DOCUMENT RESUME

ED 475 893 CG 032 366

AUTHOR Joseph, Donald E., Ed. TITLE Drugs of Abuse. INSTITUTION Drug Enforcement Administration (Dept. of Justice), Washington, DC. PUB DATE 2003-02-00 NOTE 69p. AVAILABLE FROM For full text: http://www.usdoj.gov/dea/pubs/ abuse/index.html. PUB TYPE Guides Non-Classroom (055) EDRS PRICE EDRS Price MF01/PC03 Plus Postage. DESCRIPTORS *Drug Education; *Drug Legislation; *Illegal Drug Use; ; Marijuana; Narcotics IDENTIFIERS ---; Steroids

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

Reproductions supplied by EDRS are the best that can be made from the original document. U.S. Department of Justice Drug Enforcement Administration

wwwdea.gov February 2003

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U S DEPARTMENT OF EDUCATION (Ace of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) A This document has been reproduced as received from the person or organization originating it Minor changes have been made to improve reproduction quality

Points of view or opinions stated in this document do not necessarily represent official OERI position or policy

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3ES COPY AVAILABLE 2 DRUGS OF ABUSE www.d ea. g ov PRODUCED & PUBLISHED BY Drug Enforcement Administration U.S. Department of Justice Arlington, Virginia 22202

Donald E. Joseph Editor

Charles J. Lyles Art Director

Suzanne T. Vigil Design and Layout

Gretchen Feussner Pharmacologist

Drug and Chemical Evaluation Staff Text and Research

National Guard Counterdrug Program

3 DRUGS OF BUS:

FROM THE ADMINISTRATOR

I am pleased to introduce this latest edition of Around the world and across the nation, the DEA Drugs of Abuse.This DEA magazine delivers clear, is working hard to identify and arrest the traffickers scientific information about drugs in a factual, of these dangerous drugs. We're succeeding in straightforward way, combined with scores of that. But just as important, we're working hard to precise photographs shot to scale. educate America's youth, their parents, and their teachers about the very real dangers of club drugs I believe that Drugs of Abuse fulfills an important and all other illegal drugs. Drugs of Abuse is an educational need in our society because of a important step in that direction. For additional growing trend to view the abuse of drugs as information about drugs, I invite you to explore our a harmless personal decision. Unfortunately, web site at: www.dea.gov. that kind of misinformation can have lethal consequences. For example, there was Brittney I would like to express my appreciation to the Chambers in Colorado who died after taking a National Guard for joining us as partners in the single Ecstasy pill on her 16th birthday. A friend publication of this magazine. And I am deeply who was with Brittney when she took the Ecstasy grateful to the dedicated men and women of the later said, "I'd heard nothing bad would happen DEA who work hard every day to keep our schools when you took Ecstasy." and neighborhoods safe and secure.

There is also a widespread belief that marijuana is a I am optimistic about winning our national struggle benign drug that should be excluded from the anti- against drugs, overcoming the crime and terrorism drug effort.However, we know that marijuana they spawn, and restoring the broken families they impairs judgement, makes workers groggy, and leave in their wake. Together, we can make a dif- renders motor vehicle drivers unsafe on America's ference. Thank you. highways. In addition, anti-social behavior among youth is clearly linked to frequency of marijuana use. The difficult truth is that there is no safe way John B. Brown, III to take marijuana, Ecstasy, or any other illegal Acting Administrator drug. CONTENTS DRUGS OF ABUSE

THE CONTROLLED STIMULANTS 35 SUBSTANCES ACT 1 Federal Traficking Penalties (Chart) Methcathinone Federal Traficking Penalties- Marijuana (Chart) Anorectic Drugs Regulatory Requirements (Chart) Khat

CHEMICAL CONTROL 10 CANNABIS 42 Marijuana INTRODUCTION TO Hashish DRUG CLASSES 12 Hashish Oil

HALLUCINOGENS.. . .46 NARCOTICS ...... 14 LSD Narcotics of Natural Origin & Psiocyn and Other Tryptamines Peyote & MDMA (Ecstasy) & Thebaine Other Semi-Synthetic Narcotics (PCP) & Related Drugs STEROIDS 53 Hydrododone Synthetic Narcotics Meperidine INHALANTS...... 56 Narcotics Treatment Drugs DOMESTIC DEA Dextroproxyphene OFFICES 58 NATIONAL GUARD 59 Counterdrug Coordinators Drug Demand Reduction DEPRESSANTS 26 Administrators Controlled Substances Uses and Effects (Chart) Bensodiazepines Gamma Hydroxybutric Acid Hydrate Glutethimide 7 Newly Marketed Drugs CONTROLLED SUBSTANCES The Controlled Substances Act /CSAI, Title 11 of the Comprehensive Drug Abuse Prevention ACTand Control Act of 1970, is the legal foun- dation of the government fight against abuse of drugs and other substances.This law is a consolidation of numerous laws regulating the manufacture and distribution of narcotics, stimulants, depressants, anabolic steroids and chemicals used in the illicit pro- duction of controlled substances. DRUGS OF ABUSE Once DEA has collected the necessary data, the Ad- Controlling Drugs or ministrator of DEA, by authority of the Attorney Gen- Other Substances eral, requests from HHS a scientific and medical evalu- ation and recommendation as to whether the drug or other substance should be controlled or removed from FORMAL SCHEDULING control. This request is sent to the Assistant Secretary The CSA places all substances which were in some of Health of HHS. HHS solicits information from the manner regulated under existing Federal law into Commissioner of the Food and Drug Administration one of five schedules. This placement is based upon (FDA), evaluations and recommendations from the the substance's medical use, potential for abuse, and National Institute on Drug Abuse, and on occasion safety or dependence liability. The Act also provides a from the scientific and medical community at large. mechanism for substances to be controlled, or added The Assistant Secretary, by authority of the Secretary, to a schedule; decontrolled, or removed from control; compiles the information and transmits back to DEA a and rescheduled or transferred from one schedule to medical and scientific evaluation regarding the drug another. The procedure for these actions is found in or other substance, a recommendation as to whether Section 201 of the Act (21 U.S.C. 81 1). the drug should be controlled, and in what schedule it should be placed. Proceedings to add, delete, or change the schedule of a drug or other substance may be initiated by The medical and scientific evaluations are binding the Drug Enforcement Administration (DEA), the on DEA with respect to scientific and medical mat- Department of Health and Human Services (HHS), ters. The recommendation on scheduling is binding or by petition from any interested person: the manu- only to the extent that if HHS recommends that the facturer of a drug, a medical society or association, substance not be controlled, DEA may not control a pharmacy association, a public interest group con- the substance. cerned with drug abuse, a state or local government agency, or an individual citizen. When a petition is Once DEA has received the scientific and medical received by DEA, the agency begins its own inves- evaluation from HHS, the Administrator will evaluate tigation of the drug. all available data and make a final decision whether to propose that a drug or other substance should The agency also may begin an investigation of a be controlled and into which schedule it should be drug at any time based upon information received placed. from law enforcement laboratories, state and local law enforcement and regulatory agencies, or other The threshold issue is whether the drug or other sub- sources of information. stance has potential for abuse. If a drug does not have

6 a potential for abuse, it cannot be con- findings are not required for each trolled. Although the term "potential factor. These factors are listed in Sec- for abuse" is not defined in the CSA, tion 201 (c), (21 U.S.C. 811 (c)), of there is much discussion of the term the CSA and are as follows: in the legislative history of the Act. II)The drugs actual or relative The following items are indicators potential for abuse. that a drug or other substance has a (2) Scientific evidence of the drug.- potential for abuse: pharmacological effects.The

( I ) There is evidence that individuals state of knowledge with respect are taking the drug or other sub- to the effects of a specific drug stance in amounts sufficient to is, of course, a major consid- create a hazard to their health or eration. For example, it is vital to the safety of other individuals to know whether or not a drug or to the community; or has a hallucinogenic effect if it Over 60 percent of the heroin that is (2) There is significant diversion of is to be controlled because of sold in the United States originates in the drug or other substancethe poppy fields of South America. that. The best available knowl- from legitimate drug channels; edge of the pharmacological or properties of a drug should be (3) Individuals are taking the drug considered. or other substance on their (3) The state of current scientific own initiative rather than on the knowledge regarding the sub- basis of medical advice from a stance. Criteria (2) and (3) are practitioner licensed by law to closely related.However, (2) administer such drugs; or is primarily concerned with (4)The drug is a new drug so re- pharmacological effects and lated inits action to a drug or (3) deals with all scientific other substance already listed knowledge with respect to the as having a potential for abuse substance. to make it likely that the drug (4) Its history and current pat- will have the same potential for I tern of abuse.To determine abuse as such drugs, thus mak-The milky fluid that oozes from the whether or not a drug should ing it reasonable to assume thatseedpod of the poppy is opium. be controlled, it is important to there may be significant diver- 41VMd.% know the pattern of abuse of sions from legitimate channels, that substance, including the significant use contrary to or socio-economic characteristics without medical advice, or that of the segments of the popula- it has a substantial capability of tion involved in such abuse. creating hazards to the health of (5) The scope, duration, and signifi- the user or to the safety of thet cance of abuse. In evaluating community. Of course, evidence existing abuse, the Administra- of actual abuse of a substance tor must know not only the is indicative that a drug has a pattern of abuse but whether potential for abuse. the abuse is widespread.In reaching his decision, the In determining into which schedule Administrator should consider a drug or other substance should the economics of regulation be placed, or whether a substance and enforcement attendant to should be decontrolled or such a decision.In addition, rescheduled, certain factors areHeroin is manufactured in remote he should be aware of the "laboratories" using rudimentary required to be considered. Specificequipment. social significance and impact

2 of such a decision upon those people, especially the young, Schedule II that would be affected by it. The drug or other substance has a (6) What, if any, risk there is to the high potential for abuse. public health. If a drug creates The drug or other substance has a dangers to the public health, currently accepted medical use in in addition to or because of treatment in the United States or its abuse potential, then these a currently accepted medical use dangers must also be consid- with severe restrictions. ered by the Administrator. Abuse of the drug or other sub-

171 The drug's psychic or physi- stance may lead to severe psycho- ological dependence liability. logical or . There must be an assessment Schedule II substances include of the extent to which a drug is morphine, PCP, cocaine, metha- physically addictive or psycho-Heroin can then be pressed into done, and . logically habit-forming, if such bricks for bulk shipment to destination information is known. countries. Schedule Ill

18) Whether the substance is The drug or other substance has an immediate precursor of a a potential for abuse less than substance already controlled. the drugs or other substances in The CSA allows inclusion of Schedules I and II. immediate precursors on this The drug or other substance has a basis alone into the appropri- currently accepted medical use in ate schedule and thus safe- treatment in the United States. guards against possibilities of Abuse of the drug or other sub- clandestine manufacture. stance may lead to moderate or After considering the above listed low physical dependence or high factors, the Administrator must psychological dependence. make specific findings concerning Anabolic steroids, codeine and the drug or other substance. This with or Ty- will determine into which schedule lenol®, and some barbiturates are the drug or other substance will Schedule III substances. In another method of smuggling heroin, be placed.These schedules arecouriers swallow heroin-filled latex established by the CSA. They are balloons before boarding commercial Schedule IV as follows: airlines. The drug or other substance has a low potential for abuse relative Schedule I to the drugs or other substances in The drug or other substance has Schedule III. a high potential for abuse. The drug or other substance has a The drug or other substance has currently accepted medical use in no currently accepted medical treatment in the United States. use in treatment in the United Abuse of the drug or other States. substance may lead to limited There is a lack of accepted physical dependence or psycho- safety for use of the drug or logical dependence relative to other substance under medical the drugs or other substances in supervision. Schedule III. Some Schedule I substances are Included in Schedule IV are. heroin, LSD, marijuana, and Darvon ®,Talwin ®, Equanil® ,Va- methaqualone. Mexican brown heroin and Southeast lium® and Xanax ®. Asian heroin.

3 Schedule V Judge, at the close of the hearing, The drug or other substance has prepares findings of fact and con- a low potential for abuse relative clusions of law and a recommended to the drugs or other substances decision which is submitted to the in Schedule IV. Administrator of DEA. The Adminis- The drug or other substance has a trator will review these documents, currently accepted medical use in as well as the underlying material, treatment in the United States. and prepare his/her own findings of Abuse of the drug or other sub- fact and conclusions of law (which stances may lead to limited phys- may or may not be the same as ical dependence or psychological those drafted by the Administrative dependence relative to the drugs Law Judge). The Administrator then or other substances in Schedule publishes a final order in the Federal IV. Register either scheduling the drug Over-the-counter cough medi- or other substance or declining to cines with codeine are classified do so. The Upper Huallaga Valley of Peru is in Schedule V. the primary source of the coca leaf. Once the final order is published in When the Administrator of DEA has the Federal Register, interested par- determined that a drug or other ties have 30 days to appeal to a U.S. substance should be controlled, Court of Appeals to challenge the decontrolled, or rescheduled, a pro- order.Findings of fact by the Ad- posal to take action is published in ministrator are deemed conclusive if the Federal Register The proposal supported by "substantial evidence". invites all interested persons to file The order imposing controls is not comments with DEA. Affected parties stayed during the appeal, however, may also request a hearing with DEA. unless so ordered by the Court. If no hearing is requested, DEA will evaluate all comments received andrt Emergency or Temporary publish a final order in the Federal Scheduling Register, controlling the drug as pro- The CSA was amended by the posed or with modifications based Comprehensive Crime Control Act After they are picked, coca leaves are upon the written comments filed.dried in the open air. of 1984. This Act included a provi- This order will set the effective dates sion which allows the Administrator for imposing the various require- of DEA to place a substance, on a ments imposed under the CSA. temporary basis, into Schedule I when necessary to avoid an immi- If a hearing is requested, DEA will nent hazard to the public safety. enter into discussions with the party or parties requesting a hearing in an This emergency scheduling au- attempt to narrow the issue for litiga- thority permits the scheduling of tion. If necessary, a hearing will then a substance which is not currently be held before an Administrative Law controlled, is being abused, and Judge. The judge will take evidence is a risk to the public health while on factual issues and hear arguments the formal rule making procedures on legal questions regarding the con- described in the CSA are being con- trol of the drug. Depending on the ducted. This emergency scheduling scope and complexity of the issues, applies only to substances with no the hearing may be brief or quite 3 accepted medical use. A temporary extensive.The Administrative LawCoca leavesare "stomped" in crude pits scheduling order may be issued for called pozos as part of the process to extract alkaloids.

4 one year with a possible extension of up to six months if formal scheduling REGULATION procedures have been initiated. The The CSA creates a closed system of proposal and order are published in distribution for those authorized to the Federal Register as are the pro- handle controlled substances. The posals and orders for formal schedul- cornerstone of this system is the reg- ing. [21 U.S.C. 811 (h)j istration of all those authorized by DEA to handle controlled substances. Controlled Substance Analogues All individuals and firms that are A new class of substances was created registered are required to maintain by the Anti-Drug Abuse Act of 1986. complete and accurate inventories Controlled substance analogue are and records of all transactions involv- substances which are not controlled ing controlled substances, as well as substances, but may be found in the security for the storage of controlled illicit traffic.They are structurally orThe process results in coca paste. substances. pharmacologically similar to Schedule I or II controlled substances and have Registration no legitimate medical use.A sub- Any person who handles or intends stance which meets the definition of to handle controlled substances a controlled substance analogue and must obtain a registration issued by is intended for human consumption DEA. A unique number is assigned is treated under the CSA as if it were a to each legitimate handler of con- controlled substance in Schedule I. trolled drugs: importer, exporter, [21U.S.C.802(32)(A).21U.S.C.813) manufacturer, distributor, hospital, pharmacy, practitioner, and research- International Treaty Obligations er. This number must be made avail- United States treaty obligations may able to the supplier by the customer require that a drug or other sub- prior to the purchase of a controlled stance be controlled under the CSA, substance. Thus, the opportunity for or rescheduled if existing controls are unauthorized transactions is greatly less stringent than those required by diminished. Powdered cocaine. a treaty. The procedures for these scheduling actions are found in Sec- Record keeping tion 201 (d) of the Act. [21 U.S.C. The CSA requires that complete and 811 (d)] accurate records be kept of all quanti- ties of controlled substances manu- The United States is a party to the factured, purchased, and sold. Each Single Convention on Narcotic Drugs substance must be inventoried every of 1961, designed to establish effec- two years. Some limited exceptions tive control over international and to the recordkeeping requirements domestic traffic in narcotics, coca may apply to certain categories of leaf, cocaine, and cannabis. A registrants. second treaty, the Convention on From these records itis possible to Psychotropic Substances of 1971, trace the flow of any drug from the which entered into force in 1976, time it is first imported or manufac- is designed to establish comparable tured through the distribution level, control over stimulants, depressants, to the pharmacy or hospital that and hallucinogens. Congress ratified dispensed it, and then to the actual The bright green plants in the center of this treaty in 1980. the photo are cannabis, hidden among patient who received the drug. The other foliage to avoid detection. mere existence of this requirement is

5 sufficient to discourage many forms supplier is held fully accountable of diversion.It actually serves large for any drugs which are shipped to drug corporations as an internal lor a purchaser who does not have a check to uncover diversion, such as valid registration. pilferage by employees. Manufacturers must submit periodic There is one distinction between reports of the Schedule I and II con- scheduled items for recordkeeping trolled substances they produce in requirements. Records for Schedule bulk and dosage forms.They also I and II drugs must be kept separate report the manufactured quantity and from all other records of the handler; form of each narcotic substance listed records for Schedule III,IV, and V in Schedules III, IV and V as well as substances must be kept in a "readily the quantity of synthesized psychotro- retrievable" form. The former method pic substances listed in Schedules I,II, Because of successful marijuana allows for more expeditious investiga-eradication efforts by law enforcement, III, and IV.Distributors of controlled tions involving the highly abusablemany illicit growers cultivate the plant substances must report the quantity substances in Schedules I and II. indoors. and form of all their transactions of controlled drugs listed in Schedules I Distribution and II and narcotics listed in Schedule The keeping of records is required for III.Both manufacturers and distribu- distribution of a controlled substance tors are required to provide reports of from one manufacturer to another, their annual inventories of these con- from manufacturer to distributor, and trolled substances. This data is entered from distributor to dispenser.In the into a system called the Automated case of Schedule I and II drugs, the Reports and Consolidated Orders supplier must have a special order System (ARCOS).It enables DEA to form from the customer. This order monitor the distribution of controlled form (DEA Form 222) is issued by substances throughout the country, DEA only to persons who are prop- and to identify retail level registrants erly registered to handle Schedules I that receive unusual quantities of and II.The form is preprinted with controlled substances. the name and address of the custom-In the past, it was the marijuana leaves er. The drugs must be shipped to thisthat were dried, crushed and smoked. Dispensing to Patients name and address. The use of this The dispensing of a controlled sub- device is a special reinforcement of stance is the delivery of the controlled the registration requirement; it makes substance to the ultimate user, who doubly certain that only authorized may be a patient or research subject. individuals may obtain Schedule I Special control mechanisms operate and II drugs. Another benefit of the here as well.Schedule I drugs are form is the special monitoring it per- those which have no currently ac- mits. The form is issued in triplicate: cepted medical use in the United the customer keeps one copy; two States; they may, therefore, be used copies go to the supplier who, after in the United States only in research filling the order, keeps a copy and situations.They generally are sup- forwards the third copy to the nearest plied by only a limited number of firms DEA office. For drugs in Schedules III, to properly registered and qualified IV and V no order form is necessary. researchers.Controlled substances The supplier in each case, however,Today, marijuana abusers prefer the may be dispensed by a practitioner by is under an obligation to verify thecolas, or buds of the plant, because of direct administration, by prescription, authenticity of the customer.Theits higher THC content. Leaves are nowor by dispensing from office supplies. discarded or used as filler.

