Compendium of Drug Abuse Jargon

Ronald P. Evens, PharmD William Clementi, BS (Pharm) San Antonio and Austin, Texas

Drug abuse slang is an originative and a protean language, which poses the problem of identification and definition of terms. This compilation of nomenclature provides an extensive list to serve as a resource for the busy family physician, who frequently deals with drug abuse problems.

Despite efforts by the government encompassing the following abuse The list on the following pages is and in the private sector to identify agents: alcohol, glue, hallucinogens, organized in alphabetical sequence drug abuse problems and collate the narcotics, sedative-hypnotics, and according to the drug abuse term. terminology of the “drug culture,” the stimulants; and the street slang em­ resultant lists of nomenclature usually ployed in association with their distri­ References describe only the “top 100 or 50” bution and administration, and 1. Konner DD, Rubin I: The pharma­ terms. This severely limits their useful­ reactions to them. cist's drug abuse manual. Pharmacy Times 39:35-37, 1973 ness as a resource tool because a The difficulty in comprehension of 2. Narcotics Identification Guide. significant proportion of the terms are this specialized lingo is primarily due Richmond, Va, Jump Street, The Drug Treatment Program of the Medical College already familiar to practitioners while to its protean nature and the continual of Virginia, 1970 generation of new terms. Different 3. Some Substances Used for Non- a vastly greater number of terms in use prescribed Drugging Effects. Washington, do not appear on the lists at all. subpopulations in the drug abuse cul­ DC, Pharmaceutical Manufacturers Associa­ tion, January, 1973 Therefore, we have accumulated and ture use dissimilar, changeable subsets 4. US Department of Health, Educa­ defined an extended list of drug abuse of this nomenclature, and newly tion, and Welfare, Health Services and Mental Health Administration: LSD. PHS phrases and jargon from several exist­ created terms filter through abuse Publication 1828. Washington, DC, US ing references and from individuals groups at variable rates. Out-dated Government Printing Office, 1969 5. Southwick WW: Inhalants-Solvents. knowledgeable about drug abuse. The jargon in a college crowd, for example, Downers Grove, III, Kwik-Fac, Media may be new language to a high school Publishers, 1971 review describes over 325 terms 6. Southwick WW: Speed, Cocaine, group. Further confusion in term defi­ and Other Stimulants. Downers Grove, III, Kwik-Fac, Media Publishers, 1971 nition is caused by the multiple slang 7. Southwick WW: Barbiturates. designations for a single drug and the Downers Grove, III, Kwik-Fac, Media Pub­ lishers, 1971 multiple meanings for a single slang 8. Southwick WW: Heroin. Downers word or phrase. In addition, the Grove, III, Kwik-Fac, Media Publishers, 1971 colloquialism and regionalism of our 9. Blakeslee A: What You Can Do society’s language also increase the About Dangerous Drugs. New York, Associ­ ated Press, 1971, pp 20-21 From the Department of Pharmacology, variability of this jargon. Finally, the 10. Einstein S: The Use and Misuse of University of Texas Health Science Center Drugs. Belmont, Calif, Wadsworth Publish­ at San Antonio and the Department of malevolent search for new drugs for ing Co, 1970, pp 1-72, 79-84 Pharmacy, University of Texas at Austin. abuse from botanical sources, the 11. Maurer DW, Vogel VH: Narcotics Requests for reprints should be addressed to and Narcotic Addiction, ed 4. Springfield, Dr. Ronald P. Evens, Department of chemist’s laboratory, and even house­ III, Charles C Thomas, 1973 Pharmacology, University of Texas Health hold items continually generates new 12. Richter RW (ed): Medical Aspects Science Center at San Antonio, 7703 Floyd of Drug Abuse. New York, Harper and Row, Curl Drive, San Antonio, Tex 78284. nomenclature. 1 9 7 5

THE JOURNAL OF FAMILY PRACTICE, VOL. 4, NO. 1, 1977 67 Compendium of Drug Abuse Jargon

