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1 The Controlled Substances Act13 U.S. Chemical Control16 Introduction to Drug Classes

18 Narcotics20 Opium20 Morphine21 Codeine21 Thebaine21 Heroin22 Hydromorphone23 Oxycodone23 Hydrocodone24 Meperidine24 Dextropropoxyphene24 Fentanyl25 Pentazocine25 Butorphanol25 Methadone26 LAAM26 Buprenorphine

31 Stimulants32 Cocaine34 Amphetamines35 Methcathinone35 Methylphenidate35 Anorectic Drugs36 Khat

39 Depressants40 Barbiturates41 Benzodiazepines41 Flunitrazepam42 GHB42 Paraldehyde43 Chloral Hydrate43 Glutethimide & Methaqualone43 Meprobamate43 Newly Marketed Drugs

48 Cannabis49 Marijuana50 Hashish50 Hashish Oil

51 Hallucinogens52 LSD53 Psilocybin & Psilocyn53 Peyote & Mescaline54 New Hallucinogens54 MDMA (Ecstasy)56 Phencyclidine (PCP)56 Ketamine

58 Inhalants60 Steroids63 List of Coordinators76 Metric Conversion Table

Table of Contents Drugs of Abuse

Drug Enforcement Administration

PRODUCED AND PUBLISHED BY

Drug Enforcement AdministrationU.S. Department of Justice

WWW.DEA.GOV

Drugs of Abuseii

Drugs of Abuse

Credits

Donald E. JosephEditor

Gretchen FeussnerPharmacologist

Katherine C. TichacekLinell BroeckerAssociate Editors

Patrick A. HurleyDesign and Production

John J. BoylePhotographer

Drugs and Chemical Evaluation StaffWriting and Research

Special Testing LaboratoryDrug Identification

Printing DisclaimerDue to printing variabilities and controls,we can not ensure the color accuracy of everyimage in this publication.

Individual copies of this publication maybe purchased from the Government Print-ing Office at: bookstore.gpo.govor... [email protected]

Drugs of Abuse is also available in itsentirety on the DEA website at:www. dea.gov in the Publications Library.

Drugs of Abuse iii

Drugs of Abuse

We are pleased to introduce the 2005 edition of Drugs of Abuse.This DEA magazine delivers clear, scientific information about drugsin a factual, straightforward way, combined with scores of precisephotographs shot to scale. We believe that Drugs of Abuse fulfillsan important educational need in our society.

Around the world and across the nation, the dedicated men andwomen of the DEA are working hard to investigate and arrest thetraffickers of the dangerous drugs depicted in this magazine. Theyhelp keep our schools and neighborhoods safe and secure. But just as important, they are workinghard to educate America’s youth, their parents, and their teachers about the very real dangers ofillegal drugs. Drugs of Abuse magazine is an important step in that direction. For additionalinformation about drugs, we invite you to explore our web site at: www.dea.gov, where you willfind a wealth of research and drug-related news.

Finally, we would like to express our appreciation to the United States National Guard (USNG)and the National Drug Intelligence Center (NDIC) for joining us as partners in the publication ofthis magazine.

Drugs of Abuseiv

Drugs of Abuse

Contents

Chapter 1 Page 1The Controlled Substances ActFederal Trafficking Penalties ChartMarijuana Trafficking Penalties ChartRegulatory Requirements Chart

Chapter 2 Page 13U.S. Chemical ControlListed CSA Chemical Chart

Chapter 3 Page 16Introduction to Drug Classes

Chapter 4 Page 18NarcoticsNarcotics of Natural Origin

•Opium•Morphine•Codeine•Thebaine

Semi-Synthetic Narcotics•Heroin•Hydromorphone•Oxycodone•Hydrocodone

Synthetic Narcotics•Meperidine•Dextropropxyphene•Fentanyl•Pentazocine•Butorphanol

Narcotics Treatment Drugs•Methadone•LAAM•Buprenorphine

Chapter 5 Page 31Stimulants

•Cocaine•Amphetamines•Methcathinone•Methylphenidate•Anorectic Drugs•Khat

Drugs of Abuse Chart Centerfold

Chapter 6 Page 39Depressants

•Barbiturates•Benzodiazepines•Flunitrazepam•Gamma Hydroxybutyric Acid•Paraldehyde•Chloral Hydrate•Glutethimide and Methaqualone•Meprobamate•Newly Marketed Drugs

Chapter 7 Page 48Cannabis

•Marijuana•Hashish•Hashish Oil

Chapter 8 Page 51Hallucinogens

•LSD•Psilocybin, Psilocyn, other

Tryptamines•Peyote & Mescaline•MDMA (Ecstasy), other

Phenethylamines•Phencyclidine (PCP) and Related

Drugs•Ketamine

Chapter 9 Page 58Inhalants

Chapter 10 0Steroids

Chapter 11 Page 63National Guard Counterdrug Coordinators & AdministratorsDemand Reduction Coordinators

Drugs of Abuse

Chapter 1

Controlling Drugs orOther Substances

FORMAL SCHEDULING

The Controlled Substances Act (CSA) places allsubstances which were in some manner regulatedunder existing federal law into one of fiveschedules. This placement is based upon thesubstance’s medical use, potential for abuse, andsafety or dependence liability. The Act alsoprovides a mechanism for substances to becontrolled, or added to a schedule; decontrolled, orremoved from control; and rescheduled ortransferred from one schedule to another. Theprocedure for these actions is found in Section 201of the Act (21 U.S.C. 811).

Proceedings to add, delete, or change the scheduleof a drug or other substance may be initiated bythe Drug Enforcement Administration (DEA), theDepartment of Health and Human Services (HHS),

The Controlled Substances Act (CSA), Title II and Title III of theComprehensive Drug Abuse Prevention and Control Act of 1970, is thelegal foundation of the U.S. Government’s fight against the abuse of drugsand other substances. This law is a consolidation of numerous lawsregulating the manufacture and distribution of narcotics, stimulants,depressants, hallucinogens, anabolic steroids, and chemicals used in theillicit production of controlled substances.

or by petition from any interested person: themanufacturer of a drug, a medical society orassociation, a pharmacy association, a publicinterest group concerned with drug abuse, a state orlocal government agency, or an individual citizen.When a petition is received by the DEA, theagency begins its own investigation of the drug.

The DEA also may begin an investigation of a drugat any time based upon information receivedfrom law enforcement laboratories, state and locallaw enforcement and regulatory agencies, or othersources of information.

Once the DEA has collected the necessary data, theDEA Administrator, by authority of the AttorneyGeneral, requests from HHS a scientific andmedical evaluation and recommendation as towhether the drug or other substance should becontrolled or removed from control. This request issent to the Assistant Secretary of Health of HHS.HHS solicits information from the Commissionerof the Food and Drug Administration (FDA),

1

Drugs of Abuse

evaluations and recommendations from theNational Institute on Drug Abuse, and on occasionfrom the scientific and medical community at large.The Assistant Secretary, by authority of theSecretary, compiles the information and transmitsback to the DEA a medical and scientificevaluation regarding the drug or other substance, arecommendation as to whether the drug should becontrolled, and in what schedule it should beplaced.

The medical and scientific evaluations are bindingon the DEA with respect to scientific and medicalmatters and form a part of the scheduling decision.The recommendation on the initial scheduling of asubstance is binding only to the extent that if HHSrecommends that the substance not be controlled,the DEA may not add it to the schedules.

Once the DEA has received the scientific andmedical evaluation from HHS, the Administratorwill evaluate all available data and make a finaldecision whether to propose that a drug or othersubstance should be removed or controlled and intowhich schedule it should be placed.

The threshold issue is whether the drug or othersubstance has potential for abuse. If a drug does nothave a potential for abuse, it cannot be controlled.Although the term “potential for abuse” is notdefined in the CSA, there is much discussion of theterm in the legislative history of the Act. Thefollowing items are indicators that a drug or othersubstance has a potential for abuse:

(1 ) There is evidence that individuals are takingthe drug or other substance in amounts sufficient tocreate a hazard to their health or to the safety ofother individuals or to the community; or

(2) There is significant diversion of the drug orother substance from legitimate drug channels; or

(3) Individuals are taking the drug or othersubstance on their own initiative rather than on thebasis of medical advice from a practitioner licensedby law to administer such drugs; or

(4) The drug is a new drug so related in its action to adrug or other substance already listed as having apotential for abuse to make it likely that the drug willhave the same potential for abuse as such drugs, thusmaking it reasonable to assume that there may besignificant diversions from legitimate channels,significant use contrary to or without medical advice,or that it has a substantial capability of creatinghazards to the health of the user or to the safety of thecommunity. Of course, evidence of actual abuse of asubstance is indicative that a drug has a potential forabuse.

In determining into which schedule a drug or othersubstance should be placed, or whether a substanceshould be decontrolled or rescheduled, certain factorsare required to be considered. Specific findings are notrequired for each factor. These factors are listed inSection 201 (c), [21 U.S.C. 811 (c)] of the CSA asfollows:

(1) The drug’s actual or relative potential forabuse.

(2) Scientific evidence of the drug’spharmacological effects. The state ofknowledge with respect to the effects of aspecific drug is, of course, a majorconsideration. For example, it is vital to knowwhether or not a drug has a hallucinogeniceffect if it is to be controlled due to that effect.The best available knowledge of thepharmacological properties of a drug should beconsidered.

(3) The state of current scientific knowledgeregarding the substance. Criteria (2) and (3)are closely related. However, (2) is primarilyconcerned with pharmacological effects and (3)deals with all scientific knowledge with respectto the substance.

(4) Its history and current pattern of abuse. Todetermine whether or not a drug should becontrolled, it is important to know the patternof abuse of that substance, including the socio-economic characteristics of the segments of thepopulation involved in such abuse.

2

Drugs of Abuse

(8) Whether the substance is an immediateprecursor of a substance alreadycontrolled. The CSA allows inclusion ofimmediate precursors on this basis aloneinto the appropriate schedule and thussafeguards against possibilities ofclandestine manufacture.

After considering the above listed factors, theAdministrator must make specific findingsconcerning the drug or other substance. This willdetermine into which schedule the drug or othersubstance will be placed. These schedules areestablished by the CSA. They are as follows:

Schedule I• The drug or other substance has a high

potential for abuse.• The drug or other substance has no currently

accepted medical use in treatment in theUnited States.

• There is a lack of accepted safety for use of thedrug or other substance under medicalsupervision.

• Examples of Schedule I substances includeheroin, lysergic acid diethylamide (LSD),marijuana, and methaqualone.

Schedule II• The drug or other substance has a high

potential for abuse.• The drug or other substance has a currently

accepted medical use in treatment in theUnited States or a currently accepted medicaluse with severe restrictions.

• Abuse of the drug or other substance may leadto severe psychological or physicaldependence.

• Examples of Schedule II substances includemorphine, phencyclidine (PCP), cocaine,methadone, and methamphetamine.

(5) The scope, duration, and significance ofabuse. In evaluating existing abuse, theDEA Administrator must know not only thepattern of abuse, but whether the abuse iswidespread. In reaching a decision, theAdministrator should consider theeconomics of regulation and enforcementattendant to such a decision. In addition, theAdministrator should be aware of the socialsignificance and impact of such a decisionupon those people, especially the young,that would be affected by it.

(6) What, if any, risk there is to the publichealth. If a drug creates dangers to thepublic health, in addition to or because ofits abuse potential, then these dangers mustalso be considered by the Administrator.

(7) The drug’s psychic or physiologicaldependence liability. There must be anassessment of the extent to which a drug isphysically addictive or psychologicallyhabit forming, if such information isknown.

3

Coca flower.

Drugs of Abuse

Schedule III• The drug or other substance has less potential

for abuse than the drugs or other substances inschedules I and II.

• The drug or other substance has a currentlyaccepted medical use in treatment in theUnited States.

• Abuse of the drug or other substance may leadto moderate or low physical dependence orhigh psychological dependence.

• Anabolic steroids, codeine and hydrocodonewith aspirin or Tylenol ®, and somebarbiturates are examples of Schedule IIIsubstances.

Schedule IV• The drug or other substance has a low

potential for abuse relative to the drugs orother substances in Schedule III.


• Abuse of the drug or other substance may leadto limited physical dependence orpsychological dependence relative to the drugsor other substances in Schedule III.

• Examples of drugs included in schedule IVare Darvon®,Talwin®, Equanil® ,Valium ®and Xanax®.

Schedule V• The drug or other substance has a low

potential for abuse relative to the drugs orother substances in Schedule IV.


• Abuse of the drug or other substances maylead to limited physical dependence orpsychological dependence relative to the drugsor other substances in Schedule IV.

• Cough medicines with codeine are examplesof Schedule V drugs.

When the DEA Administrator has determined that adrug or other substance should be controlled,decontrolled, or rescheduled, a proposal to take

action is published in the Federal Register. Theproposal invites all interested persons to filecomments with the DEA. Affected parties may alsorequest a hearing with the DEA. If no hearing isrequested, the DEA will evaluate all commentsreceived and publish a final order in the FederalRegister, controlling the drug as proposed or withmodifications based upon the written commentsfiled. This order will set the effective dates forimposing the various requirements of the CSA.

If a hearing is requested, the DEA will enter intodiscussions with the party or parties requesting ahearing in an attempt to narrow the issue forlitigation. If necessary, a hearing will then be heldbefore an Administrative Law Judge. The judgewill take evidence on factual issues and heararguments on legal questions regarding the controlof the drug. Depending on the scope andcomplexity of the issues, the hearing may be briefor quite extensive. The Administrative Law Judge,at the close of the hearing, prepares findings of factand conclusions of law and a recommendeddecision which is submitted to the DEAAdministrator. The DEA Administrator will reviewthese documents, as well as the underlyingmaterial, and prepare his/her own findings of factand conclusions of law (which may or may not bethe same as those drafted by the AdministrativeLaw Judge). The DEA Administrator thenpublishes a final order in the Federal Registereither scheduling the drug or other substance ordeclining to do so.

4

Methamphetamine pipe.

Drugs of Abuse

Once the final order is published in the FederalRegister, interested parties have 30 days to appealto a U.S. Court of Appeals to challenge the order.Findings of fact by the Administrator are deemedconclusive if supported by “substantial evidence.”The order imposing controls is not stayed duringthe appeal, however, unless so ordered by theCourt.

Emergency or TemporaryScheduling

The CSA was amended by the ComprehensiveCrime Control Act of 1984. This Act included aprovision which allows the DEA Administrator toplace a substance, on a temporary basis, intoSchedule I when necessary to avoid an imminenthazard to the public safety.

This emergency scheduling authority permits thescheduling of a substance which is not currentlycontrolled, is being abused, and is a risk to thepublic health while the formal rule-makingprocedures described in the CSA are beingconducted. This emergency scheduling appliesonly to substances with no accepted medical use.A temporary scheduling order may be issued forone year with a possible extension of up to sixmonths if formal scheduling procedures have beeninitiated. The proposal and order are published inthe Federal Register as are the proposals andorders for formal scheduling. [21 U.S.C. 811 (h)]

Controlled Substance Analogues

A new class of substances was created by the Anti-Drug Abuse Act of 1986. Controlled substanceanalogues are substances which are not controlledsubstances, but may be found in the illicit traffic.They are structurally or pharmacologically similarto Schedule I or II controlled substances and haveno legitimate medical use. A substance whichmeets the definition of a controlled substanceanalogue and is intended for human consumptionis treated under the CSA as if it were a controlledsubstance in Schedule I.[21U.S.C.802(32),.21U.S.C.813]

International Treaty Obligations

United States treaty obligations may require that adrug or other substance be controlled under theCSA, or rescheduled if existing controls are lessstringent than those required by a treaty. Theprocedures for these scheduling actions are foundin Section 201 (d) of the Act. [21 U.S.C. 811 (d)]

The United States is a party to the SingleConvention on Narcotic Drugs of 1961, designedto establish effective control over international anddomestic traffic in narcotics, coca leaf, cocaine, andcannabis. A second treaty, the Convention onPsychotropic Substances of 1971, which enteredinto force in 1976, is designed to establishcomparable control over stimulants, depressants,and hallucinogens. Congress ratified this treaty in1980.

REGULATION

The CSA creates a closed system of distribution forthose authorized to handle controlled substances.The cornerstone of this system is the registration ofall those authorized by DEA to handle controlledsubstances. All individuals and firms that areregistered are required to maintain complete andaccurate inventories and records of all transactionsinvolving controlled substances, as well as securityfor the storage of controlled substances.

Registration

Any person who handles or intends to handlecontrolled substances must obtain a registrationissued by DEA. A unique number is assigned toeach legitimate handler of controlled drugs:importer, exporter, manufacturer, distributor,hospital, pharmacy, practitioner, and researcher.This number must be made available to thesupplier by the customer prior to the purchase of acontrolled substance. Thus, the opportunity forunauthorized transactions is greatly diminished.

5

Drugs of Abuse

Recordkeeping

The CSA requires that complete and accuraterecords be kept of all quantities of controlledsubstances manufactured, purchased, and sold.Each substance must be inventoried every twoyears. Some limited exceptions to the record-keeping requirements may apply to certaincategories of registrants.

From these records it is possible to trace the flow ofany drug from the time it is first imported ormanufactured, through the distribution level, to thepharmacy or hospital that dispensed it, and then tothe actual patient who received the drug. The mereexistence of this requirement is sufficient todiscourage many forms of diversion. It actuallyserves large drug corporations as an internal checkto uncover diversion, such as pilferage byemployees.

There is one distinction between scheduled itemsfor record keeping requirements. Records forSchedule I and II drugs must be kept separate fromall other records of the handler; records forSchedule III, IV, and V substances must be kept ina “readily retrievable” form. The former methodallows for more expeditious investigationsinvolving the highly abusable substances inSchedules I and II.

Distribution

The keeping of records is required for distribution ofa controlled substance from one manufacturer toanother, from manufacturer to distributor, and fromdistributor to dispenser. In the case of Schedule Iand II drugs, the supplier must have a special orderform from the customer. This order form (DEAForm 222) is issued by DEA only to persons whoare properly registered to handle Schedules I and II.The form is preprinted with the name and addressof the customer. The drugs must be shipped to thisname and address. The use of this device is aspecial reinforcement of the registrationrequirement; it ensures that only authorizedindividuals may obtain Schedule I and II drugs.

Another benefit of the form is the specialmonitoring it permits. The form is issued intriplicate: the customer keeps one copy; two copiesgo to the supplier who, after filling the order, keepsa copy and forwards the third copy to the nearestDEA office. For drugs in Schedules III, IV, and V,no order form is necessary. The supplier in each case, however, is under an obligation toverify the authenticity of the customer. Thesupplier is held fully accountable for any drugswhich are shipped to a purchaser who does not havea valid registration. Manufacturers must submitperiodic reports of the Schedule I and II controlledsubstances they produce in bulk and dosage forms.They also report the manufactured quantity andform of each narcotic substance listed in SchedulesIII, IV, and V, as well as the quantity of synthesizedpsychotropic substances listed in Schedules I, II,III, and IV. Distributors of controlled substancesmust report the quantity and form of all theirtransactions of controlled drugs listed in SchedulesI and II and narcotics listed in Schedule III. Bothmanufacturers and distributors are required toprovide reports of their annual inventories of thesecontrolled substances. This data is entered into asystem called the Automated Reports andConsolidated Orders System (ARCOS). It enablesthe DEA to monitor the distribution of controlledsubstances throughout the country, and to identifyretail level registrants that receive unusualquantities of controlled substances.

Dispensing to Patients

The dispensing of a controlled substance is thedelivery of the controlled substance to the ultimateuser, who may be a patient or research subject.Special control mechanisms operate here as well.Schedule I drugs are those which have no currentlyaccepted medical use in the United States; theymay, therefore, be used in the United States only inresearch situations. They generally are supplied byonly a limited number of firms to properlyregistered and qualified researchers. Controlledsubstances may be dispensed by a practitioner bydirect administration, by prescription, or bydispensing from office supplies.

6

Drugs of Abuse

Records must be maintained by the practitioner of alldispensing of controlled substances from officesupplies and of certain administrations. The CSAdoes not require the practitioner to maintain copiesof prescriptions, but certain states require the use ofmultiple-copy prescriptions for Schedule II andother specified controlled substances.