6 Records must be maintained by the Quotas practitioner of all dispensing of con- DEA limits the quantity of Schedule trolled substances from office supplies I and II controlled substances which and of certain administrations. The may be produced in the United CSA does not require the practitioner States in any given calendar year. to maintain copies of prescriptions, By utilizing available data on sales but certain states require the use of and inventories of these controlled multiple copy prescriptions for Sched- substances, and taking into account ule II and other specified controlled estimates of drug usage provided substances. by the FDA, DEA establishes annual aggregate production quotas for The determination to place drugs on Schedule I and II controlled sub- prescription is within the jurisdiction stances. The aggregate production of the FDA.Unlike other prescrip- quota is allocated among the various tion drugs, however, controlled manufacturers who are registered substances are subject to additional to manufacture the specific drug. Marijuana buds are hung out to dry. restrictions. Schedule II prescription DEA also allocates the amount of orders must be written and signed < bulk drug which may be procured by the practitioner; they may not be by those companies which prepare telephoned into the pharmacy except the drug into dosage units. in an emergency. In addition, a pre- scription for a Schedule II drug may Security not be refilled; the patient must see DEA registrants are required by the practitioner again in order to ob- regulation to maintain certain tain more drugs. For Schedule III and security for the storage and dis- IV drugs, the prescription order may tribution of controlled substances. be either written or oral (that is, by Manufacturers and distributors of telephone to the pharmacy). In addi- Schedule I and II substances must tion, the patient may (if authorized by store controlled substances in spe- the practitioner) have the prescription cially constructed vaults or highly refilled up to five times and at anytime rated safes, and maintain electronic within six months from the date of the security for all storage areas. Lesser Marijuana is rolled into cigarettes and initial dispensing. smoked. physical security requirements ap- ply to retail level registrants such Schedule V includes some prescrip- as hospitals and pharmacies. All tion drugs and many over-the-coun- registrants are required to make ev- ter narcotic preparations, including ery effort to ensure that controlled antitussives and antidiarrheals. Even substances in their possession are here, however, the law imposes re- not diverted into the illicit market. strictions beyond those normally re- This requires operational as well as quired for the over-the-counter sales; physical security. For example, reg- for example, the patient must be at istrants are responsible for ensuring least 18 years of age, must offer some that controlled substances are distrib- form of identification, and have his or uted only to other registrants that her name entered into a special log are authorized to receive them, or to maintained by the pharmacist as part legitimate patients and consumers. of a special record.

Hollowed out cigars packed with marijuana are called blunts, and are gaining in popularity.

7 PENALTIES

The CSA provides penalties for unlawful manufac- There is also a provision in the law that makes public turing, distribution, and dispensing of controlled housing projects drug-free by evicting those residents substances. The penalties are basically determined who allow their units to be used for illegal drug ac- by the schedule of the drug or other substance, and tivity, and denies Federal benefits, such as housing sometimes are specified by drug name, as in the case assistance and student loans, to individuals convicted of mar juana. As the statute has been amended since of illegal drug activity. Depending on the offense, an its initial passage in 1970, the penalties have been individual may be prohibited from ever receiving any altered by Congress. The following charts are an benefit provided by the Federal Government. overview of the penalties for trafficking or unlawful distribution of controlled substances. This is not inclu- Personal Use Amounts sive of the penalties provided under the CSA. This section of the 1 988 Act allows the government to punish minor drug offenders without giving the User Accountability /Personal Use Penalties offender a criminal record if the offender is in pos- On November 19, 1988, Congress passed the Anti- session of only a small amount of drugs. This law is Drug Abuse Act of 1 988, P L. 100-690. Two sections designed to impact the "user" of illicit drugs, while of this Act represent the Federal Government's attempt simultaneously saving the government the costs of to reduce drug abuse by dealing not just with the a full-blown criminal investigation. person who sells the illegal drug, but also with the person who buys it.The first new section is titled Under this section, the government has the option "UserAccountability" and is codified at 21 U.S.C. § 862 of imposing only a civil fine on individuals possessing and various sections of Title 42, U.S.C. The second only a small quantity of an illegal drug. Possession involves "personal use amounts" of illegal drugs, and of this small quantity, identified as a "personal use is codified at 21 U.S.C. § 844a. amount" carries a civil fine of up to S 10,000.

User Accountability In determining the amount of the fine in a particular The purpose of User Accountability is to not only make case, the drug offender's income and assets will be the public aware of the Federal Governments position considered. This is accomplished through an admin- on drug abuse, but to describe new programs intend- istrative proceeding rather than a criminal trial, thus ed to decrease drug abuse by holding drug abusers reducing the exposure of the offender to the entire personally responsible for their illegal activities, and im- criminal justice system, and reducing the costs to the posing civil penalties on those who violate drug laws. offender and the government.

It is important to remember that these penalties are The value of this section is that it allows the gov- in addition to the criminal penalties drug abusers ernment to punish a minor drug offender without are already given, and do not replace those criminal saddling the offender with a criminal record.This penalties. section also gives the drug offender the opportunity to fully redeem himself or herself, and have all public The new User Accountability programs call for more record of the proceeding destroyed.If this was the instruction in schools, kindergarten through senior drug offender's first offense, and the offender has high, to educate children on the dangers of drug paid all fines, can pass a drug test, and has not been abuse. These programs will include participation by convicted of a crime after three years, the offender students, parents, teachers, local businesses and the can request that all proceedings be dismissed. local, state and Federal Government. If the proceeding is dismissed, the drug offender can User Accountability also targets businesses inter- lawfully say he or she had never been prosecuted, ested in doing business with the Federal Govern- either criminally or civilly, for a drug offense. ment.This program requires those businesses to maintain a drug-free workplace, principally Congress has imposed two limitations on this section's through educating employees on the dangers of use.It may not be used if (1) the drug offender has drug abuse, and by informing employees of the been previously convicted of a Federal or state drug penalties they face if they engage in illegal drug offense; or (2) the offender has already been fined activity on company property. twice under this section.

8 U.S. Department of Justice Drug Enforcement Administration Federal Trafficking Penalties Dr g Qua tity Quan rty Schedule

Methamphetamine 5 - 49 gms 50 gms or Schedule II pure or 50- more pure 499 gms or 500 gms mixture or more mixture

Heroin 100-999 1 kg or Schedule I gms mixture more mixture Not less than 5 Not less than 10 Not less than 10 Not less than 20 Cocaine 500-4,999 5 kgs or yrs and not more yrs and not more yrs and not more yrs and not more Schedule II gms mixture more than 40 yrs.If than life.If death than life.If death than life.If death mixture death or serious or serious injury, or serious injury, or serious injury, Cocaine Base 5- 49 gms injury, not less not less than life. 50 gms or not less than 20 not less than life. Schedule II mixture than 20 or more Fine of not more more or more than life. Fine of not more than life.Fine of than $4 million if mixture Fine of not more than $8 million if not more than $2 an individual, than $4 million if an individual, PCP 10- 99 gms 100 gms or million if an $10 million if an individual, $20 million if Schedule II pure or 100- more pure individual, $5 other than an $10 million if other than an 999 gms or 1 kg or million if other individual. other than an individual. mixture more than an individual. mixture individual.

LSD 1 9 gms 10 gms or Schedule I mixture more mixture

Fentanyl 40-399 gms 400 gms or Schedule II mixture more mixture Life imprisonment

Fentanyl Analogue 10 - 99 gms 100 gms or Schedule I mixture more mixture Others Any Not more than 20 Not more than 30 (Schedules I & II) yrs.If death or yrs.If death or

(Includes I gm or more ) serious injury, serious injury, not less than 20 life. Fine $2 yrs, not more million individual, than life.Fine $1 $10 million not million individual, individual. $5 million not individual. Off

Others Any Not more than 5 yrs. Fine not more Not more than 10 yrs. Fine not more than Schedule III than $250,000 individual, $1 million $500,000 individual, $2 million not individual. (Includes 30 mgs - 999 mgs flunitrazepam) not individual. Others* Any Not more than 3 yrs. Fine not more Not more than 6 yrs. Fine not more than $500,000 Schedule IV than $250,000 individual, $1 million individual, $2 million not individual. (Includes less than 30 mgs flunitrazepam) not individual. All Any Not more than 1 yr. Fine not more than Not more than 2 yrs. Fine not more than $200,000 Schedule V $100,000 individual, $250,000 not individual, $500,000 not individual. individual.

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

4111.1,

1 I

Quantity 1st Offense 2nd Offense M rjuana

Not less than 10 years, Not less than 20 years, not more than life not more than life 1,000 kgs or more mixture, If death or serious injury, not less If death or serious injury, or 1,000 than 20 years, not more than life then life or more plants Fine not more than $4 million individual, Fine not more than $8 million individual, $10 million other than individual $20 million other than individual

Not less than 5 years, Not less than 10 years, 100 kgs to not more than 40 years not more than life 999 kgs mixture, or If death or serious injury, not less If death or serious injury, 100-999 than 20 years, not more than life then life plants Fine not more than $2 million individual, Fine not more than $4 million individual, $5 million other than individual $10 million other than individual

Bf 50 to 99 kgs mixture 50 to 99 Not more than 20 years Not more than 30 years plants If death or serious injury, not less If death or serious injury, then life More than10 kgs than 20 years, not more than life

Fine $1 million individual, Fine $2 million individual, $5 million other than individual $10 million other than individual More than 1 kg

Less than 50 kgs mixture 1 to 49 Not more than 5 years Not more than 10 years plants

Fine not more than $250,000, Fine $500,000 individual, 10 kgs or less $1 million other than individual $2 million other than individual

1 kg or less

*Includes Hashish and Hashish Oil (Marijuana is a Schedule I Controlled Substance) 15 a a

D - - 42. 4111P 0 ' a

Schedule Schedule Schedule Schedule Schedule III IV V R gistration

Required Required Required Required Required

Recordke

Readily Readily Readily Separate Separate retrievable retrievable retrievable Distribution Rest icti ns Records Records Order forms Order forms Records required required required

aspenig Limits Rx. written or Rx. written or OTC (Rx drugs Research use Rx: written, oral; refills oral; refills limited to only no refills Note 1 Note 1 M D 's order) Manufacturing Securit

Vault/safe Vault/safe Secure storage Secure storage Secure storage area area area Manu cturing ot NO but some NO but some NO but some Yes Yes drugs limited drugs limited drugs limited by Schedule II by Schedule II by Schedule II Import/Export ar -o is

Permit to Permit Permit Permit Permit import, declara- tion to export mport/Exps No areotic

Permit Permit Note 2 Declaration Declaration ep,orto D by Manufactureristributor

Yes Yes Yes Manufacturer Manufacturer only only epo s to by Manufacturer/Distributo No -aotic Yes Yes Note 3 Note 3 No

Note 1- With medical aurthorization, refills up to 5 in 6 months Note 3 - Manufacturer reports required for specific drugs Note 2 Permit for some drugs, declaration for others 16 U.S. Chemical Control

DRUGS OF ABUSE

The Controlled Substances Act (CSA) is the principal The controls placed on chemicals are substan- federal law directed at combating the illicit manu- tially less than those imposed on controlled drugs facture and distribution of controlled drugs in the because most of the chemicals have legitimate United States.Since its passage in 1970, the CSA industrial applications. For this reason, the term has been amended on a number of occasions. "regulated" more appropriately describes chemicals The most recent change in the scope of the CSA covered under the CSA as compared to the term is the implementation of amendments and regu- "controlled" that is used for drugs.Several items lations regarding chemicals and equipment used that are regulated as chemicals under the CSA are in the illicit production of controlled substances. also non-controlled ingredients in drug products The clandestine production of drugs is depen- lawfully marketed under the Federal Food, Drug dent on the availability of chemicals necessary to and Cosmetic Act and are, therefore, widely avail- accomplish the illicit activity. Most of the drugs in able to the general public. Examples of these prod- the illicit traffic, with the exception of marijuana, ucts include over-the-counter (OTC) medications require chemicals to be produced. For example, containing ephedrine, pseudoephedrine, and/or although cocaine is produced naturally in the coca phenylpropanolamine. plant, large amounts of chemicals are needed to successfully extract the drug and purify it for the DEA chemical control was initiated in the United illicit market. States with the passage of the Chemical Diversion and Trafficking Act of 1988 (CDTA) that became effective on August 1,1989. The initial legislation was drafted in 1985. The CDTA regulated 12 pre- cursor chemicals, eight essential chemicals, tablet- ing machines, and encapsulating machines by imposing record keeping and import/export report- ing requirements on transactions involving these materials. U.S. companies were the main source of tons of chemicals used in the production of cocaine in the Andean countries of South America. The principal chemicals used in the production of cocaine at that time included , methyl ethyl ketone, methyl isobutyl ketone, ethyl ether, potas- sium permanganate, hydrochloric acid, and sulfu- ric acid. Soon after the CDTA became effective, the quantity of many of these chemicals exported from the United States declined significantly.

10

17 Cocaine traffickers reacted to the reduction in the the authority to remove the exemption for any other availability of U.S. chemicals for illicit production by drugs containing listed chemicals if it was shown that developing new sources of supply in other parts of they were being diverted for the illicit production of the world. The U.S. Government, with the leadership controlled substances. The DCDCA required that all and assistance of the DEA, responded by eliciting the manufacturers, distributors, importers, and exporters support of the international community for world- of List I chemicals be registered with the DEA and wide chemical control. The international community that bulk manufacturers of List I and List II chemicals responded by incorporating Article 12 into the U.N. report on the total quantity of listed chemicals pro- Convention Against Illicit Drug Traffic of 1988. Article duced during the year. Record keeping and reporting 12 established chemical controls on a list of 22 chemi- requirements for transactions in single-entity ephed- cals used in the production of heroin, cocaine, LSD, rine products were also imposed by the DCDCA. PCP, , methamphetamine, MDMA and related drugs, and numerous other clandestinely pro- Methamphetamine traffickers quickly reacted to the duced drugs. The DEA has sponsored a number of provisions of the DCDCA by switching to single-entity international meetings and training seminars to edu- pseudoephedrine products and combination prod- cate other nations in the benefits of chemical control ucts of ephedrine. The Comprehensive Methamphet- as a tool to fight drug trafficking.DEA efforts have amine Control Act of 1996 (MCA) was passed to coun- resulted in chemical control legislation and active pro- ter the traffickers' response to the DCDCA. The MCA grams to prevent the diversion of chemicals used in expanded regulatory controls on all lawfully marketed the clandestine production of drugs in many nations. drug products containing ephedrine, pseudoephed- rine, and phenylpropanolamine, and it increased pen- The Chemical Diversion and Trafficking Act (CDTA) alties for the trafficking and manufacturing of meth- also had an initial impact on the number of clan- amphetamine and listed chemicals.The MCA also destine methamphetamine laboratories in the United made it unlawful for any person to distribute a "labo- States.In the first three years after the law was ratory supply" to a person who uses, or attempts to passed, the number of clandestine laboratories seized use, that "laboratory supply" to manufacture a con- by the DEA declined by 61 percent. In addition, inju- trolled drug or listed chemicals with reckless disregard ries attributed to illicitly manufactured controlled sub- for the illegal uses to which such "laboratory supply" stances that were reported to the Drug Abuse Warn- will be put.The Special Surveillance List was pub- ing Network (DAWN) declined by almost 60 percent lished by the Attorney General and consisted of all during the same time period. listed chemicals, all mixtures, and all OTC products and dietary supplements that contain listed chemicals, The provisions of the CDTA regarding bulk ephedrine 28 other chemicals frequently used in the clandes- and pseudoephedrine caused methamphetamine traf- tine production of controlled drugs, or listed chemi- fickers to look for other sources of the precursors. The cals and 4 pieces of laboratory equipment commonly traffickers noted that the CDTA contained an exemp- found at clandestine drug laboratories.Individuals tion for over-the-counter (OTC) products that con- who violate the "laboratory supply" provision of the tained regulated chemicals. They took advantage of MCA are subject to a maximum civil fine of $25,000. this loophole by turning to single entity OTC ephed- Businesses that violate the provision are subject to a rine tablets and capsules whose single active ingredi- maximum civil fine of $250,000. ent was ephedrine as a source of precursor material for the illicit production of methamphetamine. Ready access to chemical supplies is critical to drug traffickers. Traffickers continuously look for loopholes Federal legislation was passed in 1993 in response in legislation and new methods of clandestine pro- to the methamphetamine traffickers' switch to OTC duction routes in an effort to continue their illegal ephedrine products. The legislation was the Domestic activity. The DEA has embraced chemical control as Chemical Diversion and Control Act of 1993 (DCDCA) an important tool in reducing the availability of clan- that became effective on April 16, 1994. The DCDCA destinely produced drugs and is committed to depriv- eliminated the CDTA terminology of "precursors" and ing drug traffickers of the chemicals needed to manu- "essential" for chemicals regulated under that act and facture illicit drugs. Currently, ListI and List II of the replaced them with the terms "List I" and "List II" chem- CSA contain 35 chemicals. icals.The DCDCA also removed the exemption for OTC single entity ephedrine tablets, thus closing the loophole left by the CDTA. In addition, it gave the DEA

