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U.S. Department of Justice Drug Enforcement Administration

1988 ED;T~ON

! 1 J

'i 118772 U.S. Department of Justice National Institute of Justice

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For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.O. 20402 ------tmel)l 0, Message From ~ \S'~. The Administrator

~ Factual, accurate information on drug abuse and the federal drug laws is an essential weapon in all areas of the federal effort to control drug abuse in the United States. The vital need for complete and readily available information exists in all of the five major elements of our national strategy to prevent d rug abuse and drug trafficking-i nterna­ tional cooperation, education and prevention, treatment, research, and law enforcement. It is particularly important in the areas of law enforcement and education, where so much of our efforts and attention is focused today. Drugs of Abuse has been acclaimed by educators, scientists, public officials, law enforcement officers, and civic leaders as a practical and easily used reference for a consensus of current scientific findings within the frame­ work of federal law. This publication was first published in 1975 as Volume 6, No.2 of Drug Enforcement magazine. Periodic revisions have been produced as additional infor­ mation has become available and as federal statutes have changed. While new drugs and new forms of old drugs have appeared, and while the elements of drug laws and our enforcement techniques continue to change, one thing remains constant: all the drugs discussed in this publication can have a substantial and detrimental effect on the health and welfare of the American people. The drugs and their dangers vary, and those differences are presented here in a format designed for quick use and ease of understanding. Many of these drugs have legiti­ mate medical uses, but are liable to psychological and physical dependence. Others so affect the central nervous system that they render the user dangerous to himself and those around him. All of them pose recognizable social as well as behavioral problems. The foundation of the federal fight against drugs is Title II of the Comprehensive Drug Abuse Prevention and Con­ trol Act of 1970, Commonly known as the Controlled Sub­ stances Act. The basic provisions of that law were strength­ ened by the Congress in 1984 and again with the Anti-Drug Abuse Act of 1986. It is significant to note that a major segment of the latter, the Narcotics Penalties and Enforce­ ment Act, provides for mandatory minimum sentences. These laws are discussed in detail in this publication. The success of any national effort ultimately depends on the public attitude and the extent to which it can be focused on the problems. To that end, Drugs of Abuse is provided as a means to alert and inform a concerned and aware citizenry-and its public servants, those who enforce its laws. I ask all who use this publication to join actively and aggressively in the ongoing efforts to mobilize public sup­ port and involvement in the war on drugs, both in the United States and abroad. . The demand for and supply of illicit drugs can be abated only through continuing cooperation and complete commit­ ment at all levels-federal, state, and local. I hope that this new edition of Drugs of Abuse assists you in your active participation. John C. Lawn Drugs Administrator William F. Alden Chief, Office of Congressional of Abuse and Public Affairs

Harri j. Kramer Chief, Communication Services Staff

Paul E. Fitzgerald-Editor Suzanne T. Rice-Art Director

The Attorney General has determined that publication of this periodical is necessary in the transacticn of the public business required by law of the Department of Justice. 2 The Controlled Table of Substances Act 4 Contents Narcotics 11 Depressants 24

Stimulants 36

Cannabis 44

Hallucinogens 48

Drug Abuse and AIDS 54 3 The agency also may begin an investigation of a drug at any time based upon information received The Controlled from law enforcement laboratories, state and local law enforcement and regulatory agencies, or other sources of information. Substances Once DEA has collected the necessary data, the Administrator of DEA, by authority of the Attorney General, requests from HHS a scientific and medical evaluation and recommendation as te whether the Act drug or other substance should be controlled or removed from control. This request is sent to the Assistant Secretary of Health of HHS. HHS solicits The Controlled Substances Act (CSA), Title /I of information from the Commissioner of FDA, evalu­ the Comprehensive Drug Abuse Prevention and ations and recommendations from the Nationallnsti­ Control Act of 1970, is the legal foundation of the tute on Drug Abuse, and on occasion from the scien­ Government's fight against abuse of drugs and other tific and medical community at large. The Assistant substances. This law is a consolidation of numerous Secretary (by authority of the Secretary) compiles the laws regulating the manufacture and distribution of information and transmits back to DEA a medical and narcotics, stimulants, depressants, and hallucino­ scientific evaluation regarding the drug or other sub­ gens. stance, a recommendation as to whether the drug should be controlled, and in what schedule it should be placed. The medical and scientific evaluations are binding on DEAwith respectto sCientific and medical matters. The recommendation on scheduling is binding only to the extent that if HHS recommends that the sub­ stance not be controlled, DEA may not control the substance. Once DEA has received the scientific and medical Controlling Drugs or evaluation from HHS, the Administrator wi" evaluate a" available data and make a final decision whether Other Substances to propose that a drug or other substance should be controlled and into which schedule it should be placed. Formal Scheduling The threshold issue is whether the drug or other substance has potential for abuse. If a drug does not The CSA places all substances which were in have a potential for abuse, it cannot be controlled. EJOme manner regulated under existing federal law Although the term potential for abuse is not defined in into one of five schedules. This placement is based the CSA, there is much discussion of the term in the upon the substance's medical use, potential for legislative history of the Act. The following items are abuse, and safety or dependence liability. The Act indicators that a drug or other substance has a also provides a mechanism for substances to be con­ potential for abuse: trolled, or added to a schedule; decontrolled, or (1) There is evidence that individuals aretakingthe removed from control; and rescheduled or trans­ drug or drugs containing such a substance in ferred from one schedule to another. The procedure amounts sufficient to create a hazard to their health or for these actions is found in Section 201 of the Act (21 to the safety of other individuals or of the community; U.S.C.811). or Proceedings to add, delete, or change the sched­ (2) There is significant diversion of the drug or ule of a drug or other substance may be initiated by drugs containing such a substance from legitimate the Department of Health and Human Services drug channels; or (HHS), by DEA, or by petition from any interested (3) Individuals are taking the drug or drugs contain­ person: the manufacturerof adrug, a medical society ing such a substance on their own initiative rather or association, a pharmacy association, a public than on the basis of medical advice from a practitioner interest group concerned with drug abuse, a state or licensed by lawto administer such drugs inthe course local government agency, or an individual citizen. of his professional practice; or When a petition is received by DEA, the agency (4) The drug ordrugs containing such a substance 4 begins its own investigation of the drug. are new drugs so related in their action to a drug or drugs already listeq as haying a:potenl'ial for abuse to (8) Whether the substance is an immediate precur­ make it likely that the drUg will have the same poten­ sor of a substance already controlled. The CSA tiality for abuse as such drugs, thus making it reason­ allows inclusion of immediate precursors on this able to assumelhat there may be s'ignificant dlver­ basis alone into the appropriate schedule and thus . sions frorrUegitimate channels" significant use con- safeguards against possibilities of clandestine manu­ trary to' orwithQut medical adv'ice, or that it has a facture. sUb,$tantiaJ capability of cr9i:lting hazards to the After considering the above listed factors, the health oftheuserortothe safetyofthe community. Of Administrator must make specific findings concern­ course, evidence of actual abuse of a substance is ing the drug or other substance. This will determine indicative, that adru,9 has a potential for abuse. into which schedule the drug or other substance will In determining into which schedule alldrug or other be placed. These schedules are established by the substance should be placed, orwhether a substance CSA. They are as follows: should be decontrolled or rescheduled, certain fac­ tors are required to be considered. Specific findings Schedule I are not required for each factor. These factors are listed in Sectlon 201 (c), 21 U.S.C. 811 (c), of the CSA t/ The drug or other substance has a high poten­ and are as follows: tial for abuse. (1) The drug's actual or relative potentialfor abuse. t/ The drug or other substance has no currently (2) Scientific evidence of the drug's pharmacologi­ accepted medical use in treatment in the United cal effects. The state of knowledge with respect to the States. effects of a specific drug is, of course, a major t/ There is a lack of accepted safety for use of the consideration, e.g., it is vital to knowwhetheror not a drug or other substance under medical supervision. drug has a hallucinogenic effect if it is to be controlled because of that. The best available knowledge of the Schedule II pharmacological properties of a drug should be con­ sidered. t/ The drug or other substance has a high poten­ (3) The state of current scientific knowledge re­ tial for abuse. garding the substance. Criteria (2) and (3) are closely t/ The drug or other substance has a currently related. However, (2) is primarily concerned with accepted medical use in treatment in the United pharmacological effects and (3) deals with all States or a currently accepted medical use with scientific knowledge with respect to the substance. severe restrictions. (4) Its history and current pattern of abuse. To t/ Abuse of the drug or other substance may lead determine whether or not a drug should be controlled, to severe psychological or physical dependence. it is important to know the pattern of abuse of that substance, including the socio-economic character­ Schedule III istics of the segments of the population involved in such abuse. t/ The drug or other substance has a potential for (5) The scope, duration, and significance of abuse. abuse less than the drugs or other substances in In evaluating existing abuse, the Administrator must Schedules I and II. know not only the pattern of abuse but whether the t/ The drug or other substance has a currently ac­ abuse is widespread. In reaching his decision, the cepted medical use in treatment in the United States. Administratorshould considerthe economics of regu­ t/ Abuse of the drug or other substance may lead lation and enforcement attendant to such a decision. to moderate or low physical dependence or high In addition, he should be aware of the social signifi­ psychological dependence. cance and impact of such a decision upon those people, especially the young, that would be affected Schedule IV by it. (6) What, if any, risk there is to the public health. If t/ The drug or other substance has a low potential a drug creates dangers to the public health, in addi­ for abuse relative to the drugs or other substances in tion to or because of its abuse potential, then these Schedule III. dangers must also be considered by the Administra­ t/ The drug or other substance has a currently tor. accepted medical use in treatment in the United (7) The drug's psychic or physiological depend­ States. ence liability. There must be an assessment of the t/ Abuse of the drug or other substance may lead extent to which a drug is physically addictive or to limited physical dependence or psychological psychologically habit-forming, if such information is dependence relative to the drugs or other substances known. in Schedule III. 5 Schedule V Emergency or Temporary Scheduling

..... The drug or other substance has a low potential In 1984, the CSA was amended by the Compre­ for abuse relative to the drugs or other substances in hensive Crime Control Act of 1984. This Act included Schedule IV. a provision which allows the Administrator of DEA to V The drug or other substance has a currently place a substance, on a temporary basis, into Sched­ accepted medical use in treatment in the United ule I when necessary to avoid an imminent hazard to States. the public safety. V Abuse of the drug or other substances may lead This emergency scheduling authority permits the to limited physical dependence or psychological scheduling of a substance which is not currently dependence relative to the drugs or other substances controlled, is being abused, and is a risk to the public in Schedule IV. health while the formal rulemaking procedures de­ scribed in the CSA are being conducted. This emer­ When the Administrator of DEA has determined gency scheduling applies only to substances with no that a drug or other substance should be controlled, accepted medical use. A temporary scheduling order decontrolled, or rescheduled, a proposal will be pub­ may be issued for one year with a possible extension lished in the Federal Register setting forth the sched­ of up to six months if formal scheduling procedures ule for which control is proposed, orthat a substance have been initiated. The proposal and order are should be decontrolled, and inviting all interested published in the Federal Register as are the propos­ persons to file comments with DEA. Affected parties als and orders for formal scheduling. may also request a hearing with DEA. If no hearing is requested, DEA will evaluate all comments re­ Controlled Substance Analogues ceived and publish a final order in the Federal Regis­ ter, controlling the drug as proposed orwith modifica­ A new class of substances was created by the Anti­ tions based upon the written comments filed. This Drug Abuse Act of 1986. Controlled substance ana­ order will set the effective dates for imposing the logues are substances which are not controlled sub­ various requirements imposed under the CSA. stances, but may be found in the illicit traffic. They are If a hearing is requested, DEA will enter into structurally or pharmacologically similar to Schedule discussions with the party or parties requesting a lor II controlled substances. A controlled substance hearing in an attempt to narrow the issue for litigation. analogue has no legitimate medical use. Asubstance If necessary, a hearing will then be held before an which meets the definition of a controlled substance Administrative Law Judge. The Judge will take evi­ analogue that is intended for human consumption is dence on factual issues and hear arguments on legal treated under the CSA as if it were a controlled questions regarding the control of the drug. Depend­ substance in Schedule I. ing on the scope and complexity of the issues, the hearing may be brief orquite extensive. The Admin­ International Treaty Obligations istrative Law Judge, at the close of the hearing, prepares findings of fact and conclusions of law and United States treaty obligations may require that a a recommended decision which is submitted to the drug orothersubstance be controlled under the CSA, Administrator of DEA. The Administrator will review or rescheduled if existing controls are less stringent these documents, as well as the underlying material, than those required by the treaty. The procedures for and prepare his own findings of fact and conclusions these scheduling actions are found in Section 201 (d) of law (which mayor may not be the same as those of the Act. drafted by the Administrative Law Judge). The The United States is a party to the Single Conven­ Administrator then publishes a final order in the tion on Narcotic Drugs of 1961, design~d to establish Federal Register either scheduling the drug or other effective control over international and domestic traf­ substance Oi declining to do so. fic in narcotics, coca leaf, cocaine, and cannabis. A Once the final order is published in the Federal second treaty, the Convention on Psychotropic Sub­ Register, interested parties have 30 days to appeal to stances of 1971, which entered into force in 1976, is a U.S. Court of Appeals to challenge the order. designed to establish comparable control over stimu­ Findings of fact by the Administrator are deemed lants, depressants, and certain hallucinogens. Con­ conclusive if supported by "substantial evidence." gress ratified this treaty in 1980. The order imposing controls is not stayed during the appeal, however, unless so ordered by the Court.