The determination to place drugs on prescription iswithin the jurisdiction of the FDA. Unlike otherprescription drugs, however, controlled substancesare subject to additional restrictions. Schedule IIprescription orders must be written and signed bythe practitioner; they may not be telephoned intothe pharmacy except in an emergency. In addition,a prescription for a Schedule II drug may not berefilled; the patient must see the practitioner again inorder to obtain more drugs. For Schedule III and IV

drugs, the prescription order may be either written ororal (that is, by telephone to the pharmacy). Inaddition, the patient may (if authorized by thepractitioner) have the prescription refilled up to fivetimes and at anytime within six months from the datethe prescription was issued.

Schedule V includes some prescription drugs andmany narcotic preparations, including antitussivesand antidiarrheals. Even here, however, the lawimposes restrictions beyond those normallyrequired for the over-the-counter sales; forexample, the patient must be at least 18 years ofage, must offer some form of identification, andhave his or her name entered into a special logmaintained by the pharmacist as part of a specialrecord.

7

Because of successful marijuana eradication efforts by law enforcement, many illicit growerscultivate the cannabis plant indoors.

Drugs of Abuse

Quotas

DEA limits the quantity of Schedule I and IIcontrolled substances which may be produced inthe United States in any given calendar year. Byutilizing available data on sales and inventories ofthese controlled substances, and taking into accountestimates of drug usage provided by the FDA, theDEA establishes annual aggregate productionquotas for Schedule I and II controlled substances.The aggregate production quota is allocated amongthe various manufacturers who are registered tomanufacture the specific drug. DEA also allocatesthe amount of bulk drug which may be procured bythose companies which prepare the drug intodosage units.

Security

DEA registrants are required by regulation tomaintain certain security for the storage anddistribution of controlled substances.Manufacturers and distributors of Schedule I and IIsubstances must store controlled substances inspecially constructed vaults or highly rated safes,and maintain electronic security for all storageareas. Lesser physical security requirements applyto retail level registrants such as hospitals andpharmacies. All registrants are required to makeevery effort to ensure that controlled substances intheir possession are not diverted into the illicitmarket. This requires operational as well asphysical security. For example, registrants areresponsible for ensuring that controlled substancesare distributed only to other registrants that areauthorized to receive them, or to legitimate patientsand consumers.

PENALTIES

The CSA provides penalties for unlawfulmanufacturing, distribution, and dispensing ofcontrolled substances. The penalties are basicallydetermined by the schedule of the drug or othersubstance, and sometimes are specified by drugname, as in the case of marijuana. As the statutehas been amended since its initial passage in 1970,the penalties have been altered by Congress. The

following charts are an overview of the penalties fortrafficking or unlawful distribution of controlledsubstances. This is not inclusive of the penaltiesprovided under the CSA.

User Accountability/Personal UsePenalties

On November 19, 1988, Congress passed the Anti-Drug Abuse Act of 1988, P. L. 100-690. Twosections of this Act represent the U.S. Government’sattempt to reduce drug abuse by dealing not justwith the person who sells the illegal drug, but alsowith the person who buys it. The first new section istitled “User Accountability” and is codified at 21U.S.C. § 862 and various sections of Title 42,U.S.C. The second involves “personal useamounts” of illegal drugs, and is codified at 21U.S.C. § 844a.

User Accountability

The purpose of User Accountability is to not onlymake the public aware of the Federal Government’sposition on drug abuse, but to describe newprograms intended to decrease drug abuse byholding drug abusers personally responsible fortheir illegal activities, and imposing civil penaltieson those who violate drug laws.

It is important to remember that these penalties arein addition to the criminal penalties drug abusersare already given, and do not replace those criminalpenalties.

The new User Accountability programs call formore instruction in schools, kindergarten throughsenior high, to educate children on the dangers ofdrug abuse. These programs will includeparticipation by students, parents, teachers, localbusinesses and the local, state and FederalGovernment.

User Accountability also targets businessesinterested in doing business with the FederalGovernment. This program requires thosebusinesses to maintain a drug-free workplace,

8

Drugs of Abuse 9

principally through educating employees on thedangers of drug abuse, and by informing employeesof the penalties they face if they engage in illegaldrug activity on company property.

There is also a provision in the law that makespublic housing projects drug-free by evicting thoseresidents who allow their units to be used for illegaldrug activity, and denies federal benefits, such ashousing assistance and student loans, to individualsconvicted of illegal drug activity. Depending on theoffense, an individual may be prohibited from everreceiving any benefit provided by the FederalGovernment.

Personal Use Amounts

This section of the 1988 Act allows the governmentto punish minor drug offenders without giving theoffender a criminal record if the offender is inpossession of only a small amount of drugs. Thislaw is designed to impact the “user” of illicit drugs,while simultaneously saving the government thecosts of a full-blown criminal investigation.

Under this section, the government has the optionof imposing only a civil fine on individualspossessing only a small quantity of an illegal drug.Possession of this small quantity, identified as a“personal use amount” carries a civil fine of up to$10,000.

In determining the amount of the fine in a particularcase, the drug offender’s income and assets will beconsidered. This is accomplished through anadministrative proceeding rather than a criminal trial,thus reducing the exposure of the offender to theentire criminal justice system, and reducing the coststo the offender and the government.

The value of this section is that it allows thegovernment to punish a minor drug offender,gives the drug offender the opportunity to fullyredeem himself or herself, and have all publicrecord of the proceeding destroyed. If this was thedrug offender’s first offense, and the offender haspaid all fines, can pass a drug test, and has not beenconvicted of a crime after three years, the offendercan request that all proceedings be dismissed.

If the proceeding is dismissed, the drug offendercan lawfully say he or she had never beenprosecuted, either criminally or civilly, for a drugoffense.

Congress has imposed two limitations on thissection’s use. It may not be used if (1) the drugoffender has been previously convicted of a Federalor state drug offense; or (2) the offender hasalready been fined twice under this section.

The cash profits (below) from illicit drugsales (left) help fund a wide variety ofdrug-related activities and violent crimes.

Drugs of Abuse10

DrugSchedule

Quantity

MethamphetamineSchedule II

HeroinSchedule I

CocaineSchedule II

Cocaine BaseSchedule II

PCPSchedule II

LSDSchedule I

FentanylSchedule II

OthersSchedules I & II

U.S. Department of JusticeDrug Enforcement Administration Federal Trafficking Penalties

1stOffense

2ndOffense

Not less than 20

yrs and not more

than life. If death

or serious injury,

not less than life.

Fine of not more

than $8 million if

an individual,

$20 million if

other than an

individual.

Not less than 10

yrs and not more

than life. If death

or serious injury,

not less than 20

or more than life.

Fine of not more

than $4 million if

an individual,

$10 million if

other than an

individual.

Not less than 10

yrs and not more

than life. If death

or serious injury,

not less than life

or more than life.

Fine of not more

than $4 million if

an individual,

$10 million if

other than an

individual.

Not less than 5

yrs and not more

than 40 yrs. If

death or serious

injury, not less

than 20 or more

than life. Fine of

not more than

$2 million if

an individual,

$5 million if

other than an

individual.

1stOffense

2ndOffense

Quantity

Fentanyl AnalogueSchedule I

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

(Includes 1 gm or more

fluntrazepam and

gamma hydroxybutyric acid)

Not more than 20yrs. If death or serious injury, not less than 20 yrs, not more than life. Fine of $1 million ifan individual,$5 million ifother than anindividual.

Any Not more than 30yrs. If death or serious injury, life. Fine of $2 million ifan individual,$10 million ifother than anindividual.

Any

Any

Any

1st Offense 2nd OffenseOthers

Schedules III

Others*Schedules IV

AllSchedules V

(Includes 30 mgs - 999 mgs fluntrazepam)

(Includes less than30 mgs fluntrazepam)

Not more than 5 yrs. Fine not morethan $250,000 if an individual, $1 million if other than an individual.

Not more than 3 yrs. Fine not morethan $250,000 if an individual, $1 million if other than an individual.

Not more than 1 yr. Fine not morethan $100,000 if an individual, $250,000 if other than an individual.

Not more than 10 yrs. Fine not more than$500,000 if an individual, $2 million if otherthan an individual.

Not more than 6 yrs. Fine not more than$500,000 if an individual, $2 million if otherthan an individual.

Not more than 2 yrs. Fine not more than$200,000 if an individual, $500,000 if otherthan an individual.

3rd Offenseor More

Life Imprisonment

100 gms ormore

mixture

400 gms ormore

mixture

10 gms ormore

mixture

100 gms ormore pureor 1 kg or

moremixture

50 gms ormore

mixture

5 kgs ormore

mixture

1 kg ormore

mixture

50 gms ormore pure

or 500 gms or moremixture

5-49 gmspure or

50-499 gmsmixture

500-4,999 gmsmixture

100-999 gmsmixture

5-49 gmsmixture

10-99 gmspure or

100-999 gmsmixture

1-9 gmsmixture

40-399 gmsmixture

10-99 gmsmixture

Drugs of Abuse 11

Federal Trafficking Penalties - Marijuana*

U.S. Department of JusticeDrug Enforcement Administration

Quantity 1st Offense 2nd Offense

1,000 kgs

or more

mixture;

or 1,000

or more

plants

3rd Offense

Marijuana

Not less than 10 years, not more than life.

If death or seriousinjury, not less than20 years, not morethan life.

Fine not more than$4 million individual,$10 million other thanindividual.


If death or seriousinjury, then life.


Life imprisonmentwithout release.

Not less than 5 years, not more than 40 years.

If death or seriousinjury, not less than20 years, not morethan life.



If death or seriousinjury, then life.


100 kgs to

999 kgs

mixture; or

100-999

plants

Marijuana

Not more than 20 years.

If death or serious injury,not less than 20 years,not more than life.

Fine $1 million individual,$5 million other thanindividual.


If death or serious injury,then life.

Fine $2 million individual,$10 million other thanindividual.


Fine not more than $250,000,$1 million other thanindividual.


Fine $500,000 individual,$2 million other thanindividual.

Marijuana

Hashish

Hashish Oil

Marijuana

Hashish

Hashish Oil

*Includes Hashish and Hashish Oil

Less than

50 kgs

mixture

1 to 49 plants

50 to 99 kgs

mixture

50 to 99plants

10 kgs or less

(Marijuana is a Schedule I Controlled Substance)

1st Offense 2nd Offense

1 kg or less

More than10 kgs

More than1 kg

Drugs of Abuse12

Registration

Recordkeeping

DistributionRestrictions

Dispensing Limits

ManufacturingQuotas

Import/ExportNarcotic

Import/ExportNon-Narcotic

Reports to DEAby Manufacturer/Distributor

Narcotic

ScheduleI

ScheduleII

ScheduleIV

ScheduleV

Required Required Required Required Required

Separate SeparateReadilyretrievable

Readilyretrievable

Readilyretrievable

Recordsrequired

Recordsrequired

Recordsrequired

Order forms

Research useonly

Vault/safe Vault/safe

Yes Yes

Permit Permit Permit Permit

Permit Permit Note 2 Declaration Declaration

Yes Yes Yes

Yes Yes

Manufactureronly

Manufactureronly

Note 3 Note 3 No

ManufacturingSecurity

U.S. Department of JusticeDrug Enforcement Administration Regulatory Requirements

Controlled Substances

Note 1-With medical authorization, up to 5 in 6 months.

Note 2-Permit for some drugs, declaration for others.

Note 3-Manufacturer reports required for specific drugs.

Reports to DEAby Manufacturer/Distributor

Non--Narcotic

NO but somedrugs limitedby Schedule II



Permit toimport; declara-tion to export

Rx: writtenor oral; refillsNote 1

Rx: writtenor oral; refillsNote 1

OTC (Rx drugslimited toM.D.'s order)

Order forms

Rx: written;no refills

Secure storagearea

Secure storagearea

Secure storagearea

ScheduleIII

Drugs of Abuse

Chapter 2

The Controlled Substances Act (CSA) is theprincipal federal law directed at combating the illicitmanufacture and distribution of controlled drugs inthe United States. Since its passage in 1970, theCSA has been amended on a number of occasions.The most recent change in the scope of the CSA isthe implementation of amendments and regulationsregarding chemicals and equipment used in theillicit production of controlled substances. Theclandestine production of drugs is dependent on theavailability of chemicals necessary to accomplishthe illicit activity. Most of the drugs in the illicittraffic, with the exception of marijuana, requirechemicals to be produced. For example, althoughcocaine is produced naturally in the coca plant, largeamounts of chemicals are needed to successfullyextract the drug and process it for the illicit market.

The controls placed on chemicals are substantiallyless than those imposed on controlled drugs becausemost of the chemicals have legitimate industrialapplications. For this reason, the term “regulated”more appropriately describes chemicals coveredunder the CSA as compared to the term “controlled”that is used for drugs. Several items that areregulated as chemicals under the CSA are also non-controlled ingredients in drug products lawfullymarketed under the Federal Food, Drug andCosmetic Act and are, therefore, widely available tothe general public. Examples of these productsinclude over-the-counter (OTC) medicationscontaining ephedrine and pseudoephedrine.

DEA chemical control was initiated in the UnitedStates with the passage of the Chemical Diversion

and Trafficking Act of 1988 (CDTA) that becameeffective on August 1, 1989. The initial legislationwas drafted in 1985. The CDTA regulated 12precursor chemicals, eight essential chemicals,tableting machines, and encapsulating machines byimposing record keeping and import/export reportingrequirements on transactions involving thesematerials. U.S. companies were the main source oftons of chemicals used in the production of cocaine inthe Andean countries of South America prior to 1985.The principal chemicals used in the production ofcocaine at that time included acetone, methyl ethylketone, methyl isobutyl ketone, ethyl ether, potassiumpermanganate, hydrochloric acid and sulfuric acid.Soon after the CDTA became effective, the quantityof many of these chemicals exported from the UnitedStates declined significantly.

Cocaine traffickers reacted to the reduction in theavailability of U.S. chemicals for illicit productionby developing new sources of supply in other partsof the world. The U.S. Government, with theleadership and assistance of the DEA, responded byeliciting the support of the international communityfor worldwide chemical control. The internationalcommunity responded by incorporating Article 12into the U.N. Convention Against Illicit Drug Trafficof 1988. Article 12 established chemical controls ona list of 22 chemicals used in the production ofheroin, cocaine, LSD, PCP, amphetamine,methamphetamine, MDMA and related drugs, andnumerous other clandestinely produced drugs.Moreover, the DEA has sponsored a number ofinternational meetings and training seminars toeducate other nations in the benefits of chemical

13

Drugs of Abuse

control as a tool to fight drug trafficking. DEAefforts have resulted in chemical control legislationand active programs to prevent the diversion ofchemicals used in the clandestine production ofdrugs in many nations.

The CDTA also had an initial impact on thenumber of clandestine methamphetaminelaboratories in the United States. In the first threeyears after the law was passed, the number ofclandestine laboratories seized by the DEAdeclined by 61 percent. In addition, injuriesattributed to illicitly manufactured controlledsubstances that were reported to the Drug AbuseWarning Network (DAWN) declined by almost60 percent during the same time period.

The provisions of the CDTA regarding bulkephedrine and pseudoephedrine causedmethamphetamine traffickers to look for othersources of the precursors. The traffickers noted thatthe CDTA contained an exemption for over-the-counter (OTC) products that contained regulatedchemicals. They took advantage of this loopholeby turning to single entity OTC ephedrine tabletsand capsules whose single active ingredient wasephedrine as a source of precursor material for theillicit production of methamphetamine.

Federal legislation was passed in 1993 in response tothe methamphetamine traffickers’ switch to OTCephedrine products. The legislation was the DomesticChemical Diversion and Control Act of 1993(DCDCA) that became effective on April 16, 1994.The DCDCA eliminated the CDTA terminology of“precursors” and “essential” for chemicals regulatedunder that act and replaced them with the terms “List I”and “List II” chemicals. The DCDCA also removedthe exemption for OTC single entity ephedrine tabletsthus closing the loophole left by the CDTA. Inaddition, it gave the DEA the authority to remove theexemption for any other drugs containing listedchemicals if it was shown that they were being divertedfor the illicit production of controlled substances. TheDCDCA required that all manufacturers, distributors,importers, and exporters of List I chemicals beregistered with the DEA and that bulk manufacturers ofList I and List II chemicals report on the total quantity

of listed chemicals produced during the year. Recordkeeping and reporting requirements for transactions insingle-entity ephedrine products were also imposed bythe DCDCA.

Methamphetamine traffickers quickly reacted tothe provisions of the DCDCA by switching tosingle-entity pseudoephedrine products andcombination products of ephedrine. TheComprehensive Methamphetamine Control Actof 1996 (MCA) was then passed to counter thetraffickers’ response to the DCDCA. The MCAexpanded regulatory controls on all lawfullymarketed drug products containing ephedrine,pseudoephedrine, and phenylpropanolamine, andit increased penalties for the trafficking andmanufacturing of methamphetamine and listedchemicals. The MCA also made it unlawful forany person to distribute a “laboratory supply” toa person who uses, or attempts to use, that“laboratory supply” to manufacture a controlleddrug or listed chemicals with reckless disregardfor the illegal uses to which such “laboratorysupply” will be put. The Special SurveillanceList was published by the Attorney General andconsisted of all listed chemicals, all mixtures,and all OTC products and dietary supplementsthat contain listed chemicals, 28 other chemicalsfrequently used in the clandestine production ofcontrolled drugs, or listed chemicals and 4pieces of laboratory equipment commonly foundat clandestine drug laboratories. Individualswho violate the “laboratory supply” provision ofthe MCA are subject to a maximum civil fine of$25,000. Businesses that violate the provisionare subject to a maximum civil fine of $250,000.

Ready access to chemical supplies is critical todrug traffickers while they continuously look forloopholes in legislation and new methods ofclandestine production routes in order to continuetheir illegal activity. The DEA has embracedchemical control as an important tool in reducingthe availability of clandestinely produced drugsand is committed to depriving drug traffickers ofthe chemicals needed to manufacture illicit drugs.Currently, List I and List II of the CSA contain 38chemicals.

14

Drugs of Abuse 15

38. Toluene

on Public Law 104-237 § 401(f)

21 USC §§ 802(39)(A)(iv), 802(45) and Historical and Statutory Notes following 21 USC § 802For pseudoephedrine, phenylpropanolamine and combination ephedrine drug products, see

37. Sulfuric acid

36. Potassium permanganate

35. Methyl isobutyl ketone

34. Methyl ethyl ketone (2-Butanone)

33. Iodine

32. Hydrochloric acid

32a. Hydrogen chloride gas

31. Ethyl ether

30. Benzyl chloride

29. Acetone

28. Acetic anhydride

27. Safrole

26. Pseudoephedrine

25. Propionic anhydride

24. Piperonal

23. Piperidine

20. Phenylpropanolamine

22. Phosphorus (white or yellow)

21. Phosphorus (Red)

19. Phenylacetic acid

18. Norpseudoephedrine

17. Nitroethane

16. N-Methylpseudoephedrine

15. N-Methylephedrine

14. 3,4-Methylenedioxyphenyl-2-propanone

13. Methylamine

12. Isosafrole

10. Hydriodic acid

11. Hypophosphorous acid

9. gamma-Butyrolactone (GBL)

8. Ethylamine

7. Ergotamine

6. Ergonovine

5. Ephedrine

4. Benzyl cyanide

3. Benzaldehyde

2. Anthranilic acid

1. N-Acetylanthranilic acid

LIS

T I

LIS

T I

ICONTROLLED SUBSTANCE PRODUCED

40

2.5

0

0

0

0

1,023

0

4

4

N/C

4

2.5

4

1

0.020

1

1

145

N/C

30

1

1.7

150

0.010

0.001

1

0.4

55

1

0.500

1

135.8

1

4

2.5

N/C

159

40

2.5

0

0

0

0

1,023

0

4

4

222.3

27

4

2.5

4

4

0

0.020

1

1

1,455

347

30

1

1.7

1,500

0.010

0.001

1

N/C

500

1

0.500

1

1,364

1

4

2.5

1,523

1,591

N,N

-Dim

ethy

lam

phet

amine

Am

phet

amine

Coc

aine

GHB

MDA

Met

ham

phet

amine

4-M

ethy

lam

inor

ex

Phe

nyl-2

-pro

pano

ne

Phe

ncyc

lidine

(PCP)

Met

hcat

hino

ne

Met

haqu

lone

MDM

A

MDE

LSD

Her

oin

Fenta

nyl &

ana

logu

es

Eth

ylam

phet

amine

THRESHOLD

S

3

3

3

3 & 7

3 & 7

1

2

1

1

1

1

1

2

5 & 6

5 & 6

5 & 6

4

1

2

3

5

6

7

4

2

3 & 7

October 31, 2001

See 21 C.F.R. §§ 1309, 1310 and 1313 for details

Listed Chemicals regulated under theControlled Substances Act

Precursor =

Solvent =

Reagent =

and its salts

N/C = Not Controlled

and its salts and estersand its salts, optical isomers, and salts of optical isomersExports only, to all Western Hemisphere except CanadaExports to all South American countries & Panama - Domestic for HCl gasThreshold for HCl acid and sulfuric acid is 50 gallons, the equivalent weight in kilograms is shown D

OM

ES

TIC

KILOGRAMS

IMP

OR

TS

&E

XP

OR

TS

Chapter 3

The Controlled Substances Act (CSA) regulatesfive classes of drugs: narcotics, depressants,stimulants, hallucinogens, and anabolic steroids.Each class has distinguishing properties, and drugswithin each class often produce similar effects.However, all controlled substances, regardless ofclass, share a number of common features. It is thepurpose of this introduction to familiarize thereader with some of these shared features and togive definition to terms frequently associated withthese drugs.