18 v

INTRODUCTION TO DRUG CLASSES

DRUGS OF ABUSE

The Controlled Substances Act (CSA) regulates five under control in the CSA are prescribed and used classes of drugs: narcotics, depressants, stimulants, by patients for medical treatment, the use of these hallucinogens, and anabolic steroids. Each class same pharmaceuticals outside the scope of sound has distinguishing properties, and drugs within medical practice is drug abuse. each class often produce similar effects. However, all controlled substances, regardless of class, share In addition to having abuse potential, most con- a number of common features.It is the purpose of trolled substances are capable of producing depen- this introduction to familiarize the reader with some dence, either physical or psychological.Physical of these shared features and to give definition to dependence refersto the changes that have terms (printed in bold) frequently associated with occurred in the body after repeated use of a drug these drugs. that necessitates the continued administration of the drug to prevent a withdrawal syndrome. With the exception of anabolic steroids, drugs in the This withdrawal syndrome can range from mildly other classes are utilized to alter mood, thought, unpleasant to life-threatening and is dependent and feeling through their actions on the central on a number of factors.The type of withdrawal nervous system (brain and spinal cord). For experienced is related to the drug being used; the example, some of these drugs alleviate pain, anxi- dose and route of administration; concurrent use of ety, or depression. Some induce and others other drugs; frequency and duration of drug use; energize. Though therapeutically useful, the "feel and the age, sex, health, and genetic makeup of good" effects of these drugs contribute to their the user. Psychological dependence refers to the abuse. The extent to which a substance is reliably perceived "need" or "craving" for a drug. Individuals capable of producing intensely pleasurable feelings who are psychologically dependent on a particular (euphoria) increases the likelihood of that substance substance often feel that they cannot function with- being abused. out continued use of that substance. While physical dependence disappears within days or weeks after When drugs are used in a manner or amount drug use stops, psychological dependence can last inconsistent with the medical or social patterns of much longer and is one of the primary reasons for a culture, it is called drug abuse.In legal terms, relapse (initiation of drug use after a period of absti- the non-sanctioned use of substances controlled nence). in Schedules I through V of the CSA is considered drug abuse.While legal pharmaceuticals placed Contrary to common belief, physical dependence

12

19 is not addiction. While addicts are usually physically illicit drug by the time they leave high school and dependent on the drug they are abusing, physical about 25 percent of all seniors are current (within dependence can exist without addiction. For exam- the past month) users.The behaviors associated ple, patients who take narcotics for chronic pain with teen and preteen drug use often result in tragic management or to treat anxiety consequences with untold harm to the community, are likely to be physically dependent on that medi- themselves, and their families.For example, an cation.Addictionis defined as compulsive drug- analysis of data from the National Household Survey seeking behavior where acquiring and using a drug on Drug Abuse indicates that youngsters between becomes the most important activity in the user's the ages of 12 and I7 who have smoked marijuana life. This definition implies a loss of control regarding within the past year are more than twice as likely to drug use, and the addict will continue to use a drug cut class, steal, and destroy property than are those despite serious medical and/or social consequences. who did not smoke marijuana. The more frequently The National Institute on Drug Abuse (NIDA) esti- a youth smokes marijuana, the more likely he or she mates that about five million Americans suffer from is to engage in these antisocial behaviors. drug addiction. In the sections that follow, each of the five classes Individuals that abuse drugs often have a preferred of drugs is reviewed and various drugs within each drug that they use, but may substitute other drugs class are profiled.Although marijuana is classified that produce similar effects (often found in the same in the CSA as a hallucinogen, a separate section is drug class) when they have difficulty obtaining their dedicated to that topic. There are also a number drug of choice. Drugs within a class are often com- of substances that are abused but not regulated pared with each other with terms likepotencyand under the CSA. and tobacco, for example, efficacy.Potency refers to the amount of a drug are specifically exempt from control by the CSA.In that must be taken to produce a certain effect, while addition, a whole group of substances called inhal- efficacy refers to whether or not a drug is capable ants are commonly available and widely abused by of producing a given effect regardless of dose. Both children. Control of these substances under the CSA the strength and the ability of a substance to pro- would not only impede legitimate commerce, but duce certain effects play a role in whether that drug would likely have little effect on the abuse of these is selected by the drug abuser. substances by youngsters. An energetic campaign aimed at educating both adults and youth about Itis important to keep in mind that the effects inhalants is more likely to prevent their abuse. To produced by any drug can vary significantly and that end, a section is dedicated to providing infor- islargely dependent on the dose and route of mation on inhalants. administration. Concurrent use of other drugs can enhance or block an effect and substance abusers often take more than one drug to boost the desired effects or counter unwanted side effects. Risks asso- ciated with drug abuse cannot be accurately pre- dicted because each user has his/her own unique sensitivity to a drug. There are a number of theories that attempt to explain these differences, and it is clear that a genetic component may predispose an individual to certain toxicities or even addictive behavior.

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

13

20 Narcotics Crude opium

DRUGS OF ABUSE 4T11 en Chineseit 't iithe 1$'6ekoil gold en ty,difyiadc,

jth"

,

14 Doctor's hypodermic syringe kit, circa 1900

The term"narcotic," centration and purity, clandestinely produced street derived from the Greek drugs have unknown compositions. Medical com- word for stupor,originally plications common among narcotic abusers arise referredtoavarietyof primarily from adulterants found in street drugs and substances that dulled the in the non-sterile practices of injecting.Skin, lung, senses and relievedpain. and brain abscesses,endocarditis (inflammation Today, the term is used in a number of ways. Some of the lining of the heart), hepatitis, and AIDS are individuals define narcotics as those substances commonly found among narcotic abusers.Since that bind at receptors (cellular membrane there is no simple way to determine the purity of a proteins activated by substances like heroin or mor- drug that is sold on the street, the effects of phine) while others refer to any illicit substance as a narcotic. In a legal context, narcotic refers to opium, opium derivitives, and their semi-synthetic substi- tutes. Cocaine and coca leaves, which are also clas- sified as "narcotics" in the Controlled Substances Act (CSA), neither bind to opiate receptors nor produce morphine-like effects, and are discussed in the sec- tion on stimulants. For the purposes of this discus- sion, the term narcotic refers to drugs that produce morphine-like effects and have abuse potential.

Narcotics are used therapeutically to treat pain, sup- press cough, alleviate diarrhea, and induce anesthe- illicitnarcotic sia.Narcotics are administered in a variety of ways. use are unpredictable Some are taken orally, transdermally (skin patches), and can be fatal Physical or injected. They are also available in suppositories. signs of narcotic overdose include As drugs of abuse, they are often smoked, sniffed, or constricted (pinpoint) pupils, cold clammy injected. Drug effects depend heavily on the dose, skin,confusion,convulsions, severe drowsiness, route of administration, and previous exposure to and respiratory depression (slow or troubled breath- the drug.Aside from their medical use, narcotics ing). With repeated use of narcotics, tolerance and produce a general sense of well-being by reducing dependence develop.The development of toler- tension, anxiety and aggression. These effects are ance is characterized by a shortened duration and helpful in a therapeutic setting but contribute to a decreased intensity of analgesia, euphoria, and their abuse. sedation, which creates the need to consume pro- gressively larger doses to attain the desired effect. Narcotic use is associated with a variety of unwanted effects including drowsiness, inability to concentrate, In this 191,1 apathy, lessened physical activity, constriction of the illustration for pupils, and dilation of the subcutaneous blood ves- Meaure's story, sels, causing flushing of the face and neck, constipa- the )voman displays her needle tion, nausea and vomiting, and most significantly, marks, confessing respiratory depression. As the dose is increased, the she became subjective, (pain relief), and toxic effects "habituated" when become more pronounced. Except in cases of acute a doctor provided a intoxication, there is no loss of motor coordination stock of morphine or slurred speech as occurs with many depressants. to ease pain from "muscular Among the hazards of illicit drug use is the ever- rheumatism." increasing risk of infection, disease, and overdose. Genteel ladies with easy access to doctors and drugs While pharmaceutical products have a known con- made up the majority of the late 19th century addicts.

15

22 Tolerance does not develop uniformly for all actions There are two major patterns of narcotic abuse or of these drugs, giving rise to a number of toxic dependence seen in the United States. One involves effects.Tolerant users can consume doses far in individuals whose drug use was initiated within the excess of the dose they initially started with. Physical context of medical treatment who escalate their dependence refers to an alteration of normal body dose by obtaining the drug through fraudulent pre- functions that necessitates the continued presence scriptions and "doctor shopping" or branching out of a drug in order to prevent a withdrawal or absti- to illicit drugs. The other, more common, pattern nence syndrome. The intensity and character of the of abuse is initiated outside the therapeutic setting physical symptoms experienced during withdrawal with experimental or recreational use of narcotics. are directly related to the particular drug of abuse, The majority of individuals in this category may the total daily dose, the interval between doses, the abuse narcotics sporadically for months or even duration of use, and the health and personality of years.Although they may not become addicts, the user.In general, shorter acting narcotics tend the social, medical, and legal consequences of their to produce shorter, more intense withdrawal symp- behavior is very serious. Some experimental users toms, while longer acting narcotics produce a with- will escalate their narcotic use and will eventually drawal syndrome that is protracted but tends to be become dependent, both physically and psycholog- less severe. Although unpleasant, withdrawal from ically. The younger an individual is when drug use narcotics is rarely life threatening. is initiated, the more likely the drug use will progress to dependence and addiction. The withdrawal symptoms associated with heroin/ morphine addiction are usually experienced shortly before the time of the next scheduled dose.Early NARCOTICS OF symptoms include watery eyes, runny nose, yawn- ing, and sweating.Restlessness, irritability, loss of NATURAL ORIGIN appetite, nausea, tremors, and drug craving appear as the syndrome progresses. Severe depression and vomiting are common. The heart rate and blood pressure are elevated.Chills alternating with flush- ing and excessive sweating are also characteristic symptoms.Pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms.Without intervention, the syndrome will run its course, and most of the overt physical symptoms will disappear within 7 to 10 days.

The psychological dependence associated with narcotic addiction is complex and protracted. Long After the opium poppy pod has been scored, the liquid after the physical need for the drug has passed, opium oozes out and dries on the pod. It is collected the addict may continue to think and talk about and scraped into a ball shape. the use of drugs and feel strange or overwhelmed, coping with daily activities without being under the The poppy plant is the source for non-synthetic nar- influence of drugs. There is a high probability that cotics.It was grown in the Mediterranean region as relapse will occur after narcotic withdrawal when early as 5000 B.C., and has since been cultivated in neither the physical environment nor the behavioral a number of countries throughout the world. The motivators that contributed to the abuse have been milky fluid that seeps from incisions in the unripe altered. seedpod of this poppy has, since ancient times, been scraped by hand and air-dried to produce what is known as opium. A more modern method

16

23 of harvesting is by the industrial poppy straw pro- Although opium is used in the form of to cess of extracting alkaloids from the mature dried treat diarrhea, most opium imported into the United plant. The extract may be in liquid, solid, or powder States is broken down into its alkaloid constituents. form, although most poppy straw concentrate avail- These alkaloids are divided into two distinct chemi- able commercially is a fine brownish powder. More cal classes, phenanthrenes and isoquinolines. The than 500 tons of opium or its equivalent in poppy principalphenanthrenesaremorphine, straw concentrate are legally imported into the codeine, and thebaine, while the isoquino- UnitedStatesannuallyforlegitimate lines have no significant central nervous medical use system effects and are not regulated under the CSA. MORPHINE

Morphine isthe principal con- stituent of opium and can range in concentration from 4 to 21 percent. Commercial opium is standardized to contain 10-per- cent morphine.In the United 4 States, a small percentage of the morphine obtained from opium is used directly (about 15 tons): the remaining is converted to codeine and other derivatives (about 120 tons). Morphine is one of the most effective drugs known for the relief of severe pain and remains the standard against which new are measured.Like most narcotics, the use of morphine has increased signifi- These opiate -based cantly in recent yearsSince 1990, there has been syrups were popular about a 3-fold increase in morphine products in the for treating children with United States teething and dysentary. Morphine is marketed under generic and brand OPIUM name products including MS-ContinO, Oramorph There were no legal restrictions on the importation SRO,MSIRO,RoxanolO,KadianO, and RMSO. or use of opium until the early 1900s. In the United Morphine is used parenterally (by injection)for States, the unrestricted availability of opium, the preoperative sedation, as a supplement to anes- influx of opium-smoking immigrants from East Asia, thesia, and for analgesia.It is the drug of choice and the invention of the hypodermic needle contrib- for relieving pain of myocardial infarction and for its uted to the more severe variety of compulsive drug cardiovascular effects in the treatment of acute pul- abuse seen at the turn of the 20th century. In those monary edema. Traditionally; morphine was almost days, medicines often contained opium without any exclusively used by injection. Today, morphine is warning label.Today, there are state, federal, and marketed in a variety of forms, including oral solu- international laws governing the production and tions, immediate and sustained-release tablets and distribution of narcotic substances. capsules, suppositories, and injectable preparations.

17 In addition, the availability of high-concentration morphine preparations(i.e.,20-mg/m1 oral solu- SEMI-SYNTHETIC tions, 25-mg/m1 injectable solutions, and 200-mg sustained-release tablets) partially reflects the use of this substance for chronic pain management in NARCOTICS opiate-tolerant patients. HEROIN First synthesized from morphine in1874, heroin CODEINE was not extensively used in medicine until the early 1900s. Commercial production of the new pain Codeine is the most widely used, naturally occur- remedy was first started in 1898. While it received ring narcotic in medical treatment in the world. This widespread acceptance from the medical profes- alkaloid is found in opium in concentrations ranging sion, physicians remained unaware of its potential from 0.7 to 2.5 percent.However, most codeine for addiction for years. The first comprehensive con- used in the United States is produced from mor- trol of heroin occurred with the Harrison Narcotic phine. Codeine is also the starting material for the Act of 1914.Today, heroin is an illicit substance production of two other narcotics, having no medical utility in the United States.It is in and hydrocodone. Codeine is medically prescribed Schedule I of the CSA. for the relief of moderate pain and cough suppres- sion. Compared to morphine, codeine produces less Four foreign source areas produce the heroin avail- analgesia, sedation, and respiratory depression, and able in the United States: South America (Colombia), is usually taken orally.It is made into tablets either Mexico, Southeast Asia (principally Burma), and alone (Schedule II) or in combination with aspirin or Southwest Asia(principally Afghanistan). How- acetaminophen (i.e., Tylenol with Codeine, Sched- ever, South America and Mexico supply most of the ule 111). As a cough suppressant, codeine is found illicit heroin marketed in the United States.South in a number of liquid preparations (these products American heroin is a high-purity powder primarily are in Schedule V). Codeine is also used to a lesser distributed to metropolitan areas on the East Coast. extent as an injectable solution for the treatment of Heroin powder may vary in color from white to dark pain. Codeine products are diverted from legitimate brown because of impurities left from the manufac- sources and are encountered on the illicit market. turing process or the presence of additives. Mexican heroin, known as "black tar," is primarily available in THEBAINE the western United States.The color and consis- tency of black tar heroin result from the crude pro- Thebaine, a minor constituent of opium, is con- cessing methods used to illicitly manufacture heroin trolled in Schedule 11 of the CSA as well as under in Mexico. Black tar heroin may be sticky like roofing international law.Although chemically similar to tar or hard like coal, and its color may vary from dark both morphine and codeine, thebaine produces brown to black. stimulatory rather than effects. Thebaine is not used therapeutically, but is converted into a Pure heroin is rarely sold on the street, and the aver- variety of substances including oxycodone, oxy- age purity of heroin for major metropolitan areas morphone, , naloxone, naltrexone, and nationally averaged about 37.2 percent in 2000. A . The United States ranks first in the "bag"- slang for a small unit of heroin sold on the world in thebaine utilization. The following narcot- streetcurrently contains about 30 to 50 milligrams ics are among the more significant substances that of powder; only a portion of which is heroin; the have been derived by modification of the phenan- remainder could be sugar, starch, acetaminophen, threne alkaloids contained in opium. procaine, benzocaine, or quinine, to name a few of the cutting agents for heroin.Traditionally, the purity of heroin in a bag ranged from 1to 10 per- cent. More recently, heroin purity has ranged from

18

25 about 10 to 70 percent.Black tar heroin is often hydromorphone is usually obtained by the abuser sold in chunks weighing about an ounce. Its purity through fraudulent prescriptions or theft. The tab- is generally far less than South American heroin and lets are often dissolved and injected as a substitute it is most frequently dissolved, diluted, and injected. for heroin.

In the past, heroin in the United States was almost always injected, because it was the most practical OXYCODONE and efficient way to administer low-purity heroin. Oxycodone is synthesized from thebaine. Like mor- However, the recent availability of higher purity phine and hydromorphone, oxycodone is used as heroin at relatively low cost has meant that a larger an analgesic.It is effective orally and is marketed percentage of today's users are either snorting or alone in 10, 20, 40, and 80mg controlled-release smoking heroin, instead of injecting it. This trend tablets (OxyContin ®), or 5 mg immediate-release was first captured in the 1999 National Household capsules (Oxy1R0), or in combination products with Survey on Drug Abuse, which revealed that 60 to 70 aspirin (Percodan®) or acetaminophen (Percocet®) percent of people who used heroin for the first time for the relief of pain.All oxycodone products are from 1996 to 1998 never injected it. in Schedule II.Oxycodone is abused orally or the tablets are crushed and sniffed or dissolved in water According to that survey, an estimated 73 percent and injected. The use of oxycodone has increased of the 471,000 first-time heroin users (from 1996 to significantly.In 1990, nearly three tons of oxyco- 1999) were under 25 years old. Snorting or smok- done were manufactured in the United States.In ing heroin is more appealing to these new users 2000, about 47 tons were manufactured.Histori- because it eliminates both the fear of acquiring cally, oxycodone products have been popular drugs syringe-borne diseases, such as HIV and hepatitis, of abuse among the narcotic abusing population. as well as the social stigma attached to intravenous In recent months, concern has grown among fed- heroin use. Many new users of heroin mistakenly eral, state, and local officials about the dramatic believe that smoking or snorting heroin is a safe increase in the illicit availability and abuse of Oxy- technique for avoiding addiction.However, both Contin® products. These products contain large the smoking and the snorting of heroin are directly amounts of oxycodone (10 to 80 mg) in a formula- linked to high incidences of dependence and addic- tion intended for slow release over about a 12-hour tion. period. Abusers have learned that this slow-release mechanism can be easily circumvented by crushing Accordingtothe2001 NationalHousehold the tablet and swallowing, snorting, or injecting the Survey, during the 1990's, heroin incidence rates drug product for a more rapid and intense high. rose to a level not reached since the 1970's.The The criminal activity associated with illicitly obtaining annual number of new users ranged from 55,000 and distributing this drug, as well as serious conse- to 69,000 between 1989 and 1992. However, quences of illicit use, including addiction and fatal there were 110,000 new heroin users in 1994 and overdose deaths, are of epidemic proportions in 146,000 in 2000. Between 1975 and 1977, there some areas of the United States. were approximately 120,000 to 140,000 new users of heroin per year. HYDROCODONE HYDROMORPHONE Hydrocodone is an orally active analgesic and anti- tussive Schedule II narcotic that is marketed in multi- Hydromorphone (Dilaudid®) is marketed in tablets ingredient Schedule III products. Hydrocodone has (2,4, and 8 mg), rectal suppositories, oral solu- an analgesic potency similar to or greater than that tions, and injectable formulations.All products are of oral morphine. Sales and production of this drug in Schedule II of the CSA.Its analgesic potency is have increased significantly in recent years (a four- from two to eight times that of morphine, but it is fold increase between 1990 and 2000), as have shorter acting and produces more sedation than diversion and illicit use. Trade names include Anex- morphine. Much sought after by narcotic addicts,