6 another, from manufacturer to wholesaler, and from II Regulation wholesaler to dispenser. In the case of Schedule I and II drugs, the supplier must have a special order form from the customer. This order form (DEA Form The CSA creates a closed system of distribution 222) is issued by DEA only to persons who are forthose authorized to handle controlled substances. properly registered to handle Schedules I and II. The The cornerstone ofthis system is the registration of all form is preprinted with the name and address of the those authorized by DEA to handle controlled sub­ customer. The drugs must be shipped to this name stances. All individuals and firms that are registered and address. The use of this device is a special rein­ are required to maintain complete and accurate forcement of the registration requirement; it makes inventories and records of all transactions involving doubly certain that only authorized individuals may controlled substances, as well as security for the obtain Schedule I and II drugs. Another benefit of the storage of controlled substances. form is the special monitoring it permits. The form is issued in triplicate: the customer must keep one copy Registration for his own files; he forwards two copies to the supplier who, after filling the order, keeps a copy for Any person who handles or intends to handle his own records and forwards the third copy to the controlled substances must obtain a registration is­ nearest DEA office. sued by DEA. A unique number is assigned to each Fordrugs in Schedules III, IV, and V, no orderform legitimate handler of controlled drugs: importer, is necessary. The supplier in each case, however, is exporter, manufacturer, wholesaler, hospital, phar­ under an obligation to verify the authenticity of his macy, physician, and researcher. This number must customer. The supplier is held fully accountable for be made available to the supplier by the customer any drugs which are shipped to a purchaserwho does prior to the pu rchase of a controlled su bstance. Thus, not have a valid registration. the opportunity for unauthorized transactions is Those registrants registered as manufacturers greatly diminished. and distributors in Schedules I, II, or III narcotics are also required to submit periodic reports to DEA of Recordkeeping their manufacturing and distribution transactions. They are also required to file annual inventories of the The CSA requires that complete and accurate Schedule I, II, or III narcotic controlled substances records be kept of all quantities of controlled sub­ that they handle. This data is entered into a system stances manufactured, purchased, and sold. Each called the Automated Reports and Consolidated substance must be inventoried every two years. Orders System (ARCOS). It enables DEA to monitor Some limited exceptions to the recordkeeping re­ the distribution of controlled substances throughout quirements may apply to certain categories of regis­ the country, and to identify retail level registrants that trants. receive unusual quantities of controlled substances. From these records it is possible to trace the flow of any drug from the time it is first imported or Dispensing to Patients manufactured through the wholesale level, to the pharmacy or hospital that dispensed it, and then to The dispensing of a controlled substance is the the actual patient who received the drug. The mere delivery of the controlled substance to the ultimate existence of this requirement is sufficient to discour­ user, who may be a patient or research subject. age many forms of diversion. It actually serves large Special control mechanisms operate here as well. corporations as an internal check to uncover diver­ Schedule I drugs are those which have no currently sion, such as pilferage by employees. accepted medical use in the United States; they may, There is one distinction between scheduled items therefore, be used in the United States only in re­ for recordkeeping requirements. Records for Sched­ search situations. They generally are supplied by ule I and II drugs must be kept separate from all other only a limited number of firms to properly registered records of the handler; records for Schedule III IV and qualified researchers. Controlled substances and V substances must be kept in a "readily ret;iev~ may be dispensed by a practitioner by direct admini­ able" form. The former method allows for more stration, by prescription, or by dispensing from office expeditious investigations involving the highly abus­ supplies. Records must be maintained by the practi­ able substances in Schedules I and II. tioner of all dispensing of controlled substances from office supplies and of certain administrations. The Distribution CSA does not require the practitioner to maintain copies of prescriptions, but certain states require the The keeping of records is required for distribution use of multiple copy prescriptions for Schedule II and of a controlled substance from one manufacturer to other specified controlled substances. 7 The determination to place drugs on prescription is drug which may be procured by those companies within the jurisdiction of FDA. Unlike other prescrip­ which prepare the drug into dosage units. tion drugs, however, controlled substances are sub­ jectto additional restrictions. Schedule II prescription Security orders must be written and signed by the practitioner; they may not be telephoned into the pharmacy except DEA registrants are required by regulation to in an emergency. In addition, a prescription for a maintain certain security for the storage and distribu­ Schedule" drug may not be refilled; the patient must tion of controlled substances. Manufacturers and see the physician again in orderto obtain more drugs. distributors of Schedule I and II substances must For Schedule III and IV drugs the prescription order store controlled substances in specially constructed may be either written or oral (that is, by telephone to vaults or highly rated safes, and maintain electronic the pharmacy). in addition, the patient may (if author­ security for all storage areas. Lesser physical secu­ ized by the doctor) have the prescription refilled on his rity requirements apply to retail level registrants such own up to five times and at anytime within six months as hospitals and pharmacies. from the date of the initial dispensing. All registrants are required to make every effort to Schedule V includes some prescription drugs and ensure that controlled substances in their possession many over-the-counter narcotic preparations, includ­ are not diverted into the illicit market. This requires ing antitussives and antidiarrheals. Even here, operational as well as physical security. Forexample, however, the law imposes restrictions beyond those registrants are responsible for ensuring that con­ normally required for the over-the-counter sales; for trolled substances are distributed only to other regis­ example, the patient must be at least 18 years of age, trants that are authorized to receive them, or to must offer some form of identification, and have his legitimate patients and consumers. name entered into a special log maintained by the pharmacist as part of a special record.

Quotas III Penalties

DEA limits the quantity of Schedule I and II con­ The CSA provides penalties for unlawful manufac­ trolled substances which may be prodliced in the turing, distribution, and dispensing of controlled sub­ United States in any given calendar year. By utilizing stances. The penalties are basically determined by available data on sales and inventories of these the schedule of the drug or other substance, and controlled substances, and taking into account esti­ sometimes are specified by drug name, as in the case mates of drug usage provided by the FDA, DEA of marijuana. As the statute has been amended since establishes annual aggregate production quotas for its initial passage in 1970, the penalties have been Schedule I and" controlled substances. The aggre­ altered by Congress. The following charts are an gate production quota is allocated among the various overview of the penalties for trafficking or unlawful manufacturers who are registered to mRnufacturethe distribution of controlled substances. This is not specific drug. DEA also allocates the amount of bulk inclusive of the penalties provided under the CSA.

8 Federa~ Trafficking Penalties Narcotics Penalties & Enforcement Act of 1986

CSA 1-,...--,,---:.=:.;.=.:....:....------1

- HEROIN , " ..'- Not less than 10 Not Jess thin 5 ~00-4,999 gm . years;Ni>tmore years. Not more mixture COCAINE . .' than life. .":C::;/ than 40 years. =----~------~---~ If deaih or serious. If death or serious COCAINE BASE Injury, flot less and inJ!.!!)" not less . ihan life.' than 20 years. Not ;i.. '~"t , more than life. PCP II 'Fine ornot more Fine of not more "than $4 million than $2 million LSD .' individual, Individual, $5 $10 million other million other than lllan individual. individual. FENTANYL

FENTANYL ANALOGUE' 00 gm

Not more than 20 years. If death or serious Injury, not less than 20 years, not more than life. Fine $1 million individual, $5 million not individual.

Not more than 1 year. Not more than 2 years .. v Fine not more than $100,000 individual, $250,000 not Individual .. Fine not more than $200,00Q indivfdual, $500,000 not iridividu~L

'Does not include marijuana, hashish, or hashish oil. (See separate char:.)

Federal Trafficking Penalties - Marijuana Narcotics Penalties & Enforcement Act of 1986

Quantity Description First Offense .Second Offense

.1,000 kg ,Marijuana OJ more Mixture containing detectable, quantity·

'Includes hashish and hash oil (Marijuana is a Schedule I controlled sUbstance.) Regulatory Requirements

REGISTRATION " '

Q i.\~" RECORDKEEPING' " DISTRIBUTrC>Ji RESTRICTIONS

MANUFACTURING Security'

MANUFACTURING Quotas

IMPORT/EXPORT; Narcotic

REPORTS TO DEA by Manufllclurer/Dislribulor Non-Narcotic '

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

10

The term narcotic in its medical meaning refers to ing, and perspiration, appear about 8 to 12 hours after opium and opium derivatives or synthetic substi­ the last dose. Thereafter, the addict may fa" into a tutes. 1 restless sleep. As the abstinence syndrome pro­ Nal cotics are essential in the practice of medicine: gresses, restlessness, irritability, loss of appetite, they are the most effective agents known forthe relief insomnia, goose flesh, tremors, and finally yawning of intense pain. They are also used as cough sup­ and severe sneezing occur. These symptoms reach pressants as well as a centuries-old remedy for their peak at 48 to 72 hours. The patient is weak and diarrhea. depressed, with nausea and vomiting. Stomach Under medical supeNision, narcotics are admini­ cramps and diarrhea are common. Heart rate and stered orally or by intramuscular injection. As drugs of blood pressure are elevated. Chills alternating with abuse, however, they also are sniffed, smoked, or flushing and excessive sweating are also character­ self-administered by the more direct routes of subcu­ istic symptoms. Pains in the bones and muscles of the taneous ("skin-popping") and intravenous ("mainlin­ back and extremities occur as do muscle spasms and ing") injection. kicking movements, which may be the source of the The relief of suffering, whether of physical or expression "kicking the habit." At this time an individ­ psychological origin, may result in a sholt-lived state ual may become suicidal. Without treatment the of euphoria. The initial effects, however, are often syndrome eventually runs its course and most of the unpleasant . leading many to conclude that those who symptoms will disappear in 7 to 10 days. How long it persist in their illicit use may have latent personality takes to restore physiological and psychological disturbances. Narcotics tend to induce pinpoint pupils equilibrium, however, is unpredictable. For a few and reduced vision, together with drowsiness, apa­ weeks following withdrawal the addict will continue to thy, decreased physical activity, and constipation. A think and talk about his use of drugs and be particu­ larger dose may induce sleep, butthere is an increas­ larly susceptible to an urge to use them again. ing possibility of nausea, vomiting, and respiratory The withdrawal syndrome may be avoided by depression-the major toxic effect of the opiates. reducing the dose of narcotic over a one-to-three­ Except in cases of acute intoxication, there is no loss week period. Detoxification of an addict can be ac­ of motor coordination or slurred speech as in the case complished by substituting oral methadone for the of the depressants. illicit narcotic and gradually reducing the dose. How­ To the extent that the response may be felt to be ever, since the addict's entire pattern of life usually is pleasurable, its intensity maybe expected to increase built around drug taking, narcotic dependence is with the amount of the dose administered. Repeated never entirely resolved by withdrawal alone. use, however, will result in increasing tolerance: the Since addicts tend to become preoccupied with the user must administer progressively larger doses to daily ritual of obtaining and taking drugs, they often attain the desired effect, thereby reinforcing the neglectthemselves and may suffer from malnutrition, compulsive behavior known as drug dependence. infections, and unattended diseases or injuries. Physical dependence refers to an alteration of the Among the hazards of narcotic addiction are toxic normal functions of the body that' necessitates the reactions to contaminants, such as quindine, sugars, continued presence of a drug in order to prevent the and talcum power, as well as unsterile needles and withdrawal or abstinence syndrome, which is charac­ injection techniques, resulting in abscesses, blood teristic of each class of addictive drugs. The intensity poisoning, hepatitis, and AIDS.2 of physical symptoms experienced during the with­ Since there is no Simple way to determine the drawal period is related directly to the amount of purity of a drug that is sold on the street, the potency narcotic used each day. is unpredictable, posing the ever present danger of an Deprivation of an addictive drug causes increased unintentional overdose. A person with a mild over­ excitability of those same bodily functions that have dose may be stuporous or asleep. Larger doses may been depressed by its habitual use. induce a coma with slow, shallow respiration. The With the deprivation of narcotics, the first with­ skin becomes clammy cold, the body limp, and the drawal signs are usually experienced shortly before jaw relaxed; there is a danger that the tongue may fall the time of the next scheduled dose. Complaints, back, blocking the air passageway. If the condition is pleas, and demands by the addict are prominent, sufficiently severe, convulsions may occur, followed increasing in intensity and peaking from 36 to 72 by respiratory arrest and death. Specific antidotes for hours after the last dose, then gradually subsiding. narcotic poisoning are available at hospitals. Symptoms, such as watery eyes, runny nose, yawn- 2See Drug Abuse and AIDS, by the National AIDS 1Cocaine, ecgonine, and coca leaves, classified as Program Office of the U.S. Public Health Service, narcotics under the CSA, are discussed in the section regarding intravenous transmission of communi­ 12 on stimulants, Page 36. cable diseases, on Page 54. The poppy Papaver somniferum is the main source of nonsynthetic narcotics

The milky fluid oozes from incisions in the unripe seedpod

Since ancient times the fluid has been scraped by hand and air dried to produce opium