All controlled substances have abuse potential orare immediate precursors to substances with abusepotential. With the exception of anabolic steroids,controlled substances are abused to alter mood,thought, and feeling through their actions on thecentral nervous system (brain and spinal cord).Some of these drugs alleviate pain, anxiety, ordepression. Some induce sleep and others energize.Though therapeutically useful, the “feel good”effects of these drugs contribute to their abuse. Theextent to which a substance is reliably capable ofproducing intensely pleasurable feelings (euphoria)increases the likelihood of that substance beingabused.

When drugs are used in a manner or amountinconsistent with the medical or social patterns of aculture, it is called drug abuse. In legal terms, the

non-sanctioned use of substances controlled inSchedules I through V of the CSA is considereddrug abuse. While legal pharmaceuticals placedunder control in the CSA are prescribed and usedby patients for medical treatment, the use of thesesame pharmaceuticals outside the scope of soundmedical practice is drug abuse.

In addition to having abuse potential, mostcontrolled substances are capable of producingdependence, either physical or psychological.Physical dependence refers to the changes that haveoccurred in the body after repeated use of a drugthat necessitates the continued administration of thedrug to prevent a withdrawal syndrome. Thiswithdrawal syndrome can range from mildlyunpleasant to life-threatening and is dependent on anumber of factors. The type of withdrawalexperienced is related to: the drug being used; thedose and route of administration; concurrent use ofother drugs; frequency and duration of drug use;and the age, sex, health, and genetic makeup of theuser. Psychological dependence refers to theperceived “need” or “craving” for a drug.Individuals who are psychologically dependent ona particular substance often feel that they cannotfunction without continued use of that substance.While physical dependence disappears within daysor weeks after drug use stops, psychologicaldependence can last much longer and is one of the

Drugs of Abuse16

Confiscated cocaine packaged in multi-kilogram bricks.

primary reasons for relapse (initiation of drug useafter a period of abstinence).

Contrary to common belief, physical dependence isnot addiction. While addicts are usually physicallydependent on the drug they are abusing, physicaldependence can exist without addiction. Forexample, patients who take narcotics for chronicpain management or benzodiazepines to treatanxiety are likely to be physically dependent onthat medication. Addiction is defined ascompulsive drug-seeking behavior where acquiringand using a drug becomes the most importantactivity in the user’s life. This definition implies aloss of control regarding drug use, and the addictwill continue to use a drug despite serious medicaland/or social consequences. The National Instituteon Drug Abuse (NIDA) estimates that about fivemillion Americans suffer from drug addiction.

Individuals that abuse drugs often have a preferreddrug that they use, but may substitute other drugsthat produce similar effects (often found in thesame drug class) when they have difficultyobtaining their drug of choice. Drugs within aclass are often compared with each other with termslike potency and efficacy. Potency refers to theamount of a drug that must be taken to produce acertain effect, while efficacy refers to whether ornot a drug is capable of producing a given effectregardless of dose. Both the strength and the abilityof a substance to produce certain effects play a rolein whether that drug is selected by the drug abuser.

It is important to keep in mind that the effectsproduced by any drug can vary significantly and islargely dependent on the dose and route ofadministration. Concurrent use of other drugs canenhance or block an effect and substance abusersoften take more than one drug to boost the desiredeffects or counter unwanted side effects. The risksassociated with drug abuse cannot be accuratelypredicted because each user has his/her own uniquesensitivity to a drug. There are a number of

theories that attempt to explain these differences,and it is clear that a genetic component maypredispose an individual to certain toxicities oreven addictive behavior.

Youths are especially vulnerable to drug abuse.According to NIDA, young Americans engaged inextraordinary levels of illicit drug use in the lastthird of the twentieth century. Today, the majorityof young people (about 53 percent) have used anillicit drug by the time they leave high school andabout 25 percent of all seniors are current (withinthe past month) users. The behaviors associatedwith teen and preteen drug use often result in tragicconsequences with untold harm to others,themselves, and their families. For example, ananalysis of data from the National HouseholdSurvey on Drug Abuse indicates that youngstersbetween the ages of 12 and 17 who have smokedmarijuana within the past year are more than twiceas likely to cut class, steal, commit assault, anddestroy property than are those who did not smokemarijuana. The more frequently a youth smokesmarijuana, the more likely he or sheis to engage in these antisocial behaviors.

In the sections that follow, each of the five classesof drugs is reviewed and various drugs within eachclass are profiled. Although marijuana is classifiedin the CSA as a hallucinogen, a separate section isdedicated to that topic. There are also a number ofsubstances that are abused but not regulated underthe CSA. Alcohol and tobacco, for example, arespecifically exempt from control by the CSA. Inaddition, a whole group of substances calledinhalants are commonly available and widelyabused by children. Control of these substancesunder the CSA would not only impede legitimatecommerce, but would likely have little effect on theabuse of these substances by youngsters. Anenergetic campaign aimed at educating both adultsand youth about inhalants is more likely to preventtheir abuse. To that end, a section is dedicated toproviding information on inhalants.

Drugs of Abuse 17

Drugs of Abuse

Chapter 4

The term “narcotic,” derived from the Greek wordfor stupor, originally referred to a variety ofsubstances that dulled the senses and relievedpain. Today, the term is used in a number ofways. Some individuals define narcotics as thosesubstances that bind at opiate receptors (cellularmembrane proteins activated by substances likeheroin or morphine), while others refer to anyillicit substance as a narcotic. In a legal context,narcotic refers to opium, opium derivatives, andtheir semi-synthetic substitutes. Cocaine andcoca leaves, which are also classified as“narcotics” in the Controlled Substances Act(CSA), neither bind at opiate receptors, norproduce morphine-like effects and are discussedin the section on stimulants. For the purposes ofthis discussion, the term narcotic refers to drugsthat produce morphine-like effects.

Narcotics are used therapeutically to treat pain,suppress cough, alleviate diarrhea, and induceanesthesia. Narcotics are administered in avariety of ways. Some are taken orally,transdermally (skin patches), intranasally, orinjected. They are also available in suppositories,and more recently in “troches,” a form of

narcotics that can be sucked like candy. As drugsof abuse, they are often smoked, sniffed, orinjected. Drug effects depend heavily on thedose, route of administration, and previousexposure to the drug. Aside from their medicaluse, narcotics produce a general sense of well-being by reducing tension, anxiety, andaggression. These effects are helpful in atherapeutic setting but contribute to their abuse.

Narcotic use is associated with a variety ofunwanted effects including drowsiness, inabilityto concentrate, apathy, lessened physical activity,constriction of the pupils, dilation of thesubcutaneous blood vessels causing flushing ofthe face and neck, constipation, nausea, vomiting,and most significantly, respiratory depression. Asthe dose is increased, the subjective, analgesic(pain relief), and toxic effect become morepronounced. Except in cases of acuteintoxication, there is no loss of motorcoordination or slurred speech as occurs withmany depressants.

Among the hazards of illicit drug use is the ever-increasing risk of infection, disease, and

18

Drugs of Abuse

overdose. Medical complications commonamong narcotic abusers arise primarily fromadulterants found in street drugs and inthe non-sterile practices of injecting. Skin,lung, and brain abscesses, endocarditis(inflammation of the lining of the heart),hepatitis, and AIDS are commonly foundamong narcotic abusers. Whilepharmaceutical products have a knownconcentration and purity, clandestinely producedstreet drugs have unknown compositions. Sincethere is no simple way to determine the purityof a drug that is sold on the street, theeffects of illicit narcotic use areunpredictable and can be fatal.Physical signs of narcotic overdoseinclude constricted (pinpoint) pupils,cold clammy skin, confusion, convulsions,severe drowsiness, and respiratory depression(slow or troubled breathing). Most narcoticdeaths are a result of respiratory depression.

With repeated use of narcotics, tolerance anddependence develop. The development oftolerance is characterized by a shortened durationand a decreased intensity of analgesia, euphoria,and sedation, which creates the need to consumeprogressively larger doses to attain the desiredeffect. Tolerant users can consume doses far inexcess of the dose they initially started with.

Chronic narcotic use is associated with physicaldependence and a withdrawal or abstinencesyndrome when drug use is discontinued. Ingeneral, shorter acting narcotics tend to produceshorter, more intense withdrawal symptoms,while longer acting narcotics produce awithdrawal syndrome that is protracted but lesssevere. Although unpleasant, withdrawal fromnarcotics is rarely life threatening. Thewithdrawal symptoms associated with heroin/morphine addiction are usually experiencedshortly before the time of the next scheduleddose. Early symptoms include watery eyes, runnynose, yawning, and sweating. Restlessness,irritability, loss of appetite, nausea, tremors, anddrug craving appear as the syndrome progresses.

Severe depression and vomiting are common.The heart rate and blood pressure are elevated.Chills, alternating with flushing and excessivesweating, are also characteristic symptoms. Painsin the bones and muscles of the back andextremities occur, as do muscle spasms. At anypoint during this process, a suitable narcotic canbe administered to dramatically reverse thewithdrawal symptoms. Without intervention, thesyndrome will run its course, and most of theovert physical symptoms will disappear within 7to 10 days.

The psychological dependence associated withnarcotic addiction is complex and protracted.Long after the physical need for the drug haspassed, the addict may continue to think and talkabout the use of drugs and feel strange oroverwhelmed coping with daily activities withoutbeing under the influence of drugs. There is ahigh probability that relapse will occur afternarcotic withdrawal when neither the physicalenvironment, nor the behavioral motivators thatcontributed to the abuse have been altered.

There are two major patterns of narcotic abuse ordependence seen in the United States. Oneinvolves individuals whose drug use was initiatedwithin the context of medical treatment who

19

Doctor’s hypodermic syringe kit, circa 1900.

Drugs of Abuse

escalate their dose by obtaining the drug throughfraudulent prescriptions and “doctor shopping” orbranching out to illicit drugs. The other pattern ofabuse is initiated outside the therapeutic settingwith experimental or recreational use of narcotics.The majority of individuals in this category mayabuse narcotics sporadically for months or evenyears. Although they may not become addicts,the social, medical, and legal consequences oftheir behavior are very serious. Someexperimental users will escalate their narcotic useand will eventually become dependent, bothphysically and psychologically. The younger anindividual is when drug use is initiated, the morelikely the drug use will progress to dependenceand addiction.

Narcotics of Natural Origin

The poppy plant, Papaver somniferum, is thesource for non-synthetic narcotics. It was grownin the Mediterranean region as early as 5000B.C., and has since been cultivated in a numberof countries throughout the world. The milkyfluid that seeps from incisions in the unripe seedpod of this poppy has, since ancient times, beenscraped by hand and air-dried to produce what isknown as opium. A more modern method ofharvesting is by the industrial poppy strawprocess of extracting alkaloids from the maturedried plant. The extract may be in liquid, solid,or powder form, although most poppy strawconcentrate available commercially is a finebrownish powder. More than 500 tons of opiumor equivalents in poppy straw concentrate arelegally imported into the United States annuallyfor legitimate medical use.

Opium

There were no legal restrictions on theimportation or use of opium until the early 1900s.In the United States, the unrestricted availability

of opium, the influx of opium-smokingimmigrants from East Asia, and the invention ofthe hypodermic needle contributed to the moresevere variety of compulsive drug abuse seen atthe turn of the 20th century. In those days,medicines often contained opium without anywarning label. Today, there are state, federal, andinternational laws governing the production anddistribution of narcotic substances.

Although opium is used in the form of paregoricto treat diarrhea, most opium imported into theUnited States is broken down into its alkaloidconstituents. These alkaloids are divided into twodistinct chemical classes, phenanthrenes andisoquinolines. The principal phenanthrenes aremorphine, codeine, and thebaine, while theisoquinolines have no significant central nervoussystem effects and are not regulated under theCSA.

Morphine

Morphine is the principal constituent of opiumand ranges in concentration from 4 to 21 percent.Commercial opium is standardized to contain 10-percent morphine. In the United States, a smallpercentage of the morphine obtained from opiumis used directly (about 20 tons); the remaining isconverted to codeine and other derivatives (about110 tons). Morphine is one of the most effectivedrugs known for the relief of severe pain andremains the standard against which newanalgesics are measured. Like most narcotics, theuse of morphine has increased significantly inrecent years. Since 1998, there has been about atwo-fold increase in the use of morphine productsin the United States.

Morphine is marketed under generic and brandname products including MS-Contin®, OramorphSR®, MSIR®, Roxanol®, Kadian®, and RMS®.Morphine is used parenterally (by injection) forpreoperative sedation, as a supplement toanesthesia, and for analgesia. It is the drug of

20

Drugs of Abuse

choice for relieving thepain of myocardialinfarction and for itscardiovascular effects inthe treatment of acutepulmonary edema.Traditionally, morphinewas almost exclusivelyused by injection. Today,morphine is marketed ina variety of forms,including oral solutions,immediate and sustained-release tablets andcapsules, suppositories,and injectablepreparations. Inaddition, the availability of high-concentrationmorphine preparations (i.e., 20-mg/ml oralsolutions, 25-mg/ml injectable solutions, and200-mg sustained-release tablets) partiallyreflects the use of this substance for chronic painmanagement in opiate-tolerant patients.

Codeine

Codeine is the most widely used, naturallyoccurring narcotic in medical treatment in theworld. This alkaloid is found in opium inconcentrations ranging from 0.7 to 2.5 percent.However, most codeine used in the United Statesis produced from morphine. Codeine is also thestarting material for the production of two othernarcotics, dihydrocodeine and hydrocodone.Codeine is medically prescribed for the relief ofmoderate pain and cough suppression. Comparedto morphine, codeine produces less analgesia,sedation, and respiratory depression, and isusually taken orally. It is made into tablets eitheralone (Schedule II) or in combination with aspirinor acetaminophen (i.e., Tylenol with Codeine®,Schedule III). As a cough suppressant, codeine isfound in a number of liquid preparations (theseproducts are in Schedule V). Codeine is alsoused to a lesser extent as an injectable solutionfor the treatment of pain. Codeine products are

diverted from legitimate sources and areencountered on the illicit market.

Thebaine

Thebaine, a minor constituent of opium, iscontrolled in Schedule II of the CSA as well asunder international law. Although chemicallysimilar to both morphine and codeine, thebaineproduces stimulatory rather than depressanteffects. Thebaine is not used therapeutically, butis converted into a variety of substances includingoxycodone, oxymorphone, nalbuphine, naloxone,naltrexone, and buprenorphine. The UnitedStates ranks first in the world in thebaineutilization.

Semi-Synthetic Narcotics

The following narcotics are among the moresignificant substances that have been derivedfrom morphine, codeine, or thebaine contained inopium.

21

Opiate-based syrups were once popular fortreating children with teething and dysentery.

Drugs of Abuse

Heroin

First synthesized from morphine in 1874, heroinwas not extensively used in medicine until theearly 1900s. Commercial production of the newpain remedy was first started in 1898. It initiallyreceived widespread acceptance from the medicalprofession, and physicians remained unaware ofits addiction potential for years. The firstcomprehensive control of heroin occurred withthe Harrison Narcotic Act of 1914. Today, heroinis an illicit substance having no medical utility inthe United States. It is in Schedule I of the CSA.

Four foreign source areas produce the heroinavailable in the United States: South America(Colombia), Mexico, Southeast Asia (principallyBurma), and Southwest Asia (principallyAfghanistan). However, South America andMexico supply most of the illicit heroin marketedin the United States. South American heroin is ahigh-purity powder primarily distributed tometropolitan areas on the East Coast. Heroinpowder may vary in color from white to darkbrown because of impurities left from themanufacturing process or the presence ofadditives. Mexican heroin, known as “black tar,”is primarily available in the western UnitedStates. The color and consistency of black tarheroin result from the crude processing methodsused to illicitly manufacture heroin in Mexico.Black tar heroin may be sticky like roofing tar orhard like coal, and its color may vary from darkbrown to black.

Pure heroin is rarely sold on the street. A “bag”(slang for a small unit of heroin sold on the street)currently contains about 30 to 50 milligrams ofpowder, only a portion of which is heroin. Theremainder could be sugar, starch, acetaminophen,procaine, benzocaine, or quinine, or any ofnumerous cutting agents for heroin. Traditionally,the purity of heroin in a bag ranged from 1 to 10percent. More recently, heroin purity has rangedfrom about 10 to 70 percent. Black tar heroin isoften sold in chunks weighing about an ounce. Itspurity is generally less than South American

heroin and it is most frequently smoked, ordissolved, diluted, and injected.

In the past, heroin in the United States was almostalways injected, because this is the most practicaland efficient way to administer low-purity heroin.However, the recent availability of higher purityheroin at relatively low cost has meant that alarger percentage of today’s users are eithersnorting or smoking heroin, instead of injecting it.This trend was first captured in the 1999 NationalHousehold Survey on Drug Abuse, whichrevealed that 60 to 70 percent of people who usedheroin for the first time from 1996 to 1998 neverinjected it. This trend has continued. Snorting orsmoking heroin is more appealing to new usersbecause it eliminates both the fear of acquiringsyringe-borne diseases, such as HIV and hepatitis,as well as eliminating the social stigma attachedto intravenous heroin use. Many new users ofheroin mistakenly believe that smoking orsnorting heroin is a safe technique for avoidingaddiction. However, both the smoking and thesnorting of heroin are directly linked to highincidences of dependence and addiction.

According to the 2003 National Survey on DrugUse and Health, during the latter half of the1990s, heroin initiation rates rose to a level notreached since the 1970s. In 1974, there were anestimated 246,000 heroin initiates. Between 1988and 1994, the annual number of new users rangedfrom 28,000 to 80,000. Between 1995 and 2001,the number of new heroin users was consistently

22

After the opium poppy pod has been scored, theliquid opium oozes out and dries on the pod. Itis collected and scraped into a ball shape.

Drugs of Abuse

greater than 100,000. Overall, approximately 3.7million Americans reported using heroin at leastonce in their lifetime.

Hydromorphone

Hydromorphone (Dilaudid®) is marketed intablets (2, 4, and 8 mg), suppositories, oralsolutions, and injectable formulations. Allproducts are in Schedule II of the CSA. Itsanalgesic potency is from two to eight times thatof morphine, but it is shorter acting and producesmore sedation than morphine. Much sought afterby narcotic addicts, hydromorphone is usuallyobtained by the abuser through fraudulentprescriptions or theft. The tablets are oftendissolved and injected as a substitute for heroin.In September 2004 the FDA approved the use ofPalladone® (hydromorphone hydrochloride) forthe management of persistent pain. Thisextended-release formulation could have the samerisk of abuse as OxyContin®.

Oxycodone

Oxycodone is synthesized from thebaine. Likemorphine and hydromorphone, oxycodone is usedas an analgesic. It is effective orally and ismarketed alone in 10, 20,40, 80, and 160 mgcontrolled-release tablets(OxyContin®), or 5 mgimmediate-releasecapsules (OxyIR®), or incombination productswith aspirin (Percodan®)or acetaminophen(Percocet®) for the reliefof pain. All oxycodoneproducts are in Schedule II.Oxycodone is abusedorally, or the tablets arecrushed and sniffed ordissolved in water andinjected. The use ofoxycodone has increasedsignificantly. In 1993,

about 3.5 tons of oxycodone were manufacturedfor sale in the United States. In 2003, about 41tons were manufactured.