19

2 6 sia0, Hycodan®, Hycomine0, Lorcet®, Lortab®, Tussionex®, Ty lox®, Vicodin®, and Vicoprofen®. NARCOTICS These are available as tablets,capsules, and/or syrups. Generally, this drug is abused orally rather TREATMENT than by intravenous administration. Currently, about20tons of hydrocodone products are used annually in the United States. DRUGS SYNTHETIC METHADONE German scientists synthesized methadone during World War II because of a shortage of morphine. NARCOTICS Although chemically unlike morphine or heroin, methadone produces many of the same effects. In contrast to the pharmaceutical products derived Introduced into the United States in1947as an from opium,syntheticnarcoticsare produced analgesic (Dolophine®), it is primarily used today for entirely within the laboratory. The continuing search the treatment of narcotic addiction.It is available for products that retain the analgesic properties of in oral solutions, tablets, and injectable Schedule II morphine without the consequent dangers of toler- formulations, and is almost as effective when admin- ance and dependence has yet to yield a product istered orally as it is by injection. Methadone's effects that is not susceptible to abuse. A number of clan- can last up to24hours, thereby permitting once-a- destinely produced drugs, as well as drugs that have day oral administration in heroin detoxification and accepted medical uses, fall within this category. maintenance programs. High-dose methadone can block the effects of heroin, thereby discouraging the continued use of heroin by addicts under treatment MEPERIDINE with methadone. Chronic administration of metha- Introduced as an analgesic in the1930s,meperi- done results in the development of tolerance and dine produces effects that are similar,but not dependence. The withdrawal syndrome develops identical, to morphine (shorter duration of action more slowly and is less severe but more prolonged and reduced antitussive and antidiarrheal actions). than that associated with heroin withdrawal.Ironi- Currently it is used for pre-anesthesia and the relief cally, methadone used to control narcotic addiction of moderate to severe pain, particularly in obstetrics is frequently encountered on the illicit market and and post-operative situations.Meperidine is avail- has been associated with a number of overdose able in tablets, syrups, and injectable forms under deaths. generic and brand name (Demerol®, Mepergan®, etc.) Schedule II preparations.Several analogues LAAM of meperidine have been clandestinely produced. During the clandestine synthesis of the analogue Closelyrelatedtomethadone,thesynthetic MKT a neurotoxic by-product (MPTP) was pro- compoundlevoalphacetylmethadol,or LAAM duced. A number of individuals who consumed the (ORLAM®), has an even longer duration of action MPPP-MPTP preparation developed an irreversible (from48to72hours) than methadone, permitting Parkinsonian-like syndrome. It was later found that a reduction in frequency of use.In1994,it was MPTP destroys the same neurons as those damaged approved as a Schedule II treatment drug for nar- in Parkinsons Disease. cotic addiction.Both methadone and LAAM have high abuse potential. Their acceptability as narcotic treatment drugs is predicated upon their ability to substitute for heroin, the long duration of action, and their mode of oral administration.

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27 transdermal patch used in chronic pain manage ment, and Actiq® is a solid formulation of fentanyl BUPRENORPHINE citrate on a stick that dissolves slowly in the mouth for transmucosal absorption. Actiq® is intended for This drug is a semi-synthetic narcotic derived from opiate-tolerant individuals and is effective in treating thebaine. High-dose sublingual tablets(Subox- breakthrough pain in cancer patients. one®, Subutex®) have recently been approved for (Wildnil®) is an analogue of fentanyl with an anal- the treatment of narcotic addiction.Like metha- gesic potency 10,000 times that of morphine and done and LRAM, buprenorphine is potent (30 to is used in veterinary practice to immobilize certain 50 times the analgesic potency of morphine), has large animals.Illicit use of pharmaceutical a long duration of action, and does not need to first appeared in the mid-1970s in the medical com- be injected. Unlike the other treatment drugs, munity and continues to be a problem in the United buprenorphineproduces far less respiratory States. To date, over 12 different analogues of fen- depression and is thought to be safer in overdose. tanyl have been produced clandestinely and identi- Buprenorphine is also available in the United States fied in the U.S. drug traffic.The biological effects as an injectable narcotic analgesic (Buprenex®) for of the fentanyls are indistinguishable from those of human and veterinary use. heroin, with the exception that the fentanyls may be hundreds of times more potent. Fentanyls are most DEXTROPROPDXYPHENE commonly used by intravenous administration, but like heroin, they may also be smoked or snorted. A close relative of methadone, was first marketed in 1957 under the trade name PENTAZOCINE of Darvon®. Oral analgesic potency is one-half to one-third that of codeine, with 65 mg approximately The effort to find an effective analgesic with less equivalent to about 600 mg of aspirin. Dextroproxy- dependence-producing consequences led to the phene is prescribed for relief of mild to moderate development of pentazocine ( Talwin®). Introduced pain.Bulk dextropropoxyphene is in Schedule II, as an analgesic in 1967, it was frequently encoun- while preparations containing it are in Schedule IV. tered in the illicit trade, usually in combination with More than 100 tons of dextropropoxyphene are pro- and placed into Schedule IV of the duced in the United States annually, and more than CSA in 1979. An attempt at reducing the abuse of 30 million prescriptions are written for the products. this drug was made with the introduction of Talwin This narcotic is associated with a number of toxic Nx®. This product contains a quantity of antagonist side effects and is among the top 10 drugs reported (naloxone) sufficient to counteract the morphine-like by medical examiners in drug abuse deaths. effects of pentazocine if the tablets are dissolved and injected. FENTANYL BUTORPHANOL First synthesized in Belgium in the late 1950s, fen- tanyl, with an analgesic potency of about 80 times While butorphanol can be made from thebaine, itis usually manufactured synthetically.It was ini- that of morphine, was introduced into medical prac- tially available in injectable formulations for human tice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze®. Thereafter; two (Stadol®) and veterinary (Torbugesic0 and Tor other fentanyl analogues were introduced; alfent- butrol®) use. More recently, a nasal spray (Stadol NSO) became available, and significant diversion anil (Alfenta®), an ultra-short (5-10 minutes) acting and abuse of this product led to the 1997 control analgesic, and (Sufenta®), an exception- ally potent analgesic (5 to 10 times more potent of butorphanol in Schedule IV of the CSA.Butor- phanol is a clear example of a drug gaining favor as than fentanyl) for use in heart surgery. Today, fentanyls are extensively used for anesthesia and a drug of abuse only after it became available in a form that facilitated its mode of administration (nasal analgesia.Duragesic®, for example, is a fentanyl spray v. injection).

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28 I DE 0 I

Trade Name: Demerol Trade Name: Hydromorphone Controlled Ingredient: meperidine Hydrochloride hydrochloride, 100 mg Controlled Ingredient: hydromorphone hydrochloride, 2 mg

Trade Name: Demerol Controlled Ingredient: meperidine Trade Name: MS Contin hydrochloride, 50 mg Controlled Ingredient: morphine sulfate, 100 mg

Trade Name: Dilaudid Trade Name: MS Contin Controlled Ingredient: Controlled Ingredient: morphine sulfate, 15 mg hydromorphone hydrochloride, 2 mg

Trade Name: MS Contin Trade Name: Dilaudid Controlled Ingredient: morphine sulfate, 30 mg Controlled Ingredient: hydromorphone hydrochloride, 4 mg

Trade Name: Oramorph SR Controlled Ingredient: morphine sulfate, 30 mg Trade Name: Dolophine Controlled Ingredient: methadone hydrochloride, 10 mg

Trade Name: Oramorph SR Controlled Ingredient: morphine sulfate, 100 mg

Trade Name: Hydromorphone Hydrochloride Controlled Ingredient: hydromorphone hydrochloride, 2mg t

Trade Name: Oramorph SR Controlled Ingredient: morphine sulfate, 60 mg

22 BEST COPY AVAILA8LL 29 Trade Name: OxyContin Trade Name: Percodan-Demi Controlled Ingredient: Controlled Ingredient: oxycodone hydrochlo- oxycodone hydrochloride, 10 mg ride 2.25 mg and oxycodone terephthalate 0.19 mg Other Ingredients: aspirin, 325 mg

Trade Name: OxyContin Controlled Ingredient: oxycodone hydrochloride, 160 mg Trade Name: Percodan Controlled Ingredient: oxycodone hydrochlo- ride 4.5 mg and oxycodone terephthalate 0.38 mg Other Ingredients: aspirin, 325 mg

Trade Name: OxyContin Controlled Ingredient: oxycodone hydrochloride, 20 mg

Trade Name: Tylox Controlled Ingredient: oxycodone hydrochlo- ride 4.5 mg and oxycodone terephthalate .38 mg Other Ingredients: Acetominophen, 500 mg Trade Name: OxyContin Controlled Ingredient: oxycodone hydrochloride, 80 mg Schedule III

Trade Name: Oxycodone & Trade Name: Aspirin with APAP Codeine No. 4 Controlled Ingredient: oxycodone hydrochloride, 5 mg Controlled Ingredient: codeine phosphate, 60 mg Other Ingredients: Acetominophen, 325 mg Other Ingredients: aspirin, 325 mg

Trade Name: Percocet Controlled Ingredient: oxycodone hydrochloride, 5 mg Trade Name: Fiorinal with Other Ingredients: Acetominophen, 325 mg Codeine Controlled Ingredient: codeine phosphate 30 mg and butalbitol , 50mg Other Ingredients: aspirin, 325 mg; caffeine, 40mg

23 BEST COPY AVAILABLE Trade Name: Lorcet Trade Name: Phenaphen with Controlled Ingredient: Codeine No. 4 hydrocodone Controlled Ingredient: codeine bitartrate, 10 mg phosphate, 60 mg Other Ingredients: acetaminophen, 650 mg Other Ingredients: acetaminophen, 325 mg

Trade Name: Lorcet Trade Name: Phenaphen with Controlled Ingredient: hydrocodone Codeine No. 2 bitartrate, 7.5 mg Controlled Ingredient: codeine Other Ingredients: acetaminophen, 650 mg phosphate, 15 mg Other Ingredients: acetaminophen, 325 mg

Trade Name: Lortab Controlled Ingredient: hydrocodone bitartrate, 2.5 mg Trade Name: Phenaphen-650 with Other Ingredients: acetaminophen, 500 mg Codeine Controlled Ingredient: codeine phosphate, 30 mg Other Ingredients: acetaminophen, 650 mg

Trade Name: Lortab Controlled Ingredient: hydrocodone bitartrate, 7.5 mg Trade Name: Synalgos Other Ingredients: acetominophen, 500 mg Controlled Ingredient: dihydrocodeine, 16 mg Other Ingredients: aspirin, 356.4 mg; caffeine, 30 mg

Trade Name: Phenaphen with Codeine No. 3 Controlled Ingredient: codeine phosphate, 30 mg Other Ingredients: acetominophen, 325 mg Trade Name: Tussionex Controlled Ingredient: hydrocodone, 5 mg Other Ingredients: phenyltoloxamine, 10 mg

BEST COPY AVAILAbu 24 31 IL

Trade Name: Tylenol with Trade Name: Darvon Codeine No. 2 Controlled Ingredient: propoxyphene Controlled Ingredient: codeine hydrochloride, 65 mg phosphate, 15 mg Other Ingredients: acetominophen, 300 mg

Trade Name: Darvon Compound-65 Controlled Ingredient: propoxyphene hydro- Trade Name: Tylenol with chloride, 65 mg Codeine No. 4 Other Ingredients: aspirin, 389 mg; Controlled Ingredient: codeine caffeine, 32.4 mg phosphate, 30 mg Other Ingredients: acetominophen, 300 mg

Trade Name: Darvon-N Controlled Ingredient:propoxyphene Trade Name: Tylenol with napsylate, 100 mg Codeine No. 3 Controlled Ingredient: codeine phosphate, 60 mg Other Ingredients: acetominophen, 300 mg

Trade Name: Talacen Controlled Ingredient: pentazocine hydrochloride, 50 mg Trade Name: Vicodin Other Ingredients: acetaminophen, 650 mg Controlled Ingredient: hydrocodone bitartrate, 5 mg Other Ingredients: acetominophen, 500 mg

Trade Name: Talwin Nx Controlled Ingredient: pentazocine Trade Name: Vicodin ES hydrochloride, 50 mg Controlled Ingredient: hydrocodone bitartrate, Other Ingredients: naloxone 7.5 mg hydrochloride, 0.5 mg Other Ingredients: acetaminophen, 750 mg Schedule IV

Trade Name: Wygesic Controlled Ingredient: propoxyphene hydro- chloride,65 mg Trade Name: Darvocet-N 100 Other Ingredients: acetaminophen, 650 mg Controlled Ingredient: propoxyphene napsylate,100 mg Other Ingredients: acetominophen, 650 mg BEST COPY AVAILABLE 25 32 DRUGS OF ABUSE Depressants

Historically, people of almost every culture have used classes of drugs of abuse, depressants are rarely chemical agents to induce sleep, relieve stress, and produced in clandestine laboratories. Generally, allay anxiety. While alcohol is one of the oldest and legitimate pharmaceutical products are diverted to most universal agents used for these the illicit market. A notable exception to this is a rela- purposes,hundredsof sub- tively recent drug of abuse, gamma hydroxybutyric stances have been devel- acid (GHB). opedthatproduce centralnervous Chioral hydrate and paraldehyde are two of the system oldest pharmaceutical depressants still in use today. Other depressants, including gluthethimide, meth- aqualone, and meprobamate have been important players in the milieu of depressant use and abuse. However, two major groups of depressants have dominated the licit and illicit market for nearly a cen- tury, first barbiturates and now benzodiazepines.

Barbiturates were very popular in the first half of the 20th century.In moderate amounts, these drugs produce a state of intoxication that is remarkably similar to alcohol intoxication.Symptoms include depression. slurred speech, loss of motor coordination, and These drugs have impaired judgment. Depending on the dose, fre- been referred to as down- quency, and duration of use, one can rapidly develop ers, , , minor tolerance, physical dependence, and psychological tranquilizers,anxiolytics,and anti- dependence to barbiturates. With the development anxiety medications Unlike most other of tolerance, the margin of safety between the effec-

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33 tive dose and the lethal dose becomes very narrow. That is, in order to obtain the same level of intoxica- BARBITURATES tion, the tolerant abuser may raise his or her dose to a level that may result in coma or death. Although Barbiturates were first introduced for medical use many individuals have taken barbiturates therapeu- in the early 1900s.More than 2,500 barbiturates tically without harm, concern about the addiction have been synthesized, and at the height of their potential of barbiturates and the ever-increasing popularity, about 50 were marketed for human number of fatalities associated with them led to the use. Today, about a dozen are in medical use. development of alternative medications. Today, less Barbiturates produce a wide spectrum of central than 10 percent of all depressant prescriptions in the nervous system depression, from mild sedation to United States are for barbiturates. coma, and have been used as sedatives, hypnotics, anesthetics, and anticonvulsants. The primary dif- Benzodiazepines were first marketed in the 1960s. ferences among many of these products are how Touted as much safer depressants with far less fast they produce an effect and how long those addiction potential than barbiturates, today these effects last.Barbiturates are classified as ultrashort, drugs account for about one out of every five pre- short, intermediate, and long-acting.The ultra- scriptions for controlled substances. Although ben- short-acting barbiturates produce anesthesia within zodiazepines produce significantly less respiratory about one minute after intravenous administration. depression than barbiturates, it is now recognized Those in current medical use are the Schedule IV that benzodiazepines share many of the undesirable drug (Brevital0) and the Schedule side effects of the barbiturates. A number of toxic III drugs thiamyl (Surital0) and thiopental (Pento- central nervous system effects are seen with chronic thal0). abusers prefer the Schedule II high-dose therapy, including head- short-acting and intermediate-acting barbiturates aches,irritability,confusion, memory impairment that include (Amyta0), and depression. The risk of developing over-seda- (Nembutal0), (Seconal0), and Tuinal0 tion, dizziness, and confusion increases substantially (an amobarbital/secobarbital combination product). with higher doses of benzodiazepines.Prolonged Other short and intermediate-acting barbiturates use can lead to physical dependence even at doses are in Schedule III and include (Fiorinal0), recommended for medical treatment.Unlike bar- (Butisolq, (Lotusate0), and biturates, large doses of benzodiazepines are rarely (Alurate0).After oral administration, fatal unless combined with other drugs or alcohol. the onset of action is from 15 to 40 minutes, and Although primary abuse of benzodiazepines is well the effects last up to six hours.These drugs are documented, abuse of these drugs usually occurs primarily used for and preoperative seda- as part of a pattern of multiple drug abuse.For tion. Veterinarians use pentobarbital for anesthesia example, heroin or cocaine abusers will use benzo- and euthanasia.Long-acting barbiturates include diazepines and other depressants to augment their (Lumina 10) and mephobarbital (Meb- "high" or alter the side effects associated with over- aral0), both of which are in Schedule IVEffects stimulation or narcotic withdrawal. of these drugs are realized in about one hour and last for about 12 hours, and are used primarily for There are marked similarities among the withdrawal daytime sedation and the treatment of seizure dis- symptoms seen with most drugs classified as depres- orders. sants. In the mildest form, the withdrawal syndrome may produce insomnia and anxiety, usually the same symptoms that initiated the drug use.With a greater level of dependence, tremors and weak- ness are also present, and in its most severe form, the withdrawal syndrome can cause seizures and . Unlike the withdrawal syndrome seen with most other drugs of abuse, withdrawal from depres- sants can be life threatening.

