Issues in Religion and Psychotherapy
Volume 8 Number 2 Article 4
4-1-1982
An Approach to Drug Classification in Psychopharmacology
Bruce H. Woolley
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Recommended Citation Woolley, Bruce H. (1982) "An Approach to Drug Classification in Psychopharmacology," Issues in Religion and Psychotherapy: Vol. 8 : No. 2 , Article 4. Available at: https://scholarsarchive.byu.edu/irp/vol8/iss2/4
This Article or Essay is brought to you for free and open access by the Journals at BYU ScholarsArchive. It has been accepted for inclusion in Issues in Religion and Psychotherapy by an authorized editor of BYU ScholarsArchive. For more information, please contact [email protected], [email protected]. AN APPROACH TO DRUG CLASSIFICATION IN PSYCHOPHARMACOLOGY Bruce H. Woolley,* Pharm.D. Presented at the AMCAP Convention 2 October 1981
In our fast-paced society, numerous .emotional and c. Oxymorphone (Numorphan) physiological factors often produce stress, anxiety, d. Methyldihydromorphinone (Metopon) depression, and other dysfunctional behavior. One of e. Codeine the significant stressors that appear regularly where f. Hydrocodone (Dicodidl there are family and/or emotional problems is the use g. Oxycodone (Percodan) and abuse of drugs and substances which affect the 2. Phenylheptylamines a. Methadone (Dolophine) central nervous system (brain and spinal cord). These b. Propoxyphene (Darvon) agents can include prescribed drugs improperly taken, 3. Phenylpiperidines over-the-counter drugs purchased at local pharmacies a. Meperidine (Demerol) or grocery stores, or illicit substances ingested for the b. Alphaprodine (Nisentil) "high" they seem to provide. However, when utilized c. Anileridine (Lentine) and administered bycompetent medical personnel, these d. Piminodine (Alvodinel agents offer excellent palliation for psychopathology. e. Diphenoxylate (in Lomotil) The therapeutic use of pharmacologically active drugs 4. Morphinans for behavioral dysfunctions requires competent a. Levorphanol (Levo-Dromoranl diagnostic skills, expertise in clinical pharmacology, and b. Methorphan c. Levallorphan (Lorfan) proper monitoring techniques. Each involves years of 5. Benzomorphans preparation and training and are far beyond the scope of a. Phenazoci'"e (Prinadol) this paper. Within this context the author seeks to b. Pentazocine (Talwip) provide the reader with a survey of the major B. HYPNOTIC·SEDATIVES classifications of frequently prescribed and/or abused 1. Barbiturates drugs only as a reference. a. Ultra short acting There have been many attempts in the literature to Thiopental (Pentothal Sodium) categorize and segment psychoactive agents. These b. Short acting attempts have varied, depending upon the reason for Pentobarbital (Nembutal) classification, from pharmacological approaches to Secobarbital (Seconal) c. Intermediate acting pathological approaches to therapeutic approaches. All Amobarbital (Amytal) have merit and clearly show that any attempt at drug d. Long acting classification is, at best, superficial. Add to these Phenobarbital attempts the ever-increasing abuse problem with Mephobarbital (Mebaral) psychoactive agents, and the problem of categorizing Metharbital (Gemonil) these agents becomes even more formidable. 