Historically, oxycodone products have beenpopular drugs of abuse among the narcoticabusing population. In recent years, concern hasgrown among federal, state, and local officialsabout the dramatic increase in the illicitavailability and abuse of OxyContin® products.These products contain large amounts ofoxycodone (10 to 160 mg) in a formulationintended for slow release over about a 12-hourperiod.

Abusers have learned that this slow-releasemechanism can be easily circumvented bycrushing the tablet and swallowing, snorting, orinjecting the drug product for a more rapid andintense high. The criminal activity associatedwith illicitly obtaining and distributing this drug,as well as serious consequences of illicit use,including addiction and fatal overdose deaths, areof epidemic proportions in some areas of theUnited States.

Hydrocodone

Hydrocodone is structurally related to codeinebut more closely related to morphine in itspharmacological profile. As a drug of abuse, it isequivalent to morphine with respect to subjectiveeffects, opiate signs and symptoms, and “liking”scores. Hydrocodone is an effective coughsuppressant and analgesic. It is most frequentlyprescribed in combination with acetaminophen(i.e., Vicoden®, Lortab®) but is also marketed inproducts with aspirin (Lortab ASA®), ibuprofen(Vicoprofen®) and antihistamines (Hycomine®).All products currently marketed in the UnitedStates are either Schedule III combinationproducts primarily intended for pain managementor Schedule V antitussive medications oftenmarketed in liquid formulations. The ScheduleIII products are currently under review at theFederal level to determine if an increase inregulatory control is warranted.

23

Samples of OxyContintablets. (Not to scale)

Drugs of Abuse

Hydrocodone products are the most frequentlyprescribed pharmaceutical opiates in the UnitedStates with over 111 million prescriptionsdispensed in 2003. Despite their obvious utilityin medical practice, hydrocodone products areamong the most popular pharmaceutical drugsassociated with drug diversion, trafficking, abuse,and addiction. In every geographical area in thecountry, the DEA has listed this drug as one of themost commonly diverted. Hydrocodone is themost frequently encountered opiatepharmaceutical in submissions of drug evidenceto federal, state, and local forensic laboratories.Law enforcement has documented the diversionof millions of dosage units of hydrocodone bytheft, doctor shopping, fraudulent prescriptions,bogus “call-in” prescriptions, and diversion byregistrants and Internet fraud.

Hydrocodone products are associated withsignificant drug abuse. Hydrocodone was ranked6th among all controlled substances in the 2002Drug Abuse Warning Network (DAWN)emergency department (ED) data. Poison controldata, DAWN medical examiner (ME) data, andother ME data indicate that hydrocodone deathsare numerous, widespread, and increasing innumber. In addition, the hydrocodoneacetaminophen combinations (accounting forabout 80 % of all hydrocodone prescriptions)carry significant public health risk when taken inexcess.

Synthetic Narcotics

In contrast to the pharmaceutical products derivedfrom opium, synthetic narcotics are producedentirely within the laboratory. The continuingsearch for products that retain the analgesicproperties of morphine without the consequentdangers of tolerance and dependence has yet toyield a product that is not susceptible to abuse. Anumber of clandestinely produced drugs, as wellas drugs that have accepted medical uses, fallwithin this category.

Meperidine

Introduced as an analgesic in the 1930s,meperidine produces effects that are similar, butnot identical, to morphine (shorter duration ofaction and reduced antitussive and antidiarrhealactions). Currently it is used for pre-anesthesiaand the relief of moderate to severe pain,particularly in obstetrics and post-operativesituations. Meperidine is available in tablets,syrups, and injectable forms under generic andbrand name (Demerol®, Mepergan®, etc.)Schedule II preparations. Several analogues ofmeperidine have been clandestinely produced.During the clandestine synthesis of the analogueMPPP, a neurotoxic by-product (MPTP) wasproduced. A number of individuals whoconsumed the MPPP-MPTP preparationdeveloped an irreversible Parkinsonian-likesyndrome. It was later found that MPTP destroysthe same neurons as those damaged in ParkinsonsDisease.

Dextropropoxyphene

A close relative of methadone,dextropropoxyphene was first marketed in 1957under the trade name of Darvon®. Oral analgesicpotency is one-half to one-third that of codeine,with 65 mg approximately equivalent to about600 mg of aspirin. Dextropropoxyphene isprescribed for relief of mild to moderate pain.Bulk dextropropoxyphene is in Schedule II, whilepreparations containing it are in Schedule IV.More than 150 tons of dextropropoxyphene areproduced in the United States annually, and morethan 25 million prescriptions are written for theproducts. This narcotic is associated with anumber of toxic side effects and is among the top10 drugs reported by medical examiners in drugabuse deaths.

24

Drugs of Abuse

Fentanyl

First synthesized in Belgium in the late 1950s,fentanyl, with an analgesic potency of about 80times that of morphine, was introduced intomedical practice in the 1960s as an intravenousanesthetic under the trade name of Sublimaze®.Thereafter, two other fentanyl analogues wereintroduced: alfentanil (Alfenta®), an ultra-short(5-10 minutes) acting analgesic, and sufentanil(Sufenta®), an exceptionally potent analgesic (5to 10 times more potent than fentanyl) for use inheart surgery. Today, fentanyls are extensivelyused for anesthesia and analgesia. Duragesic®,for example, is a fentanyl transdermal patch usedin chronic pain management, and Actiq® is asolid formulation of fentanyl citrate on a stick thatdissolves slowly in the mouth for transmucosalabsorption. Actiq® is intended for opiate-tolerantindividuals and is effective in treatingbreakthrough pain in cancer patients. Carfentanil(Wildnil®) is an analogue of fentanyl with ananalgesic potency 10,000 times that of morphineand is used in veterinary practice to immobilizecertain large animals.

Illicit use of pharmaceutical fentanyls firstappeared in the mid-1970s in the medicalcommunity and continues to be a problem in theUnited States. To date, over 12 different analoguesof fentanyl have been produced clandestinely andidentified in the U.S. drug traffic. The biologicaleffects of the fentanyls are indistinguishable fromthose of heroin, with the exception that the

25

fentanyls may be hundreds of times more potent.Fentanyls are most commonly used byintravenous administration, but like heroin, theymay also be smoked or snorted.

Pentazocine

The effort to find an effective analgesic with lessdependence-producing consequences led to thedevelopment of pentazocine (Talwin®).Introduced as an analgesic in 1967, it wasfrequently encountered in the illicit trade, usuallyin combination with tripelennamine and placedinto Schedule IV of the CSA in 1979. Anattempt at reducing the abuse of this drug wasmade with the introduction of Talwin Nx®. Thisproduct contains a quantity of antagonist(naloxone) sufficient to counteract the morphine-like effects of pentazocine if the tablets aredissolved and injected.

Butorphanol

While butorphanol can be made from thebaine, itis usually manufactured synthetically. It wasinitially available in injectable formulations forhuman (Stadol®) and veterinary (Torbugesic®and Torbutrol®) use. More recently, a nasalspray (Stadol NS®) became available, andsignificant diversion and abuse of this productled to the 1997 control of butorphanol inSchedule IV of the CSA. Butorphanol is a clearexample of a drug gaining favor as a drug ofabuse only after it became available in a formthat facilitated greater ease of administration(nasal spray vs. injection).

Fentanyl 600mcg

Drugs of Abuse26

Narcotics Treatment Drugs

Methadone

German scientists synthesized methadone duringWorld War II because of a shortage of morphine.Although chemically unlike morphine or heroin,methadone produces many of the same effects. Itwas introduced into the United States in 1947 asan analgesic (Dolophine®). Today, methadone isprimarily used for the treatment of narcoticaddiction, although a growing number ofprescriptions are being written for chronic painmanagement. It is available in oral solutions,tablets, and injectable Schedule II formulations.

Methadone’s effects can last up to 24 hours,thereby permitting once-a-day oral administrationin heroin detoxification and maintenanceprograms. High-dose methadone can block theeffects of heroin, thereby discouraging thecontinued use of heroin by addicts in treatment.Chronic administration of methadone results inthe development of tolerance and dependence.The withdrawal syndrome develops more slowlyand is less severe, but more prolonged than thatassociated with heroin withdrawal. Ironically,methadone used to control narcotic addiction isencountered on the illicit market. Recentincreases in the use of methadone for painmanagement have been associated with increasingnumbers of overdose deaths.

LAAM

Closely related to methadone, the syntheticcompound levo alphacetylmethadol, or LAAM(ORLMM®), has an even longer duration ofaction (from 48 to 72 hours) than methadone,permitting a reduction in frequency of use. In1994, it was approved as a Schedule II treatmentdrug for narcotic addiction. Both methadone andLAAM have high abuse potential. Theiracceptability as narcotic treatment drugs ispredicated upon their ability to substitute forheroin, the long duration of action, and their modeof oral administration. Recent data regardingcardiovascular toxicity of LAAM has limited theuse of this drug as a first-line therapy foraddiction treatment.

Buprenorphine

This drug is a semi-synthetic narcotic derivedfrom thebaine. Buprenorphine was initiallymarketed in the United States as an analgesic(Buprenex®). In 2002, two new products(Suboxone® and Subutex®) were approved forthe treatment of narcotic addiction. Likemethadone and LAAM, buprenorphine is potent(30 to 50 times the analgesic potency ofmorphine), has a long duration of action, and doesnot need to be injected. Unlike the othertreatment drugs, buprenorphine produces far lessrespiratory depression and is thought to be saferin overdose. All buprenorphine products arecurrently in Schedule III of the CSA.

Methadone 40mg

Drugs of Abuse 27

Narcotics Identification

Drugs of Abuse28


Drugs of Abuse 29


Drugs of Abuse30


Drugs of Abuse 31

Chapter 5

Stimulants, sometimes referred to as “uppers,”reverse the effects of fatigue on both mental andphysical tasks. Two commonly used stimulants arenicotine, which is found in tobacco products, andcaffeine, an active ingredient in coffee, tea, somesoft drinks, and many non-prescription medicines.Used in moderation, these substances tend torelieve malaise and increase alertness. Althoughthe use of these products has been an accepted partof U.S. culture, the recognition of their adverseeffects has resulted in a proliferation of caffeine-free products and efforts to discourage cigarettesmoking.

A number of stimulants, however, are under theregulatory control of the CSA. Some of thesecontrolled substances are available by prescriptionfor legitimate medical use in the treatment ofobesity, narcolepsy, and attention deficit disorders.As drugs of abuse, stimulants are frequently takento produce a sense of exhilaration, enhance selfesteem, improve mental and physical performance,increase activity, reduce appetite, produceprolonged wakefulness, and to “get high.” Theyare among the most potent agents of reward andreinforcement that underlie the problem ofdependence.

Stimulants are diverted from legitimate channelsand clandestinely manufactured exclusively for theillicit market. They are taken orally, sniffed,smoked, and injected. Smoking, snorting, orinjecting stimulants produce a sudden sensationknown as a “rush” or a “flash.” Abuse is oftenassociated with a pattern of binge use--sporadicallyconsuming large doses of stimulants over a shortperiod of time. Heavy users may inject themselvesevery few hours, continuing until they havedepleted their drug supply or reached a point ofdelirium, psychosis, and physical exhaustion.During this period of heavy use, all other interestsbecome secondary to recreating the initial euphoricrush. Tolerance can develop rapidly, and bothphysical and psychological dependence occur.Abrupt cessation, even after a brief two- or three-day binge, is commonly followed by depression,anxiety, drug craving, and extreme fatigue knownas a “crash.”

Therapeutic levels of stimulants can produceexhilaration, extended wakefulness, and loss ofappetite. These effects are greatly intensified whenlarge doses of stimulants are taken. Physical side

Coca plants.

Drugs of Abuse

“Crack,” the chunk or “rock” form of cocaine, is aready-to-use freebase. On the illicit market, it issold in small, inexpensive dosage units that aresmoked. Smoking delivers large quantities ofcocaine to the lungs, producing effects comparableto intravenous injection. Drug effects are feltalmost immediately, are very intense, and arequickly over. Once introduced in the mid-1980s,crack abuse spread rapidly and made the cocaineexperience available to anyone with $10 andaccess to a dealer. In addition to other toxicitiesassociated with cocaine abuse, cocaine smokerssuffer from acute respiratory problems includingcough, shortness of breath, and severe chest painswith lung trauma and bleeding. It is noteworthythat the emergence of crack was accompanied by adramatic increase in drug abuse problems anddrug-related violence.

The intensity of the psychological effects ofcocaine, as with most psychoactive drugs, dependson the dose and rate of entry to the brain. Cocainereaches the brain through the snorting method inthree to five minutes. Intravenous injection ofcocaine produces a rush in 15 to 30 seconds, andsmoking produces an almost immediate intenseexperience. The euphoric effects of cocaine arealmost indistinguishable from those ofamphetamine, although they do not last as long.These intense effects can be followed by adysphoric crash. To avoid the fatigue and thedepression of coming down, frequent repeateddoses are taken. Excessive doses of cocaine maylead to seizures and death from respiratory failure,

effects, including dizziness, tremor, headache,flushed skin, chest pain with palpitations,excessive sweating, vomiting, and abdominalcramps, may occur as a result of takingtoo large a dose at one time or taking largedoses over an extended period of time.Psychological effects include agitation, hostility,panic, aggression, and suicidal or homicidaltendencies. Paranoia, sometimes accompanied byboth auditory and visual hallucinations, may alsooccur. Overdose is often associated with highfever, convulsions, and cardiovascular collapse.Because accidental death is partially due to theeffects of stimulants on the body’s cardiovascularand temperature-regulating systems, physicalexertion increases the hazards of stimulant use.

Cocaine

Cocaine, the most potent stimulant of naturalorigin, is extracted from the leaves of the coca plant(Erythroxylum coca), which is indigenous to theAndean highlands of South America. Natives inthis region chew or brew coca leaves into a tea forrefreshment and to relieve fatigue, similar to thecustoms of chewing tobacco and drinking tea orcoffee.

Pure cocaine was first isolated in the 1880s andused as a local anesthetic in eye surgery. It wasparticularly useful in surgery of the nose and throatbecause of its ability to provide anesthesia, as wellas to constrict blood vessels and limit bleeding.Many of its therapeutic applications are nowobsolete due to the development of safer drugs.

Illicit cocaine is usually distributed as a whitecrystalline powder or as an off-white chunkymaterial. The powder, usually cocainehydrochloride, is often diluted with a variety ofsubstances, the most common being sugars such aslactose, inositol, and mannitol, and localanesthetics such as lidocaine. The adulterationincreases the volume and thus multiplies profits.Cocaine hydrochloride is generally snorted ordissolved in water and injected. It is rarely smokedbecause it is heat labile (destroyed by hightemperatures).

Chapter 5

32

Paraphernalia used for smoking crack cocaine.

Drugs of Abuse 33

Cocaine: Cultivation to Product

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 two 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. Gasoline is then added to the basic solution and mixed.7. Cocaine hydrochloride (HCl) is produced through further refining and processing the cocaine base.8. Cocaine HCl is the final product exported from South America.9. Crack cocaine is made in the U.S. from several basic household products and cocaine HCl.

Drugs of Abuse

stroke, or heart failure. There is no specificantidote for cocaine overdose.

Cocaine is the second most commonly used illicitdrug (following marijuana) in the United States.According to the 2003 National Survey on DrugUse and Health, more than 34 million Americans(14.7%) age 12 or older had used cocaine at leastonce in their lifetime. There are no drugs approvedfor replacement-pharmacotherapy (drugs taken ona chronic basis as a substitute for the abused drug,like methadone for heroin addiction). Cocaineaddiction treatment relies heavily on psychotherapyand drugs like antidepressants to relieve some ofthe effects of cocaine abuse.

Amphetamines

Amphetamine, dextroamphetamine,methamphetamine, and their various salts, arecollectively referred to as amphetamines. In fact,their chemical properties and actions are so similarthat even experienced users have difficultyknowing which drug they have taken.

Amphetamine was first marketed in the 1930s asBenzedrine® in an over-the-counter inhaler to treatnasal congestion. By 1937, amphetamine wasavailable by prescription in tablet form and wasused in the treatment of the sleeping disorder,narcolepsy, and the behavioral syndrome calledminimal brain dysfunction, which today is called

attention deficit hyperactivity disorder (ADHD).During World War II, amphetamine was widelyused to keep the fighting men going and bothdextroamphetamine (Dexedrine®) andmethamphetamine (Methedrine®) were readilyavailable.

As use of amphetamines spread, so did their abuse.In the 1960s, amphetamines became a perceivedremedy for helping truckers to complete their longroutes without falling asleep, for weight control, forhelping athletes to perform better and train longer,and for treating mild depression. Intravenousamphetamines, primarily methamphetamine, wereabused by a subculture known as “speed freaks.”With experience, it became evident that the dangersof abuse of these drugs outweighed most of theirtherapeutic uses.

Increased control measures were initiated in 1965with amendments to the federal food and drug lawsto curb the black market in amphetamines. Manypharmaceutical amphetamine products wereremoved from the market including all injectableformulations, and doctors prescribed those thatremained less freely. Recent increases in medicaluse of these drugs can be attributed to their use inthe treatment of ADHD. Amphetamine productspresently marketed include generic and brand nameamphetamine (Adderall®, Dexedrine®,Dextrostat®) and brand name methamphetamine(Desoxyn®). Amphetamines are all controlled inSchedule II of the CSA.

To meet the ever-increasing black market demandfor amphetamines, clandestine laboratoryproduction has mushroomed. Today, mostamphetamines distributed to the black market areproduced in clandestine laboratories.Methamphetamine laboratories are, by far, the mostfrequently encountered clandestine laboratories inthe United States. The ease of clandestinesynthesis, combined with tremendous profits, hasresulted in significant availability of illicitmethamphetamine, especially on the West Coast,where abuse of this drug has increased dramaticallyin recent years. Large amounts of methamphetamine

34

DEA Special Agents and chemists conduct araid on a clandestine methamphetamine lab.

Drugs of Abuse 35

are also illicitly smuggled into the United States fromMexico.

Amphetamines are generally taken orally orinjected. However, the addition of “ice,” the slangname for crystallized methamphetaminehydrochloride, has promoted smoking as anothermode of administration. Just as “crack” issmokable cocaine, “ice” is smokablemethamphetamine. Methamphetamine, in all itsforms, is highly addictive and toxic.

The effects of amphetamines, especiallymethamphetamine, are similar to cocaine, but theironset is slower and their duration is longer. Incontrast to cocaine, which is quickly removed fromthe brain and is almost completely metabolized,methamphetamine remains in the central nervoussystem longer, and a larger percentage of the drugremains unchanged in the body, producingprolonged stimulant effects. Chronic abuseproduces a psychosis that resembles schizophreniaand is characterized by paranoia, picking at theskin, preoccupation with one’s own thoughts, andauditory and visual hallucinations. Thesepsychotic symptoms can persist for months andeven years after use of these drugs has ceased andmay be related to their neurotoxic effects. Violentand erratic behavior is frequently seen amongchronic abusers of amphetamines, especiallymethamphetamine.

Methcathinone

Methcathinone, known on the streets as “Cat,” is astructural analogue of methamphetamine andcathinone. Clandestinely manufactured,methcathinone is almost exclusively sold in thestable and highly water soluble hydrochloride saltform. It is most commonly snorted, although it canbe taken orally by mixing it with a beverage ordiluted in water and injected intravenously.Methcathinone has an abuse potential equivalent tomethamphetamine and produces amphetamine-likeeffects. It was placed in Schedule I of the CSA in1993.

Methylphenidate

Methylphenidate, a Schedule II substance, has ahigh potential for abuse and produces many of thesame effects as cocaine and the amphetamines. Theabuse of this substance has been documentedamong narcotic addicts who dissolve the tablets inwater and inject the mixture. Complicationsarising from this practice are common due to theinsoluble fillers used in the tablets. When injected,these materials block small blood vessels, causingserious damage to the lungs and retina of the eye.Binge use, psychotic episodes, cardiovascularcomplications, and severe psychological addictionhave all been associated with methylphenidateabuse.