27 34 41111 . I . I I 1 I I I 1 I . I I I II Narcotics Substance I NeqraDiamorphine, Horse, Smack, Black tar, Chiva, (black tar) None in U.S., Analgesic, Antitussive Yes smokedInflected, snorted, drowsiness,Euphoria, breathing,slow and shallow r, runnyWatery nose, eyes, MorphineHeroin Substance I I MS-Conlin,1.1U;:frPcpcic'ne Roxanol, Oramorph SR, MSIR x to Analgesic.Analgesic Antitussive High High Yes 3123-4 OralOral, injected convictedrespiratorydepression. convulsiews.coma.clammy skin. initability,lossyawnins of apatite, HydrocodoneHydromorphone Substance II,Pw/Aceminophen. Vicodin, Vicoprofen, Substance II roduct III Roma,Dilaudid Oxycodone. w/Acetominophen, OxyContin, Analgesic High High Yes 3_43-6 Oral, injected nauseapupils, possible death nausea,cramps,Park-tremors, CodeineOxycodone Substance II,Products III,V Substance II,III,IV Substance II TalwinFentanyl,Fiorinol,Acetominophen,Endocet, Par FioriceL Percocet,Demerol, Guaifenesinor PercodanMethadone,Tylenol w/Codeine or Darvon, Stadol, w/Codeine, oric Bu renex Analgesic, Antidiarrheal,Antitussive Antitussive ModerateHigh ModerateHigh Yes Yes 3-43-12 Oral, injected.injected chills and sweating Other Narcotics Depressants GHB, Liquid Ecstasy, Liquid X, , Xyrerns None in U.S., Anesthetic High-Low High-Low Yes Variable Oral disorieraation,Slurred speech. drunken clammyShallow skin,respiration dilated tremors.Anxiety, insomnia,delirium. Benzodiazepinesgamma Hydroxybutyric Acid Sub I, Product III Substance IV Ambien,RohypnolValium, Xanax, Sonata, (Roofies, Halcion, Meprobamate, R-2), ;divan, Klonopin Reston]. , ,Anhangety,Antianxiety, Muscle . Sedative, Relaxant Anuconvulsant. Hypnotic ModerateModerate Moderate Yes 3-61-8 OralOral, injected enemasmemoryalcoholbehavior of with with=kap..eVentS. Weald odor of posit*Mdse.pups. weakcoma. death and rapid possibleconvulsions. death taSfiiIi,014111Other Depressants Substance I,II,III,IV Coke,Barbiturates, Flake, Snow, Met Crack. Coca, Blanca, Perim, ualone (Quaalude) r.; Moderate Moderate Yes 2-6 Snorted, smoked, Increased alert- Agitation, APalhY. icog Amphetamine/MethamphetamineCocaine Substance UII Sub II Ritalin,Dexedrine.Crank,Nieve, SodaIce,Concerta, DesoxvnDistal, Focalin, Krystal MetadateMeth, Speed, Adderall, Attentionnarcolepsy, deficiUhyperactivitydeficit/hyperactway weight control disorder,disorder Possible High Yes 2-41-2 smoked,Oral,injected iryected,injected, snorted &creasedeuphoria,ness, blood excitation, pressure,pulse in- rate convulsions,hallucinations.temperature,increased body disorientationdepression.irritability.periods of sleep, MethylphenidateOther Stimulants Substance 11111V Adipex P, lonamin, Prelu-2, Oidrex, Provigil Appetite suppression, Narcolepsy MEM PossiblePossible Nommonso HighModerate Yes Yes 2-4 Oral, injected 111appetiteinsomnia, loss of possible death MDMA and Analogs aluci negen SubstanceSubstance II I Acid,MBDB,(Ecstasy, Microdot. DOM, X IC, DOB Adam),Sunshine, MDA Boomers (Love Drug), MDEA (Eve), None None Moderate Yes 4-6 OralsmokedOral, snorted, \lehydraten teethHiw,atered grinding Sen.. and am.imbalanceb.klaeaSed electrolyte Cody cardiac tempera- drowskwas.Muscle achm. depression are PhencyclidineLSD and Analogs Substance 1,11,111 PsilocybePCE,PCP, PCPy,Angel mushrooms, TCPDust. Hog. Loveboat.Mescaline, Ketamine Peyote Cactus. (Special K), NoneAnesthetic (Ketamine) NonePossible UnknownHigh Yes Yes 8-121-12 Oralinjected,Smoked, snortedoral, akaedhallucirMions.Illusions perception ad an meet,node:tensed11.501 feel toLonger. direct pain. mere ormorn remember episodes None Drug making behavior 'Nal regulated Other Hallucinogens CaTfraB" s Substance Pot,A hausca Grass, DMTSinsemilla, F Blunts, Mora, Yerba, COM AMT None None None Possible 4-8 Smoked, oral Euphoria.inn and &ranee relaxed Fatigue. paranoia. Occasianal reports TetrahydrocannabinolMarijuana Substance I,Product III Substance I THC,Hash, Marino! Hash oil NoneAntinauseant, Appetite stimulant YesUnknown Moderate Yes 2-4 Smoked,Smoked, oral oral disorientationincreasedinhibitions, appetite, psychosispossible appetitedecreasedhyperactivity.of insonwiia, Hashish and Hashish Oil Substance 1 Unknown Moderate Yes 2-4 Virikration edmian Unknown OtherTestosterone Anabolic Steroids Ana bo IkStero SubstanceSubstance III III Pnmabolin-Depo,Parabolan,Depo , Winstrol, D-Ball SustanonEquipose, Sten.Anadrol, CPI Dianabol, Anemia,Hypogonadism Breast cancer Unknown YesUnknown Unknown 14-28 days Unknown Variable Oral,Injected irjected aggressivegiver....terticular atrophy, behavier atm. Possible depression Amyl and Butyl Nitrates inatantS LaughingPearls, Poppers, gas, balloons, Rush, Locker Whippets Room AnestheticAngina (Amyl) Unknown Unknown No 1 InhaledInhaled I Impairedhernia.Flusluq. memory. lannenso, depressionVomiting.Methemenlobrnenm nwira.yloss ct Trentfing.Agitation moiety. inscriatin Adhesives. spray paint, hair spray, dry cleaning fluid, None Unknown Low No 0.5 belwricr,slurred speech. slaw onset drunken conwiciusness hallucinations.vitiemM deficiency. moderns confusion June 2000 Other Inhalants A1Mo Beer,spot remover, wine, liquor lighter fluid None HighUnknown HighHigh YesNo 1-30.5-2 OralInhaled damagevi.nin deficiency. organ possible acted are marketed in other countries. Benzodiazepines BENZODIAZEPINES are controlled in Schedule IV of the CSA.

The benzodiazepine family of depressants is used Short-acting benzodiazepines are generally used for therapeutically to produce sedation, induce sleep, patients with sleep-onset insomnia (difficulty falling relieve anxiety and muscle spasms, and to prevent asleep) without daytime anxiety. Shorter-acting seizures. In general, benzodiazepines act as benzodiazepines used to manage insomnia include hypnotics in high doses, anxiolytics in moderate (ProSom ®), (Dalmane®), doses, and sedatives in low doses. (Restoril®), and (Halcion®). Of the drugs marketed in the United (Versed®), a short-acting benzodiaz- States that affect central nervous epine, is utilized for sedation, anxiety, and amnesia system function,benzodiazepines in critical care settings and prior to anesthesia.It are among the most widely prescribed is available in the United States as an injectable medications. Fifteen members of this group preparation and as a syrup (primarily for pediatric are presently marketed in the United States, patients). and about 20 additional benzodiazepines Benzodiazepines with a longer duration of action are utilized to treat insomnia in patients with a daytime anxiety. These benzodiazepines include (Xanax0), chlordiazepox- ide(librium0),(Tranxene®), (Valium®, (Paxi- pam®),lorzepam(Ativan0), (Serax®), (Centrax®), and quaz- epam (Doral®). (Klonopin®), diazepam, and clorazepate are also used as anticonvulsants.

Benzodiazepines are classified inthe CSA as depressants. Repeated use of large doses or, in some cases, daily use of therapeutic doses of benzodiazepines is associated with amnesia, hostility,irritability, and vivid or disturbing dreams, as well as tolerance and physical dependence. The withdrawal syn- drome is similar to that of alcohol and may require hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering-down the dose eliminates many of i the unpleasant symptoms. 01140, Given the millions of prescriptions written for benzodiazepines (about 100 million in 1999),relatively few individualsincrease their dose on their own initiative or engage in drug-seeking behavior. Those individuals who do abuse benzodiazepines often main- tain their drug supply by getting prescrip-

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36 tions from several doctors, forging prescriptions, effects or as an intoxicant or euphoriant; (2) body- or buying diverted pharmaceutical products on the builders who abuse GHB for its alleged utility as an illicit market.Abuse is frequently associated with anabolic agent or as a sleep aid; and (3) individuals adolescents and young adults who take benzodi- who use GHB as a weapon for sexual assault. These azepines to obtain a "high."This intoxicated state categories are not mutually exclusive and an abuser results in reduced inhibition and impaired judgment. may use the drug illicitly to produce several effects. Concurrent use of alcohol or other depressant with GHB is frequently taken with alcohol or other drugs benzodiazepines can be life threatening. Abuse of thatheightensits effects and is often foundat benzodiazepines is particularly high among heroin bars, nightclubs, rave parties, and gyms. Teenagers and cocaine abusers. A large percentage of people and young adults who frequent these establish- entering treatment for narcotic or cocaine addiction ments are the primary users.Like flunitrazepam, also report abusing benzodiazepines.Alprazolam benzodiazepine is often referred to as a "date-rape" and diazepam are the two most frequently encoun- drug, and GHB involvement in rape cases is likely tered benzodiazepines on the illicit market. to be unreported or unsubstantiated. GHB is quickly eliminated from the body making detection in body fluids unlikely; and its fast onset of depressant effects FLUNITRAZEPAM may render the victim with little memory of the details of the attack. GHB produces a wide range Flunitrazepam (Rohypnol ®)isa benzodiazepine of central nervous system effects, including dose- that is not manufactured or legally marketed in the dependent drowsiness, dizziness, nausea, amnesia, United States, but is smuggled in by traffickers.In visualhallucinations,hypotension,brady-cardia, the mid-1990s, flunitrazepam was extensively traf- severe respiratory depression, and coma. The use of ficked in Florida and Texas.Known as "rophies," alcohol in combination with GHB greatly enhances "roofies," and "roach," flunitrazepam gained popu- its depressant effects. Overdose frequently requires larity among younger individuals as a "party" drug. emergency room care and many GHB-related fatali- It has also been utilized as a "date rape" drug.In ties have been reported.Gamma butyrolactone this context, flunitrazepam is placed in the alcoholic (GBL) and 1,4-butanediol are GHB analogues that drink of an unsuspecting victim to incapacitate them can be used as substitutes for GHB. When ingested, and prevent resistance from sexual assault.The these analogues are converted to GHB and produce victim is frequently unaware of what has happened identical effects. GBL is also used in the clandestine to them and often does not report the incident to production of GHB as an immediate precursor. Both authorities. A number of actions by the manufac- GBL and 1,4-butanediol have been sold at health turer of this drug and by government agencies have food stores and on various internet sites. The abuse resulted in reducing the availability and abuse of of GHB began to seriously escalate in the mid-1990s. flunitrazepam in the United States. For example, in 1994, there were 56 emergency department episodes involving GHB reported in the Drug Abuse Warning Network ((DAWN) a statistical GAMMA record of times a drug is involved in a drug abuse episode in emergency rooms in the United States). HYDROXY In 2001, there were 3,340 GHB episodes. DAWN data also indicated that most users were males, BUTYRIC ACID less than 25 years of age, taking the drug orally for recreational use. GHB was placed in Schedule (GHB) I of the CSA in March 2000. Gamma butyrolactone (GBL) was made a List I Chemical in February 2000. GHB has recently been approved as a medication In recent years, GHB has emerged as a significant (XYREM ®). GHB is being used in the treatment of drug of abuse throughout the United States. Abus- cataplexy associated with some types of narcolepsy. ers of this drug fall into three major groups: (1) users This approved medication is in schedual III of the who take GHB for its MDMA-like hallucinogenic CSA.

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37 barbiturates.In the United States, the marketing of PARALDEHYDE methaqualone pharmaceutical products stopped in Paraldehyde (Paral ®) is a Schedule IV depressant 1984, and methaqualone was transferred to Sched- used most frequently in hospital settings to treat ule I of the CSA.In 1991, glutethimide was trans- delirium tremens associated with alcohol with- ferred into Schedule II in response to an upsurge in drawal.Many individuals who become addicted the prevalence of diversion, abuse, and overdose to paraldehyde have been initially exposed during deaths. Today, there is little medical use of glutethi- treatment for alcoholism and, despite the disagree- mide in the United States. able odor and taste, come to prefer it to alcohol. This drug is not used by injection because of tissue MEPROBAMATE damage, and taken orally, it can be irritating to the throat and stomach. One of the signs of paraldehyde Meprobamate was introduced as an anti-anxiety use is a strong, characteristic smell to the breath. agent in 1955 and is prescribed primarily to treat anxiety,tension, and associated muscle spasms. More than 50 tons are distributed annually in the CHLORAL HYDRATE United States under its generic name and brand The oldest of the hypnotic (sleep inducing) depres- names such as Miltown® and Equanil®.Its onset sants, chloral hydrate was first synthesized in 1832. and duration of action are similar to the intermedi- Marketed as syrups or soft gelatin capsules, chloral ate-acting barbiturates; however, therapeutic doses hydrate takes effect in a relatively short time (30 of meprobamate produce less sedation and toxic- minutes) and will induce sleep in about an hour. A ity than barbiturates. Excessive use can result in solution of chloral hydrate and alcohol constituted psychological and physical dependence.Cari- the infamous "knockout drops" or "Mickey Finn." At soprodol (Soma®), a skeletal , is therapeutic doses, chloral hydrate has little effect on metabolized to meprobamate. This conversion respiration and blood pressure. However, a toxic may account for some of the properties associated dose produces severe respiratory depression and with and likely contributes very low blood pressure. Chronic use is associated to its abuse. with damage and a severe withdrawal syn- drome. Although some physicians consider chloral hydrate to be the drug of choice for sedation of children before diagnostic, dental, or medical pro- cedures, its general use as a hypnotic has declined. Chloral hydrate (Noctec® and other) and com- pounds, preparations, or mixtures containing choral hydrate are in Schedule IV of the CSA. NEWLY GLUTETHIMIDEAND MARKETED METHAQUALONE DRUGS Glutethimide (Doriden®) was introduced in 1954 and methaqualone (Quaalude® Sopor®) in 1965 (Ambien®) and (Sonata®) are as safe barbiturate substitutes.Experience demon- two relatively new, benzodiazepine-like CNS depres- strated, however that their addiction liability and sants that have been approved for the short-term the severity of withdrawal symptoms were similar to treatment of insomnia.Both of these drugs share those of barbiturates. By 1972, "luding out," taking many of the same properties as the benzodiazepines methaqualone with wine, was a popular college and are in Schedule IV of the CSA. pastime.Excessive use leads to tolerance, depen- dence, and withdrawal symptoms similar to those of

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38 EPRES SA --"c N CATION

Schedule II

Trade Name: Amble. Zopidem Controlled Ingredient: Zolpidem Tartrate, 5 mg Trade Name: Awns! Sodium Controlled Ingredient amobarbital. 200 mg

I Trade Name: Advert Controlled Ingredient: . 1.0 mg Trade Name: Doriden Controlled Ingredient glutethimide, 500 mg

Trade Name: Alvan Trade Name: Nembutal Sodium Controlled Ingredient: lorazepam. 0.5 mg Controlled Ingredient: pentobarbital 100 mg

Trade Name: Alvan Trade Name: Seconal Sodium Controlled Ingredient: lorazepam. 2.0 mg Controlled Ingredient: secobarbital sodium, 100 mg

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

Trade Name: Taloa Controlled Ingredient: amobarbital sodium, 100 m&secobarbitalsodium, 100 mg

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

Trade Name: Centre: Trade Name: Ambien Zolpidem Controlled Ingredient: prazepam 5 mg Controlled Ingredient: Zolpidem Tartrate, 10 mg

31 BEST COPY AVAILABLE 39 J111 -SA, I .1 CAT

Trade Name: Centrax Prazepam Trade Name: Klonopin Controlled Ingredient: prazepam Controlled Ingredient: clonazepam, 5 mg 0.50 mg

Trade Name: Dalmane Controlled Ingredient: flurazepam hydrochloride, Trade Name: Klonopin 15 mg Controlled Ingredient: clonazepam, 1.0 mg

Trade Name: Dalmane Controlled Ingredient: flurazepam hydrochloride, Trade Name: Klonopin 30 mg Controlled Ingredient: clonazepam, 2.0 mg

Trade Name: Equanil Controlled Ingredient: meprobamate, 200 mg Trade Name: Librium Controlled Ingredient: hydrochloride, 10 mg

Trade Name: Equanil Controlled Ingredient: meprobamate, 400 mg Trade Name: Librium Controlled Ingredient: chlordiazepoxide hydrochloride, 25 mg

Trade Name: Halcion Controlled Ingredient: triazolam, 0.25 mg

Trade Name: Librium Controlled Ingredient: chlordiazepoxide hydrochloride, 5 mg

Trade Name: Halcion Controlled Ingredient: triazolam, 0.50 mg

32 BEST COPYAVAILhuL. 40 Trade Name: Miltown 400 Trade Name: Serax Controlled Ingredient: meprobamate, Controlled Ingredient: oxazepam, 400 mg 15 mg

Trade Name: Miltown 600 Trade Name: Serax Controlled Ingredient: meprobamate, Controlled Ingredient: oxazepam, 600 mg 15 mg

Trade Name: Placidyl Trade Name: Serax Controlled Ingredient: , Controlled Ingredient: oxazepam, 200 mg 30 mg

Trade Name: Placidyl Controlled Ingredient: ethchlorvynol, 500 mg Trade Name: Tranxene Controlled Ingredient: chlorazepate dipotassium, 15 mg

Trade Name: Placidyl Controlled Ingredient: ethchlovynol, 750 mg Trade Name: Tranxene Controlled Ingredient: chlorazepate dipotassium, 3.75 mg

Trade Name: Restoril Controlled Ingredient: temazepam. 15 mg Trade Name: Tranxene Controlled Ingredient: chlorazepate dipotassium, 7.5 mg

Trade Name: Restoril Controlled Ingredient: temazepam. 30 mg

33 BEST COPY AVAILABLL 41 Trade Name: Valium Trade Name: Rohyphnol Controlled Ingredient: diazepam, Controlled Ingredient: flunitrazepam -not 10 mg sold or marketed in the U.S. but illicitly smuggled into the country

Trade Name: Valium Controlled Ingredient: diazepam, 5 mg

Trade Name: Rohyphnol

Trade Name: Valium Controlled Ingredient: diazepam, 2 mg

Trade Name: Xanax Controlled Ingredient: alprazolam, 0.25 mg

Trade Name: Xanax Controlled Ingredient: alprazolam, 0.5 mg

Trade Name: Xanax Controlled Ingredient: alprazolam, 1.0 mg

34 BEST COPY AVAILABLE 42 Stimulants

DRUGS OF ABUSE

Stimulants are sometimes referred to as uppers and binge use sporadically consuming large doses reverse the effects of fatigue on both mental and of stimulants over a short period of time. Heavy physical tasks. Two commonly used stimulants are users may inject themselves every few hours, con- nicotine, found in tobacco products, and caffeine, tinuing until they have depleted their drug supply an active ingredient in coffee, tea, some soft drinks, or reached a point of delirium, psychosis, and physi- and many non-prescription medicines. Used in cal exhaustion. During this period of heavy use, all moderation, these substances tend to relieve mal- other interests become secondary to recreating the aise and increase alertness.Although the use of initial euphoric rush. Tolerance can develop rapidly, these products has been an accepted part of U.S. and both physical and psychological dependence culture, the recognition of their adverse effects has occur. Abrupt cessation, even after a brief two or resulted in a proliferation of caffeine-free products three-day binge, is commonly followed by depres- and efforts to discourage cigarette smoking. sion, anxiety, drug craving, and extreme fatigue known as a "crash." A number of stimulants, however, are under the regulatory control of the CSA. Some of these con- Therapeutic levels of stimulants can produce exhila- trolled substances are available by prescription for ration, extended wakefulness, and loss of appetite. legitimate medical use in the treatment of obesity, These effects are greatly intensified when large narcolepsy, and attention deficit disorders. As drugs doses of stimulants are taken.Physical side effects, of abuse, stimulants are frequently taken to pro- including dizziness, tremor, headache, flushed skin, duce a sense of exhilaration, enhance self esteem, chest pain with palpitations, excessive sweating, improve mental and physical performance, increase vomiting, and abdominal cramps, may occur as a activity, reduce appetite, produce prolonged wake- result of taking too large a dose at one time or taking fulness, and to "get high."They are recognized large doses over an extended period of time.Psy- as among the most potent agents of reward and chological effects include agitation, hostility, panic, reinforcement that underlie the problem of depen- aggression, and suicidal or homicidal tendencies. dence. Paranoia, sometimes accompanied by both audi- tory and visual hallucinations, may also occur.In Stimulants are diverted from legitimate channels or overdose, unless there is medical intervention, high clandestinely manufactured exclusively for the illicit fever, convulsions, and cardiovascular collapse may market. They are taken orally, sniffed, smoked, and precede death. Because accidental death is partially injected. Smoking, snorting, or injecting stimulants due to the effects of stimulants on the body's cardio- produces a sudden sensation known as a "rush" or vascular and temperature-regulating systems, physi- a "flash." Abuse is often associated with a pattern of cal exertion increases the hazards of stimulant use.