2. Non-barbiturates For this paper the agents are classified into three a. Tertiary carbinols categories (Table 1) utilizing a pharmacological approach Ethchlorvynol (Placidyl) and taking the chemical structure into consideration. Ethinamiate (Valmid) b. Piperidinediones Major drugs of abuse have been included to show action Glutethimide (Doriden) correlation. It must be kept in mind, however, that Methyprylon (Noludarl I agents placed in one category can and do therapeutically c. Chloral derivatives 1 and pathologically fall into other categories. Chloral hydrate (Noctecl 1--, Chloral betane (Beta-Chlor) TABLE 1 Traclo!os (Triclos) Outline of Draa Cbssiflalion d. Quinazolones Methaqualone (Qualude) e. Monoureides I. CNS DEPRESSANTS Paraldehyde (Paral) A. NARCOTIC ANALGESICS Acetylcarbromal (Paxarel, Sedamyl) 1. Natural and semisynthetic opiate alkaloids 3. Phencyclidine a. Morphine . 11-(Phenylcyclohexyl) piperidineI b. Hydromorphone (Dilaudid) C. TRANQUILIZERS 1. Neuroleptics (antipsychotics or major tranquilizers) *Brother Woolley is Director of the BrighilDl Young a. Phenothiazines University Health Center. 1) Aliphatics (Aminoalkyls)
13 AMCAP JOURNAl/APRIL 1982 Promazine (Sparine) 1. Amphetamines Chlorpromazine (Thorazine) 2. Other Triflupromazine (Vesprin) J1J, MOOD MODIFIERS 2) Piperidines A. ANTIDEPRESSANTS Thioridazine (Mellaril) 1. Monoamine oxidase (MAO) inhibitors Mesoridazine (Serentil) a) Hydrazines Piperacetazine (Quide) Iproniazid (Marsilid) 3) Piperazines b) Nonhydrazines Prochlorperazine (Compazine) Tranylcypromine (Parnate) Trifluoperazine (Stelazine) 2. Tricyclic antidepressants Butaperazine (Repoise) a. Dibenzazepine derivatives Acetophenazine (Tindal) Imipramine (Trofranil) Fluphenazine (Prolixin) T rimipramine (Surmontil) Perphenazine (Trilafon) Desipramine (Norpramin, Pertrofrane) Carphenazine (Proketazine) b. Dibenzocycloheptadiene derivatives b. Thioxanthenes Amitryptyline (EIavil) Thiothixene (Navane) Nortriptylene (Avenlyl) Chlorprothixene (Taractan) Protriptylene (Vivactil) c. Butyrophenones Doxepin (Adapin,Sinequan) Haloperidol (Haldol) 3. Tetracyclics d. Dibenzoxapines Maprotiline (Ludiomil) Loxapine (loxitane) 4. Miscellaneous e. Indoles Amoxapine (Asendin) Molindone (Lidone, Moban) B. LITHIUM f. Rauwolfia alkaloids C. PSYCHOTOMIMETICS 2. Anxiolytics (minor tranquilizers) (HALLUCINOGENS, PSYCHODYSLEPTICS) a. Diphenylmethane antihistamines 1. Mescaline Diphenhydramine (Benadryl) 2. Psylocibin Hydroxyzine (Vistaril. Atarax) 3. Lysergic acid derivatives b. Propanediol carbamates 4. Tryptamines Meprobamate (Equanil. Miltown) 5. Cannabis (marihuana) Tybamate (Solacen) Central Nervous System Depressants (psycholeptics) c. Benzodiazepines Chlordiazepoxide (Librium) Generally, excluding the anesthetics, the CNS Diazepam (Valium) depresssant substances can be divided into five divisions: Prazepam (Centrax) the narcotic analgesics and antagonists, the sedative Chlorazepate Monopotassium (Azene) hypnotics, the tranquilizers, the antiparkinson agents, Chlorazepate Dipotassium (Tranxene) and alcohol. Alprazolam (Xanax) Clonazepam (Clonopin) Narcotics Flurazepam
AMCAP JOURNAL/APRIL 1982 14 TABLE 1 development of dependence. They are classified by their Commonly Us~ NarcotiC'S chemical structure and include the tertiary carbinols • (Placidyl, Valmid), the piperidinediones (Doriden, Usu,l Sinsle Dur.tion Noludar), chloral derivatives (chloral hydrate), the Proprietuy NU''le Generic N.me Aduh Dou~e of Action quinazolones (Quaaludel, and the monoureides (Paral,
Opium S hrs_ Paxarel). They are used in medical practice to induce Morphine Morphine Sulf,te ISmS 4 hrs. sleep. Codrine Codeine Phosph,te 30-6sm. 4 hrs. TABLE 4 Heroin 2-3 hrs. Nonbubitur..tes Dilfudide Hydromorphine 2m, 4 hrs. Perroc"n- Oxycodone HCI I t.blel '" hrs. Demer~e Meperidine SO-100m. 4 hrs. Usu.. 1SinKle Dur.. tion OoIophine- Meth,done 5-10 m, 4 hrs. Adult Dose of Action