Methylphenidate is used legitimately in thetreatment of excessive daytime sleepinessassociated with narcolepsy, as is the newlymarketed Schedule IV stimulant, modafinil(Provigil®). However, the primary legitimatemedical use of methylphenidate (Ritalin®,Methylin®, Concerta®) is to treat attention deficithyperactivity disorder (ADHD) in children. Theincreased use of this substance for the treatment ofADHD has paralleled an increase in its abuseamong adolescents and young adults who crushthese tablets and snort the powder to get high.Abusers have little difficulty obtainingmethylphenidate from classmates or friends whohave been prescribed it.

Anorectic Drugs

A number of drugs have been developed andmarketed to replace amphetamines as appetitesuppressants. These anorectic drugs includebenzphetamine (Didrex®), diethylproprion(Tenuate®, Tepanil®), mazindol (Sanorex®,Mazanor®), phendimetrazine (Bontril®, Prelu-27®), and phentermine (Lonamin®, Fastin®,Adipex®). These substances are in Schedule III orIV of the CSA and produce some amphetamine-likeeffects. Of these diet pills, phentermine is the mostwidely prescribed and most frequently encountered

Drugs of Abuse36

on the illicit market. Two Schedule IV anorecticsoften used in combination with phentermine,fenfluramine and dexfenfluramine, were removedfrom the U.S. market because they were associatedwith heart valve problems.

Khat

For centuries, khat, the fresh young leaves of theCatha edulis shrub, has been consumed where theplant is cultivated, primarily East Africa and theArabian Peninsula. There, chewing khat predatesthe use of coffee and is used in a similar socialcontext. Chewed in moderation, khat alleviatesfatigue and reduces appetite. Compulsive use mayresult in manic behavior with grandiose delusionsor in a paranoid type of illness, sometimesaccompanied by hallucinations. Khat has beensmuggled into the United States and other countriesfrom the source countries for use by emigrants. Itcontains a number of chemicals, among which aretwo controlled substances, cathinone (Schedule I)and cathine (Schedule IV). As the leaves mature ordry, cathinone is converted to cathine, whichsignificantly reduces its stimulatory properties.

Harvested Khat plants.

Drugs of Abuse 37

Stimulants Identification

Drugs of Abuse38

Stimulants Identification

Illusions andhallucinations,altered perception oftime and distance

(LSD) Longer, moreintense "trip" episodes

None

Heightened senses,teeth grinding and dehydration

Increased body temper-ature, electrolyteimbalance, cardiacarrest

Muscle aches,drowsiness, depression,acne

Unable to direct move-ment, feel pain, or remember

Drug seeking behavior*Not regulated

Amyl and Butyl NitratesNitrous OxideOther Inhalants

MDMA and AnalogsLSDPhencyclidine and AnalogsOther Hallucinogens

Narcotics

StimulantsCocaineAmphetamine/MethamphetamineMethylphenidateOther Stimulants

gamma Hydroxybutyric AcidBenzodiazepinesOther Depressants

HeroinMorphineHydrocodoneHydromorphoneOxycodoneCodeineOther Narcotics

Drugs

Hallucinogens

MarijuanaTetrahydrocannabinolHashish and Hashish Oil

Cannabis

Anabolic SteroidsSubstance III

Substance III

Substance I

Sub I, Product III

Substance I

Substance I

Substance I

Sub I, II, III

Substance I

Substance II

Sub II

Substance II

Substance III, IV

Sub I, Product III

Substance IV

Substance I, II, III,

IV

U.S. Department of JusticeDrug Enforcement Administration

GHB, Liquid Ecstasy, Liquid X, Sodium Oxybate, Xyrem

Ambien, Sonata, Meprobamate, Chloral Hydrate,Barbiturates, Methaqualone (Quaalude)

Antianxiety, Sedative, Anticonvulsant,Hypnotic, Muscle Relaxant

Moderate

Physical

Moderate

High

Moderate

Possible

Smoked, oral,injected, snorted

Oral

Snorted, smoked,injected

PossibleEffects

Effects ofOverdose

WithdrawalSyndrome

UsualMethod

Duration(Hours)ToleranceMedical UsesTrade or Other NamesCSA Schedules

DependencePsychological

Increased alert-ness, excitation,euphoria, in-creased pulse rate& blood pressure,insomnia, loss ofappetite

Agitation,increased bodytemperature,hallucinations,convulsions,possible death

Apathy, longperiods of sleep,irritability,depression,disorientation

DRUGS OF ABUSE / Uses and Effects

Slurred speech,disorientation, drunkenbehavior without odor ofalcohol, impairedmemory of events,interacts with alcohol

Shallow respiration,clammy skin, dilatedpupils, weak and rapidpulse, coma,possible death

Anxiety, insomnia,tremors, delirium,convulsions,possible death

Euphoria,drowsiness,respiratorydepression,constrictedpupils,nausea

Slow and shallowbreathing,clammy skin,convulsions,coma,possible death

Watery eyes,runny nose,yawning,loss of appetite,irritability,tremors,panic,cramps,nausea,chills and sweating

Virilization, edema,testicular atrophy,gynecomastia, acne,aggressive behavior

Unknown Possible depression

Occasional reportsof insomnia,hyperactivity,decreasedappetite

Fatigue, paranoia,possiblepsychosis

Euphoria, relaxedinhibitions,increased appetite,disorientation

YesYes

Yes

YesYes

YesYes

Yes

YesYes

YesYes

Yes

Yes

YesYesYes

UnknownUnknown

UnknownYes

UnknownUnknown

14-28 days

Variable

2-42-42-4

Smoked, oral

Smoked, oral

Smoked, oral

Injected

1-128-12

2-42-4

1-2Oral, injected,smoked

HighHighHigh

Possible

PossiblePossible

Unknown

Unknown

None

None

None

ModerateModerate

Moderate

ModerateModerate

ModerateModerate

3-61-8

Oral

Oral, injected

Oral

High

High-Low

High

High

High

High

3-43-123-63-43-12

Variable

Injected, snorted,smokedOral, injected

Oral

Oral, injected

OralHigh

High-Low

High

High

High

High

Diamorphine, Horse, Smack, Black tar, Chiva,Negra (black tar)

MS-Contin, Roxanol, Oramorph SR, MSIR

Hydrocodone w/Acetaminophen, Vicodin, Vicoprofen,Tussionex, LortabDilaudid

Roxicet, Oxycodone w/Acetaminophen, OxyContin,Endocet, Percocet, Percodan

None in U.S., Analgesic, Antitussive

Analgesic

Analgesic, Antitussive

Analgesic

Analgesic

Analgesic, Antidiarrheal, Antitussive

Antianxiety, Sedative, Hypnotic

None in U.S., Anesthetic

Local anesthetic

Attention deficit/hyperactivity disorder,narcolepsy, weight control

Attention deficit/hyperactivity disorder

None

None

None

None

Antinauseant, Appetite stimulant

Hypogonadism

Anemia, Breast cancerParabolan, Winstrol, Equipose, Anadrol, Dianabol,Primabolin-Depo, D-Ball

Depo Testosterone, Sustanon, Sten, Cypt

Hash, Hash oil

THC, Marinol

Pot, Grass, Sinsemilla, Blunts, Mota, Yerba, Grifa

Psilocybe mushrooms, Mescaline, Peyote Cactus,Ayahausca, DMT, Dextromethorphan* (DXM)

PCP, Angel Dust, Hog, Loveboat, Ketamine (Special K),PCE, PCPy, TCP

Acid, Microdot, Sunshine, Boomers

Coke, Flake, Snow, Crack, Coca, Blanca, Perico,Nieve, SodaCrank, Ice, Cristal, Krystal Meth, Speed, Adderall,Dexedrine, Desoxyn

Ritalin (Illy's), Concerta, Focalin, Metadate

Adipex P, Ionamin, Prelu-2, Didrex, Provigil

Valium, Xanax, Halcion, Ativan, Restoril,Rohypnol (Roofies, R-2), Klonopin

Fentanyl, Demerol, Methadone, Darvon, Stadol,Talwin, Paregoric, Buprenex

TestosteroneOther Anabolic SteroidsInhalants

Alcohol Beer, wine, liquor None

Laughing gas, balloons, Whippets

Pearls, Poppers, Rush, Locker Room

Adhesives, spray paint, hair spray, dry cleaning fluid,spot remover, lighter fluid

Vasoconstriction Possible Moderate Yes Oral

PossibleNone

Yes

Yes

Oral, injected

Anesthetic

Angina (Amyl)

None

Low

High HighHigh

Yes 1-3 Oral

Unknown4-6

None

(Ecstasy, XTC, Adam), MDA (Love Drug), MDEA (Eve),MBDB

Oral

Impaired memory,slurred speech, drunkenbehavior, slow onsetvitamin deficiency, organdamage

Vomiting, respiratorydepression, loss ofconsciousness,possible death

Trembling, anxiety,insomnia,vitamin deficiency,confusion,hallucinations, convulsions

Agitation

June 2004

2-6

2-4

UnknownUnknownUnknown

Unknown NoNoNo 0.5-2

10.5

Inhaled

Inhaled

Inhaled

Flushing, hypotension,headache Methemoglobinemia

Anesthetic (Ketamine)

4-8

Depressants

Acetaminophen, Guaifenesin or Promethazine w/Codeine,Fiorinal, Fioricet or Tylenol w/Codeine Analgesic, Antitussive ModerateModerate Yes 3-4 Oral, injected

Substance I

Substance II

Substance II, Product III, V

Substance II

Substance II

Substance II, Products III, V

Substance II, III, IV

R

Oral, injected,snorted, smoked

Oral, injected,snorted, smoked

Oral, snorted,smoked

Drugs of Abuse 39

Historically, people of almost every culture haveused chemical agents to induce sleep, relieve stress,and allay anxiety. While alcohol is one of the oldestand most universal agents used for these purposes,hundreds of substances have been developed thatproduce central nervous system depression. Thesedrugs have been referred to as downers, sedatives,hypnotics, minor tranquilizers, anxiolytics, andanti-anxiety medications. Unlike most other classesof drugs of abuse, depressants are rarely producedin clandestine laboratories. Generally, legitimatepharmaceutical products are diverted to the illicitmarket. A notable exception to this is a relativelyrecent drug of abuse, gamma hydroxybutyric acid(GHB).

Choral hydrate and paraldehyde are two of theoldest pharmaceutical depressants still in use today.Other depressants, including gluthethimide,methaqualone, and meprobamate have beenimportant players in the milieu of depressant useand abuse. However, two major groups ofdepressants have dominated the licit and illicitmarket for nearly a century, first barbiturates andnow benzodiazepines.

Barbiturates were very popular in the first half ofthe 20th century. In moderate amounts, thesedrugs produce a state of intoxication that isremarkably similar to alcohol intoxication.Symptoms include slurred speech, loss of motorcoordination, and impaired judgment. Dependingon the dose, frequency, and duration of use, onecan rapidly develop tolerance, and physical andpsychological dependence on barbiturates. Withthe development of tolerance, the margin of safetybetween the effective dose and the lethal dosebecomes very narrow. That is, in order to obtainthe same level of intoxication, the tolerant abusermay raise his or her dose to a level that may resultin coma or death. Although many individuals havetaken barbiturates therapeutically without harm,concern about the addiction potential ofbarbiturates and the ever-increasing number offatalities associated with them led to thedevelopment of alternative medications. Today, lessthan 10 percent of all depressant prescriptions inthe United States are for barbiturates.

Benzodiazepines were first marketed in the 1960s.Touted as much safer depressants with far less

GHB (Liquid Ecstasy, Liquid E, Liquid X, Fantasy,Georgia Home Boy, Grievous Bodily Harm, and Vita G).

Chapter 6

addiction potential than barbiturates, today thesedrugs account for about one out of every fiveprescriptions for controlled substances. Althoughbenzodiazepines produce significantly lessrespiratory depression than barbiturates, it is nowrecognized that benzodiazepines share many of theundesirable side effects of the barbiturates. Anumber of toxic central nervous system effects areseen with chronic high-dose benzodiazepine therapy,including headaches, irritability, confusion, memoryimpairment, and depression. The risk of developingover-sedation, dizziness, and confusion increasessubstantially with higher doses of benzodiazepines.Prolonged use can lead tophysical dependence evenat doses recommended formedical treatment. Unlikebarbiturates, large doses ofbenzodiazepines are rarelyfatal unless combined withother drugs or alcohol.Although primary abuse ofbenzodiazepines is welldocumented, abuse of thesedrugs usually occurs aspart of a pattern ofmultiple drug abuse. Forexample, heroin or cocaineabusers will usebenzodiazepines and other depressants to augmenttheir “high” or alter the side effects associated withover-stimulation or narcotic withdrawal.

There are marked similarities among the withdrawalsymptoms seen with most drugs classified asdepressants. In the mildest form, the withdrawalsyndrome may produce insomnia and anxiety,usually the same symptoms that initiated the druguse. With a greater level of dependence, tremorsand weakness are also present, and in its most severeform, the withdrawal syndrome can cause seizuresand delirium. Unlike the withdrawal syndrome seenwith most other drugs of abuse, withdrawal fromdepressants can be life threatening.

Barbiturates

Barbiturates were first introduced for medical usein the early 1900s. More than 2,500 barbiturateshave been synthesized, and at the height of theirpopularity, about 50 were marketed for human use.Today, about a dozen are in medical use.Barbiturates produce a wide spectrum of centralnervous system depression, from mild sedation tocoma, and have been used as sedatives, hypnotics,anesthetics, and anticonvulsants. The primarydifferences among many of these products are howfast they produce an effect and how long those

effects last. Barbiturates areclassified as ultrashort, short,intermediate, and long-acting.

The ultrashort-actingbarbiturates produce anesthesiawithin about one minute afterintravenous administration.Those in current medical useare the Schedule IV drugmethohexital (Brevital®), andthe Schedule III drugs thiamyl(Surital®) and thiopental(Pentothal®). Barbiturateabusers prefer the Schedule IIshort-acting and intermediate-

acting barbiturates that include amobarbital(Amytal®), pentobarbital (Nembutal®),secobarbital (Seconal®), and Tuinal (anamobarbital/secobarbital combination product).Other short and intermediate-acting barbituratesare in Schedule III and include butalbital(Fiorina®), butabarbital (Butisol®), talbutal(Lotusate®), and aprobarbital (Alurate®). Afteroral administration, the onset of action is from 15to 40 minutes, and the effects last up to six hours.These drugs are primarily used for insomnia andpreoperative sedation. Veterinarians usepentobarbital for anesthesia and euthanasia.

Long-acting barbiturates include phenobarbital(Luminal®) and mephobarbital (Mebaral®), bothof which are in Schedule IV. Effects of these drugsare realized in about one hour and last for about 12

40

Klonopin 1mg

Klonopin 0.50mg

Drugs of Abuse

41

hours, and are used primarily for daytime sedationand the treatment of seizure disorders.

Benzodiazepines

The benzodiazepine family of depressants is usedtherapeutically to produce sedation, induce sleep,relieve anxiety and muscle spasms, and to preventseizures. In general, benzodiazepines act ashypnotics in high doses, anxiolytics in moderatedoses, and sedatives in low doses. Of the drugsmarketed in the United States that affect centralnervous system function, benzodiazepines areamong the most widely prescribed medications.Fifteen members of this group are presentlymarketed in the United States, and about 20additional benzodiazepines are marketed in othercountries. Benzodiazepines are controlled inSchedule IV of the CSA.

Short-acting benzodiazepines are generally used forpatients with sleep-onset insomnia (difficultyfalling asleep) without daytime anxiety. Shorter-acting benzodiazepines used to manage insomniainclude estazolam (ProSom®), flurazepam(Dalmane®), temazepam (Restoril®), andtriazolam (Halcion®). Midazolam (Versed®), ashort-acting benzodiazepine, is utilized forsedation, or treating anxiety and amnesia in criticalcare settings and prior to anesthesia. It is availablein the United States as an injectable preparationand as a syrup (primarily for pediatric patients).

Benzodiazepines with a longer duration of actionare utilized to treat insomnia in patients withdaytime anxiety. These benzodiazepines includealprazolam (Xanax®), chlordiazepoxide(Librium®), clorazepate (Tranxene®), diazepam(Valium®), halazepam (Paxipam®), lorzepam(Ativan®), oxazepam (Serax®), prazepam(Centrax®), and quazepam (Doral®).Clonazepam (Klonopin®), diazepam, andclorazepate are also used as anticonvulsants.

Benzodiazepines are classified in the CSA asdepressants. Repeated use of large doses or, insome 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. Thewithdrawal syndrome is similar to that of alcoholand may require hospitalization. Abrupt cessationof benzodiazepines is not recommended andtapering-down the dose eliminatesmany of the unpleasant symptoms.

Given the millions of prescriptions written forbenzodiazepines, relatively few individualsincrease their dose on their own initiative or engagein drug-seeking behavior. Those individuals whodo abuse benzodiazepines often maintain their drugsupply by getting prescriptions from severaldoctors, forging prescriptions, or buying divertedpharmaceutical products on the illicit market.Abuse is frequently associated with adolescents andyoung adults who take benzodiazepines to obtain a“high.” This intoxicated state results in reducedinhibition and impaired judgment. Concurrent useof alcohol or other depressant with benzodiazepinescan be life threatening. Abuse of benzodiazepines isparticularly high among heroin and cocaineabusers. A large percentage of people enteringtreatment for narcotic or cocaine addiction alsoreport abusing benzodiazepines. Alprazolam anddiazepam are the two most frequently encounteredbenzodiazepines on the illicit market.

Flunitrazepam

Flunitrazepam (Rohypnol®) is a benzodiazepinethat is not manufactured or legally marketed in theUnited States, but is smuggled in by traffickers. Inthe mid-1990s, flunitrazepam was extensivelytrafficked in Florida and Texas. Known as“rophies,” “roofies,” and “roach,” flunitrazepamgained popularity among younger individuals as a“party” drug. It has also been utilized as a “daterape” drug. In this context, flunitrazepam is placedin the alcoholic drink of an unsuspecting victim toincapacitate them and prevent resistance fromsexual assault. The victim is frequently unaware ofwhat has happened to them and often does notreport the incident to authorities. A number ofactions by the manufacturer of this drug and by

Drugs of Abuse

government agencies haveresulted in reducing theavailability and abuse offlunitrazepam in the UnitedStates.

GammaHydroxybutyric Acid(GHB)

In recent years, gammahydroxybutyric acid (GHB) has emerged as asignificant drug of abuse throughout the UnitedStates. Abusers of this drug fall into three majorgroups: (1) users take GHB for its intoxicant oreuphoriant effects; (2) bodybuilders who abuseGHB for its alleged utility as an anabolic agent oras a sleep aid; and (3) individuals who use GHB asa weapon for sexual assault. These categories arenot mutually exclusive and an abuser may use thedrug illicitly to produce several effects. GHB isfrequently taken with alcohol or other drugs thatheighten its effects and is often found at bars,nightclubs, rave parties, and gyms. Teenagers andyoung adults who frequent these establishments arethe primary users. Like flunitrazepam, GHB isoften referred to as a “date-rape” drug. GHBinvolvement in rape cases is likely to be unreportedor unsubstantiated because GHB is quicklyeliminated from the body making detection in bodyfluids unlikely. Its fast onset of depressant effectsmay render the victim with little memory of thedetails of the attack.

GHB produces a wide range of central nervoussystem effects, including dose-dependentdrowsiness, dizziness, nausea, amnesia, visualhallucinations, hypotension, bradycardia, severerespiratory depression, and coma. The use ofalcohol in combination with GHB greatly enhancesits depressant effects. Overdose frequently requiresemergency room care, and many GHB-relatedfatalities have been reported.

Gamma butyrolactone (GBL) and 1,4-butanediolare GHB analogues that can be used as substitutes

for GHB. When ingested, these analogues areconverted to GHB and produce identical effects.GBL is also used in the clandestine production ofGHB as an immediate precursor. Both GBL and1,4-butanediol have been sold at health food storesand on various internet sites.

The abuse of GHB began to seriously escalate inthe mid-1990s. For example, in 1994, there were55 emergency department episodes involving GHBreported in the Drug Abuse Warning Network(DAWN) system. By 2002, there were 3,330emergency room episodes. DAWN data alsoindicated that most users were male, less than 25years of age, and taking the drug orally forrecreational use.