35

43 "Crack," the chunk or "rock" form of cocaine,is a ready- to-use freebase. On the illicit COCAINE market, itis sold in small, inex- pensive dosageunitsthatare smoked. Smoking deliverslarge Cocaine, the most potent stimulant of natural origin, quantities of cocaine to the lungs, pro- is extracted from the leaves of the coca plant (Eryth- ducing effects comparable to intravenous roxylon coca), which is indigenous to the Andean injection; these effects are felt almost immedi- highlands of ately, are very intense, and are quickly over. Once SouthAmerica. introduced in the mid-1980s, crack abuse spread Nativesinthis rapidly and made the cocaine experience avail- region chew able to anyone with $10 and access to a dealer.In orbrewcoca addition to other toxicities associated with cocaine leaves into a abuse, cocaine smokers suffer from acute respiratory teaforrefresh- problems including cough, shortness of breath, and ment and to severe chest pains with lung trauma and bleeding. relieve fatigue, It is noteworthy that the emergence of crack was similar to the accompanied by a dramatic increase in drug abuse custom of chew- problems and drug- related violence. ing tobacco and drinkingteaor The intensity of the psychological effects of cocaine, coffee. as with most psychoactive drugs, depends on the dose and rate of entry to the brain. Cocaine reaches Pure cocaine the brain through the snorting method in three to was first isolated five minutes.Intravenous injection of cocaine pro- in the 1880s duces a rush in 15 to 30 seconds, and smoking pro- and used as duces an almost immediate intense experience. The a local anes- euphoric effects of cocaine are almost indistinguish- thetic in eye able from those of amphetamine, although they do surgery. It was not last as long. These intense effects can particularly useful in surgery of the nose and throat be followed by a dysphoric crash because of its ability to provide anesthesia, as well as To avoid the fatigue and the to constrict blood vessels and limit bleeding Many depressionofcoming of its therapeutic applications are now obsolete due down, frequent, to the development of safer drugs. repeated doses Illicit cocaine is usually distributed as a white crys- talline powder or as an off-white chunky material are taken. The powder, usually cocaine hydrochloride, is often Excessive doses diluted with a variety of substances, the most of cocaine may lead common being sugars such as lactose, ino- to seizures and death sitol, and mannitol, and local anesthet- from respiratory fail- ics such as . The adulteration ure, stroke, or heart increases the volume and for the drug failure There is no traffickermultipliesprofits. Cocaine specific antidote for hydrochloride is generally snorted or cocaine overdose dissolved in water and injected. Itis rarely smoked because itis heat labile (destroyed by high temperatures).

A small tool used to snort cocaine.

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44 COCAINE Cultivation to product

7

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

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45 Cocaine is the second most commonly used illicit laws to curb the black market in amphetamines. drug (following mar juana) in the United States. Many pharmaceutical amphetamine products were Approximately 10 percent of the population over removed from the market including all injectable the age of 12 has tried cocaine at least once in their formulations, and doctors prescribed those that lifetime, about two percent has tried crack, and remained less freely.Recent increases in medical nearly one percent is currently using cocaine. There use of these drugs can be attributed to their use are no drugs approved for replacement-pharmaco- in the treatment of ADHD. Amphetamine prod- therapy (drugs taken on a chronic basis as a substi- ucts presently marketed include generic and brand tute for the abused drug, like methadone for heroin nameamphetamine (Adderall®, Dexedrine®, addiction). Cocaine addiction treatment relies heav- Dextrostat®) and brand name methamphetamine ily on psychotherapy and drugs like (Desoxyn®).Amphetamines are all controlled in to relieve some of the effects resulting from cocaine Schedule II of the CSA. abuse. To meet the ever-increasing black market demand for amphetamines, clandestine laboratory produc- AMPHETAMINES tion has mushroomed. Today, most amphetamines Amphetamine, dextroamphetamine, methamphet- distributed to the black market are produced in amine, and their various salts, are collectively referred clandestine laboratories. Methamphetamine labora- to as amphetamines. In fact, their chemical proper- tories are, by far,the most frequently encountered ties and actions are so similar that even experienced clandestine laboratories in the United States.Law users have difficulty knowing which drug they have enforcement personnel routinely raid both large and taken. small ("mom and pop") laboratories.The ease of clandestine synthesis, combined with tremendous Amphetamine was first marketed in the 1930s as profits, has resulted in significant availability of illicit Benzedrine®, in an over-the-counter inhaler to treat methamphetamine, especially on the West Coast nasal congestion. By 1937, amphetamine was avail- where abuse of this drug has increased dramati- able by prescription in tablet form and was used in cally in recent years. Large amounts of metham- the treatment of the sleeping disorder narcolepsy phetamine are also illicitly smuggled into the United and the behavioral syndrome called minimal brain States from Mexico. dysfunction, which today is called attention deficit hyperactivity disorder (ADHD). During World War II, Amphetamines are generally taken orally or injected. amphetamine was widely used to keep the fighting However, the addition of "ice," the slang name for men going; both dextroamphetamine (Dexedrine()) crystallized methamphetamine hydrochloride, has and methamphetamine (Methedrine®) became promoted smoking as another mode of administra- readily available. tion.Just as "crack" is smokable cocaine, "ice" is smokable methamphetamine. Methamphetamine, As use of amphetamines spread, so did their abuse. in all its forms, is highly addictive and toxic.The In the 1960s, amphetamines became a cure-all for effects of amphetamines, especially methamphet- helping truckers to complete their long routes with- amine, are similar to cocaine, but their onset is out falling asleep, for weight control, for helping slower and their duration is longer.In contrast to athletes to perform better and train longer, and cocaine, which is quickly removed from the brain for treating mild depression.Intravenous amphet- and is almost completely metabolized, metham- amines, primarily methamphetamine, were abused phetamine remains in the central nervous system by a subculture known as "speed freaks." With expe- longer, and a larger percentage of the drug remains rience, it became evident that the dangers of abuse unchanged in the body, producing prolonged stim- of these drugs outweighed most of their therapeutic ulant effects.Chronic abuse produces a psychosis uses. that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with Increased control measures were initiated in 1965 one's own thoughts, and auditory and visual hallu- with amendments to the federal food and drug cinations. These psychotic symptoms can persist for

38 months and even years after use of these drugs has ceased and may be related to the neurotoxic effects ANORECTIC of these drugs. Violent and erratic behavior is fre- quently seen among chronic abusers of amphet- DRUGS amines, especially methamphetamine. A number of drugs have been developed and marketed to replace amphetamines as appetite suppressants. These anorectic drugs include benz- METHCATHINONE phetamine (Didrex ®), diethylproprion (Tenuate®, Methcathinone, known on the streets as "Cat," is a Tepanil ®), mazindol (Sanorex®, Mazanor ®), phen- structural analogue of methamphetamine and cathi- dimetrazine (Bontril®, Pre 1u-270), and phentermine none. Clandestinely manufactured, methcathinone (lonamin ®, Fastin®, Adipex®).These substances is almost exclusively sold in the stable and highly are in Schedule III or IV of the CSA and produce water soluble hydrochloride salt form. Itis most some amphetamine-like effects. Of these diet pills, commonly snorted, although it can be taken orally phentermine is the most widely prescribed and most by mixing it with a beverage or diluted in water and frequently encountered on the illicit market. Two injected intravenously. Methcathinone has an abuse Schedule IV anorectics often used in combination potential equivalent to methamphetamine and pro- with phentermine (phen-fen combo), duces amphetamine-like activity.It was placed in and dexfenfluramine, were removed from the U.S. Schedule I of the CSA in 1993. market due to heart valve problems. METHYLPHENIDATE KHAT Methylphenidate, a Schedule IIsubstance, has a For centuries,khat, the fresh high potential for abuse and produces many of youngleavesoftheCatha the same effects as cocaine or the amphetamines. edulis shrub, have been con- The abuse of this substance has been documented sumed where the plant is culti- among narcotic addicts who dissolve the tablets in vated, primarily East Africa and water and inject the mixture. Complications arising the Arabian Peninsula.There, from this practice are common due to the insoluble chewingkhatpredatesthe fillers used in the tablets.When injected, these use of coffee and is used in a materials block small blood vessels, causing serious similar social context. Chewed damage to the lungs and retina of the eye. Binge in moderation, khat alleviates use, psychotic episodes, cardiovascular complica- fatigue and reduces appetite. tions, and severe psychological addiction have all Compulsive use may result in beenassociatedwithmethylphenidate abuse. manic behavior with grandiose Methylphenidate is used legitimately in the treat- delusions or in a paranoid type ment of excessive daytime sleepiness associated of illness, sometimes accompa- with narcolepsy, as is the newly marketed Schedule nied by hallucinations. Khat has IV stimulant, modafinil (Provigil ®).However; the been smuggled into the United primary legitimate medical use of methylphenidate States and other countries from (Rita lin®, Methylin®, Concerta®, Focalin ®)isto the source countriesfor use treat attention deficit hyperactivity disorder (ADHD) by emigrants. Itcontains a in children. The increased use of this substance for number of chemicals, among the treatment of ADHD has paralleled an increase which are two controlled sub- in its abuse among adolescents and young adults stances, cathinone (Schedule I) who crush these tablets and snort the powder to and cathine (Schedule IV).As get high. Youngsters have little difficulty obtaining the leaves mature or dry, cathi- methylphenidate from classmates or friends who none is converted to cathine, have been prescribed it. which significantly reduces its stimlatory properties.

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47 Schedule II

Trade Name: Desoxyn Gradumet Controlled Ingredients: methamphet- amine hydrochlorate, 10 mg Trade Name: Biphetamine 12 1/2 Controlled Ingredients: dl-amphet- amine, 6.25 mg ; dextroamphet- amine, 6.25 mg

Trade Name: Desoxyn Gradumet Controlled Ingredients: methamphet- amine hydrochlorate, 15 mg Trade Name: Biphetamine 20 Controlled Ingredients: dl-amphet- amine, 10 mg; dextroamphetamine, 10 mg

Trade Name: Methylphenidate Hydrochloride Controlled Ingredients: methylpheni- date hydrochloride, 10 mg

Trade Name: Dexedrine Controlled Ingredients: dextroam- phetamine sulfate, 10 mg

Trade Name: Methylphenidate Hydrochloride Controlled Ingredients: methylpheni- Trade Name: Dexedrine date hydrochloride, 20 mg Controlled Ingredients: dextroam- phetamine sulfate, 15 mg

Trade Name: Ritalin Controlled Ingredients: methylpheni- Trade Name: Dexedrine Spansule date hydrochloride, 5 mg Controlled Ingredients: dextroam- phetamine sulfate, 5 mg

Trade Name: Ritalin Controlled Ingredients: methylpheni- Trade Name: Desoxyn date hydrochloride, 10 mg Controlled Ingredients: metham- phetamine hydrochlorate, 5 mg

Trade Name: Ritalin Controlled Ingredients: methylpheni- Trade Name: Desoxyn Gradumet date hydrochloride, 20 mg Controlled Ingredients: metham- phetamine hydrochlorate, 5 mg 40

BEST COPY AVAILABLE S

Schedule III

Trade Name: Fastin Controlled Ingredients: phenter- Trade Name: Didrex mine hydrochloride, 30 mg Controlled Ingredients: benzphet- amine hydrochloride, 50 mg

Trade Name:, lonamin Trade Name: Plegine Controlled Ingredients: phenter- Controlled Ingredients: phendimet- mine hydrochloride, 15 mg razine tartrate, 35 mg

Trade Name: Pre lu-2 Controlled Ingredients: phendimet- Trade Name: lonamin razine tartrate, 105 mg Controlled Ingredients: phenter- mine hydrochloride, 30 mg

Schedule IV

Trade Name: Mazanor Controlled Ingredients: mazindol, Trade Name: Adipex 1.0 mg Controlled Ingredients: phenter- mine hydrochloride, 37.5 mg

r' Trade Name: Sanorex Controlled Ingredients: mazindol, Trade Name: Tenuate 1.0 mg Controlled Ingredients: diethylpro- prion hydrochloride, 25 mg

Trade Name: Sanorex I Controlled Ingredients: mazindol, 2.0 mg Trade Name: Tenuate Dospan Controlled Ingredients: diethylpro- prion hydrochloride, 75 mg

41 BEST COPY AVAILABLE ya

CAN NABI

DRUGS OF ABUSE

Cannabis sativa L.,the hemp plant, grows wild (synthetic THC) product, Marinol®, for the control throughout most of the tropic and temperate regions of nausea and vomiting caused by chemotherapu- of the world. Prior to the advent of synthetic fibers, tic agents used in the treatment of cancer and to the cannabis plant was cultivated for the tough fiber stimulate appetite in AIDS patients.Marinol® was of its stem.In the United States, cannabis is legiti- rescheduled in 1999 and placed in Schedule III of mately grown only for scientific research. the CSA.

Cannabis contains chemicals called Cannabis products are usually smoked. Their effects that are unique to the cannabis plant.Among are felt within minutes, reach their peak in 10 to 30 the cannabinoids synthesized by the plant are minutes, and may linger for two or three hours. cannabinol, , cannabinolidic acids, can- The effects experienced often depend upon the nabigerol, cannabichromene, and several isomers experience and expectations of the individual user, of .One of these, delta -9- as well as the activity of the drug itself. tetrahydrocannabinol (THC), is believed to be Low doses tend to induce a sense responsible for most of the characteristic of well- psychoactive effects of canna- bis Research has resulted in development and marketing of the dronabinol

42

50 being and a dreamy state of relaxation, which may Three drugs that come from cannabismarijuana, be accompanied by a more vivid sense of sight, hashish, and hashish oilare distributed on the U.S. smell, taste, and hearing, as well as subtle altera- illicit market. Having no currently accepted medical tions in thought formation and expression. This state use in treatment in the United States, they remain of intoxication may not be noticeable to an observer. under Schedule I of the CSA. Today, cannabis is illic- However; driving, occupational, or household acci- itly cultivated, both indoors and out, to maximize its dents may result from a distortion of time and space THC content, thereby producing the greatest pos- relationships and impaired coordination.Stronger sible psychoactive effect. doses intensify reactions. The individual may expe- rience shifting sensory imagery, rapidly fluctuating emotions,fragmentarythoughtswithdisturb- MARIJUANA ing associations, an altered sense of self-identity, impaired memory and a dulling of attention despite Marijuana is the most frequently encountered illicit an illusion of heightened insight.High doses may drug worldwide.The term "marijuana," as com- result in image distortion, a loss of personal identity, monly used, refers to the leaves and flowering tops fantasies, and hallucinations. of the cannabis plant that are dried to produce a tobacco-like substance. Marijuana varies sig- nificantly in its potency, depending on the source and selection of plant materials used. The form of marijuana known as sinsemilla (Spanish, sin semilla: without seed), derived from the unpollinated female cannabis plant, is preferred for its high THC content. Marijuana is usually smoked in the form of loosely rolled cigarettes called joints, or hollowed out com- mercial cigars called blunts. Joints and blunts may be laced with a number of adulterants including phencyclidine (PCP), substantially altering the effects and toxicity of these products.Street names for marijuana include pot, grass, weed, Mary Jane, and reefer.Although marijuana grown in the United States was once considered inferior because of a low concentration of THC, advancements in plant selec- tion and cultivation have resulted in highly potent domestic marijuana. In 1974, the average THC con- tent of illicit marijuana was less than one percent; in 1999, potency averaged 7.03 percent. The THC content in today's sinsemilla averages 13.65 percent and ranges as high as 30 percent.

43 51 Marijuana contains known toxins and cancer-caus- ing chemicals. Marijuana users experience the same health problems as tobacco smokers, such as bron- chitis, emphysema, and bronchial asthma. Some of the effects of marijuana use also include increased heart rate, dryness of the mouth, reddening of the eyes, impaired motor skills and concentration, and frequently hunger and an increased desire for Below: Growing marijuana sweets. Extended use increases risk to the lungs and indoors has become a popular reproductive system, as well as suppression of the means of cultivation. It immune system. Occasionally, hallucinations, fanta- reduces the likelihood of sies, and paranoia are reported. Long-term chronic detection more readily marijuana use is associated with an Amotivational and provides higher, more Syndrome characterized by apathy, impairment of technologically advanced judgement memory and concentration, and loss of agricultural methods. interest in personal appearance and the pursuit of unconventional goals.

"- t.