13 Narcotics of Natural Origin Codeine-This alkaloid is found in raw opium in The poppy Papaver somniferum is the main concentrations ranging from 0.7to 2.5 percent. It was source of the nonsynthetic narcotics. It was grown in first isolated in 1832 as an impurity in a batch of the Mediterranean region as early as 300 B.C. and morphine. Although it occurs naturally, most codeine has since been cultivated in countries around the is produced from morphine. As compared with mor­ world, such as Hungary, Turkey, India, Burma, China, phine, codeine produces less analgesia, sedation, Lebanon, Pakistan, Afghanistan, Laos, and Mexico. and respiratory depression. It is widely distributed in The milky fluid that oozes from incisions in the products of two general types. Codeine for the relief unripe seedpod has, since ancient times, been of moderate pain may co nsist of codeine tablets or be scraped by hand and air dried to produce opium gum. combined with other products, such as aspirin or A more modern method of harvesting is by the indus­ acetaminophen (Tylenol). Some examples of liquid trial poppy straw process of extracting alkaloids from codeine preparations forthe relief of coughs (antitus­ the mature dried plant. The extract may be in either sives) are Robitussin AC, Cheracol, and elixir of liquid, solid, or powder form. Most poppy straw con­ terpin hydrate with codeine. Codeine is also manu­ centrate made available commercially is a fine factured to a lesser extent in injectable form for the brownish powder with a distinct odor. More than 400 relief of pain. It is by farthe most widely used naturally tons of opium or its equivalent in poppy straw concen­ occurring narcotic in medical treatment. trate are legally imported annually into the United States Thebaine-A minor constituent of opium, theba­ Opium-There were no legal restrictions on the ine is the principal alkaloid present in another species importation or use of opium until the early 1900s. In of poppy, Papaver bracteatum, which as been grown those days, patent medicines often contained opium experimentally in the United States as well as in other without any warning label. Today, there are state, parts of the world. Although chemically similar to both federal, and international laws governing the produc­ codeine and morphine, it produces stimulant rather tion and distribution of narcotics substances, and than depressant effects. Thebaine is not used in this there is little abuse of opium in the United States. country for medical purposes, but it is converted into At least 25 alkaloids can be extracted from opium. a variety of medically important compounds, includ­ These fall into two general categories, each produc­ ing codeine, hydrocodone, oxycodone, oxymor­ ing markedly different effects. The first, known as the phone, nalbuphine, naloxone, and the Bentley com­ phenanthrene alkaloids, represented by morphine pounds. It is controlled in Schedule" of the CSA as and codeine, are used as analgesics and cough well as under international law. suppressants;the second, the isoquinoline alkalOids, represented by papaverine (an intestinal relaxant) Semi-Synthetic Narcotics and noscapine (a cough suppressant), have no sig­ nificant influence on the central nervous system and The following narcotics are among the more sig- . are not regulated under the CSA. nificant synthetic substances that have been derived Although a small amount of opium is used to make by modification of the chemicals contained in opium. antidiarrheal preparations, such as paregoric, virtu­ ally all the opium imported into this country is broken Heroin-First synthesized from morphine in 1874, down into its alkaloid constituents, principally mor­ heroin was not extensively used in medicine until the phine and codeine. beginning of this century. The Bayer Company in Germany first started commercial production of the Morphine-The principal constituent of opium, new pain remedy in 1898. While it received wide­ ranging in concentration from 4 to 21 percent, mor­ spread acceptance, the medical profession for years phine is one of the most effective drugs known for the remained unaware of its potential for addiction. The relief of pain. It is marketed in the form of white first comprehensive control of heroin in the United crystals, hypodermic tablets, and injectable prepara­ States was establisheti with the Harrison Narcotic Act tions. Its licit use is restricted primarily to hospitals. of 1914. Morphine is odorless, tastes bitter, and darkens with Pure heroin is a white powder with a bitter taste. age. It may be administered subcutaneously, intra­ Illicit heroin may vary in both form and color. Most muscularly, or intravenously, the latter method being illicit heroin is a powder which may vary in color from the one most frequently resorted to by addicts. Toler­ white to dark brown because of impurities left from the ance and dependence develop rapidly in the user. manufacturing process or the presence of additives, Only a small part of the morphine obtained from such as food coloring, cocoa, or brown sugar. opium is used medically. Most of it is converted to Pure heroin is rarely sold on the street. A "bag"­ 14 codeine and, secondarily, to hydromorphone. slang for a single dosage unit of heroin-may weigh Opium Mexican heroin

Field of poppies Black tar heroin

Highly refined Southwest Asian heroin or Southwest Asian heroin Southeast Asian heroin

15 about 100 mg. usually containing about five percent Synthetic Narcotics heroin. To increase the bulk of the material sold to the addict, diluents are mixed with the heroin in ratios In contrast to pharmaceutical products derived ranging from 9 to 1 to as much as 99 to 1. Sugars, directly or indirectly from narcotics of natural origin, starch, powdered milk, and quinine are among the synthetic narcotics are produced entirely within the diluents used. laboratory. A continuing search for a product that will Anotherform of heroin known as "black tar" heroin retain the analgesic properties of morphine without has also become increasingly available in recent the consequent dangers of tolerance and depend­ years, especially in the western United States. Black ence has yet to yield a drug that is not susceptible to tar heroin is a crudely processed form of heroin illicitly abuse. The two that are most widely available are manufactured in Mexico. It may be sticky like roofing meperidine and methadone. tar or hard like coal, and it is dark brown to black in color. Black tar heroin is often sold on the street in its Meperidine (pethidine)-The first synthetic nar­ tar-like state, sometimes at purities ranging as high as cotic, meperidine, is chemically dissimilar to mor­ 40-80 percent. Black tar heroin is sometimes diluted, phine but resembles it in its analgesic effect. It is however, by adding materials of similar consistency probably the most widely used drug for the relief of (such as burnt cornstarch), or by converting the tar moderate to severe pain. Available in pure form as heroin into a powder and adding conventional dilu­ well as in products containing other medicinal ingre­ ents, such as mannitol or quinine. It is most com­ dients, it is administered either orally or by injection, monly used through injection. the latter method being the most widely abused. Tolerance and dependence develop with chronic Hydromorphone--Most commonly sold as Dilau­ use, and large doses can result in convulsions or did, hydromorphone is the second oldest semi-syn­ death. thetic narcotic analgesic. Marketed both in tablet and injectable form, it is shorter acting and more sedating Methadone and Related Drugs-German scien­ than morphine, but its potency is from two to eight tists synthesized methadone during World War II times as great. It is, therefore, a highly abusable drug, because of a shortage of morphine. Although chemi­ much sought after by narcotic addicts, who usually cally unlike morphine or heroin, it produces many of obtain it through fraudulent prescription or theft. The the same effects. Introduced into the United States in tablets, stronger than available liquid forms, may be 1947 as an analgesic and distributed under such dissolved and injected. names as Amidone, Dolophine, and Methadone, it became widely used in !he 1960s in the treatment of Oxycodone--Oxycodone is synthesized from narcotic addicts. The effects of methadone differ from thebaine. It is similar to codeine, but more potent and morphine-based drugs in that they have a longer with a higher dependence potential. It is effective duration of action, lasting up to 24 hours, thereby orally and is marketed in combination with aspirin as permitting administration only once a day in heroin Percodan forthe relief of pain. Addicts take Percodan detoxification and maintenance programs. Moreover, orally or dissolve tablets in water, filter out the insol­ methadone is almost as effective when administered uble material, and "mainline" the active drug. orally as it is by injection. But tolerance and depend­ ence may develop, and withdrawal symptoms, Etorphine and Dlprenorphine--Two of the though they develop more slowly and are less severe, Bentley compounds, these substances are both are more prolonged. Ironically, methadone, designed made from thebaine. Etorphine is more than one to control narcotic addiction, has emerged in some thousand times as potent as morphine in its analge­ metropolitan areas as a major cause of overdose sic, sedative, and respiratory depressant effects. For deaths. human use, its potency is a distinct disadvantage Closely related chemically to methadone is the because of the danger of overdose. Etorphine hydro­ synthetic compound levo-alpha-acetylmethadol chloride (M99) is used by veterinarians to immobilize (LAAM), which has an even longer duration of action large wild animals. Diprenorphine hydrochloride (from 48 to 72 hours), permitting a further reduction in (M50-50), acting as an antagonist, counteracts the clinic visits and the elimination of take-home medica­ effects of etorphine. The manufacture and distribu­ tion. Its potential in the treatment of narcotic addicts tion 01 both substances are strictly regulated under is under investigation. the CSA. Another close relative of methadone is p'ro­ poxyphene, first marketed in 1957 under the trade name Darvon for the relief of mild to moderate pain. Less dependence-producing than the other opiates, 16 it is less effective as an analgesic. Propoxyphene is in Control/ed Ingredient: codeine phosphate 60 mg Trade Name: Tylenol with Codeine No.4 CSA Schedule: III Other Ingredient: acetaminophen 300 mg

Control/ed Ingredient: codeine phosphate 60 mg Trade Name: Empirin with Codeine No.4 CSA Schedule: III Other Ingredient: aspirin 325 mg

Control/ed Ingredient: codeine phosphate 60 mg Trade Name: A. P. C. with Codeine No.4 CSA Schedule: III Other Ingredients: aspirin 227 mg phenacetin 162 mg caffeine 32 mg

Control/ed Ingredient: codeine phosphate (vial) 30 mg per ml Trade Name: Codeine Phosphate Injection GSA Schedule: II

Control/ed Ingredient: codeine phosphate (syringe) 30 mg in 2 ml Trade Name: Codeine Phosphate Injection CSA Schedule: II

Control/ed Ingredient: codeine phosphate 60 mg Trade Name: Tylenol with Codeine NO.4 CSA Schedule: III Other Ingredient: acetaminophen 300 mg

Controlled Ingredients: codeine phosphate 7.5 mg butalbital 50 mg Trade Name: Fiorinal with Codeine NO.1 CSA Schedule: III Other Ingredients: aspirin 200 mg phenacetin 130 mg caffeine 40 mg

Control/ed Ingredients: codeine phosphate 15 mg butalbital 50 mg Trade Name: Fiorinal with Codeine No.2" GSA Schedule: III Other Ingredients: aspirin 200 mg phenacetin 130 mg caffeine 40 mg

Control/ed Ingredients: codeine phosphate 30 mg butalbital 50 mg Trade Name: Fiorinal with Codeine NO.3 CSA Schedule: III Other Ingredients: aspirin 200 mg phenacetin 130 mg caffeine 40 mg 17 Schedule II and preparations containing it are in Another agonist-antagonist is pentazocine Schedule IV. (Talwin). Introduced as an analgesic in 1967, it was determined to be an abusable drug and placed under Narcotic Antagonists-The deliberate effort to Schedule IV in 1979. On the street, pentazocine is find an effective analgesic that is not dependence­ frequently used in combination with another drug: producing led to the development of compounds tripelennamine. This combination is commonly re­ known as narcotic antagonists. These drugs, as the ferred to as "Ts and B's" or "T's and Blues" with "T' name implies, block or reverse the effects of narcot­ referring to Talwin and "B" indicating the blue PBZ ics. Naloxone (Narcan), having no morphine-like ef­ (tripelennamine) tablet. fects, was removedfromthe CSAwhen introduced as A further attempt at reducing the abuse of this drug a specific antidote for narcotic poisoning in 1971. Nal­ was made in 1983 with the addition of naloxone to the orphine (Nalline), introduced into clinical medicine in pentazocine tablets. The new product, Talwin Nx, 1951 and now in Schedule III, is called a narcotic contains a quantity of antagonist sufficient to counter­ agonist-antagonist. In a drug-free individual, it pro­ act the morphine-like effects of pentazocine if the duces morphine-like effects; it counteracts these tablets are dissolved and injected. effects in an individual under the influence of narcotics.