1-12 D e fin itio n Street Name D efinitio n Street Name

. Marijuana A b ...... Abscess which forms at site of Bush ...... injection B u s te d ...... To be caught, usually arrested, by local authorities or to be caught Acapulco G o ld ...... Mexican marijuana (extremely potent) by parents . Methamphetamine; A cid ...... Lysergic acid diethylamide (LSD) Businessman's Special . or other hallucinogens dimethyltryptamine (DMT) (hallucinogen) A cid H e a d ...... One who takes LSD on a regular basis B utter ...... Marijuana A lley Juice ...... Methyl alcohol B u t t o n ...... Peyote button; tops of marijuana A m id o n e ...... Methadone plant flower Angel Dust ...... Phencyclidine hydrochloride sprinkled on parsley or marijuana C ...... Cocaine Cabal l o ...... Heroin Cactus ...... Peyote B a g ...... A small quantity of either heroin or Cadet ...... New addict cocaine packaged in cellophane California Sunshine . . LSD (hallucinogen) envelopes C a n ...... One ounce of marijuana Bang ...... The exhilaration experienced after Candy ...... Barbiturates; pills in general drug administration C a n d y m a n ...... Dealer or pusher of addicting drugs Barbs ...... Barbiturates Canary ...... Pentobarbital B e n n ...... Amphetamine sulfate Cashing-A-Script . . . . Getting a forged or bogus Belongs ...... On the habit prescription order dispensed Bennies ...... Benzedrine (amphetamine sulfate) C a rtw h e e ls ...... Amphetamine tablets Bernies F la k e ...... Cocaine Catch Up ...... Withdrawal process Bhang ...... Marijuana, smoking pipe CD ...... Glutethimide tablet Binge ...... An extended period of continued Cecil ...... Cocaine consumption of alcohol C h a r lie ...... Cocaine B itter ...... Paregoric C h ie f ...... Mescaline Black Beauties ...... Amphetamines Chippin'; Chipper . . . Subcutaneous administration of Black Hash ...... Hashish containing opium small dose of heroin; Black Russian ...... Hashish (potent, dark) “ weekend user" w ho used drugs Black Stuff ...... Opium, prepared for smoking less than da ily Blackjack ...... , Paregoric w hich has been prepared Cleared Up ...... To have withdrawn from drugs to be injected C o a s tin g ...... Under drug influence B la n k s ...... Poor quality merchandise Cohobe ...... D M T in powdered seeds B lotter A c i d ...... LSD on paper (hallucinogen) Blow Charlie or Snow . . Sniff cocaine C o k e ...... Cocaine Blow H o r s e ...... Sniff heroin Cokomo (Kokomo) . . Cocaine Blow Weed ...... To smoke marijuana Cold Turkey ...... Withdrawal process Blue Birds ...... Amobarbital capsules Come Down; Crash . Dissipation of drug effects Blue Devils ...... Amobarbital capsules Connect ...... Make a purchase Blue H e a v e n ...... Amobarbital capsules Cook It U p ...... To prepare a drug for injection B o g a r t ...... Not to pass the "joint" to a C o o k e r...... The apparatus used to heat and neighbor dissolve a drug prior to injection B o m b id o ...... Injectable amphetamine (spoons or bottle top) B o m b it a ...... Methamphetamine C o p ...... To obtain a small quantity of a B o y ...... Heroin drug B r i c k ...... Marijuana compressed, usually for C offin ...... Tobacco purposes of transport C o -p ilo ts ...... Amphetamines Brody ...... A f it or spasm staged by an addict Courage Pills ...... Barbiturates to elicit sympathy C ra n k s ...... Metham phetamine B ro w n s ...... Amphetamine tablets Crap ...... Heroin of weak potency Bull J i v e ...... Marijuana heavily cut with tea. C r y s ta l...... Methamphetamine catnip, or other impurities Cube (The) ...... LSD B u m m e r ...... A bad trip or experience C u t ...... To adulterate with agents such as Burned ...... Received fake narcotics quinine, milk sugar Burned O u t ...... Sclerotic blood vessel fro m too many injections; relative overdose; addict who tires of abuse "hassle" Daytop Lodge ...... Drug abuse treatment center and tries to stop drug abuse directed by ex-addicts

68 THE JOURNAL OF FAMILY PRACTICE, VOL. 4, NO. 1, 1977 Compendium of Drug Abuse Jargon (continued)

Street Name Definition Street Name Definition

Dealer ...... One w ho sells drugs Garbage ...... Poor q u a lity merchandise D e c k ...... Packet of cigarettes, narcotics, etc Garbage H ead ...... Individual who takes any kind of D ( B ig ) ...... LSD drug DET ...... Diethyltryptamine (hallucinogen) Gear ...... Drugs in general D ia n e ...... Meperidine hydrochloride Gee Head ...... Paregoric user D e x ie s ...... D extroam phetam ine sulfate Get It Together...... To become mentally organized (Dexedrine) Get O ff ...... To initially experience the effects DMZ ...... Benactyzine (hallucinogen) o f a drug DMT ...... Dimethyltryptamine (Businessman's Special) (hallucinogen) Gift of the Sun God . . . Cocaine D o e ...... Methamphetamine Glad Rag ...... Cloth or handkerchief that is Dolls; D o llie s ...... Methadone saturated with a material to be DOM ...... 4-methyl-2,5-Dimethoxy- inhaled (eg, fo r use in amphetamine (stimulant — STP) glue sniffing) D o o Je e ...... Heroin G old D u s t ...... Cocaine Double T r o u b le ...... C om bination o f both am obarbital G oofballs ...... Amphetamine sodium and secobarbital sodium G r a m ...... Q ua ntity o f hashish Doper ...... Regular drug abuser G ra s s ...... Marijuana D o w n e rs ...... Sedatives, usually barbiturates Grasshopper...... A marijuana user D re a m e r...... M orphine Greezy Addict ...... Drug abuser who will take Dream S t ic k ...... An opium pipe any drug, anytime D ro p p e d ...... Consumed a drug abuse agent G riffo ...... Marijuana DT's ...... Delirium tremens (acute alcohol withdrawal syndrome) D u d s ...... Bags o f heroin containing no H ...... Heroin narcotic agent H a b it ...... Dependence upon drugs Dust ...... Heroin; cocaine Happy Trails ...... Cocaine Dust of A ngels ...... Phencyclidine base (hallucinogen) Hard S t u f f ...... M orphine Dynam ite ...... High grade narcotics; Harry; Big Harry; Hairy . Heroin heroin, cocaine Hash ...... Hashish (TH C ), resin fro m to p of Dummy ...... Drug purchase w ith o u t purported Cannabis sativa content Hash O i l ...... Concentrate extracting hash H e a d ...... User o f drugs Hearts ...... Amphetamine Heavenly Blue ...... LSD (hallucinogen) Emma (Miss) ...... M orphine Heavy Grass High .... Strong, stuperous reaction to Emsel ...... M orphine marijuana Eyeopeners ...... Amphetamines Hemp ...... Marijuana (Cannabis sativa or indica) High ...... Stimulant trip F a g ...... Tobacco Hikori, Kikuli, F-40s ...... Secobarbital Huatari, Wokouri .... Peyote F i x ...... To inject drugs; satiate addictive H i t ...... Make a purchase; take a drag needs H itting U p ...... Injecting drugs F iz z ie s ...... M ethadone tablets Hocus ...... M orphine F la k e ...... Cocaine H o g ...... Phencyclidine mixed with vegetable Flake O u t ...... To pass o u t fro m drug use material; veterinary tranquilizer F la s h ...... Rapid, intense, euphoric reaction Holding ...... Drugs are in user's possession F lo w e r ...... M arijuana Hooked ...... Addicted to drugs Flying Saucers ...... PCP, phencyclidine (hallucinogen) Hop H e a d ...... Person who smokes opium; addict Footballs ...... Amphetamine tablets H orror D r u g ...... Belladonna preparations F la s h b a c k ...... Recurrence of some feature of a H o rs e ...... Heroin previous LSD experience H ot Shot ...... Poisons concealed in injectable F re a k ...... A n addict w ho enjoys playing w ith narcotics for the purpose of the needle hom icide Freak o u t ...... To be intensely affected by H y p e ...... A needle addict som ething