Rolling papers

44 HASHISH HASHISH OIL

The term hash oil is used by illicit drug users and dealers, but is a misnomer in suggesting any resem- blance to hashish. Hash oil is produced by extracting the cannabinoids from plant material with a solvent. The color and odor of the resulting extract will vary, depending on the type of solvent used. Current samples of hash oil, a viscous liquid ranging from amber to dark brown in color, average about 15 percent THC. In terms of its psycho- active effect, a drop or two of this liquid on a cigarette Hashish consists of the THC-rich resinous material of is equal to a single "joint" the cannabis plant, which is collected, dried, and of marijuana. then compressed into a variety of forms, such as balls, cakes, or cookie-like sheets.Pieces are then broken off,placed in pipes, and smoked. The Middle East, North Africa, and Pakistan/Afghanistan are the main sources of hashish. The THC content of hashish that reached the United States, where demand is limited, averaged about 5 percent in the 1990s.

Schedule III

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

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

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

45 14,

*)Ax iyy

LSD blotter paper

Hallucinogens

W.* * Ark DRUGS OF ABUSE 44' P Hallucinogens are among the oldest 0 known group of drugs used for their ability to alter human perception and mood.

A For centuries, many of the naturally occurringhallucinogens foundin plants and fungi have been used for a variety of shamanistic practices. In more recent years, a number of synthetic hal- lucinogens have been produced, some of which are much more potent than their naturally occurring counterparts.

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

46

54 However, taken in non-toxic dosages, these sub- stances produce changes in perception, thought, LSD and mood. Physiological effects include elevated Lysergic acid diethylamide (LSD) is the most potent heart rate, increased blood pressure, and dilated hallucinogen known to science, as well as the most pupils. Sensory effects include perceptual distor- highly studied. LSD was originally synthesized in tions that vary with dose, setting, and mood. Psy- 1938 by Dr. Albert Hoffman.However, its halluci- chic effects include disorders of thought associated nogenic effects were unknown until 1943 when with time and space.Time may appear to stand Hoffman accidentally consumed some LSD.It was still and forms and colors seem to change and take later found that an oral dose of as little as 0.000025 on new significance. This experience may be either grams (or 25 micrograms, equal in weight to a few pleasurable or extremely frightening.It needs to be grains of salt) is capable of producing rich and vivid stressed that the effects of hallucinogens are unpre- hallucinations. LSD was popularized in the 1960s dictable each time they are used. by individuals like Timothy Leary who encouraged American students to "turn on, tune in, and drop Weeks or even months after some hallucinogens out." LSD use has varied over the years but it still have been taken, the user may experience flash- remains a significant drug of abuse. backsfragmentary recurrences of certain aspects of the drug experience in the absence of actually Because of its structural similarity to a chemical pres- taking the drug. The occurrence of a flashback is ent in the brain and its similarity in effects to unpredictable, but is more likely to occur during certain aspects of psychosis, LSD was times of stress and seem to occur more frequently used as a research tool to study in younger individuals.With time, these episodes mental illness. The average effec- diminish and become less intense. tive oral dose is from 20 to 80 micrograms with the effects of The abuse of hallucinogens in the United States higher doses lasting for 10 to received much public attention in the 1960s and 12 hours. LSD is usually sold 1970s. A subsequent decline in their use in the in the form of impregnated 1980s may be attributed to real or perceived haz- paper (blotter acid),typi- ards associated with taking these drugs. However, cally imprinted with color- a resurgence of the use of hallucinogens in the ful graphic designs. It has 1990s is cause for concern. According to the 2001 also been encountered National Household Survey, the incidence of hallu- intablets(microdots), cinogen use has exhibited two notable periods of thin squares of gelatin increase. Between 1965 and 1971, the number of (window panes), in initiates rose tenfold, from 90,000 to 900,000. The sugar cubes and, rarely, second period of increase began in 1990 when in liquid form. there were approximately 600,000 new users.By 2000, the number of initiates rose nearly threefold, Physicalreactionsmay to 1.5 million.Hallucinogenic mushrooms, LSD, include dilated pupils, low- and MDMA are popular among junior and senior ered body temperature, nausea, LSD high school students who use hallucinogens. "goose bumps," profuse perspiration, increased blood sugar, and rapid heart There is a considerable body of literature that links the use of some of the hallucinogenic substances to neuronal damage in animals, and recent data support that some hallucinogens are neurotoxic to humans.However, the most common danger of hallucinogen use is impaired judgment that often leads to rash decisions and accidents. LSD in hardpack containers

47

55 rate. During the first hour after ingestion, the 10 to 20 mg, these hallucinogens produce muscle user may experience visual changes with extreme relaxation, dilation of pupils, vivid visual and auditory changes in mood.In the hallucinatory state, the distortions, and emotional disturbances. However, user may suffer impaired depth and time percep- the effects produced by consuming preparations of tion, accompanied by distorted perception of the dried or brewed mushrooms are far less predictable size and shape of objects, movements, color, sound, and largely depend on the particular mushrooms touch, and the users own body image. During this used and the age and preservation of the extract. period, the users' ability to perceive objects through There are many species of "magic" mushrooms that the senses is distorted: they may describe "hearing contain varying amounts of these tryptamines, as colors" and "seeing sounds." The ability to make well as uncertain amounts of other chemicals. As sensible judgments and see common dangers is a consequence, the hallucinogenic activity, as well impaired, making the user susceptible to personal as the extent of toxicity produced by various plant injury. After an LSD "trip," the user may suffer acute samples, are often unknown. anxiety or depression for a variable period of time. Flashbacks have been reported days or even months Dimethyltryptamin (DMT) has a long history of use after taking the last dose. and is found in a variety of plants and seeds.It can also be produced synthetically. It is ineffective when taken orally, unless combined with another drug Psilocybin & Psilocyn that inhibits its metabolism. Generally it is sniffed, smoked, or injected.The effective hallucinogenic and Other dose in humans is about 50 to 100 mg and lasts for about 45 to 60 minutes.Because the effects Tryptamines last only about an hour; the experience has been referred to as a "businessmans trip." A number of Schedule I hallucinogenic substances are classified chemically as tryptamines. Most of A number of other hallucinogens have very similar these are found in nature but many, if not all, can structures and properties to those of DMT.Dieth- be produced synthetically.Psilocybin (0- phospho- yltryptamine (DET), for example,is an analogue ryl-4- hydroxy -N,N-ethyltryptamine) and psilocyn of DMT and produces the same pharmacological (4-hydroxy-N, N-dimethyltryptamine) are obtained effects but is somewhat less potent than DMT. from certain mushrooms indigenous to tropical and Alpha-ethyltryptamine (AET) is another tryptamine subtropical regions of South America, Mexico, and hallucinogen added to the list of Schedule Ihal- the United States. As pure chemicals at doses of lucinogens in1994. Bufotenine (5-hydroxy-N-N- dimethyltryptamine) is a Schedule I substance found in certain mushrooms, seeds, and skin glands of Bufo toads.In general, most bufotenine prepa- rations from natural sources are extremely toxic. N,N-Diisopropy1-5-methoxytryptamine(referredto as Foxy-Methoxy and methyl treptamine) are orally active tryptamines recently encountered in the United States.

48 Peyote & Mescaline MDMA (Ecstasy) Peyote is a small, spineless cactus, Lophophora wil- liamsii, whose principal active ingredient is the hal- & Other lucinogen mescaline (3, 4, 5-trimethoxyphenethyl- amine).From earliest recorded time, peyote has Phenethylamines been used by natives in northern Mexico 3.4-Methylenedioxymethamphetamine (MDMA, and the southwestern United States as Ecstasy) was first synthesized in 1912 but remained a part of their religious rites. in relative obscurity for many years.In the 1980s, MDMA gained popularity as a drug of abuse result- The top of the cactus growing ing in its final placement in Schedule 1 of the CSA. above groundalso referredto Today MDMA is extremely popular among "rave" as the crownconsists of disc- participants, and in 2000, it was estimated that two shaped buttons that are cut million tablets were smuggled into the United States from theroots and dried. every week. Thesebuttonsaregener- ally chewed or soaked in water to produce an intoxicatingliquid. The hal- lucinogenic dose of mescaline is about 0.3 to 0.5 grams and lasts about 12 hours. While peyote produced rich visual hal- lucinations that were important to the native peyote cults, the full spectrumofeffects served as a chemically induced model of mental illness.Mescaline canbe extracted from peyote or produced synthetically. Both peyote and mescaline are listed in the CSA as Schedule I hallucinogens.Many chemical variations of mescaline and amphetamine have been synthesized for their "feel good" effects. 4-Methyl-2,5-dimethoxyamphetamine (DOM) was introduced into the San Francisco drug scene in the late1 960s and was nicknamed STP; an acro- nym for "Serenity Tranquility, and Peace."Other illicitly produced analogues include 4-bromo-2,5- dimethoxyamphetamine (DOB) and 4-bromo-2.5- dimethoxyPhenethylamine (-B or Nexus). In 2000, para methoxyamphetamine (PMA,) and para methoxymethamphetamine (PMMA) were identified in tablets sold as Ecstasy. PMA, which first appeared on the illicit market briefly in the early 1970s, is asso- ciated with a number of deaths in both the United States and Europe.In 2001, significant seizures of 2c-t-7 (dimethoxy-4-(n)-propylthiophenethylamide) and BZP (benzerpiperazine/and TFMPP Trifluoro- methylphenolpiperazine) were made. BZP and TFMPP were sold in combination and promoted as MDMA-like or even as MDMA. Tablets are often very similar to MDMA tablets.

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57 Assorted samples of MDMA

MDMA users at a 'Rare" (usually held in a warehouse) often become dehydrated and grind their teeth. Sucking on a pacifier can reduce sonic of these symptoms.

Individual tablets are oftenimprinted MDMA produces both amphetamine-like stimu- with graphic designs lation and mild mescaline-like hallucinationsIt is or commercial logos, touted as a "feel good" drug with an undeserved and typically contain reputation of safety MDMA produces euphoria, 100 mg of MDMA After increased energy, increased sensual arousal, and oral administration, effects are enhanced tactile sensations.However, it also pro- felt within 30 to 45 minutes, peak at 60 to 90 duces nerve cell damage that can result in psychi- minutes, and last for 4 to 6 hours. Analysis of seized atric disturbances and long-term cognitive impair- MDMA tablets indicates that about 80 percent of all ments. The userwill often experience increased samples actually contain MDMA. About 10 percent muscle tension, tremors, blurred vision, and hyper- of the MDMA-positive samples also contain MDA thermia. The increased body temperature can result (3.4-meth- ylenedioxyamphetamine), and MDEA in organ failure and death. (3.4-methyl-enedioxyethyl amphetamine), while another 10 percent contain amphetamine, meth- MDMA is usually (distributed in tablet form and amphetamine, or both.Fraudulent MDMA tablets taken orally at doses ranging from 2 to1 0 mg per frequently contain combinations of ephedrine, dex- kilogram, depending on the users body weight. tromethorphan, and caffeine.

50 58 Hundreds of compounds can be produced by applied to a leafy material, such as parsley, mint, making slight modifications to the oregano, or marijuana, and smoked. molecule. Some of these analogues are phar- maccologically active and differ from one another The drug's effects are as varied as its appearance. in potency, speed of onset, duration of action, and A moderate amount of PCP often causes the user capacity to modify mood with or without produc- to feel detached, distant, and estranged from his ing overt hallucinations.The drugs are usually surroundings. Numbness, slurred speech, and loss taken orally, sometimes snorted, and rarely injected. of coordination may be accompanied by a sense of Because they are produced in clandestine labora- strength and invulnerability. A blank stare, rapid and tories, they are seldom pure and the amount in a involuntary eye movements, and an exaggerated capsule or tablet is likely to vary considerably. gait are among the more observable effects. Audi- tory hallucinations, image distortion, severe mood According to the 2001 National Household Survey, disorders, and amnesia may also occur.In some initiation of Ecstasy use has been rising steadily since users, PCP may cause acute anxiety and a feeling of 1992. The increase from 1.3 million new users in impending doom; in others, paranoia and violent 1999 to 1.9 million in 2000 was statistically signifi- hostility; and in some, it may produce a psychosis cant, as were the age- specific increases among 12 indistinguishable from schizophrenia.PCP use is to 17 year olds and 18 to 25 year olds. associated with a number of risks, and many believe it to be one of the most dangerous drugs of abuse.

Phencyclidine (PCP) Modification of the manufacturing process may yieldchemicallyrelated analogues capable of & Related Drugs producing psychic effects similar to PCPFour of these substances (N-ethyl-l-phenylcyclohexylamine In the 1950s, phencyclidine was investigated as an or PCE,l- (phenylcyclohexyl)- pyrrolidine or PCPy, anesthetic but, due to the side effects of confusion II-I-( 2-thieny1)-cyclohexyll-piperdine or TCP and HI- and delirium, its development for human use was (2-thienyl)cyclohexyll-pyrrolidine or TCPy have been discontinued.It became commercially available for encountered on the illicit market and have been use as a veterinary anesthetic in the 1960s under the placed in Schedule I of the CSA. Telazol®, a Sched- trade name of Sernylan, and was placed in Schedule ule III veterinary anesthetic containing (a III of the CSA.In 1978, due to considerable abuse, PCP analogue), in combination with , (a phencyclidine was transferred to ScheduleIIof benzodiazepine), is sporadically encountered as a the CSA and manufacturing of Sernylan, was dis- drug of abuse. continued. Today, virtually all of the phencyclidine encountered on the illicit market in the United States is produced in clandestine laboratories. Ketamine

Ketamine is arapidlyacting Phencyclidine, more commonly known as PCP is 101111 general anesthetic.Its pharma- illicitly marketed under a number of other names, cologicalprofile is essentially including Angel Dust, Supergrass, Killer Weed, the same as phencyclidine. Like Embalming Fluid, and Rocket Fuel, reflecting the PCP ketamine is referred to as a range of its bizarre and volatile effects. In its pure dissociativeanestheticbecause form, it is a white crystalline powder that readily patientsfeeldetached ordis- dissolves in water.However, most PCP on the connected from their pain and illicit market contains a number of contaminants environment when anesthetized as a result of makeshift manufacturing, causing with this drug. Unlike most anes- the color to range from tan to brown, and the thetics, ketamine produces only consistency from powder to a gummy mass. mild respiratory depression and Although sold in tablets and capsules as well appears to stimulate, not depress, as in powder and liquid form, itis commonly the cardiovascular system.

51

59 In addition, ketamine has both analgesic and amne- doses produce disorganized thinking, altered body sic properties and is associated with less confusion, image, and a feeling of unreality with vivid visual irrationality, and violent behavior than PCP. Use hallucinations. High doses produce analgesia, of ketamine as a general anesthetic for humans amnesia, and coma. has been limited due to adverse effects including delirium and hallucinations. Today,itis primarily used in veterinary medicine, but has some utility for emergency surgery in humans.

Although ketamine has been marketed in the United States for many years, it was only recently associated with significant diversion and abuse and placed in Schedule III of the CSA in 1999. Known in the drug culture as "Special K" or "Super K," ketamine has become a staple at dance parties or "raves." Ket- amine is supplied to the illicit market by the diversion of legitimate pharmaceuticals (Ketaset®, Ketalar ®). Itis usually distributed as a powder obtained by removing the liquid from the pharmaceutical prod- ucts. As a drug of abuse, ketamine can be adminis- tered orally, snorted, or injected.It is also sprinkled on mar juana or tobacco and smoked.After oral or intranasal administration, effects are evident in about 10 to 15 minutes and are over in about an hour. After intravenous use, effects begin almost immediately and reach peak effects within minutes. Ketamine can act as a depressant or a psychedelic. Low doses produce vertigo, ataxia, slurred speech, slow reaction time, and euphoria. Intermediate

52 60 Steroids

DRUGS OF ABUSE

As athletes gathered at the 2002 Olympic Once viewed as a problem associated only with Games in Salt Lake City, Utah, the issue of per- professional and elite amateur athletes,various formance enhancing drugs, especially anabolic reports indicate that abuse has steroids, once again gained international atten- increasedsignificantly among adolescents.For tion. These drugs are used by high school, college, example, the National Institute on Drug Abuse 2001 professional, and elite amateur athletes in a variety Monitoring the Future survey reveals that steroids of sports (e.g., weight lifting, track and field, swim- are used predominately by males. For example, ming, cycling, and others) to obtain a competitive in 2001, the annual prevalance rates were two to advantage. Body builders and four times as high among males as fitness buffs take anabolic ste- among females. The use of steroids roids to improve their physical increased significantly among 12th appearance, and individu- graders in 2001, perhaps reflecting alsinoccupations requiring a cohort effect, since steroid use had enhancedphysicalstrength risen sharpley among the younger (e.g., body guards, night club students in the prior two years. bouncers, construction work- ers) are also known to use these Most illicit anabolic steroids are sold drugs. at gyms, competitions, and through I is mail operations. For the most part, Concerns over a growing illicit these substances are smuggled into market, abuse by teenagers, the United States from many coun- and the uncertainty of possible tries.The illicit market includes vari- harmful long-term effects of ste- ous preparations intended for human roid use, led Congress in 1991 and veterinary use as well as bogus to place anabolic steroids as a and counterfeit products.The most class of drugs into Schedule III commonly encountered anabolic ste- of the Controlled Substances Act roids on the illicit market include tes- (CSA). The CSA defines anabolic tosterone, nandrolone, methenolone, steroids as any drug or hor- stanozolol, and methandrostenolone. monal substance chemically and Other steroids seen in the illicit market pharmacologically related to tes- include boldenone, fluxoymesterone, tosterone (other than estrogens, methandriol, methyl testosterone, progestins, and corticosteroids) oxandrolone, oxymetholone, and that promotes muscle growth. trenbolone.

53

61 A limited number of anabolic steroids have been Physical side effects include elevated blood pressure approved for medical and veterinary use. The pri- and levels, severe acne, premature bald- mary legitimate use of these drugs in humans is for ing, reduced sexual function, and testicular atrophy. the replacement of inadequate levels of testosterone In males, abnormal breast development (gyneco- resulting from a reduction or absence of functioning mastia) can occur. In females, anabolic steroids have testes. Other indications include anemia and breast a masculinizing effect, resulting in more body hair, a cancer. Experimentally, anabolic steroids have been deeper voice, smaller breasts, and fewer menstrual used to treat a number of disorders including AIDS cycles. Several of these effects are irreversible. In wasting, erectile dysfunction, and osteoporosis. In adolescents, abuse of these agents may prematurely veterinary practice, anabolic steroids are used to pro- stop the lengthening of bones, resulting in stunted mote feed efficiency and to improve weight gain, growth. With some individuals the use of anabolic vigor, and hair coat. They are also used in veterinary steroids may be associated with psychotic reac- practice to treat anemia and counteract tissue break- tions, manic episodes, feelings of anger or hostility, down during illness and trauma. aggression, and violent behavior.