Many.other agents have been developed to produce Doridens Gh.tethimide 0500 ma "blels .5hrs analgesic and antitussive properties similar to the opiate .nd upsules PbodylS Ethchlorvynol sao ma t.blets alkaloids without the problem of dependency. However, Quuludea Meeth,qu.. lone 1.50·)00 ma dependency has proven to be a problem with all of these upsules agents. Noclec· Chlor..1hydr.. te leo m~ upsules S hrs. Usual short-term effects include sedation, analgesia, Nolud.. ra Melhprylon laO ma upsules euphoria, and impaired intellectual functioning and coordination. Chronic effects include constipation, loss Usual short-term effects of the barbiturates and of weight and appetite, and temporary impotency or nonbarbiturates include relaxation and sedation, sterility together with dependence and tolerance. drowsiness, sleep induction, euphoria, impaired Sedative-Hypnotics judgment and reaction time and, to some degree, muscle One group of sedatives and hypnotics are derivatives relaxation. Chronic effects include irritability and of barbituric acid and are referred to as barbiturates. weight loss as well as dependency. They induce a high degree of both physiological and Another sedative-hypnotic agent is a drug psychological dependence and tolerance develops quite synthesized in 1957 called phencyclidine (Sernyl, rapidly. Barbiturates (Table 3) are divided into four Sernylan). During clinical trials it soon became apparent groups by their duration of action. The ultra short that the adverse effects of agitation, disorientation, and acting barbiturates, such as thiopental (Pentothal), act hallucinatory phenomena precluded its use in humans. very rapidly and have a duration of roughly an hour, Since that time, phencyclidine has been available for depending upon the individual. The short-acting legitimate use only as a veterinary sedative and hypnotic barbiturates, such as pentobarbital (Nembutal) and for primates. secobarbital (Seconal), react at a slower rate and have a On the streets, it is called "PCP" or the "peace pill." duration of around three to four hours. The Recently, it has been called "angel dust." This agent is intermediate-acting barbiturates such as amobarbital extremely toxic in large doses, and the illegally produced and butabarbital have a duration of action between four thiophene analog appears to be even more toxic. and six hours. The classic example of long-acting Tranquilizers barbiturates is phenobarbital, which has a duration of Another subcategory of central nervous system five to eight hours. depressants is tranquilizers. The tranquilizers are TABLE .) divided into two basic groups, the neuroleptics and Commonly UHd B.ubltur.ltn anxiolytics, and are used medically in the treatment of psychoses and neuroses. Dur..ion The neuroleptics (major tranquilizers or of Action ProduCl Hypnollc Dot.e antipsychotics) include (1) the phenothiazines- including the aliphatics, the piperazines, and the Uhruhort II hour) Thiopent,l (Penloth,I-J piperidines; (2) the thioxanthenes, such as Short (.) hours) Secob,rbit,IISecon,le, 0.1-0.2 1m Penlob,rbit,l fNembul"-' O.lam chlorprothixene (Taractan) and thiothixene (Navene); Inlermf'di,te Bul,b.,bit,1 fButilOle) 0.1·0.2 am (3) the butyrophenones, such as haloperidol (Haldol), (4·6 houn) Amobubit..i (Amyt.. I-) o.OS-O.lam whose action resembles that of the piperazine Lona (More Phenob.rbit.1 0.1-0.2 1m phenothiazines; (4) the in doles, such as molindone th,n 6 hOuri) B.. rbit.1 (Veron,I-) 0.3-a.Ssm (Moban); and (5) the dibenzoxapines such as loxapine (Loxitane) and chlozapine. The neuroleptics are used to Another group of sedatives and hypnotics (Table 4) is treat the psychoses. similar in action to the barbiturates, but is not a The major drug-induced aclverse reactions from derivative of barbituric acid. In the past there was some neuroleptics are called extrapyramidal symptoms and question about whether these drugs produce real are generally broken down into five distinct disorders or physiological. dependence; however, as new data syndromes: becomes available, evidence now points to a 1. Tardive dyskinesia (Table 5) is a hyperkinetic
