA 23824(434) 292-8529Virgin IslandsCounterdrug Coordinator4031 Lagrande Princesse Lot 1BChristianstedSt. Croix, VI 00820(340) 774-3066WashingtonCounterdrug CoordinatorDCSOPS-CDTF, Camp Murray, Bldg 33Tacoma, WA 98430(253) 512-8894West VirginiaCounterdrug Coordinator610 Dame StSt. Albans, WV 25177(304) 722-7007WisconsinCounterdrug Coordinator2400 Wright St, PO Box 8111Madison, WI 53704(608) 242-3540WyomingCounterdrug CoordinatorDCSOPS-CDC, 5500 Bishop BlvdCheyenne, WY 82009(307) 772-5259

BEST COPY AVAILABLE

DRUGS OF ABUSENational GuardDrug Demand Reduction AdministratorsAlabamaDrug Demand Reduction Administrator1750 Congressman Dickinson, PO Box 3711Montgomery, AL 36109(334) 213-7724AlaskaDrug Demand Reduction AdministratorPO Box 5800, Bldg 60802, Camp CarrollFt. Richardson, AK 99505(907) 428-3617ArizonaDrug Demand Reduction Administrator5636 E. McDowell RoadPhoenix, AZ 85008(602) 267-2901ArkansasDrug Demand Reduction AdministratorDOMS-CD, Bldg 16412, Camp JT JohnsonN. Little Rock, AR 72199(501) 212-5484CaliforniaDrug Demand Reduction Administrator10293 Rockingham DriveSacramento, CA 95827(916) 854-3889ColoradoDrug Demand Reduction Administrator55 S. Potomac StreetAurora, CO 80012(303) 677-8303ConnecticutDrug Demand Reduction Administrator360 Broad StreetHartford, CT 06105(860) 493-2724DelawareDrug Demand Reduction AdministratorHQ, DEARNG, First Regiment RoadWilmington, DE 19808(302) 326-7079District of ColumbiaDrug Demand Reduction Administrator2001 E. Capital StreetWashington, DC 20003(202) 685-9724FloridaDrug Demand Reduction AdministratorPOMSO-CD/DDR, 2305 State Rd #207St. Augustine, FL 32086(904) 823-0355GeorgiaDrug Demand Reduction AdministratorJOPS-CD, 1651 Perry Street, Bldg 826Dobbins ARB, GA 30069(770) 919-3475GuamDrug Demand Reduction Administrator622 E. Harmon Ind Park RoadFort Juan MunaTamuning, GU 96911(671) 475-0834HawaiiDrug Demand Reduction Administrator3949 Diamond Head RoadHonolulu, HI 96816(808) 732-0209IdahoDrug Demand Reduction Administrator4736 Kennedy Street, Bldg 1-927Boise, ID 83705(208)422-3534

IllinoisDrug Demand Reduction Administrator5200 S. Cottage CroveChicago, IL 60615(309) 477-2223IndianaDrug Demand Reduction AdministratorIN Nat'l Guard, c/OHIDTA, PO Box 420Crown Point, IN 46308(219) 769-7679IowaDrug Demand Reduction Administrator7700 NW Beaver DriveJohnston, IA 50131(515) 252-4190KansasDrug Demand Reduction AdministratorPO Box 19012, Bldg 684, Forbes FieldPauline, KS 66619(785) 862-0001KentuckyDrug Demand Reduction AdministratorBluegrass Sta, Bldg 26, 5751 Briar Hill RdLexington , KY 40516(859) 293-3900LouisianaDrug Demand Reduction AdministratorBldg 35, Rm 251, Jackson BarracksNew Orleans, LA 70146(504) 278-8555MaineDrug Demand Reduction AdministratorMENG-CDC, Camp KeyesAugusta, ME 04333(207) 626-4334MarylandDrug Demand Reduction Administrator29th Div St, 5th Regt ArmoryBaltimore, MD 21201(410) 576-6137MassachusettsDrug Demand Reduction Administrator50 Maple StreetMilford, MA 01757(508) 233-6867MichiganDrug Demand Reduction Administrator2500 S. Washington AvenueLansing, MI 48913(517) 483-5601MinnesotaDrug Demand Reduction AdministratorMNAG-MSO-CDC, 20 W. 12th StSt. Paul, MN 55155(651) 282-4149MississippiDrug Demand Reduction Administrator550 Keyway Dr.Flowood, MS 39233(601) 313-1670MissouriDrug Demand Reduction AdministratorMONG CD Program, 2302 Militia DriveJefferson City, MO 65101(816) 512-4990MontanaDrug Demand Reduction Administrator1900 Williams St, PO Box 4789Helena, MT 59604(406) 324-3179