Ice Cream H abit ...... Small, irregular drug use Idiot Pills ...... Barbiturates G a n ja ...... Jamaican marijuana In A ctio n ...... To seek narcotics

THE JOURNAL OF FAMILY PRACTICE, VOL. 4, NO. 1, 1977 6 9 Compendium of Drug Abuse Jargon (continued)

Street Name Definition Street Name Definition

In-Betweens ...... Barbiturates, in combination with Mescalito ...... Peyote; mescaline amphetamines Meth; Methedrine . . . Methamphetamine Indian Hay ...... Marijuana Mickey Finn ...... Chloral hydrate and alcohol In F lig h t ...... To be very high from drugs. M in d b io w e r...... A hallucinogenic drug especially methamphetamine Monkey; Morf; Morpho Morphine hydrochloride (Methadrine) M o th e r ...... The drug peddler M o o n s h in e ...... Ethyl alcohol Mooters ...... Marijuana j ...... Marijuana cigarette Mountain D e w ...... A lcohol Jabber ...... A needle addict Mud ...... Stramonium preparation mixed Jammed U p ...... An overdose with carbonated beverage J iv e ...... Marijuana Muggles ...... Crude marijuana before rolled into Jo in t ...... Syringe and needle; one stick of cigarette marijuana; or an opium smoker's Mushrooms; den Sacred Mushrooms; J o lly Babies, Beans . . . Amphetamine Magic Mushrooms . . Psilocybin (hallucinogen) Joy Juice ...... Chloral hydrate Mutah ...... Marijuana Joy Popping ...... Narcotic injections under the skin M o h a s k y ...... Marijuana Joy P o w d e r ...... Heroin Mu ...... Marijuana J u ic e ...... A lcohol Juice Freak ...... One who prefers alcohol Jugs ...... Injectable amphetamines N a rc s ...... Federal narcotics agents J u n k ...... Narcotics N e m m ie s...... Yellow capsules of pentobarbital Junkie ...... Heroin abuser Nickel B a g ...... A five-dollar bag of a drug Nimbie; Nimbles .... Barbiturates N o s e ...... Cocaine K ick ...... Euphoria Kick Inducers ...... Cough elixirs (alcohol) Kicking ...... Withdrawal process K ilo ...... Two pounds of marijuana Odyssey H ouse ...... Drug abuse treatment center K if ...... Marijuana O D ...... Overdose; death On ...... Using drugs On the N o d ...... Drowsiness from narcotics L a y ...... An opium den Ounce ...... 30 grams of marijuana Layout ...... Equipment for injecting drugs; O u tfit ...... Narcotic injection equipment opium smoker's outfit Leaf ( T h e ) ...... Cocaine L e m o n ...... Bad or fake dope Licorice ...... PCP; Peace Pill ...... Phencyclidine (hallucinogen) Panama R e d ...... Hashish; marijuana L i d ...... 3/4 oz of marijuana Papers ...... Lid P o lle rs ...... Amphetamines Papers usually used to ro ll a Lords ...... Hydromorphone hydrochloride marijuana cigarette. Popular brands include: Zig-Zag, Love Drug ...... MDA (methyldioxyamphetamine) LSD ...... Lysergic acid diethylamide Wheatstraw, Papel del Trigo, (hallucinogen) Bambu, Job, Roach, Tops Peace ...... Luding O u t ...... Stupor produced from alcohol and STP Peaches ...... methaqualone Amphetamine tablets Peanuts ...... Lum ber ...... Marijuana stems which are found in Barbiturates Pearly G a te s ...... an ounce of marijuana M orning glory seeds