Controlled Ingredients: codeine phosphate 7.5 mg butalbital 50 mg Trade Name: Fiorinal with Codeine No. 1 CSA Schedule: III Other Ingredients: aspirin 325 mg caffeine 40 mg

Controlled Ingredients: codeine phosphate 15 mg butalbital 50 mg Trade Name: Fiorinal with Codeine No.2 CSA Schedule: III Other Ingredients: aspirin 325 mg caffeine 40 mg

Controlled Ingredients: codeine phosphate 30 mg butalbital 50 mg Trade Name: Fiorinal with Codeine No. 3 CSA Schedule: III Other Ingredients: aspirin 325 mg caffeine 40 mg

Controlled Ingredient: codeine phosphate 30 mg Trade Name: Phenaphen-650 with Codeine CSA Schedule: III Other Ingredient: acetaminophen 650 mg

Controlled Ingredient: codeine phosphate 15 mg Trade Name: Phenaphen with Codeine No.2 CSA Schedule: III Other Ingredient: acetaminophen 325 mg

18 Controlled Ingredient: Codeine phosphate 30 mg Trade Name: Phenaphen with Codeine No.3 CSA Schedule: III Other Ingredient: acetaminophen 325 mg

Controlled Ingredient: morphine sulfate 15 mg per ml Trade Name: Morphine Sulfate Injection (syringe) CSA Schedule: II

Controlled Ingredient: morphine sulfate Trade Name: Morphine Sulfate (powder) CSA Schedule: II

Controlled Ingredient: morphine sulfate 15 mg per ml Trade Name: Morphine Sulfate Injection (vial) CSA Schedule: II

Controlled Ingredient: hydromorphone hydro­ chloride 2 mg per ml (syringe) Trade Name: Hydromorphone Hel CSA Schedule: II

Controlled Ingredient: hydromorphone hydro­ chloride 2 mg per ml (ampule) Trade Name: Dilaudid CSA Schedule: II

Controlled Ingredient: hydromorphone hydro­ chloride 1 mg Trade Name: Dilaudid CSA Schedule: Ii

Controlled Ingredient: hydromorphone hydro­ chloride 2 mg Trade Name: Dilaudid CSA Schedule: II

Controlled Ingredient: hydromorphone hydro­ chloride 3 mg Trade Name: Dilaudid CSA Schedule: II

Controlled Ingredient: hydromorphone hydrochloride 4 mg Trade Name: Dilaudid CSA Schedule: II

19 Controlled Ingredients: oxycodone hydrochloride 4.5 mg oxycodone terephthalate 0.38 mg Trade Name: Percodan CSA Schedule: II Other Ingredient: aspirin 325 mg

Controlled Ingredients: oxycodone hydrochloride 2.25 mg oxycodone terephthalate 0.19 mg Trade Name: Percodan-Demi CSA Schedule: II Other Ingredient: aspirin 325 mg

Controlled Ingredient: oxycodone hydrochloride 5 mg Trade Name: Percocet CSA Schedule: II Other Ingredient: acetaminophen 325 mg

Controlled Ingredients: oxycodone hydrochloride 4.5 mg oxycodone terephthalate 0.38 mg Trade Name: Tylox CSA Schedule: II Other Ingredient: acetaminophen 500 mg

Controlled Ingredient: hydrocodone 5 mg Trade Name: Tussionex CSA Schedule: III Other Ingredient: phenyltoloxamine 10 mg

Controlled Ingredient: hydrocodone 5 mg Trade Name: Tussionex CSA Schedule: III Other Ingredient: phenyltoloxamine 10 mg

Controlled Ingredient: hydrocodone 5 mg Trade Name: Vicodin CSA Schedule: III Other Ingredient: acetaminophen 500 mg

Controlled Ingredient: hydrocodone bitartrate 5 mg Trade Name: Duradyne DHC CSA Schedule: III Other Ingredient: acetaminophen 500 mg

20 Controlled Ingredient: diprenorphine hydrochloride 2 mg per ml Trade Name: M50-50 CSA Schedule: II

Controlled Ingredient: etorphine hydrochloride 1 mg per ml Trade Name: M99 CSA Schedule: II

Controlled Ingredient: meperidine hydrochloride 100 mg Trade Name: Demeral HCI (tablets) CSA Schedule: II

Controlled Ingredient: meperidine hydrochloride 50 mg per ml (ampule) Trade Name: Demeral HCI CSA Schedule: II

Controlled Ingredient: meperidine hydrochloride 25 mg in 1 ml (syringe) Trade Name: Demerol HCI CSA Schedule: II

Controlled Ingredient: meperidine hydrochloride 100 mg per mi. (vial) Trade Name: Demerol Hel CSA Schedule: II

Controlled Ingredient: methadone hydrochloride 40 mg Trade Name: Methadone Hel Diskets CSA Schedule: II

Controlled Ingredient: methadone hydrochloride 5 mg Trade Name: Dolophine Hel CSA Schedule: II

Controlled Ingredient: methadone hydrochloride 10 mg Trade Name: Dolophine Hel CSA Schedule: II

21 Controlled Ingredient: propoxyphene hydrochloride 65 mg Trade Name: Darvon CSA Schedule: IV

Controlled Ingredient: propoxyphene hydrochloride 32 mg Trade Name: Darvon Compound CSA Schedule: IV Other Ingredients: aspirin 227 mg phenacetin 162 mg caffeine 32.4 mg Controlled Ingredient: propoxyphene hydrochloride 65 mg Trade Name: Darvon Compound - 65 CSA Schedule: IV Other Ingredients: aspirin 227 mg phenacetin 162 mg caffeine 32.4 mg Controlled ingredient: propoxyphene hydrochloride 65 mg Trade Name: SK - 65 Compound CSA Schedule: IV Other Ingredients: aspirin 227 mg phenacetin 162 mg caffeine 32.4 mg Controlled Ingredient: propoxyphene hydrochloride 65 mg Trade Name: Darvon with A.S.A. CSA Schedule: IV Other Ingredient: aspirin 325 mg

Controlled Ingredient: propoxyphene napsylate 100 mg Trade Name: Darvon - N CSA Schedule: IV

Controlled Ingredient: propoxyphene napsylate 100 mg Trade Name: Darvon-N with A.S.A. CSA Schedule: IV Other Ingredient: aspirin 325 mg

Controlled Ingredient: propoxyphene napsylate 100 mg Trade Name: Darvocet-N 100 CSA Schedule: IV Other Ingredient: acetaminophen 650 mg

22 Controlled Ingredient: propoxyphene hydrochloride 65 mg Trade Name: SK-65 APAP CSA Schedule: IV Other Ingredient: acetaminophen 650 mg

Controlled Ingredient: propoxyphene hydrochloride 65 mg Trade Name: Wygesic CSA Schedule: IV Other Ingredient: acetaminophen 650 mg

Controlled Ingredient: pentazocine hydrochloride 50 mg Trade Name: Talwin CSA Schedule: IV

Controlled Ingredient: pentazocine hydrochloride 50 mg Trade Name: Talwin Nx CSA Schedule: IV Other Ingredient: naloxone hydrochloride 0.5 mg

Controlled Ingredient: pentazocine hydrochloride 25 mg Trade Name: Talacen CSA Schedule: IV Other Ingredient: acetaminophen 650 mg

23 (i

. -'.-":;..

-~ ;} ~:;; .. i''''~\

,,-..", Substances regulated under the CSA as depres­ The abrupt cessation or reduction of high-dose sants have a potential for abuse associated with both depressant intake may result in a characteristic with­ physical and psychological dependence. Taken as drawal syndrome, which should be recognized as a prescribed as a physician, depressants may be bene­ medical emergency more serious than that of any ficial for the relief of anxiety, irritability, and tension, other drugs of abuse. An apparent improvement in and for the symptomatic treatment of insomnia. In the patient's condition may be the initial result of excessive amounts, however, they produce a state of detoxification. Within 24 hours, however, minor with­ intoxication that is remarkably similar to that of alco­ drawal symptoms manifest themselves, among them hol. anxiety and agitation, loss of appetite, nausea and As in the case of alcohol, these effects may vary vomiting, increased heart rate and excessive sweat­ not only from person to person but from time to time ing, tremulousness and abdominal cramps. The in the same individual. Low doses produce mild symptoms usually peak during the second orthird day sedation. Higher doses, insofar as they relieve anxi­ of abstinence from the short-acting barbiturates or ety or stress, may produce a temporary sense of well­ meprobamate; they many not be reached until the being; they may also produce mood depression and seventh or eighth day of abstinence from the long­ apathy. In marked contrast to the effects of narcotics, acting barbiturates or benzodiazepines. It is during however, intoxicating doses invariably result in im­ the peak period that the major withdrawal symptoms paired judgment, slurred speech, and loss of motor usually occur. The patient may experience convul­ coordination. In addition to the dangers of disorienta­ sions indistinguishable from those occurring in grand tion, resulting in a high incidence of highway acci­ mal epilepsy. More than half of those who experience dents, recurrent users incur risks of long-term in­ convulsions will go on to develop delirium, often volvement with depressants. resulting in a psychotic state identical to the delirium Tolerance to the intoxicating effects develops tremens associated with the alcohol withdrawal syn­ rapidly, leading to a progressive narrowing of the drome. Detoxification and treatment must therefore margin of safety between an intoxicating and lethal be carried out under close medical supervision. While dose. The person \vho is una\AJare of the dangers of treatment techniques va,lyto some extent, they shaie increasing dependence will often increase the daily common objectives: stF,bilization of the drug-depend­ dose up to 10 or 20 times the recommended thera­ ent state to allay withdrawal symptoms followed by peutic level. The source of supply may be no farther gradual withdrawal to prevent their recurrence. than the family medicine cabinet. Depressants are Among the depressants that give rise to the gen­ also frequently obtained by theft, illegal prescription, eral conditions described are chloral hydrate, a broad or purchase on the illicit market. array of barbiturates, glutethimide, methaqualone, I n the world of illicit drug use, depressants often are meprobamate, and the benzodiQ;zepines. used as self-medication to soothe jangled nerves brought on by the use of stimulants, to quell the Chloral Hydrate anxiety of "flashbacks" resulting from prior use of hallucinogens, orto ease withdrawal from heroin. The The oldest of the hypnotic (sleep-inducing) drugs, dangers, it should be stressed, are compounded chloral hydrate was first synthesized in 1862 and when depressants are used in combination with alco­ soon supplanted alcohol, opium, and cannabis hol or other drugs. Chronic intoxication, though it preparations for inducing sedation and sleep. Its affects every age group, is not common in middle age. popularity declined after the introduction of the bar­ The problem often remains unrecognized until the biturates. It has a penetrating, slightly acrid odor, and user exhibits recurrent confusion or an obvious inabil­ a bitter caustic taste . Its depressant effects, as well as ity to function. Depressants also serve as a means of resulting tolerance and dependence, are comparable suicide, a pattern particularly common among to those of alcohol, and withdrawal symptoms re­ women. semble delirium tremens. Chloral hydrate is a liquid, The depressants vary with respect to their poten­ marketed in the form of syrups and soft gelatin cap­ tial for overdose. Moderate depressant poisoning sules. Cases of poisoning have occurred from mixing closely resembles alcoholic inebriation. The symp­ chloral hydrate with alcoholic drinks. Chloral hydrate toms of severe depressant poisoning are coma, a is not a street drug of choice. Its main misuse is by cold clammy skin, a weak and rapid pulse, and a slow older adults. to rapid but shallow respiration. Death will follow if the reduced respiration and low blood pressure are not Barbiturates counteracted by proper medical treatment.

Among the drugs most frequently prescribed to induce sedation and sleep by both physicians and 25 veterinarians are the barbiturates. About 2,500 de­ Methaqualone rivatives of barbituric acid have been synthesized, but of these only about 15 remain in medical use. Small Methaqualone is a synthetic sedative chemically therapeutic doses tend to calm nervous conditions, unrelated to the barbiturates, glutethimide, or chloral and larger dozes cause sleep 20 to 60 minutes after hydrate. It has been widely abused and has caused oral administration. As in the case of alcohol, some many cases of serious poisoning. It was placed in individuals may experience a sense of excitement Schedule II in 1973 and rescheduled to Schedule I in before sedation takes effect. If dosage is increased, 1984. It is administered orally and is rapidly absorbed however, the effects ofthe barbiturates may progress from the digestive tract. Large doses can cause through successive stages of sedation, sleep, and coma, which may be accompanied by thrashing coma to death from respiratory arrest and cardiovas­ movements or convulsions. Continued heavy use of cular complications. large doses leads to tolerance and dependence. Barbiturates are classified as ultrashort, short, Methaqualone was marketed in the United States intermediate, and long-acting. The ultrashort-acting under various brand names, such as Quaalude, barbiturates produce anesthesia within one minute Parest, Mequin, Optimil, Somnafac, and Sopor. after intravenous administration. The rapid onset and Mandrax is a European name for methaqualone in brief duration of action make them undesirable for combination with an antihistamine. purposes of abuse. Those in current medical use are Mecloqualone, a chemical similar to methaq­ hexobarbital (Sombulex), methohexital (Brevital), ualone in all significant respects, is not legally sold in thiamylal (Surital), and thiopental (Pentothal). the United States and is in Schedule I. Among the short-acting and intermediate-acting barbiturates are pentobarbital (Nembutal), secobar­ Meprobamate bital (Seconal), and amobarbital (Amytal)-three of the drugs in the depressant category most sought Meprobamate, first synthesized in 1950, intro­ after by abusers. The group also includes butabarbi­ duced the era of mild or "minor" tranquilizers. In the tal (8utisol), talbuta! (Lotusate), and aprobarbltal United States today more than 70 tons of mepro­ (Alurate). After oral administration, the onset time of bamate are distributed annually under its generic action is from 15 to 40 minutes and duration of action name, as well as under brand names such as MiI­ is up to 6 hours. Physicians prescribe short-acting town, Equanil, and SK-Bamate. Meprobamate is pre­ barbiturates to induce sedation or sleep. Veterinari­ scribed primarily for the relief of anxiety, tension, and ans use pentobarbital for anesthesia and euthanasia. associated muscle spasms. Its onset and duration of Long-acting barbiturates, which include pheno­ action are like those of the intermediate-acting bar­ barbital (Luminal), mephobarbital or methylpheno­ biturates; it differs 1rom them in that it is a muscle barbital (Mebaral), and metharbital (Gemonil), have relaxant, does not produce sleep at therapeutic onset times of up to one hour and durations of action doses, and is relatively less toxic. Excessive use, up to 16 hours. They are used medicinally as seda­ however, can result in psychological and physical tives, hypnotics, and anticonvulsants. Their slow dependence. onset of action discourages their use for episodic Benzodlazeplnes intoxication, and they are not ordinarily distributed on the illicit market except when sold as something else. The benzodiazepine family of depressants relieve It should be emphasized, however, that all barbitu­ anxiety, tension, and muscle spasms, product seda­ rates result in a buildup of tolerance, and dependence tion, and prevent convulsions. These substances are on them is widespread. marketed as anxiolytics (mild or minor tranquilizers), Glutethimide sedatives, hypnotics or anticonvulsants based to some extent on differences in their duration of action. When glutethimide (Doriden) was introduced in Twelve members of this group currently are marketed 1954, it was said to be a safe barbiturate substitute in the United States. They are alprazolam (Xanax), without an addiction potential. Experience has chlordiazepoxide (Librium): clonazepam (Clonopin), shown, however, that glutethimide is yet another clorazepate (Tranxene), diazepam (Valium), fluraze­ depressant having no particular advantage over the pam (Dalmane), halazepam (Paxipam), lorazepam barbiturates and several important disadvantages. (Ativan), midazolam (Versed), oxazepam (Serax), The sedative effects of glutethimide begin about 30 prazepam (Centrax), quazepam (Dormalin), temaze­ minutes after oral administration and last for 4 to 8 pam (Restoril), and triazolam (Halcion). While the hours. Glutethimide is marketed as Doriden in 250 margin of safety associated with these drugs is con­ and 500 mg tablets. Because the effects of this drug Siderable, overdose can occur, and continuous use are of long duration, it is exceptionally difficult to for several months can result in psychic or physical 26 reverse overdoses, which often result in death. dependence. Librium and Valium are among the most widely days after continual high doses are abruptly discon­ prescribed drugs in this country. These drug.s have a tinued. The delay in appearance of the abstinence relatively slow onset but long duration of action. syndrome is due to the slow elimination of the drug Prolonged use of excessive doses may result in from the body. When these drugs are used to obtain physical and psychological dependence. Withdrawal a "high," they are usually taken in conjunction with symptoms develop approximately one week to 10 another drug, such as alcohol.

