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Designer-Drugs-China-White-And-MPTP.Pdf Selected Papers of William L. White www.williamwhitepapers.com Collected papers, interviews, video presentations, photos, and archival documents on the history of addiction treatment and recovery in America. Citation: White, W. (2014). Designer drugs, China white, and the story of MPTP. Posted at www.williamwhitepapers.com Designer Drugs, China White, and the Story of MPTP William L. White Emeritus Senior Research Consultant Chestnut Health Systems [email protected] NOTE: The original 1,000+ page manuscript for Slaying the Dragon: The History of Addiction Treatment and Recovery in America had to be cut by more than half before its first publication in 1998. This is an edited excerpt that was deleted from the original manuscript. "Designer drugs"--a term coined by The modern story of designer drugs pharmacologist Gary Henderson, of the begins in 1976 with Barry, a bright, twenty- University of California--represent efforts by three-year-old college student from chemists to alter the molecular structure of a Bethesda, Maryland. Barry created an psychoactive drug to change the drug analogue of meperidine (Demerol)--MPPP, identity while maintaining or intensifying the that was not legally controlled as a way to original drug's psychoactive properties. avoid contact with the illicit drug market. He Designer drugs are often analogues-- continued to synthesize and use MPPP for chemical cousins--of the drugs they’re six months without incident. In the summer modeled after and may have effects and of 1976, he made a new batch of MPPP but risks quite different than these original through a mistake in the synthesis procedure substances. The primary reason people produced not MPPP, but a highly potent created such chemical cousins was that they neurotoxin--MPTP. Following ingestion of were legal to possess and sell before new MPTP, the young college student suffered legislation was passed in 1986 that rendered partial paralysis, muscle spasms.tremors, these analogues illegal. Before 1986, slowness of movement, a masklike face and persons arrested with these substances a loss of speech. He had, in short, could not be prosecuted because the developed what appeared to be the classic substances were not explicitly prohibited in symptoms of Parkinson's disease. The state and federal drug laws. These drugs contaminant MPTP had destroyed his were also not detected through routine blood brain's dopamine-producing cells. While and urine testing procedures. Over the medical treatment controlled some of the years the term "designer drug" has been worst of the symptoms, Barry’s Parkinson’s broadened to refer to an illicitly continued unabated. Becoming increasingly manufactured synthetic drug. depressed about his condition, Barry sat williamwhitepapers.com 1 under a shade tree on the grounds of the body. This latter substance virtually destroys National Institute of Health in the fall of 1978 a small area of the base of the brain called and killed himself with an overdose of the substantia nigra. It is in this small region cocaine. His story, briefly outlined in a 1979 that the brain produces dopamine, a article in Psychiatric Research, might have neurotransmitter essential for normal human been easily lost to history if it were not for functioning. The brains of Dr. Langston’s future developments (McCormick, 1989; frozen patients had, through their absence of Restak, 1994). dopamine, lost their capacity to convert In 1979 two California men were thought into action. This error in street found dead with fresh needle tracks and chemistry had produced a product that could drug injection paraphernalia and white by-pass all the brains protective systems. powder found close to their bodies. The MPPP, itself non-toxic, passed into the brain Drug Enforcement Agency’s Washington lab as what Langston called a chemical Trojan identified the powder as a designer narcotic. Horse where natural occurring brain Deaths from "synthetic heroin" continued to enzymes converted MPTP into MPPP, one be reported through 1980 and 1981. Then of the most powerful neurotoxins ever in the summer of 1982 a completely new discovered (Langston and Palfreman, 1996). chapter of this story unfolded in Southern Langston’s frozen addicts responded California. to the medication L-Dopa, but experienced Following the Fourth of July weekend, many of the problematic side effects that neurologist Dr. J. William Langston treated a some Parkinson’s patients experience who forty year old patient brought to Santa Clara are maintained on the drug--periods where Valley Medical Center. The patient had even the medicine fails to work, confusion, more severe symptoms than those those hallucinations, and paranoia. described above in our young college Langston's analysis