M ...... M orphine Phoenix H ouse ...... Drug abuse treatment center MDA ...... 3,4-methyldioxyamphetamine Pep P i l l s ...... Amphetamines (hallucinogen) Pethidine ...... Meperidine hydrochloride M ainliner ...... One who injects directly into the P h e n n ie s ...... Barbiturates vein PG; P O ...... Paregoric Mary J a n e ...... Marijuana Pimp's D rug ...... Cocaine M e s c ...... Mescaline (hallucinogen) Poppies ...... Flowering plant from which opium Mescal B utton; is derived Mescal Beans .... . Peyote; mescaline P o t ...... Marijuana

7 0 THE JOURNAL OF FAMILY PRACTICE, VOL. 4, NO. 1, 1977 Compendium of Drug Abuse Jargon (continued)

Street Name Definition Street Name Definition

Quill ...... Matchbook cover for sniffing Stick ...... Marijuana cigarette cocaine Stoned ...... Under the influence of narcotics Straw; Smoke; Splim . . Marijuana Straight ...... Describes one who avoids the use of R a in b o w ...... Amobarbital and secobarbital capsule (red and blue) Strung Out ...... In need of a fix, sedative, trip; Reader ...... Prescription order Reader W ith T a i l ...... Forged prescription order STP ...... Dimethoxymethylamphetamine Reds; Red Devils; (DOM — hallucinogen) Red Birds (capsules) . Barbiturates, secobarbital Sugar ...... LSD; heroin R e e f e r ...... Marijuana cigarette Syndicate A c id ...... STP (hallucinogen) Rich Man's D ru g ...... Cocaine Synthetic Marijuana . . . Phencyclidine (hallucinogen) Roach ...... Butt of marijuana cigarette S w e e tie s ...... Phenmetrazine hydrochloride To make a marijuana cigarette Roll ...... (stimulant) R oses...... Amphetamine tablets Synanon ...... Drug abuse treatment center, Royal Blue ...... LSD directed by ex-addicts Run ...... Period of stimulant abuse R u s h ...... Rapid, intense, euphoric reaction

T a b ...... General term to describe drug of solid dosage Safe ...... Addict feels protected from problems and challenges of life Texas T e a ...... Marijuana during trip THC ...... Tetrahydrocannabinol (hallucinogen Scag; Scat; Smack; Stuff Heroin in marijuana and hashish) T o k e ...... Inhalation o f smoke S c h o o lb o y ...... Codeine Tops ...... S c o re ...... To establish a connection with a Peyote dealer Track D r iv e r s ...... Amphetamines Tracks; Turkey Trots . . Script ...... Prescription order Marks and scars fro m the use o f a Script W riter ...... Sympathetic physician; one who hypodermic needle forges Rx orders T ra n q u ility ...... STP, hallucinogen Seggy; Seccy ...... Barbiturates Travel Agent ...... LSD seller Seni ...... Peyote Trips; Trippin' ...... High mediated by LSD Serenity ...... STP Sharps ...... Needles Shoot Up ...... To inject drugs Shooting G allery ...... Place where addicts inject drugs U nkie ...... M orphine Sickle ...... College student using drugs U p p e rs ...... Stim ulants Skin P o p ...... Intradermal or subcutaneous injection Sleepers ...... Barbiturates S nap pers...... Amyl nitrite ampules Wake-up ...... Amphetamines S n a r f ...... Nasal inhalation of cocaine Wasted ...... Under influence of drugs S n o r t...... Inhalation through nose Water Pipe ...... Device for bubbling smoke through S n o w ...... Cocaine water for cooler inhalation Sopors (R) ...... Methaqualone Wedding B ells ...... LSD Spaced; Spaced O ut . . . Altered consciousness W e e d ...... Marijuana Splash ...... Methamphetamine W hite Lady ...... Heroin Speed ...... Metham phetam ine usually, bu t White Lightning ...... Ethyl alcohol; also name for a may be any stim ulant specific speed drug Speed Freak ...... Amphetamine abuser (or amphetamine) Speed ball ...... Heroin and cocaine mixture; also W h it e s ...... Amphetamine tablets Percodan and methadrine W hite S t u f f ...... Morphine; heroin Spoon ...... A gram of cocaine Windowpane ...... LSD S ta rd u s t...... Heroin with cocaine W ire d ...... Intoxicated state due to marijuana Star Spangled Powder . . Cocaine S p ik e ...... Needle for injection Stash ...... Collective term for the accumulation of marijuana Yellows; Yellow Jackets . Pentobarbital capsules paraphernalia Yen S le e p ...... S om nolent stage during drug Stepped-on ...... Process of diluting abuse drugs w ithdraw al