15 AMCAP JOURNAl/APRIL 1982 TABLE. disorder developed by some patients. on long-term Acut.. Dystonic R...tIOM antiphsychotic therapy (particularly phenothiazines) • which appears and persists after drug withdrawal. This I. SHn in only .Ibout 2-. of tr....lt'd plli..n1'. disorder, at least at present, seems to be irreversible. 2. U,u,lIy .un within 14-48 houn .. hlE'r dNa adminiltr.lton hu bnn in,UtutN. Nl.....ty ptrc..nt of IhlE' curt occur within 4 1/1 d..y,. TABLE .5 3. Sun morl!' ofllE'n in m.I.., under Iht' 'St' of 40 .nd in children. Tudlvt' O)'lkln"', 4. Sten more lrfllut'nlly with piptr'linl!' phl!'nothi.linlft .nd wilh h.klp.,idol. .5. Ch"Ktt'm..d by oculoayric crili•. torticollis.•nd protrutMM of IN 1onlulE'. ~. RlE'sponds well to Irl!'.Ilml!'nt with .50 mR 01 hn.-dryl. I. Incidence m.y ~ u hilh u 1S·20"t0. 2. .Occurs mort' oEtrn in elderly p",tients. lr'pKi.lly ,hOJr with .. hIStory of br.ln d.lm.&t'. J. Moay not b«OfM .p~r.nl unhl the .ntiptychollc druB is IIOpP'f'd or Iht' dOH' rf'duCH The anxiolytics (minor tranquilizers) (Table 9) can 4. Chu.cleflud by Itt'rfOly~ mOYt'mtflts of Iht' lips .nd lon~u••nd wmelime, of the trunk or ."In'mili.,. lead to a psychological and physiological dependence, 5. Anllpolrk!",,," droIt m.. k. II more ~Y.. re. Symptoms ue luu·ne-d by .nllpsycholtc and tolerance is developed. They are divided into three mf'd,c.tion. groups: (1) the propanediol carbamates, (2) the b. OUr.ltion of dlsord.r molY ~ from WH", 10 yr,". 7. Possibly dut' 10 .Irv.tf'd ,.nlr,,1 level, of dop.mlnt' diphenylmethane derivatives, and (3) the benzodiazepines. Most common short-term effects 2. Akinesia (Table 6) is a drug-induced disorder include drowsiness and fatigue. Effects of chronic characterized by muscle rigidity and weakness. ingestion include insomnia, delusions, and anxiety. TAlLE 9 TABLE' Srlmed Anxlolytk Apnb Akln"l,
Occurs ,n .bout 15"- of p.lM-n'S 'rto",tf'd With .nIlPl)'chohC drUB' 'n 90".. of Ih.. US" It Vt"",ISlnlM- Dur.hCMt occurs within th. finl 71 hours of ',••Imenl. rrC'p'lri.lry N.. _ Gt-fWric N.. _ Adul,~ 01 Anion 2 Occun more fre-qut'ntly In f.m.lu Gvrr olaf' so ,nd morlE' ohlE'n WIth IhlE' .1,ph'hC lyplE' ul phlE'nolhiuinlE's .nd butyrophl!'non". 3. Ch,u.cll!'riud by. m.uldikl!' I.cl!'. rf'dueed um movcml!'nl.shulfllnl B.,I, .nd rulhnM h.nd rr",...",.J,ou movl!'ml!'nl •. Equ.nll· MlE'proNlNlt' 400 m8 I",bfell 4 hn. 4. Rudily conlrollf'd wilh tr,dllion.1 .nliplrl..in,un dru81 Millown- Ml!'p,ob.ItNt.. 400 ms r",bI..u 4 hn. D,rll",,,,I,,,,....,A.. "l,.,~",,'lI(' 1'.l.lr....-.\'"I.ril· Hydrollyzint' 100 ml ,..bMIs 4h~ 3. Akathisia (Table 7) is the name for a condition of 8A:#OI'eur"I"" inner disquiet accompanied by an uncontrollable motor Llbflum· ChlordunpolKt' .5-10 ml up'uln 5hn restlessness. The most frequently observed symptom is 2.5ma o ps.u1n the patient's inability to sit or lie quietly. \·.llum· (A.lle~m 2me.''''8- 4-' hn. 10 ms t.lbkt. SlE'rn- (huep.un IOma.l.5ma 4-5 hr... TABLE 1 Alullhl'.... JO rna uptu.... Tr,nllel'll!'· CIOr.lzepoillf 3.7S rna,. 7..5 ml- 4-' hn.. 15 rna "p'uln 1. Inddl!'nee of .Ibout 2t..... 'Hn Al!'nlE'ully .hl!'r .. 