GHB was placed in Schedule I of the CSA inMarch 2000. Gamma butyrolactone (GBL) wasmade a List I Chemical in February 2000. GHBhas recently been approved as a medication(Xyrem®) for the treatment of cataplexy associatedwith some types of narcolepsy. This approvedmedication is in Schedule III of the CSA.

Paraldehyde

Paraldehyde (Paral®) is a Schedule IV depressantused most frequently in hospital settings to treatdelirium tremens associated with alcoholwithdrawal. Many individuals who becomeaddicted to paraldehyde have been initially exposedduring treatment for alcoholism and, despite thedisagreeable odor and taste, come to prefer it toalcohol. This drug is not used by injection because

42

Rohypnol R

Drugs of Abuse

43

of tissue damage, and taken orally, it can beirritating to the throat and stomach. One of thesigns of paraldehyde use is a strong, characteristicsmell to the breath.

Chloral Hydrate

The oldest of the hypnotic (sleep inducing,depressants, chloral hydrate was first synthesized in1832. Marketed as syrups or soft gelatin capsules,chloral hydrate takes effect in a relatively shorttime (30 minutes) and will induce sleep in about anhour. A solution of chloral hydrate and alcoholconstituted the infamous “knockout drops” or“Mickey Finn.” At therapeutic doses, chloralhydrate has little effect on respiration and bloodpressure; however, a toxic dose produces severerespiratory depression and very low blood pressure.Chronic use is associated with liver damage and asevere withdrawal syndrome. Although somephysicians consider chloral hydrate to be the drugof choice for sedation of children before diagnostic,dental, or medical procedures, its general use as ahypnotic has declined. Chloral hydrate, Noctec®,and other compounds, preparations, or mixturescontaining choral hydrate are in Schedule IV of theCSA.

Glutethimide and Methaqualone

Glutethimide (Doriden®) was introduced in 1954and methaqualone (Quaalude®, Sopor®) in 1965as safe barbiturate substitutes. Experiencedemonstrated, however, that their addiction liabilityand the severity of withdrawal symptoms weresimilar to those of barbiturates. By 1972, “ludingout,” taking methaqualone with wine, was apopular college pastime. Excessive use leads to

tolerance, dependence, and withdrawal symptomssimilar to those of barbiturates. In the UnitedStates, the marketing of methaqualonepharmaceutical products stopped in 1984, andmethaqualone was transferred to Schedule I of theCSA. In 1991, glutethimide was transferred intoSchedule II in response to an upsurgein the prevalence of diversion, abuse, and overdosedeaths. Today, there is little medical use ofglutethimide in the United States.

Meprobamate

Meprobamate was introduced as an anti-anxietyagent in 1955 and is prescribed primarily to treatanxiety, tension, and associated muscle spasms.More than 50 tons are distributed annually in theUnited States under its generic name and brandnames such as Miltown® and Equanil®. Its onsetand duration of action are similar to theintermediate-acting barbiturates; however,therapeutic doses of meprobamate produce lesssedation and toxicity than barbiturates. Excessiveuse can result in psychological and physicaldependence. Carisoprodol (Soma®), a skeletalmuscle relaxant, is metabolized to meprobamate.This conversion may account for some of theproperties associated with carisoprodol and likelycontributes to its abuse.

Newly Marketed Drugs

Zolpidem (Ambien®) and zaleplon (Sonata®) aretwo relatively new, benzodiazepine-like CNSdepressants that have been approved for the short-term treatment of insomnia. Both of these drugsshare many of the same properties as thebenzodiazepines and are in Schedule IV of theCSA.

Drugs of Abuse

44

Depressants Identification

Drugs of Abuse

45


Drugs of Abuse


46 Drugs of Abuse

47


Drugs of Abuse

Chapter 7

Cannabis sativa L., the cannabis plant, grows wildthroughout most of the tropic and temperateregions of the world. Prior to the advent ofsynthetic fibers, the cannabis plant was cultivatedfor the tough fiber of its stem. In the United States,cannabis is legitimately grown only for scientificresearch.

Cannabis contains chemicals called cannabinoidsthat are unique to the cannabis plant. Among thecannabinoids synthesized by the plant arecannabinol, cannabidiol, cannabinolidic acids,cannabigerol, cannabichromene, and severalisomers of tetrahydrocannabinol. One of these,delta-9-tetrahydrocannabinol (THC), is believed tobe responsible for most of the characteristicpsychoactive effects of cannabis. Research hasresulted in development and marketing of thedronabinol (synthetic THC) product, Marinol®, forthe control of nausea and vomiting caused bychemotheraputic agents used in the treatment ofcancer and to stimulate appetite in AIDS patients.Marinol® was rescheduled in 1999 and placed inSchedule III of the CSA.

Cannabis products are usually smoked. Theireffects are felt within minutes, reach their peak in10 to 30 minutes, and may linger for two or threehours. The effects experienced often depend uponthe experience and expectations of the individualuser, as well as the activity of the drug itself. Lowdoses tend to induce a sense of well-being and adreamy state of relaxation, which may beaccompanied by a more vivid sense of sight, smell,taste, and hearing, as well as by subtle alterations inthought formation and expression. This state ofintoxication may not be noticeable to an observer.However, driving, occupational, or householdaccidents may result from a distortion of time andspace relationships and impaired motorcoordination. Stronger doses intensify reactions.The individual may experience shifting sensoryimagery, rapidly fluctuating emotions, fragmentarythoughts with disturbing associations, an alteredsense of self-identity, impaired memory, and adulling of attention despite an illusion of heightenedinsight. High doses may result in image distortion,a loss of personal identity, fantasies, andhallucinations.

48

Indoormarijuana growth

has become apopular means of

clandestine cultivation.

Drugs of Abuse

Three drugs that come from cannabis—marijuana,hashish, and hashish oil—are distributed on theU.S. illicit market. Having no currently acceptedmedical use in treatment in the United States, theyremain under Schedule I of the CSA. Today,cannabis is illicitly cultivated, both indoors andout, to maximize its THC content, therebyproducing the greatest possible psychoactive effect.

Marijuana

Marijuana is the most frequently encountered illicitdrug worldwide. In the United States, according tothe 2003 Monitoring the Future Study, 57 percentof adults aged 19 to 28 reported having usedmarijuana in their lifetime. Among youngerAmericans, 17.5 percent of 8th graders and 46.1percent of 12th graders had used marijuana in theirlifetime. The term “marijuana,” as commonlyused, refers to the leaves and flowering tops of thecannabis plant that are dried to produce a tobacco-like substance. Marijuana varies significantly in itspotency, depending on the source and selection ofplant materials used. The form of marijuana knownas sinsemilla (Spanish, sin semilla: without seed),derived from the unpollinated female cannabisplant, is preferred for its high THC content.Marijuana is usually smoked in the form of looselyrolled cigarettes called joints, bongs, or hollowedout commercial cigars called blunts. Joints andblunts may be laced with a number of adulterantsincluding phencyclidine (PCP), substantiallyaltering the effects and toxicity of these products.Street names for marijuana include pot, grass,weed, Mary Jane, and reefer. Although marijuanagrown in the United States was once consideredinferior because of a low concentration of THC,advancements in plant selection and cultivationhave resulted in higher THC-containing domestic

marijuana. In 1974, theaverage THC content of illicitmarijuana was less than onepercent. Today mostcommercial grade marijuanafrom Mexico/Columbia anddomestic outdoor cultivatedmarijuana has an averageTHC content of about 4 to 6percent. Between 1998 and2002, NIDA-sponsoredMarijuana PotencyMonitoring System (MPMP)analyzed 4,603 domesticsamples. Of those samples,379 tested over 15 percentTHC, 69 samples tested

between 20 and 25 percent THC and four samplestested over 25 percent THC.

Marijuana contains known toxins and cancer-causingchemicals. Marijuana users experience the samehealth problems as tobacco smokers, such asbronchitis, emphysema, and bronchial asthma. Someof the effects of marijuana use also include increasedheart rate, dryness of the mouth, reddening of theeyes, impaired motor skills and concentration, andhunger with an increased desire for sweets.Extended use increases risk to the lungs andreproductive system, as well as suppression of theimmune system. Occasionally, hallucinations,fantasies, and paranoia are reported. Long-termchronic marijuana use is associated with anAmotivational Syndrome characterized by: apathy;impairment of judgment, memory and concentration;and loss of interest in personal appearance andpursuit of goals.

49

Bongs.

Rolling papers used tomake marijuana

cigarettes (joints).

Drugs of Abuse

50

Hashish

Hashish consists of the THC-rich resinous materialof the cannabis plant, which is collected, dried, andthen compressed into a variety of forms, such asballs, cakes, or cookie-like sheets. Pieces are thenbroken off, placed in pipes, and smoked. TheMiddle East, North Africa, and Pakistan/Afghanistan are the main sources of hashish. TheTHC content of hashish that reached the UnitedStates, where demand is limited, averaged aboutfive percent in the 1990s.

Hashish Oil

The term “hash oil” is used by illicit drug users anddealers, but is a misnomer in suggesting anyresemblance to hashish. Hash oil is produced byextracting the cannabinoids from plant materialwith a solvent. The color and odor of the resultingextract will vary, depending onthe type of solvent used.Current samples of hash oil, aviscous liquid ranging fromamber to dark brown in color,average about 15 percentTHC. In terms of itspsychoactive effect, a dropor two of this liquid on acigarette is equal to asingle “joint” of marijuana.

Synthetic THC Identification

Drugs of Abuse

Chapter 8

Hallucinogens are among the oldest known groupof drugs used for their ability to alter humanperception and mood. For centuries, many of thenaturally occurring hallucinogens found in plantsand fungi have been used for a variety ofshamanistic practices. In more recent years, anumber of synthetic hallucinogens have beenproduced, some of which are much more potentthan their naturally occurring counterparts.

The biochemical, pharmacological, andphysiological basis for hallucinogenic activity isnot well understood. Even the name for this class ofdrugs is not ideal, since hallucinogens do notalways produce hallucinations.

However, taken in non-toxic dosages, thesesubstances produce changes in perception, thought,and mood. Physiological effects include elevatedheart rate, increased blood pressure, and dilatedpupils. Sensory effects include perceptualdistortions that vary with dose, setting, and mood.Psychic effects include disorders of thought

associated with time and space. Time may appearto stand still and forms and colors seem to changeand take on new significance. This experience maybe either pleasurable or extremely frightening. Itneeds to be stressed that the effects of hallucinogensare unpredictable each time they are used.

Weeks or even months after some hallucinogenshave been taken, the user may experienceflashbacks—fragmentary recurrences of certainaspects of the drug experience in the absence ofactually taking the drug. The occurrence of aflashback is unpredictable, but is more likely tooccur during times of stress and seem to occurmore frequently in younger individuals. With time,these episodes diminish and become less intense.

The abuse of hallucinogens in the United Statesreceived much public attention in the 1960s and1970s. A subsequent decline in their use in the1980s may be attributed to real or perceivedhazards associated with taking these drugs.

51

LSD blotter paper.Mushrooms. Rave poster.

Drugs of Abuse

However, a resurgence of the use of hallucinogensis cause for concern. According to the 2003Monitoring the Future Study, 10.6 percent of 12thgraders reported hallucinogenic use in theirlifetime. According to the 2003 National Surveyon Drug Use and Health, approximately 1 millionAmericans were current hallucinogen users.Hallucinogenic mushrooms, LSD, and MDMA arepopular among junior and senior high schoolstudents who use hallucinogens.

There is a considerable body of literature that linksthe use of some of the hallucinogenic substances toneuronal damage in animals, and recent datasupport that some hallucinogens are neurotoxic tohumans. However, the most common danger ofhallucinogen use is impaired judgment that oftenleads to rash decisions and accidents.

LSD

Lysergic acid diethylamide (LSD) is the mostpotent hallucinogen known to science, as well asthe most highly studied. LSD was originallysynthesized in 1938 by Dr. Albert Hoffman.However, its hallucinogenic effects were unknown

until 1943 when Hoffman accidentally consumedsome LSD. It was later found that an oral dose ofas little as 0.000025 grams (or 25 micrograms,equal in weight to a couple grains of salt) iscapable of producing rich and vivid hallucinations.Because of its structural similarity to a chemicalpresent in the brain and its similarity in effects tocertain aspects of psychosis, LSD was used as aresearch tool to study mental illness. LSD abusewas popularized in the 1960s by individuals likeTimothy Leary who encouraged American studentsto “turn on, tune in, and drop out.” LSD use hasvaried over the years but it still remains asignificant drug of abuse. In 2003, lifetimeprevalence of LSD use for 8th and 12th graderswas 2.1 and 5.9 percent, respectively.

The average effective oral dose is from 20 to 80micrograms with the effects of higher doses lastingfor 10 to 12 hours. LSD is usually sold in the formof impregnated paper (blotter acid), typicallyimprinted with colorful graphic designs. It has alsobeen encountered in tablets (microdots), thinsquares of gelatin (window panes), in sugar cubesand, rarely, in liquid form.

Physical reactions may includedilated pupils, lowered bodytemperature, nausea, “goosebumps,” profuse perspiration,increased blood sugar, and rapidheart rate. During the first hourafter ingestion, the user mayexperience visual changes withextreme changes in mood. In thehallucinatory state, the LSD usermay suffer impaired depth and timeperception, accompanied bydistorted perception of the size andshape of objects, movements, color,sound, touch, and the user’s ownbody image. During this period, theability to perceive objects throughthe senses is distorted: a user maydescribe “hearing colors” and“seeing sounds.” The ability tomake sensible judgments and see

52

High school students often purchase drugs from fellow students.

Drugs of Abuse

common dangers is impaired, making the usersusceptible to personal injury. After an LSD “trip,”the user may suffer acute anxiety or depression fora variable period of time. Flashbacks have beenreported days or even months after taking the lastdose.

Psilocybin & Psilocyn and otherTryptamines

A number of Schedule I hallucinogenic substancesare classified chemically as tryptamines. Most ofthese are found in nature but many, if not all, canbe produced synthetically. Psilocybin and psilocyn(4-hydroxy-N,N-dimethyltryptamine) are obtainedfrom certain mushrooms indigenous to tropical andsubtropical regions of South America, Mexico, andthe United States. As pure chemicals at doses of 10to 20 mg, these hallucinogens produce musclerelaxation, dilation of pupils, vivid visual andauditory distortions, and emotional disturbances.However, the effects produced by consumingpreparations of dried or brewed mushrooms are farless predictable and largely depend on theparticular mushrooms used and the age andpreservation of the extract. There are many speciesof “magic” mushrooms that contain varyingamounts of these tryptamines, as well as uncertainamounts of other chemicals. As a consequence, thehallucinogenic activity, as well as the extent oftoxicity produced by various plant samples, areoften unknown.

Dimethyltryptamine (DMT) N,N-Dimethyltryp-tamine has a long history of use and is found in avariety of plants and seeds. It can also be producedsynthetically. It is ineffective when taken orally,unless combined with another drug that inhibits itsmetabolism. Generally it is sniffed, smoked, orinjected. The effective hallucinogenic dose inhumans is about 50 to 100 mg and lasts for about45 to 60 minutes. Because the effects last onlyabout an hour; the experience has been referred toas a “businessman’s trip.”

A number of other hallucinogens have very similarstructures and properties to those of DMT.

Diethyltryptamine(DET) N,N-Die-thyltryptamine, forexample, is ananalogue of DMTand produces thesame pharmacolo-gical effects but issomewhat lesspotent than DMT.Alpha-ethyltryp-tamine (AET) isanother tryptaminehallucinogen addedto the list of Schedule I hallucinogens in 1994.Bufotenine (5-hydroxy-N,N-dimethyltryptamine) isa Schedule I substance found in certainmushrooms, seeds, and skin glands of Bufo toads.In general, most bufotenine preparations fromnatural sources are extremely toxic. N,N-Diisopropyl-5-methoxytryptamine (referred to asFoxy-Methoxy) is an orally active tryptaminerecently encountered in the United States.

Peyote & Mescaline

Peyote is a small, spineless cactus, Lophophorawilliamsii, whose principal active ingredient is thehallucinogen mescaline (3, 4, 5-trimethoxyphenethylamine). From earliestrecorded time, peyote has been used by natives innorthern Mexico and the southwestern UnitedStates as a part of their religious rites.

The top of the cactus above ground—also referredto as the crown—consists of disc-shaped buttonsthat are cut from the roots and dried. These buttonsare generally chewed or soaked in water to producean intoxicating liquid. The hallucinogenic dose ofmescaline is about 0.3 to 0.5 grams and lasts about12 hours. While peyote produced rich visualhallucinations that were important to the nativeAmerican peyote users, the full spectrum of effectsserved as a chemically induced model of mentalillness. Mescaline can be extracted from peyote orproduced synthetically. Both peyote and mescalineare listed in the CSA as Schedule I hallucinogens.

53

Peyote

Drugs of Abuse

Many chemical variations of mescaline andamphetamine have been synthesized for their “feelgood” effects. 4-Methyl-2,5-dimethoxy-amphetamine (DOM) was introduced into the SanFrancisco drug scene in the late 1960s and wasnicknamed STP; an acronym for “Serenity,Tranquility, and Peace.” Other illicitly producedanalogues include 4-bromo-2,5-dimethoxy-amphetamine (DOB) and 4-bromo-2,5-dimethoxy-phenethylamine (2C-B or Nexus). In 2000, para-methoxyamphetamine (PMA,) and para-methoxy-methamphetamine (PMMA) were identified intablets sold as Ecstasy. PMA, which first appearedon the illicit market briefly in the early 1970s, isassociated with a number of deaths in both theUnited States and Europe.

New Hallucinogens

A number of phenethylamine and tryptamineanalogues have been encountered on the illicitmarket. Those recently placed under federal controlinclude 2C-T-7 (dimethoxy-4-(n)-propylthio-phenethylamine), permanently placed in Schedule I inMarch 2004, and 5-MeO-DIPT (5-methoxy-diisopropyltryptamine) and AMT (alpha-methyltryptamine), which were placed in Schedule I

on an emergency basis in April 2003. In addition, anumber of other analogues are being encountered.These include DIPT (N,N-diiso-propyltryptamine), DPT (N,N-dipropyltryptamine),5-MeO-AMT (5-methoxy-alpha-methyltryptamine),MIPT (N,N-methylisopropyltryptamine) and 5-MeO-MIPT (5-Methoxy, N,N-methyliso-propyltryptamine) to name a few. While thesedrugs are not specifically listed under the CSA,individuals trafficking in these substances can beprosecuted under the Analogue Statute of the CSA.The ever-increasing number of these types ofhallucinogens being encountered by lawenforcement is a testament to the efforts ofindividuals to engage in profitable drug enterpriseswhile trying to avoid criminal prosecution.

MDMA (Ecstasy)and other Phenethylamines

3,4-Methylenedioxymethamphetamine (MDMA,Ecstasy) was first synthesized in 1912 butremained in relative obscurity for many years. Inthe 1980s, MDMA gained popularity as a drug ofabuse resulting in its final placement in Schedule Iof the CSA. Today, MDMA is extremely popular.In 2000, it was estimated that two million tabletswere smuggled into the United States every week.

54

MDMA (Ecstasy)tablets are sold inmany colors witha variety of logos

designed toattract young

abusers.

Drugs of Abuse

MDMA produces both amphetamine-likestimulation and mild mescaline-like hallucinations.It is touted as a “feel good” drug with anundeserved reputation of safety. MDMA produceseuphoria, increased energy, increased sensualarousal, and enhanced tactile sensations. However,it also produces nerve cell damage that can result inpsychiatric disturbances and long-term cognitiveimpairments. The user will often experienceincreased muscle tension, tremors, blurred vision,and hyperthermia. The increased body temperaturecan result in organ failure and death.

MDMA is usually distributed in tablet form andtaken orally at doses ranging from 50 to 200 mg.

Individual tablets are often imprintedwith graphic designs or commerciallogos, and typically contain 80-100mg of MDMA. After oraladministration, effects are felt within30 to 45 minutes, peak at 60 to 90minutes, and last for 4 to 6 hours.Analysisof seized MDMA tablets indicatesthat about 80 percent of all samplesactually contain MDMA. About 10percent of the MDMA-positivesamples also contain MDA (3,4-methylenedioxyam-phetamine) and MDEA (3,4-methylenedioxy-ethylamphetamine), while another10 percent contain amphetamine,methamphetamine, or both.Fraudulent MDMA tabletsfrequently contain combinations ofephedrine, dextromethorphan, andcaffeine or newer piperazinecompounds.