THE JOURNAL OF FAM ILY PRACTICE, VOL. 4, NO. 1, 1977 71 C ontinued fro m page 62 note 1, at 32, 33 87. Id, at x-xi; see also Health Services and Mental Health Administration, U.S. N.Y.S.2d 3, 143 N.E.2d 3 (1957) 64. Darling v Charleston Community Dept, of H.E.W., Quality Assurance of Memorial Hosp., 33 lll.2d 326, 211 N.E.2d Medical Care, (Monograph, February, 1973) Pcritrate Sfl Sustained Redon 253 (1965), cert, denied, 383 U.S. 946 88. W. Curran & G. Moseley, supra (pentaerythrifol tetranitrate) 80mg (1 9 6 6 ) note 1, at 138-140; their report indicated 65. Bader v United Orthodox Syna­ that only one of twelve GPHPs surveyed had CAUTION: Federal law prohibits dispensing gogue, 148 Conn. 449, 172 A.2d 192, 194 such a contractual requirement without prescription. (1 9 6 1 ) 89. 50 III. App.2d 253, 200 N.E.2d,. Description: Each tablet of Peritrate SA 66. Edwards v Grace Hospital Soc., 149, 179 (1964), quoting Seldon v City of Sustained Action contains: pentaerythritol Sterling, 316 III. Opp.2d 455, 45N.E.2d 130 Conn. 568.36 A.2d 273 (1944) tetranitrate 80 mg (20 mg in immediate 67. Southwick, supra note 12, at 465 329,332 (1942) release layer and 60 mg in sustained release 68. Id, at 437. It should also be 90. Darling v Charleston Community pointed out that the corporate duty to Memorial Hosp., 33 III.2d 326, 211 N.E.2d base). Peritrate* (pentaerythritol tetrani­ control a physician's medical care does not 253, 257 (1965): accord, Stanhope v Los trate) is a nitric acid ester of a tetrahydric require the institution to violate statutes Angeles College of Chiropractic, 54 Cal. alcohol (pentaerythritol). that prohibit the corporate practice of App.2d 141, 146, 128 P.2d 705, 708 (1942) medicine. Arguing that it does is, ". . . mere (1 9 4 2 ) In d ic a tio n s : Based on a re v ie w o f this drug 9 1 . Id . semantic trickery." Rapp, Darling and its by the National Academy of Sciences — Progeny: A Radical Approach Toward Hos­ 92. W. Curran & G. Moseley, supra National Research Council and/or other pital Liability, 60 III. B.J. 883, 890-91 note 1, at 6 information, FDA has classified the indica­ (1 9 7 2 ) 93. W. Curran & G. Moseley, 19 Study 69. Hedgepeth, Darling Revisited, 46 J on Legal Issues in the Reorganization of tions as follows: Am Hosp Assn 58 (August, 1972) Health Care Institutions, 22, 23 (1974) '’Possibly" effective: Peritrate (penta­ 7 0. See text accompanying notes 94. Beeck v Tucson Gen. Hosp., 18 erythritol tetranitrate), is indicated for the 1 6 1 -1 6 3 Ariz. App. 165, 500 P.2d 1153 (1972); relief of angina pectoris (pain associated 71. Southwick, supra note 41, at 104 Seneris v Haas, 45 Cal.2d 811,291 P.2d 915 with coronary artery disease). It is not (1955), Hedlund v Sutter Medical Serv. Co., 72. Southwick, supra note 45, at 161 intended to abort the acute anginal 73. Bing v Thunig, 2 N.Y.2d 656, 163 51 Cal. App.2d 327, 124 P.2d 878 (1942): episode but it is widely regarded as use­ N.Y.S.2d 3, 143 N.E.2d 3, 8 (1957) Vanaman v Milford Memorial Hosp., Inc., 74. Group Health Cooperative of Puget 272 A.2d 718 (Del., 1970); Schagrin v ful in the prophylactic treatm ent of angina Sound v. King County Medical Soc., 39 Wilmington Medical Center, Inc., 304 A.2d pectoris. Wash.2d 586, 604, 237 P.2d 737, 747 61 (Del. Super Ct. 1973) Final classification of the less-than- (1 9 5 1 ) 95. See text at note 78 effective indications requires further 75. W. Curran & G. Moseley, supra 96. See text at notes 121-25 investigation. note 1, at 6-8; and see Southwick, supra 97. See also text at notes 103-08 98. Beeck v Tucson Gen. Hosp., 18 note 41, at 93, where Professor Southwick Contraindications: Peritrate-SA Sustained indicates that hospital liability is influenced Ariz. App. 165, 500 P.2d 1153 (1972); Action (pentaerythritol tetranitrate) 80 mg is j by the addition of preventive health pro­ Seneris v Haas, 45 Cal.2d 811,291 P.2d 915 grams (equivalent to a GPHP) because this (1955); Hedlund v Suller Medical Serv. Co., contraindicated in patients who have a history added function is a further institutionali­ 51 Cal. App.2d 327, 124 P.2d 878 of sensitivity to the drug. zation of the delivery system (1942); Kober v Stewart, 148 Mont. 117, Warning: Data supporting the use of Peritrate i 7 6 . Id . 417 P.2d 476 (1966); Lundberg v Bay View (pentaerythritol tetranitrate) during the Hosp., 175 Ohio St. 133, 191 N.E.2d 821 77. Aspen Systems Corp. Health Law early days of the acute phase of myocardial Center, Digest of State Laws. Affecting the (1 9 6 3 ) 99. See Beeck v Tucson Gen. Hosp., 18 infarction (the period during which clinical Prepayment of Medical Care, Group Practice and laboratory findings are unstable) are and HMO's, App. F "liabilities of HMO's, Ariz. App. 165, 500 P.2d 1153 (1972); insufficient to establish safety. A-181, A-194; W. Curran & G. Moseley, Vanaman v Milford Memorial Hosp., 272 supra note 1, at 108; Anno.," Hospital's A.2d 718 (Del. 1970) This drug can act as a physiological Liability for Negligence in Failing to Re­ 100. Beeck v Tucson Gen. Hosp. 18 antagonist to norepinephrine, acetylcholine, view," supra note 62, at 875-78 Ariz. App. 165, 500 P.2d 1153 (1972); histamine, and many other agents. 