Controlled Ingredient: chloral hydrate 500 mg Trade Name: Chloral Hydrate CSA Schedule: IV

Controlled Ingredient: chloral hydrate 500 mg Trade Name: Chl.oral Hydrate CSA Schedule: IV

Controlled Ingredient: chloral hydrate 500 mg Trade Name: Chloral Hydrate GSA Schedule: IV

Controlled Ingredient: amobarbital sodium 200 mg Trade Name: Amy tal' Sodium CSA Schedule: "

Controlled Ingredient: pentobarbital sodium 100 mg Trade Name: Nembutal Sodium CSA Schedule: II

Controlled Ingredient: secobarbital sodium 100 mg Trade Name: Seconal Sodium CSA Schedule: "

27 Controlled Ingredients: amobarbital sodium 100 mg secobarbital sodium 100 mg Trade Name: Tuinal CSA Schedule: II

Controlled Ingredient: talbutal 120 mg Trade Name: Lotusate CSA Schedule: III

Controlled Ingredient: phenobarbital 30 mg Trade Name: Luminal CSA Schedule: IV

Controlled Ingredient: phenobarbital 30 mg Trade Name: Phenobarbital CSA Schedule: IV

Controlled Ingredient: phenobarbital 60 mg Trade Name: Phenobarbital CSA Schedule: IV

Controlled Ingredient: glutethimide 500 mg Trade Name: Doriden CSA Schedule: III

Controlled Ingredient: methaqualone 300 mg Trade Name: Quaalude - 300 CSA Schedule: I (no longer marketed in U.S.)

Controlled Ingredient: methaqualone 250 mg Trade Name: Mandrax (not marketed in U.S.) GSA Schedule: I Other Ingredient: diphenhydramine hydrochloride 25 mg

28 Controlled Ingredient: meprobamate 400 mg Trade Name: Equanil CSA Schedule: IV

Controlled Ingredient: meprobamate 400 mg Trade Name: Miltown CSA Schedule: IV

Controlled Ingredient: meprobamate 600 mg Trade Name: Miltown 600 CSA Schedule: IV

Controlled Ingredient: meprobamate 400 mg ... : "', . ,',' .; ...... ,~. • < Trade Name: SK-Bamate CSA Schedule: IV ...•... "',

Controlled Ingredient: methyprylon 200 mg Trade Name: Noludar CSA Schedule: III

Controlled Ingredient: methyprylon 300 mg Trade Name: Noludar - 300 CSA Schedule: III

Controlled Ingredient: ethchlorvynol 500 mg Trade Name: Placidyl CSA Schedule: IV

Controlled Ingredient: ethchlorvynol 750 mg Trade Name: PI acidyl CSA Schedule: IV

29 ,.- ., . ,. . - . - I . - • --- ._!- , I •• I • • I , • • • • . ". , I _ .. '- -- " ." . Dover's Powder, -Paregoric Opium II III V Pare _ectolin ,_ Anal c esic, antidiarrhe~1 HLh Morphit1e, MS-Conlin, Morphine II III Roxanol, Roxanol-SR Anal. esic,- antitussive HLh Tylenol w/Codeine, Empirin w/Codeine Codeine II III V Robitussan A-C, Fiorinal w/Codeine _AnaL _~sic, C!OJitussivl3_ Moderate --Diacetylmorphine, .. _- Heroin None Hi.~h Horse, Smack. ' __''_ ------Hydromorphone II Dilaudid Anal.esic HLh. II Demerol, Meperidine (Pethidine) Mepergan Analgesic HLh Dolophine, Methadone, Methadone II Methadose Analgesic '._ HLh Numorphan, Percodan, Percocet, Tylox, Analgesic, antidiarrheal, Other Narcotics III III IV V Tussionex, Fentan I, Darvon, Lomotil, Talwin 2 antitussive Hi. h-Low

-. . . ..

Chloral .... ",...... Y£> Moderate Barbiturates Benz6diazepines Low"; ------Methaqualone Quaalude Sedative h . notic Hi.h - --- Glutethimide III Doriden Sedative, h .notic Hi.h Equanil, Millown, Noludar, AntianxietY, sedative~· Other Depressants III IV Placid I, Valmid h ,notic .Moderate 'I ..., 1 ,',. Coke;'Flake, Cocaine '/'. . Snow, Crack Local·anesthetic ,iBiphetamine, Delcobese, DesQxyn, Attention deficit. disorders, Amphetamines . .Dexedrille; .Obetrol_ . ..:.. .' n.arcole , s .YI~LI'lt contrQl . Posslb'ei -, . '. Phenmetrazine ',' 1.1 Preludin Wei. htcontro' . .J Possible ------". Attention-deficit disorders; . 'Methylphenidate '. '.11 Ritalin . .• . .' ..' ...... narcolepsy" '1.·,V ... Adipe~, .CY,!ert, Didrex,lonamio, Melfiat;. Plegin~, Other Stimulants Sanorex Tenuate Teanil Prelu-2 . .... Wei. htcontrol ... • • I ..,. .. .." ..,

OtherHaJliJCir1ogens ••..•.....• . '-. ," .' -',-:,' ,«".' "':t'" '. • -• - - •"' • ,.. ,...... • -. -- : - .::: II -.-,H, • •• .l' _- •• _ - ... ~ .- .,

Oral, HLh Yes 3-6 smoked Oral, smoked, Euphoria, Slow Watery eyes, HLh Yes 3-6 in'ected drowsiness, and shallow runny nose, Oral, respiratory breathing, Moderate Yes 3-6 in'ected yawning, ' depression, clammy skin, loss of appetite, HLh Yes 3-~---~~~C:~moked constricted pupils, convulsions, irritability, Oral, nausea coma, tremors, panic, HLh Yes 3-6 injected ~. ------po~sible death Oral, cramps, nausea, HLh Yes 3-6 in'ected chills and Oral, sweating HLh-Low Yes 12-24 in'ected HLh-Low Yes Variable ~~~ted

5-8 . Oral Shall~w , ~nxiety!; .

I~i:~~~::. ". - ~>~~ ·f~~.P;!P~~IB:ry~~~~~~~~~~7~~~~~~~~~- ;:.. I'l~~~PJ~!e'~·:~~_·?~~~;~~:~~~-··-- - "'clamm~rsKm-;--' ·~--tremors-,: _. . .. -... Low dilated pupils, • delirium, HLh wea.k and convulsions, . rapid pulse, possible death coma, ,,-' possible death '. Oral

------~------,------,------,------' h Yes.'. 1 2" SniffE!(f, smoked, .H I _ " .. '. - .injected 'Increased alertness,', Agitation",' , " ... ' .. ' , ,Apathy, Y 24 Oral,. excitation, euphoria, increase in ,body , long periods HLh 'es·. ~' in'ected "increased pulse rate of Sleep,' HL h ~--'-Y~e~s-~~2-4 . '~~~:d'---- temperature, & blood pressLJre" 'hallucinations, , . irritability, Oral, insOmnia, ; "'convulsions, depreSSion, Moderat~e_~_~Y~e~s~" ~~''---c-- 2-4,~~--,::rn"""je7ct=ed:....~,..-.;....; (iisorientation' , '," Oral, Io'ss. of appetite possib!edeath HL h Yes' 2-4 in' ,

t.Jnknowrl.; .. UnkrloWn u Controlled Ingredient: alprazolam 0.25 mg Trade Name: Xanax CSA Schedule: IV

Controlled Ingredient: alprazolam 0.5 mg Trade Name: Xanax CSA Schedule: IV

Controlled Ingredient: alprazolam 1 mg Trade Name: Xanax CSA Schedule: IV

Controlled Ingredient: chlordiazepoxide hydrochloride 5 mg Trade Name: Librium CSA Schedule: IV

Controlled Ingredient: chlordiazepoxide hydrochloride 10 mg Trade Name: Librium CSA Schedule: IV

Controlled Ingredient: chlordiazepoxide hydrochloride 25 mg Trade Name: Librium CSA Schedule: IV

Controlled Ingredient: clorazepate dipotassium 3.75 mg Trade Name: Tranxene CSA Schedule: IV

Controlled Ingredient: clorazepate dipotassium 7.5 mg Trade Name: Tranxene CSA Schedule: IV

32 Controlled Ingredient: clorazepate dipotassium 15 mg Trade Name: Tranxene CSA Schedule: IV

Controlled Ingredient: clorazepate dipotassium 22.5 mg Trade Name: Tranxene - SO CSA Schedule: IV

Controlled Ingredient: clorazepate dipotassium 3.75 mg Trade Name: Tranxene CSA Schedule: IV

Controlled Ingredient: clorazepate dipotassium 7.5 mg Trade Name: Tranxene CSA Schedule: IV

Controlled Ingredient: clorazepate dipotassium 15 mg Trade Name: Tranxene CSA Schedule: IV

Controlled Ingredient: diazepam 2 mg Trade Name: Valium CSA Schedule: IV

Controlled Ingredient: diazepam 5 mg Trade Name: Valium CSA Schedule: IV

Controlled Ingredient: diazepam 10 mg Trade Name: Valium CSA Schedule: IV

33 Controlled Ingredient: flurazepam 15 mg Trade Name: Dalmane CSA Schedule: IV

Controlled Ingredient: flurazepam 30 mg Trade Name: Dalmane CSA Schedule: IV

Controlled Ingredient: lorazepam 0.5 mg Trade Name: Ativan CSA Schedule: IV

Controlled Ingredient: lorazepam 1.0 mg Trade Name: Ativan CSA Schedule: IV

Controlled Ingredient: lorazepam 2.0 mg Trade Name: Ativan CSA Schedule: IV

Controlled Ingredient: oxazepam 10 mg Trade Name: Serax CSA Schedule: IV

Controlled Ingredient: oxazepam 15 mg Trade Name: Serax CSA Schedule: IV

Controlled Ingredient: oxazepam 30 mg Trade Name: Serax CSA Schedule: IV

34 Controlled Ingredient: oxazepam 15 mg Trade Name: Serax CSA Schedule: IV

Controlled Ingredient: prazepam 5 mg Trade Name: Centrax CSA Schedule: IV

Controlled Ingredient: prazepam 10 mg Trade Name: Centrax CSA Schedule: IV

Controlled Ingredient: prazepam 10 mg Trade Name: Centrax CSA Schedule: IV

Controlied Ingredient: temazepam 15 mg Trade Name: Restoril CSA Schedule: IV

Controlled Ingredient: temazepam 30 mg Trade Name: Restoril CSA Schedule: IV

Controlled Ingredient: triazolam 0.25 mg Trade Name: Halcion CSA Schedule: IV

Controlled Ingredient: triazolam 0.5 mg Trade Name: Halcion CSA Schedule: IV

35 ~ ....':·": ,. t'I.:

.. .~- .. The two most prevalent stimulants are nicotine in onset of death. It should be added that physical tobacco products and caffeine, the active ingredient exertion increases the hazards of stimulant use since of coffee, tea, and some bottled beverages that are accidental death is due in part to their effects on the sold in every supermarket. When used in moderation, cardiovascular and temperature regulating systems. these stimulants tend to rel1ave fatigue and increase Fatalities under conditions of extreme exertion have alertness. They are an accepted part of our culture. been reported among athletes who have taken stimu­ There are, however, more potent stimulants that lants in moderate amounts. because of their dependence-producing potential are If withdrawn from stimulants, chronic high-dose under the regulatory control of the CSA. These con­ users exhibit profound depreSSion, apathy, fatigue, trolled stimulants are available by prescription for and disturbed sleep for up to 20 hours a day. The medical purposes; they are also clandestinely manu­ immediate withdrawal syndrome may last for several factured for distribution on the illicit market. days. There may also be a lingering impairment of Users tend to rely on stimulants to feel stronger, perception and thought processes. Anxiety, an inca­ more decisive, and self-possessed. Because of the pacitating tenseness, and suicidal tendencies may cumulative effects of the drugs, chror:ic users often persist for weeks or months. Many experts now follow a pattern of taking "uppers" in the morning and interpret these symptoms as indicating that stimulant "downers," such as alcohol or sleeping pills, at night. drugs are capable of producing physical depend­ Such chemical manipulation interferes with normal ence. Whether the withdrawal syndrome is physical body processes and can lead to mental and physical or psychological in origin is, in this instance, aca­ illness. demic since the stimulants are recognized as among Individuals who resort to stimulants for their eu­ the most potent agents of reward and reinforcement phoric effects consume large doses sporadically, that underlie the problem of dependence. over weekends or at night, often going on to experi­ ment with other drugs of abuse. The consumption of Cocaine stimulants may result in a temporary sense of exhila­ ration, superabundant energy, hyperactivity, ex­ The most potent stimulant of natural origin, co­ tended wakefulness, and a loss of appetite. It may caine is extracted from the leaves of the coca plant also induce irritability, anxiety, and apprehension. (Erythroxylon coca), which has been grown in the These effects are greatly intensified with administra­ Andean highlands of South America since prehistoric tion by intravenous injection, which may produce a times. The leaves of the plant are chewed in the sudden sensation known as a ''flash'' or "rush." The region for refreshment and relief from fatigue. protracted use of stimulants is followed, however, by Pure cocaine, the principal psychoactive ingredi­ a period of depression known as "crashing" that is ent, was first isolated in the 1880s. It was used as an invariably described as unpleasant. Since the de­ anesthetic in eye surgery for which no previously pression can be easily counteracted by a further known drug had been suitable. It became particularly injection of stimulant, this abuse pattern becomes useful in surgery of the nose and throat because of its increasingly difficult to break. Heavy users may inject ability to anesthetize tissue while simultaneously themselves every few hours, a process sometimes constricting blood vessels and limiting bleeding. continued to the point of delirium, psychosis, or physi­ Many of its therapeutic applications are now obsolete cal exhaustion. because of the development of safer drugs as local Tolerance to both the euphoric and appetite sup­ anesthetics. pressant effects develops rapidly. Doses large Illicit cocaine is usually distributed as a white enough to overcome the insensitivity that develops crystalline powder, often diluted by a variety of other may cause various mental aberrations, the early ingredients, the most common of which are sugars signs of which include repetitive grinding of the teeth, such as lactose, inositol, mannitol, and local anes­ touching and picking the face and extremities, per­ thetics such as lidocaine. The frequent adulteration is forming the same task over and over, a preoccupation to increase volume and thus to multiply profits. with one's own processes, suspiciousness, and a The drug is most commonly administered by being sense of being watched. Paranoia with auditory and "snorted" through the nasal passages. Symptoms of visual hallucinations characterizes the toxic syn­ repeated use in this manner may resemble the con­ drome resulting from continued high doses. Dizzi­ gested nose of a common cold. ness, tremor, agitation, hostility, panic, headache, The intenSity of the psychological effects of co­ flushed skin, chest pain with palpitations, excessive caine, as with many psychoactive drugs, depends on sweating, vomiting, and abdominal cramps are the rate of entry into the blood. Intravenous injection among the symptoms of a sublethal overdose. In the or smoking produces an almost immediate intense absence of medical intervention, high fever, convul­ experience. Cocaine hydrochloride, the usual form in sions, and cardiovascular collapse may precede the which cocaine is sold, while soluble in water and 37 Cocaine hydrochloride

Coca flower

Coca leaf

38 Field of coca bushes, with berries Baskets of gathered coca leaves

Jungle maceration pit for leaching coca leaves

Crack 39 sometimes injected, is fairly insensitive to heat. known to inject as much as 1,000 mg every 2 or 3 Conversion of cocaine hydrochloride to cocaine base hours. Recognition of the deleterious effects of these yields a substance that will become volatile when drugs and their limited therapeutic value led to a heated. "Crack," or cocaine base in the form of chips, marked reduction in their use by the medical profes­ chunks or "rocks," is usually vaporized in a pipe or sion. The medical use of amphetamines is now lim­ smoked with plant material in a Cigarette or a "joint." ited to narcolepsy, attention deficit disorders in chil­ Inhalation of the cocaine fumes produces effects that dren, and certain cases of obesity-as a short-term are very fast in onset, very intense, and are quickly adjunct to a restricted diet for patients resistant to over. These intense effects are often followed within other forms of therapy. minutes by a dysphoric "crash," leading to frequently Their illicit use closely parallels that of cocaine in repeated doses and rapid addiction. the range of its short-term and long-term effects. Because of the intensity of its pleasurable effects, Despite broad recognition of the risks, clandestine cocaine has the potential for extraordinary psychic laboratories produce vast quantities of ampheta­ dependency. Recurrent users may resort to larger mines, particularly methamphetamine, for distribu­ doses at shorter intervals until theIr lives are largely tion on the illicit market. committed to their drug addiction. Anxiety, restless­ ness, and extreme irritability may indicate the onset of Phenmetrazine (Preludln) and a toxic psychosis similar to paranoid schizophrenia. Methylphenidate (Ritalin) Tactile hallucinations so afflict some chronic users that they injure themselves in attempting to remove The medical indications, patterns of abuse, and imaginary insects from under the skin. Others feel adverse effects of phenmetrazine (Preludin) and persecuted and fear that they are being watched and methylphenidate (Ritalin) compare closely with those followed. of the other stimulants. Phenmetrazine is medically Excessive doses of cocaine may cause seizures used only as an appetite suppressant and methylphe­ and death from, for example, respiratory failure, nidate mainly for treatment of attention deficit disor­ stroke, cerebral hemorrhage, or heart failure. There is ders in children. They have been subject to abuse in no specific treatment for cocaine overdose. Nor does countries where freely available, as they are here in tolerance develop to the toxic effects of cocaine. In localities where medical practitioners write prescrip­ fact, there are studies which indicate that repeated tions on demand. While the abuse of these drugs use lowers the dose at which toxicity occurs. There is involves both oral and intravenous use, most of the no "safe" dose of cocaine. abuse involves the injection of tablets dissolved in water. Complications arising from such use are Amphetamines common since the tablets contain insoluble materials which, when injected, block small blood vessels and Amphetamine, dextroamphetamine, and metham­ cause serious damage, especially in the lungs and phetamine are so similar in the effects they induce retina of the eye. that they can be differentiated from one another only by laboratory analysis. Amphetamine was first used Anorectic Drugs clinically in the mid-1930s to treat narcolepsy, a rare disorder resulting in an uncontrollable tendency to In recent years, a number of drugs have been sleep. Afterthe introduction of the amphetamines into manufactured and marketed to replace ampheta­ medical practice, the number of conditions for which mines as appetite suppressants. These so-called they were prescribed multiplied, as did the quantities anorectic drugs include benzphetamine (Didrex), made available. chlorphentermine (Pre-Sate, etc.), clortermine (Vora­ For a time, they were sold without prescription in nil), diethy!propion (Tenuate, Tepanil, etc.), fenflu­ inhalers and other over-the-counter preparations. ramine (Pondimin), mazindol (Sanorex, Mazanor), Abuse became popular. Many segments of the popu­ phendimetrazine (Plegine, Bacarate, Melfiat, Stato­ lation, especially those concerned with extensive or bex, Tanorex, etc.), phentermine (Ionamin, Adipex­ irregular hours, were among those who used am­ P, etc.). They produce many of the effects of the phetamines orally in excessive amounts. "Speed amphetamines, but are generally less potent. All are freaks,"who injected amphetamines, became known controlled because of the similarity of their effects to for their bizarre and often violent behavior. Over-the­ those of the amphetamines. Fenfluramine differs counter availability (except inhalers) was terminated somewhat from the others in that at low doses it and amphetamines now are available only by pre­ produces sedation. scription.lnhalers still are available over-the-counter. Whereas a prescribed dose is between 2.5 and 15 40 mg per day, those on a "speed" binge have been Controlled Ingredient: amphetamine sulfate 10 mg Trade Name: Benzedrine CSA Schedule: II

Controlled Ingredients: amphetamine 6.25 mg dextroamphetamine 6.25 mg Trade Name: Biphetamine '121/2' CSA Schedule: II

Controlled Ingredients: amphetamine 10 mg dextroamphetamine 10 mg Trade Name: Biphetamine '20' CSA Schedule: II

Controlled Ingredient: dextroamphetamine sulfate 5 mg Trade Name: Dexedrine CSA Schedule: II

Controlled Ingredient: dextroamphetamine sulfate 15 mg Trade Name: Dexedrine CSA Schedule: II

Controlled Ingredient: methamphetamine hydrochloride 10 mg Trade Name: Desoxyn CSA Schedule: II

Controlled Ingredient: methamphetamine hydrochloride 15 mg Trade Name: Desoxyn CSA Schedule: II

41 Controlled Ingredient: phenmetrazine hydrochloride 75 mg Trade Name: Preludin CSA Schedule: "

Controlled Ingredient: methylphenidate hydrochloride 10 mg Trade Name: Ritalin CSA Schedule: II

Controlled Ingredient: methylphenidate hydrochloride 20 mg Trade Name: Ritalin CSA Schedule: "

Controlled Ingredient: fenethylline hydrochloride 50 mg Trade Name: Captagon (not marketed in U.S.) CSA Schedule: I

Controlled Ingredient: benzphetamine 50 mg Trade Name: Didrex CSA Schedule: III

Controlled Ingredient: phendimetrazine tartrate 35 mg Trade Name: Plegine CSA Schedule: III

Controlled Ingredient: phendimetrazine tartrate 105 mg Trade Name: Prelu-2 CSA Schedule: III

Controlled Ingredient: phendimetrazine tartrate 70 mg Trade Name: Statobex-D CSA Schedule: III

42 Controlled Ingredient: diethylpropion hydrochloride 75 mg Trade Name: Tenuate Dospan CSA Schedule: IV

Controlled Ingredient: mazindol 1 mg Trade Name: Mazanor CSA Schedule: IV

Controlled Ingredient: mazindol 1 mg Trade Name: Sanorex CSA Schedule: IV

Controlled Ingredient: mazindol 2 mg Trade Name: Sanorex CSA Schedule: IV

Controlled Ingredient: phentermine hydrochloride 37.5 mg Trade Name: Adipex-P CSA Schedule: IV

Controlled Ingredient: phentermine hydrochloride 30 mg Trade Name: Fastin CSA Schedule: IV