Hundreds of compounds can beproduced by making slightmodifications to thephenethylamine molecule. Some ofthese analogues are

pharmacologically active and differ from oneanother in potency, speed of onset, duration ofaction, and capacity to modify mood, with orwithout producing overt hallucinations. The drugsare usually taken orally, sometimes snorted, andrarely injected. Because they are produced inclandestine laboratories, they are seldom pure andthe amount in a capsule or tablet is likely to varyconsiderably.

According to the National Survey on Drug Use andHealth , initiation of Ecstasy use has increasedfrom 1993 until 2001, when it peaked at 1.8million new users. In 2002 the number declined to1.1 million. Two-thirds (66 percent) of newEcstasy users in 2002 were 18 or older, and 50percent were male.

55

Ecstasy is often purchased at “rave” partiesadvertised by colorful posters.

Drugs of Abuse

56

Phencyclidine and Related Drugs

In the 1950s, phencyclidine (PCP) was investigatedas an anesthetic but, due to the side effects ofconfusion and delirium, its development for humanuse was discontinued. It became commerciallyavailable for use as a veterinary anesthetic in the1960s under the trade name of Sernylan® and wasplaced in Schedule III of the CSA. In 1978, due toconsiderable abuse, phencyclidine was transferredto Schedule II of the CSA and manufacturing ofSernylan® was discontinued. Today, virtually all ofthe phencyclidine encountered on the illicit marketin the United States is produced in clandestinelaboratories.

PCP is illicitly marketed under a number of othernames, including Angel Dust, Supergrass, KillerWeed, Embalming Fluid, and Rocket Fuel,reflecting the range of its bizarre and volatileeffects. In its pure form, it is a white crystallinepowder that readily dissolves in water. However,most PCP on the illicit market contains a number ofcontaminants as a result of makeshiftmanufacturing, causing the color to range from tanto brown, and the consistency from powder to agummy mass. Although sold in tablets and capsulesas well as in powder and liquid form, it iscommonly applied to a leafy material, such asparsley, mint, oregano, or marijuana, and smoked.

The drug’s effects are as varied as its appearance. Amoderate amount of PCP often causes the user tofeel detached, distant, and estranged from hissurroundings. Numbness, slurred speech, and lossof coordination may be accompanied by a sense ofstrength and invulnerability. A blank stare, rapidand involuntary eye movements, and anexaggerated gait are among the more observableeffects. Auditory hallucinations, image distortion,severe mood disorders, and amnesia may alsooccur. In some users, PCP may cause acute anxietyand a feeling of impending doom; in others,paranoia and violent hostility; and in some, it mayproduce a psychosis indistinguishable fromschizophrenia. PCP use is associated with anumber of risks, and many believe it to be one ofthe most dangerous drugs of abuse.

Modification of the manufacturing process may yieldchemically related analogues capable of producingpsychic effects similar to PCP. Four of thesesubstances N-ethyl-l-phenylcyclohexylamine or PCE,l-(phenylcyclohexyl)pyrrolidine or PCPy, l-[l-(2-thienyl)cyclohexyl]piperdine or TCP, and l-[l-(2-thienyl)cyclohexyl]pyrrolidine or TCPy have beenencountered on the illicit market and have beenplaced in Schedule I of the CSA. Telazol®, aSchedule III veterinary anesthetic containingtiletamine (a PCP analogue), in combination withzolazepam, (a benzodiazepine), is sporadicallyencountered as a drug of abuse.

Ketamine

Ketamine is a rapidly acting general anesthetic. Itspharmacological profile is essentially the same asphencyclidine. Like PCP, ketamine is referred to asa dissociative anesthetic because patients feel

Ketamine.

Ketamine powder is clandestinely sold at “rave”parties and is usually snorted.

Drugs of Abuse

detached or disconnected from their pain andenvironment when anesthetized with this drug.Unlike most anesthetics, ketamine produces onlymild respiratory depression and appears tostimulate, not depress, the cardiovascular system.In addition, ketamine has both analgesic andamnesic properties and is associated with lessconfusion, irrationality, and violent behavior thanPCP. Use of ketamine as a general anesthetic forhumans has been limited due to adverse effectsincluding delirium and hallucinations. Today, it isprimarily used in veterinary medicine, but hassome utility for emergency surgery in humans.

Although ketamine has been marketed in theUnited States for many years, it was only recentlyassociated with significant diversion and abuse andplaced in Schedule III of the CSA in 1999. Knownin the drug culture as “Special K” or “Super K,”ketamine has become a staple at dance parties or

“raves.” Ketamine is supplied to the illicit market bythe diversion of legitimate pharmaceuticals(Ketaset®, Ketalar®). It is usually distributed as apowder obtained by removing the liquid from thepharmaceutical products. As a drug of abuse,ketamine can be administered orally, snorted, orinjected. It is also sprinkled on marijuana ortobacco and smoked. After oral or intranasaladministration, effects are evident in about 10 to 15minutes and are over in about an hour.

After intravenous use, effects begin almostimmediately 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. Intermediatedoses produce disorganized thinking, altered bodyimage, and a feeling of unreality with vivid visualhallucinations. High doses produce analgesia,amnesia, and coma.

57 Drugs of Abuse

Drugs of Abuse

Chapter 9

Inhalants are a diverse group of substances thatinclude volatile solvents, gases, and nitrites that aresniffed, snorted, huffed, or bagged to produceintoxicating effects similar to alcohol. Thesesubstances are found in common householdproducts like glues, lighter fluid, cleaning fluids,and paint products. Inhalant abuse is the deliberateinhaling or sniffing of these substances to get high,and it is estimated that about 1,000 substances aremisused in this manner. The easy accessibility, lowcost, legal status, and ease of transport andconcealment make inhalants one of the firstsubstances abused by children.

According to the National Survey on Drug Use andHealth, there were over 1 million new inhalantusers in 2002. During 2003, almost 23 million(9.7%) persons ages 12 and older reported using aninhalant at least once in their lifetime. The 2003Monitoring the Future Study from the University ofMichigan reported that 8.7 percent of 8th graders,5.4 percent of 10th graders, and 3.9 percent of 12thgraders used inhalants in the past year. The studyalso showed that 4.1 percent of 8th graders, 2.2percent of 10th graders, and 1.6 percent of 12thgraders used inhalants in the past month.

The highest incidence of use is among 10 to 12year old children with rates of use declining withage. Parents worry about alcohol, tobacco, anddrug use but may be unaware of the hazardsassociated with products found throughout theirhomes. Knowingwhat these productsare, how they mightbe harmful, andrecognizing the signsand symptoms oftheir use asinhalants, can help aparent preventinhalant abuse.

For example,volatile solvents arefound in a number ofeveryday products.Some of theseproducts include nail polish remover, lighter fluid,gasoline, paint and paint thinner, rubber glue,waxes, and varnishes. Chemicals found in theseproducts include toluene, benzene, methanol,methylene chloride, acetone, methyl ethyl ketone,

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Many types of household glues contain harmfulvapors that are inhaled when placed in bags orspread inside of a painters face mask.

Drugs of Abuse

methyl butyl ketone, trichloroethylene, andtrichlorethane. The gas used as a propellant incanned whipped cream and in small lavendermetallic containers called “whippets” (used tomake whipped cream) is nitrous oxide or “laughinggas”—the same gas used by dentists for anesthesia.Tiny cloth-covered ampules, called poppers orsnappers by abusers, contain amyl nitrite, amedication used to dilate blood vessels. Butylnitrite, sold as tape head cleaner and referred to as“rush,” “locker room,” or “climax,” is often sniffedor huffed to get high.

Inhalants may be sniffed directly from an opencontainer or huffed from a rag soaked in thesubstance and held to the face. Alternatively, theopen container or soaked rag can be placed in a bagwhere the vapors can concentrate before beinginhaled. Some chemicals are painted on the handsor fingernails or placed on shirt sleeves or wristbands to enable an abuser to continually inhale thefumes without being detected by a teacher or otheradult. Although inhalant abusers may prefer oneparticular substance because of taste or odor, avariety of substances may be used because ofsimilar effects, availability, and cost. Once thesubstance is inhaled, the extensive capillary surfaceof the lungs allows rapid absorption of thesubstance, and blood levels peak rapidly. Entryinto the brain is fast, and the intoxicating effects areshort-lived but intense.

Inhalants depress the central nervous system,producing decreased respiration and bloodpressure. Users report distortion in perceptions oftime and space. Many users experience headaches,nausea, slurred speech, and loss of motorcoordination. Mental effects may include fear,anxiety, or depression. A rash around the nose andmouth may be seen, and the abuser may startwheezing. An odor of paint or organic solvents onclothes, skin, and breath is sometimes a sign ofinhalant abuse. Other indicators of inhalant abuseinclude slurred speech or staggering gait, red,glassy, watery eyes, and excitability orunpredictable behavior.

The chronic use of inhalants has been associatedwith a number of serious health problems. Sniffingglue and paint thinner causes kidney abnormalities,while sniffing the solvents toluene andtrichloroethylene cause liver damage. Memoryimpairment, attention deficits, and diminished non-verbal intelligence have been related to the abuse ofinhalants. Deaths resulting from heart failure,asphyxiation, or aspiration have occurred.

For more information regarding inhalants, contactthe National Inhalant Prevention Coalition bytelephone (1-800-269-4237) or by the Internet(www.inhalants.org).

59

Left. Vapors from pocket lightersare inhaled or “huffed” through thenostrils. These lighters are cheapand easily concealed.

Right. Markers are placed in asandwich bag and then stepped onand crushed to breath the vapors.

Drugs of Abuse

Chapter 10

When athletes gather the issue of performanceenhancing drugs, especially anabolic steroids, onceagain gained international attention. These drugsare used by high school, college, professional, andelite amateur athletes in a variety of sports (e.g.,weight lifting, track and field, swimming, cycling,and others) to obtain a competitive advantage.Body builders and fitness buffs take anabolicsteroids to improve their physical appearance, andindividuals in occupations requiring enhancedphysical strength (e.g., body guards, night clubbouncers, construction workers) are also known touse these drugs.

Concerns over a growing illicit market, abuse byteenagers, and the uncertainty of possible harmfullong-term effects of steroid use, led Congress in1991 to place anabolic steroids as a class of drugsinto Schedule III of the Controlled Substances Act(CSA). The CSA defines anabolic steroids as anydrug or hormonal substance chemically andpharmacologically related to testosterone (otherthan estrogens, progestins, and corticosteroids) thatpromotes muscle growth.

Once viewed as a problem associated only withprofessional and elite amateur athletes, variousreports indicate that anabolic steroid abuse hasincreased significantly among adolescents.According to the 2003 Monitoring the FutureStudy, 2.5 percent of 8th graders, 3.0 percent of10th graders, and 3.5 percent of 12th gradersreported using steroids at least once in theirlifetime.

Most illicit anabolic steroids are sold at gyms,competitions, and through mail-order operations.For the most part, these substances are smuggledinto the United States from many countries. Theillicit market includes various preparationsintended for human and veterinary use as well asbogus and counterfeit products. The mostcommonly encountered anabolic steroids on theillicit market include testosterone, nandrolone,methenolone, stanozolol, and methandrostenolone.Other steroids seen in the illicit market includeboldenone, fluoxymesterone, methandriol,methyltestosterone, oxandrolone, oxymetholone,and trenbolone.

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Drugs of Abuse 61

A limited number of anabolic steroids have beenapproved for medical and veterinary use. Theprimary legitimate use of these drugs in humans isfor the replacement of inadequate levels oftestosterone resulting from a reduction or absence offunctioning testes. Other indications includeanemia and breast cancer. Experimentally, anabolicsteroids have been used to treat a number ofdisorders including AIDS wasting, erectiledysfunction, and osteoporosis. In veterinarypractice, anabolic steroids are used to promote feedefficiency and to improve weight gain, vigor, andhair coat. They are also used in veterinary practiceto treat anemia and counteract tissue breakdownduring illness and trauma.

When used in combination with exercise trainingand a high protein diet, anabolic steroids canpromote increased size and strength of muscles,improve endurance, and decrease recovery timebetween workouts. They are taken orally or byintramuscular injection. Users concerned aboutdrug tolerance often take steroids on a schedulecalled a cycle. A cycle is a period of between 6 and14 weeks of steroid use, followed by a period ofabstinence or reduction in use. Additionally, userstend to “stack” the drugs, using multiple drugsconcurrently. Although the benefits of thesepractices are unsubstantiated, most users feel thatcycling and stacking enhance the efficiency of thedrugs and limit their side effects.

Another mode of steroid use is called “pyramiding.”With this method users slowly escalate steroid use(increasing the number of drugs used at one timeand/or the dose and frequency of one or moresteroids), reach a peak amount at mid-cycle andgradually taper the dose toward the end of the cycle.The escalation of steroid use can vary with differenttypes of training. Body builders and weight lifterstend to escalate their dose to a much higher levelthan do long distance runners or swimmers.

The long-term adverse health effects of anabolicsteroid use are not definitely known. There is,however, increasing concern of possible serioushealth problems associated with the abuse of these

agents, including cardiovascular damage,cerebrovascular toxicity, and liver damage.

Physical side effects include elevated bloodpressure and cholesterol levels, severe acne,premature balding, reduced sexual function, andtesticular atrophy. In males, abnormal breastdevelopment (gynecomastia) can occur. In females,anabolic steroids have a masculinizing effect,resulting in more body hair, a deeper voice, smallerbreasts, and fewer menstrual cycles. Several ofthese effects are irreversible. In adolescents, abuseof these agents may prematurely stop thelengthening of bones, resulting in stunted growth.For some individuals, the use of anabolic steroidsmay be associated with psychotic reactions, manicepisodes, feelings of anger or hostility, aggression,and violent behavior.

A variety of non-steroid drugs are commonly foundwithin the illicit anabolic steroid market. Thesesubstances are primarily used for one or more ofthe following reasons: 1) to serve as an alternativeto anabolic steroids; 2) to alleviate short-termadverse effects associated with anabolic steroid use;or 3) to mask anabolic steroid use. Examples ofdrugs serving as alternatives to anabolic steroidsinclude clenbuterol, human growth hormone,insulin, insulin-like growth factor, and GHB.Drugs used to prevent or treat adverse effects ofanabolic steroid use include tamoxifen, diuretics,and human chorionic gonadotropin. Diuretics,probenocid, and epitestosterone may be used tomask anabolic steroid use.

Over the last few years, a number of precursors toeither testosterone or nandrolone have beenmarketed as dietary supplements in the UnitedStates. Some of these substances includeandrostenedione, androstenediol,norandrostenedione, norandrostenediol, anddehydroepiandrosterone (DHEA). New legislationhas been introduced in Congress to add severalsteroids to the CSA and to alter the CSArequirements needed to place new steroids undercontrol in the CSA.

Drugs of Abuse

Steroids Identification

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The 22 controlled steroid substances are sold underhundreds of brand names. This is just a sampling.

Alabama AlabamaCounterdrug Coordinator Drug Demand Reduction Administrator1750 Congressman Dickinson, PO Box 3711 1750 Congressman Dickinson, PO Box 3711Montgomery, AL 36109 Montgomery, AL 36109(334) 213-7658 (334) 213-7724

Alaska AlaskaCounterdrug Coordinator Drug Demand Reduction AdministratorPO Box 5800, Bldg 60802, Camp Carroll PO Box 5800, Bldg 60802, Camp CarrollFt. Richardson, AK 99505 Ft. Richardson, AK 99505(907) 428-3617 (907) 428-3617

Arizona ArizonaCounterdrug Coordinator Drug Demand Reduction Administrator5636 E. McDowell Road 5636 E. McDowell RoadPhoenix, AZ 85008 Phoenix, AZ 85008(602) 267-2623 (602) 267-2901

Arkansas ArkansasCounterdrug Coordinator Drug Demand Reduction AdministratorDOMS-CD, Bldg 16412, Camp JT Robinson DOMS-CD, Bldg 16412, Camp JT RobinsonN. Little Rock, AR 72199 N. Little Rock, AR 72199(501) 791-5492 (501) 212-5484

California CaliforniaCounterdrug Coordinator Drug Demand Reduction Administrator10293 Rockingham Drive 10293 Rockingham DriveSacramento, CA 95827 Sacramento, CA 95827(916) 854-3715 (916) 854-3889

Colorado ColoradoCounterdrug Coordinator Drug Demand Reduction Administrator55 S. Potomac Street 55 S. Potomac StreetAurora, CO 80012 Aurora, CO 80012(303) 677-8303 (303) 677-8303

Connecticut ConnecticutCounterdrug Coordinator Drug Demand Reduction Administrator360 Broad Street 360 Broad StreetHartford, CT 06105 Hartford, CT 06105(860) 493-2723 (860) 493-2724

National GuardCounterdrug Coordinators

National GuardDemand Reduction Administrators

Drugs of Abuse

Drugs of Abuse 63

Delaware DelawareCounterdrug Coordinator Drug Demand Reduction AdministratorFirst Regiment Road HQ, DEARNG, First Regiment RoadWilmington, DE 19808 Wilmington, DE 19808(302) 326-7085 (302) 326-7079

District of Columbia District of ColumbiaCounterdrug Coordinator Drug Demand Reduction Administrator2001 E. Capital Street 2001 E. Capital StreetWashington, DC 20003 Washington, DC 20003(202) 685-9726 (202) 685-9723

Florida FloridaCounterdrug Coordinator Drug Demand Reduction AdministratorPOMSO-CD, 2305 State Rd #207 POMSO-CD/DDR, 2305 State Rd #207St. Augustine, FL 32086 St. Augustine, FL 32086(904) 823-0438 (904) 823-0355

Georgia GeorgiaCounterdrug Coordinator Drug Demand Reduction AdministratorJOPS-CD, 1651 Perry Street, Bldg 826 JOPS-CD, 1651 Perry Street, Bldg 826Dobbins ARB, GA 30069 Dobbins ARB, GA 30069(678) 919-3473 (770) 919-3475

Guam GuamCounterdrug Coordinator Drug Demand Reduction Administrator622 E. Harmon Ind Park Road 622 E. Harmon Ind Park RoadFort Juan Muna Fort Juan MunaTamuning, GU 96911 Tamuning, GU 96911(671) 472-7588 (671) 475-0834

Hawaii HawaiiCounterdrug Coordinator Drug Demand Reduction Administrator3949 Diamond Head Road 3949 Diamond Head RoadHonolulu, HI 96816 Honolulu, HI 96816(808) 732-0209 (808) 732-0209

Idaho IdahoCounterdrug Coordinator Drug Demand Reduction Administrator4736 Kennedy Street, Bldg T-927 4736 Kennedy Street, Bldg T-927Boise, ID 83705 Boise, ID 83705(208) 422-3530 (208) 422-3534

Illinois IllinoisCounterdrug Coordinator Drug Demand Reduction Administrator1301 N. MacArthur Blvd, Camp Lincoln 1301 N. MacArthur Blvd, Camp LincolnSpringfield, IL 62702 Springfield, IL 62702(217) 761-3728 (773) 288-5482

Drugs of Abuse64



Indiana IndianaCounterdrug Coordinator Drug Demand Reduction Administrator3766 W. Morris Street IN Nat’l Guard, c/o HIDTA, PO Box 420Indianapolis, IN 46241 Crown Point, IN 46308(317) 486-8291 (219) 769-7679

Iowa IowaCounterdrug Coordinator Drug Demand Reduction Administrator7700 NW Beaver Drive 7700 NW Beaver DriveJohnston, IA 50131 Johnston, IA 50131(515) 252-4606 (515) 252-4190

Kansas KansasCounterdrug Coordinator Drug Demand Reduction AdministratorPO Box 19012, Bldg 684, Forbes Field PO Box 19012, Bldg 684, Forbes FieldPauline, KS 66619 Pauline, KS 66619(785) 862-0001 (785) 862-0001

Kentucky KentuckyCounterdrug Coordinator Drug Demand Reduction AdministratorJoint Spt Opns, 5751 Briar Hill Rd Bluegrass Sta, Bldg 26, 5751 Briar Hill RdLexington, KY 40512 Lexington , KY 40516(859) 293-4192 (859) 293-3900