78. W. Curran & G. Moseley, supra Schagrin v Wilmington Medical Center, Inc., Precautions: Should be used with caution in j 304 A .2d 61 (Del. Super. Ct. 1973); Kober note 1, at viii, 75, 85, 86, and 105. For patients who have glaucoma. Tolerance to v Stewart, 148 Mont. 117, 417 P.2d 476 example, a California jury awarded this drug, and cross-tolerance to other nitrites $730,000 damages to a widow and children (1966). See Southwick, supra note 12, at and nitrates may occur. against Kaiser Foundation Hospitals in an 441 institutional malpractice suit where plaintiff 101. W. Curran & G. Moseley, supra Adverse Reactions: Side effects reported to | contended that the medical attention given note 1, at 81 -2 date have been predominantly related to ras^ to the deceased was fragmented by the 102. Beeck v Tucson Gen. Hosp., 18 (which requires discontinuation of medication] Kaiser system of medical care in which no Ariz. App. 165, 500 P.2d 1153, 1159 and headache and gastrointestinal distress, single doctor was following the patient nor (1972); contra Pogue v Hospital Authority which are usually m ild and transient with con of DeKalb County, 120 Ga. App. 230, 170 was in control of the deceased's case. Larson tinuation of medication. In some cases severs; v Kaiser Foundation Hospitals, No. 43238 S.E.2d 53, 54 (1969), where the Georgia persistent headaches may occur. (Cal. Super. Ct., Santa Clara Co., April 9, court refused to find the hospital an appar­ In a d d itio n , th e fo llo w in g a dve rse reaction: 1 9 7 3 ) ent agent even though many of the above 79. Purcell v Zimbelman, 18 Ariz. recited factors were present, primarily be­ to nitrates such as pentaerythritol tetranitrate j App. 75,500 P.2d 335 (Ct. App. 1972); cause the contract between the doctor and have been reported in the literature: Moore v Board of Trustees of Carson-Tahoe hospital labeled him as an "independent (a ) C utaneous v a s o d ila ta tio n w ith flushing Hosp., 88 Nev. 207, 495 P.2d 605 (1972), contractor." This appears to be a distinctly (b) Transient episodes of dizziness and minority rule cert, denied, 409 U.S. 879 (1972); see also weakness, as well as other signs of 103. Note. Independent Duty of a Hos­ Southwick, supra note 12, at 436-38, cerebral ischemia associated with 4 5 0 - 5 1 ,4 6 4 pital to Prevent Malpractice, 15 Ariz. I. Rev. postural hypotension, may occasionally j 80. 7 N .Y .2d 56, 194 N.Y.S.2d 509, 953, 967 (1973) for a persuasive summary 163 N.E.2d 333 (1959) of this argument d evelop. 81. C .F. Bledosoe, Defending Hospital- 104. W. Curran & G. Moseley, supra (c) An occasional individual exhibits marker Negligence of Physician-Employee, 19 Am. note 1, at 9 sensitivity to the hypotensive effects oi l Jur. Trials 431,442 (1972) 1 0 5 . Id , at 1 0 , 11 nitrite and severe responses (nausea, 82. See id, at 442-43: see also text 106. Id, at 77; caution, these HMOs vomiting, weakness, restlessness, pall:' with pushy salesmen most probably are accompanying notes 91-102 infra perspiration and collapse) can occur, j 83. Purcell v Zimbelman, 18 Ariz. for-profit organizations even with the usual therapeutic doses. App. 75,500 P.2d 335 (Ct. App. 1972); W. 107. The extent of this problem is Alcohol may enhance this effect. Curran & G. Moseley, supra note 1; see also indicated by Annot., 36 A.L.R.3d 541 text at notes 87-90 infra (1 9 7 1 ) Dosage: Peritrate SA Sustained Action 84. Southwick, supra note 41 108. See Note, supra note 103 (pentaerythritol tetranitrate) 80 mg (b.i.d.o' j 85. Telephone interview with George 109. As to breach of contract actions, an empty stomach), 1 tablet immediately on B. Moseley, III, Assistant General Counsel, see text accompanying notes 21 -25, supra arising and 1 tablet 12 hours later. Tablets 110. Garfield Memorial Hospital v Mar­ Massachusetts Executive Office of Human should not be chewed. Services, June 24, 1974 shall, 92 D.C. App. 234, 204 F.2d 721, 37 Supplied: Peritrate SA Sustained Action 86. "This legal defense [to a liability A.L.R.2d 1270 (1953); Evangelista v Black, suit] clearly is unavailable to those several 100 Ohio St. 223 and 100 Ohio St. 264, (pentaerythritol tetranitrate) 80 mg, double HMOs which directly employ their physi­ 126 N.E.2d 71 (1953); Guilliams v Holly­ layer, biconvex, dark green/light green table cians, or to HMOs which are so closely wood Hospital, 18 Cal.2d 97, 114 P.2d 1 in bottles of 100 (N 0047-0004-51) and 1000 associated with their physician groups as to (1941); Annot., supra note 62, at 875-78 (N 0047-0004-60). A lso in u n it dose —package be considered involved in the provision of 111. G. Moseley, supra note 85 of 10 x 10 strips (N 0047-0004-11). 