When used in combination with exercise train- A variety of non-steroid drugs are commonly found ing and high protein diets, anabolic steroids can within the illicit anabolic steroid market. These sub- promote increased size and strength of muscles, stances are primarily used for one or more of the improve endurance, and decrease recovery time following reasons: 1) to serve as an alternative to between workouts. They are taken orally or by intra- anabolic steroids; 2) to alleviate short-term adverse muscular injection. Users concerned about drug effects associated with anabolic steroid use; or 3) to tolerance often take steroids on a schedule called mask anabolic steroid use. Examples of drugs serv- a cycle. A cycle is a period of between 6 and 14 ing as alternatives to anabolic steroids include clenb- weeks of steroid use, followed by a period of absti- uterol, human growth hormone, insulin, insulin-like nence or reduction in use. Additionally, users tend to growth factor, and GHB. Drugs used to prevent or "stack" the drugs, using multiple drugs concurrently. treat adverse effects of anabolic steroid use include Although the benefits of these practices are unsub- tamoxifen, diuretics, and human chorionic gonado- stantiated, most users feel that cycling and stacking tropin.Diuretics, probenocid, and epitestosterone enhance the efficiency of the drugs and limit their may be used to mask anabolic steroid use. side effects. Over the last few years, a number of precursors to Another mode of steroid use is called "pyramiding." either testosterone or nandrolone have been mar- With this method users slowly escalate steroid use keted as dietary supplements in the United States. (increasing the number of drugs used at one time Some of these substances include androstenedi- and/or the dose and frequency of one or more ste- one, androstenediol, norandrostenedione, noran- roids), reach a peak amount at mid-cycle and gradu- drostenediol, and (DHEA). ally taper the dose toward the end of the cycle. The escalation of steroid use can vary with different types of training. Body builders and weight lifters tend to escalate their dose to a much higher level than do long distance runners or swimmers.

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

54 62 STEROIDS IDENTIF CATION

Schedule III

Trade Name: Anadrol Controlled Ingredients: oxymetholone, 50 mg

Trade Name: Android-25 Controlled Ingredients: methyltestoster- Trade Name: Testosterone one, 25 mg Controlled Ingredients: testosterone cypionate, 200 mg/ml

Trade Name: Winstrol Controlled Ingredients: stanozolol, 2mg/m1

Trade Name: Depo- Testosterone Controlled Ingredients: testosterone cypionate, 200 mg/ml Inhalants

DRUGS OF ABUSE

Inhalants are a diverse group of substances that Household survey, between 1994 and 2000, the include volatile solvents, gases, and nitrites that number of new users increased more than are sniffed, snorted, huffed, or bagged to produce 50 percent, from 618,000 new users in 1994 to intoxicating effects similar to alcohol.These sub- 979,000 in 2000. These estimates were higher than stances are found in common household products a previous peak in 1978 (662,000 new users). like glues, lighter fluid, cleaning fluids, and paint The highest incidence of use is among 10 products. Inhalant abuse is the deliberate inhaling to 12 year old children with rates of use or sniffing of these substances to get high, declining with age. Parents worry about and it is estimated that about 1,000 sub- alcohol, tobacco, and drug use but stances are misused in this manner. The may be unaware of the hazards easy accessibility, low cost, legal status, associated with products found and ease of transport and concealment throughout their homes. Know- make inhalants one of the first substances ing what these products are, how abused by children. About 15 to 20 percent they might be harmful, and recog- of junior and senior high school students have nizing the signs and symptoms of tried inhalants with about 2 to 6 percent report- their use as inhalants, can help a parent ing current use. According to the 2001 National prevent inhalant abuse.

56

64 For example, volatile solvents are found in a number rapidly. Entry into the brain is fast and the intoxicat- of everyday products.Some of these products ing effects are short lived but intense. include nail polish remover, lighter fluid, gasoline, paint and paint thinner, rubber glue, waxes, and Inhalants depress the central nervous system, pro- varnishes.Chemicals foundintheseproducts ducing decreased respiration and blood pressure. include , , , methylene Users report distortion in perceptions of time and chloride, acetone, methyl ethyl ketone, methyl butyl space. Many users experience headaches, nausea, ketone, trichhloroethylene, and trichlorethane. The slurred speech, and loss of motor coordination. gas used as a propellant in canned whipped cream Mental effects may include fear, anxiety, or depres- and in small lavender metallic containers called sion. A rash around the nose and mouth may be "whippets" (used to make whipped cream) is nitrous seen, and the abuser may start wheezing. An odor oxide or "laughing gas"the same gas used by of paint or organic solvents on clothes, skin, and dentists for anesthesia. Tiny cloth-covered ampules breath is sometimes a sign of inhalant abuse. Other called poppers or snappers by abusers contain amyl indicators of inhalant abuse include slurred speech nitrite, a medication used to dilate blood vessels. or staggering gait, red, glassy, watery eyes, and Butyl nitrite, sold as tape head cleaner excitability or unpredictable behavior. and referred to as "rush," "locker room," or "climax," is The chronic use of inhalants has been associated often sniffed or with a number of serious health problems.Glue huffed to and paint thinner sniffing produce kidney abnormal- get high. ities while the solvents toluene and cause liver damage.Memory impairment, atten- Inhalants tion deficits, and diminished non-verbal intelligence may be sniffed have been related to the abuse of inhalants. Deaths directly from an resulting from heart failure, asphyxiation, or aspira- open container tion have occurred. or huffed from a rag soaked in For more information regarding inhalants, contact the substance theNationalInhalantPreventionCoalitionby and held to the telephone (1-800-269-4237) or by the Internet face. Alternatively, (www.inhalants org) the open container or soaked rag can be placed in a bag wherethevapors can concentrate before being inhaled. Some chemicalsare painted on the hands or fingernails or placed on shirt sleeves or wrist bands toenable an abuser to continually inhale the fumes without being detected by a teacher or other adult. Although inhalant abusers may prefer one particular substance because of taste or odor, a variety of substances may be used because of simi- lar effects, availability, and cost. Once inhaled, the extensive capillary surface of the lungs allows rapid absorption of the substance and blood levels peak

57 65 DR GS ABU E

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Alabama Illinois Nebraska South Carolina Counterdrug Coordinator Counterdrug Coordinator Counterdmg Coordinator Counterdrug Coordinator 1750 Congressman Dickinson, 1301 N. MacArthur Blvd, DCSOPS-CD, 1300 Military Road TAG-CS-CD, 1 Nat'l Guard Rd, Stop 24 PO Box 3711 Camp Lincoln Lincoln, NE Columbia, SC 29201 Montgomery, AL 36109 Springfield, IL 62702 (402) 309-1860 (803) 806-1559 (334) 213-7658 (217) 761-3728 Nevada South Dakota Alaska Indiana Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator 685 East Plum Lane SDMSCA-CD, 2823 W Main Street PO Box 5800, Bldg 60802, Camp Carroll 3766 W. Morris Street Reno, NV 89502 Rapid City, SD 57702 Ft. Richardson, AK 99505 Indianapolis, IN 46241 (775) 348-9724 (605) 737-6723 (907)428-3617 (317) 486-8291 New Hampshire Tennessee Arizona Iowa Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator Countcrdrug Coordinator St Mil Res, 4 Pembroke Rd Voluntrrt Tng Site 5636 E. McDowell Road 7700 NW Beaver Drive Concord, NH 03301 Bldg 603, Fitzhugh Blvd, Phoenix, AZ 85008 Johnston, IA 50131 (603) 227-1542 Smyma, TN 37167 (602) 267-2623 (515) 252-4606 New Jersey (615) 355-3901 Arkansas Kansas Counterdmg Coordinator Texas Counterdrug Coordinator Counterdrug Coordinator POTO-CDTF, Bldg 3650, Counterdrug Coordinator DOMS-CD, PO Box 19012, Bldg 684, Saylors Pond Rd PO Box 5218, Bldg 10, Camp Mabry Bldg 16412, Camp JT Robinson Forbes Field Ft. Dix, NJ 08640 Austin, TX 78763 N. Little Rock, AR 72199 Pauline, KS 66619 (609) 562-0812 (512) 782-5154 (501) 791-5492 (785) 862-0001 New Mexico Utah California Kentucky Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator PO Box 5610 12953 S. Minuteman Drive 10293 Rockingham Drive Joint Spt Opns, 5751 Briar Hill Rd Albuquerque, NM 87185 Draper, UT 84020 Sacramento, CA 95827 Bldg28 (505) 846-1031 (801) 523-4150 (916) 854-3715 Lexington, KY 40512 New York Vermont Colorado (859) 293-4142 Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator Louisiana 109th AG, 1 Air National Guard Rd VT NG, Green Mtn Armory, 55 S. Potomac Street Counterdrug Coordinator Scotia, NY 12302 Camp Johnson Aurora, CO 80012 LANG-POTO-CD, Bldg 35, (518) 786-3477 Colchester, VT 05446 (303) 677-8303 Jackson Barracks North Carolina (802) 338-3350 Connecticut New Orleans, LA 70146 Counterdrug Coordinator Virginia Counterdrug Coordinator (504) 278-8556 4105 Reedy Creek Road Counterdrug Coordinator 360 Broad Street Maine Raleigh, NC 27607 VAOT, Bldg 473, Ft Pickett Hartford, CT 06105 Counterdrug Coordinator (919) 664-6322 Blackstone, VA 23824 (860) 493-2723 HQ, MEARNG, Camp Keyes North Dakota (434) 292-8529 Delaware Augusta, ME 04333 Counterdmg Coordinator Virgin Islands Counterdrug Coordinator (207) 626-4416 Frain Barracks, Bldg 040, Counterdrug Coordinator First Regiment Road Maryland PO Box 5511 4031 Lagrande Princesse Lot 1B Wilmington, DE 19808 Counterdrug Coordinator Bismarck, ND 58502 Christiansted (302) 326-7085 29th Div St, 5th Regt Armory (701)333-2050 St. Croix, VI 00820 District of Columbia Baltimore, MD 21201 Ohio (340) 774-3066 Counterdrug Coordinator (410) 576-6135 Counterdrug Coordinator Washington 2001 E. Capital Street Massachusetts AGOH-PA, 2825 W. Dublin Granville Rd Counterdrug Coordinator Washington, DC 20003 Counterdrug Coordinator Columbus, OH 43235 DCSOPS-CDTF, Camp Murray, Bldg 33 (202) 685-9726 50 Maple Street (614) 336-6426 Tacoma, WA 98430 Florida Milford, MA 01757 Oklahoma (253) 512-8894 Counterdrug Coordinator (508) 233-6804 Counterdrug Coordinator West Virginia POMSO-CD, 2305 State Rd #207 Michigan OK-POT-MS-CD, 3501 Military Cir NE Counterdrug Coordinator St. Augustine, FL 32086 Counterdrug Coordinator Oklahoma City, OK 73111 610 Dame St (904) 823-0438 2500 S. Washington Avenue (405) 228-5043 St. Albans, WV 25177 Georgia Lansing, MI 48913 Oregon (304) 722-7007 Counterdrug Coordinator (517) 483-5896 Counterdrug Coordinator Wisconsin JOPS-CD, 1651 Perry Street, Bldg 826 Minnesota PO Box 12889 Counterdrug Coordinator Dobbins ARB, GA 30069 Counterdrug Coordinator Salem, OR 97309 2400 Wright St, PO Box 8111 (678) 655-3473 MNAG-MSO-CDC, 20 W. 12th St (503)584-3938 Madison, WI 53704 Guam St. Paul, MN 55155 Pennsylvania (608) 242-3540 Counterdrug Coordinator (651) 282-4147 Counterdrug Coordinator Wyoming 622 E. Harmon Ind Park Road Mississippi Ft Indiantown Gap, Bldg 8-64 Counterdrug Coordinator Fort Juan Muna Counterdrug Coordinator Annville, PA 17003 DCSOPS-CDC, 5500 Bishop Blvd Tamuning, GU 96911 NGMS-OTO-DS, 550 Keyway Dr. (717) 861-2482 Cheyenne, WY 82009 (671) 472-7588 Flowood, MS 39233 Puerto Rico (307) 772-5259 Hawaii (601) 313-1670 Counterdrug Coordinator Counterdrug Coordinator Missouri PO Box 9023786, Stop 3 1/2 3949 Diamond Head Road Counterdrug Coordinator Gen Esteves St #100 Honolulu, HI 96816 MONG CD Program, 2302 Militia DriveSan Juan, PR 00901 (808) 732-0209 Jefferson City, MO 65101 (787) 977-4867 (573) 638-9599 Rhode Island Idaho Montana Counterdrug Coordinator Counterdrug Coordinator Counterdrug Coordinator 570 Read School House Road 4736 Kennedy Street, Bldg T-927 1900 Williams St, PO Box 4789 Coventry, RI 02816 Boise, ID 83705 Helena, MT 59604 (401) 392-0827 (208)422-3530 (406) 324-3177 59 BEST COPY AVAILABLE 67 DRUGS OF ABUSE National Guard Drug Demand Reduction Administrators

Alabama Illinois Nebraska South Carolina Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator 1750 Congressman Dickinson, PO Box 3711 5200 S. Cottage Crove DCSOPS-CD, 1300 Military Road TAG-CS-CD, 1 Nat'l Guard Rd, Stop 24 Montgomery, AL 36109 Chicago, IL 60615 Lincoln, NE Columbia, SC 29201 (334) 213-7724 (309) 477-2223 (402) 309-1875 (803) 806-2623 Alaska Indiana Nevada South Dakota Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator PO Box 5800, Bldg 60802, Camp Carroll IN Nat'l Guard, c/OHIDTA, PO Box 420 685 East Plum Lane SDMSCA-CD, 2823 W Main Street Ft. Richardson, AK 99505 Crown Point, IN 46308 Reno, NV 89502 Rapid City, SD 57702 (907) 428-3617 (219) 769-7679 (775) 348-9749 (605) 737-6602 Arizona Iowa New Hampshire Tennessee Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator 5636 E. McDowell Road 7700 NW Beaver Drive State Military Reservation Bldg 603, Fitzhugh Blvd, Volunteer Tng Site Phoenix, AZ 85008 Johnston, IA 50131 Concord, NH 03301 Smyrna, TN 37167 (602) 267-2901 (515) 252-4190 (603) 228-3364 (615) 355-3902 Arkansas Kansas New Jersey Texas Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator DOMS-CD, Bldg 16412, Camp JT Johnson PO Box 19012, Bldg 684, Forbes Field POTO-CDTF, Bldg 3650, Saylors Pond Rd PO Box 5218, Bldg 10, Camp Mabry N. Little Rock, AR 72199 Pauline, KS 66619 Ft. Dix, NJ 08640 Austin, TX 78763 (501) 212-5484 (785) 862-0001 (201) 368-5154 (512) 782-5238 California Kentucky New Mexico Utah Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator 10293 Rockingham Drive Bluegrass Sta, Bldg 26, 5751 Briar Hill Rd PO Box 5610 17800 Camp Williams Rd, Bldg 605 Sacramento, CA 95827 Lexington , KY 40516 Albuquerque, NM 87185 Riverton, UT 84065 (916) 854-3889 (859) 293-3900 (505) 846-7234 (801) 253-5521 Colorado Louisiana New York Vermont Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator 55 S. Potomac Street Bldg 35, Rm 251, Jackson Barracks 109th AG, Air National Guard Rd VT NG, Green Mtn Armory, Camp Johnson Aurora, CO 80012 New Orleans, LA 70146 Scotia, NY 12302 Colchester, VT 05446 (303) 677-8303 (504) 278-8555 (518) 786-3452 (802) 338-3440 Connecticut Maine North Carolina Virginia Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator 360 Broad Street MENG-CDC, Camp Keyes 145 AW, 5225 Morris Field Drive VAOT-CDC, Bldg 316, Ft Pickett Hartford, CT 06105 Augusta, ME 04333 Charlotte, NC 28208 Blackstone, VA 23824 (860) 493-2724 (207) 626-4334 (704) 391-4424 (804) 328-3198 Delaware Maryland North Dakota Virgin Islands Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator HQ, DEARNG, First Regiment Road 29th Div St, 5th Regt Armory FraMe Barracks, Bldg 040, PO Box 5511 4031 Lagrande Princesse Lot 1B Wilmington, DE 19808 Baltimore, MD 21201 Bismarck, ND 58502 Christianstead (302) 326-7079 (410) 576-6137 (701) 333-2054 St. Croix, VI 00820 District of Columbia Massachusetts Ohio (340) 774-3066 Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Washington 2001 E. Capital Street 50 Maple Street AGOH-PA, 2825 W. Dublin Granville Rd Drug Demand Reduction Administrator Washington, DC 20003 Milford, MA 01757 Columbus, OH 43235 DCSOPS-CDTF, Camp Murray, Bldg 34 (202) 685-9724 (508) 233-6867 (614) 336-6432 Tacoma, WA 98430 Florida Michigan Oklahoma (253) 512-8355 Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator West Virginia POMSO-CD/DDR, 2305 State Rd #207 2500 S. Washington Avenue OK-POT-MS-CD, 3501 Military Cir NE Drug Demand Reduction Administrator St. Augustine, FL 32086 Lansing, MI 48913 Oklahoma City, OK 73111 610 Dame St (904) 823-0355 (517) 483-5601 (405) 475-1491 St. Albans, WV 25177 Georgia Minnesota Oregon (304) 727-5068 Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Wisconsin JOPS-CD, 1651 Perry Street, Bldg 826 MNAG-MSO-CDC, 20 W. 12th St PO Box 12889 Drug Demand Reduction Administrator Dobbins ARB, GA 30069 St. Paul, MN 55155 Salem, OR 97309 2400 Wright St, PO Box 8111 (770) 919-3475 (651) 282-4149 (503) 584-3351 Madison, WI 53704 Guam Mississippi Pennsylvania (608) 242-3540 Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator Wyoming 622 E. Harmon Ind Park Road 550 Keyway Dr. Ft Indiantown Gap, Bldg 8-64 Drug Demand Reduction Administrator Fort Juan Muna Flowood, MS 39233 Annville, PA 17003 DCSOPS-DDR, 5500 Bishop Blvd Tamuning, GU 96911 (601) 313-1670 (717) 861-2231 Cheyenne, WY 82009 (671) 475-0834 Missouri Puerto Rico (307) 772-5959 Hawaii Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator MONG CD Program, 2302 Militia Drive PO Box 9023786, Gen Esteves St #100 3949 Diamond Head Road Jefferson City, MO 65101 San Juan, PR 00901 Honolulu, HI 96816 (816) 512-4990 (787) 289-1622 (808) 732-0209 Montana Rhode Island Idaho Drug Demand Reduction Administrator Drug Demand Reduction Administrator Drug Demand Reduction Administrator 1900 Williams St, PO Box 4789 570 Read School House Road 4736 Kennedy Street, Bldg 1-927 Helena, MT 59604 Coventry, RI 02816 Boise, ID 83705 (406) 324-3179 (401)392-0830 (208)422-3534

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