'lE'w wnl..l oJf Ihl!'upy o.polu1ium 15 mit "p'uWs 2 Inddl!'ncl!' is hi~htr '" yuunA fl!'m.ll!'l. 3. Ch"ull!'riud by .In in.bihly to III ur II.nd still OnHt is ohl!'n prt'Ct'df'd by muKul" dlscomlort. Alcohol ..I. Rl!'spondl rudily h' lriE'.tmiE'nt wilh l,.dillon..1 .nhp,,}.,n$OJ\ drugs. s SI!'t'n moriE' fr~uiE'nlly wllh ptPlE'rn'nt' phlE'no.llhl.. lInt's Another category of depressants commonly used is alcohol. Usual short-term effects include central 4. Dystonic reactions (Table 8). The dystonias are nervous system depression and impaired judgment, acute disorders of muscle coordination, particularly in coordination, and reaction time. Chronic ingestion the face--e.g., grimaces, protrusion of the tongue, effects include possible obesity and irreversible damage dysarthrias (imperfect articulation of speech), and to the brain and liver. oculogyric crisis 1. Other symptoms include tics, Central Nervous System Stimulants (Thymoleptics) opisthotonos2, and torticollis'. The central nervous system stimulants can be divided s. Dyskinesia is an acute disorder characterized by the into three main divisions: the xanthine alkaloids impairment of the power of voluntary movement. This (purines), the ecgonine derivatives, and the impairment results in fragmentary or incomplete phenylethylamine sympathomimetic amines. movements. The xanthine alkaloids (purines) include theophylline, theobromine, and caffeine. Usual short-term effects 1. Oculogyric crisis is an adverse reaction to antipsychotic medication include central nervous system stimulation, reduction of that is characterized by a sudden turning up of the eyeballs. The fatigue, and diuresis. Chronic ingestion and abuse patient is unable to move them and experiences severe pain due to dosages elicit such effects as insomnia, tolerance, and the muscle spasms of the eye. psychological dependence. 2. Opisthotonos - when a person's back muscles go into spasms causing his head and feet to bend backward and his torso to arch Ecgonine derivatives include cocaine and other forward. miscellaneous atropine-like compounds. They are 3. Commonly called wry n«k, torticollis is a unilateral spasm of neck included here because of their high abuse and muscles. The IT'!ost easily recognized symptom is the turning of the psychotoxic potential. Cocaine is obtained from the head to one side. leaves of Erythroxylon coca trees and other species of
AMCAP JOURNAl/APRIL 1982 16 Erythroxylon. These trees are indigenous to Peru and to moderate psychological dependence, and tolerance Bolivia and have been used by the natives for centuries can develop. It should be pointed out that even though to increase endurance. There are many plants growing these drugs are classified as "hallucinogens," they do not freely in almost all climates that are related to this cause true hallucinations every time they are used. alkaloid. Many times they cause the person who abuses these The third category includes the phenylethylamine substances to perceive the environment in a distorted sympathomimetic amines (Table 10). The major group form--synesthesia, not strictly hallucination. The of agents in this category is the amphetamines, but must psychotomimetics can be classified into four agents or also include other phenylethylamines with action similar groups of agents. These are mescaline. psylocibin, to that of the amphetamines. lysergic acid derivatives, and the tryptamines. These agents have a potential for inducing both psychological and physiological dependence and they TABLE 11 develop tolerance. Current medical uses include the Psychotomimetics (HallucinOiens or Psychodysleplics) treatment of narcolepsy and as a therapeutic agent for hyperkinetic children. Usual SinJtle Durati~ln Common Name Cheminl Name TABLE 10 Adult Dose of Achon Phnlylethylaminn (Sympathomimetic Aminn) LSD LyMrSK acid 150-"'00 mit 111'1" dirthy"mide tartralll' USWlI Sin~le Duution Propri""y Psylocibin Dimethyl..... Ij InJt 3hn. N..... Genene N.me Adult Dow of Act.on hydro.y-Iryptamlne DH OJethyllryp.amlne 0.7 mltJkJt 1/1-1hrs. ~nudrint'· Amphet.. min.. 1.5-5.0 m~ ~·o hno DMT Dimethyltryptamlnr 0_1 mit/kit 112·2hn. sulf.,,, IS mil: MDA Methyline dlmtthol.Y- 100 mit 12hn Out'drin..e OucrOoimphet.. mine 2.'