of this student. Langston’s patient was frozen into phenomenon of “frozen addicts” included a immobility and speechlessness, appearing dire warning: in some users, the MPTP may more like a marble sculpture than a human have only partially damaged the substantia being. A week later, the girlfriend of nigra which would not reveal active Langston's patient experienced the same symptoms now but would reveal those extreme symptoms. Dr. Langston was symtpoms later through the aging process. baffled by symptoms that looked like In short, some users could already have set Parkinson's disease but which came on too a course that would unfold the early onset of quickly and at too young an age to fit that Parkinson's disease in coming years. In diagnosis. Within three weeks, Langston perhaps a touch of poetic justice, the had identified six drug users with what individual who manufactured the China appeared to be advanced Parkinson's White that Langston’s six addicts used with disease. But this was an impossible such disastrous results, himself later diagnosis. consulted Langston about early signs of The answer to this medical riddle was Parkinson’s disease (Langston and found when someone remembered an article Palfreman, 1996, Shafer, 1985). on a drug-using college student who had New substances entering the illicit experienced similar symptoms. Analysis of drug market in the 1970s that required a the drugs Langston's patients had used higher level of skill to produce. Mistakes in confirmed the presence of MPTP--obtained the preparation of these substances often in heroin sold under the brandname of brought ominous results. One substance "China White" (McCormick, 1989). Langston that followed MPPP was another Demerol determined that the MPTP, created through cousin--PEPAOP which sometimes included mistakes in the synthesis of the desired a contaminant PEPTP, which was linked to MPPP, interacted with a naturally occurring chemically induced Huntington's Chorea brain enzyme as it was metabolized, (Kirsch, 1986). The DEA, used its producing the substance MPPP inside the emergency powers, designated MPP and williamwhitepapers.com 2 PEPAOP as Schedule I drugs in August, Use of designer opiates increased 1985. This loophole was permanently during the mid-1980s. Kirsch reported in addressed with passage of the Federal 1986 that 10% of clients in Northern Analogue Act of 1986. California methadone clinics tested positive The above mistakes in chemical for fentanyl derivatives when special tested synthesis signaled the introduction of for fentanyl were administered for all fentanyl analogues into the illicit drug supply. incoming clients. The number of cases of Fentanyl is a synthetic narcotic introduced MPTP-induced Parkinson's disease also into American medicine as Sublimaze in rose. By 1985, the Center of Disease 1972. It is widely used in surgery to produce Control had identified 400 MPTP exposed short-term anesthesia. Its availability and individuals. These individuals presented potency have linked it to the dramatic rise in with symptoms such lost or impaired speech, addiction among anesthesiologists and impaired mobility (slow, stooped gait), nurse anesthetists in the U.S. This addiction stiffness, and tremors. The CDC also rate has promoted concern by medical reported more than 100 deaths related to associations and institutions and promoted designer opiates (Kirsch, 1986). Some of experts like Dr. David Smith to refer to the fentanyl overdose deaths were caused addiction as an "occupational hazard" of by synergistic interaction between fentanyl anesthesiology. analogues and other drugs, particularly While there was early evidence of cocaine and alcohol. misuse of fentanyl by medical personnel, Designer drugs are the latest stage of fentanyl was not expected to be a candidate evolution in the Twentieth Century's major for illicit diversion because of its short contribution to the history of addiction: the duration of effect. According to laboratory synthesis of new psychoactive pharmacologist Gary Henderson, this drugs that require no plant-based materials. problem was solved in 1979 when a Dr. Richard Restak, in his review of designer "phantom chemist" created two fentanyl drugs, also pointed out that their history analogues that were longer acting. These underscores the thin line between benefit analogues--alpha-methyl fentanyl and 3- and injury and that the smallest modification methyl fentanyl--approach the duration of in a drugs structure can "unleash powerful effect of heroin. (Gallagher, 1986). The unintended forces." (Restak, 1994, p. 115). potency of the more than 200 known fentanyl To the reader wondering, how illicit chemists analogues is also quite remarkable. The two would know how to manufacture various most common analogues
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