Controlled Ingredient: phentermine 15 mg Trade Name: lonamin CSA Schedule: IV

Controlled Ingredient: phentermine 30 mg Trade Name: lonamin CSA Schedule: IV

43

Cannabis sativa L., the hemp plant, grows wild noticeable to an observer. High doses may result in throughout most of the tropic and temperate regions image distortion, a loss of personal identity, and of the world. It is a single species. This plant has long fantasies and hallucination. Very high doses may been cultivated for the tough fiber of the stem, the result in a toxic psychosis. seed used in feed mixtures, and the oil as an ingredi­ During the past 20-25 years, there has been a ent of paint, as well as for its biologically active resurgence in the scientific study of cannabis, one substances, most highly concentrated in the leaves goal of which has been to develop therapeutic agents and resinous flowering tops. which, if used as directed in medical treatment, will The plant materia: has been used as a drug for not produce harmful side effects. THC can be synthe­ centuries. In 1839, it entered the annals of western sized in the laboratory. Because it is a liquid insoluble medicine with the publication of an article surveying in water and it decomposes on exposure to air and its therapeutic potential, including possible uses as light, it is administered in soft gelatin capsules. Re­ an analgesic and anticonvulsant agent. It was alleged search has resulted in development and marketing of to be effective in treating a wide range of physical and a product containing THC for the control of nausea mental ailments during the remainder of the 19th and vomiting caused by chemotherapeutic agents century. With the introduction of many new synthetic used in the treatment of cancer. None of the synthetic drugs in the 20th century, interest in it as a medication cannabinoids have so far been detected in the drug waned. traffic. The controls imposed with the passage of the Three drugs that come from cannabis are currently Marihuana Tax Act of 1937 fu rther curtailed its use in distributed on the U.S. illicit market. Having no treatment, and by 1941 it had been deleted from the currently accepted medical use in treatment in the U.S. Pharmacopoeia and the National Formulary, the United States, they remain under Schedule I of the official compendia of drugs. But advances continued CSA. to be made in the chemistry of cannabis. Among the Marijuana many cannabinoids synthesized by the plant are cannabinol, cannabidiol, cannabinolidic acids, can­ The term marijuana is used in this country to refer nabigerol, cannabichromene, and several isomers of to the cannabis plant and to any part or extract of itthat tetrahydrocannabinol, one of which is believed re­ produces somatic or psychic changes in humans. A sponsible for most of its characteristic psychoactive tobacco-like substance produced by drying the effects. This is delta-9-tetrahydrocannabinol (THC), leaves and flowering tops of the plant, marijuana one of 61 cannabinoids which are unique chemicals varies significantly in its potency, depending on the found only in cannabis. source and selectivity of plant materials used. Most Cannabis products are usually smoked in the form wild U.S. cannabis is considered inferior because of of loosely rolled cigarettes ("joints"). They may be a low concentration of THC, usually less than 0.5 used alone or in combination with other substances. percent. Jamaican, Colombian, and Mexican varie­ They may also be administered orally, but are re­ ties range between 0.5 and 7 percent. The most ported to be about three times more potent when selective produce is reputed to be sinsemilla (Span­ smoked. The effects are felt within minutes, reach ish, sin semilla: without seed), prepared from the un­ their peak in 10 to 30 minutes, and may linger for 2 or pollinated female cannabis plant, samples of which 3 hours. have been found to contain up to 20 percent THC. A condensed description of these effects is apt to Southeast Asian "Thai sticks," consisting of mari­ be inadequate or even misleading. So much depends juana buds bound on short sections of bamboo, are upon the experience and expectations of the individ­ encountered infrequently on the U.S. illicit market. ual as well as the activity of the drug itself. Low doses Hashish tend to induce restlessness and an increasing sense of well-being, followed by a dreamy state of relaxa­ The Middle East is the main source of hashish. It tion, and frequently hunger, especially a craving for consists of the drug-rich resinous secretions of the sweets. Changes of sensory perception-a more cannabis plant, which are collected, dried, and then vivid sense of sight, smell, touch, taste, and hearing­ compressed into a variety of forms, such as balls, may be accompanied by subtle alterations in thought cakes, or cookie-like sheets. The THC content of formation and expression. Stronger doses intensify hashish in the United States averages 3 percent. reactions. The individual may experience shifting Hashish 011 sensory imagery, rapidly fluctuating emotions, a flight of fragmentary thoughts with disturbed associations, The name is used by illicit drug users and dealers an altered sense of self-identity, impaired memory, but is a misnomer in suggesting any resemblance to and a dulling of attention despite an illusion of height­ hashish other than its objec1ive of further concentra­ tion. Hashish oil is produced by a process of repeated ened insight. This state of intoxication may not be 45 extraction of cannabis plant materials to yield a dark viscous liquid, current samples of which average about 20 percent THe. In terms of its psychoactive effect, a drop ortwo of this liqu id on a cigarette is equal to a single "joint" of marijuana.

Field of marijuana

Female marijuana flower

Manicured marijuana

46 Thai sticks

Hashish (so/e)

Hashish oil

47 f';,,~U' . ~

i' . i~~"~'1'

~_ " Yf';"'/".~'<,,?:'Io.,A .

2!~~.: . ~~t Hallucinogenic drugs, both natural and synthetic, DOM, DOB, MDA, and MDMA are substances that distort the perception of objective reality. They induce a state of excitation of the central Many chemical variations of mescaline and am­ nervous system, manifested by alterations of mood, phetamine have been synthesized in the laboratory, usually euphoric, but sometimes severely depres­ certain of which at various times have won accep­ sive. Under the influence of hallucinogens, the tance among illicit drug users and traffickers. DOM (4- senses of direction, distance, and time become dis­ methyl-2,5-dimethoxyamphetamine), synthesized in oriented. A user may speak of "seeing" sounds and 1963, was introduced in 1967 into the Haight-Asbury "hearing" colors. If taken in a large enough dose, the drug scene in San Francisco. At first named STP after drug produces delusions and visual hallucinations. a motor oil additive, the acronym was quickly reinter­ Occasionally, depersonalization and depression are preted to stand for "Serenity, Tranquility, and Peace." so severe that suicide is possible, but the most A host of related chemicals are illiCitly manufactured, common danger is impaired judgment, leading to including DOB (4-bromo-2,5-dimethoxyamphetam­ rash decisions and accidents. Persons in hallucino­ ine), MDA (3, 4-methylenedioxyamphetamine), and genic states should, therefore, be closely supervised MDMA (3, 4-methylenedioxymethamphetamine) and upset as little as possible to keep them from (XTC). These drugs differ from one another in their harming themselves and others. Acute anxiety, rest­ speed of onset, duration of action, potency, and lessness, and sleeplessness are common until the capacity to modify mood with or without producing drug wears off. hallucinations. They are usually taken orally, some­ Long after hallucinogens are eliminated from the times "snorted," and rarely injected intravenously. body, users may experience flashbacks-fragmen­ Because they are produced in clandestine laborato­ tary recurrences of psychedelic effects-such as the ries, they are seldom pure, and the dose in a tablet, in intensification of a perceived color, the apparent a capsule, or on a square of impregnated paper may motion of a fixed object, or the mistaking of one object be expected to vary considerably. The names of for another. Recurrent use produces tolerance, which these drugs are sometimes used to misrepresent tends to encourage resorting to greater amounts. other chemicals. Although no evidence of physical dependence is detectable when the drugs are withdrawn, recurrent Psilocybin and Psllocyn use tends to produce psychic dependence, varying according to the drug, the dose, and the individual Like the peyote cactus, Psilocybe mushrooms user. It should be stressed that the hallucinogens are have been used for centuries in traditional Indifl.n unpredictable in their effects each time they are used. rites. When they are eaten, these "sacred" or "magic" The abuse of hallucinogens in the United States mushrooms affect mood and perception in a manner reached a peak of popularity in the late 1960s, and a similar to mescaline and LSD. Their active ingredi­ subsequent decline was attributed to broader aware­ ents, psilocybin and psilocyn, are chemically related ness of their hazardous effects. Their abuse, how­ to LSD. They can now be made synthetically, but ever, reemerged in the late 1970s and has continued much of what is sold under these names on the illicit in this decade. market consists of other chemical compounds.

Peyote and Mescaline LSD (LSD-25, Iyserglde)

The primary active ingredient of the peyote cactus LSD is an abbreviation of the German expression is the hallucinogen mescaline. It is derived from the for lysergic acid diethylamide. It is produced from fleshy parts or buttons of this plant, which has been lysergic acid, a substance derived from the ergot employed by Indians in northern Mexico from the fungus which grows on rye or from lysergic acid earliest recorded time as a part of traditional religious amide, achemicalfound in morning glory seeds. Both rites. The Native American Church, which uses pe­ ofthese precursorchemicals are in Schedule III of the yote in religious ceremonies, has been exempted CSA. from certain provisions of the CSA. Peyote, or mescal LSD was first synthesized in 1938. Its psychoto­ buttons, and mescaline should not be confused with mimetic effects were discovered in 1943 when a mescal, the colorless Mexican liquor distilled from the chemist accidentally took some LSD. As he began to leaves of maguey plants. Usually ground into a experience the effects now known as a '1rip," he was powder, peyote is taken orally. Mescaline can also be aware of vertigo and an intensification of light. Closing produced synthetically. A dose of 350 to 500 mg of his eyes, he saw a stream of fantastic images of mescaline produces illusions and hallucinations last­ extraordinary vividness accompanied by a kaleido­ ing from 5 to 12 hours. scopic play of colors. This condition lasted for about two hours. 49 Because of the extremely high potency of LSD, its invulnerability. A blank stare, rapid and involuntary structural relationship to a chemical which is present eye movements, and an exaggerated gait are among in the brain, and its similarity in effects to certain the more common observable effects. Auditory hallu­ aspects of psychosis, LSD was used as a tool of cinations, image distortion as in a fun-house mirror, research to study the mechanism of mental illness. and severe mood disorders may also occur, produc­ Although there was a marked decline from its initial ing in some acute anxiety and a feeling of impending popularity in illicit channels during the 1960s, there doom, in others paranoia and violent hostility. PCP is are indications that its illicit use once again may be unique among popular drugs of abuse in its power to increasing to some extent. produce psychoses indistinguishable from sC~iizo­ LSD is usually sold in the form of tablets, thin phrenia. Although such extreme psychic reactions squares of gelatin ("window panes"), or impregnated are usually associated with repeaterj use of the drug, paper ("blotter acid"), The average effective oral dose they have been known to occur in some cases after is from 30 to 50 micrograms, but the amount per only one dose and to last, or recur intermittently, long dosage unit varies greatly. The effects of higher after the drug has left the body. Phencyclidine now doses persist for 1 0 to 12 hours. Tolerance develops poses greater risks to the user than any other drug of rapidly. abuse, with the possible exception of crack-the smokable form of cocaine-whose street distribution Phencyclidine (PCP) and Related Drugs and use by inhalation parallels that of PCP. Modification of the manufacturing process may Phencyclidine was investigated in the 1950s as a further yield chemically related analogues capable of human anesthetic, but, because of side effects of producing, so far as is known, similar psychic effects. confusion and delirium, its development for human Three of these analogues have so far been encoun­ use was discontinued. It became commercially avail­ tered on the U.S. illicit market, where they have been able for use in veterinary medicine in the 1960s under sold as PCP.2 In view of the severe behavioral tox­ the trade name Sernylan. In 1978, however, the icity of phencyclidine and its analogues, in November manufacturer stopped production. That same year 1978 the Congress passed legislation increasing the phencyclidine was transferred from Schedule III to penalties for manufacture, distribution, and posses­ Schedule II of the CSA, 10gether with two previously sion with intent to distribute these chemicals. The unscheduled precursor chemicals. 1 Most, if not all, penalties for manufacture, distribution, and posses­ phencyclidine on the U.S. illicit market is produced in sion with intent to distribute PCP were further in­ clandestine laboratories. creased by the Controlled Substances Penalties More commonly known as PCP, it is sold under at Amendments Act of 1984 and the Narcotics Penalties least 50 other names, including Angel Dust, Crystal, and Enforcement Act of 1986. There are enhanced Supergrass, Killer Weed, Embalming Fluid, and penalties for violations involving specified quantities Rocket Fuel, that reflect the range of its bizarre and of PCP or substances containing PCP. volatile effects. It is also frequently misrepresented as mescaline, LSD, or THC. In its pure form, it is a white crystalline powder that readily dissolves in water. Most PCP now contains contaminants resulting from its makeshift manufacture, causing the colorto range from tan to brown and the consistency from a powder to a gummy mass. Although sold in tablets and capsules, as well as in powder and liquid form, it is commonly applied to a leafy material, such as pars­ ley, mint, oregano, or marijuana, and smoked. The drug is as variable in its effects as it is in its appearance. A moderate amount often produces in the user a sense of detachment, distance, and es­ trangement from the surroundings. Numbness, slurred or blocked speech, and a loss of coordination may be accompanied by a sense of strength and

lThe chemicals are 1-phenylcyclohexylamine and 1- 2The analogues are N-efhyl-1-phenylcyclohexylam­ piperidinocyclohexanecarbonifrile (PCC). ine (PCE), 1-(1-phenylcyclohexyl)-pyrro/idine (PCP; PHP), and 1-[1-(2-fhienyl-cyclohexyl)J-piperdine 50 (TPCP; TCP). Peyote cactus

Psilocybe mushroom

LSD blotter paper

51 LSD blotter paper

LSD blotter paper

Phencyclidine (PCP)

52 Clandestine Laboratories During the past 25 years, the demand for psy­ In an attempt to circumvent existing drug laws, choactive drugs-stimulants, depressants, and hallu­ some individuals have used clandestine laboratories cinogens-has spawned a rising incidence of illicit to synthesize analogues of controlled substances. clandestine laboratories. They were first noticed in Known as "designer drugs" in the media, these con­ California, and now have been encountered in virtu­ trolled substance analogues usually retain the phar­ ally every other part of the country. macological properties of controlled substances, but, Government actions to control the legitimate because of slight variations in chemical structur:e, are manufactu re and distribution of dangerous drugs also not specifically listed as controlled substances. Ana­ contributed to the growth of these laboratories. logues of potent narcotics, stimulants, depressants, Clandestine laboratories have proliferated be­ and hallucinogens have been produced in clandes­ cause of the ease of production and the limited skill tine laboratories. needed to operate them. Equipment, chemicals, and These analogues carry increased health risks due facilities are relatively easy and inexpensive to ob­ to their unknown purity, toxicity, and potency. tain. No great skills are needed to follow the manufac­ The emergency scheduling provisions of the turing procedures. In fact, most laboratory operators Comprehensive Crime Control Act of 1984 and the employ or are themselves "cooks" rather than trained Controlled Substance Analogue Enforcement Act of chemists. The overall risks are minimal despite spo­ 1986 are aimed at closing the legal loopholes used by radic fires and explosions and the threat of discovery individuals who manLlfacture and distribute these and arrest. The potential profits from these enter­ analogues. ' prises can be enormous. Most clandestine laboratories are set up to manu­ facture a single drug, although several laboratories have been able to manufacture many different ones. The majority of clandestine laboratories are estab­ lished in rural areas and have relatively modest production capabilities. Occasionally, they are lo­ cated in suburban or urban areas. Large-scale laboratories are usually set up on rural tracts of land in large outbuildings. In some instances, these laboratories are set up in rented warehouses or other large buildings and are equipped with commer­ cial production facilities capable of producing thou­ sands and even millions of dosage units of controlled substances. Some laboratory operators have been students, teachers, or professional chemists or engi­ neers who have utilized university or company labo­ ratories for the illicit production of dangerous drugs. Clandestine laboratory operators have produced almost two dozen kinds of contrC!lt;l] substances, including such stimulants as amphetar'1'1(l~, metham­ phetamine, and cocaine; such depressants as methaqualone and mecloqualone; such narcotic drugs as morphine, heroin, fentanyl/fentanyl ana­ logues, alphaprodine/alphaprodine analogues, methadone, and hashish oil; and a wide varietyof hal­ lucinogenic drugs such as PCP, LSD, DET, DMT, MDA, MDMA, TMA, PHP, PCE, DMA, psilocybin, and mescaline. The two most prevalent types of laborato­ ries in recent years have been engaged in the produc­ tion of methamphetamine and a.mphetamine. Illicit ciandestine laboratory 53 '-'r',~~ '~;_~c Drug Abuse , ' .. and lJr.;, .,., , ...,. .,' [J iI!." ,