112. Giusti v C. K Weston Co., 165 Or. health services. It may be that H.I.P., ... is Additional Dosage Forms: Peritrate 20 mg- j the only HMO sufficiently disassociated 525, 108 P.2d 1010 (1941) light green, scored tablets in bottles of 100 from its physicians to allow the use of this 113. W. Prosser, The Law of Torts (N 0047-0001-51) and 1000 (N 0047-0001-60! defense." W. Curran & G. Moseley, supra Continued on page 75 Also in unit dose — package of 10 x 10 strips (N 0047-0001-11). Peritrate 10 mg —light gree unscored tablets in bottles of 100 (N 0047- 7 2 0007-51) and 1000 (N 0047-0007-60). Full information is available on request. Continued fro m page 72 Fairness & Utility in Tort Theory, 85 Harv. 470-74 (4th ed. 1971) L. Rev. 537 (1972) 114 Schagrin v Wilmington Medical 134. For example, see text accompany­ Back Issue Information Center,’lnc.f 304 A.2d 61 (Del. 1973) ing notes 21-71 and 91-132 115 Giusti v C. H. Weston Co., 165 Or. 135. See text accompanying notes 129- Back issues* of THE JOURNAL OF FAM­ 525, 108 P.2d 1010 (1941) ISO ILY PRACTICE are available directly from the 116. Id. at 1013 136. For example, indemnification publisher . . . or they may be ordered 117. Gavin v Rhode Island Hosp., 12 clauses and quality control procedures through your subscription agency. p I 411 (1879); see text accompanying 137. See eg, W. Curran & G. Moseley, notes 12-17 and 61-70, especially 67, for supra note 1, at Supplement A page 23; VOLUME 1, 1974 discussions of the similarity of hospital and Havighurst & Tancredi, “Medical Adversity GPHP purposes Insurance" — A No-Fault Approach to No. 1 out of stock 118. Tunkl v Regents of Univ. of Cal., Medical Malpractice and Quality Assurance, No. 2 $12.00 60 Cal.2d 92, 32 Cal. Rpn. 33, 383 P.2d 613 Ins. L. J. 69, 93 (1974) argues for No. 3/4 out of stock 441 (1963); Annot., 6 A.L.R.3d 704, 705 no-fault liability in such a situation: Havig­ (1966) ; Annot., supra note 62, at 880, hurst, HMO's and the Market for Health VOLUME 2, 1975 Compare plan/subprovider contracts con­ Services, 35 Law and Contemp. Prob. 716 at taining indemnification clauses in which the 755 (1970); W. Curran & G. Moseley, supra No. 1, 2, 3. 4, 5, and 6—are all available— subproviders save the plan harmless from note 93, at 22 they are $10.00 each. malpractice liability. On their face, these 138. See text accompanying notes 87- clauses seem similar in effect to disclaimer 89 and 126-132 VOLUME 3, 1976 clauses in p la n /c o n s u m e r c o n tra c ts . B u t 139. For a detailed explanation of this, such in d e m n ific a tio n clauses s h o u ld u su ally see F. Harper & F. James, supra note 132, at No. 1 is $13.50. No. 2, 3. 4. 5 and 6 are $7.50 be enforced. Realistically, such a clause does 756, 757; for a specific GPHP example of each. not eliminate the plan's financial burden for these principles, see the text accompanying subprovider malpractice. The burden and note 88, supra If all six are ordered, a 10% discount may be motivation on the plan remains intact be­ 140. Also see text accompanying notes taken on the entire volume. cause the clauses have their own costs. 38-70 and 121-125 Indemnification clauses really only shift and 141. W. Curran &. G. Moseley, supra To order contact: modify the burden within the GPHP. The note 1, at ix cost of malpractice will still filter through to 142. Id. at 96; Medical Group Manage­ The Journal of Family Practice the plan in the form of increased fees ment Ass'n Manual on Insurance, supra note 292 Madison Avenue, subproviders will demand in return for 1 1 , a t 41 New York, NY 10017 indemnifying the GPHP 143. F. Harper & F. James, supra note Telephone: 212-532-1700 119. Tunkl v Regents of Univ. of Cal., 133, at 1299 60 Cal.2d 92, 32 Cal. Rptr. 33, 383 P.2d 144. Id. at 4 (Vol. 2 Supp.) 441 (1963); Annot., supra note 118, at 701 145. W. Curran & G. Moseley, supra *AII back issues are subject to availability. 