Louisiana LouisianaCounterdrug Coordinator Drug Demand Reduction AdministratorLANG-POTO-CD, Bldg 35, Jackson Barracks Bldg 35, Rm 251, Jackson BarracksNew Orleans, LA 70146 New Orleans, LA 70146(504) 278-8556 (504) 278-8555

Maine MaineCounterdrug Coordinator Drug Demand Reduction Administrator74 Drummond Avenue 74 Drummond AvenueWaterville, MA 04091 Waterville, MA 04091(207) 873-4727 (207) 873-4727

Maryland MarylandCounterdrug Coordinator Drug Demand Reduction Administrator29th Div St, 5th Regt Armory 29th Div St, 5th Regt ArmoryBaltimore, MD 21201 Baltimore, MD 21201(410) 576-6135 (410) 576-6137

Massachusetts MassachusettsCounterdrug Coordinator Drug Demand Reduction Administrator50 Maple Street 50 Maple StreetMilford, MA 01757 Milford, MA 01757(508) 233-6804 (508) 233-6834

Drugs of Abuse 65



Michigan MichiganCounterdrug Coordinator Drug Demand Reduction Administrator2500 S. Washington Avenue 2500 S. Washington AvenueLansing, MI 48913 Lansing, MI 48913(517) 483-5896 (517) 483-5601

Minnesota MinnesotaCounterdrug Coordinator Drug Demand Reduction AdministratorMNAG-MSO-CDC, 20 W. 12th St MNAG-MSO-CDC, 20 W. 12th StSt. Paul, MN 55155 St. Paul, MN 55155(651) 282-4147 (651) 282-4149

Mississippi MississippiCounterdrug Coordinator Drug Demand Reduction AdministratorNGMS-OTO-DS, 550 Keyway Dr. 550 Keyway Dr.Flowood, MS 39233 Flowood, MS 39233(601) 313-1670 (601) 313-1670

Missouri MissouriCounterdrug Coordinator Drug Demand Reduction AdministratorMONG CD Program, 2302 Militia Drive MONG CD Program, 2302 Militia DriveJefferson City, MO 65101 Jefferson City, MO 65101(573) 638-9599 (816) 512-4990

Montana MontanaCounterdrug Coordinator Drug Demand Reduction Administrator1900 Williams St, PO Box 4789 1900 Williams St, PO Box 4789Helena, MT 59604 Helena, MT 59604(406) 324-3177 (406) 324-3179

Nebraska NebraskaCounterdrug Coordinator Drug Demand Reduction AdministratorDCSOPS-CD, 1300 Military Road DCSOPS-CD, 1300 Military RoadLincoln, NE 68505 Lincoln, NE 68505(402) 309-1860 (402) 309-1875

Nevada NevadaCounterdrug Coordinator Drug Demand Reduction Administrator685 East Plum Lane 685 East Plum LaneReno, NV 89502 Reno, NV 89502(775) 348-9724 (775) 348-9749

New Hampshire New HampshireCounterdrug Coordinator Drug Demand Reduction AdministratorState Military Reservation State Military ReservationConcord, NH 03301 Concord, NH 03301(603) 227-1542 (603) 228-3364

Drugs of Abuse66



New Jersey New JerseyCounterdrug Coordinator Drug Demand Reduction AdministratorPOTO-CDTF, Bldg 3650, Saylors Pond Rd POTO-CDTF, Bldg 3650, Saylors Pond RdFt. Dix, NJ 08640 Ft. Dix, NJ 08640(609) 562-0812 (201) 368-0583

New Mexico New MexicoCounterdrug Coordinator Drug Demand Reduction AdministratorPO Box 5610 PO Box 5610Albuquerque, NM 87185 Albuquerque, NM 87185(505) 846-1031 (505) 846-7234

New York New YorkCounterdrug Coordinator Drug Demand Reduction Administrator109th AG, 1 Air National Guard Rd 109th AG, Air National Guard RdScotia, NY 12302 Scotia, NY 12302(518) 786-3477 (518) 786-3478

North Carolina North CarolinaCounterdrug Coordinator Drug Demand Reduction Administrator4105 Reedy Creek Road 145 AW, 5225 Morris Field DriveRaleigh, NC 27607 Charlotte, NC 28208(919) 664-6322 (704) 391-4424

North Dakota North DakotaCounterdrug Coordinator Drug Demand Reduction AdministratorFraine Barracks, Bldg 040, PO Box 5511 Fraine Barracks, Bldg 040, PO Box 5511Bismarck, ND 58502 Bismarck, ND 58502(701) 333-2050 (701) 333-2054

Ohio OhioCounterdrug Coordinator Drug Demand Reduction Administrator8302 South Perimeter Road 8302 South Perimeter RoadColumbus, OH 43217-5931 Columbus, OH 43217-5931(614) 336-6426 (614) 336-6432

Oklahoma OklahomaCounterdrug Coordinator Drug Demand Reduction AdministratorOK-POT-MS-CD, 3501 Military Cir NE OK-POT-MS-CD, 3501 Military Cir NEOklahoma City, OK 73111 Oklahoma City, OK 73111(405) 228-5043 (405) 475-1491

Oregon OregonCounterdrug Coordinator Drug Demand Reduction AdministratorPO Box 12889 PO Box 12889Salem, OR 97309 Salem, ,OR 97309(503) 584-3938 (503) 584-3351

Drugs of Abuse 67



Pennsylvania PennsylvaniaCounterdrug Coordinator Drug Demand Reduction AdministratorFt Indiantown Gap, Bldg 8-64 Ft Indiantown Gap, Bldg 8-64Annville, PA 17003 Annville, PA 17003(717) 861-2482 (717) 861-2231

Puerto Rico Puerto RicoCounterdrug Coordinator Drug Demand Reduction AdministratorPO Box 9023786, Stop 3 1/2, Puerta de Tierra PO Box 9023786, Stop 3 1/2, Puerta de TierraSan Juan, PR 00902-3786 San Juan, PR 00902-3786(787) 289-1548 (787) 289-1548

Rhode Island Rhode IslandCounterdrug Coordinator Drug Demand Reduction Administrator570 Read School House Road 570 Read School House RoadCoventry, RI 02816 Coventry, RI 02816(401) 392-0827 (401) 392-0830

South Carolina South CarolinaCounterdrug Coordinator Drug Demand Reduction AdministratorTAG-CS-CD, 1 Nat’l Guard Rd, Stop 24 TAG-CS-CD, 1 Nat’l Guard Rd, Stop 24Columbia, SC 29201 Columbia, SC 29201(803) 806-1559 (803) 806-2623

South Dakota South DakotaCounterdrug Coordinator Drug Demand Reduction AdministratorSDMSCA-CD, 2823 W Main Street SDMSCA-CD, 2823 W Main StreetRapid City, SD 57702 Rapid City, SD 57702(605) 737-6723 (605) 737-6602

Tennessee TennesseeCounterdrug Coordinator Drug Demand Reduction AdministratorBldg 603, Fitzhugh Blvd, Volunteer Tng Site Bldg 603, Fitzhugh Blvd, Volunteer Tng SiteSmyrna, TN 37167 Smyrna, TN 37167(615) 355-3901 (615) 355-3902

Texas TexasCounterdrug Coordinator Drug Demand Reduction AdministratorPO Box 5218, Bldg 10, Camp Mabry PO Box 5218, Bldg 10, Camp MabryAustin, TX 78763 Austin, TX 78763(512) 782-5154 (512) 782-5238

Utah UtahCounterdrug Coordinator Drug Demand Reduction Administrator12953 S. Minuteman Drive 17800 Camp Williams Rd, Bldg 605Draper, UT 84020 Riverton, UT 84065(801) 523-4150 (801) 253-5521

Drugs of Abuse68



Vermont VermontCounterdrug Coordinator Drug Demand Reduction AdministratorVT NG, Green Mtn Armory, Camp Johnson VT NG, Green Mtn Armory, Camp JohnsonColchester, VT 05446 Colchester, VT 05446(802) 338-3350 (802) 338-3440

Virginia VirginiaCounterdrug Coordinator Drug Demand Reduction AdministratorVAOT-CDC, Bldg 473, Ft Pickett VAOT-CDC, Bldg 316, Ft PickettBlackstone, VA 23824 Blackstone, VA 23824(804) 292-8529 (434) 292-8522

Virgin Islands Virgin IslandsCounterdrug Coordinator Drug Demand Reduction Administrator4031 Lagrande Princesse Lot 1B 4031 Lagrande Princesse Lot 1BChristianstead ChristiansteadSt. Croix, VI 00820 St. Croix, VI 00820(340) 712-7772 (340) 712-7772

Washington WashingtonCounterdrug Coordinator Drug Demand Reduction AdministratorDCSOPS-CDTF, Camp Murray, Bldg 33 DCSOPS-CDTF, Camp Murray, Bldg 34Tacoma, WA 98430 Tacoma, WA 98430(253) 512-8894 (253) 512-8355

West Virginia West VirginiaCounterdrug Coordinator Drug Demand Reduction Administrator101 High Street 101 High StreetSt. Albans, WV 25177 St. Albans, WV 25177(304) 727-5068 (304) 727-5068

Wisconsin WisconsinCounterdrug Coordinator Drug Demand Reduction Administrator2400 Wright St, PO Box 8111 2400 Wright St, PO Box 8111Madison, WI 53704 Madison, WI 53704(608) 242-3540 (608) 242-3540

Wyoming WyomingCounterdrug Coordinator Drug Demand Reduction AdministratorDCSOPS-CDC, 5500 Bishop Blvd DCSOPS-DDR, 5500 Bishop BlvdCheyenne, WY 82009 Cheyenne, WY 82009(307) 772-5259 (307) 772-5959

69 Drugs of Abuse



Drugs of Abuse70

DIVISION OFFICES

ATLANTA DIVISION(GEORGIA, SOUTH CAROLINA,NORTH CAROLINA, TENNESSEE)Atlanta, GA Division Office75 Spring Street SWSuite 800Atlanta, GA 30303404-893-7124/7123

COLUMBIA, SC DISTRICT OFFICE(SOUTH CAROLINA)1835 Assembly StreetSuite 1229Columbia, SC 29201803-765-5251

NASHVILLE, TN DISTRICT OFFICE(TENNESSEE)Estes Kefauver Bldg.FB-USCH801 Broadway, Suite 500Nashville, TN 37203615-736-2952

AVIATION(OFFICE OF AVIATION OPERATIONS)USDEA Aviation Operations Center2300 Horizon RoadFt. Worth, TX 76177-5300817-837-2028

CARIBBEAN DIVISION(PUERTO RICO, VIRGIN ISLANDS, BARBADOS,DOMINICAN REPUBLIC, HAITI, JAMAICA,TRINIDAD & TOBAGO, CURACAO)San Juan, P.R. Division OfficeP.O. Box 2167San Juan, Puerto Rico 00922-2167787-775-1736

DEA Demand Reduction Coordinators

Drugs of Abuse

CHICAGO DIVISION(NORTHERN AND CENTRAL ILLINOIS, INDIANA,WISCONSIN, MINNESOTA, NORTH DAKOTA)Chicago, IL Division Office320 S. Dearborn StreetSuite 1200Chicago, IL 60604312-8865241

MINNEAPOLIS/ST. PAUL DISTRICT OFFICE330 Second Avenue SouthSuite 450Minneapolis, MN 55401-2224612-348-1712

DALLAS DIVISION(NORTHERN TEXAS, OKLAHOMA)Dallas, TX Division Office10160 Technology Blvd. EastDallas, TX 75220214-366-6970

DETROIT DIVISION(MICHIGAN, OHIO, KENTUCKY)Detroit, MI Division Office431 Howard StreetDetroit, MI 48226313-234-4310

LOUISVILLE, KY DISTRICT OFFICE(KENTUCKY)1006 Federal Building600 Martin Luther King PlaceLouisville, KY 40202502-582-5908 ext 106

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EL PASO DIVISION(SOUTHWESTERN TEXAS, NEW MEXICO)El Paso, TX Division Office660 N. Mesa HillsSuite 2000El Paso, TX 79912915-832-6233

ALBUQUERQUE, NM DISTRICT OFFICE301 Martin Luther King Ave., N.E.Albuquerque, NM 79912505-346-7419

EPIC(INTELLIGENCE SUPPORT WORLDWIDE)11339 SSG Sims StreetEl Paso, TX 79912915-760-2013

HOUSTON DIVISION(SOUTHEASTERN & SOUTH-CENTRAL TEXAS)Houston, TX Division Office1433 West Loop SouthHouston, Texas 77027-9506713-693-3152/3153

LOS ANGELES DIVISION(CENTRAL CALIFORNIA, NEVADA, & HAWAII)Los Angeles, CA Division Office255 East Temple Street20th FloorLos Angeles, CA 90012213-621-6768

HONOLULU, HI DISTRICT OFFICE(HAWAII, GUAM, SIAPAN)P.O. Box 50163Honolulu, HI 96850808-541-3053

LAS VEGAS, NEVADA DISTRICT OFFICE550 South Main StreetSuite ALas Vegas, NV 89101702-759-8117


MIAMI DIVISION(FLORIDA & THE BAHAMAS)Miami, FL Division Office8400 N.W. 53rd StreetMiami, FL 33166305-994-4604

NEWARK DIVISION(NEW JERSEY)Newark, NJ Division Office80 Mulberry StreetNewark, NJ 07102973-273-5095

NEW ENGLAND DIVISION(CONNECTICUT, MAINE, MASSACHUSETTS,NEW HAMPSHIRE, RHODE ISLAND, VERMONT)

SPRINGFIELD, MA RESIDENT OFFICE (BOSTON)(CONNECTICUT, MASSACHUSETTS, RHODE ISLAND)1441 Main Street, 10th FloorSpringfield, MA 01103413-785-0284 ext. 203

MANCHESTER, NH RESIDENT OFFICE(MAINE, NEW HAMPSHIRE, VERMONT)197 LoundonConcord, NH 03301603-225-1574 ext. 112

NEW ORLEANS DIVISION(ALABAMA, ARKANSAS, LOUISIANA,MISSISSIPPI)New Orleans, LA Division Office3838 North Causeway Blvd.Suite 1800Metairie, LA 70002504-840-1032

LITTLE ROCK, AR DISTRICT OFFICE(ARKANSAS)10825 Financial Centre Pkwy.Building #2, Suite 200Little Rock, AR 72211501-312-8613

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NEW YORK DIVISION(NEW YORK)New York, NY Division Office99 Tenth Avenue, 8th FloorNew York, NY 10011212-337-1266

PHILADELPHIA DIVISION(PENNSYLVANIA & DELAWARE)Philadelphia, PA Division Office600 Arch Street, Suite 10224Philadelphia, PA 19106215-861-3291

PHOENIX DIVISION(ARIZONA)Phoenix, AZ Division Office3010 North Second StreetSuite 301Phoenix, AZ 85012602-664-5657

ROCKY MOUNTAIN DIVISION (DENVER)(COLORADO, UTAH, MONTANA, WYOMING)Denver, CO Division Office115 Inverness Drive EastEnglewood, CO 80112-5116303-705-7340

SALT LAKE CITY, UT DISTRICT OFFICE348 East South TempleSalt Lake City, UT 84111801-524-4353

BILLINGS, MT RESIDENT OFFICE303 North Broadway, Suite 302Billings, MT 59101406-657-6020

ST. LOUIS DIVISION(IOWA, KANSAS, MISSOURI, NEBRASKA,SOUTH DAKOTA, SOUTHERN ILLINOIS)St. Louis, MO Division Office317 South 16th StreetSt. Louis, MO 63103314-538-4752


OMAHA, NE DISTRICT OFFICE2707 North 108th StreetSuite D-201Omaha, NE 68164

KANSAS CITY, MO DISTRICT OFFICEMidwest HIDTA10220 NW Ambassador DriveKansas City, MO 64153816-746-4962 ext. 250

SAN DIEGO DIVISION(SOUTHERN CALIFORNIA)San Diego, CA Division Office4560 Viewridge AvenueSan Diego, CA 92123858-616-4410

SAN FRANCISCO DIVISION(NORTHERN CALIFORNIA)San Francisco, CA Division Office450 Golden Gate AvenueRoom 12215San Francisco, CA 94102415-436-7851

SACRAMENTO, CA DISTRICT OFFICE(SACRAMENTO)Sacramento District Office4328 Watt AvenueSacramento, CA 95660916-480-7154

SEATTLE DIVISION(WASHINGTON, OREGON, IDAHO, ALASKA)Seattle, WA Division Office400 2nd Avenue WestSeattle, WA 98119206-553-2824

PORTLAND, OR DISTRICT OFFICE(OREGON)1220 SW Third AvenueRoom 1525Portland, OR 97204503-326-2466

WASHINGTON DIVISION(WASHINGTON, DC, MARYLAND,VIRGINIA, & WEST VIRGINIA)Washington, DC Division Office801 I Street NW, Room 514Washington, DC 20024202-305-8259

HEADQUARTERS, DEMAND REDUCTION SECTIONARLINGTON, VIRGINIAPhone: 202-307-7936


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NDIC Washington Liaison Office8201 Greensboro Drive, Suite 1001

McLean, VA 22102-3840Telephone: 703-556-8970

Fax: 703-556-7807

The National Drug Intelligence Center (NDIC), established in1993, is a component of the U.S. Department of Justice and the

nation’s principal center for strategic domestic counterdrugintelligence.

Document andComputerExploitation(Doc Ex)NDIC supports major druginvestigations by quicklyanalyzing information to expediteevidence processing. Doc Exteams in reviewing seizeddocuments and electronic mediause the Real-time AnalyticalIntelligence Database (RAID) toidentify hidden assets, previouslyunknown associates, and otherleads for further investigation.Investigators and prosecutors areprovided with a fully sourcedsummary report of the keyfindings in about a week’s time.

CounterdrugAnalysisTrainingNDIC provides a 1-week counterdruganalysis training course at no cost forfederal, state, and local lawenforcement personnel via videoteleconferencing to networkeddistance learning sites in four cities,four times per year.

Strategic DrugThreatAssessmentsNDIC produces national,regional, and state drug threatassessments to providepolicymakers and law enforce-ment officials with timely,predictive reports of the threatposed by illicit drugs in theUnited States. The reportshighlight the most currentinformation on availability,demand, production andcultivation, transportation, anddistribution of illicit drugs in theUnited States.

Narcotics DigestWeeklyNDIC publishes a weekly digestof current intelligence, indica-tions and warnings of emergingdrug trends. Law enforcementofficials, drug treatmentproviders and educators mayreceive the digest by e-mail or inhard copy.

For more information on NDIC's products and services:Telephone: 814-532-4601 Internet: www.usdoj.gov/ndic ADNET: http://ndicosaE-mail: [email protected] LEO: home.leo.gov/lesig/ndic RISS: ndic.riss.net

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Conversion Tables

Length1 inch = 25.4 millimeters1 foot = 30 centimeters1 yard = 0.9 meters1 mile = 1.6 kilometers

Area1 square inch = 6.5 sq. centimeters1 square foot = 0.09 sq. meter1 square mile = 2.6 sq. kilometers1 acre = 0.4 hectare

1 square cm = 0.16 sq. inches1 square meter = 1.2 sq. yards1 square km = 0.4 sq. miles1 hectare = 2.5 acres

Mass & Weight1 pound = 0.4536 kilograms1 short ton = 0.9 metric tons1 kilogram = 2.2 pounds1 metric ton = 1.1 short ton

Liquid Volume1 ounce = 30 milliliters1 pint = 0.47 liters1 quart = 0.95 liters1 gallon = 3.8 liters1 milliliter = 0.034 ounces1 liter = 2.1 pints1 liter = 1.06 quarts1 liter = 0.26 gallons

Temperature1000 Fahrenheit = 37.70 Celsius37.70 Celsius = 99.80 Fahrenheit

For more information on NDIC contact:

National Drug Intelligence Center319 Washington Street, 5th Floor

Johnstown, PA 15901-1622Telephone: 814-532-4601

FAX: 814-532-4690

NDIC Washington Liaison Office8201 Greensboro Drive, Suite 1001

McLean, VA 22102-3840Telephone: 703-556-8970

FAX: 703-556-7807

This publication provided to you compliments of

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