By the National AIDS Program Office ._, i!J!- u.s. Public Health Service , ,~

An estimated 25 percent of all cases of acquired immu­ drug dependent, they are likely to engage in needle sharing. nodeficiency syndrome, or AIDS, are intravenous (IV) drug Thus, the key to eliminating needle sharing-and the asso­ abusers. This group is the second largest at risk for AIDS, ciated spread of AIDS-is drug abuse treatment to curb exceeded only by homosElxual and bisexual men. And the drug dependence. NIDA is working to find ways to get more numbers may be growin~l. Data for the first half of 1988 IV users into treatment and to develop new methods to fight show that IV drug abusers, made up about 31 percent of the drug addiction. total reported cases. Most non-drug users characteristically associate heroin with IV drug use. However, thousands of others inject ie••• the number of IV drug users with cocaine or amphetamines. Recent evidence suggests that AIDS is doubling every 14-16 months." IV cocaine use is increasing and that the AIDS virus is spreading in those users. One reason for this may be According to the National Institute on Drug Abuse because cocaine's effects last only a short time. When the (NIDA). There are 1.1 to 1.3 million IV drug users in the drug, which is a stimulant, wears off, users may inject again United States, and, so far, about 17,500 have developed and again, sharing a needle many times in a few hours. In AIDS. Thousands' more are infected with the virus that contrast, heroin users usually inject once and fall asleep. causes this fatal illness, which kills by destroying the body's ability to fight disease. ie, •• IV cocaine use is increasing and Currently, the number of IV drug users with AIDS is the AIDS virus is spreading in those doubling every 14-16 months. Although the numbers of IV users." drug users who carry the AIDS virus varies from region to region, in some places the majority may already be in­ The apparent increase in IV cocaine is especially worri­ fected. In New York City, for example, 60 percent of IV drug some, drug abuse experts say, because there are no users entering treatment programs have the AIDS virus. standard therapies for treating cocaine addiction. Until Among IV drug abusers, the AIDS virus is spread scientists find effective treatments for this problem, the primarily by needle sharing. As long as IV drug abusers are ability to control the spread of AIDS will be hampered.

54 State Drug Abuse Prevention and Treatment Coordinators

Alabama Commissioner Connecticut Executive Director Department of Mental Health Connecticut Alcohol and Drug and Mental Retardation Abuse Commission 200 Interstate Park Drive 999 Asylum Avenue P.O. Box 3710 Third Floor Montgomery, Alabama 36193 Hartford, CT 06105 (205) 271-9209 (203) 566-4145

Alaska Coordinator Delaware Chief Office of Alcoholism and Bureau of Alcoholism and Drug Abuse Drug Abuse Department of Health and 1901 North DuPont Highway Social Services Newcastle, DE 19720 Pouch H-05F (302) 421-6101 Juneau, Alaska 99811-0607 (907) 586-6201 District Chief ,,')f Health Planning and Arizona Manager Columbia Development Drug Abuse Section 1875 Connecticut Ave., N.W. Department of Health Services Suite 823 Division of Behavioral Health Washington, DC 20009 Services (202) 673-7481 411 North 24th St. Phoenix, Arizona 85008 Florida Director (602) 220-6478 Drug Abuse Program 1317 Winewood Blvd. Arkansas Director Building 6, Room 156 Office on Alcohol and Drug Tallahassee, FL 32301 Abuse Prevention (904) 488-0900 400 Donaghey Plaza, N. P.O. Box 1437 Georgia Director Little Rock, AR 72203-1437 Alcohol and Drug Section (501) 371-2603 Division of Mental Health, Mental Retardation and California Director Substance Abuse Department of Alcohol and Department of Human Drug Programs Resources 111 Capitol Mall Suite 319 Sacramento, CA 95814 878 Peach Tree St. N.E. (916) 322-6690 Atlanta, GA 30309 (404) 894-4785 Colorado Director Alcohol and Drug Abuse Hawaii Branch Chief Division Alcohol and Drug Abuse Branch Department of Health Department of Health 4210 East 11th Ave. P.O. Box 3378 Denver, CO 80220 Honolulu, HI 96801 (303) 320-8333 (808) 548-4280 55 Idaho Director Bureau of Substance Abuse Department of Health Maine Director and We-Ifare Office of Alcoholism and Drug 450 West State Street Abuse Prevention Boise, ID 83720 State House Station 11 (208) .334-5935 Augusta, ME 04333 (207) 289-2781 Illinois Director Department of Alcoholism Maryland Director and Substance Abuse Alcohol and Drug Abuse Suite 5-600 Administration 100 W. Randolph St. 201 W. Preston St. Chicago, IL 60610 Baltimore, MD 21201 (312) 917-3840 (301) 225-6910

Indiana Director Massachusetts Director Division of Addiction Services Division of Alcoholism and Department of Mental Health Drug Rehabilitation 117 East Washington St. 150 Tremont St. Indianapolis, IN 46204 6th Floor (317) 232-7816 Boston, MA 02111 (617) 727-8617 Iowa Director Iowa Division of Substance Michigan Director Abuse and Health Office of Substance Abuse Promotion Services 320 E. 12th Street Department of Public Health Des Moines, 10 P.O. Box 30195 (515) 281-3641 Lansing, Ml48909 (517) 335-8810 Kansas Commissioner Alcohol and Drug Abuse Minnesota Director Services Chemical Dependency Program 2700 West Sixth Street Division Biddle Building Department of Human Services Topeka, KS 66606 444 Layfayette Rd. (913) 296-3925 St. Paul, MN 51555 (612) 296-4610 Kentucky Manager Substance Abuse Division Mississippi Director Health Building-1 E Division of Alcohol and Drug 275 East Main Street Abuse Frankfort, KY 40621 Department of Mental Health (502) 564-2880 1500 Woolfolk Building Jackson, MS 39201 Louisiana Director (601) 359-1297 Department of Health and Hospitals Missouri Director Office of Prevention and Division of Alcohol and Recovery from Drug Abuse Alcohol and Drug Abuse Department of Mental Health Baton Rouge Area Substance 1915 Southridge Dr. Abuse Clinic P.O. Box 687 Baton Rouge, LA 70806 Jefferson City, MO 65102 56 (504) 342-6685 (314) 751-4942 ------

New York Assistant Director Division of Substance Abuse Services Executive Park South Box 8200 Montana Administrato r Albany, NY 12203 Alcohol and Drug Abuse (518) 457-7629 Division Department of Institutions North Carolina Deputy Director 1539 11th Ave. Alcohol and Drug Abuse Helena, MT 59620 Services (406) 444-3904 Division of Mental Health, Mental Retardation, Nebraska Director and Substance Abuse Division of Alcoholism and Services Drug Abuse 325 North Salisbury St. Department of Public Raleigh, NC 27611 Institutions (919) 733-4670 P.O. Box 94728 Lincoln, NB 68509 North Dakota Director (402) 471-2851 Division of Alcoholism and Drug Abuse Nevada Chief Department of Human Services Bureau of Alcohol and State Capitol, Judicial Wing Drug Abuse Bismarck, ND 58505 Department of Human (701) 224-2769 Resources Room 500 Ohio Chief 505 East King St. Bureau of Drug Abuse Carson City, NV 89'710 170 North High St. (702) 885-4790 3rd Floor Columbus, OH 43215 New Hampshire Director (614) 466-7893 Office of Alcohol and Drug Abuse Prevention Oklahoma Director Health and Welfare Building Alcohol and Drug Programs 6 Hazen Dr. Department of Mental Health Concord, NH 03301-6525 P.O. Box 53277, Capitol Station (60~j) 271-4627 1200 N. East 13th Oklahoma City, OK 73152 New Jersey Director (405) 271-7474 Division of Narcotic and Drug Abuse Control Oregon Associate Administrator Department of Health State Alcohol and Drug Programs CN 362 Office Trenton, NJ 08625 1178 Chemeketa, NE Salem (609) 292-5760 Salem, OR 97310 (503) 378-2163 New Mexico ChiElf Substance Abuse Bureau Pennsylvania Deputy Secretary Behavioral Health Services Drug and Alcohol Programs Division Department of Health P.O. Box 968 P.O. Box 90 Santa Fe, NM 87504-0968 Harrisburg, PA ·17108 (505) 827-2587 (717) 787-9857 57 Rhode Island Assistant Director Department of Mental Health, Mental Retardation and Hospitals Division of Substance Abuse Substance Abuse Administration Vermont Director Building Office of Alcohol and Drug Cranston, RI 02920 Abuse Programs (401) 464-2091 103 South Main St. Waterbury, VT 05676 South Carolina Director (802) 241-2170 South Carolina Commission on Alcohol and Drug Abuse Virginia Assistant Commissioner Suite 300 Department of Mental Health, 3700 Forest Dr. Mental Retardation and Columbia, SC 29204 .. Substance Abuse (803) 734-9520 109 Governor St. (ZIP 23214) P.O. Box 1797 (ZIP 23219) South Dakota Director Richmond, VA Division of Alcohol and (804) 786-3906 Drug Abuse Joe Foss Building Washington Director Room 125 Bureau of Alcoholism and 523 East Capitol St. Substance Abuse Pierre, SD 57501-3182 Department of Social and (605) 773-3123 Health Services Mail Stop OB44W Tennessee Assistant Commissioner Olympia, WA 98504 Alcohol and Drug Abuse (206) 753-5866 Services Department of Mental Health West Virginia Director and Mental Retardation Division of Alcohol and Drug Doctor's Building Abuse 4th Floor State Capitol 706 Church St. 1800 Washington St., East Nashville, TN 37219-5393 Charleston, WV 25305 (615) 741-1921 (304) 348-2276

Texas Director Wisconsin Director Texas Commission on Alcohol Bureau of Alcohol and Other and Drug Abuse Drug Abuse Prevention Department 1 West Wilson St. 1705 Guadalupe St. P.O. Box 7851 Austin, TX 78701 Madison, WI 53707 (512) 463-5510 (608) 266-2717

Utah Director Wyoming Director Division of Alcoholism and Drugs Alcohol and Drug Abuse 120 North 200 West, 4th Floor Programs P.O. Box 45500 350 Hathaway Building Salt Lake City, Utah 84145-0500 Cheyenne, WY 82002-0710 58 (801) 538-3939 (307) 777-7115 Drug Enforcement Adm inistration Division Offices

Atlanta Field Division Miami Field Division Richard B. Russell Federal Building 8400 N.W. 53rd St. 75 Spring St. S.W., Room 740 Miami, FL 33166 Atlanta, GA 30303 (305) 591-4870 (404) 331-4401 Newark Field Division Boston Field Division 970 Broad St. Rm. G-64 JFK Federal Building 806 Federal Office Building Boston, MA 02203 Newark, NJ 07102 (617) 565-2800 (201) 645-6060

Chicago Field Division New Orleans Division 500 Dirksen Federal Building 1661 Canal St. 219 S. Dearborn St. Suite 2200 Chicago, IL 60604 New Orleans, LA 70112 (312) 353-7875 (504) 589-3894

Dallas Field Division New York Field Division 1880 Regal Row 555 W. 57th St. Dallas, TX 75235 Suite 1900 (214) 767-7151 New York, NY 10019 (212) 399-5151 Denver Field Division 721 19th St., Room 316 (ZIP 80201) Philadelphia Field Division P.O. Box 1860 (ZIP 80202) 10224 William J. Green Federal Building Denver, CO 600 Arch St. (303) 844-3951 Philadelphia, PA 19106 (215) 597-9530 Detroit Field Division 357 Federal Building Phoenix Field Division 231 West Lafayette One North First St. Detroit, MI 48226 Suite 201 (313) 226-7290 Phoenix, AZ 85004 (602) 261-4866 Houston Field Division 333 West Loop North San Diego Field Division Suite 300 402 W. 35th St. Houston, TX 77024 National City, CA 92050 (713) 681-1771 (619) 585-4200

Los Angeles Field Division Suite 800 350 South Figueroa St. Los Angeles, CA 90071 (213) 894-2650 59 San Francisco Field Division St. Louis Field Division Room 12215 7911 Forsythe Blvd. 450 Golden Gate Ave. Suite 500 P.O. Box 36035 United Missouri Bank Bldg. San Francisco, CA 94102 St. Louis, MO 63105 (415) 556-6771 (314) 425-3241

Seattle Field Division Washington Field Division Suite 301 Room 2558 220 West Mercer 400 Sixth St., S.W. Seattle, WA 98119 Washington, DC 20024 (206) 442-5443 (202) 724-7834

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