·5.0 rnA 4·0 hn phenrthy"mlnr sulf.,.. ISml\: STP "'-mrt"yl-2.S dime· ).2·10.0 mit 0·24 hrs, Drumy'8 Dtudrinl' .nd 2..5·.5.0 mil: "'0 nn. t"o:l:y-mrthylphl'nf'- .mob..,btt..1 t"y"mlnr Didrl'lIe 8f'nzphltl.lminl' SO mJt 4-0 hn. Peyotl' Tn mrt "Ol{y,u:l:yphrn. 112.·31-1 l1l or Uhn. Btphltl.llmin..- R".n comptu", of 2.S-'.0 mil: -4-0 hn. rlhylaminr 0-12. bultons .. mphrt.. mln.. .-nd IMuuhnel IMethyl.led sao·aoo mit dUlrGolmph.'.rrunl' cat«hobn'llnnl Ml'ltwdrin..e Mt"lh"mphlrlolminl' 2 .5-S.0 m~ ~·o hn o.-yn· hydrochlondl'
PI.,."I,.""t.••-.n 11'''' ""_ j ••,l.r lit TIl..' ~ "'lIIr.tf...r~n Mescaline is a pharmacologically active alkaloid from various species of the cactus Lophophora. The top of the Pr.ludi"· Phfnml'lrUlnl' 2.S-S.0 m~ "-0 hn hydrochlonde aerial shoots is cut off and dried. the needles removed, R,ulin· Mf.hylphl'ntCbll' 10-20 rnA 4-0 hrs and what is left is called a peyote button or mescal hydrochloride button. Mescaline is a phenylethylamine and has actions T..nlU'''· OifthylproptOn 2.'-'.0 mil: 4'0 hn those agents. hydrochloride similar to lon.mi"- Ph..nl..rmin.. 1$·30 mx 4·0 hrs Psylocibin comes from the sacred Mexican mushroom (Psylocybe mexicana). It is an alkaloid with Mood Modifiers phenylethylamine properties and is reported to be up to Antidepressants 100 times more potent than mescaline. Monoamint oridast (MAOI inhibitors. MAO inhibitors can Lysergic acid derivatives are numerous. Many plants be divided into the hydrazines and the nonhydrazines. including morning glory seeds and ergot, are precursors They are used as antidepressants, and the dosage varies to lysergic acid. Ergot comes from the rye plant in the with each individual agent. lsocarboxazid (Morplan) and form of a copper-colored rust that grows around the top tranylcypromine (Parnate) are the most potent on a when the plant remains too moist. The most commonly milligram per milligram basis, and nialamide (Niamid) is abused lysergic acid analog is LSD (d-lysergic acid the least potent. MAO inhibitors have numerous diethylamide tartrate). The dose of LSD is 1140,000 gm. adverse effects including insomnia, hallucinations, Tryptamines are generally shorter acting than the muscle weakness, headache, dryness of the mouth. and lysergic acid derivatives. Lysergic acid "trips" can range blurred vision. Other effects include hypotensive up to a day in length. Tryptamines last two hours. reactions, infrequent anorexia (loss of appetite). Dimethyltryptamine (DMT) is sometimes called hepatobiliary reactions, and inability to ejaculate. "businessman's trip" and lasts about 45 minutes. Tricyclic antidtpmsants. Tricyclic antidepressants are Diethyltryptamine (DET) lasts about two hours and is divided into the dibenzazapine derivatives (Tofranil and similar to DMT. Fertofrane or Norpramin) and the dibenzocyclohep Usual short-term effects of the psychotomimetics tadiene derivatives (e.g., Elavil and Aventyl). Another include visual imagery. increased sensory awareness, compound, doxepin, (Sinequan) is closely related to the anxiety, nausea, and impaired coordination and sensory dibenzocycloheptadiene derivatives. perception. Chronic ingestion effects are generally no Psychotomimetics (Hallucinogens or Psychodysleptics) different from short-term effects; however, long-term The psychotomimetics (Table 11) are agents with no use has been shown to produce a more pronounced panic currently accepted medical use. They produce minimal reaction.