NebraskaDrug Demand Reduction AdministratorDCSOPS-CD, 1300 Military RoadLincoln, NE(402) 309-1875NevadaDrug Demand Reduction Administrator685 East Plum LaneReno, NV 89502(775) 348-9749New HampshireDrug Demand Reduction AdministratorState Military ReservationConcord, NH 03301(603) 228-3364New JerseyDrug Demand Reduction AdministratorPOTO-CDTF, Bldg 3650, Saylors Pond RdFt. Dix, NJ 08640(201) 368-5154New MexicoDrug Demand Reduction AdministratorPO Box 5610Albuquerque, NM 87185(505) 846-7234New YorkDrug Demand Reduction Administrator109th AG, Air National Guard RdScotia, NY 12302(518) 786-3452North CarolinaDrug Demand Reduction Administrator145 AW, 5225 Morris Field DriveCharlotte, NC 28208(704) 391-4424North DakotaDrug Demand Reduction AdministratorFraMe Barracks, Bldg 040, PO Box 5511Bismarck, ND 58502(701) 333-2054OhioDrug Demand Reduction AdministratorAGOH-PA, 2825 W. Dublin Granville RdColumbus, OH 43235(614) 336-6432OklahomaDrug Demand Reduction AdministratorOK-POT-MS-CD, 3501 Military Cir NEOklahoma City, OK 73111(405) 475-1491OregonDrug Demand Reduction AdministratorPO Box 12889Salem, OR 97309(503) 584-3351PennsylvaniaDrug Demand Reduction AdministratorFt Indiantown Gap, Bldg 8-64Annville, PA 17003(717) 861-2231Puerto RicoDrug Demand Reduction AdministratorPO Box 9023786, Gen Esteves St #100San Juan, PR 00901(787) 289-1622Rhode IslandDrug Demand Reduction Administrator570 Read School House RoadCoventry, RI 02816(401)392-0830

South CarolinaDrug Demand Reduction AdministratorTAG-CS-CD, 1 Nat'l Guard Rd, Stop 24Columbia, SC 29201(803) 806-2623South DakotaDrug Demand Reduction AdministratorSDMSCA-CD, 2823 W Main StreetRapid City, SD 57702(605) 737-6602

TennesseeDrug Demand Reduction AdministratorBldg 603, Fitzhugh Blvd, Volunteer Tng SiteSmyrna, TN 37167(615) 355-3902TexasDrug Demand Reduction AdministratorPO Box 5218, Bldg 10, Camp MabryAustin, TX 78763(512) 782-5238UtahDrug Demand Reduction Administrator17800 Camp Williams Rd, Bldg 605Riverton, UT 84065(801) 253-5521VermontDrug Demand Reduction AdministratorVT NG, Green Mtn Armory, Camp JohnsonColchester, VT 05446(802) 338-3440VirginiaDrug Demand Reduction AdministratorVAOT-CDC, Bldg 316, Ft PickettBlackstone, VA 23824(804) 328-3198Virgin IslandsDrug Demand Reduction Administrator4031 Lagrande Princesse Lot 1BChristiansteadSt. Croix, VI 00820(340) 774-3066WashingtonDrug Demand Reduction AdministratorDCSOPS-CDTF, Camp Murray, Bldg 34Tacoma, WA 98430(253) 512-8355West VirginiaDrug Demand Reduction Administrator610 Dame StSt. Albans, WV 25177(304) 727-5068WisconsinDrug Demand Reduction Administrator2400 Wright St, PO Box 8111Madison, WI 53704(608) 242-3540WyomingDrug Demand Reduction AdministratorDCSOPS-DDR, 5500 Bishop BlvdCheyenne, WY 82009(307) 772-5959


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