120. As to this important duty, see note 1, at iv All prices apply to orders received prior to Beeck v Tucson Gen. Hosp., 18 Ariz. App. 146. Id. at vii December 31, 1977. All prices are for U.S.A. 165, 500 P.2d 1153, 1157 (1972), where 147. C. F. Restatement (Second) of and Canada. All foreign quotes are on an the Arizona court said: Torts § 402A, comment C individual basis. Having undertaken one of mankind's 148. Interview with L. Michael Messina, most critically important and delicate Esq., Partner of McRae & Messina, in fields of endeavor, concomitantly Albuquerque, New Mexico, April 26, 1974 therewith the hospital must assume the 149. See Annot., 89 A.L.R.2d 1180 grave responsibility of pursuing this (1 9 6 3 ) calling with appropriate care. The care 150. See generally, Annot., supra note and service dispensed through this high 6 2 , a t 8 7 9 trust, however technical, complex and 151. See text accompanying notes 135- are you moving esoteric its character may be, must 7 1 4 2 meet standards of responsibility com­ 152. F. Harper & F. James, supra note Let us know 4 weeks in advance so that you mensurate with the undertaking to 133, at 746, 747 won’t miss an issue. Attach old label where preserve and protect and health, and 153. See id. at 752-53 indicated and print new address in space indeed, the very lives of those placed in 154. For example, workman's compen­ provided. Also include your mailing label the hospital's keeping. Darling v sation laws provide such a system. Id. at whenever you write concerning your copy Charleston Community Memorial 753. The general analysis of the moral of The Journal of Family Practice. Hosp., 33 III.2d 326, 211 N.E.2d 253 justification for accident law in this section (1 9 6 5 ) owes much to Professors Harper and James w r it e : ^ f c m i l y 121. Hansen, supra note 15, at 544 155. And a concomitant subjectification 122. Fiorentino v Wenger, 19 N.Y.2d of the standard applied to plaintiffs, Id. at practice 407, 280 N.Y.S.2d 373, 227 N.E.2d 296 7 4 6 address: 292 Madison Ave., N.Y., N.Y. 10017 (1967) 156. Darling v Charleston Community ______Change of address only 123. Smith v Duke University, 219 N.C. Memorial Hosp., 50 III. App.2d 253, 200 ______Extend my paid subscription 628, 14 S.E.2d 643, 647 (1941); see also N.E.2d 149 (1964) affd, 33 lll.2d 236,211 ______Enter my new paid subscription Annot., 72 A.L.R.2d 396 (1960) N.E.2d 253 (1965). cert, denied, 383 U.S. ______Payment Enclosed ______Bill me 124. 33 III.2d 326, 211 N.E.2d 253, 9 4 6 (1 9 6 6 ) 256 (1 9 6 5 ) 157. W. Curran & G. Moseley, supra RATES: 125. Beeck v Tucson Gen. Hosp. 18 note 10, at 13 U.S.A. and Canada (institutions and Ariz. App. 165, 500 P.2d 1153, 1158 158. See n. 4, supra personal*) ...... $30 (1 9 7 2 ) 159. See text accompanying notes 87- Foreign (institutions and personal*)...... 35 126. Most of the topics relevant to this 90 and 126-128 Residents (not in Family Practice) ...... 15 heading have previously been discussed. See 160. For a 1957 court's rejection of this Medical Students ...... 15 text accompanying notes 21-25; 77-102; same baseless worry, see Bing v Thunig, 2 •NOTE. These rates apply to interested personal and 109-125 N.Y.2d 656, 163 N.Y.S.2d 3, 143 N.E.2d 3 subscribers from disciplines other than general/ 127. W. Curran & G. Moseley, supra (1 9 5 7 ) family practice/D.O.’s. All institutions are billed note 10, at vol. 19 161. See Southwick, sup a note 12, at $30 or $35 per year. 128. See text accompanying notes 87- 440-443 and 452-453 *Back issues are available upon request. Contact 90 162. See: Center for the Study of Dem­ publisher for availability and prices. 129. For an explanation of “capitation ocratic Institutions, Medical Malpractice — contracts" see text accompanying note 20 ATTACH LABEL OR WRITE IN THIS SPACE A Discussion of Alternative Compensation I 130. A GPHP official admitted that his and Quality Control Systems, 13-18 L J plan/subprovider contract, whereby the (November, 1971); Ellwood, Implications of \ name please print ✓ physicians share in the savings that occur if Recent Health Legislation, Amer. J. Pub. / less medical care is provided than was Health 20, 21 (January, 1972); W. Curran & J address \ projected and paid for, “ . . . could lead the G. Moseley, supra note 1, Supp. A at 76 - ' city doctors to cut back on care or at least be 163. See Rubsamen, The Experience of extra efficient in order to increase the Binding Arbitration in the Ross-Loos Medi­ state zip code i savings p o o l." W . C u rra n & G . M o s e le y , cal Group, in Report of the Secretary's supra note 1, at 80, 81; see also id. Supp. A. Commission on Medical Malpractice; Appen­ at 23 dix at 421; Center for the Study of Demo­ NEW ADDRESS 131. See text accompanying note 160 cratic Institutions, supra note 162, at 8; for an explanation of why plan liability also Medical Group Management Association, name please print reduces the motivation on physicians to supra note 11, at 77, Henderson, Contrac­ address practice defense medicine tual Problems in the Enforcement of Agree­ 132. F. Harper & F. James, The Law of ments to Arbitrate Medical Malpractice, 58 city Torts 742-43 (1956) Va. L. Rev. 947 (1972); and W. Curran & G. state zip code 133. Other rationales for tort law have, Moseley, supra note 1, at v, vi, 42, Appen­ EFFECTIVE DATE: of course, been advanced. See eg, Fletcher, dices 3 and 4, Supp. A at 26-28

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