17 AMCAP JOURNAL/APRIL 1982 CANNABIS (Marihuana) R,port". 1982, 5(7):1-3. Cannabis is not a narcotic, not a depressant, not a Gay, G.R., Matzer, A.D., and Bathurst, W. Short-term heroin detoxification on an outpatient basis. 'nltrnt{lion,,1 jOllrnll1 of Iltt stimulant, not a tranquilizer, and not '8 hallucinogen- although it has properites similar to each of these. In IIddic/ions. 1972,6:241-64. animals, cannabis potentiates barbiturate sleeptime. It Goldberg, G.J., and Korczyn, A.D. Intravenous diazepam in drug also potentiates amphetamine stimulation in animals. induced dystonic reactions. Brit. f. Psychial. 1972,121:75-77. Gonzales, E.R. Alter drug structure--Avert induced lupus. JIIMA. All the agents listed under psychotomimetics have cross 1981, 246(15):1634. tolerance; however, cannabis does not have cross Goodman, L.S., and Gilman, A. (eds.) H, pha ...... cologico' basi' of tolerance with the hallucinogens. /htrap,utics. 4th ed. New York: Macmillan, 1968. Use of cannabis creates a moderate psychological Greenblatt, D.J .• and Shader, R.J. Benzodiazepines. H, NtID Engl..d dependence, and it has moderate tolerance potential. JOIl,n,,1 of Mtdi(int, 291:1011. Cannabis is not a single substance. A number of Groth, A. Psychopharmacology. Mldical Pharmacology. 5th ed.; C. V. different varieties have been isolated. Examples of Mosby Co.. St. Louis, MO., 1970. various types include Cannabis sativa, Cannabis indica, Guymon, A.C. Textbook of medical physiology. Philadelphia: W.B. Cannabis americanus, and Cannabis mexicana. Saunders, 1970. Differentiation has been made between several varieties Hollister, L.E. Tricyclic antidepressants. H, NtID England Journal of such as michoacan, columbian, and synsimillia. These Mttlirin,. Nov. 1978, 16:1106. varieties can have such a low potency that the person The how of anxiety. H, lanCt/. Aug. 1981. 1:237. lippmann. Steven. Lithium's effects on the kidney. Posl G,,,JII,,'t ingesting the substance has almost no discernible effect. Mldicin,. 1982,71:99. On the other hand, there are some varieties that have Mangla. J.D., and Pereira. M. Tricyclic antidepressants in the shown toxic manifestations in the nerve pathways in the treatment of peptiC ulcer disease. Arcltitlts o/lnft,n,,1 MtJicint, 1982. brain. 172:173. Usual short-term effects include relaxation, euphoria, Martin, W.R .. and Jasinski, D.R. Physiological parameters of morphine increased appetite, and possible impairment in and dependence in man; Tolerance. early abstinence, protracted judgment, time perception, and coordination. Possible abstinence. JOIl,nal 0/ Psychitflric Rtsta,ch, 1969.7:9-11. long-term effects include subtle personality changes and Meyers, F.H., Jawetz. E.. and Goldfein. A. RtoitID of mttlical pharmacology. diminution of intellectual acuity. 3rd ed. Los Altos, CA: Lang Medical Publications. 1970. Conclusion Nichols. J.R. How opiates change behavior. Stirnli!ic Am";c"",,, 1965, The drugs or agents mentioned, as well as the 212:80-88. O'Malley. J.E., Anderson, W.H., and Lazaare. A. Failure of outpatient terminology presented, are given as an overview with treatment of drug abuse. I. Heroin. A.mmcan JOllrPUlI 0/ Psychiatry, the expectation that there will be a closer health 1972, 128:865-68. professional team relationship. This closer relationship Physicians' 0". R'ftrtnCt. 30th ed. Oradell, N.I.: Medical Economics, can lead to more adequate understanding of and rapport 1976. with patients who are being treated (or are otherwise Rech. R.H .• and Moore. K.E. A.n ;nt,odllcl;oll to psychopharmacology. New involved) with agents having an effect on mood, York: Raven. 1971. perception, and behavior. This presentation is made Reed. K. Trcyclic antidepressant blood levels. Post G,,,dIlJllt Mtdicint, with the hope that better management and monitoring 1981,70(5):81. of the patient will occur to reduce possible drug sIde Rickels, Karl et al. 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